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Showing posts from March, 2009


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Pistachios Cause Salmonella Fear

The FDA is advising us to stop eating all foods containing pistachios because of the possibility of salmonella contamination.

Two cases of gastrointestinal illness have been reported and may be from eating pistachio nuts. Because of the recent outbreak of Salmonella related to peanuts, the largest producer of Pistachios is voluntarily recalling a portion of the 2 million pounds of nuts it has produced since last fall.

California is the second-largest producer of pistachios in the world and Setton Pistachio of Terra Bella Inc ships pistachios to other companies that use the products or repackage them for consumers. Kraft Foods, who produces Back to Nature Nantucket Blend Trail mix detected salmonella through routine product testing. Kraft receives the pistachios from Setton. The grocery store Kroger Co. also recalled bagged pistachios because they receive bulk from Setton.

Setton Pistachio shipped 2000 lb bags to 36 wholesalers across the country since September 1, 2008 and many of …

Therapists Try to Cure Homosexuality

A study from the BMC Psychiatry showed 17% of British therapists still try to "cure" gay, bisexual and lesbian patients from homosexuality and try to help them become heterosexual.

It is hard to believe that in 2009, with all of the evidence that shows attempting to change a person's sexual orientation is not only ineffective but can be psychologically damaging, this type of practice persists. The "gay cures" that have been reported in the literature have been thoroughly discredited. That a trained therapist would be so out of touch with current research is malpractice.

In the 1970s, "aversion" therapy was in vogue. This involved using electric shocks when presenting a patient with a same sex erotic image to try and create a sense of revulsion. Those techniques belong with other archaic treatments such as lobotomy as a sign of psychiatry failures.

The American Psychiatric Association's website notes in part that, "There is no published sc…

98% of Babies are Manic-Depressive

Breaking news from The Onion:

March 23, 2009

NEW YORK—A new study published in The Journal Of Pediatric Medicine found that a shocking 98 percent of all infants suffer from bipolar disorder.

"The majority of our subjects, regardless of size, sex, or race, exhibited extreme mood swings, often crying one minute and then giggling playfully the next," the study's author Dr. Steven Gregory told reporters.

"Additionally we found that most babies had trouble concentrating during the day, often struggled to sleep at night, and could not be counted on to take care of themselves—all classic symptoms of manic depression."

Gregory added that nearly 100 percent of infants appear to suffer from the poor motor skills and impaired speech associated with Parkinson's disease.

Hat tip to LOTD

Leishmaniasis is the Answer to Challenge

The answer to yesterdays Medical Challenge was Leishmaniasis. This illness is found in tropical and subtropical areas and it is a parasite spread by bites of the sand fly. The skin sores erupt weeks to months after infection and the infection can also damage the spleen and liver. Cure rates are high with the proper antibiotics.

Lucky for us, we do not have this disease in the United States.

Electronic Health Record - Don't Hold Your Breath

The New England Journal of Medicine study that shows less than 2% of U.S. hospitals have a comprehensive electronic record is being discussed all over the news.

The benefits of going electronic, getting rid of wasteful paper, and providing all caregivers with the right information to care for patients has been proven time and time again. We can go to the moon. We can log onto Amazon and be recognized personally for our reading habits. We can have 6000 friends on Facebook. We can share our every thought on Twitter. So why are we stuck doing medicine like we did in 1950?

Here are some reasons why this is so damn hard.

Electronic health records, where physicians and caregivers can document, write notes, see information real time, do assessments and orders for patients, require millions of dollars in capital to develop and install. Seventy four percent of hospitals reported inadequate capital and 44% couldn't afford the maintenance costs.

Another barrier is the fact that electron…


New Medical Challenge

Here is this weeks medical challenge from the New England Journal of Medicine. You be the doctor. This patient is from Tunisia (North Africa on the Mediterranean) and this is what her ear looks like. What is the diagnosis? (These are all infectious diseases) 1. Leprosy (a mycobacterium) 2. Leishmaniasis (a protozoa from the bite of a sand fly) 3. Syphilis (a sexually transmitted spirochete bacterium) 4. TB (another mycobacterium) 5. Yaws (a spirochete bacterium transmitted by skin to skin contact) Give your best shot and I'll post the answer tomorrow. This is how you get smarter.

