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    Monday, December 28, 2009

    7 REASONS WHY MEDICAL ERRORS OCCUR

    Approximately 100,000 people per year die from medical errors caused by doctors alone. According to Dr. RJ Roberts of the University of Wisconsin Medical School there are 7 reasons why medical errors occur:

    1. Failure to Obtain Informed Consent: This allegation stems from the failure of the physician to ensure the patient is fully informed of expected outcomes, potential risks and reasonable alternatives to the recommended course of action advised by the doctor resulting in damages to the patient.

    2. Cancer Misdiagnosis or Failure to Diagnose or a Delay in Diagnosis: This is especially true of breast cancer patients. Doctors who rely on false negative mammogram studies rather than on patient complaints and following up appropriately may cause harm to the patient and be liable for medical malpractice. Approximately 29 percent of screening mammograms return false negative results.

    3. Physician Malpractice Resulting From Negligent Procedures or Surgical Errors: Physicians do not necessarily have to be performing unfamiliar procedures for such a medical malpractice suit to ensue. Many physicians are sued because they performed procedures they are trained for when the doctor was not alert due to physical exhaustion or mental distraction. In these circumstances, sleep deprivation or mental stress may cause a deficiently performed procedure leading to patient complications.

    4. Wrong Diagnosis and Negligent Misdiagnosis of Fracture or Trauma: This medical malpractice claim occurs when a doctor assumes that a fracture is merely a sprain or other minor injury without follow through investigation with x-rays or other proper diagnostic tests. Dependent on the location of the fracture, this can have severe consequences, including loss of a limb.

    5. Delay in Diagnosis or Failure to Consult in a Timely Manner: A doctor who is sued for failure to consult in a timely manner has hesitated too long before making a referral and the patient has suffered adverse repercussions as a result. Within a reasonable amount of visits to the family doctor, the patient should be referred to a specialist if the family doctor is having difficulty pronouncing a diagnosis or symptoms are not improving or worsening despite treatment.

    6. Medication Errors or Medication Malpractice Resulting From Negligent Drug Treatment: This is the third leading cause of death. Medical error or negligence in prescribing medications may be the cause of 225,000 deaths per year. Lack of patient education about the medications prescribed is a component of negligent drug treatment. Prescription drug malpractice claims can also result from a doctor's poor handwriting on the prescription order and misinterpretation by a pharmacist.

    7. Birth Injury Malpractice or Negligent Maternity Care Practice: The two most common birth defect or birth injury medical malpractice claims arise from excessive use of oxytocin, specifically if the baby is experiencing distress, and the doctor's failure to ensure their patient is covered by another physician informed about the patient's clinical history should the primary doctor be unavailable.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for THE BEST TREATMENT FOR PATIENTS WITH HEART DISEASE AND DIABETES.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, December 21, 2009

    THE SIX QUESTIONS:
    A GUIDE TO JUDGING FAVORABLY

    As Jews approach the High Holy days it is useful to remember that the Torah teaches that, whenever we experience or hear about the negative behavior of another person, we must "judge favorably." In simple terms, that means giving the benefit of the doubt. But how can one follow that advice when it seems that the facts clearly point to someone's guilt?

    Sometimes we jump to the wrong conclusion because the facts are different from what we perceive them to be. Even if our facts are accurate, we often misinterpret the intent behind them. When we drop the assumption that there was a negative intention behind someone's actions towards us, we automatically deflate much of the anger and hurt that we feel.

    Here are six possible ways to analyze a situation and jump to a good conclusion:
    1. Are you sure it happened at all? Sometimes our perceptions of what we see and hear are mistaken.

    2. Are you sure the details are correct? One small detail can completely alter the scenario. Something may have been exaggerated or omitted that would make a big difference.

    3. Do you know if the other person intended harm? Often the consequences are unforeseen.

    4. Do you know the assumptions the other person was operating under? Maybe the other person was operating under a misconception that would explain their behavior.

    5. Could the other person's act have been the result of an innocent, human error? Everyone has limitations. Perhaps this person lacked experience, was forgetful, distracted or simply didn't think carefully enough before acting.

    6. Do you know what events preceded the negative action? The other person may be enduring a great deal of pain, frustration or stress. This might be a response to a specific situation, like an illness or financial loss. Or it could be a deeper, more pervasive problem that effects the person's entire life.

    Although the Torah requires us to judge others with favor and compassion, we are not required to accept abusive behavior from others. Physical, verbal or emotional abuse must be addressed and corrected.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for THE SEVEN REASONS WHY MEDICAL ERRORS OCCUR.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, December 14, 2009

    Thin Thighs Associated with Increased Risk for Death, Cardiovascular Disease

    Thin Thighs Associated with Increased Risk for Death, Cardiovascular Disease
    Adults with very thin thighs may be at increased risk for cardiovascular disease and death, BMJ reports. Published 3 September 2009, doi:10.1136/bmj.b3292
    Cite this as: BMJ 2009;339:b3292

    Researchers measured thigh circumference in some 2800 men and women, aged 35 to 65, and then followed them for about 10 years to assess incident cardiovascular disease, coronary heart disease (CHD), and mortality.

    In adjusted analyses, a thigh circumference below roughly 24 inches (60 cm) was associated with significantly elevated risk for death and cardiovascular disease (but not CHD), with risk increasing as circumference decreased. While a circumference above 24 inches appeared to be protective, the benefit did not continue to increase with increasing circumference. As a potential underlying mechanism, the authors cite research suggesting that low subcutaneous thigh fat results in poor glucose and lipid metabolism. They and an editorialist call for further research to confirm these findings.

    Participants 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance.

    Main outcome measures 10 year incidence of cardiovascular and coronary heart disease and 12.5 years of follow-up for total death.
    Results A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women. A threshold effect for thigh circumference was evident, with greatly increased risk of premature death below around 60 cm. Above the threshold there seemed to be no additional benefit of having larger thighs in either sex. These findings were independent of abdominal and general obesity, lifestyle, and cardiovascular risk factors such as blood pressure and lipid concentration.

    Conclusion A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death. The adverse effects of small thighs might be related to too little muscle mass in the region. The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of premature morbidity and mortality. Several studies have shown a U-shaped association between body mass index (BMI) and mortality, suggesting both a high and a low BMI are associated with premature death. More recent data suggest that while the increased risk seen with a high BMI is mirrored by the risk associated with a high body fat mass, the risk observed at low BMI seems more closely linked to the risk associated with low fat free mass than low fat mass. A larger hip circumference relative to BMI and waist circumference seems a strong inverse predictor of both morbidity and mortality. In this context, a recent study suggested that lower body muscle mass is particularly related to the development of type 2 diabetes. Indeed, studies have reported that insulin resistance could be provoked in lower body muscle, such as leg muscle, but not in arm muscle,8 9 suggesting that the size of the lower body muscle might have great relevance for developing type 2 diabetes. These findings are in line with results from a study among patients with chronic obstructive pulmonary disease, a condition characterized by wasting of muscle, particularly of the lower extremities, which found that the cross sectional area of mid-thigh muscle was a far better predictor of mortality than BMI. Lower body fat, however, might also offer cardioprotection through endocrine secretion of various adipokines, such as adiponectine, a peptide with apparent anti-inflammatory properties.

    DISCUSSION
    The asuthors found independent inverse associations between thigh circumference and total death and morbidity from cardiovascular disease in both men and women that were particularly evident when thigh circumference was below a threshold of around 60 cm. Above this threshold there did not seem to be any further benefit of having larger thighs. The increased risk associated with smaller thigh circumferences was seen independently of percentage body fat mass and height or of waist circumference and BMI for all end points, suggesting that for any given degree of general and abdominal obesity, smaller thighs are a disadvantage to health and survival for both sexes. Further analyses with adjustment for systolic blood pressure, total cholesterol and triglyceride concentrations, and alcohol weakened the associations only slightly, and suggested that associations between thigh size and the end points were not mediated by differences in these variables. Some power was lost, however, by the inclusion of more covariates and the associations between thigh circumference and particularly coronary heart disease did not remain significant. Their analyses indicated that associations were independent of heavy smoking as measured by pack years, and associations seemed to be stronger for smokers than for never smokers, but this difference was not significant, probably because of too few end points in the two groups of the stratified analysis.

    SUMMARY
    Low BMI and low fat free mass are associated with early mortality
    High BMI, waist circumference, waist to hip ratio, and low hip circumference are also associated with early mortality
    Among both men and women, smaller thighs were associated with increased risk of cardiovascular disease and total mortality
    A threshold effect for smaller thigh circumference was seen at around 60 cm; above this threshold the protective effect of having larger thighs carried no further survival advantage
    A focus on thigh circumference might help medical providers identify individuals who are at increased risk of early morbidity and mortality


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for THE SIX QUESTIONS: A GUIDE TO JUDGING FAVORABLY.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, December 7, 2009

    WHAT IS GERD?

