News News News
UNIVERSITY OF NEW MEXICO MEDICAL RESIDENTS FIRST TO SIGN UNION CONTRACT
550 residents, interns and fellows working at the University of New Mexico hospital have joined an affiliate union of the Services Employees International Union as of August 2007.
One of the more interesting negotiated “benefits” of this contract is the provision for taxi reimbursements for residents who are too tired to drive home after their 24 hour shifts. (American Medical News September 10, 2007 p. 18) For obvious reasons, no question is raised as to whether these doctors should be practicing medicine when they are not safe to operate a car.
Even though pilots, truckers, air traffic controllers and many others are restricted by safety rules regarding how many hours they can function at top capacity, it has long been mythology in medicine that the judgment and motor skills of doctors in training do not deteriorate after six to eight hours of intense, physically and emotionally demanding work.
Maintaining this myth and the self-serving falsehood that these graduate physicians are “students” and thus not subject to the minimum wage, overtime, or safety regulations which protect all other workers in the United States (except nurses, of course) has been very, very lucrative.
This lie allows a resident who is paid only $35-45,000 to generate millions of dollars worth of tests and procedures each year, a very good return for this “investment” for the fat cats who run training programs.
What is even sweeter for the pinstriped crowd is the knowledge that the average educational debt of graduates of the class of 2006 is $130,571. Nice profits for the bankers there, too.
PHARMACEUTICAL DANGERS INCREASING
Reports of serious harmful side effects in the U.S. from drugs are 2.6 times more frequent in 2005 than in 1998, while deaths increased by 2.7 times.
The number of prescriptions during this period increased, but the rate of adverse reactions increased four times as fast. (Annals of Internal Medicine Vol. 167 p. 1752).
A similar trend is also evident in the United Kingdom (New Scientist, September 15, 2007, page 4)
HOMOCYSTEINE REDUCTION WITH VITAMINS DOES NOT CONFER BENEFIT
Data from several studies have confirmed that elevated homocysteine is associated with increased cardiovascular risk.
During the 1990’s efforts were made to decrease the level of this substance in the blood with folate and other B vitamins in the expectation that cardiovascular risk would be reduced.
Four large studies have evaluated this hypothesis, and so far there is no evidence that vitamin supplements have reduced risk to any degree, even though homocysteine levels are indeed lowered by the therapy.
The most recent study in patients with kidney disease who are also at risk for increased cardiovascular mortality and morbidity confirms that lowering homocysteine levels also does not confer any benefit for these patients.
The findings may suggest that one or more other factors are causing both increased risk and increased homocysteine, but they are not reduced by vitamin treatment. (JAMA September 12, 2007 p. 1212)
ROGLITAZONE, PIOGLITAZONE, AND CARDIOVASCULAR EVENTS
Two widely used drugs for diabetes have been found to increase the risk of cardiovascular events, which are already more common in diabetics.
Analysis of several smaller studies to determine an overall trend, or unmask rare complications, called meta-analysis, were published in the September 12, 2007 JAMA: pioglitazone was found to increase the risk of heart failure, but overall decreased the risk of death, myocardial infarction, and stroke.
Roglitazone was found to increase the risk of heart failure and myocardial infarction, but the overall risk of death was not increased.
MEDITERRANEAN DIET & LONGER LIFE
Adherence to the Mediterranean diet, characterized by a high intake of vegetables, legumes, fruits, and cereals; a moderate to high intake of fish; a low intake of saturated fats, but high intake of unsaturated fats, particularly olive oil; a low intake of dairy products and meat; and a modest intake of alcohol, mostly as wine, is associated with longer life expectancy.
In a study of over 74,000 healthy men and women, aged 60 or older, living in nine European countries, information on diet, lifestyle, medical history, smoking, physical activity levels, and other factors was recorded, and the degree to which the participants adhered to a Mediterranean diet was measured using a recognized scoring scale.
A two point increase in the score corresponded to an 8% reduction in mortality, while a three or four point increase was associated with a reduction of total mortality by 11% or 14% respectively. (BMJ, doi:10.1136/bmj.38415.644155.8F).
OLIVE OIL & BREAST CANCER
It has been demonstrated that the Mediterranean diet appears to protect women against breast cancer. Now a study suggests that olive oil may be the main protective ingredient in the diet.
Oleic acid, the major fatty acid in olive oil, was found to be highly effective in killing the Her2/neu protein, a major factor in the growth of breast cancer tumors, as effective in fact as the anticancer drug Herceptin and, when combined with this drug, resulted in a reduction of 70% in Her2/neu levels (in test tube experiments). (New Scientist, January 15, 2005, p.7)
FRUIT, VEGETABLES & BREAST DISEASE
A Chinese study has found that eating a diet rich in fruit and vegetables significantly reduces the risk of developing benign fibrocystic breast conditions.
