Monday, August 31, 2009

Medical news of the obvious

Space InvadersAmong adult video game players, men have a higher average body mass index and women have more depression and lower health status, reported a study in the American Journal of Preventive Medicine. No surprises there, although the study confirms findings among players in their 30s, not just among children and teens.

Another thing that can distract you from getting exercise? Children! Declining health also reduces the quantity of exercise women get, according to this groundbreaking report. There is a weird, non-obvious silver lining: young women who suffer harassment at work tend to boost their activity levels. So, please, keep those crabby comments coming.
Friday, August 28, 2009

ACP Master speaks his mind on H1N1 vaccines for health care workers

William Schaffner, MACPFollowing studies on Canadian and Hong Kong health workers unsure about getting vaccinated for H1N1, William Schaffner, MACP, now questions whether American health workers will, as well.

"There isn't a doubt that it's a severe challenge," Dr. Schaffner told MSNBC. "It's primarily a patient safety issue."

He's not only a Master of the College but also chairman of the infectious diseases division at Vanderbilt University in Nashville, and is in a position to encourage others. Clinical trials for it appear safe, he said, and health care workers should protect themselves and their patients.

"It's a professional and ethical responsibility of every health care worker to be vaccinated," he said.

A totally different vision of health reform

Often the phrase "consumer-driven health care" is a cue to hold on to your pockets because there's an unexpected bill headed your way. But in the cover story of this month's issue of the Atlantic, David Goldhill makes an interesting argument about the benefits that a truly consumer-driven system could provide. Or, at least, he's pretty convincing on the idea that it couldn't be any worse than things are now. His plan's not going to be enacted anytime soon and has some flaws (boy, does he hate hospitals), but it's definitely an interesting read.
Wednesday, August 26, 2009

Pinpointing the transition from human to doctor

"When they embark on the journey to become physicians, most students are enthusiastic, filled with idealism and a genuine intention to serve those in need of help," says a new study in Academic Medicine. What happens to them, you wonder? The study authors did too, so they set out to analyze the loss of empathy in a group of medical students.

Turns out empathy takes a big hit during the third year of medical school, when the students start really interacting with patients. And no, it's not just because real patients are more obnoxious and difficult than hypotheticals. Researchers attribute the problem to a number of factors, including a lack of role models, too much to learn, lack of sleep, technology and a focus on the science of medicine. The article suggests several methods for teaching empathy to med students (including keeping them away from the really obnoxious patients) and calls on medical educators to take action.

"Most of us in medical education advocate empathy, but the effect of simply advocating empathy without embracing it and living with it, and without implementing targeted programs to enhance it, is analogous to singing a lovely song only in one's own mind without others ever enjoying it!"

More health workers unsure about H1N1 vaccination

In a follow-up to Tuesday's post that found Canadian health workers might refuse an H1N1 vaccine during a pandemic, another report finds about half of Hong Kong's health workers would refuse the swine flu vaccine. According to the BMJ, when the World Health Organization raised the H1N1 flu alert level to 5 in May, only 47.9% of 2,255 Hong Kong surveyed health workers were willing to get vaccinated, up from 28.4% surveyed a few months prior. An accompanying editorial in BMJ gently encourages vaccination while quelling fears of potential harms from vaccination.
Tuesday, August 25, 2009

Health workers, public may refuse H1N1 vaccines

Health care workers will balance the risks of H1N1 flu against the novelty of vaccines developed to combat it, according to research published in Emerging Health Threats Journal.

Canadian researchers conducted 11 focus groups (eight community groups and three for health care workers) in Vancouver asking participants how willing they would be to accept a new vaccine in case of a pandemic. They found that respondents were reluctant to get vaccinated against an illness they perceived as mild.

"Participants were very concerned that in a pandemic, a vaccine would be brought to market without sufficient testing for safety," researchers wrote. Many among all 11 focus groups believed that hand washing, social distancing or a good diet conferred protection. In the words of one health care worker: "A lot, well all of us probably practice basic body, blood, fluid precautions, right? ... So, we're equipped in that way to handle new diseases. We know how to protect ourselves. At least we think we do."

Similarly, health care workers are balancing the severity of the disease vs. any potential risk in a new vaccine. One health care worker told researchers: "Information would be key and I'd have to weigh the cost and the benefit of ... I'd have to know what would be the implications of getting the disease. And what would be the implications of getting the vaccine."