    WHAT IS GERD?
    Acid reflux [GASTRO-ESOPHAGEAL REFLUX DISORDER]occurs when the lower esophageal sphincter (LES) muscle allows the stomach's contents to splash back into the esophagus, resulting in painful heartburn, chest pain, coughing or choking while lying down, or increased asthma symptoms while sleeping. Eating too much at one time, too much acid in the stomach, or food remaining in the stomach for too long a time can all prevent this muscle from doing what it is supposed to. Ideally, food should move smoothly and relatively quickly through the stomach and on to the lower digestive tract.

    WHAT FOODS TO AVOID?
    Foods that can increase acid production include coffee (caffeinated and decaffeinated), chocolate, soft drinks and cocoa. Acidic foods that should be avoided include citrus fruits and juices (orange, lemon, grapefruit), cranberry juice, lemonade, pineapple, tomatoes and tomato products (spaghetti sauce, salsa, soup).
    Other foods that can cause heartburn are those high in fat, such as french fries, ground beef (chuck), marbled steak, chicken nuggets, buffalo wings, sour cream, milkshakes, ice cream, regular cottage cheese, macaroni and cheese, doughnuts, corn chips, regular potato chips, brownies, butter cookies, mayonnaise, butter, margarine, creamy sauces, salad dressing and whole-milk dairy products.
    Raw onions and spicy foods can cause heartburn and alcohol relaxes the LES muscle causing it to allow acid reflux.
    Avoid when possible processed foods, white sugar, white flour and wheat, which can produce an acidic reaction. Healthcentral.com suggests that wheat, a known allergen, may be the sole cause of some acid reflux and that eliminating gluten from your diet might be all that is necessary to stop acid reflux.

    LOW-RISK FOODS
    Foods that carry little risk of causing heartburn include apples (juice, dried and fresh), bananas, baked potato, broccoli, cabbage, carrots, green beans, peas, extra lean ground beef, London broil, skinless chicken breast, egg whites, egg substitute, fish prepared with no additional fat, feta or goat cheese, fat-free cream cheese and sour cream, low-fat soy cheese, multi-grain or white bread, bran cereal or oatmeal, corn bread, graham crackers, pretzels, brown or white rice, rice cakes, mineral water, low-fat salad dressing, fat-free cookies, jelly beans, red licorice, angel food cake, baked potato chips.

    WORTH TRYING
    These foods may require some experimentation, but may be tolerated in moderate amounts by some GERD patients: low-acid orange juice, peaches, blueberries, raspberries, strawberries, grapes and dried cranberries, garlic, cooked onion, leeks, chicken salad, eggs scrambled in butter, fried eggs, tuna salad, beef or pork hot dogs, ham, yogurt, 2-percent or skim milk, frozen yogurt, cheddar or mozzarella cheese, garlic bread, granola, non-alcoholic wine or beer, root beer, small amounts of ketchup.
    Complex carbohydrates, whole grains and starchy vegetables, including sweet potatoes and plantains, are not only gentle on the stomach, but also help control excess stomach acid. Among the best whole grains for long-term acid reflux reduction are millet, couscous and amaranth, all of which are considered alkaline.

    MORE TIPS
    Eating five or six small meals per day instead of three large ones prevents the stomach from becoming too full.
    Putting your fork down between bites will prevent you from eating too much too fast.
    After dinner, chewing gum stimulates saliva production which can help neutralize stomach acid and increase peristalsis, the contractions and relaxation of muscles along the digestive tract that helps move stomach contents along the digestive system.
    Drinking a glass of lukewarm water or herbal tea after a meal can dilute and flush out stomach acid.
    An after-dinner cigarette, cigar or pipe can cause problems by weakening the LES muscle.

    WEB SITES
    www.heartburn.about.com/library/bl_samplemenu_charts.html.
    http://www.drgourmet.com/gerd

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Thin Thighs Associated with Increased Risk for Death.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, November 30, 2009

    Section III of III The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

    Section III of III The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

    MY OPINION:
    The idea of paying physicians more for providing guideline-based care has taken the American health system by storm in the last decade. Today, more than 150 pay-for-performance programs are centered on the notion that rewarding evidence-based care is key to improving health care quality.

    Does evidence based research show that P4P is efficacious and improves quality care? No. At least not yet.

    Some P4P efforts have shown beneficial results, according to the Centers for Medicare & Medicaid Services. An evaluation of its Physician Group Practice Demonstration found that all 10 participating practices hit or exceeded targets on at least seven of 10 quality metrics of diabetes care. A Feb. 1, 2007, New England Journal of Medicine study found that Medicare's pay-for-performance demonstration project was associated with a modest improvement on quality metrics, compared with hospitals not in the project.

    Steven D. Pearson, MD, president of Harvard Medical School's Institute for Clinical and Economic Review says that "Unless you look at a control group of some kind, you may be misled about what's really happening."

    There appears to be a fundamental problem with current P4P programs. They have had little to no impact on quality. That is the conclusion of many studies, including an analysis of quality incentives, published in the July/August, 2008 of Health Affairs. It compared 81 Massachusetts physician groups eligible for quality incentives with 73 that were not. The study did find, however, that overall performance from 2001 to 2003 improved on 73% of preventive care measures such as diabetes hemoglobin A1c testing, breast cancer screening and well-child visits. But the performance of the 5,350 physicians analyzed was statistically indistinguishable. Everyone's quality improved, regardless of whether the physician group stood to earn a bonus, which ranged from $200 to $2,500 per quality measure for an individual physician, depending on the health plan.

    Another study that examined the CMS hospital P4P data also wasn't positive about P4P. A June 6, 2007, Journal of the American Medical Association study of heart attack care found no significant improvement for 54 hospitals in the CMS P4P demonstration, compared with 446 nonparticipating hospitals.

    And a systematic review of 17 studies, published in the Aug. 15, 2006, Annals of Internal Medicine, found positive or partially positive effects of P4P programs, but the impact was usually small.

    We actually have remarkably few evaluations that have a comparison group of any kind, so the evidence on pay-for-performance is rather spotty.
    Overall the P4P programs evaluated over the last five years have been largely unimpressive in their results.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Acid reflux foods.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, November 23, 2009

    Section II of III. The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

    1. From Woolf, SH, JAMA, Vol. 282, 1999 - Estimated savings for good treatment of DM, HTN, MI, Colorectal CA, Pneumonia over current treatment levels.
    a. DM control could prevent 2,600 cases of blindness and 29,000 cases of kidney failure.
    b. HTN control could prevent 68,000 deaths
    c. Following evidence guidelines in MI could prevent 37,000 deaths
    d. Administration of pneumoccal vaccine could prevent an estimated 10,000 deaths per year
    e. Colorectal cancer screening could prevent an estimated 9,600 deaths per year (not to mention the cases where multiple hospitalizations and chemotherapy are needed.)

    2. From Diabetes Care - Vol 20, Number 12, Dec 1997 - Cost of diabetic with A1c at 6-7% is $378/year, with A1c of 9-10% is $1205 per year. Cost of Diabetic with CAD and HTN is $1505/year at A1c of 6-7%, $4116/year at a1c of 9-10%

    3. Premier Report came out last month: Simple adherence to basic medical treatment guidelines for Medicare patients hospitalized for CABG, MI, and Knee replacement would save $1.35 billion per year. 5,700 deaths, 8,100 complications and 10,000 readmission to the hospital could be averted if clinicians followed medically prescribed treatment steps.

    4. Bridges to Excellence (Bridgestoexcellence.org) has found that for every $1 bonused to a primary care doctor, there was a savings of $3 to the payor (not insurance company in this case, but employer). BTE is an initiative initally by fortune 500 companies and was outside of insurance companies.

    Doctors say:
    The doctors respond with their argument is not that P4P is the solution to all problems. Instead, the main focus now should be on the current reimbursement system that does not simply not pay for good care, but it encourages bad care.
    The recent study that showed that over half of elderly patients leave the doctor's office without proper medication advice is a good example. Why is this? It happens because doctors are pressured to see as many patients as possible to meet overhead and consequently spend less time on each patient. Medicare cuts should only add fuel to this fire.

    There’s plenty of data that shows that medical care in the US is not nearly at the quality it should be. It is not the doctors that are at fault (in their opinion) but the system that does not reward good care, but instead rewards doctors who spend as little time as possible with patients.

    Doctors say:
    The doctor’s main point, is that the current payment system is broken, CMS is dead set on fixing it via P4P.
    But say the doctors instead of being judged for whether a test was done (without EMR, this is the only way to measure performance, as it is based on claims data), but whether it was addressed by the physician.
    If a patient chooses to not have a mammogram, the doctor should be able to report that they refused it and get credit for addressing the issue.
    If blood pressure is up and the doctor responds appropriately, he/she should be credited for doing the right thing, regardless of the outcome.
    The concept should be that measuring physician behaviors on an EMR system so as to accurately record the intent of the physician.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Section III of III. The Debate.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, November 16, 2009

    Section I of III. The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

    Doctors say:
    "Pay for Performance" (often abbreviated P4P) is based on the false concept that doctors will take better care of patients if they're paid more.
    Big insurers in each state; are discussing P4P as the next thing as they ratchet down reimbursements and pile on the denial hassles according to practicing physicians.
    Why P4P?
    Is it to save more money for medical insurance carriers.
    Or is it truly to reward better quality medical care?

