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Showing posts from August, 2011

Research in Guatemala Lacked Medical Ethics

The shocking details of  U.S. medical experiments done in the 1940's in Guatemala are just now coming to light.  A Presidential Commission for the Study of Bioethical Issues has been looking at medical "research" that was done from 1946-48 by the U.S. Public Health Service and the Pan American Sanitary Bureau.  This research in Guatemala was paid for by the U.S. Government and it involved deliberately infecting people with sexually transmitted diseases.  The researchers were trying to see if the new drug penicillin could prevent infections.

The full report is still pending but here is what we know now.  The researchers infected 1,300 soldiers, prostitutes, prisoners and mental patients with syphilis, gonorrhea or chancroid.  Only 700 of those infected received some sort of treatment and 83 people died.

One particularly egregious example involved seven women with epilepsy who were housed at the Home for the Insane.  They were infected with syphilis into the spinal column …

Readmission After Hospital Discharge is Not an Indication of Poor Care

Hospitals across the country are working on quality initiatives to reduce re-admissions to hospitals.  There are consultants, conferences, forums, meetings, physicians, nurses and administrators who are spending hours upon hours (and lots of $$$) to find ways to keep patients who have been discharged from being readmitted within 30 days.  Why all of this activity?  It is one of the quality measures that is being tracked by Medicare and Medical (CMS) and decreased reimbursement will be next if a patient is readmitted to any hospital within 30 days of a discharge. The diagnosis doesn't matter.

A new study shows all of this focus and cost may not be worth it.  Readmission after a hospital discharge may not be an indication of poor care.

The study, published in the Canadian Medical Association Journal looked at 4,812 patients and had medical experts review the cases of the 649 who needed urgent readmission within 6 months. (Not one month as we are measuring).  They found that avoidabl…

Ten Things to Do Before Summer Ends

I can't believe August is almost over.  Here are 10 things to do before summer ends:

1.  Buy luscious fruit at a local farmer's market.  The tomatoes, corn,  peaches, nectarines and plums are in full bloom.  Buy local and enjoy tastes that need no extra sugar or seasoning. (I just ate the best cantaloupe I have ever tasted from our local market.  I didn't even know I liked cantaloupe)

2. Put on your favorite music and dance like no one is watching.  (Hey, no-one really notices except your teenage kid and who cares!)

3. Take a family (or best friend) day drive to a town or place you haven't seen.  (Be bold and spend the night at a cheap hotel with a pool, even if you have no reservations)

4. Get out in nature.  (Go on a trail walk, hike through the woods, take a picnic to the park)

5. Invite friends over for desert. ( No need to worry about dinner entertaining.  Wine and desert are perfect and stress free)

6. Walk barefoot in the sand or on lush grass.

7.  If you haven&…

Price List for Medical Tests

I am smacking myself on the forehead and saying, "Why didn't I think of this?"  Dr. Richard Parker, Medical Director at Beth Israel Deaconess Medical Center,  has sent out a list to his physician colleagues of 56 common medical tests and procedures.  What is revolutionary is that there are prices next to each item.  You non physicians may be surprised to know that we doctors have no idea what the tests or drugs we order actually cost.  Unless we get billed as a patient, we are as clueless as you are.

As I wrote before, the ostrich excuse just won't fly any more.  We all need to be aware of the cost of care and have skin in the game.  Some will argue that price can't be the only driver.  I've heard physicians say you can't compare one price to another because "quality" costs more.  I say prove it.  If you have a quality product or are a higher quality physician, show us the results.  What are your outcomes?  Is your customer service better?  Is i…

Patients and Doctors Need Skin in the Game for Appropriate Care

Dr. Victor Fuchs, Ph.D. wrote an op-ed in the New England Journal of Medicine about "The Doctor's Dilemma - Delivering Appropriate Care".  Physicians are trained to deal with each patient one at a time and to make decisions based on that patient alone.  Now we are in an era when the high cost of treatment can actually bankrupt the system.  Rising health care costs are everyone's problem.  Employers are shifting insurance costs to workers and another article mentioned health costs as the biggest cause of bankruptcy.  Since the biggest driver of health expenditure is the doctor's pen, we can no longer think it is someone else's problem to solve.

A new Seattle Genetics cancer drug (Adcetris) will cost $121,000 for a course of treatment to treat Hodgkin's lymphoma. A new prostate cancer vaccine, Provenge, will cost $93,000.   When the FDA approves new drugs, they do not look at cost or cost/benefit ratios.  Most of the new drugs approved by the FDA offer marg…

Answer to Medical Challenge

The answer to yesterday's Medical Challenge is #3 - mucocele.