Women with the highest fruit intake (more than 435 times a year) had a 60% lower incidence of nonproliferative lesions, an 80% lower incidence of proliferative lesions, and a 90% lower incidence of atypical proliferative lesions compared to those with the lowest fruit intake (less than 202 times a year).
For high versus low vegetable intake, the reduced risk was 40%, 60%, and 90% respectively. (Am J Epidemiol. 2004 Nov 15;160(10):945-60).
CRANBERRIES HELP BLOOD VESSELS
In a study in pigs, cranberry juice helped relax blood vessels clogged with high blood cholesterol and narrowed by atherosclerosis, according to researchers at the University Of Wisconsin School Of Veterinary Medicine.
The pigs used in the study had a genetic defect - familial hypercholesterolemia (FH) - that causes them to develop high blood cholesterol, which in turn causes atherosclerosis and vascular dysfunction.
The blood vessels of these pigs fed cranberry juice powder, made from whole cranberries, for six months, started to function like those of normal pigs. (35th Congress of the International Union of Physiological Sciences, San Diego, March 2005).
ESTROGEN THERAPY INCREASES GALL BLADDER DISEASE
A large randomized trial of the effects of estrogen therapy in relation to gallbladder disease in postmenopausal women involved 22,579 women at 40 clinical centers.
Women with hysterectomy received estrogen or placebo and those without hysterectomy received estrogen plus progestin or placebo.
After five to seven years of follow-up, there was an 80% increase of risk of gall stones in the estrogen group and 54% in the combination group, and an 86% and 68% respectively increased risk of cholecystitis.
Risk of undergoing cholecystectomy was increased by 93% for the women on estrogen and 67% for women on the combined therapy. (JAMA. 2005; 293:330-339).
HONEY AND AGING
Visitors to this website are certainly aware of our recommendations that honey can treat many disorders. Although animal studies are never easily comparable to humans, a study at the University of Waikato in Hamilton, New Zealand compared rat anxiety and spatial memory who were raised with diets of 10 per cent honey, 8 per cent glucose, and no sugar at all.
Honey fed rats seemed to be more capable in dealing with novel situations presented by the researchers. “Diets sweetened with honey may be beneficial in decreasing anxiety and improving memory during aging", reported the researchers at the Association for the Study of Animal Behavior meeting held at Newcastle University, UK in September, 2007.
DIET, AGEING & DISABILITY
A diet which is rich in fruits, vegetables and dairy products helps maintain normal function in people in their 50s, 60s and 70s.
The greater the consumption of fruits and vegetables, the lower the risk of physical limitation (ability to walk a quarter of a mile, walk up 10 steps without resting, cook and manage money).
The findings were particularly marked for African American women. (Am J Clin Nutr 2005 81: 515-522).
KEEP MOVING, DESPITE THE ARTHRITIS
In a study of over 6,000 people over the age of 65 with arthritis, it was found that taking regular exercise halved the rate of decline in the ability to perform basic activities of daily living (ADL).
ADL includes walking across a room, dressing, bathing, eating and using the toilet, cooking, shopping, making telephone calls, taking medications and managing money. (Arthritis & Rheumatism,Volume 52, Issue 4, Pages 1274-1282).
SPIRITUAL HEALING FAILS IN ASTHMA TEST
A Scottish study into spiritual healing, partially funded by the Chief Scientist’s Office, set out to evaluate the effect of spiritual healing on asthma.
88 patients were assigned to receive healing from a spiritual healer, or from an actor, or received no treatment and acted as controls.
The primary outcome measures were improvement in the volume of air that can be forced out in one second after taking a deep breath (FEV1), the maximum flow of air that can be breathed out at force after taking a breath (PEF) and the Asthma Quality of Life Questionnaire (AQLQ).
Secondary outcome measures included general health, anxiety, depression and a problem-specific scale where patients generated outcomes they thought were most important.
The study found “no evidence for clinically valuable impacts from spiritual healing for asthma”. (Chief Scientist's Office, Scottish Executive funded-project).
ESSENTIAL OILS TREAT SUPERBUGS
Three essential oils have been found to destroy the MRSA ‘superbug’ and E.coli bacteria within two minutes, two of them acting almost immediately.
The researchers believe the oils could be blended into hygiene products such as soaps, shampoos and hand-washes to help eradicate the superbugs from hospitals. The UK’s Department of Health has indicated that it plans to fund further research into the possible benefits of essential oils.
