News News News
In addition to the increased risk of musculoskeletal pain and atrial fibrillation for patients taking drugs such as Boniva, Fosamax, Didronel, Actonel, and Reclast, new risks are emerging as time passes. The half life of these drugs is estimated to be 10 years or more, so long term experience is uncovering new hazards.
The latest include “low energy” femoral fractures, where very little trauma results in a fracture of the thigh bone, death of bone in the jaw, and increased development of esophageal cancer. (JAMA February 18, 2009 p. 709).
LESSONS FROM THE 19TH CENTURY STILL IGNORED
Inadequate infection control practices in endoscopy clinics, long term care facilities, outpatient settings and hemodialysis centers have caused more than 400 cases of hepatitis B and C since 1998. The U.S. Centers for Disease Control and Prevention in Atlanta estimate more than 60,000 patients were at risk during these outbreaks.
The true number of those infected was probably underestimated according to the investigators, who stated that simple precautions could have prevented all of the infections. (Medical Economics Feb 6, 2009 p 37).
ACUPUNCTURE FOR POST TRAUMATIC STRESS DISORDER
A randomized controlled trial in 55 veterans suggests that brief treatment with acupuncture significantly improves the symptoms of PTSD when compared with usual care. Acupuncture was used in eight 90 minute sessions twice a week.
The acupuncture session were standardized for the first four sessions and individualized for the second four sessions, and were provided by acupuncturists with a master’s degree. In addition to a decrease in PTSD symptoms, symptoms of depression and pain were also significantly improved in the acupuncture group. (Family Practice News, February 15, 2009 p. 17).
VIAGRA/CIALIS AND EYE DISORDERS
Evidence has linked the use of anti erectile dysfunction medications (Viagra and Cialis) with vision problems. In a study of 78 men presenting to an ophthalmology clinic it was found that those who were taking either drug and who also had a history of heart attack were eleven times more likely to develop nonarteritic anterior ischemic optic neuropathy, whilst for users of the medications who also had hypertension, the risk was sevenfold. (Pomeranz H D. Can erectile dysfunction drug use lead to ischemic optic neuropathy? Br J Ophthalmol 2006; 90: 127-128).
EMERGENCY CARE SYSTEM FAILING
“Access to [emergency care] is as close as you can get to a complete failure, and that’s where we’re at”, states Nick Jouriles M.D., president of the American College of Emergency Physicians and professor of emergency medicine at Northeastern Ohio Universities College of Medicine.
The ACEP issued a “National Report Card on the State of Emergency Medicine” in December 2008, and graded access to emergency care in the country a D-minus. Marshall Morgan, M.D., chief of emergency medicine at the University of California at Los Angeles Medical Center points to overcrowding, an inability to find on-call specialists, and “boarding” patients in the emergency room as major problems.
“Boarding” is a euphemism for leaving patients in rooms or on gurneys for many hours or even days in the halls of emergency departments when there are no rooms available or not enough nursing staff.
Smaller hospitals who try to transfer patients to better equipped centers cannot, because, as Dr. Morgan says, “We are almost always closed to transfers because we are stuffed to the gills and there is no place in our hospital for them. And that’s true for a lot of big medical centers” (American Medical News January 26, 2009 p. 10).
WINE VERSUS BEER
Several clinical studies appear to have demonstrated the greater health benefits of drinking wine compared to drinking beer, resulting in lower mortality among wine drinkers. Now a new study has suggested that these benefits may be associated with the fact that wine drinkers tend to have better diets than beer drinkers.
Analysis of supermarket shopping habits in two large Danish supermarket chains revealed that wine drinkers tend to buy more olives, fruit and vegetables, poultry and low fat foods, whilst beer drinkers tended towards ready-cooked meals, sugar, fatty meat, chops and soft drinks. (British Medical Journal).
