Friday, July 31, 2009

President's former physician pulls for single-payer

One ACP Member with potentially unique influence is pulling for single-payer health care reform--President Obama's former private physician. Chicago-based David L. Scheiner, MD, cared for the not-yet-president for 22 years. CNN profiled him here.
Wednesday, July 29, 2009

Is it wrong to sell your body?

Corruption in New Jersey is depressingly unsurprising, so the most interesting news to come out of last week's mass arrests was about the group of rabbis who had been selling organs. They were allegedly raking in the bucks buying organs low ($10,000) from poor donors and selling them high ($150,000) to the wealthy. Obviously, that kind of profiteering seems wrong, but what about the actual transaction?

An article in Slate explains why the rabbis would be OK with selling organs: their priority is the preservation of life above all else. If you have to pay people to get the organ donated, you do it.

And a column in U.S. News and World Report makes another good point. If we let women be paid for providing their eggs, what's so different about a kidney?

This is one scandal that will keep bioethicists busy for a while.
Tuesday, July 28, 2009

Blue M&Ms treat spinal cord injuries

Photo by the University of RochesterScientists at the University of Rochester suspect the blue dye used in M&Ms and Gatorade may interrupt the cell death that follows spinal cord injury.

Adenosine triphosphate floods the spinal cord after an injury, and spinal cord neurons carry a receptor that lets ATP latch on and die from metabolic stress, worsening paralysis. An agonist to this reaction is Brilliant Blue G, akin to FD&C blue dye No. 1.

So the researchers injected it in mice following spinal cord injury, which were able to limp again compared to controls, who never regained mobility, they reported. The mice did have to deal with a temporary blue tinge.

Because you can't inject a human who's just had a spinal injury, scientists are searching for a way to administer the dye into the body. I'd suggest orally, via a blue, sugary pill-like capsule that's available over the counter.

Scary statistic of the week

The CDC is predicting that, without vaccination, up to 40% of Americans could catch swine flu and hundreds of thousands could die this winter, the Washington Post recently reported. Aah! What are they trying to do? Make us panic?

I don't think the CDC would do that, but then when I read this other article--about the government's plans for the biggest vaccine promotion campaign ever--I started to wonder. "Everything is going to be done to try to encourage people to get it," an official told AFP. Everything...including the distribution of apocalyptic statistics?
Monday, July 27, 2009

Medical news of the obvious

Is it obvious that in this slow research season, we're going to pick on another study about children? If so, sorry--you can feel free to blog about the obviousness of our obvious post and get all meta about it.

Physician's First Watch alerted us to this study in the Archives of Disease in Childhood which found that running around does eventually wear children out. "Overall, the more activity children got, the faster they fell asleep." The real news here is the depressingly small size of the effect: for each hour spent in sedentary activity during the day, it took 3 minutes longer for Junior to fall asleep at night. In other words, you can chase your little monsters all day long just to bump bedtime up by half an hour. And we're no scientists, but we'd bet that after that much activity, Mom and Dad won't be able to stay awake and enjoy the extra quiet time anyway.
Friday, July 24, 2009

1 in 6 public health workers would stay home during a pandemic

One in six public health workers would stay home during a pandemic flu outbreak regardless of its severity, according to a survey by the Johns Hopkins Bloomberg School of Public Health. The key to getting workers to show up was that they believed their role would have a positive outcome on the crisis.

Overall, 16% of 1,835 public health workers in Minnesota, Ohio and West Virginia said they would not report regardless of the severity of the outbreak, with the key factor being how important an employee felt his or her job is.

We Love Crisis by Daquella Manera via Flickr Public health workers who were concerned about a pandemic, confident that they could fulfill their response roles and that their roles would have a meaningful impact on the situation were 31 times more likely to come to work in an emergency. Workers whose perception of the threat was low but who strongly believed in the efficacy of their job were 18 times more likely to say they would come to work. Full results are online.

Researchers want to apply this information in ways to encourage more workers to show up. The first step is to better educate public health workers about their role in an emergency and then motivate them with an understanding of why this role makes a difference. Downplaying the potential threats won't work because "A sense of threat is an important component in the worker's motivation to prepare for the event and to respond to it."

By the way, current findings are better than the 2005 study, in which more than 40% of public health employees said they would stay home during a pandemic.

Survey shows clinical use for social media

About 60% of ACP Internist readers acknowledged using some form of social media, using it not only personally and professionally but clinically as well.

ACP Internist polled its readership online, through its Web site, weekly e-mail update and through the College's Facebook and Twitter accounts, which probably skewed results.