Meanwhile, a panel of U.S. presidential advisors finds looked at a plausible planning scenario--not a prediction--that H1N1 could infect 60 million to 120 million Americans (20%-40% of the population), killing 30,000 to 90,000 people. And the Washington Post looks at history for a lesson from the flu outbreak of 1957.
Monday, August 24, 2009

Concierge medicine keeps traditional practices afloat

An interesting twist is happening for concierge care, the controversial practice where doctors eschew insurance reimbursement and enter into private arrangements with patients who pay a lump sum to get longer appointments, more access and often around-the-clock availability.

The practice model works for the physicians who do it, and nationally, about 800 offices have gone to concierge care, according to this profile in the Philadelphia Inquirer. The practice hasn't always earned the respect of internists, though, who say the model drives the burden of community care to doctors in the traditional model. In this twist, however, revenue from concierge arm of the practice keeps the rest of the office in the black.

Medical News of the Obvious

Remember when your Scout leader told you to hug a tree if you got lost in the woods? Turns out they were right, according to a new study.

Researchers had subjects walk in the woods, then the Sahara, and finally through a field blindfolded. What happened? Not so surprisingly, without the sun or some other object to guide themselves by, the people got lost and wandered around in circles. Especially the poor blindfolded ones. "Not only did they walk in circles, some of the circles were as small as about 66 feet, similar in size to a basketball court," sniffs the HealthDay article about the study.

We're looking forward to the follow-up, in which Smokey the Bear finally provides the evidence that only you can prevent forest fires.
Friday, August 21, 2009

2 years and counting...HPV vaccine controversy continues

Some medical advances slide quietly into practice; others seem to be neverending sources of controversy. The HPV vaccine definitely falls into the latter category. When we first covered it, the big issues were whether vaccination should be mandated and whether insurers would pay enough for it. There was also public debate about the moral message of vaccinating pre-teens against a sexually-transmitted disease. Then came horror stories about mysterious side effects.

The latest issue of JAMA digs into all these issues. One article reports postlicensure safety data from the Vaccine Adverse Event Reporting System. Basically, they didn't find anything particularly out of line with other vaccines, except higher rates of fainting and blood clots (mostly in women who were also on the pill). A less reassuring article delves into the marketing strategy employed by Merck, particularly the involvement of professional medical associations. Not that pharma marketing usually is, but it's not pretty.

All together, the research causes the author of an accompanying editorial to come to a fairly negative conclusion on the value of the vaccine. "The net benefit of the HPV vaccine to a woman is uncertain. Even if persistently infected with HPV, a woman most likely will not develop cancer if she is regularly screened. So rationally she should be willing to accept only a small risk of harmful effects from the vaccine."

Only one thing is certain--this controversy doesn't seem likely to go away any time soon.
Thursday, August 20, 2009

Our image challenge

We've encounter some unusual medical swag before, but this one has us stumped. Clearly it's a pen and it's meant to go around your neck, but what purpose does the rectangular part serve? If you can solve our mystery, we'll send you this fabulous fashion/business accessory.
Wednesday, August 19, 2009

Worrisome statistics

Ever wonder what all those presidential pollsters do when it's not an election year? Based on today's health news, it looks like they spend their time asking Americans about their worries.

First, from CQ Politics, "Consumer Worry Grows on Health Care Access." The health care consumer confidence level (whatever that is) dropped more than 10 points among people 65 and older and 4 points in those 50-64 last month. The pollsters didn't bother to ask people whether they were worried that health care reform would pass or that it wouldn't, so it's a little hard to figure exactly what you could actually learn from these statistics.

On the other hand, people are not troubling themselves about swine flu, according to the Washington Post. "Only about one in eight Americans is very worried that swine flu will affect his or her family," the article reports. Six in eight are "not too worried" or "not at all worried," which we guess leaves that last guy sorta worried? The survey does teach us one thing. Despite the media's best efforts, it seems like the pandemic paranoia plan has been a failure.
Tuesday, August 18, 2009

A job opening for an internist

It's clear that many of our blog's readers and at least one contributor are concerned about the way Medicare is being run. So maybe it will come as good news that the top slot at the agency is available, as the New York Times reported today. Did you know that there hasn't been a Senate-confirmed administrator at CMS since 2006? Time to brush off the old resume and show them how it ought to be done.
Monday, August 17, 2009

Medical news of the obvious

Someone needs to buy these researchers a drink. Because it's pretty clear they've never been to a bar before.

