How Doctors and Patients Do HarmBy TARA PARKER-POPEChristopher T. Martin Dr. Otis Brawley, chief medical officer for the American Cancer Society. Just how broken is the United States health care system? Dr. Otis Brawley, chief medical officer for the American Cancer Society, paints a grim picture in his new book “How We Do Harm: A Doctor Breaks Ranks About Being Sick In America’’ (St. Martin’s Press).If the title alone doesn’t clue you in, the reader quickly discovers that Dr. Brawley is determined to make everyone as uncomfortable as possible about the flaws, inconsistencies and inequities that are rampant in American medical care... I am trying to get folks, through this book, to talk a little more about rational use of health care and realize that we are actually hurting people with overtreatment. Health care needs to be consumed in a wiser way that is much more concerned about allegiance to the science. We need to be more concerned about the welfare of our patients. There was a recent report, the 45 tests we do too much, that I was thrilled to see. People are starting to realize that we need to be a little wiser in our use of health care.
Saturday, April 21, 2012
NYTimes Book Review: How Doctors and Patients Do Harm
Thursday, April 19, 2012
Genentech Tries New Tack on Shelved Breast Cancer Drug Avastin
I wrote about Avastin here. Info on my practice here.
Online study of Avastin breast cancer patientsPlease click on the title if you'd like to read the whole article.
Victoria Colliver
Saturday, April 14, 2012
South San Francisco's Genentech has teamed up with personal genetics company 23andMe for a new kind of study - one that doesn't require patients to find a clinical trial center or make frequent visits to a doctor's office.
The Bay Area companies are initiating an online effort to recruit 1,000 patients with metastatic breast cancer who have taken Genentech's Avastin, a drug that had its approval for breast cancer revoked last year over safety and efficacy concerns.
Genentech officials hope to find genetic markers in those patients that could identify who might respond better to the drug than others. They say the study is not necessarily designed to get the drug back on the market for breast cancer, but to figure out if Avastin helps certain types of breast cancer patients. Such research could ultimately lead to its reapproval...
Critics say the online study appears to be biased toward women who have done well on Avastin, but its sponsors say they're simply trying to find common factors in a large group of patients that could be tested in more traditional clinical trials...
The U.S. Food and Drug Administration revoked its approval of Avastin for breast cancer after studies showed the drug caused life-threatening side effects such as bleeding and heart failure. Studies also found it failed to help patients with metastatic breast cancer live longer...
Tuesday, April 17, 2012
Cancer Screening: Opinions from the Field
Endless Screenings Don’t Bring Everlasting Health
By LISA M. SCHWARTZ, M.D. and STEVEN WOLOSHIN, M.D.
Since there is no reliable way to know whether a screening-detected cancer represents overdiagnosis, most people seek treatment. People on the receiving end of overdiagnosis can only be harmed — sometimes seriously — by unnecessary surgery, radiation and chemotherapy. While it’s hard to precisely estimate the amount of overdiagnosis that occurs, most experts agree that it’s an inevitable consequence of screening.
The bottom line is that while screening may help some people avoid a cancer death, it will harm many others...
As noted by the task force, the harms of P.S.A. screening probably outweigh the benefits, which actually are uncertain. None were observed in an American trial, and just a small benefit was found in a European trial. The test results in a disturbing amount of overdiagnosis.
For women at average risk, mammography is a close call. Trials suggest that there are about one to three fewer deaths for every 1,000 women screened over 10 years (the benefit increases with age). But there is substantial overdiagnosis — as many as 10 unnecessary diagnoses per death avoided. Rather than persuading women to be screened, we should help them be informed.
For colon cancer screening, the benefit of the fecal occult blood test outweighs the harms. (Surprisingly, colonoscopy hasn’t been evaluated yet in a randomized trial.) There are about three fewer colon cancer deaths per 1,000 people screened over 13 years, without a lot of false alarms requiring invasive procedures. There has been no evidence of cancer overdiagnosis with this test.