These lesions are nontender, smooth and usually translucent.  They are commonly found on the cheek or lip and can be the result of repetitive cheek or lip biting.  They usually disappear without any treatment.  Any new growth or lesion in the mouth should be checked out by a physician.

Thanks for playing.

Research Drug Might Extend Life for Obese

I usually choose not to write about the "new new scientific thing" that gets picked up by the press,  because early research is usually not reproducible and good science takes a long time to validate as true.  But since we know that mice and rats that are kept on low-calorie diets live 30% longer (and healthier) than their fat cohorts, I was interested in a new research compound, SRT-1720,  that was shown to protect obese mice from diseases of obesity.  Fat mice lived 44% longer if they were given this drug.

The "designer" drug works by chemically mimicking resveratrol which stimulates protective proteins called sirtuins.  These sirtuins regulate metabolism and are found with very low levels of calories.  Since most people cannot sustain a very low calorie diet indefinitely, nor can they drink 100 bottles of red wine a day to get resveratrol, SRT-1720 may lead to an answer to combat the obesity epidemic and the health problems that go with it.

Sirtris is the small …

Image Challenge

Here we go again where you get to be the diagnostician.  This young boy presented with a non-tender mouth lesion that developed with no known trauma or cause.  Can you guess the right answer?
Click on the image for a better view and then make your choice in the comment section.  Return tomorrow for the answer and bragging rights if you get it right.
1. Dermoid Cyst
2. Hemangioma
3. Mucocele
4. Mucosal neuroma
5. Pyogenic granuloma

(sign up on the right side of the blog as a subscriber and you will get an email link for each new post)

What Pregnant Women Eat Influences Baby

Attention, pregnant women!  The foods you eat now might influence your babies' palates after they are born.  New research published in the journal Pediatrics, shows that the fetus actually drinks amniotic fluid in the womb.  The amniotic fluid is flavored by the foods the mother has recently eaten and flavors can be transmitted to the amniotic fluid and mother's milk.

It makes sense that as the baby is developing, memories are being created by a sense of taste.  Could what a mother eats influence food preferences and odor preferences for life?  Researchers fed babies cereal flavored with carrot juice vs. water.  They showed that babies who experienced daily carrots in amniotic fluid or mother's milk ate more carrot-flavored cereal and made less negative faces when eating it.

Julie Mennella studies taste in infants at the Monell Chemical Senses Center (Philadelphia) and she says it makes evolutionary sense because mothers tend to feed their children what they eat themselves…

Physicians and Pharmacists Scheme to Steal from Medicare

A large group of physicians and pharmacists were indicted today in U.S. district court of Michigan for healthcare fraud by billing Medicare, Medicaid and private insurers for illegally prescribed drugs.  Four physicians, 1 psychologist and 12 pharmacists used 26 pharmacies across Michigan to bill Medicare for Xanax, Vicodin and Oxycodone to the tune of at least $37.7 million.  They billed $20.8 million to the Medicaid program.

One pharmacist, Babubhai Patel, RPh, owned and managed the 26 pharmacies involved in the scheme.  He and his business associates gave kickbacks and bribes to physicians and podiatrists to write medically unnecessary prescriptions for patients.  They then billed third party payers for the fake encounters and bogus prescriptions.

What is even more astonishing is that these charges occurred since January 2009.  The pharmacies dispensed at least 4.6 million doses of Vicodin and 1.5 million doses of Xanax.  It seems that those amounts should raise a red flag somewher…

Answer -Scrotal Calcinosis

Readers of EverythingHealth have great diagnostic skill .  The correct answer to yesterday's Medical Challenge is #5- scrotal calcinosis.  These yellowish scrotal nodules are benign and have nothing to do with calcium or phosphate metabolism.  The cause is unknown.  It was first described in 1883.  Here is another photo of scrotal calcinosis.  

This Weeks Medical Challenge

I know this will gross some of you out, but, hey folks, this is the wondrous human body!  (click on the image for a better view)

 Here is a hint:  These lesions are not tender and variations of this photo are quite common on men's scrotums.

Take your best shot at the diagnosis and make a comment.  The answer will be posted tomorrow so check back.  (Sign up on the right side of the blog as a subscriber and you will get an email link with each new post)

Family Diets

I'm just back from a safari in Tanzania and experiencing the culture, the animals and the beauty of that Country was a thrill.  Seeing how some of the traditional Massai and other African natives live reminded me of a fascinating comparison of how families around the world eat.  Check out Time Magazine's comparison photos from the book "Hungry Planet".  

The Massai villages we saw were extremely impoverished and we were told they do not eat any fruits or vegetables.  I don't know how that is possible.  They have no water or electricity.   They walk miles daily to find water holes and one village has no water at all and needs to bring it in. (We paid $50 to visit the village and were told that money goes for water).