Their study (which was oh-so-appropriately published in Human Nature) found that men are more likely than women to agree to casual sex. Greater percentages of men said they would go out, go to an apartment, and go to bed with members of the opposite sex whether they were "slightly unattractive," "moderately attractive" or "exceptionally attractive." (Don't worry, the scientists weren't categorizing actual women that way; it was all hypothetical.) Women, on the other hand, reserved their one-night stands for the exceptionally attractive guys.

In an addendum that will only be shocking to anyone who has never walked down the street in Europe, Italian men were most likely to accept sex with a stranger, followed by American guys and then Germans.
Friday, August 14, 2009

This guy is cool.

If you've ever sat in front of the TV wishing that every other commercial didn't reinforce your desire to stuff yourself with junk food, you might appreciate the efforts of Dr. Jason Newsom. According to USA Today, the Florida physician had a digital sign outside his office with messages like "French fries=Thunder thighs" and "America Dies on Dunkin'".

Not so surprisingly, that second one got him in trouble. The doughnut dealers protested and Dr. Newsom had to find himself a new job. You have to appreciate his attempt to fight the messaging imbalance between consumption of crap and healthy living. But if you want to follow his example, it may be safer to avoid targeting specific brand names. Try it "Coming to America"-style: "Eating at McDowell's will increase your jowls."

Mr. President, please fix Medicare

Dear President Obama,

I am in favor of health care reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.

But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever-expanding diagnosis codes, the excessive documentation rules and the poor payment to "cognitive, diagnosing, talking" physicians make the idea of expansion untenable.

May I give you one small example? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, 22 pages for a change of address. It is now mid-August and I still do not have the "approval" for my address change.

I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes half an hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests and treatments and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules I cannot submit a bill to Medicare because they have not approved my change of office address.

I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I sent the forms and information "overnight, registered" because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my "bank officer" and a utility bill from the office. Mr President, I don't have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients...but I certainly did comply.

I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.

I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for five months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patients or their supplemental Medicare insurance either.

Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.

An internal medicine (read: primary care) physician

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.
Thursday, August 13, 2009

A reason not to worry about the flu.

When experts are predicting the future, you can be guaranteed that someone will take the other side, if only so they can say "I told you so" when things go contrary to expectations. But let's hope that the experts writing in JAMA this week really know what they're talking about.

These NIH scientists use data from past pandemics to argue that swine flu isn't likely to get more fatal or more transmissable this fall. Basically, they say that the 1918 pattern of infection and death growing from one season to the next isn't very well understood and wasn't repeated in later pandemics. Another expert, who supports their analysis, was ready to go even farther. "It's hard to conceive that if the H1N1 should reappear in the fall in the Northern Hemisphere that we would have a more severe epidemic," he told HealthDay.

But don't start sneezing on your friends and licking doorknobs just yet. The NIH guys warn, of course, that "it is difficult to predict the future course of the present H1N1 pandemic." At least now, though, we have one Pollyanna-perspective pandemic prediction.
Wednesday, August 12, 2009

The government, online.

It's not exactly an impartial view of health reform, but if you want to know what the administration is thinking and saying about health care without risking a town hall meeting, check out It's a snazzy site, complete with an interactive map, blog and videos from Kathleen Sebelius.
Tuesday, August 11, 2009

Is your office full of girly men?

A new study, reported by HealthDay, finds that masculinity is inversely related to a man's likelihood of receiving routine medical care. In other words, the more macho they are, the less likely they are to see a doctor. The findings might help explain why men overall use primary care less than women, and indicate that ad developers should get Arnold Schwarzenegger or some other tough guy to do their next colonoscopy campaign.

One caveat: the researchers defined masculinity as a "John Wayne- and Sylvester Stallone-style" life. If these guys are actually living their lives like Rambo and The Duke, maybe they figure they're more likely to catch a bullet than a chronic disease.
Monday, August 10, 2009

Medical news of the obvious

Dark cloudy landscape by Camille Boulière via FlickrDepressed people were almost three times as likely to have impaired cognition after gloomy weather in one study. Researchers screened by phone 16,800 Americans enrolled in a stroke study for signs of depression and then administered a cognition test. Data were correlated with NASA's daily records of how bright sunlight was at any given location for the two weeks before the test. We're not rocket scientists, but two weeks of cloudy weather is enough to fog anyone's senses, let alone people who are already depressed.