But results did show that internists are just like other social media users, with 90% using it to keep track of birthdays, anniversaries and marriages, or sharing pictures with friends and family. It's social media, after all.

But social media are increasingly being co-opted professionally, and nearly 70% of respondents use it to reconnect with distant friends or former colleagues, to promote health policy information, or to compare the legal and financial aspects of the practice of medicine. One respondent said social media "helps keep me in touch as a military physician stationed overseas--tough with the time change."

And almost one in four respondents used it clinically, keeping up to date on medical news, sharing cases through Sermo, or responding to questions as a health expert, such as using a blog for patient education. Respondents use social media to communicate lab results, or measure patient improvement or clinical response.

Physicians' cited privacy as their main concern, either releasing too much information online, or outright hacking of personal data, followed closely by the perceived lack of quality of clinical information online. Others worried about how social media might change the doctor-patient relationship.

"I do have patients that have asked to 'friend me,'" one respondent said. "I have always accepted these requests. I am more careful about my postings with that in mind." Another responded, "I would never use it with patients--there is a need to keep personal and professional lives as separate as possible."

And doctors are also aware of the pitfalls of trying to practice medicine online, with the potential for patients to oversimplify their symptoms online when a comprehensive, in-person exam would be warranted. "People may get too comfortable with using the Internet and neglect normal means of communication," one person said.

They're not going to ask for a shot

To the long list of things about which young American adults are woefully ignorant (history, geography), you can add the importance of vaccines, according to a new survey. Less than half of 18- to 26-year-olds know that tetanus causes lockjaw and should be prevented with a vaccination every 10 years, reports HealthDay. Compare that to 84% of people over 50 who claim that knowledge.

The impetus for change is on physicians, according to an official with the National Foundation for Infectious Diseases, which sponsored the survey. "The majority of adults [87 percent] are very likely to get vaccinated if their doctor or other clinician advises that they get vaccinated," she told HealthDay.

Either that, or kill off one of the characters on Grey's Anatomy with tetanus.
Wednesday, July 22, 2009

Primary Care "Provider"

I am ashamed to admit that I actually felt annoyed tonight over being referred to as a "primary care provider." It is hard to explain that after 21 years of education and another 23 years of practice as a specialist in Internal Medicine, I would be bothered by this.

One of my patients that I have cared for for 20 years was admitted to the hospital after going to the ER with abdominal pain. I was not informed of his admission and the hospitalist became the attending physician. The patient called me today from his hospital bed to inform me. He actually had a previously scheduled appointment with me in the office today and, good patient that he is, was calling to say he couldn't make it. He assumed I already knew he was admitted to the hospital. I asked him to have the attending doctor call me as soon as he/she made rounds.

Fedex Man by Ed Yourdon via FlickrI got the call from a young-sounding hospitalist who did not know my name and wondered if I was the "primary care provider." When I replied that I was his physician, she then said, "Oh, I don't usually call the primary care provider." That phrase just stopped me cold. It is so "insurance" sounding. So contrived and replaceable. Primary care provider ... delivery man ... vacuum cleaner salesman ... Roto-Rooter man. It's the doctor you can dismiss if you are a hospitalist, one or two years out of training.

"I don't usually call the primary care provider."

Guess I better get thicker skin.

Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Bye bye for BMI?

My dance major friend who was once classified as obese by a school nurse would appreciate this new article on Slate. After reviewing the the history of the body-mass index (did you know it was developed in 1832?), the author makes a case for giving it up as a measure of individual patients' health. A doctor's eyeballing is often a better judge of whether a person should lose weight than the BMI, the article argues.

It may be worthwhile to also have a more objective measure. (After all, we wouldn't want weight assessment to slide into the common standard I once heard an expert describe for alcohol abuse: "Anything more than mine.") So why not a tape measure around the waist? It's cheap, quick, and an evidence-based predictor of disease, notes the Slate article.

Will the tape measure be replacing the scale in an office near you? Probably not, but it's another reason to start doing those sit-ups. Better be ready to suck it in when the time comes.
Tuesday, July 21, 2009

Apologizing for errors halves malpractice suits

University of Michigan Health System reports that admitting medical errors and offering compensation before being sued resulted in malpractice claims falling from 121 in 2001 to 61 in 2006, with corresponding savings in costs per claim.

The Associated Press profiled the hospital system's efforts not only as a business decision but also an ethical one that benefits patients, while not exposing the system to further litigation.

