News News News
NO CONFUSION HERE
Unlike physicians, who have relinquished professionalism by adopting business priorities, the 3rd party payment bureaucracy has no illusions: “We will not sacrifice profitability for membership”, stated WellPoint president and CEO Angela Braly to analysts in a conference call to analysts. (American Medical News May 19, 2008 p. 1)
As the average family premium in the U.S. for health “insurance” soars beyond 12,000 dollars, the affordability of these expensive payment systems has induced businesses and individuals to drop coverage. Health plan executives know that politicians will ensure that all taxpayers will eventually be forced by law to purchase these policies, as they are presently in Massachusetts, so they have every reason to maximize profits.
No matter how payments to physicians and other workers are reduced, the other links in the "cost of health care" chain are sacrosanct. Therefore, the uncontrolled profits and costs of third parties will continue to drain resources and inflate the cost and inefficiency of “health care”.
Nitwit ideas such as “Cover the Uninsured” week, promoted by the Robert Wood Johnson Foundation, promote the false premise that a medical system cannot exist without a parasitic, financial black hole of “health plan” middlemen.
BENEFITS OF SUNSHINE
A study has shown the benefits of sun in preventing prostate cancer. Among men aged 40-79 in the San Francisco Bay area, high sun exposure is linked to reduced risk of developing advanced prostate cancer. (Cancer Res. 2005, June 125; 65(12):5470-9).
There has been a marked turnaround in thinking on sun exposure. In a recent presentation by Dr. Edward Giovannucci to the American Association for Cancer Research meeting in California, he suggested that adequate vitamin D from sun exposure prevents 30 deaths for every one cause by skin cancer.
In the absence of supplements, dietary vitamin D only accounts for a proportion of the vitamin in the human body.
SLEEP CURES FROM DOWN UNDER
Two studies suggest some strategies to improve sleep. In one, carried out at the University of Tasmania in Launceston, 25 people were placed on 30 grams of chopped chili a day (an ounce is 28.5 grams) for four weeks.
On average, these volunteers went to bed two hours later and slept for 20 minutes less than during the previous four weeks, when their diet was chili free. They were less active during sleep and slept more deeply, arising more refreshed. They were also more physically active during the daytime.
Researchers have not pinpointed what might be responsible for this effect, but it is known that chilies contain a substance that reduces pain, perhaps improving discomforts that disturb sleep at night, and decrease physical activity during the day.
The second study, carried out at Sydney University, found that those who ate a meal with a high glycemic index four hours before bed took an average of 9 minutes to fall asleep and those who ate a meal with a low index took 17.5 minutes.
The higher the glycemic index, the more quickly foods are metabolized into sugars. (New Scientist, Oct. 15, 2005, p. 14)
MORE ISSUES WITH TRANSFUSION
The January newsletter reported the increased risk of death with transfusion of red cells and stored whole blood. Despite long established belief by Western surgeons that blood transfusions are beneficial, practice indicates that transfusions of blood more than 2 weeks old increases the risk of death for the following year by 70%. Infection rates also increase after transfusion, possibly due to immune suppression by foreign blood. (New England Journal of Medicine, vol. 358, p 1229)
"Artificial" blood provides no solution to this dilemma: Developing opinion and newly revealed data now supports a moratorium on the use of all artificial blood products, as they have also failed to show any benefit and their use increases the risk of complications and death.
Investigators working at the National Institutes of Health have concluded that artificial blood is too risky for further testing, because patients who receive it have a 30 percent increased chance of dying and a 171 percent increased risk of heart attack.
Studies available to the FDA, but not to the scientific community at-large, would have made it clear by 2000 that these blood substitutes posed a 27 percent greater risk of death and a 177 percent greater risk of heart attacks based on trials of four products. Some are questioning the judgment of the U.S. Food and Drug Administration to continue to allow human trials of these substances once this was apparent.
A similar situation exists with hormone-like drugs (brand names are Procrit, Aranesp, and Epogen), which stimulate tissues in the body to produce more blood.
These drugs are heavily marketed to oncologists and in “direct to consumer” advertising. Studies on breast and cervical cancer suggest that these drugs increase the growth of cancer and decrease survival time, and a new study associates their use with increases in death rates and blood clot risk.
