Anthony Lee's Blog
Posted by Anthony Lee
I have said it before and I will say it again: Prevention is the best way to live a long and healthy life.
Imagine, for example, the consequences of not eating right, not exercising enough, and choosing to smoke and drink. The first thing that may occur is obesity, which can lead to problems like diabetes mellitus, hypertension, hyperlipidemia, osteoarthritis, and obstructive sleep apnea. These problems, in turn, have their own complications, such as heart attacks, strokes, congestive heart failure, and kidney failure. Let's not forget difficulties with sleep, chronic obstructive pulmonary disease, lung cancer, liver cirrhosis, and hepatocellular carcinoma.
Just imagine how any of the above diseases requires at least one type of treatment, whether medical or surgical. Now picture the amount of money that goes into all of it. One thing automatically comes to mind: disability. I'm not just talking about the physical inability to do things in life. I'm also talking about financial burden, regardless of how much health insurance coverage one has. Just being preoccupied with such problems can significant impact one's quality of life.
These physical and financial constraints have a ripple effect on everyone else. Think about how a patient's family can be affected. I won't list examples of this, but I'm sure you can think of at least a few. I will say, however, that treatment of active disease does impact society. It is often cited as a factor associated with rising healthcare costs, shortages of nurses and doctors, and lost work productivity. All of this, of course, can circle back and affect the individual.
This is why prevention of disease is the way to go. It takes some discipline and effort, but if one can accomplish this task, it can do wonders. Trust me. It'll help everyone in the long run.
Posted by Anthony Lee
This week, I am posting two blog entries, both of which are a major departure from my usual musings. Instead of disease or the inner workings of the medical profession, I would like to discuss rising healthcare costs in America.
President Barack Obama is working to provide health coverage for the uninsured, an effort I applaud given how the issue has always been all talk and no action. At the same time, I am reminded of factors that could possibly drive up healthcare costs. After all, a problem is best solved from multiple angles, including the root causes (why costs are rising) and the end consequences (the now increased costs). While generating money to fill health insurance gaps is a start, one might also want to think about the following issues:
Malpractice Jury Awards
- Problem: Award money for pain and suffering in medical malpractice cases can be so excessive that malpractice insurance for doctors spins out of control.
- Suggestion: Legislate a cap on noneconomic damages for medical malpractice cases or, ideally, set up a medical court system.
Fear of Malpractice Litigation
- Problem: Doctors fear litigation and order unnecessary tests to prevent losing a lawsuit, if it occurs.
- Suggestion: While doctors should openly admit mistakes if they do happen, nonmedical people should understand that malpractice means negligence with standard of care, not unsatisfactory results despite the doctor's best efforts.
Pharmaceutical Ads
- Problem: Pharmaceutical companies spend much money on advertising to both consumers and doctors, often more than research and development of the drugs themselves.
- Suggestion: Drug advertising should never be directed to the consumer, and doctors should be free to objectively evaluate new drugs on the market without influence by the drug companies.
For more thoughts on U.S. healthcare costs, see my other blog entry.
Posted by Anthony Lee
This week, I am posting two blog entries, both of which are a major departure from my usual musings. Instead of disease or the inner workings of the medical profession, I would like to discuss rising healthcare costs in America.
President Barack Obama is working to provide health coverage for the uninsured, an effort I applaud given how the issue has always been all talk and no action. At the same time, I am reminded of factors that could possibly drive up healthcare costs. After all, a problem is best solved from multiple angles, including the root causes (why costs are rising) and the end consequences (the now increased costs). While generating money to fill health insurance gaps is a start, one might also want to think about the following issues:
Fee for Service
- Problem: A fee-for-service health plan reimburses the doctor for any office visits, test, and treatment, creating a financial incentive for the doctor to order unnecessary tests.
- Suggestion: Pay the doctor on a fixed salary, leaving services to be decided based on medical necessity.
Emphasis on Sick Care
- Problem: Some health plans pay little to none for preventive health and much more for services related to disease, leading many patients to wait until they get sick before requiring expensive tests and treatments.