PRINCE CHARLES LECTURES THE DOCTORS
Prince Charles (heir to the throne of the United Kingdom) in a speech to the World Health OrganiZation has urged doctors to start using complementary medical techniques such as chiropractic, acupuncture and herbal medicines to treat serious illnesses like diabetes and heart disease. He also tried to persuade them to put less reliance on conventional drug-based treatments and take a more holistic view by putting greater emphasis on preventive healthcare, diet, healthy lifestyles, and a reduction in environmental pollution and the use of harmful chemicals in homes and farming.
In a previous speech to the Royal Society of Medicine, Charles said "The human body has too often been mechanistically reduced to individual parts and treated with limited reference to the whole person … We need to harness the best of modern science and technology, but not at the expense of losing the best of what complementary approaches have to offer. That is integrated health - it really is that simple."
VOWS TO REMAIN VIRGINAL UNFULFILLED
The Johns Hopkins Bloomberg School of Public Health has released a study indicating that adolescents who pledge virginity are just as likely to be sexually active as not-pledgers, and are less likely to use birth control or condoms.
At five years of follow up, 81.9 percent of pledges deny ever having taken the pledge. There was no difference in the age of first sexual encounter, prevalence of sexual intercourse, or number of sexual partners. (Pediatrics, January 2009 p.110-120).
HOW BENEFICIAL IS THE FLU VACCINE?
For all the marketing hype that surrounds the flu vaccine, studies have not found much impact. Vaccination increased 3 fold between 1980 and 2001, but this increase cannot be linked to any decline in mortality. An August 2, 2008 study in the Lancet compared 1173 elderly people with community acquired pneumonia and 2346 controls and found no evidence that vaccination reduced this illness.
A study in the January 15, 2009 Journal of Infectious Diseases reports the vaccine’s benefit in preventing an infection that requires medical attention ranged from 5% in the 2004-2005 flu season to 37% in 2006-2007. (American Medical News January 26, 2009 p. 1).
ANOTHER BISPHENOL A DANGER
Sterilizing or adding boiling water to polycarbonate plastic bottles releases up to 55 times more bisphenol A (BPA) than filling them with room temperature water. Scott Belcher and colleagues at the University of Cincinnati in Ohio found that the increased release of bisphenol A into the water when boiling water was used, continued after the water had cooled and even after the bottles have been rinsed out.
Bisphenol A has been associated with a variety of endocrine disruptions, and baby bottles and beverage bottles made of polycarbonate are increasingly suspect. High density polyethylene is preferred. (New Scientist February 2, 2008 p. 15).
OPINION: ANNIE OAKLEY ON MARKSMANSHIP TRAINING
“I have often and persistently maintained that women should be prepared; not necessarily for war, although it would not be undesirable to have them ready for extreme emergencies in war times, but to defend themselves… And if women and young girls would take up the practice and gain the skill, which requires but little effort, they would add to their happiness by falling in love with one of the finest of outdoor sports." (Arms And The Man, October, 1919)
BREAST IS BEST
Current advice from the American Academy of Pediatrics is that mothers should breastfeed their babies exclusively (with little or no formula supplementation) for at least six months after delivery. Now a study has confirmed the value of this advice. The parents of over 2000 children were asked about how long they had been breastfed, how long they had been exclusively breastfed, and how often their babies had respiratory symptoms (including pneumonia, ear infections, colds, flu and wheezing).
When the study authors compared the difference between four and six months exclusive breastfeeding, they found a reduced risk of developing pneumonia and otitis media in the babies who were breastfed longer, with no significant differences for colds, flu and wheezing. (Chantry CJ et al. Full Breastfeeding Duration and Associated Decrease in Respiratory Tract Infection in US Children. Pediatrics 2006; 117: 425-432).
FRUITS & VEGETABLES MAY PREVENT CHILDHOOD ASTHMA
A retrospective Norwegian study that investigated the eating habits of 502 children (aged 6-16) in the first year of life found a correlation between daily intake of fresh fruits and vegetables and a 43% reduction in the risk of developing asthma. No similar association was found for breastfeeding or cod-liver oil supplementation.