First Study to Show Red Meat Linked to Early Death

We've known that there is a link between eating red meat and an increased risk of heart disease and colorectal cancer, but a new large study was published in the Archives of Internal Medicine that shows the changes of dying prematurely (mortality) was 30% higher in Americans that consumed just 4 ounces of red meat a day.

The study looked at almost 6,000 predominantly white volunteers ages 50-71. They controlled for other variables such as smoking, physical activity, vitamin use, age and they found that those who ate the most red meat and processed meat were more likely to die from any reason than those who consumed less.

Red meat was considered beef, pork, bacon, cold cuts, ham, liver and processed meats such as sausage, hot dogs and lunch meat. Processed meats were rated differently than non processed red meat in the study and high intake of processed meats caused higher deaths from cancer and cardiovascular disease than those who ate less nor no processed meats.

The people who a…

A Little Girl Needs Help

I have made international friends by blogging and I want to share an appeal from another blogger who has family in Armenia.

Gayane is a 13 year old girl who lives in a remote village of Davtashen. She has been diagnosed with a large ovarian tumor and she needs an immediate hysterectomy in the capital, Yerevan. The surgery will determine the tumor type (benign vs. cancer) and most tumors in young girls have low malignant potential and can be cured by removal. The tumor could be a teratoma, which is also curable with removal.

The surgery will cost $600-800 and Gayane's poor parents do not have the money. My blogging friend, Armen, will set up an account today in Gayane's name to pay for her surgery. I trust him and I am personally donating. I have a son Gayane's age and while I know there are millions of children that need help...this is the one that has reached out to me.

If you would like to contribute, please email: and Armen will promptly reply and…

PSA Tests for Men

I wish I would have written the post that Dr. Bob Wachter did on the new evidence about Prostate Specific Antigen (PSA) tests for men. Two new rigorous studies have been published in the New England Journal that address the value of PSA screening.

I can tell you that every man I treat asks for these tests and I have been pretty unsuccessful in influencing anyone to forgo the test or "watch and wait" if their levels were elevated. Yet I have seen elderly men decline rapidly after receiving prostate surgery or radiation that they never needed. Wachter quotes a Dartmouth Endocrinologist:

… In the final analysis, most of these one million extra cases of prostate cancer [diagnosed through PSA screening] represent nothing more than pseudodisease: disease that would never progress enough to cause symptoms—or flat-out would never progress at all… I should be clear that none of this should be interpreted as saying that PSA testing will never work. In fact, while many men may have b…

Swipe-It Medical Cards

Despite the fact that everything has changed in life with electronics, the way patients and insurance interact with providers remains back in the 1950s.

There is a effort being pushed for "swipe-it" ID cards that would be standardized no matter what health insurance or Medicare coverage a patient has. Here is how it would work:

The "Swipe-it" card would look like a credit card with an electronic stripe on the back. One swipe and the doctor or pharmacist or hospital would have your name, dependents, address and phone number. But even more, it would identify your exact insurance plan, your co-pay or deductible and what amount has been fulfilled for the year. It could link to a personal health record with your medications, allergies, medical conditions and other important information.

If I can go anywhere in the world and use (or be denied because I am over my limit) a credit card, this should be easy.

The savings would be profound. It is estimated that $1 billion i…

Smart People Think Faster

My mind is racing!

It turns out the smarter a person is, the faster their brain works. A study published in the Journal of Neuroscience, looked at intelligence (participants took an IQ test) and then used a technique called diffusion tensor imaging (DTI) that can measure the cells that carry nerve impulses from one part of the brain to another. The smarter the person, the more the pathways connecting brain cells lit up on the scan. Smarter people = faster nerve inpuse travel.

The lead researcher Dr. Paul Thompson, professor of neurology at UCLA School of Medicine said, "When you say someone is quick-thinking, it's genuinely true. The impulses are going faster and they are just more efficient at processing information, and then making a decision based on it."