    Capitation is broken say doctors.
    Capitation is/was a way to shift the risk of having to pay for a doctor's visit away from the insurance company and onto the doctor. Somehow or another back in the early '80s enough people were fooled, but have since wised up say doctors. If no one's willing to take it on, capitation won't work. That's why it's fading away, say doctors.

    Fee for service is broken say the insurance carriers.
    Baloney- say the doctors. “Pay me a reasonable rate for what I do and I'll be happy as a clam.”

    Insurance carriers say:
    • Fee for service has no incentive for quality
    • Thus we need Fee for service + bonus/incentive to reward quality
    Doctors say:
    At no point in P4P discussions has the word "Quality" ever effectively been defined in the context of medical care.

    Insurance carriers say:
    What percentage of your diabetic patients have A1C's under 7%; how many of your hypertensives' blood pressures are controlled?
    What % of patients had mammograms and colonoscopies?
    That’s what tells us that your patients are getting food or bad quality care.

    Doctors say:
    The central element of "quality" will forever remain fundamentally un-measureable; and here's why:

    In the primary care context, the essence of a given encounter for medical care consists of an interaction between two people: the doctor and the patient. There are certain things doctors expected to do: ask appropriate question to elicit sufficient information to come to an accurate diagnosis; decide upon and discuss various treatment options with the patient; make sure that the patient has enough information, education and emotional support to understand and implement the treatment (or work up) plan; and so on.
    But the key element is that the encounter is an interaction. There are two of us. The quality of that interaction is not 100% dependent on me. Any attempt to "measure" it implies that it is. And doctors don't buy it.

    The discussions on P4P inevitably turns to EMRs (electronic medical records) as an integral part of P4P. Everyone has to have them; that's how they're going to get the performance data they're going to pay doctors.
    But once all the numbers are crunched, though, it turns out a doctor will see only about $3,000 in P4P bonuses for a $30,000 EMR investment..
    The response by insurance carriers is that the real return is more likely to be in the areas of quality and lifestyle.
    Doctors reply:
    Imagine presenting a proposal to an insurance company -- actually to any kind of business -- and saying, "Now, you'll only make back about 10% of your initial investment, but you're likely to see improvement the areas of quality and lifestyle."

    Doctors see P4P as in the early 1990’s when the buzzword was "vertical integration." Hospitals and health systems were buying up medical practices. The idea was that by consolidating the referral base, the "system" would rake in the profits, which would then trickle down to the now employed physicians. The private office, especially solo, was considered an unworkable business model. Over the next ten years, it didn't work out quite the way the hospitals and health systems said it would. So docs were stuck either buying back their own practices, or being subjected to more and more outrageous working conditions (required to see 56 patients in 8 hours, etc.)

    Doctors say:
    This whole "pay for performance" thing doesn't sound quite right for many reasons. They believe that when everyone seems to think something is so, but can't explain it in a way that it makes sense to them, there's something wrong with what they're saying.

    And what is quality they ask?
    Openly discussing both benefits and risks of screening or just using scare tactic to get more patients screened?
    If you are not mentioning the risks, if you using relative mortality reduction and not mentioning the real chance of your patient benefitting, are you not misleading the patient?
    It happens already, but at least now, the doctors respect the right to choose.

    Doctors say:
    With P4P doctors will be loosing money for every patient with LDL 4 points above guidelines (even those with 10-year heart attack risk of 1%). A 40-something ballet teacher with no family history of heart disease and normal ratio, albeit slightly elevated LDL is complaining of muscle side effects that interfere with her ability to do her job (saw this woman's post on one of the forums) - "what would you rather have: a heart attack or muscle pain?"

    No explanation of the actual magnitude of benefit for her; after all if you mention that you are only talking about 0.3 percentage points in ARR, a patient might refuse and here goes you P4P. "It'll reduce your heart attack risk by whopping 30%".

    Very few patients would think to ask "n% of what number exactly?"
    Incidentally, maybe P4P should also evaluate physicians on providing honest and accurate information (to the best of the existing evidence) to the patients and respecting their right of informed refusal?

    Anybody thought of making this one of the criteria?
    Whether or not it is cost effective depends on absolute risk reduction for a particular person. For diabetics or people who already had heart disease it may well be (although if someone doesn't take drugs and dies sooner, will this person save money or use more of it?)
    But when you are talking about measures with small absolute benefit, it should be individual choice.
    As a patient I have a right to decide for myself whether certain small risk reduction worth the risks or side effects for me or not.
    I don't want an incentive for a doctor that would depend on the choices I have a right to make.
    I want an incentive to provide accurate information but without the vested interest in my decision.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Section II of III. The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, November 9, 2009

    Survey suggests more than two-thirds of Americans may be overweight or obese.

    Vital Statistics reports that, according to a "nationwide survey of obesity" based "on data for 2005 through 2009 gathered by state health departments with the help of the" CDC, "more than two-thirds of Americans are now overweight or obese, and the percentage is still rising." The study, which was "published by the Robert Wood Johnson Foundation and the Trust for America's Health," defined "overweight as a body mass index (BMI) of 25 to 30, and obesity as a BMI over 30." Specifically, "compared with 2008, obesity rates rose in almost half the states, and decreased in none." Notably, in Alabama, Mississippi, Tennessee, and West Virginia, "more than 30 percent of adults are obese," and "eight of the 10 states with the highest obesity rates are in the South." The study also revealed that "in 30 states, 30 percent or more of children ages 10 to 17 were overweight or obese." In 1991, no state had an obesity rate above 20 percent, and in 1981 the national average was 15 percent."

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Section I of III. The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, November 2, 2009

    Stroke, tPA & Statistical Chance

    Knowledge should accompany any patient experiencing the symptoms of stroke when presenting at an emergency room for treatment. Assuming the facility is not a stroke center, with enhanced diagnosis resources and treatment options for combating the effects of ischemic stroke, one’s prospects for full or partial recovery could well depend upon the confidence in and willingness of the E.R. physician to administer tissue plasminogen activator or "tPA," a thrombolytic agent, capable of recanalizing a passage through an arterial clot in the brain tissue.

    Although the use of tPA is recommended by the American Heart Association as a first line treatment for ischemic stroke the use of the drug is controversial because of significant risk of inducing intracranial hemorrhage and other organic damage in a small but significant number of patients.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Survey suggests more than two.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, October 26, 2009

    Post-cholecystectomy cystic duct stump leak: a preventable morbidity

    Irshad Ahammed et al writes that “While major bile duct injury is the most serious complication following laparoscopic cholecystectomy, bile leak from the cystic duct stump remains the commonest morbidity.” This is a retrospective assessment of all patients who had a cholecystectomy over a 5-year period from April 2003 to March 2008.

    Data related to bile leakage were obtained from the Unisoft endoscopic retrograde cholangio-pancreatography (ERCP) database.

    Overall 2011 cholecystectomies were performed, of which 488 were done as emergency procedures. Thirteen patients had significant bile leakage, three of which were from accessory ducts, in one the source could not be identified and nine had a cystic duct stump leak (CDSL), which formed the basis of this study. Emergency cholecystectomies seem to have a higher incidence of CDSL Eight of the nine CDSL patients had successful ERCP and stenting. One had a percutaneous trans-hepatic cholangiography and stenting. CDSL following emergency laparoscopic cholecystectomy was up to threefold higher than after elective procedures.

    CONCLUSION: The CDSL of 0.44% was comparable to the reported incidence in the literature. Endoscopic management remains the treatment of choice.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for STROKES.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, October 23, 2009

    COLLISIONS BETWEEN MEDICAL HUMANISM AND EVIDENCE-BASED GUIDELINES FOR STANDARDIZED MEDICAL CARE

    Outright collisions between medical humanism and evidence-based guidelines for standardized care can be avoided as long as clinical guidelines (beyond safety measures) remain recommendations rather than mandates. Hartzman and Groopman believe it is essential to respect the ethical principle that any choice of treatment must ultimately be made by the patient who will benefit or suffer from it. Many patients have become aware of the scientific limitations of guidelines through reports in the media about recent reversals of expert advice on hormone-replacement therapy for postmenopausal women, low-fat diets for obesity, the use of erythropoietin for cancer-associated anemia, and tight regulation of glucose levels in various settings. Because guidelines are derived from clinical studies carried out in selected groups of patients and their statistical conclusions are based on study populations, they may not apply to an individual patient, especially if he or she has coexisting conditions. In many instances, the results of larger and better-designed clinical trials have contradicted what appeared to be firm conclusions from earlier research. Furthermore, there are frequently experts who dissent from the majority opinion on which guidelines are based, and their views are not routinely represented in the guidelines.