- Suggestion: Create a level playing field by reimbursing more on prevention and less on sick care.
Abundance of Specialists
- Problem: Primary care physicians earn much less than specialists, an incentive for doctors to specialize while creating a shortage of generalists to do preventive medicine.
- Suggestion: As with health plan reimbursements, create a level playing field by boosting salaries for generalists and controlling salaries for specialists.
For more thoughts on U.S. healthcare costs, see my other blog entry.
Posted by Anthony Lee
As patients, we like to view our doctors as people who can help us. Naturally, it's easy to assume that, if they want to help us, they will grant our every wish to be healthy and disease-free. It's no wonder that some people feel upset if he or she asks for a specific test or treatment and the doctor says no.
At first, it may seem that the doctor is cruel. However, I know enough about how doctors think to say that there's often a good rationale for such a response. For example, a doctor may say no to a test or treatment because it may be more expensive than the standard without actually being better. This is especially true when a medically-oriented advertisement seems promising. Also, the requested test or treatment may be more dangerous than the standard that has a more acceptable safety profile.
In such cases, you also want to consider how the doctor is acting in the patient's best interest by thinking in the long term. Suppose a patient asks for a test or treatment that the doctor says is neither efficacious nor safe, but the patient really believes it will help. What will happen if the patient finds out the doctor is right? Will the patient regret not listening in the first place?
Basically, thinking of the patient's best interests doesn't just mean making sure the best options are available. It also means advising against bad options if the patient is tempted to pursue them without understanding their risks and benefits. The next time you find yourself not getting what you're asking your doctor for, take a step back and consider the doctor's position. It never hurts, and it's often a good idea, to talk with your doctor in order to come to a consensus.
Posted by Anthony Lee
Some people like to consider snoring to be an annoying but harmless sleep phenomenon. Is it possible, however, that this supposedly normal occurrence during slumber could be a warning sign for something worse?
During sleep, the muscles of the upper airways and throat relax, reducing the diameter of the air passages. A simple law in physics applies here. When the diameter of a tube is smaller, the resistance faced by liquid or gas flow increases. In the upper airways of humans, this resistance causes tissues to vibrate, resulting in the characteristic sound of snoring.
In severe cases, the airway narrows and closes off. This is the phenomenon known as obstructive sleep apnea (OSA). It is a serious condition because sensations of being unable to breathe cause the person to repeatedly wake up. This results in sleep deprivation among other consequences.
Given how loud snoring occurs with narrow airways and OSA occurs when the airways close, it may help to look at snoring, particularly very loud snoring, as a warning sign for OSA. If you have a bed partner who complains that you snore too loudly, consider it more than just a comfort issue for that other person. Consider it a potential health issue for yourself as well.
Posted by Anthony Lee
This past week, two news stories have caught my attention. Both are related to drug safety, something the public may be interested in knowing more about.
Since the death of pop superstar Michael Jackson, there has been much discussion about his use of multiple prescription drugs. In the midst of these rumors, there was talk about Jackson suffering from insomnia to the point where he requested the intravenous sedative drug Diprivan (whose generic name is propofol). This drug is used in intensive care units to calm patients when they're on ventilators as well as for certain procedures, such as colonoscopy. However, it's never used outside a clinical setting under any circumstances.
I'm not going to comment on whether Diprivan was a factor in Jackson's death. What I shall do instead is remind everyone that all drugs have warning labels and precautions for a reason. They can be dangerous if used for unapproved situations. If a doctor is reluctant to prescribe something because of its risks for the patient, it may be something to keep in mind.
This, of course, segues into the other news story I noticed. The U.S. Food and Drug Administration (FDA) is being urged to place restrictions on the dosage of Tylenol (whose generic name is acetaminophen). While this pain medication is used very commonly, it is responsible for a significant number of cases of acute liver failure.
Some might find this hard to believe. How can this happen if Tylenol is over-the-counter (OTC)? It is true that OTC drugs are safe enough to not require a doctor's prescription, but it doesn't mean they're completely safe. They can still be dangerous if used incorrectly against the warnings on the box.