For people at high risk of lung cancer because of heavy smoking, the benefits of CT screening outweigh harms if it is done at highly skilled centers.
Friday, April 6, 2012
Doctor Panels Recommending Fewer Tests for Patients
Looking at the report what they did is ask each specialty to come up with 5 treatments or tests that should be given extra thought. A quick read through reveals some of the following. 1) No antibiotics for simple rhinosinusitis 2) No imaging for low back pain less than 6 weeks duration 3) No pap smears for women under 21 years of age or post hysterectomy 4) Cardiac stress tests should be needed not routine 5) No CT nor MRI for simple sycope nor for headache 6) For GERD,use the lowest dose of Proton Pump Inhibitors possible 7) Less imaging for early stage breast and prostate cancer 8) Avoid nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or Chronic Kidney Disease of all causes, including diabetes. (did not know this!!) 9) Avoid Cardiac Imaging (nuclear and CT) in low risk patients
More on my practice here.
Doctor Panels Recommend Fewer Tests for Patients
By RONI CARYN RABINIn a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.
The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.
“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”
Do Patients Want More Care or Less?
Do Patients Want More Care or Less?
As readers of this blog know, I promote the point of view that sometimes in Medicine, Less is More. The title of my blog is “First, Do No Harm.” So this article from the NYTimes illustrating how not only patients, but physicians also are starting to see the benefit in opting to do nothing. I will emphasize a few points in the article, but those interested in this topic, please go to the link and read the whole thing. I will provide links to my previous blog posts that covered some of the topics here. (For more on my practice please click here.)
April 4, 2012, 4:11 pm
Do Patients Want More Care or Less?By DAVID NEWMAN, M.D.
…While diagnosing bronchitis, a common respiratory infection, is often easy, treating the condition is more difficult. Medicines may calm the symptoms, but the only cure is time. Most notably, antibiotics, though commonly prescribed, are no better than a placebo for bronchitis.
“Traditionally, newer and more aggressive interventions were often assumed to be better.” But there are hints of a shift, he says: “When patients are fully informed, they tend to be more conservative.”
After decades of presuming that more health care leads to better health, public consciousness may be moving toward a leaner view.
Today, a group of nine medical specialty boards is recommending that doctors perform 45 common tests and procedures less often, and is urging patients to question these services if they are offered. The move is the latest by the medical community to acknowledge that many tests and procedures are performed unnecessarily, leading to excessive costs, false positives, additional testing and even harm to patients. By some estimates, unnecessary treatment constitutes one third of medical spending in the United States...
Dr. Barry also points to news reports that may also be shifting attitudes. In just the past year, medical headlines have covered record-setting fines paid by pharmaceutical companies, the overuse of potentially carcinogenic medical radiation, medical device recalls and the rise of prescription drug deaths (which now outnumber illicit drug deaths). Even once-sacred interventions like screening for cancer are under scrutiny, with a better understanding of both limited benefits and growing harms. That randomized trials of prostate specific antigen (PSA) testing, for instance, had shown little or no lifesaving benefit was hardly noticed until last year, when the United States Preventive Services Task Force drew attention to sexual and urinary problems and prostate biopsy complications, all common fallout from positive PSA results.
Saturday, March 31, 2012
When Less Treatment is More
When Less Treatment Is More
By PAULINE W. CHEN, M.D.Michele Constantini“Sometimes the hardest thing for us doctors to do,” her surgeon said to me, “is to know when not to do anything.”
The path of less, versus more, treatment has met with resistance...I was reminded of the relevance of his remark for both doctors and patients when I read a study on breast cancer treatment published this month in The Journal of Clinical Oncology.
For years, the standard treatment for most women with early-stage invasive breast cancer has been to cut out the tumor and then administer radiation. But eight years ago in a major study, that approach was re-evaluated for women over age 70. It turned out that putting older women with less aggressive early cancers through the additional rigors and complications of radiation — fatigue, rash and the need to visit a radiation center daily for a month or more — had no effect on their survival rates.