    What is the remedy ask Hartzband and Groopman writing in the NEJM?
    They suggest that shared decision making be central to any changes resulting from current health care reform initiatives. All national guidelines should acknowledge the dissenting opinions of experts. Furthermore, these guidelines should indicate which specific populations were studied and which important coexisting conditions constituted criteria for exclusion from the trials, so that physicians can judge whether and how the guidelines apply to an individual patient. Currently, some guideline committees receive financial support from pharmaceutical and device companies, and there are indications that such support has influenced the recommendations.4,5 In order to assure the public that there is no potential for a conflict of interest that would taint the guidelines, an independent government body should be established to develop guidelines without industry support — analogous to the role of the Food and Drug Administration as an unbiased party for the approval of treatments. Funding could come instead from the federal monies already designated for comparative-effectiveness research.

    *Tune in later for Post-cholecystectomy cystic duct stump leak.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, October 20, 2009

    CHILDHOOD POISONINGS RESULT IN 71,224 EMERGENCY DEPARTMENT VISITS NATIONWIDE EVERY YEAR

    Children are twice as likely to be poisoned by the medicine cabinet than by cleaning products or other household substances, researchers found.

    Emergency department visits for unintentional poisoning involved prescription or over-the-counter medication in 68.9% of pediatric cases, according to Daniel S. Budnitz, MD, of the Centers for Disease Control in Atlanta, and colleagues.

    Children taking medications without supervision caused 10 times as many poisonings as overdose errors by a parent or other caregiver in the national study of emergency department surveillance, the authors reported online ahead of print in the AMERICAN JOURNAL OF PREVENTIVE MEDICINE.

    The findings held few surprises but emphasize the need for prevention, particularly with toddlers, commented Carl Baum, MD, of the Center for Children's Environmental Toxicology at Yale-New Haven Children's Hospital, who was not involved in the study.

    Children 5 and under accounted for 81.3% of pediatric accidental poisonings in the study, which Baum chalked up to their inventiveness in bypassing adult measures to prevent access. "You have to be careful because toddlers are often one step ahead of adults," he asserted.

    Budnitz' group analyzed data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS), which receives reports from a random sample of adult and pediatric hospitals across the country.

    The database included 3,034 emergency department visits or hospital admissions of patients under 19 during 2004-2005 for a condition the treating physician attributed to a medication overdose (more than the intended dose or inadvertent exposure), or to poisoning from a nonpharmaceutical consumer product.

    Cases included ingestion and skin or eye exposures but excluded illicit substances, alcohol, tobacco, bee stings, and lead.
    The population rate of emergency care for medication overdoses was significantly higher than those for nonpharmaceutical products at 9.2 visits per 10,000 individuals per year (95% CI 7.3 to 11.0) compared with 4.2 (95% CI 3.3 to 5.0).
    Commonly available over-the-counter medications accounted for 33.9% of cases overall. The most commonly implicated drugs were:
    • Acetaminophen (9.3%).
    • Cough and cold medications (7.3%).
    • Antidepressants (6.1%).
    • Nonsteroidal anti-inflammatory drugs (NSAIDs, 5.3%).

    Inclusion of cough and cold medicines on this list highlights the risks emphasized recently by both the FDA and trade groups representing the manufacturers.

    (See Pediatric OTC Cough and Cold Remedies Should be Shunned in Toddlers and FDA Repeats Warning on Cough and Cold Medicines and Hopes That Parents Get the Message )
    Cough and cold medicines "do a very poor job of treating symptoms that are usually self-limiting" and are potentially dangerous for children, Baum noted.

    Medication overdose rates peaked at age 2 years (54.7 per 10,000 individuals per year) and fell with age until adolescence, when rates again rose (1.8 per 10,000 per year at ages 12 to 14 versus 3.3 at ages 15 to 18).

    "The fact that, annually, one of every 180 children age 2 years is treated in an emergency department for a medication overdose, despite current prevention efforts, underscores the size of this public health issue," Budnitz's group concluded.
    If anything, the results probably underestimate the scope of childhood poisonings, since poison control centers receive many more calls about pediatric poisonings, they noted. However, only a quarter of those result in direct treatment by a healthcare professional, they noted.Since unsupervised ingestion of medications by children 5 and under accounted for more than 75% of childhood poisonings, prevention efforts should concentrate on this problem, the investigators recommended.

    Child-resistant bottles, blister packs, and other packaging have been effective against childhood medication overdoses, Baum noted, though these can be defeated by failure to use them properly, such as cross-threading a lid. Further efforts are recommended to focus on improving packaging for the drugs most commonly implicated in poisonings, such as bottles that release only a single dose at a time or restrict the amount that can be ingested by an unsupervised child, the researchers said.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for COLLISIONS BETWEEN MEDICAL HUMANISM AND EVIDENCE-BASED GUIDELINES FOR STANDARDIZED MEDICAL CARE.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Saturday, October 17, 2009

    REVIEW SUGGESTS H1N1 FLU DRUGS SHOULD NOT BE USED FOR CHILDREN UNDER 12.

    A review of research published in the British Medical Journal found that children "under the age of 12 shouldn't be given the common antivirals Tamiflu [oseltamivir] or Relenza [zanamivir] to treat suspected A/H1N1 swine flu." Dr. Matthew Thomson, one of the report's authors, "said giving Tamiflu or Relenza to children under 12 reduces the length of the illness by an average of one day, which he described as a 'short effect for an illness that lasts about a week.'" Dr. Thomson also said that antivirals "could do more harm than good."

    The Oxford University researchers "also concluded that giving the drugs to children after they have been exposed to the flu virus -- post-exposure prophylaxis -- reduces transmission by only eight percent. The researchers "studied four separate randomized trials (two with Tamiflu and two with Relenza) that treated 1,766 children with the flu and three trials of post-exposure prophylaxis involving 863 children." They "concluded that, despite shortening the duration of infection, the drugs did not reduce the normal complications of flu, including asthma flareups, ear infections, sinusitis, bronchitis, and convulsions from fever."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for CHILDHOOD POISONINGS RESULT IN 71,224 EMERGENCY DEPARTMENT VISITS NATIONWIDE EVERY YEAR.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Wednesday, October 14, 2009

    Patients Spend $34 Billion on Alternative Medicines

    ‘Patients in the U.S. spent about $34 billion on complementary and alternative medicine in 2007, according to a government report,” says Kristina Fiore of MedPage Today, commenting on Nahin RL, et al "Costs of complementary and alternative medicine and frequency of visits to CAM practitioners: United States, 2007" National Health Statistics Report 2009; 18.

    About two-thirds of those out-of-pocket expenditures went to self-care items, including yoga classes and "natural" products, Richard L. Nahin, PhD, MPH, of the National Institutes of Health, and colleagues said. Complimentary and alternative medicine, otherwise known as CAM, "includes medical practices and products...which are not part of conventional medicine. These therapies are sought by Americans mainly "for pain relief and to contribute to their health and well-being

    The findings, reported in a National Center for Health Statistics brief, are consistent with other evidence that the use of self-care therapies has increased, while fewer Americans are going to complementary and alternative medicine professionals.

    The researchers said that the 354 million visits to complementary medicine practitioners in 2007 -- the latest year for which figures are available -- marked a drop of about 50% over 1997 numbers.

    The biggest decrease came among visits to practitioners of energy-healing therapies and relaxation techniques, the researchers said.
    Visits to acupuncturists, however, increased over the 10-year period, likely because more states now license the practice.
    "Natural products" not including vitamins or minerals accounted for the biggest chunk of self-care spending at $14.8 billion (44%) of total complementary medicine out-of-pocket expenditures.

    Practitioners of complementary medicine took in a total of $11.9 billion and $7.2 billion was spent for classes, homeopathic medicines, and relaxation techniques.
    The $34 billion spent on complementary and alternatives medicines is a small slice of the total $2.2 trillion spent on healthcare in 2007, and accounts for 11.2% of total out-of pocket spending.

    A total of $49.6 billion out-of-pocket was spent on physician visits and $47.6 billion went to prescription drugs.
    The findings were based on the 2007 National Health Interview Survey (NHIS), which included questions on 36 types of complementary medicine therapies. The researchers said the study may have been limited by potential recall bias because of patient self-report.

    Josephine P. Briggs, MD, director of the National Center for Complementary and Alternative Medicine, said the findings "underscore the importance of conducting rigorous research and providing evidence-based information on complementary and alternative medicines so that healthcare providers and the public can make informed decisions."

    REPORT INDICATES AMERICANS SPEND ABOUT $34 BILLION ANNUALLY ON CAM.

    USA Today (7/31, Szabo) reports that, according to a study conducted by researchers at the Centers for Disease Control and Prevention and the National Institutes of Health, "while Americans may complain about the high cost of healthcare, they're still willing to shell out roughly $34 billion a year out-of-pocket on alternative therapies that aren't covered by insurance." Josephine Briggs, of the NIH, said that "the results...show why it's important for researchers to conduct rigorous scientific studies of alternative therapies."