Overall, when it comes to drugs, efficacy is important. But so is safety.
Posted by Anthony Lee
A study published in the recent issue of the journal Archives of Internal Medicine found that abnormal test results are not sent to patients 1 out of 14 times.
For me, this is an interesting finding. It suggests possible miscommunication between patients and some clinics. Some patients might assume that test results, such as cholesterol levels and mammogram findings, are normal if their doctors do not say anything after the clinic visit. Meanwhile, operational issues at clinics may prevent abnormal test results from getting to the patients in a timely manner. Together, these factors can certainly result in the 1/14 rate of nonreporting of abnormal test results.
Of course, it doesn't happen much. From my personal experience in medicine and observations of other doctors in action, nonreporting of abnormal test results is something I don't recall ever witnessing. Still, we can certainly remember this: Even in a new age of medicine with electronic medical records and other exciting technology, human error can still be a potential problem. There still needs to be trust in the doctor-patient relationship. If efforts can be made to ensure this, then problems such as what the recent study found can be minimized.
Posted by Anthony Lee
Whenever you hear about new drugs, medical devices, or other kinds of products, you typically hear about the U.S. Food and Drug Administration (FDA), the regulatory body ensuring safety of these products for all Americans. Despite its purpose, the organization faces harsh criticism about not doing enough to keep the public safe. I have certainly noted this ever since Vioxx was pulled off the market in 2004.
I have never worked for the FDA, so I do not have close familiarity with its processes. I do, however, have some idea of how things work there, particularly the divisions responsible for approving drugs and medical devices. I know because I have read about them from the FDA web site. It helps me with my job as a medical technology consultant, because I review the U.S. regulatory status for new tests and treatments, not just the available scientific evidence.
I agree with the prevailing notion that the FDA needs improvement. Products should not be approved and then pulled off the market after safety issues arise. For me, medical devices are of special concern because these types of products have different approval procedures depending on their risk level. The simplest low-risk devices are typically exempt from approval while moderate-risk devices have a regulatory process that is less stringent than that applied to high-risk devices.
Besides the procedures, another major issue might be staffing. Each regulated product involves a ton of paperwork before marketing approval as well as post-marketing safety reporting if adverse events occur. If there are not enough people to handle the workload, approvals may be firm but slow or quick but risky.
Again, I'm not affiliated with the FDA, but this is my understanding of it. If there are any efforts to improve FDA oversight, I support them.
Posted by Anthony Lee
In 1999, the United States government launched an effort to research the many treatments under the category of complementary and alternative medicine (CAM). It founded the National Center for Complementary and Alternative Medicine (NCCAM), one of the National Institutes of Health, to carry out this mission. For the next decade, the NCCAM granted approximately $2.5 billion total to fund studies of different CAM treatments, including but not limited to ginkgo biloba, saw palmetto, and echinacea. Overall, very few treatments showed promise in studies.
I can imagine how this news could ignite the debate between conventional medicine and CAM. Supporters of conventional medicine might consider CAM research to be a waste of time while CAM proponents may feel dismayed by the news. This is an issue I've been interested in for a while, enough to have written an article about CAM. For me, I am on the side of conventional medicine but am open to CAM if the same rigorous study designs are applied to gather evidence. If something in CAM is proven enough, it can become an accepted treatment within conventional medicine. As an example, I am aware of acupuncture's benefits for chronic pain and nausea and am willing to accept that.
From this point forward, I can't say where things will go. Will funding for CAM research be restricted? Will the NCCAM be abolished and shut down? I don't know. But if the debate between the two schools of thought continues, I won't be surprised.
Posted by Anthony Lee
Two years ago, I wrote an article about sunlight in relation to sunburns and skin cancer. As with my other articles on Suite101, I prepared it to educate the public about a health topic. Now, as the summer season is ready to begin, this is a good moment to revisit sun safety.