A year later, the findings were incorporated into a widely accepted series of cancer treatment guidelines that recommended surgery — but rendered radiation optional — for women over 70 with more favorable early forms of breast cancer.
But in the latest study, researchers from Yale University’s School of Medicine discovered that the earlier study and resulting recommendations have had little effect on what treatments older breast cancer patients are receiving. ..
“We’ve become increasingly concerned about the overuse of screening tests or excessive treatments with little benefit,” said Dr. Cary P. Gross, associate professor of medicine at Yale and senior author of the study. “But these concerns aren’t reflected in changes in how we are caring for patients...”
Patients, too, may feel the same way and insist on proceeding with treatment. Convincing them otherwise can require lengthy discussions that many doctors don’t have the time for. “It’s almost simpler to present a ‘plan of action’ than convince a patient that doing nothing is a reasonable course,” said Dr. Kenneth B. Roberts, another one of the authors and an associate professor of therapeutic radiology at Yale.“Our system’s ability to find new treatments has far outpaced its ability to understand the limits of those treatments or to communicate with patients about the best strategies for those treatments,” Dr. Gross said. “What we need to do is step back and figure out how we can design our health system so that the right patient gets the right care at the right time, rather than all patients getting more care all the time.”
For more info on my practice click here.
Wednesday, March 14, 2012
Do Statins Make It Tough to Exercise?: More Statin Problems
March 14, 2012, 12:01 am
Do Statins Make It Tough to Exercise?
By GRETCHEN REYNOLDS
For years, physicians and scientists have been aware that statins, the most widely prescribed drugs in the world, can cause muscle aches and fatigue in some patients. What many people don’t know is that these side effects are especially pronounced in people who exercise.
To learn more about the effect statins have on exercising muscles, scientists in Strasbourg, France, recently gave the cholesterol-lowering drug Lipitor to a group of rats for two weeks, while a separate control group was not medicated. Some of the rats from both groups ran on little treadmills until they were exhausted.
It was immediately obvious that the medicated animals couldn’t run as far. They became exhausted much earlier than the rats that had not been given statins...
Statins’ safety has come under considerable scrutiny in recent weeks. Last month, the Food and Drug Administration added safety alerts to prescribing information for statins, warning of risks for memory loss and diabetes, as well as muscle pain.
More than 20 million Americans are taking statins, and by most estimates, at least 10 percent of them will experience some degree of muscle achiness or fatigue. That proportion rises to at least 25 percent among people taking statins who regularly exercise, and may be 75 percent or higher among competitive athletes...
“Statins are anti-aging for arteries,” he says. “If you take them, you’ll have younger arteries. Unfortunately,” he adds, “they are not anti-aging for muscles.”
More information about my practice here.
Thursday, March 1, 2012
Statins good for you? Think again. FDA issues warning
More on my practice here.
Maybe one more for the "Follow the Money", and "First Do No Harm" files.
February 28, 2012
Safety Alerts Cite Cholesterol Drugs’ Side Effects
By GARDINER HARRIS
Federal health officials on Tuesday added new safety alerts to the prescribing information for statins, the cholesterol-reducing medications that are among the most widely prescribed drugs in the world, citing rare risks of memory loss, diabetes and muscle pain.
It is the first time that the Food and Drug Administration has officially linked statin use with cognitive problems like forgetfulness and confusion, although some patients have reported such problems for years. Among the drugs affected are huge sellers like Lipitor, Zocor, Crestor and Vytorin...
Dr. Sidney M. Wolfe, director of Public Citizen’s health research group, is among those who contend statins are overused. He said the new alerts about risks provided more reasons that otherwise healthy people with cholesterol levels less than 240 “should not be taking these drugs.”..