By looking at twins, both identical (sharing the same genes) and non-identical (sharing only some genes), they were able to ascertain the genetic factors that play a role in brain speed. The genetic component of int…

Surprise About Prescription Drug Prices

A consumer report survey found that many people are getting surprised by prescription drug prices. In this time of cost consciousness, it is amazing how little people understand about how they can save money on medications.
About 52% of respondents did not have accurate information about generic drugs and these were people who spend more than $50 a month on prescriptions. Here's what the study found:
47% of people had reservations or misconceptions about generic drugs
46% said physicians never or sometimes recommended generics
28% cut costs by not filling prescriptions, skipping doses or cutting pills in half
4% talked with their doctor about the cost of a drugThe last one is the most important. Ask your doctor if the drug is available as a generic. The difference in outright cost or even the co-pay amount can be significant.
Many physicians get used to writing a certain "brand" and don't think to write for a cheaper medication that would work just as well. So prote…

Religious People Seek More Treatment

The New York Times reported on a new study that shows religious folks want more end of life, aggressive treatment when they have a terminal illness (cancer) than non church goers. We know that 80% of health care costs are spent in the last 6 weeks of life and that so many aggressive treatments are done when a person should be comfortably exiting this life. Aggressive end of life care can lead to a more painful and emotionally draining experience for family members too.

Hmmm. Let me think about this. Religious people believe in heaven (and hell) and say they trust in "God's will", but they opt for mechanical ventilators and don't prepare living wills, according the the study that will be published in JAMA. What is it about religion that would make a person want to "hang around" in an ICU on a ventilator, in this old, sick body, when heaven and the angels are beckoning? Shouldn't belief in an afterlife bring more peace and comfort about leaving t…

No Wonder Medicare is Broke

I wouldn't have believed this if I hadn't seen it with my very own eyes. A doctor I practice with send a Medicare patient (that means over age 65 with their health care covered by you and me paying taxes!!!) to a medical supply store to get a carpal tunnel splint. Even though we carry these splints in the office, we don't supply them to Medicare patients because Medicare will never reimburse us the $22 fee for the splint. So we have to send the patient to an ortho supplier, which is a hassle for the patient but what choice do we have?

This splint doesn't require fitting. It comes in small, medium and large and just "velcros" together. The patient got a copy of the bill to Medicare....drumroll...$900.00. Yes, $900.00 for a simple wrist splint.

Medicare will not pay the entire amount but the supplier knows they will get a HUGE portion of that charge. What if they only get 1/2? Folks, you can't make this stuff up. The waste and crazy payment systems ar…

True Leadership

Paul Levy, the transparent blogging CEO at Beth Israel Deaconess Medical Center in Boston, is facing what many hospitals are going through: reduced Medicaid and insurance payments, declining census due to the economy and predicted operating losses of $20 million. His financial team is looking at hard choices that include massive layoffs of valued employees.

So how does he approach this awful situation? He sent letters to all the employees and held town hall meetings at several locations where he layed out the problems clearly and openly. He made suggestions for avoiding layoffs and asked for input. He quickly developed an an electronic suggestion box and website where employees could weigh in and comment on the plans. He asked for help to find ways to minimize or even avoid laying off workers that are working 2 jobs to make ends meet.

He announced : "The senior managers of the hospital have recognized their personal responsibility to help with this problem. The senior vice pre…

Latvias Strange Restaurant

Latvia, that small little Baltic republic, is bordered by Estonia to the North and Lithuania to the South. It also abuts Belarus and Russia.

EverythingHealth has had visits from Latvia (welcome, Latvians!) and I always find it so rewarding to think of how we are interconnected via the internet.

The Latvians must have quite a bizarre sense of humor. A group of local doctors and hospitals own a restaurant that serves hearty Latvian dishes topped with realistic-looking body parts such as fingers, noses and tongues. They serve the food on gurneys and operating tables and the cutlery is tweezers and scalpels.

The trendy cocktail bar is all the rage, with bartenders in white lab coats, drinks served in beakers and waitresses in skimpy nurse outfits.

Latvia's answer to Hooters or Bubba Gumps, I guess.