Based on observations of people I know and a few reports in the media, it seems that some people who love sun tanning continue to do so, even with the known risks of excessive sun exposure. This includes individuals who do so at the beach and/or tanning salons. Attempting to explain that too much sunlight causes skin damage, and raises the risk of skin cancer, may not always work to curb their habit. Often, they believe that the tanning of their skin is a beautiful thing without realizing that it's nothing more than the skin's reaction to something harmful.
If one chooses to tan, the duration should be limited and the application of sunscreen is not a bad idea. Otherwise, wearing protective clothing can help reduce the risk of sun-related skin conditions. It is true that sun exposure helps the body produce vitamin D, but, as my doctor once said, it only requires a few minutes per day of sun.
At this point, we haven't seen a major spike in the incidence of melanoma, squamous cell carcinoma, or basal cell carcinoma, but we shouldn't have to wait for that to happen before taking sun-related precautions. That's why I reinforce the issue I made in my 2007 article. After all, prevention is always the best form of medicine.
Posted by Anthony Lee
In one of my previous blogs, I summarized the controversy that vaccines cause autism. This is something that has many parents fired up about enough to refuse vaccinations for their children. Parents may also cite other reasons for vaccine refusal, such as the fear of sudden infant death syndrome (SIDS). Whatever the rationale for their decisions may be, such actions do present with an unfortunate consequence.
Recently, a study by Kaiser Permanente Colorado found that children who were not vaccinated for pertussis were 23 times more likely to contract the disease than those who received the vaccine. Also known as whooping cough, pertussis is an infectious disease that is caused by the bacterium Bordetella pertussis and characterized by uncontrollable, repetitive, and severe coughing.
The medical community stands behind evidence that vaccines can prevent several diseases, so much that their incidence is dramatically cut short. Given this achievement, vaccines are often considered a milestone development in medicine. Sadly, with fears of vaccine safety among parents, there is the risk of the clocking being turned back. As an example, an outbreak of measles was reported in San Diego, CA, among children who were mostly not given vaccinations.
As with my other blog post about vaccines, this one will surely have some of you passionate about the issue. I continue to stand by what medical evidence says but will still examine the issue from both sides.
Posted by Anthony Lee
Whenever I see doctors and patients together, I often see two different levels of understanding. On one level, the doctor can picture the patient's disease process as it occurs, from which the doctor can understand the rationale behind diagnostic tests and therapeutic interventions. On another level, the patient, assuming one without a medical background, typically focuses on one thing: relief of symptoms. Of course, both sides are interested in the same goal of treating the patient's problem.
Still, there are situations where patients may find it helpful to understand what's going on in their bodies. This is particularly true for chronic conditions. Suppose, for example, a patient has chest pain because of a heart attack and receives acute and long-term treatment for it. If that patient only cares about how he or she feels symptomatically, then it might be clear why he or she is taking the medications prescribed. On the other hand, if that same patient were to understand that a heart attack involves death of heart muscle, which may possibly recur and/or result in further complications, then he or she may understand the importance of treatment.
Of course, I don't have studies that could back this up. They are based entirely on my own observations as a patient and as a former clinician. Even so, it might be something to consider, because the diagnostic and therapeutic approaches for any condition are based on the pathophysiology of a condition. If you can understand the underlying disease process, then everything else will make sense.
Posted by Anthony Lee
This week's blog entry is another opportunity for me to share a little medical wisdom with everyone. Recently, I've had people I know who came up to me with a personal medical question, each one concerned about having a particular disease or condition based on one symptom. I always welcome this sort of thing, even though I provide assistance for educational purposes only and not as a substitute for formal clinical evaluation by a practicing medical professional. Nevertheless, I'd like to share my latest thoughts.
Every symptom and sign has multiple explanations. For instance, abdominal pain can be explained by problems from any of the abdominal organs. The same idea applies to chest pain, jaundice, and whatever other symptom you can think of. I cannot think of an example where any abnormality is associated with one condition only.
It's perfectly normal for patients to want an explanation for a symptom. At the same time, it's easy to fall into the trap of assuming a particular diagnosis just because one doesn't like uncertainly. I mention this because such judgments might be erroneous and prevent proper care for the actual diagnosis, particularly when laypeople may not be aware of what the many other possibilities are. That's where a doctor comes in. Such professionals have knowledge of all the conditions that could cause a particular symptom and are in a position to sort out the different possibilities. This approach is more likely to correctly identify the problem.