Reports about memory loss, forgetfulness and confusion span all statin drugs and all age groups of patients, the F.D.A. said. Dozens of well-controlled trials of statins have offered few hints that the drugs cause any kind of cognitive impairment, Dr. Egan said. Still, the F.D.A. has received many reports over the years that some patients felt unfocused or “fuzzy” in their thinking after taking the medicines.
Officials in the F.D.A. debated whether such reports were truly worrisome, Dr. Egan said. But in recent years, the F.D.A. — criticized for waiting too long to issue some safety alerts — has become more willing to be public about possible drug risks, even when the evidence is uncertain...
That statins can cause muscle pain, particularly at high doses, has long been known, but in its new alert the F.D.A. reminded doctors that some other medications increase the likelihood that statins linger in the body longer than normal and increase the risk of muscle pain.
Coronary Stents: No advantage found
We learned that the FDA "endangered countless patients' lives when it stopped enforcing 30-year-old requirements that medical device makers meet federal lab standards before testing their products on humans." We also learned that the procedures could cost $30,000 to $50,000 per procedure, so no one wanted to stop that gravy train. There was a study published in 2007 in NEJM showing that many patients given stents would fare just as well without them. So this is nothing new. There are a number of forces at work here. Following the money is big, but also the tyranny of doing a procedure that makes sense, even though the data doesn't support it. I talked about "believing in treatments that don't work" here.
Talked about better mental models for treatment here.
For information about my practice please click here.
No Extra Benefits Are Seen in Stents for Coronary Artery Disease
The common practice of inserting a stent to repair a narrowed artery has no benefit over standard medical care in treating stable coronary artery disease, according to a new review of randomized controlled trials published on Monday...
Some of these devices, called drug-eluting stents, are coated with medicine that helps to keep the artery open. The cost of the procedure varies from about $30,000 to $50,000, and more than one million are performed every year in the United States.
The procedure has certain risks. According to Dr. David L. Brown, an author of the analysis, the risk for death is about one in a thousand, and complications can include stroke, heart attack, bleeding, kidney damage and serious allergic reactions. But those events are rare, and the review did not detect any increased risk in P.C.I. compared with medical treatment...
The researchers reviewed eight randomized trials comparing P.C.I. with standard medical care. Combining data from all the studies, the researchers found that prescribing beta blockers, ACE inhibitors, statins and daily aspirin — now standard for treatment of stable coronary artery disease — was just as effective as stent implantation for prevention of chest pain, heart attack, the need for a future P.C.I. and death.
More than half of patients with stable coronary artery disease are now implanted with stents without even trying drug treatment, Dr. Brown said. The reason, he believes, is financial.
“In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures,” he said.
“When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”
Angina is often the symptom that convinces doctors and patients that medical therapy is not enough and that a stent is required. But in this analysis, 29 percent of people who had P.C.I. still had angina, compared with 33 percent of those on medicine, an insignificant difference.
These results support the current concept of coronary artery disease, the authors wrote — that it is a systemic inflammatory disease of the arteries that cannot be successfully treated by surgical intervention at a particular site on one artery.
According to Dr. Brown, a professor of medicine at Stony Brook University, many doctors cannot accept this. Instead, he said, “interventional cardiologists use the analogy of a pipe blocked in a house — it’s a terrible analogy, but patients accept it. It’s simplistic and erroneous.”
Monday, January 9, 2012
Prostrate Screening Update: First, Do No Harm
Prostate Cancer Screening Shows No Benefit
By TARA PARKER-POPEUpdated findings from one of the largest studies of prostate cancer screening show that the commonly used P.S.A. blood test did not save lives, although questions remain about whether younger men or those at very high risk for the disease might benefit.
Last fall, the United States Preventive Services Task Force concluded that healthy men should no longer be routinely screened for prostate cancer using the prostate-specific antigen, or P.S.A., blood test. That decision was based on findings from five well-controlled clinical trials, including a major American study called the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial, which studied P.S.A. testing in nearly 77,000 men ages 55 to 74...