Questions about the risks of these drugs to increase tumor growth dates back to 1993: “That needed to be evaluated from the start”, stated Charles Bennett, M.D., Ph.D., the author of the most recent study. Waiting “10 to 15 years to see bad outcomes emerge”, he believes, is irresponsible. (JAMA, May 7, 2008 p 2016)
Ed. note: the obvious conclusion is to specify to your surgeon that they employ blood-sparing techniques and recycling whenever surgery is necessary. Banking your own blood is not prudent, as the loss of nitric oxide in aged stored blood makes its use dangerous.
GOOD NEWS FOR THE TIME PRESSURED
In terms of fitness; it appears that three two-minute bursts of intense exercise a week are as effective as six hours of more steady exercise a week.
23 moderately fit men and women were first asked to cycle approximately 18 miles to check their baseline fitness. Each was assigned to one of three groups which respectively: i. cycled for two hours daily at moderate pace, ii. cycled 10 minutes daily in 60 second bursts at higher intensity, iii. cycled at maximum intensity for two minutes in 30 second bursts with four minutes rest in-between.
At the end of the two-week trial, when the subjects again cycled the 18 miles, the fitness of all three groups were found to have improved to the same degree with similarly increased ability of their muscles to absorb oxygen. (J Appl Physiol 98: 1985-1990, 2005).
KUDOS TO CLEAR-THINKING PHYSICIAN CHRISTINE SINSKY OF DUBUQUE
At least a few doctors can still resist the poison of electronic medical record hyperbole. Dr. Sinsky took a stopwatch on hospital rounds and found that 21 minutes were spent with patients and 75 minutes with the computer; “it took more than an hour and a half to do work that previously took 30 minutes”, she found.
"More time spent accomplishing the same work means less capacity to care for patients."
Dr. Sinsky also pointed out that due to limited access to clinical data while entering information into their EMR system: "physicians are handwriting lab values and other clinical data on scraps of paper for reference during order entry and documentation…a work around for poorly designed technology" (American Medical News May 26, 2008 p. 22)
BURNING TONGUE SYNDROME
Dr. Robert Henkin of the taste and smell clinic in Washington D.C. has found that transcranial magnetic stimulation was helpful for 31 of 46 patients in an unpublished trial reported at the Clinical Research 2005 meeting.
Burning tongue syndrome can also affect other structures in the mouth, and the cause is presently unknown. Pharmacologic treatment with drugs that affect gamma-aminobutyric acid, a neurotransmitter in the nervous system and elsewhere, is the usual treatment, but these drugs have a variety of side effects and may have to be used for extended periods.
In contrast, Dr. Henkin found no side effects with TMS.
Magnetic fields applied through the skull have shown promise in the treatment of depression and Parkinson’s disease, and suggest a reason to be cautious that the magnetic fields from cell phones and MRI scans may have unexpected physiologic effects. (Family Practice News, September 15, 2005 p 31)
SLEEP APNEA & THE HEART
Men with untreated severe sleep apnea are more than three times more likely to suffer heart problems than men without the disorder, a risk greater than that deriving from smoking or high blood pressure.
For men with severe sleep apnea treated with continuous positive airway pressure, the risk was reduced to almost normal. (The Lancet 2005; 365:1046-1053).
CONTRACEPTIVE PILL LOWERS LIBIDO
The contraceptive pill reduces the production of testosterone in theovaries and also raises the levels of sex hormone binding globulin (SHBG) which further counters testosterone.
Disturbingly, a study of 125 women who attended a sexual dysfunction clinic has found that although levels of SHBG declined after women stopped taking the pill, one year later they remained three or four times as high as in women who had never taken the pill, raising the question of whether they will ever recover completely. (New Scientist, May 27, 2005).
HIGH BLOOD LEVELS OF FLAME RETARDANTS
There has been a dramatic rise in blood levels of PBDEs (flame retardants found in many fabrics as well as electronic equipment and Styrofoam) in the US population across all ages.
Women had higher PBDE levels than men and increasing levels have been found in breast milk.
PBDEs have a wide range of toxic effects in animal studies. (Journal of Occupational and Environmental Medicine, March 2005, 47:3).
TIGERS ON THE VERGE OF EXTINCTION
Tigers are on the "verge of extinction" because of rampant poaching according to the head of a new Indian taskforce trying to save these magnificent animals.
A century ago, there were an estimated 40,000 tigers in India, but current estimates suggest that only about 3,700 survive while some experts say the number may be barely 2,000. It is the same story in other tiger habitats in Laos and Myanmar.
Trade in dead tigers is illegal but is virtually impossible to police since a single tiger can fetch up to $50,000 on the international market, mainly for the Chinese medicine market. Bones are worth about $400 a kilogram, a penis almost $850, a tooth $120 and a claw $10. (Yahoo News).