Basically, this is why a doctor-patient relationship is important. By working together, patients can receive appropriate care from doctors they trust.
Posted by Anthony Lee
Every field of knowledge has its own jargon, or unique vocabulary, that typically sounds foreign to an outsider. Medicine is certainly no exception. I can recall several instances where people would ask me what a certain medical term means. In most cases, I was able to provide a clear explanation, and I did so by pointing out a simple method.
Except for eponymous terms named after specific people (e.g., Alzheimer's disease), many entries in a medical dictionary have prefixes and suffixes such that their individual meanings combine to form a definition for the whole world. Consider the following examples:
- "appendic-" (the appendix) + "-itis" (inflammation) = "appendicitis" (inflammation of the appendix)
- "col-" (the colon) + "-ectomy" (surgical removal) = "colectomy" (surgical removal of the colon)
- "mammo-" (the breast) + "-graphy" (x-ray imaging) = "mammography" (x-ray imaging of the breast)
- "thrombocyt-" (platelets) + "-penia" (less than normal number of cells in the blood) = "thrombocytopenia" (a condition of having fewer platelets than normal in the blood)
- "coronary" (related to the heart) + "angio-" (blood vessel) + "-plasty" (reconstruction or restructuring) = "coronary angioplasty" (a procedure to open up a narrowed artery in the heart)
The next time you find yourself confused with a medical term, see if you can break it down into its individual parts. With the aid of a medical dictionary or a medical professional, find out what the involved prefixes and suffixes mean. If you can do that, the whole term can be less confusing and, hopefully, more understandable.
Posted by Anthony Lee
Ever since swine flu, strain H1N1, was declared a health emergency last week, the public response has been quite remarkable. With a rapid rate of new cases of swine flu around the world, including approximately 140 cases in the United States over one week, it's natural for everyone to be afraid that this new strain of flu could spread rapidly. Furthermore, influenza associated with animals is often assumed to be more serious than human influenza. In my opinion, I'm happy that people have been vigilant about this infectious disease outbreak.
Obviously, the big question on everyone's mind is what will happen next. I myself can't make such a prediction, but I can at least present each side of the issue. On one hand, the number of deaths from swine flu is relatively small compared to the number of people who have the virus. Those who have died, including a child in Texas, may have various medical and social factors that played a role. On the other hand, there's always the possibility that this flu could come back with a vengeance. When the fall and winter months arrive, everyone will still have to keep an eye out for cases of strain flu, particularly if they are more serious than what we have seen recently.
For now, keep on taking the precautions that many health and media sources have pointed out: wash your hands, cough and sneeze into a tissue or shirt sleeve, avoid contact with people who appear sick, and stay home if you feel ill. Such actions can minimize the spread of swine flu to others. Meanwhile, public health officials will continue to keep an eye on trends related to swine flu. I will certainly do the same.
Posted by Anthony Lee
When people think of heart attacks, they think of chest pain as the presenting symptom. While it may be true in most cases, it's not always like that. Some people might have shortness of breath or fainting as a symptom of a heart attack. In other cases, there may be no symptoms at all.
A recent study found that silent heart attacks, which include heart attacks without symptoms and heart attacks with symptoms believed to be non-cardiovascular, may occur more frequently than previously thought. This study was conducted using cardiac magnetic resonance imaging (MRI) and a contrast technique called delayed enhancement, which involves contrast material accumulating in dead heart tissue to visually mark where heart attacks occurred.
Like any study, there will be discussion within the medical community. I can imagine that they would talk about how it's only one study and that the patients might not represent the general population. Nevertheless, the study is a platform for launching further research.
If there is one thing the study reminds us, it's that cardiovascular health, or general health for that matter, is more than just the presence or absence of symptoms. It's about what goes on inside our bodies, something to keep in mind in order to prevent symptoms from occurring.