This next video starts off with what exercisers knew intuitively: Working out makes one hungrier. But does exercise really make it harder to lose weight? Let's sit on the couch for a while and mull that over ...
Friday, August 7, 2009

Violent video game aids teens with cancer

Plenty of video games reward players with extra lives for good performance. This one rewards good performance with extra life.

A violent video game is being congratulated for helping teens with cancer. It replaces the traditional shooter with a robot and aliens and bad guys with cancer cells. The robot destroys the cells, simulating how cancer treatments affect the body and also explaining medical terms.

The game can be downloaded for free. The best part is its name: Re-Mission.

Internist asks patients to leave co-pay ... for the next patient

James S. Braude, ACP Member, of Atlanta, has started asking patients to leave a dollar (or any other amount) in an envelope at the front desk after a visit. That donation is applied toward the visits of patients without insurance--Dr. Braude comps the rest of the cost. The local TV report is here:

(The text version is here in case video is restricted on your computer.)

In May ACP Internist polled its readership how they handled uninsured patients, and doctors spoke of a variety of ways they help their patients who don't have insurance.
Thursday, August 6, 2009

Making sense instead of noise

Tired of all the people yelling about health care reform? This little article from the Wall St. Journal provides a nice respite. It uses both logic and morality to explain why a totally free-market approach to health care coverage doesn't work. Even the comments section is surprisingly civil.
Wednesday, August 5, 2009

Is prevention more politically effective than cost effective?

Last week, a study in BMJ pointed out that cervical cancer screening may be overused in young women. According to the researchers, there's probably no need to screen women under 25. They also suggested that women who are screened and have abnormal results don't necessarily benefit from immediate colposcopies.

I'm guessing that most members of Congress were too busy arguing about health reform to catch that journal article, but there may be a valuable lesson in it for them. Preventive health care has been a popular talking point for politicians--it was one of the few things President Obama and Senator McCain agreed on. But does preventive care actually have any relevance to cost-cutting?

No, but that won't stop Congress from making preventive coverage a major part of health care reform, according to new article from Kaiser Health News. "Under the House plan, patients could receive free an initial physical exam, diabetes screening tests, blood tests for heart disease, mammography, pap smears, bone mass measurements, flu and pneumonia vaccines, screenings for colon and rectal cancer, and ultrasound screenings for abdominal aortic aneurysm."

Not to say that covering screenings is a bad thing, but it does seem like a little attention to their effectiveness (cost and outcome-wise) might be worthwhile. After all, just because a pap smear's free doesn't mean it's fun.
Tuesday, August 4, 2009

Medical news of the obvious

We did learn something new from this week's study--research on the elderly can be just as obvious as that focused on children.

Elderly people who neglect themselves or are abused are also more likely to die, according to the latest issue of JAMA. The researchers even state the obviousness of their own point at the start: "Reports of elder self-neglect or abuse are often initiated based on significant concerns for an older person’s welfare, health, and safety, perhaps to levels that suggest that there may be strong concerns for the older person’s wellbeing."

In other words, reports of dangerous things happening to people seem to be associated with dangerous things actually happening to people.

Paging Dr. Big Brother

Patients who fail to take their medications properly suffer unnecessary complications, raise health care costs and drive their physicians nuts. We've written articles suggesting potential solutions to this problem, like motivational interviewing. But now those clever R&D guys have come up with an answer that will avoid the effort of patients and doctors actually talking to each other.

"Proteus Biomedical Inc., is testing a miniature digestible chip that can be attached to conventional medication, sending a signal that confirms whether patients are taking their prescribed pills. A sensing device worn on the skin uses wireless technology to relay that information to doctors," report the Wall Street Journal.

Yes, that's right. No longer will you have to ask patients whether they've been compliant with their prescriptions. Just plant a bug in their drugs and wait for the transmissions. And we thought the replacement of internists with computers was just fiction.
Monday, August 3, 2009

Getting poetic about it

An new article from JournalWatch uses a line of poetry to make the case that tight control for type 2 diabetes should be abandoned. The author convincingly points out how the evidence base shows more harm than benefit to be gained from driving A1cs down. But we wonder what's next: a haiku against drug-eluting stents? sonnets on sepsis?

Medical news of the obvious delayed

Medical news of obvious will appear on Tuesday afternoon this week, because we're waiting for some specially obvious news from JAMA to be unembargoed.