Because prostate cancer can take several years to develop, the investigators continued to collect data after reporting the initial findings.
In a new paper published today in The Journal of the National Cancer Institute, the scientists report that the additional follow-up time didn’t change the overall conclusion: that regular P.S.A. testing does not save lives and can lead to aggressive treatments that leave men impotent, incontinent or both..
The findings suggest that the type of cancer typically detected by screening is so slow-growing that it often is unlikely to cause harm before the man dies of another cause...
“I think it supports the recommendation that for the average man in the United States, mass screening is probably not beneficial at all,’’ Dr. Andriole said. “It also will keep the discussion open about whether there are indeed subsets of men who do potentially stand to benefit from P.S.A. screening.”
For more on my practice, please click here.
Wednesday, December 28, 2011
Tragic. High Cost of Failing Artificial Hips
The High Cost of Failing Artificial Hips
By BARRY MEIER
The most widespread medical implant failure in decades — involving thousands of all-metal artificial hips that need to be replaced prematurely — has entered the money phase.
Medical and legal experts estimate the hip failures may cost taxpayers, insurers, employers and others billions of dollars in coming years, contributing to the soaring cost of health care. The financial fallout is expected to be unusually large and complex because the episode involves a class of products, not a single device or just one company...
The incidents have set off a financial scramble. Recently, lawsuits and complaints against makers of all-metal replacement hips passed the 5,000 mark. Insurers are alerting patients that they plan to recover their expenses from any settlement money that patients receive. Medicare is also expected to try to recover its costs...
Still, some patients are weathering some of the financial impacts on their own. While Charmin McCune, a teacher in Wylie, Tex., is recuperating well from a recent replacement operation, she said that she and her husband, also a teacher, have had more than $12,000 in expenses that have not been covered by insurance.
Information on my practice here.
Friday, December 23, 2011
New Joint Implants no Better Than Older Ones
December 22, 2011
New Models of Implants Not Better, Study Finds
By BARRY MEIER
A new study suggests that the recent technology for artificial hips and knees did not perform any better than older, less expensive designs.
The study, which draws on data from Australia’s orthopedic registry, covered implants introduced from 2003 to 2007 and was published this week. The findings are significant for patients in the United States because many of the new designs, like so-called metal-on-metal hips, are widely used here. Those implants, which have both a ball and cup made of metal, are expected to fail prematurely in tens of thousands of patients rather than lasting 15 years or more as artificial joints are supposed to do.
The Australian study showed that not a single new artificial hip or knee introduced over a recent five-year period was any more durable than older ones. In fact, 30 percent of them fared worse...
“Not only has the introduction of this technology been potentially detrimental to patient care, but the current approach may be an important driver of increased health care costs,” the review concluded...
That review, by researchers in Austria (mistake, should be Australia), found that surgeons involved in the original published reports are often involved in its development and may have a financial stake in them. In addition, such reviews tend to be short term...
This month, bipartisan legislation was introduced in the Senate that could force manufacturers to track the performance of implants like artificial hips after they have been approved for sale. Proponents of the bill acknowledge that the measure faces an uphill fight.
Both device producers and their allies in Congress have maintained that any additional F.D.A. regulations would slow the development and marketing of innovative products that benefit patients. For his part, Dr. Graves, the Australian official, said he believed that such arguments were misleading.
Where have we heard that before?? That regulation will somehow damage innovation, or hurt business and job creation? Just about every time any sort of regulation is proposed, that's when.
Info on my practice here.
Thursday, December 22, 2011
Getting Rid of Mercury, Good News for Once
The Meaning of Mercury
Let me repeat part of that: it will save tens of thousands of lives every year and prevent birth defects, learning disabilities, and respiratory diseases. This is actually a much bigger issue, when it comes to saving American lives, than terrorism.
