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
Tuesday, September 29, 2009
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
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
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
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
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
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
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
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