(Hat tip to KM for this one.)

Big Pharma and Doctors

It is insane that we let problems get out of hand and then OVER-REACT by legislating ridiculous rules that hurt industry and growth. I am speaking about the new federal law that Congress is discussing that says medical device and pharmaceutical companies cannot give pens or lunch or sticky note pads to physicians and they have to report any consulting or speaking payments of over $50.00. Massachusetts has already adopted these bans and there is a patchwork of other states with their own laws.

I have written before about the egregious behavior of physicians and research institutes being far to cozy with big Pharma and Medical Device manufacturers. Orthopedic surgeons have received hundreds of thousands of dollars (each) in "consulting fees" for using certain expensive artificial joints. The American Academy of Psychiatry is cleaning house after being exposed by Senator Grassley's investigation into the unethical behavior and unregulated greed of academic psychiatrists…

Ecstasy for Treating Post Traumatic Stress Disorder

Ecstasy (MDMA) didn't start out as a "rave" party drug. It was first synthesized in 1912 and rediscovered in the mid 1970s by the psychotherapy community as a treatment to be used in psychoanalysis. Over 4000 psychologists were introduced to MDMA and they found it helped withdrawn patients open up and develop truthful relationships with the analyst. They found that it alleviated fear, guilt and remorse and sped up the psychoanalytic process.

In 1984 the use spread to college students and by 1987 it's use as a party drug spread around the world. In 1985 the FDA banned the use of Ecstasy as a danger to the public. Since that time it went completely underground, however it's use has continued to soar.

In 1993, limited trials were approved by the FDA to test the effects of Ecstasy in human volunteers. The Multidisciplinary Association for Psychedelic Studies is sponsoring trials to determine potential risks and benefits of using the drug as part of the psychother…

eating disorder ad

Anorexia affects mainly women (95%) and there is no single known cause for this serious condition. People who are anorexic have a distorted body image with obsessive fear of gaining weight. There are some genetic tendencies toward eating disorders (as noted in twin studies) as well as behavioral, emotional and cultural causes. It is a serious medical condition that requires treatment and sometimes hospitalization.

YouBars/YouShakes Winner

Congratulations to Tim Pope, the hardworking baggage handler who usually eats junk, for being the winner of the YouBars contest. Thanks to all who entered. There were some very compelling and heart rending stories (like "I'm hungry") and everyone can win by checking out the YouBars website.

We will have more healthy contests coming soon for the chance to win free stuff so check back daily to EverythingHealth.

Skin Patches and MRI

The FDA has issued an alert to warn patients and imaging professionals that certain medicated skin patches can overheat during an MRI scan and cause a skin burn.

Apparently some patches contain aluminum and other metals in the backing that sticks to the skin. With more and more medications being administered through the "patch" the best advice is for patients to remove the patch prior to the MRI scan and replace a new one after.

This does not apply to CT scans or ultrasounds as they are a different technology.

Stem Cell Research and Obama

I wrote this post during the Obama Inaguration. Just repeating it since it is now reality!

There is speculation on the Hill about whether President Obama will immediately reverse the ban on stem cell research by executive order, or wait until Congress submits a bill to him that he would sign. I think it is about 50/50.

Either way, these are significant steps in the right direction after 8 years of "anti-science" and suppression of expert research under the Bush administration. Former Surgeon-General under Bush, Dr. Richard Carmona complained he was muzzled in attempts to speak out on stem cell science and other issues.

The fact that Obama is likely to be lifting the restrictions on US federal funding of human embryonic stem cell research speaks volumes about how he will govern.

Stem cell research from public funding will potentially ensure open access to research results and allow easier transition from research to development of new therapies and cures for patients with a wid…

TV Does Not Improve IQ in Toddlers

A new study in Pediatrics shows that children under the age of two who watch TV do not have a boost in their IQ. There had been claims that certain shows helped children's brain development and cognitive skills but this study of 872 toddlers showed TV viewing had no effect one way or another.

Researchers evaluated the children's language and visual motor skills using the Peabody Picture Vocabulary Test III, which is associated with IQ. Preliminary results showed the kids who watched more TV had poorer scores on these tests but those effects did not hold up when they controlled for other factors such as mother's age, education, household income and marital status.