Posted by Anthony Lee
Everyone knows that a hospital emergency department is for medical cases that are worrisome and severe and/or pose the risk of complications and death. However, there are times when a situation appears borderline and one may not be sure whether a visit to the emergency department is necessary.
Recently, my mother was at home when something heavy had fallen and hit her head. Although she did not have serious signs such as vomiting or neurological dysfunction, the pain at the impact site felt more than minor pain. In light of the death of Natasha Richardson by intracranial bleeding from head injury, I took my mother to the emergency department. Fortunately, she checked out OK.
I could make a list of seemingly minor clinical scenarios that warrant emergency medical attention, but I won't. The list would be lengthy and not necessarily be complete. Instead, I shall provide general tips. If you feel worried about something, it's better to be safe than sorry. The doctor can always reassure you if it's not serious. If there are advice nurses you can call in your area, they can also give you an idea about the best course of action. The most important thing is to not put off a medical concern when it makes you feel uncomfortable.
Posted by Anthony Lee
Traditionally, it was believed that the human heart does not regenerate or grow new cells. Now there is a study that may disprove it. If it is indeed possible for the heart to grow new cells, one can dream of the possibilities for therapeutic applications, such as regenerating heart muscle following a heart attack.
Of course, this breakthrough is only in the realm of basic science research. Much more needs to be explored before the research can be carried over to clinical research. You can imagine that all of this will take many years. Nevertheless, this breakthrough is something to cheer about.
Posted by Anthony Lee
This week's blog entry is not about one topic, but rather three topics that are summarized as follows:
- Statins and Blood Clots: A recent study found that the cholesterol-lowering statin drug Crestor (generic name rosuvastatin) can also lower the incidence of blood clots in the veins. This suggests that taking Crestor lower the risk for deep vein thrombosis (DVT), a blood clot within the large veins of the leg that can cause pulmonary embolism (PE) when it break off and gets stuck in the lung circulation.
- Combination Pill for Heart Disease: Patients with heart disease have to take medications that include aspirin and drugs for high blood pressure (hypertension) and high cholesterol (hypercholesterolemia). Recently, a combination pill with aspirin, a statin, and three blood pressure drugs was studied with promising results. This has the potential to make it easier for patients to take these drugs.
- Aspirin and Plavix Instead of Warfarin: Patients with the heart rhythm abnormality atrial fibrillation are prone to forming blood clots in their heart because blood moves more slowly. These patients take the blood-thinning drug warfarin to prevent these clots and, therefore, strokes, but the drug requires careful laboratory monitoring. A new study suggests that taking aspirin and Plavix (generic name clopidogrel) may be another effective protective treatment against blood clots from atrial fibrillation.
Although these reports promise a benefit, there are still issues to consider. Primarily, the studies are early trials and need to be followed with repeat studies. Also, the combination pill may be an issue if the doses of the individual drugs in the combo pill need dose adjustments. As with any new medical development, the above three issues will continue to be explored in the years to come.
Posted by Anthony Lee
In countries where skyrocketing healthcare costs are a problem, such as the United States, one option is becoming more attractive: medical tourism. This involves traveling to other countries where medical care is much cheaper. In addition, there are services that provide accommodations for medical tourists, such as lodging and travel arrangements. Supporters of medical tourism like to mention both the cheap medical treatment and the pleasures of travel.
Of course, medical tourism is something that is debated within the medical community. There is certainly the issue of medical costs and whether measures can be taken to reduce them domestically and cut the need for medical tourism. In addition, records of treatment abroad may be separate from the medical records accessible by the patient's primary care doctor. Things might get complicated if detailed information about the treatment abroad is needed and they are not easy to obtain. Finally, even if the advertised services sound promising, one should still be wary that nothing is 100% certain.
My stance on medical tourism is very much like that of other things not yet considered standard of care. I advise caution and the need to weight the risks and benefits, even though I acknowledge that the choice lies in your hands. Over time, I will keep an eye on this new trend and reevaluate my stance accordingly.