    The AP (7/31, Marchione, Stobbe) reports, "The data, gathered in 2007 mostly before the recession was evident, don't clearly reflect whether the economy played a role in spending on these therapies." But, Briggs pointed out that "there has been 'speculation that as the number of uninsured grows, there may be increased utilization of some of these approaches, which tend to be relatively inexpensive.'" The findings are "based on a...survey by the [CDC] of more than 23,000 adults nationwide." While the current report does not cover "vitamins and minerals," they "will be addressed in a future one."

    Complimentary and alternative medicine, otherwise known as CAM, "includes medical practices and products...which are not part of conventional medicine. These therapies are sought by Americans mainly "for pain relief and to contribute to their health and well-being.

    She added that researchers aimed to "find out which areas of CAM warrant research by the [NIH]," and that Americans were surveyed "without regard as to whether any of these alternative or complementary approaches actually work."

    In the Los Angeles Times (7/30) Booster Shots blog, Shari Roan noted that "about 38 percent of the adults surveyed said they had used some form of CAM for preventative health purposes or to treat a disease or condition." Of total expenditures, "about $22 billion of that was for products, including classes, materials and non-vitamin, non-mineral natural products such as fish oil, glucosamine and Echinacea," Rob Stein wrote in the Washington Post (7/30) Checkup blog. Of that amount "$14.8 billion...was for the supplements," while "$11.9 billion was for an estimated 354.2 million visits to acupuncturists, chiropractors, massage therapists and other CAM practitioners."

    WebMD (7/30, Boyles) reported, however, that "newly published survey was so different from" data published in 1997 "that researchers were hesitant to compare them." Still, "the data suggest that adults in the US made half as many visits to CAM practitioners in 2007 as they did in 1997, a decline from roughly three visits for every 1,000 adults to 1.5 visits." But, "visits to acupuncturists increased from 27 visits per 1,000 adults in 1997 to 79 visits per 1,000 adults in 2007." The report stated that this increase "may be in part due to the greater number of states that license this practice and a corresponding increase in the number of licensed practitioners in 2007...as well as increased coverage for these therapies." The Wall Street Journal (7/30) Health Blog, the Baltimore Sun (7/31, Brewington) Picture of Health blog, and Reuters (7/31) also covered the story.

    Research article
    Small intestinal bacterial overgrowth mimicking acute flare as a pitfall in patients with Crohn's Disease
    Jochen Klaus , Ulrike Spaniol , Guido Adler , Richard A Mason , Max Reinshagen and Christian von Tirpitz C
    BMC Gastroenterology 2009, 9:61doi:10.1186/1471-230X-9-61


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for REVIEW SUGGESTS H1N1 FLU DRUGS SHOULD NOT BE USED FOR CHILDREN UNDER 12.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, October 12, 2009

    NEW LAW SEEN AS ADDING MORE RESTRICTIONS TO ENSURE PRESCRIPTION DATA PRIVACY.

    The New York Times (8/9, BU1, Freudenheim) reported on the front of its Sunday Business section about how people believe their prescription drug information is "private. But in fact, prescriptions, and all the information on them -- including not only the name and dosage of the drug and the name and address of the doctor, but also the patient's address and Social Security number -- are a commodity bought and sold in a murky marketplace." However, this "may change if some little-noted protections from the Obama administration are strictly enforced.

    The federal stimulus law enacted in February prohibits in most cases the sale of personal health information, with a few exceptions for research and public health measures like tracking flu epidemics." Still, the "law won't shut down the medical data mining industry, but there will be more restrictions on using private information without patients' consent and penalties for civil violations will be increased." Dr. David Blumenthal, the national coordinator for health IT, said, "We can't afford to go forward with our plans unless we have assured the American public that the privacy of their information is assured."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Patients Spend $34 Billion on Alternative Medicines.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, October 9, 2009

    HOW MUCH EVIDENCE DO WE NEED TO CHANGE PRACTICES IN WHICH WE FIRMLY BELIEVE?

    Enough already! Randomized trials show that tight glucose control in patients with long-standing type 2 diabetes isn't beneficial,” says Richard Saitz, MD, MPH, FACP, FASAM; Published in Journal Watch General Medicine

    Should the glycosylated hemoglobin (HbA1c) level goal in patients with long-standing type 2 diabetes be 7%? 6.5%? Lower? Although many clinicians believe in tight control for patients with type 2 diabetes, recent studies suggest that this practice is not beneficial. Several recently published commentaries cite evidence that challenges current beliefs and practices.

    In the first major trial (done in the 1960s) of tight glucose control in patients with type 2 diabetes, oral glucose-lowering agents were associated with higher cardiovascular mortality and no differences in microvascular complications compared with placebo.1 Insulin also was not associated with clinical benefit.

    In three recent large randomized trials (ACCORD,2 ADVANCE,3 and VADT4), tight control in patients with long-standing type 2 diabetes did not lower overall mortality, cardiovascular-related mortality, stroke, amputations, or even clinical (as opposed to surrogate) microvascular endpoints. Differences in specific outcomes in these trials might be related to different treatments or to duration of diabetes in participants. In some studies, fewer intensively treated patients reached composite outcomes (such as "any diabetes complications"), but the bulk of improvement was in nonclinical outcomes (e.g., incident albuminuria). Tight control was associated with severe hypoglycemia and weight gain. In the UKPDS study,5 published a decade ago, nonobese intensively treated participants with newly diagnosed type 2 diabetes were less likely to reach microvascular endpoints (including "need for photocoagulation," but not visual loss) but showed no difference in mortality (cardiovascular, diabetes-related, or all-cause) compared with nonobese control patients. Among obese participants, metformin alone lowered long-term mortality and myocardial infarction rate, but sulfonylureas and insulin did not; tight control did not lessen risk for microvascular complications. Metformin and sulfonylureas in combination were associated with excess diabetes-related deaths and all-cause mortality.

    Because trials do not support tight control and because of the cost, burden, and harms associated with tight control, we should be emphasizing cardiovascular risk reduction (particularly control of blood pressure and cholesterol levels) and healthy lifestyles for patients with type 2 diabetes.6 Several groups of editorialists suggest aiming for HbA1c levels of 7.0% or 7.5% in patients in whom this goal is achievable with one medication and adjusting this target for others based on symptoms, side effects, treatment burden, and patient values and preferences.6,7,8 Commentary authors suggest that the HbA1c goals for practice guidelines should not be <7% and that, to encourage individualized treatment, performance measures should set an upper limit (e.g., 9%) rather than a lower limit (e.g., <7%).7

    Randomized trial results often are not available to answer important clinical questions. In this case, they are. We shouldn't ignore them. Many clinical trials are completed that show benefits, and much time passes, before new treatments are adopted; similarly, many trials that show lack of benefit, or even harm, might be required before clinicians abandon ineffective practices that have become routine. Haynes and Haynes ask, "What does it take to put an ugly fact through the heart of a beautiful hypothesis?" and they quote poetry: "The chains of habit are too weak to be felt until they are too strong to be broken."9 Social psychology literature suggests that people cling to belief even in the face of mountains of evidence to the contrary. But, as physicians and scientists, we should embrace change when new evidence consistently contradicts our prior beliefs and clinical practice.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for NEW LAW SEEN AS ADDING MORE RESTRICTIONS TO ENSURE PRESCRIPTION DATA PRIVACY.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, October 6, 2009

    GUIDE TO THE MAIN HEALTHCARE FIGHT POINTS

    KEEP IT OR LOSE IT?
    If you like your doctor, you will be able to keep your doctor? If you like your health care plan, you’ll be able to keep your health care plan? No one will take it away, no matter what?

    These assurances may not be literally true or enforceable. The legislation does not require insurers or employers to continue offering the health benefits they now provide. Current insurance coverage might not be viable for long because insurers could not add benefits or enroll additional people in noncompliant policies. Your health plan may change, and your doctor may no longer accept your insurance.

    SOCIALIZED MEDICINE?

    Whether a public plan would crowd out private insurers depends on details yet to be decided, including its premiums and its payment rates for health care providers.
    The federal government already holds sway over the health care system through Medicare, Medicaid and various insurance programs for children, veterans, military personnel and other federal employees. The federal government will account for 35 percent of the expected $2.5 trillion in health spending this year, and that does not include subsidies built into the tax code.

    INSURERS ARE TO BLAME?
    Democrats have unleashed a blistering attack on private health insurers as they try to convince the vast majority of Americans who already have coverage that the current system is tilted in favor of corporate profits, not patients, and that insurers are a main obstacle to passing legislation.
    Most Americans do not know the full cost of their employer-sponsored insurance. And it is easier for Democrats to paint insurers as greedy than to explain the complex math that shows current health care spending is unsustainable.