Allergic sensitization was not apparently influenced by fruit and vegetable consumption but was positively associated with supplemental vitamins and cod-liver oil in the first 11 months.(Jia F et al. Effects of early intake of fruit or vegetables in relation to later asthma and allergic sensitization in school-age children. Acta Paediatrica 2005;94(2):147-54).
HIKING FOR DEPRESSION
Thirty minutes of brisk walking can elevate the mood of people suffering from depression, giving them a greater sense of vigor and psychological well-being for up to an hour afterwards. (Bartholomew JB et al. Effects of Acute Exercise on Mood and Well-Being in Patients with Major Depressive Disorder. Medicine & Science in Sports & Exercise. 37(12):2032-2037, December 2005).
CDC VALIDATES DIAGNOSIS OF CHRONIC FATIGUE SYNDROME
According to a new study by the Centers for Disease Control and Prevention, chronic fatigue syndrome (CFS) is caused by genetic mutations that impair the central nervous system, preventing it from rebounding from everyday stress and from less frequent, stronger pressures, eventually triggering a cascade of molecular responses that leave the patient severely debilitated.
CFS is thought to affect up to one million Americans, causing severe exhaustion, widespread musculoskeletal pain, impairments in thinking and sleep disturbances. (Vernon, S. Pharmacogenomics, April 2006; vol 7: pp 345-354).
CANNABIS-BASED MEDICINE DECREASES MS PAIN
A cannabis-based oromucosal spray has been found to be superior to placebo in relieving pain and sleep disturbance associated with multiple sclerosis. (Rog DJ et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005; 65: 812–19).
RESEARCH CONFIRMS BLOOD STASIS THEORY FOR DEMENTIA
The Chinese medical treatment of and research into dementia in the elderly has focused for some time on the importance of blood stasis as part of the clinical picture. This approach has now been backed up by a study which detected the presence of cerebral emboli (spontaneous blood clots or debris from arterial disease) in 32% of patients with Alzheimer’s disease and 37% of those with vascular dementia, compared to 15% and 14% of similarly aged controls. (Macfarlane G et al. Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study. BMJ 2006;332;1119-1124).
EMOTIONAL STATES & ALLERGIES
Allergies appear to be related to emotional and personality traits, according to a new study which found a 50% greater incidence of allergies among women with major depression, whilst among men allergies were linked to a nervous and anxious (neurotic) personality but not to depression. (Goodwin RD et al. Major Depression and Allergy: Does Neuroticism Explain the Relationship? Psychosom Med 2006 68: 94-98).
"What Were They Thinking?" Department
MULTIPLE CHOICE DOCTORS
The first page of the January 5th, 2009 American Medical News has a headline “Tech-savvy Medical Students Fear Life Without Electronic Medical Records”.
Apparently, our multiple choice educational system is creating a generation of physicians for whom “information technology is as essential a tool as the stethoscope – so much so, that they are uneasy when they are confronted with practicing in a paper based environment.”
Certainly it is easier to check off a box on a screen than it is to formulate a diagnostic workup, then propose and justify a diagnosis, and formulate a plan of treatment.
This type of analytical and problem solving skill is precisely what leads to excellence in medical practice, and its absence is most often the reason why sloppy thinking is so prevalent in our present system. Sloppy thinking leads to incorrect diagnosis and wrong treatment, which in turn leads to suffering, disability, and death.
When the real world answer in the clinic is “none of the above”, will our dumbed-down doctors have the sense to challenge their technologic masters, or will they continue on the path of witless servitude that they have demonstrated for the past half century to their political and economic masters?
Medical education is long and expensive. If filling in forms is the ultimate goal for practitioners, I believe we could save a lot of money and time and have a system that is just as bad as the present one.
