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Showing posts from May, 2011

Time for Medicare to Quit Ignoring Primary Care

An article by Brian Klepper and Paul Fischer at Health Affairs has me all fired up.  Finally these two health experts are calling it like it is.  The Wall Street Journal, New York Times and EverythingHealth have written before about the way primary care is undervalued and underpayed in this country and how it is harming the health and economics of the United States.  A secretive, specialist-dominated panel within the American Medical Association called the RUC has been valuing medical services for decades.  They divvy up billions of Medicare and Medicaid dollars and all Insurance payers base their reimbursement on these values also.  The result has been gross overpayment of procedures and medical specialists and underpayment of doctors who practice primary care. (Internal Medicine, Family Medicine and Pediatrics).  These payment inequities have led us to a shortage of these doctors and medical costs skyrocket as a result.  As Uwe E. Reinhardt says; "Surely there is something absu…

Divorce rates higher in couples with long commutes

Researchers at Umea University in  Sweden found that divorce rates are 40% higher in people who have commutes greater than 45 minutes.  The study looked at 2 million households and found that long commutes were even more difficult for women.  The risk for divorce was highest during the first few years of commuting. 

We have been a commuting culture for decades...especially in large urban areas like LA, San Francisco, New York or cities that are just sprawling and spread out like Phoenix and even Oahu, Hawaii.  It doesn't take a scientist to tell us that getting up at the crack of dawn (or earlier) to get into a car or a train and travel a long distance to work every single day would be bad for your mental and physical health.  Time spent commuting is time that is NOT spent exercising, relaxing, playing with the kids, walking the dog or talking with your spouse.

But for those of you who want more scientific proof, a Gallup-Healthways Well-Being Index survey found that the average c…

Why Health Care Costs So Much

It is my job at EverythingHealth to steer the reader to great information.  For this reason I am providing you with a Link to The New England Journal of Medicine article titled "The $650 Billion Dollar question - why does cost effective care diffuse so slowly?"  I have retitled it "Why Health Care Costs So Much".

The United States spends much more on health care than other industrialized nations with no improvement in outcomes or health status of it's citizens.  If we enacted some of the policies that other nations use, we would have $650 Billion to spend on education, infrastructure, social security and other societal needs.  Why can't we get there?

Read here to understand the barriers.  It isn't simple.  Resistance to change and instituting cost effective care has many stakeholders including legislators, doctors, hospitals, drug and equipment manufacturers, academic training centers, insurance companies and even the media.  We, the public, are also to…

Top Ten Greatest Public Health Achievements of this Century

The Center for Disease Control published the top ten public health achievements from 2001-2010, the first decade of the 21st century.  In no order they are:
Vaccine-preventable Diseases - new vaccines for herpes zoster, pneumonia, HPV and rotavirus have saved thousands of lives  When you add in the older vaccines for diptheria, pertussus, tetanus and measles/mumps millions of lives have been saved around the world.  (I saw diptheria in Haiti and it is horrible)   Tobacco Control- We have been battling tobacco since 1964 but there is finally progress with more states enacting smoke-free laws and raising cigarette taxes.  By 2010, the FDA banned flavored cigarettes and established restrictions on youth access.  We have a long way to go.  Smoking costs us all about $193 billion a year on medical costs and loss of productivity.

Motor Vehicle Safety -Enforcing seat belt and child safety legislation has reduced deaths from crashes.  Teen drivers have new policies too. Cardiovascular Disease P…

Answer to Medical Challenge

This is a really good one and several of you got it right.  The answer is #1. Endometrioma.  (scroll to post on 5/19/2011 for the image)

The woman's medical history was significant for dysmenorrhea (painful periods) and two recent laparoscopic resections of endometriomas. Histologic examination after resection of the nodule revealed the presence of endometrial glands and stroma. Endometriosis of the umbilicus, also called Villar’s nodule, is a rare presentation of extrapelvic endometriosis.

Endometriosis is a condition where cells that line the uterus start growing in other areas of the body.  They are responsive to hormones and that is why she had intermittent bleeding. (that was the cue to the diagnosis).  Endometriosis is common but having tissue like this that goes beyond the pelvis is quite rare.

California will release expensive medical prisoners

I wrote previously about the Governor from Mississippi who released two sisters from prison because the cost of providing dialysis was more than the prison system could bear.  This seems to be a nationwide trend.  Under a state law signed by Gov. Arnold Schwarzenegger in September, prisoners who are in a highly incapacitated state and deemed to pose no threat to society can be released if the parole board approves.  The legislation was passed as a cost savings measure.

The first prisoner up for release is Steven Charles Martinez, a 42 year old quadriplegic who needs total care.  He had multiple arrests before entering prison in 1998 after being convicted in a brutal rape and kidnap of a woman.  It was a very violent crime and he was sentenced to 157 years in prison.  While in prison,  two inmates attacked Martinez and stabbed him in the neck, lacerating his spinal cord and making him a quadriplegic who requires feeding, position change, oral care and cleaning of his body and bed due t…

This Weeks Medical Challenge

It's time again to test your diagnostic skill with the New England Journal of Medicine image challenge. (click on the image to see up close)   The nodule formed in this young woman in the umbilical (naval) area and bled intermittently.  What is the diagnosis?

1.  Endometrioma
2.  Metastatic adenocarcinoma
3.  Omphalith
4.  Umbilical hernia
5.  Urachal cyst

Give me your best answer as a comment and I will post the answer with fascinating learning points tomorrow.