As Roberts explains, we’ve known about these costs of mercury pollution for decades, yet it took until now to get something done. The reason is, of course, obvious: special interests, hiding behind claims of immense economic damage if anything was done, were able to block action.
It’s worth noting that these claims of economic harm from pollution regulation have always been proved wrong when the regulation finally came. Ozone regulation was supposed to cripple the economy; so was acid rain regulation; neither did.
Oh, and if we’re going to have to scrap some power plants and replace them, it’s hard to think of a better time to do it than now, when the workers and resources needed to do the replacing would largely have been unemployed otherwise...
Info on the practice here.
Tuesday, December 20, 2011
Acetaminophen and Asthma
Studies Suggest an Acetaminophen-Asthma Link
By CHRISTIE ASCHWANDEN
THE HYPOTHESIS
Acetaminophen increases the risk of childhood asthma.
THE INVESTIGATOR Dr. John T. McBride, Akron Children’s Hospital.
The sharp worldwide increase in childhood asthma over the past 30 years has long perplexed researchers, who have considered explanations as varied as improved hygiene and immunizations. Over the last decade, however, a new idea has emerged.
The asthma epidemic accelerated in the 1980s, some researchers have noted, about the same time that aspirin was linked to Reye’s syndrome in children. Doctors stopped giving aspirin to children with fevers, opting instead for acetaminophen. In a paper published in The Annals of Allergy and Asthma Immunology in 1998, Dr. Arthur Varner, then a fellow in the immunology training program at the University of Wisconsin School of Medicine, argued that the switch to acetaminophen might have fueled the increase in asthma.
Since then, more than 20 studies have produced results in support of his theory, including a large analysis of data on more than 200,000 children that found an increased risk of asthma among children who had taken acetaminophen. In November, Dr. John T. McBride, a pediatrician at Akron Children’s Hospital in Ohio, published a paper in the journal Pediatrics arguing that the evidence for a link between acetaminophen and asthma is now strong enough for doctors to recommend that infants and children who have asthma (or are at risk for the disease) avoid acetaminophen.
Dr. McBride based his assertion on several lines of evidence. In addition to the timing of the asthma epidemic, he said, there is now a plausible explanation for how acetaminophen might provoke or worsen asthma, a chronic inflammatory condition of the lungs. Even a single dose of acetaminophen can reduce the body’s levels of glutathione, an enzyme that helps repair oxidative damage that can drive inflammation in the airways, researchers have found....
For instance, a study published in The Lancet in 2008 examined information collected on more than 205,000 children from 31 countries as part of the International Study of Asthma and Allergies in Childhood, known as the Isaac study. The 2008 analysis found that children who had taken acetaminophen for a fever during the first year of life had a 50 percent greater risk of developing asthma symptoms, compared with children who had not taken the drug. The risk rose with increasing use — children who had taken acetaminophen at least once a month had a threefold increase in the risk of asthma symptoms.
A study published by British researchers in 2000 using data from the Isaac study found that the prevalence of asthma increased in lock step with sales of acetaminophen in the 36 countries examined. The more acetaminophen used in a country, the greater that country’s prevalence of asthma.
A meta-analysis published in 2009 calculated that children who had taken acetaminophen in the past year had nearly double the risk of wheezing compared with those who had not taken the drug. “We know that acetaminophen can cause increased bronchial constriction and wheezing,” said Mahyar Etminan, a pharmacoepidemiologist at the University of British Columbia and lead author of the study....
So far, only one randomized controlled trial has investigated the link. Researchers at Boston University School of Medicine randomly assigned 1,879 children with asthma to take either acetaminophen or ibuprofen if they developed a fever. The results, published in 2002, showed that children who took acetaminophen to treat a fever were more than twice as likely to seek a doctor’s care later for asthma symptoms as those who took ibuprofen...”..
Acetaminophen has been shown to reduce the antibody response to immunizations, so the drug should not be given to children in advance of a vaccination, Dr. Beasley also noted...