    DEFICIT-NEUTRAL?
    The Congressional Budget Office has yet to issue cost estimates for the latest versions of the bill approved by three House committees. But it has warned that the legislation “would probably generate substantial increases in federal budget deficits” beyond 2019, in part because health costs are rising faster than the rate of inflation and proposed new taxes would not keep up.

    EUTHANASIA?
    Critics say the legislation could limit end-of-life care and even encourage euthanasia. Moreover, some assert, it would require people to draw up plans saying how they want to die.
    These concerns appear to be unfounded. AARP, the lobby for older Americans, says, “The rumors out there are flat-out lies.” The House bill would provide Medicare coverage for optional consultations with doctors who advise patients on life-sustaining treatment and “end-of-life services,” including hospice care. The legislation instructs Medicare officials to propose ways to measure the quality of end-of-life care. Doctors would have financial incentives to report data on such care to the government.

    CUTTING MEDICARE?
    To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare, the program for older Americans and the disabled. These savings would pay nearly 40 percent of the bills’ cost.The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. The providers make a plausible case that the cutbacks could inadvertently reduce beneficiaries’ access to some types of care.Indeed some proposals could affect beneficiaries. The major bills in Congress would cut more than $150 billion over 10 years from federal payments to private health plans that care for more than 10 million Medicare beneficiaries.
    From “a primer on the details of health care reform” by R. Pear and d. M. Herszenhorn

    COMMENT:
    To pass his health proposal without busting the budget, especially this year, Obama would first need to violate his word. ... He pledged that 'no one making less than $250,000 a year will see any type of tax increase' -- the most memorable number of the 2008 campaign. Taxing health benefits would certainly cross this very bright line and add to the public stock of cynicism. Second, Obama would need to abandon economic common sense -- adding debt to debt or new taxes to a struggling economy.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for How Much Evidence Do We Need to Change Practices in Which We Firmly Believe?


    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Saturday, October 3, 2009

    FOUR LIFESTYLE CHOICES MAY HELP REDUCE RISK OF CHRONIC DISEASE, RESEARCHERS SAY.

    "If people would just do four things -- engage in regular physical activity, eat a healthy diet, not smoke, and avoid becoming obese -- they could slash their risk of diabetes, heart attack, stroke or cancer by 80 percent," CDC researchers found. "But less than 10 percent of the 23,153 people in the multiyear study -- published in the Archives of Internal Medicine -- actually lived their lives this way." The new study, however, may change some minds, because it has "such a simple straightforward focus on making the point that prevention works in preventing serious disease," noted Dr. J. Leonard Lichtenfeld, of the American Cancer Society.

    Delving into the specifics of the study, the CDC investigators, alongside scientists in Germany, "drew on data from a German study conducted between 1994 and 1998" in which participants between 35 and 65 years of age were asked about their "lifestyle characteristics," disease history, and dietary habits. "Adherence to four key lifestyle indicators were tracked: never having smoked; having a body-mass index below 30 (the threshold for obesity); exercising for a minimum of 3.5 hours per week; and eating healthfully, as evidenced by a diet high in fruit and vegetable intake, but low in meat." Although "most study participants engaged in some (one to three), but not all of the ideal behaviors," the team found that "less than four percent met none of the criteria for a healthy lifestyle, while nine percent followed all four."

    As for disease incidence, "3.7 percent of participants developed diabetes, 0.9 percent developed myocardial infarction, 0.8 percent developed stroke, and 3.8 percent developed cancer,"Yet, participants "who followed all four lifestyle factors had a 78 percent lower risk of developing a chronic disease than those with no healthy factors." Specifically, they had a "93 percent lower risk of diabetes, an 81 percent lower risk of myocardial infarction, a 50 percent lower risk of stroke," and a "36 percent lower risk of cancer." And, "reductions in risk were similar for men and women."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for GUIDE TO THE MAIN HEALTH CARE FIGHT POINTS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Thursday, October 1, 2009

    ACIP Recommends Five Groups as Priority Targets for H1N1 Vaccination

    The CDC's Advisory Committee on Immunization Practices (ACIP) has recommended which U.S. population groups should be targeted to receive H1N1 influenza vaccine when it becomes available. People over 65 have the lowest priority.
    The 15-member ACIP says these five groups should be targeted:
    • pregnant women;
    • household contacts of infants under 6 months;
    • healthcare and emergency-services workers;
    • young people between 6 months and 24 years of age;
    • and nonelderly adults with underlying risk conditions, such as diabetes and chronic lung disease.
    The five groups comprise about 160 million people, about half the U.S. population.
    Dr. Anne Schuchat, who directs the CDC's center for immunization, said at a press conference that people over 65 received ACIP's lowest priority for H1N1 vaccination because the virus "has, to a large extent, spared that population." She emphasized, however, the importance of ensuring that the elderly receive the seasonal flu vaccine.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for FOUR LIFESTYLE CHOICES MAY HELP REDUCE RISK OF CHRONIC DISEASE, RESEARCHERS SAY.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, September 29, 2009

    Unintended consequences of applying a business mindset to medicine

    As medicine changes during the past decades and even just in the past few years doctors have had to become more business-like. Drs.Hartzband, and Groopman write that rapidly rising health care costs over recent decades have prompted the application of business practices to medicine, with the goals of improving efficiency, restraining expenses, and increasing quality. Price tags are being applied to every aspect of a doctor's day, creating an acute awareness of costs and reimbursement. Physicians are now routinely provided with profit-and-loss reports reflecting their activity, and metrics are calculated to measure the cost-effectiveness of their work. Many business managers believe that clinicians will change their behavior to meet the imperatives of increased efficiency, cost containment, and improved quality only by increasing their focus on the flow of money in their work environment.

    But are there unintended consequences of applying a business mindset to medicine?
    Assigning a monetary value to every aspect of a physician's time and effort may actually reduce productivity, impair the quality of performance, and thereby even increase costs. Studies have shown that even the suggestion of money promotes behavior marked by selfishness and lack of collegiality.
    In one experiment, a control group performed a series of tasks, such as unscrambling phrases, in a "neutral" environment, whereas another group was "primed" through the inclusion of the concept of money in the scrambled phrases and the placement of play money within their visual periphery during the exercise. In a series of such experiments, money-primed subjects were consistently less willing to extend themselves to those in need of assistance. The authors concluded, "People reminded of money reliably performed independent but socially insensitive actions."

    Another recent experiment, involving 614 undergraduates, assessed the willingness of passersby to move a sofa onto a truck. The control group was asked to do it as a favor (without monetary compensation), whereas another group was offered 50 cents to help. The controls were significantly more willing to assist. When students were offered a piece of candy to help, there was no difference in willingness relative to the control group. But when the cost of the candy was mentioned ("a 50-cent candy"), willingness declined significantly, to the same low level as with the offer of 50 cents. Only by offering a substantially larger amount of money (10 times as much) did the cash group reach the same level of willingness to help as the control group. How could 50 cents be worth less as a motivator than no money at all?

    The answer may lie in the difference between "social" or "communal" interactions and "market" or "exchange" interactions.

    Researchers have described two types of relationships that involve giving a benefit to someone else.In a market relationship, when you provide goods or services, you expect to receive cash or bartered goods of similar value in return. In a communal relationship, you are expected to help when there is a need, irrespective of payment. In a communal relationship, an expectation and obligation to help when assistance is needed. Drs.Hartzband, and Groopman believe that in the current environment, the balance has tipped toward market exchanges at the expense of medicine's communal or social dimension. In the new business model there is no metric for the quality that derives from the communal dimension of medicine.

    How can we restore the balance between communal and market exchange in medicine in the current economic environment, ask Drs.Hartzband, and Groopman, given the imperative to cut costs? One answer may lie in an experimental new paradigm in primary care termed the "patient-centered medical home." The term itself suggests an emphasis on the social exchange that exists in a family rather than the market exchange of a business. The medical home is envisioned as a "compassionate partnership" of primary care providers and patients, with coordinated care for patients' ongoing problems and increased attention to preventive measures.

    The insurer would pay a set fee for each patient cared for in the medical home to cover what is now non-reimbursed time. Substantial cost savings are expected to result from coordination of care. As policymakers refine this model and extend it to include medical specialists, they should take into account the lessons of behavioral economics.

    Caregivers should be appropriately reimbursed but should not be constantly primed by money. Success in such a model will require collegiality, cooperation, and teamwork — precisely the behaviors that are predictably eroded by a marketplace environment.

    Dr. Hartzband is an endocrinologist at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School, and Dr. Groopman is a hematologist–oncologist at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School — both in Boston.

    References
    Vohs KD, Mead NL, Goode MR. The psychological consequences of money. Science 2006;314:1154-1156. ;Heyman J, Ariely D. Effort for payment: a tale of two markets. Psychol Sci 2004;15:787-793. ;Ariely D. Predictably irrational: the hidden forces that shape our decisions. New York: Harper Collins, 2008.;Clark MS, Mills J. Interpersonal attraction in exchange and communal relationships. J Pers Soc Psychol 1979;37:12-24.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Five Groups as Priority Targets for H1N1 Vaccination .