Posted by Anthony Lee
The topic of this week's blog entry stems from the recent tragedy of Natasha Richardson. The actress died this week after what appeared to be a minor ski accident. She felt fine for a short time until she experienced sudden neurological changes. An autopsy revealed the diagnosis of epidural hematoma, a type of intracranial bleeding. This means that Richardson had a head injury that caused gradual bleeding into the space between the cranium and dura surrounding the brain, eventually filling the space and exerting pressure on the brain.
It is a very heartbreaking thing to hear about. Some people might say that the use of a helmet could have prevented such an injury. This is why protective gear is highly recommended for certain activities, such as bike riding and skateboarding. Of course, prevention of fall injuries is not just limited to certain physical activities. It also applies to hospitals and nursing homes. Elderly individuals can have serious injuries to places such as the head and hips when they fall, especially when they are prone to doing so because of limitations with movement and balance. In such settings, careful observation and assistance are important.
Basically, this week's message is simple: certain settings can pose the risk for accidents and physical injuries. Prevention can often make a big difference.
Posted by Anthony Lee
In my days as a medical student and an intern physician, I have worked in various hospitals and clinics and have seen the different ways that medical records are kept. Some did it entirely the old-fashioned way with paper charts. Others maintained some or all records electronically. Between the two, many would say that electronic medical records (EMRs) are much better.
In my opinion, there is nothing more frustrating, and sometimes more risky, than reviewing a paper chart or doctor's orders with illegible handwriting. It's also more challenging to see groups of information, such as lab results, as a series of pages and not all at one time. If one needs medical records from another hospital, he or she would have to call the other facility and ask them to fax the records over. With EMRs, one can easily read computerized text, see lab results in a trend format, and access records from within a network of hospitals and clinics, not just from one facility alone. With these and other benefits, EMRs can save a lot of time.
There may be some issues regarding the need for traditional physicians to learn how to use EMRs, how much money would be spent for implementation, and the long-term clinical and financial outcomes. After all, EMRs are like anything in medicine. They have to demonstrate proven benefit before they can be widely accepted. For now, I am a big supporter of EMRs and would love to see them put in place everywhere.
Posted by Anthony Lee
By now, you've probably heard about the latest study that reveals the best way to lose weight: cutting down on calories. You can spend as much time as you want on diets that focus on particular food groups or nutrients, but in the end, the amount of food you take in, combined with the amount of exercise you get, will make the biggest difference.
Of course, it's easier said than done. Various factors can lead people to eat food in large amounts, including greater accessibility to food, a "clean plate" mentality, and more available options for leisure without physical activity (e.g., television). It does take discipline to get past these obstacles, but if you're persistent with consuming reduced amounts of food, you can get closer to your weight loss goal. I do confirm this with my own personal experience.
In fact, there is an interesting fact I can recall. Of all the weight loss programs out there, Weight Watchers is often cited as one of the most successful. The reason is simple. It's based on cutting overall calories, not specific components of the diet. Here is additional proof that the latest study might be true.
So the next time you're considering weight loss methods, don't focus on dietary components. Focus on portion size. Your chances for successful weight loss are greatest with this method.
Posted by Anthony Lee
One of the most heated medical debates is whether vaccines, particularly the measles-mumps-rubella (MMR) vaccine or vaccines containing thimerosal, cause autism. Some parents claim that they do based on anecdotal accounts that their children's autism began shortly after vaccination. The medical community maintains their position that there is no link between vaccines and autism based on scientific evidence. All of this has started because of a 1998 article in the journal Lancet in which Dr. Andrew Wakefield expressed concern about the association.
I can understand both sides. I would be concerned if I had a child who became autistic after certain vaccinations, especially with the high-profile case of Hannah Poling. On the other hand, I know that medicine is evidence-based and all statements must be backed up. I have looked at the full texts of the studies that demonstrate no vaccine-autism link in various ways. For example, some illustrate that autism cases may be on the rise, but the percentage of children covered by vaccines has always been high and constant. A study from Japan found that new cases of autism did not decrease even after removing thimerosal from vaccines. In addition, most of these studies looked at very large patient populations.