Tuesday, December 13, 2011
Ounce of prevention: Junk Food
Article in the SF Chron
Food giants fight proposed nutrition guidelines
An effort by four federal agencies to limit marketing of junk food to children has provoked a fight between the packaged food industry and public health groups as intense as the cigarette wars of the 1980s.
The agency guidelines, ordered by Congress in 2009, are due this month after a 1 1/2-year delay. They will be scaled back after a ferocious lobbying campaign by food manufacturers who fear that Twinkies are fast becoming the next tobacco.
The stakes are high, both for the $1 trillion food industry and for public health groups alarmed by Americans' growing girth. Whether a child develops a taste for fruit or Froot Loops can establish lifelong eating patterns that translate to billions of dollars in sales of packaged foods and potentially devastating consequences for public health.
We know that childhood obesity has reached epidemic proportions. A third of poor preschoolers are now obese by age 5. Obese children are more likely to become obese adults with all the resulting health problems.
Michele Simon author of "Appetite for Profit" says "Industry knows they have to get the kids while they're young because they want them hooked on their products..."
The Center for Disease Control and Prevention, The FDA, and the Department of Agriculture have issued "voluntary guidelines."
Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity, said obesity is now about as costly to public health as smoking and said that the food industry behavior is "remarkably parallel" to that of the tobacco companies years ago.
"That means, he said, "considering children prey, doing whatever they can do to circumvent parental awareness, and marketing in ways that develop strong brand loyalties at very early ages for junk food."...
"Most moms would agree that Kool-Aid and Cocoa Puffs are not healthy," Wootan said. "Certainly nutritionists would. The only ones who think those foods are healthy is the food industry itself."
Lots of money to made in the junk food, er, "packaged food" industry. The public health costs of diabetes, heart disease, etc... will be on us. No incentives for prevention in our society.
Info on my practice here.
Wednesday, December 7, 2011
Precautionary Principle and Genetically Modified Food
When it comes to cancer, the Emperor of All Maladies, how do we avoid what is negative? We know the obvious, tobacco and asbestos, nuclear fall out, maybe full body scans at the airport. But what else? What else to we avoid? I was bedside a few times a week with a friend in her final months of battling thyroid cancer, and it inspired me to become a vegan, since there is some data to suggest a plant based diet can improve your immunity and help your own system to fight cancer. But what else can we avoid?
Cue this Op-Ed by Eric Schlosser and Gary Hirshberg. You might want to read the whole thing, but I'll feature a few highlights.
More on my practice here.
The right to know what you are eating
An unprecedented agricultural experiment is being conducted at America's dinner tables. While none of the processed food we ate 20 years ago contained genetically engineered ingredients, now 75 percent of it does - even though the long-term human health and environmental impacts are unknown. The Food and Drug Administration doesn't require labeling of genetically engineered foods. But as the current drive to get labeling on the ballot in California confirms, consumers want to know whether our food contains these revolutionary new things...
Biotech companies have fought labeling, claiming genetically engineered crops are "substantially the same" and produce larger yields - both unproven claims. But genetically engineered crops have led to the increased use of pesticides, often sold by the same companies that make genetically engineered seeds...Almost all the research on the safety of genetically engineered foods has been conducted by the companies that sell them. ..A study of pregnant women found genetically engineered corn toxins in 93 percent of the women and 80 percent of their unborn children. All of their umbilical cords had glyphosate residues. Biotech companies say genetically engineered crops aren't different - but defend their patent rights by arguing they're unique and that anybody who grows them without permission should be prosecuted. These companies want it both ways...
A recent poll found 93 percent of Americans think genetically engineered foods should be labeled. This month, 384,000 people signed a Just Label It ( www.justlabelit.org) petition urging the FDA to mandate genetically engineered food labeling nationally. ..
The FDA doesn't let pharmaceutical companies test new drugs on people without their informed consent...