Powerful Men with Powerful Flaws

a Arnold Schwarzenegger's revelation about his long-term  affair with his household employee that involved a child being born is the latest in a string of powerful men with career ending flaws.  Add to that the  shocking arrest this week of powerful Dominique Strauss-Kahn for allegedly raping a hotel maid and we must ask, "What the heck is going on with these guys?"

 I can't count the number of heartfelt apologies that have been rendered to the press by wandering husbands, as their beautiful wives stood quietly by.  Think back to a few; Jimmy Swaggert, Ted Haggard, President Clinton, Tiger Woods, Jim Baker, Gary Hart, Gov. Mark Sanford, Cong. Gary Condit, Gov. Elliot Spitzer. Sen John Edwards, Newt Gingrich...the list goes on and on.  What is it about these men of power that they take such risks with their family and career? Are powerful people more likely to cheat than men who aren't in the spotlight?

One study published in Psychological Science claims the likeli…

Real Food Doesn't Need Hype

The article from The New York Times about "Foods with Benefits" is a great read.  (Don't click this post first and then read the article).  It talks about what consumers are seeing at the grocery aisles as well as in advertising.  Food is being packaged and advertised as a miracle for good health.  They say certain foods can lower cholesterol, fix irritable bowel, cause weight loss or act as an antioxidant.  The large food manufactures like Kellogg, General Mills, and Dannon advertise packaged foods and exaggerate their claims.  Since everyone in America now knows that our diets are unhealthy, these appeals to eat more healthily have a big audience...$37.3 billion big for foods that "improve body function".

So this gives me a chance to promote something that I have no financial interest in what-so-ever.  We just bought a Vitamix at Costco and this one electronic machine is going to save us thousands of dollars on juice, smoothies and other "heal…

NSAIDs are a problem for Cardiac Patients

New information published in Circulation advises against using any nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who have had a prior heart attack.  These over-the-counter drugs are commonly used  like Advil, Aleeve, Diclofenac, Ibuprofen.  Using NSAIDs for even as little as one week was associated with a 45% increase for death or recurrent myocardial infarction (MI).  The researchers could not identify a period that seemed to be safe, no matter how short.

The study used the Danish National Patient Registry and identified 83,675 patients who had a first MI between 1997 and 2006.  The average age was 68 years and 65% were men.   All the NSAIDs (except Naprosyn) used during the observation period were associated with an increased risk for death or new heart attack.  Diclofenac (brand name Voltaren) was the worst. 

Readers should not go away thinking NSAIDs cause heart attacks.  This study looked at patients who had already had an MI.  But for those patients, the over-the-coun…

Best and Worst Place to be a Mother in the World

Happy Mothers Day to mothers everywhere.  It is an important day for us to honor women and acknowledge the incredible hard work of mothering. There are some places in the world where being a mother is positively life threatening.  The worst place to be a mother is Afghanistan.

Childbirth in Afghanistan is  primeval.  One in 8 women in Afghanistan die during pregnancy or childbirth, more than any place in the world.  Unicef says 52 babies out of every 1,000 die within two weeks of birth and 134 die before their first birthday.  The deaths occur because of obstructed labor, having children too young and vitamin D deficiency from staying indoors and covered up.  Most of the women - 87%- deliver with no skilled help because women cannot leave home without a male and there are  so few midwives to help.  Poverty and illiteracy are dangerous for women.   (folks, read that paragraph again and just think about what it would be like to be pregnant in Afghanistan)

Being a mother in Afghanistan i…

Answer to Medical Challenge

The answer to yesterday's medical challenge is....drumroll.....

#4 -  Sugar

Plain granulated sugar can be applied to the mucosa of the prolapsed structure (such as the ileum in this case) to promote the osmotic shift of fluid out of the edematous tissue.  In this case, within 2 minutes, the edema had diminished sufficiently to allow spontaneous reduction of the prolapse.

Thanks to all who made guesses.  Brilliant  readers, all of you!

The Hardest Image Challenge

Q:  A prolapse such as this can be effectively reduced by applying what common household substance to the tissue?
1.  Baking powder
2.  Flour
3.  Salt
4.  Sugar
5.  Tea

This is the hardest image challenge from the New England Journal Of  Medicine that I have seen.  Fellow physicians, and EverythingHealth readers, I want you to go out on a limb and give me the answer. 

For you non-physicians, this is a colostomy and that is a piece of bowel that is outside of the body.  It is connected and can be pushed (reduced) back in where it belongs.  Also, it is not really painful for the patient, although it looks really really bad.

Make your choice and the answer will be posted tomorrow.  (click on the image for a better view)

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Pay It Forward With Organ Donations

With all of the news focus on Osama Bin Laden's death and memories of 9-11, it is time for a feel good story.  We have one compliments of Loyola University Medical Center in Illinois.   A total of 7 kidneys have been donated by perfect strangers and 5 of them were from hospital employees.  Loyola has set up a "Pay it Forward" program to inspire others to do the same.  When a person gets a good Samaritan kidney, it is hoped that a relative or friend who was not a match for that person will donate to someone else.  The new relative continues the chain by donating to yet another stranger.

Since the program started last year, 18 donors have contributed to 95 organ transplants through the National Kidney Registry.  Of all needed organs, kidneys are most in demand and every year thousands of Americans die while waiting for one.  Stranger donations are relatively rare.

The first altruistic donation was made by Dr. Susan Hou, the medical director of the renal transplant program.…