"What Were They Thinking?" Department
RIGHT THIS WAY, YOUR TABLE'S WAITING...
It’s not news that Cleveland and many areas of the United States are in the midst of a residential and commercial housing crisis. But, there is one market where construction is still booming. Structures are going up everywhere to house the increasing numbers of citizens who have lost the ability to care for themselves. The ubiquitous phenomenon of “assisted living” centers and “nursing” homes seems to be a modern phenomenon, fueled by fear and greed.
In addition, a substantial contribution to this trend comes from conferring legitimacy and cashflow on these enterprises by the medical system.
Just “GoogleTM” your city and “nursing home” and you might be surprised at how many of these there are. Three are presently under construction within 5 miles of my office.
At a time when there is not enough money to pay nurses and doctors to treat Medicare patients, it is remarkable that there is enough profit in warehousing our elderly to support this wave of construction. Of course, skilled nurses are in very short supply, so most of the maintenance of these unfortunates is left to minimum-wage and low-skilled personnel. Turnover is very high. Often temporary workers are brought in to cover for staff shortages, which further contributes to discontinuity of care and potential for error.
Glossy brochures and promises of “independent living” disguise institutional conditions and third world levels of medical care. Considerable fees up front and ongoing monthly charges exhaust a lifetime of savings and home equity, but just ask for the nurse to patient ratio and you will be answered with silence or outright denial: “We don’t have to tell you that” was heard by an acquaintance of mine when they questioned expensive programs in Cleveland and Fort Myers.
Even acute care hospitals don’t have enough nurses to provide adequate care.
In addition, Medicare rules restrict the frequency of routine doctor visits for patients. This lack of oversight can lead to neglect of conditions which are barely addressed even in the non institutionalized elderly.
People who are robust when they make these initial contracts are also often in denial that they will ever become frail and friendless enough to become a victim of neglect, often signing contracts filled with vague promises as well as “weasel” clauses which make it difficult to hold these businesses accountable. Hiding behind the façade of religious orders is another favored tactic.
Crime and sexual assault by both staff and other residents is a problem that is never openly discussed. I have observed this firsthand in expensive private institutions as well as Medicaid funded programs.
Early in my career, while serving as medical director of a 180 bed inner city nursing home after it was placed under federal court supervision for a pattern of abuses, a resident even stole the revolver of the incompetent “security” guard!
Shakedowns and physical and sexual abuse of residents were shamefully neglected, and two of the worst perpetrators were even given charge of patient funds by the administration until I put an end to that practice.
Sadly, the pattern of neglect and abuse of these vulnerable patients was not prevented by court oversight or the efforts of any of the lawyers involved in the situation, and I learned a great deal about the limitations of the legal system and so-called “watchdog” groups to protect institutionalized patients.
I also found that none of the staff physicians were adequate advocates for the safety and wellbeing of their wards. The grandiose rhetoric championing care for the neglected espoused by the academics of my medical school proved to be empty posturing when I requested help for these desperate individuals.
Antipsychotic drugs are prescribed frequently to sedate confused or combative patients in institutions, as it is easier to control and warehouse those who are sedated. A variety of other sedating drugs are mixed into this brew to treat everything from pain to motor disease to insomnia.
There is very little proof of safety or efficacy for these drugs, especially when combined ad hoc in the elderly metabolism. Interactions with the other drugs prescribed for chronic conditions have never been subject to study. It may be that increased prescribing of psychotropic medications by physicians contributes to the confusion, irritability, and inablity to function that leads to eventual institutionalization.
A repressed population is more likely to accept the monoculture of politically correct activities and the autocratic behavior control favored in these programs. And, sedation permits fewer staff, another big plus for the fat cats.
The dangers of these drugs are generally underestimated. A report in the May 26th, 2008 Archives of Internal Medicine compared two groups of patients with the diagnosis of “dementia”: 20,682 patients who lived at home and 20,559 who lived in nursing homes. Those who took antipsychotics were two to four times more likely to be hospitalized or die within 30 days of starting “treatment”.
Americans are generally overmedicated anyway, and there is little incentive for physicians to remove prescriptions which have accumulated over decades.
I was the only physician to routinely attempt to discontinue medications or rationalize the long list of inherited prescriptions burdening my floors of patients at the nursing home where I was medical director, and I did not observe any complications as a result.
In fact, some patients distinctly improved. But, I was there observing the patients and staff almost every day, and frequently at night, a luxury that few physicians enjoy in the United States.