So, in a nutshell, the companies that produce the Genetically Modified Food, run their own studies, tell us not to worry, all is well and they're exactly the same as all the other foods, but no, you can't know if you're eating them or not. What if they turn out to be implicated in cancer rates? Those of us who are not so trusting of these big conglomerates and their in-house studies ought to have the right to know what we're eating, so we can at least "first do no harm."
Monday, December 5, 2011
Monday Morning Philosophizing: Charlie Munger
This may seem off the topic of medicine, but I think if you stay with me, you'll see the relevance. Over the weekend I was reading a book about and by Charlie Munger[i], a famous and successful investor and partner of Warren Buffett. I was interested in the various "mental models"he's derived from multiple disciplines (mathematics, physics, psychology, engineering) and wanted to read more about them.
One quip that he uses over and over again is the quote from an old "rustic" who says "I wish I knew where I was going to die, and then I'd never go there." Which is funny, of course, but it echoes the great algebraist Jacobi, who said "Invert, always invert." Munger's point in investing and in life, is that in avoiding what is negative, you are much more likely to be successful. Avoid losing, spend less than you make, and save.
So what does this have to do with acupuncture and alternative medicine? I realized that the "First Do No Harm" part of acupuncture and alternative medicine, though hardly a ringing call to action is an important part of the mission. In keeping people off medications whenever possible is not a small thing. Some studies show that the side effects of pharmaceutical drugs kill some 140,000 people in the U.S. a year and cost the country over $136 billion annually. As always, it's hard to prove a negative, but the wisdom of billionaires, Chinese ancients, genius mathematicians, and "rustics" concur that by avoiding the negative, you're much more likely to flourish. Once back pain, IBS, or migraines occur if the standard was to use acupuncture first who knows how much medication, cost and work would be saved. I've discussed these issues frequently in this blog, for eg here, here, and here.
Info on my practice here.
[i] “Poor Charlie’s Almanac: Wit and Wisdom of Charlie Munger” Kaufman 2006
Friday, December 2, 2011
Most Hospitalizations in Elders due to Four Drugs
Four Drugs Cause Most Hospitalizations in Older Adults
By ANAHAD O'CONNOR
Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States, a new study shows.
Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.
Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.
All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention...
Monday, October 24, 2011
Clinical Inertia: It Can Be Good For Your Health
Of course there are myriad situations where aggressive intervention is required, but it is helpful to have the reminder that sometimes less harm is done if you leave "well enough" alone.
October 20, 2011, 10:20 am
When Doing Nothing Is the Best Medicine
By DANIELLE OFRI, M.D.
“Don’t just do something; stand there!”
It’s one of those phrases that attending physicians will spout off to their medical students while on rounds, trying to sound both sagacious and clever at the same time. It sometimes grates, but it does make a valid point, because so much of medicine is about “doing something.”
Sore throat? Prescribe an antibiotic.
New headache? Get a CT scan.
P.S.A. at the upper limit of normal? Get a biopsy.
Blood pressure still high? Add on another medication...
Of course, every “thing” a doctor does also has side effects — rampant bacterial resistance from antibiotic overuse; major increases in radiation exposure from unnecessary CT scans; incontinence or impotence from prostate cancer treatments that may do nothing to prolong life; toxic drug interactions from multiple medications, particularly in the elderly.
The admonishment “Don’t just do something; stand there!” reminds us that we should stop and think before we act, that there are many instances in which doing nothing is greatly preferable to doing something...
They focused on three common medical conditions — diabetes, elevated cholesterol and hypertension — for which there are established clinical guidelines for doctors to follow and “quality measures” that evaluate medical care. For all three illnesses, “lower is better” is the dominant mantra.
But while “lower is better” is probably true for large populations, that is not always the case for individual patients. In fact, there are some clinical trials in which aggressively lowered blood sugar or blood pressure have been associated with higher rates of dying.
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