Although the oils used in the test were not revealed because of ‘commercial sensitivities’, tea tree oil is likely to be one of them. Other possibilities include eucalyptus, geranium and lavender oils. Around 1000 patients a year die from MRSA infection.
PELVIC FLOOR EXERCISES FOR WOMEN
An item in the April 2002 News reported a study where women trained in pelvic floor exercises after childbirth reported significantly less urinary incontinence after one year than those in a control group who did not perform the exercises.
Now a long-term follow up has found that at six years, the benefits seen at one year are no longer apparent: incontinence increased in both the exercise and non-exercise groups, and only about half of the women were still performing pelvic floor exercises - irrespective of original group assignment.(BMJ 2005;330, 12 February).
PELVIC FLOOR EXERCISES FOR MEN
According to a study from the University of West of England, Bristol, pelvic floor exercises can bring about a significant improvement in male erectile dysfunction.
55 men with erectile dysfunction were randomly assigned to one of two groups. The 28 men in the first (intervention) group were taught pelvic floor exercises, with manometric biofeedback, and were advised on lifestyle changes, while the 27 men in the second (control) group only received lifestyle advice.
After 3 months, the men in the control group were taught the exercises in the same way as the first intervention group. During the first part of the trial, men in the intervention group improved significantly in measures of erectile function, with no change in the control group.
After the second part of the study, the 27 men in the previous control group also showed significant improvements.
In all, 40% of the men attained normal erectile function, 34.5% were improved, and 25.5% failed to improve. Post urinary dribbling was reported by 65.5% of subjects at the outset of the trial, yet by the end of the trial period 75% of subjects reported no dribbling.
Younger men were found to be more likely than older men to regain normal erectile function, whilst men on anti-hypertensive medication were less likely to regain normal function. (http://hsc.uwe.ac.uk/hsc/index.asp?pageid=473).
"What Were They Thinking?" Department
WISHING AWAY PROBLEMS AT THE CENTERS FOR MEDICARE AND MEDICAID
If only we ordinary folk could make our problems disappear with magical thinking. Just close our eyes and the bad stuff goes away.
In that wonderland known as Washington, D.C., where so many other unbelievable things can happen every day, the magnificent news is that our hard working bureaucrats at The Centers for Medicare and Medicaid have discovered a new way to reduce medical costs.
Wisely determining that some medical problems should never occur because they are “preventable”, final rules issued last month decree that Medicare and Medicaid will not pay any costs for any of the following diagnoses: air embolisms, transfusions of incompatible blood, patient falls in the hospital, objects which are left behind during surgery, pressure ulcers which develop during hospitalization, infection in the chest cavity after heart surgery, and infections from catheters inserted in bladders or blood vessels.
Scheduled to be added to the “no-pay” list next year are ventilator associated pneumonia, deep vein thrombosis, and infections with Clostridia difficile or methicillin resistant Staphylococcus aureus, as well as sepsis due to the latter.
No doubt that we can all agree that these events are undesirable, and some percentage of these incidents can certainly be due to ineptitude or carelessness, but it is impossible in anyplace but the minds of our government “servants” to propose that by not paying for the costs of treating such problems that they will disappear.
Patients unfortunate enough to develop infections, injure themselves if they fall in the hospital, or suffer any of The Centers’ list of forbidden complications will, of course, need treatment and it will still cost money to do this, despite any declarations that such events must never happen.
Doctors and nurses will need to use real, expensive drugs and equipment, and need to be paid themselves in real money for their time and effort to solve problems, whether they are “preventable” or not.
Infections rates for any type of catheter can never be reduced to zero, nor can it be possible to completely eliminate hospital acquired resistant infections.
Many resistant tuberculosis strains have also resulted from patients not taking their drugs as instructed: As physicians and pharmacists can hardly be expected to live with patients and make sure they are taking their drugs, the development of antibiotic resistance is at least partly a problem of our wider culture of irresponsibility.
But, holding the medical profession responsible for factors beyond their control without any rationale is a popular sport in modern day politics even when the rules are set by the politicians themselves.
Human errors due to understaffing, fatigue and “mandatory overtime”, as well as inadequate training and supervision, along with errors introduced by technology ensure that some bad outcomes will always be with us.
Exactly how do the geniuses in Washington expect all falls to be prevented? Will they next year determine that even your fall at home or a motor vehicle accident was “preventable” and so deny all medical care if you are unlucky enough to be covered by this rapidly deteriorating federal entitlement system?
As always, style trumps substance at The Centers for Medicare and Medicaid, exactly in synch with the wishful fantasies spun by politicians all throughout the Washington Wonderland: Short on specifics and long on warm and fuzzy soundbites. (American Medical News September 17, 2007 page 9)