Other studies have shown that watching TV does more harm than good for babies.

The American Academy of Pediatrics recommends no television viewing for children under age 2. The Harvard researchers found that most babies born in the U.S. watch between one to two hours of TV a day. (Perhaps they were watching Opr…

Only Two More Days For the Contest

Scroll down for the YouBars contest. Just enter your comment on why making custom YouBars and YouShakes will be good for you and you may win!

Hudson River Plane Landing (US Airways 1549) Animation with Audio

The training and improved patient safety we want for Healthcare is often compared to the aerospace industry. A pilot can fly a route thousands of times and the surgeon can do the same operation thousands of times but when something goes wrong you need to fall back on checklists, protocols, standards in communication and calm thinking. This landing is SICK (in the good way my 14 year old says sick). The pilot's calm, crisp, clear communication gives me chills. I want surgeons to have the same training and protocols for surgery outcomes.

EverythingHealth Contest

YouBars is a really cool idea where you can personalize your own nutrition bars and shakes. Instead of buying mass produced bars, you can custom make your own bars with less sugar, no milk (for those lactose intolerant folks) or with more carbs if you are a runner. By building in your own flavors, fruit, protein ( soy, egg white, rice or milk) and your own sweeteners (organic sugar cane juice, agave or splenda) you can get the exact nutrition that suits your lifestyle.

Here is your chance to win (free, absolutely free) a pack of the most popular YouBars and You Shakes so you can see what it is all about. I tried them and they are really good. I like the shakes blended with fruit to make sure I start my day with some protein. Note: they don't take the place of my morning Latte.

So make a comment and let me know why you want to try YouBars. Be creative or just whine and say "I want to win something to cheer me up since my 401K has gone to pay bonuses to the GM presidents…

Fertility Drugs Do Not Cause Ovarian Cancer

With so many women around the world taking strong hormones and fertility drugs to aid in pregnancy, there has been a fear that these drugs would be associated with increased risk of ovarian cancer. We know that infertility and no child bearing increases the risk of ovarian cancer.

Now a new large study conducted in Denmark and published in the British Medical Journal shows there is no increase in ovarian cancer for women who used fertility drugs.

This study looked at 54,362 Danish women from 1963 through 1998. They followed them for 16 years. The women used clomiphene, chorionic gonadotrophins and gonadotrophin releasing hromone...all strong stimulants of ovulation.

No increase in cancer was found in women who used these drugs individually or in 5 common combinations compared to the control group who used no drugs.

This study is reassuring to women who use fertility drugs to get pregnant.

American Culture

It's time to send David back home to Italy.

(Hat tip to Happy Hospitalist)

New Vitamin Research on B12 and Vitamin D

I have shown scientific data numerous times on EverythingHealth that shows our obsession with vitamins and supplements taken daily as cancer or cardiovascular disease prevention is money down the drain.

There are certain conditions, however, where good data shows us certain vitamins play a beneficial role. Here are two new studies:

Recurrent aphthous stomatitis (also known as mouth canker sores) is a painful and unexplained condition. Some patients have outbreak after outbreak and we use adhesive pastes, antiseptics and steroids to deal with the pain. A new study shows vitamin B12 (1000mcg) taken daily for 6 months, reduced the pain, the number of ulcers and the duration of outbreaks. By 6 months the vitamin taking group was free of outbreaks. The scientists found that the initial blood level of Vitamin B12 didn't matter so there is no need to check that test.

Score one for Vitamin B12 and canker sores.

The second study showed another benefit for taking Vitamin D if blood levels…

Grand Rounds is Up

The best of the medical blogosphere for this week can be found at Health business blog. Good reading and interesting articles.

Cocaine Nose

A picture is worth a thousand words. This 50 year old man had used cocaine for 20 years. Cocaine causes vasoconstriction and in fact, it is used as a local anesthetic medically when there is a need to do a procedure and stop bleeding. This same vasoconstrictive property can cause skin breakdown and erosion of the nasal septum.

photo credit: Consultant