Apologies aren't easy, but ACP's news publications have offered advice to make them easier:
--"Internist searches for answers when test results go missing," ACP Internist, April 2009.
--"Apologize like a pro," ACP Hospitalist, January 2008.
--"To err is human ... to not plan for it is trouble," ACP Hospitalist, December 2008.
--"Owning up to a mistake takes courage--and practice," ACP Internist, April 2009.

Also, Annals of Internal Medicine looked at the state-by-state efforts to implement shield laws for physicians who disclose errors.

Look that free drug in the mouth

Last winter, we (and the CDC) got riled up about pharmacies eliminating co-pays for antibiotics because it could encourage overuse of the drugs and antibiotic resistance. A new Wall St. Journal article points out that drug manufacturers are doing the same thing with medications for some chronic illnesses. And sure enough, pharma's co-pay rebates are also likely to have negative consequences for society.

Specifically, the elimination of the co-payment on a brand name drug (Lipitor was one cited by the article) pulls patients away from generic options and pushes up drug costs for the insurer. (The drug makers aren't offering the same kind of deals to third-party payers; for them, medication prices have only increased as co-pays went down.) Luring business away from generic competitors was explicitly the point of the rebates, explained one pharma exec quoted in the article.

Massachusetts is the only state that currently bans the practice, but it will probably become a hotter topic as health reform progresses. Under the current system, the complaints of insurance companies that have to pay a little more for drugs isn't going to elicit a lot of sympathy from consumers and legislators. But if a public plan option results in tax dollars paying for these brand-name medications, that'll be a different story.
Monday, July 20, 2009

Medical news of the obvious

Poor sleep after childbirth increases the risk of postpartum depression, Norwegian scientists reported in Sleep. They suggested having a spouse or other family member let new mothers catch up on their shut-eye. The gravid and their spouses don't need What to Expect When You're Expecting to tell us this.

Once children grow up, they become teens. And where there's teens, there texting. Teen Texting Tendonitis afflicted this girl who'd sent 8,000 messages a month and wound up in her doctor's office for an obvious diagnosis.
Thursday, July 16, 2009

Nurse shortage turns into a glut

For years we have heard there is a shortage of nurses and as recently as today, the California Senate Education Committee approved a bill (AB867) to "address a severe nursing shortage in California." The Health Resources and Services Administration (HRSA) projects that 90% more RNs must be produced in order to meet the predicted need for one million new nurses in the American health care system by 2020.

So if there is such a shortage ... why can't new nurse graduates find a position? I was pleased to pass on the name of a new RN school graduate who had great references from previous allied health care work and was told by the hospital:

"Virtually no one is doing a new grad training program at this time. We have made the commitment to "trickle in" some new grads this fall and received over 1,000 applications for five positions. I might suggest this individual get their foot in the door as a nurse's aide, phlebotomist or some other non-nursing job. Unfortunately, the economy has turned our profound nursing shortage into a glut, virtually overnight."

Upon investigation I find that there is actually an overabundance of nurses in Canada, the Philippines as well as across the United States. There may be openings for experienced critical care nurses, but medical-surgical nurses are pounding the pavement looking for work and finding few or no jobs available. There are hundreds of nurses vying for every opening. The jobs just aren't there.

The downturn in the economy means more older nurses are keeping their jobs and delaying retirement. Hospital census is down and staffing is lean. Is that enough to turn a shortage into a glut? Apparently it is, or the prior predictions just weren't true.

Experts are still saying there will be a shortage after the recession is over that will only get worse in coming years. But for now, it looks like nurses are not in demand and there are thousands of unemployed RNs looking for work.

Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Wednesday, July 15, 2009

This week in eye-catching acronyms...

Who knew ulcers could be glamorous? Apparently the authors of this study, published in the current issue of Lancet:

Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin.

Yep, for no discernible reason, they chose as their catchy study acronym-- FAMOUS.

Pay attention! Primary care faces a shortage

NBC devoted prime time news coverage to the shortage of primary care physicians, and interviewed residents on why they're not pursuing primary care. (Apologies for the short commercial NBC posts before its online outtakes.)

Near-daily coverage of the provider shortage crosses our desks at ACP Internist, shown here, here and here to post just a few from recent days. And to post a few more, here, here and here.

It may be cold comfort, but the issue doesn't lack for attention, just a solution.
Monday, July 13, 2009

A friendlier Surgeon General nominee?

Regina Benjamin, MD, has been tapped as the new Surgeon General nominee, and her family practice background might be more appealing to ACP members who'd objected to the higher-profile choice of surgeon and TV personality Sanjay Gupta, MD, last year.