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Sunday, September 27, 2009

    Role of diet in the development of inflammatory bowel disease

    Increasing incidence and prevalence figures for IBD both in the developed and developing world indicate that environmental factors are at least as significant in IBD as genetic susceptibility. Of these, diet and the host microbiota are likely to play important but as yet poorly defined roles. The major constituents of a standard Western diet may contribute to, or protect against, intestinal inflammation via several mechanisms. These include the effects of insulin resistance and short-chain fatty acids such as butyrate, modification of intestinal permeability, the antiinflammatory role of polyunsaturated fatty acids, and the effect of sulfur compounds from protein on host microbiota. This detailed review critically assesses the evidence for the role of diet in the development of IBD and examines the evidence for obesity as a contributing factor to IBD pathogenesis. Particular attention is focused on methodological issues including suitability of cases and controls, confounders such as smoking, and total energy expenditure. From Chapman-Kiddell et al. Role of diet in the development of inflammatory bowel disease Inflamm Bowel Dis 2009

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Unintended consequences of applying a business mindset to medicine.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, September 25, 2009

    Orthostatic Hypotension

    Symptomatic falls in blood pressure after standing or eating are a frequent clinical problem. Symptoms are due to cerebral hypoperfusion and include generalized weakness, sensations described as dizziness or lightheadedness, visual blurring or darkening of the visual fields and, in severe cases, loss of consciousness. Less frequently, orthostatic hypotension leads to angina or stroke.

    Symptoms of orthostatic hypotension vary in severity from mild to incapacitating; severely afflicted patients are unable to leave the supine position without experiencing presyncope or syncope.

    Postural (orthostatic) hypotension is diagnosed when, within two to five minutes of quiet standing, one or more of the following is present: At least a 20 mmHg fall in systolic pressure At least a 10 mmHg fall in diastolic pressure Symptoms of cerebral hypoperfusion

    Multiple epidemiologic surveys have found postural hypotension in as many as 20 percent of patients over age 65. Many patients with postural hypotension have systolic hypertension when seated or supine. In one study, for example, the prevalence of orthostatic hypotension was 18 percent in subjects age 65 years or older, although only 2 percent of the subjects were symptomatic (defined as dizziness with standing). There was a modest association (odds ratio 1.4 to 1.9) with systolic hypertension when supine, carotid stenosis greater than 50 percent, and the use of oral hypoglycemic agents. There was only a weak association with the use of beta blockers and no association with other antihypertensive drugs (including diuretics).In other reports, however, the use of antihypertensive medications (hydralazine, ACE inhibitors, ganglionic blockers) was, as expected, significantly related to postural hypotension in the elderly. Furthermore, discontinuing antihypertensive medications often led to an improvement of postural hypotension. Other drugs associated with postural hypotension, especially in the elderly, are vasodilators, including nitrates and calcium channel blockers; antidepressants (tricyclics and phenothiazines); opiates; and alcohol.

    Orthostatic hypotension contributes a large proportion of hospitalizations; a report from the Nationwide Inpatient Sample estimated the orthostatic hypotension hospitalization rate to be 233 per 100,000 among patients over 75 years, with a median length of stay of three days and an overall inhospital mortality rate of 0.9 percent.
    Other studies have also associated orthostatic hypotension in the elderly with mortality. Among 3522 Japanese American men, age 71 to 93 years, orthostatic hypotension was present in 6.9 percent and increased with age. The four-year age-adjusted mortality rates were 57 and 39 per 1000 patient-years.

    Orthostatic hypotension can also occur in younger and middle-age subjects, who, in the absence of volume depletion (due to diuretics, hemorrhage or vomiting), usually have chronic autonomic failure.

    Other associated diseases are diabetes, Parkinson's, dehydration, or drugs.

    Check for meds that may precipitate BP drops such as alpha
    blockers...diuretics...and many antiparkinson's drugs (levodopa, etc).

    I suggest lowering the dose...or switching to another drug that's less likely to be a problem.

    Nondrug therapies can help. I advise patients to get up slowly...increase fluid and sodium intake when possible...wear compression stockings...and avoid alcohol.

    If nursing home patients have postprandial hypotension, I suggest walking to meals and taking a wheelchair ride back to their room.

    When this isn't enough, consider therapies that increase BP.

    Fludrocortisone raises BP by causing sodium and water retention but be careful using it in patients with heart failure.Fludrocortisone can also cause hypokalemia. One must check potassium levels and prescribe a supplement if potassium goes too low.

    Midodrine raises blood pressure by causing vasoconstriction... so it must be cautiously in patients with heart disease.

    Midodrine also decreases heart rate but care must be taken in using it with other meds that lower heart rate such as beta-blockers, digoxin, etc.

    I tell patients not to be surprised if they get "goosebumps"...midodrine commonly causes hair to stand on end.

    I advise patients to avoid taking midodrine less than 4 hours before bedtime...to avoid HYPERTENSION when lying down.

    Caffeine is worth a try to see if it reduces hypotension. I suggest 1 or 2 cups of coffee or black tea up to 3 times a day.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Role of diet in the development of inflammatory bowel disease.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Wednesday, September 23, 2009

    OIG EXPECTS OVER $2.4 BILLION IN MEDICAL FRAUD RECOVERIES IN FIRST HALF OF FY 2009

    The Department of Health and Human Services (HHS) Office of Inspector General (OIG) expects to recover more than $2.4 billion in the first half of fiscal year (FY) 2009, the agency said in its Semi-Annual Report to Congress.According to the June 8 report, OIG’s expected recoveries include $274.8 million in audit-related receivables and $2.2 billion in investigative-related receivables, which includes nearly $552 million in non-HHS receivables resulting from OIG work.

    Between October 2008 and March 2009, OIG reported exclusions of 1,415 individuals and organizations for fraud or abuse involving federal health care programs and/or their beneficiaries; 775 criminal actions against individuals or organizations that engaged in crimes against HHS programs; and 342 civil actions, which include False Claims Act and unjust enrichment suits, Civil Monetary Penalties Law settlements, and administrative recoveries related to provider self-disclosure matters.

    The report also noted that OIG investigators and attorneys were instrumental in the government’s $1.4 billion settlement with Eli Lilly and Company. Lilly agreed to plead guilty to promoting its anti psychotic drug Zyprexa for uses not approved by the Food and Drug Administration and not covered by Medicaid or other federal programs.

    Another OIG investigation resulted in an over $97.5 million settlement with Bayer HealthCare LLC, the report said. That settlement related to allegations that Bayer paid kickbacks to several durable medical equipment mail order suppliers and diabetic supply distributors, leading them to submit false claims to Medicare.

    “These recoveries reflect our dedicated efforts to reduce fraud, waste, and abuse in HHS programs,” Inspector General Daniel R. Levinson said in a press release announcing the report. “We will continue to employ all of our audit, evaluation, investigation, and legal tools and also to collaborate with OIG’s government partners to accomplish this vital and expanding mission.”

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Orthostatic Hypotension.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, September 21, 2009

    STRIDES IN INCISION-LESS OPERATIONS NAMED “NOTES” USE MOUTH, OTHER ORIFICES, TO ACCESS PATIENTS' INTERNAL ORGANS

    Accessing internal organs via the body's natural orifices is the newest trend in minimally invasive surgery. And surgeons around the world are developing innovative ways to use body openings in the hope surgical patients will have less pain, a faster recovery and no scars. At an international gastroenterology conference in Chicago, surgeons unveiled the newest no-scar surgical procedures, from incision-less weight-loss surgeries to vaginal appendectomies.

    One of the experimental weight-loss surgeries, uses a stapling device that snakes down a patient's throat and into the stomach. A vacuum brings the sides of the stomach together, which the surgeon then staples together. The narrower stomach is supposed to make patients feel full faster, and help curb their appetite.

    The vagina was the body opening of choice for a team from the University of California San Diego that is also investigating no-scar weight-loss surgery. For this procedure, with the help of two small abdominal incisions, surgeons remove 70 per cent of a patient's stomach through the vagina. The team has only tried the procedure on two patients, but the surgical team called it a "viable option" for morbidly obese patients."Compared to traditional laparoscopic techniques in which patients experience a high incidence of infections and hernias, the results so far indicate this procedure accelerates weight loss while minimizing adverse events," he said in a release.

    But, most no-scar surgeries remain experimental because technology has not yet caught up with surgeons' ambitions.Surgeons, when they use these techniques, don't have the same level of precision as they would have in a standard laparoscopic or open surgery. And since less precision means more risks, most surgeons say the benefits currently don't outweigh the risks.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for OIG EXPECTS OVER $2.4 BILLION IN MEDICAL FRAUD RECOVERIES IN FIRST HALF OF FY 2009.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Saturday, September 19, 2009

    Low-Carb Diet Improves Symptoms & Quality of Life in Diarrhea predominant IBS

    Data published in Clinical Gastroenterology and Hepatology suggest that a very low-carbohydrate diet (VLCD) provides adequate relief and improves abdominal pain, stool habits and quality of life in IBS-D.