Providing a computerized fill-in-the-blank record inhibits creative thinking and permits exclusion of data that does not fit the templates of the programmers. Standardized diagnoses are not reality, as any practitioner with even a little experience can confirm. Rather than a binary “yes” and “no” option, the analog requirements of medicine demand answers that are complex and interdependent on other factors, and are often shades of grey.
Often, important data has to be included in the chart that cannot be entered into these template based systems. Many times, a sketch or a simple diagram is helpful. How many EMRs allow attaching digital photos?
“I can understand how residents and new physicians feel how paper-based systems put them at a disadvantage.” opines Memory Baker, a managing consultant with Cumberland Consulting Group, a technology implementation and project management firm in Brentwood, Tennesse.
Could we see how “paper-based systems” would put a writer at a disadvantage? Is having an online recipe system going to make a chef a better cook, or lead to more nutritious meals than a chef who uses one of those outdated and primitive “cook-books”? Does having a GPS make for better drivers?
Medicine will not be better, doctors will not be smarter, errors will not be reduced, and suffering will not be corrected by spending 50 billion dollars on information technology: The cost for our medical care will not be less, it will be far more, and the security of the information will be much less, as can be seen with ongoing revelations of widespread compromises of patient privacy and financial information.
Thousands of employees of insurers, doctors, pharmacies, clinics, and hospitals as well as practitioners will have to access these records through different and incompatible systems. Does anyone who has any experiences with computers believe that a way can be found for all of these systems to share information? Or, that anyone can create and enforce the use of a single massive database?
No one seems to have considered that some patients may not want their personal information available on a medical internet.
Will data and records just disappear due to programming errors and hardware failures? Yes. Will errors be created during data entry? Of course. A 2008 upgrade to the Veteran’s Administration EMR system scrambled patient information and hid some physician orders from being displayed. Anyone who owns a computer knows how often software and hardware incompatibility errors occur.
The real reason for the push for EMR’s is it will make billing and denial of benefits much easier for the fat cats. It is easy for programmers to build in a tendency to “upgrade” diagnoses to make more money. If programming prompts a doctor to enter “pyelonephritis” instead of “bladder infection”, thousands more dollars in tests and treatments will be forthcoming.
EMR programs are designed to comply with the arcane diagnosis and procedure codes and the rules that surround them. In fact, one of the selling points of EMR’s for doctors and big clinics is that they will increase revenue by ensuring that the requirements for higher paying procedures are met.
But, the reality has been that EMR’s enable the denial of tests and treatments if findings are not bad enough to “justify” expensive workups. Always, these decisions are made after the fact, so that deniers have the advantage that the physicians who are seeing the patient don’t have: “Turns out the patient didn’t have what you suspected, doctor, so we are not paying you for the tests or time you took to prove it.”
This is already a fact with paper based systems: “unnecessary” care and tests are not paid for, even if the doctor is required by the standard of care to rule out a dangerous, but unlikely condition. The end result is that the physician takes all the risk, and the third party payer can cherry pick which workups will be paid for. Nice for the fat cats, but another factor that will reduce the numbers of primary care practitioners.
The result is easy to predict: overpaid third party executives and a bloated and inefficient medical system whose costs are already rising many times the rate of general inflation.
Data entry will also distract your doctor from interacting with the patient and will take time away from an already pressured visit. Remember, the doctor will have to wash their hands after using the computer, and again after touching the patient so that the computer keyboard does not become contaminated. Add two or three more handwashings to the average office visit and there will be even less time to practice medicine.
Remember also that very few physicians have photographic memories. Why is that important? Try reading a medical chart on a computer screen where you can only see one page at a time. Find something on screen 5 that makes you want to review what was on page 2? Labs are on page 53; consultant reports on page 74.
Doctors will either waste their time clicking back and forth in the record, missing important information and an opportunity to synthesize findings, or do what they have already been doing to review the chart: print it out so they can page back and forth among hundreds of pages of findings. No matter how many billions are spent on the witless goal of computerizing all medical records, the project is ill-conceived, and we will see no end to the evil and primitive “paper-based environment”.