Dr. Benjamin was touted for her rural Alabama background, nonprofit work and post-Hurricane Katrina efforts. She's garnered attention for her national milestones, too, as the first black woman and the youngest doctor elected to the American Medical Association's board. Glowing news accounts are here and here.

ACP member expressed their reason why they objected to Dr. Gupta's nomination here.

Medical news of the obvious

As is so often the case, the most obvious news of the week involves children. Once again we learn that the behavior of these mysterious little creatures has some connection to their parents. Specifically, if parents like team sports, kids are more likely to play them, according to a study published in Health Psychology and reported by HealthDay. So next time you're whining about driving the carpool to practice, remember it's your own fault for not modeling the couch potato lifestyle.

Also, the same study has bad news for anyone who thought gender bias had been eliminated from the home. Boys are more likely than girls to do strenuous chores like heavy yard work and moving furniture. The lesson, according to a study author: "It's a good idea for parents to adopt a positive attitude toward all types of vigorous physical activities for boys and girls and know that girls can and want to do them." Ha. We would like to see the evidence that any child, boy or girl, wants to do chores.

Bookmark Medical News of the Obvious, which appears every Monday at ACP Internist.
Thursday, July 9, 2009

Awesome acronym of the week.

It might not be as exciting as sleep-driving (or -eating or -dating) on Ambien, but a new Internet program shows promise for helping people get to sleep. According to the Washington Post, the program offers advice on insomnia and uses stories, quizzes and games to teach people better sleep habits. A trial found that patients who used the program got more sleep than controls. Some sleep therapists may be worried about the possibility of losing their jobs to computers, though. One quoted in the news story suggested that humans may do better at helping patients to "stay motivated and identify anxieties."

But the best part of this story is the name of the program--Sleep Healthy Using the Internet. Sure, it, like every other cleverly named study, sounds a little stilted but check out the acronym: SHUTi.
Wednesday, July 8, 2009

Good news for complainers.

We reported a few months ago about the brouhaha that erupted when a JAMA reader went public about his concerns with a study author's potential conflict of interest and attracted the journal's wrath in response. At the time, journal officials said that they would require anyone with a beef to keep their complaints confidential.

According to the Wall St. Journal, they've now changed their minds. Now, the editors suggest that the complaint investigation process would be "enhanced" by keeping your mouth shut. In case you were wondering, you can feel free to go to the media with your complaints about the ACP Internist blog. We'd appreciate the publicity.
Tuesday, July 7, 2009

Remember this.

The British may have more health care coverage than we do, but at least our old people have better memories. Or so finds a new a study in BMC Geriatrics. Older people in both countries were asked to remember a list of words, and the American test subjects did significantly better than their English counterparts. So much better that, on average, 75-year-old U.S. residents had memories as good as 65-year-olds who lived in England, reported HealthDay. The researchers attributed the difference to disparities in education, net worth, depression and cardiovascular treatment.

Or maybe it's because we have a Starbucks on every corner. Another study, published by the Journal of Alzheimer's Disease, found that a lot of caffeine (the equivalent of 5 cups of coffee daily) reversed Alzheimer's mice. The next step is research in humans, scientists told HealthDay.

So go ahead, take a coffee break to celebrate our national superiority. Hey, if you have enough, maybe you'll even remember what you were supposed to be doing when you get back to your desk.
Monday, July 6, 2009

Medical news of the obvious

As the trend of disappointingly reasonable research continues in the journals of late, we have one lone outlier:

  • Kids who played a computer game that promoted healthy foods were more likely to pick healthy snacks than those who played a game promoting unhealthy foods, a study in the Archives of Pediatrics & Adolescent Medicine found. In other words, kids are indeed influenced by the outside world.
Wednesday, July 1, 2009

CRP? Fuggedaboutit.

Big news from JAMA today: High C-reactive protein (CRP) levels don't appear to cause heart disease. Cardiologists have debated for years about whether patients should have their CRP levels routinely screened as a risk factor for CV disease, and whether CRP should be targeted therapeutically. The authors of the JAMA genetics study say nope:

"In summary, our mendelian randomization study of more than 28,000 cases and 100,000 controls found no association of variants in the CRP locus and CHD, arguing against a causal role for CRP in atherosclerosis. Moreover, this study suggests that development of therapeutic strategies targeting specific reductions in plasma levels of CRP are unlikely to be fruitful," the researchers write in their article.

I'm sure this study won't be the final word on the subject, but it's a strong argument toward trending back to the basics: Using BP levels, obesity, smoking, cholesterol and family history as risk factors for CHD. Plus ca change...