    Patients with IBS-D anecdotally report symptom improvement after initiating a VLCD; this study prospectively evaluated a VLCD in IBS-D. Participants with moderate to severe IBS-D were provided a two-week standard diet, then four weeks of a VLCD (20 g carbohydrates/d). A responder was defined as having adequate relief of gastrointestinal symptoms for two or more weeks during the VLCD. Changes in abdominal pain, stool habits and quality of life also were measured.
    Of the 17 participants enrolled, 13 completed the study and all met the responder definition, with 10 reporting adequate relief for all four VLCD weeks. Stool frequency decreased and stool consistency improved from diarrheal to normal form. Pain scores and quality-of-life measures significantly improved (outcomes were independent of weight loss).

    From Clinical Gastroenterology and Hepatology; 2009: 7(6): 706-708.e1

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for STRIDES IN INCISION-LESS OPERATIONS NAMED “NOTES” USE MOUTH, OTHER ORIFICES, TO ACCESS PATIENTS'INTERNAL ORGANS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Thursday, September 17, 2009

    INFANT MORTALITY IS A MAJOR PUBLIC HEALTH PROBLEM, AND IT’S NOT IMPROVING.

    Nicholas Bakalar writes that the United States had a higher infant mortality rate than 28 countries" in "2004, the latest year for which worldwide data are available." That figure is up from "only 11 countries" in 1960. Data also indicate that "there are large differences by race and ethnicity," with "non-Hispanic black, American Indian, Alaska Native, and Puerto Rican women" among those with "the highest rates of infant mortality." “It is thought that the increase in preterm birth and preterm-related causes of death are major factors inhibiting further declines in infant mortality,” said Marian F. MacDorman, the lead author of the report and a statistician at the C.D.C. “Infant mortality is a major public health problem, and it’s not improving.”

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Low-Carb Diet Improves Symptoms & Quality of Life in Diarrhea predominant IBS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, September 15, 2009

    AMDPatients are focusing on supplements to help prevent or slow age-related macular degeneration (AMD).

    Age-related macular degeneration (AMD) is the leading cause of adult blindness. It is is a degenerative disease of the central portion of the retina (the macula) that results primarily in loss of central vision. Central vision is required for activities such as driving, reading, watching television, and performing activities of daily living. The Eye Diseases Prevalence Research Group (EDPRG) estimated that the prevalence AMD in adults age 40 and over in the United States was 1.47 percent, affecting 1.75 million people, in the year 2000, and projected that by 2020 AMD would affect almost three million people. A variety of potential risk factors have been suggested. Heavy alcohol use (more than three drinks per day) is associated with an increased risk for early AMD. AMD appears to be more prevalent in whites than in blacks with an intermediate prevalence in Hispanics and Chinese. Data are conflicting on the role of hypertension , higher body mass index, and sunlight.

    AMDPatients are focusing on supplements to help prevent or slow age-related macular degeneration (AMD).

    High doses of beta-carotene, vitamin C, vitamin E, and zinc in a specific product called PreserVision slows progression and loss of visual acuity in people who already have macular degeneration.But now there are concerns about whether these doses are safe. High doses of beta-carotene seem to increase the risk of lung cancer in smokers...and high doses of vitamin E might increase mortality. Now the NIH is testing a lutein and fish oil combo to see if it will slow progression of age-related macular degeneration.

    Diets high in foods that contain lutein or fish oil seem to show a benefit...but this doesn't always translate to supplements.

    DIETARY lutein seems to lower the risk of developing macular degeneration. Lutein is a yellow pigment that's concentrated in the macula and filters out harmful light. I encourage people to eat foods such as corn, spinach, broccoli, orange juice, grapes, etc.

    Lutein SUPPLEMENTS are assumed to help...but so far there's no proof they prevent or slow the progression of macular degeneration.

    I tell people not to count on Centrum Silver and other multivits with small amounts of lutein to prevent macular degeneration.

    NIH is testing 10 mg/day of lutein, but it's too soon to recommend this high of a dose.

    Dietary omega-3 fatty acids from fish or nuts seem to protect against early macular degeneration...but there's no proof that fish oil SUPPLEMENTS have the same benefit.

    I tell patients their best bet for prevention is to wear sunglasses and avoid smoking and heavy alcohol drinking.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Infant Mortality.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Sunday, September 13, 2009

    Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.

    Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.

    On April 26, 2007, ABC World News, the American Broadcasting Corporation's flagship television news program, aired a “good news” story about a new test for prostate cancer. Against a background of a dramatic graphic showing that 1.6 million American men undergo prostate biopsy each year, the presenter announced: “Researchers at Johns Hopkins say they have developed a more accurate blood screening test.” The story was based on a new study examining the performance of early prostate cancer antigen-2 as a serum marker for prostate cancer. Unfortunately, ABC failed to disclose one crucial fact: the principal investigator of this study receives a share of the royalty sales of the test and is a paid consultant to the test's manufacturer. There was no discussion, for example, of the scientific evidence showing that the test was “more accurate” than existing screening tests or of the uncertain benefits and proven harms of prostate cancer screening

    This failure was one of a litany of weaknesses in medical stories and poor health reporting.

    I encourage all to check an online project called HealthNewsReview.org (http://HealthNewsReview.org/) that evaluates and grades media stories about new health interventions, notifying journalists of their grades. The project builds on other initiatives that monitor the quality of health reporting, such as the Australian Media Doctor Web site (http://www.mediadoctor.org.au/) and the United Kingdom's Behind the Headlines project (http://www.nhs.uk/News/Pages/NewsIndex.aspx ).

    HealthNewsReview.org uses a 10-point grading scale. The rating criteria include whether a story adequately quantifies the benefits of an intervention, appraises the supporting evidence, and gives information on the sources of a story and the sources' competing interests. On this scale, the ABC story received a grade of just two. Based on the ratings of 500 stories from the highest circulation newspapers and news magazines, the most widely used wire service (Associated Press), and the three most popular US television networks, the report card from HealthNewsReview.org is grim.

    Most stories (62%–77%) failed to adequately address costs, harms, benefits, the quality of evidence, and the existence of other treatment options. The trouble with distorted journalistic reports, is that they can generate false hopes and unwarranted fears. Accurate, balanced, and complete health reporting is crucial, so that “health care consumers are properly informed and ready to participate in decision making about their health care.”

    When it comes to the quality of health reporting, why is the bar set so low?

    One problem is that today's health reporters may have been covering crime last week and politics the week before. They have rarely been trained to understand the complexities of health research. For example, in her survey of 165 reporters in the US (response rate 69.6%), Melinda Voss found that 83% (96/115) had received no training in interpreting health statistics, and a third said that understanding key health issues was “often” or “nearly always” difficult.

    While there are certainly studies in specialist medical journals that will be difficult for many people to grasp, nevertheless there may be some value in establishing a core set of scientific competencies for all health reporters. Indeed, the Association of Health Care Journalists' Statement of Principles states that health reporters should “understand the process of medical research in order to report accurately” (http://www.healthjournalism.org/secondarypage-details.php?id=56 ).

    When a health story gets hyped, it is all too easy for medical journal editors to deny any responsibility. The reality, of course, is that journal editors themselves are the third party in the “complicit collaboration”—the journal's press release is the usual mechanism for linking the researcher to the journalist. Medical journals issue press releases about their upcoming studies partly because media publicity drives readers to the journal and builds brand recognition. A bland press release may be less likely to get your journal and the study noticed. Not surprisingly, a content analysis of journal press releases by Steven Woloshin and Lisa Schwartz found that these releases were themselves prone to exaggeration; press releases from research institutions and funding agencies may be equally as prone. Woloshin and Schwartz argue that all journal press releases should include:

    (1) a section putting results into context,
    (2) a section for the study's limitations,
    (3) a statement of the study authors' competing interests, and
    (4) a summary of the quantitative results expressed using absolute rather than just relative measures.

    COMMENT: In this column or blog of my medical articles I assure all that I try to use all 4 criteria in the story. Wherever possible we attempt to gauge the evidence pro and con with these levels of evidence prior to writing the article.

    LEVEL OF EVIDENCE for the medical articles we publish on this website.
    Level Definition
    A High-quality randomized controlled trial (RCT)
    High-quality meta-analysis (quantitative systematic review)
    B Nonrandomized clinical trial
    Nonquantitative systematic review
    Lower quality RCT
    Clinical cohort study
    Case-control study
    Historical control
    Epidemiologic study
    C Consensus
    Expert opinion
    D Anecdotal evidence
    In vitro or animal study
    Adapted from Siwek J, et al. How to write an evidence-based clinical review article. Am Fam Physician 2002;65:251-8.
    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com