Recently, a federal court ruled that vaccines were not the cause of autism. Obviously, the big question is what causes autism. Is it caused by vaccines alone, vaccines in conjunction with another factor, or something else altogether? Until new evidence sheds light on the issue, the controversy will no doubt continue.
Posted by Anthony Lee
Recently, the journal Cancer published a study that explored a possible link between marijuana and testicular cancer in men. The investigators conceived the idea when it was observed that marijuana use and rates of testicular cancer were on the rise in the same time period. In summary, the study was a case-control study that compared 369 men with testicular cancer with 979 men who did not have testicular cancer. Marijuana was found to be more frequent in the former than the latter.
Keep in mind that the study found only an association. In order to determine if marijuana could cause testicular cancer, further studies need to be conducted, such as those that focus on testicular cells and whether they have receptors to cannabinoids, the active component of marijuana.
Although testicular cancer is not common, it tends to appear silently, if at all. It might not be a bad idea for men to periodically self-examine the testes. A good place to do so would be in the shower. Some might find such a preventive measure to be questionable, especially when it's hard to make it a habit, but at this time, it's probably better than nothing.
Source: Daling, Janet, et al. "Association of Marijuana Use and the Incidence of Testicular Germ Cell Tumors." Cancer. February 9, 2009.
Posted by Anthony Lee
It's natural to expect a certain treatment when you think it will help you. However, what happens when the doctor disagrees?
Consider the following example. A patient with obesity wants weight loss (bariatric surgery). However, because the patient can still losee some weight by other means, such as dieting and behavioral change, the surgeon feels the surgery is not necessary, even if the patient insists.
What does it mean for a treatment to be medically necessary? Usually, it means that the treatment can and will likely resolve the problem significantly when a less costly option can do the same. In the above example, bariatric surgery is not medically necessary because lifestyle modifications can still help the patient.
The lesson here is not to assume that specific treatments are always necessary. If you have a question about medical necessity, discuss it with your doctor who can weigh the risks and benefits.
Posted by Anthony Lee
Infectious outbreaks are a scary thing, especially when they are transmitted through food. I have remembered public health warnings in the United States about E. coli in undercooked hamburger meat and spinach. Now there is another ongoing outbreak. It involves peanut products, and the infectious culprit this time is Salmonella.
The tricky part about the Salmonella outbreak is the variety of products that may be tainted. Peanuts can be sold as they are or processed into other products, such as peanut butter. It has led to many product recalls, and an investigation that found the most likely source: an unlicensed peanut plant in Texas.
Obviously, this is a lesson public responsibility. Food companies are expected to follow safety regulations so that their products can be consumed safely, and regulatory bodies, such as the U.S. Food and Drug Administration, should make sure the rules are enforced. They are especially important when the issue involves processed food products that don't seem likely to be contaminated.
As for the consumer, one can take general precautions with food preparation of meat and produce. Otherwise, with other types of food products, one can only keep his or her eyes open on the latest developments. For the outbreak of Salmonella in peanuts, it may still be a lifesaver.
Posted by Anthony Lee
When people are hospitalized, they usually expect to receive care from one doctor and one doctor only. Some hospitals are like that. However, there is one type of hospital that does it differently: the academic or teaching hospital.
In such a place, your care comes from a team of individuals. The leader of the team is the attending physician, whom you could consider the main doctor. In addition, there is at least one doctor in training, a first-year intern or a resident in the second year or beyond, whom you typically see more often. Sometimes, there can even be a third- or fourth-year medical student who, like the doctors in training, are involved in your care for learning purposes.
For some patients, sorting out the members of this treatment team is tricky. Interestingly enough, a study recently published in the Archives of Internal Medicine reports that, among patients at the University of Chicago Medical Center, 75% could not correctly name any of the physicians and trainees on his or her treatment team. Of the remaining 25% who attempted to identify his or her providers, only 40% were correct. This can be problematic when such confusion leads to a lack of trust and, ultimately, suboptimal healthcare delivery.
Hence, it might be helpful for treatment teams in academic hospitals to introduce themselves clearly and have pamphlets for patients that identify the team members. The less unsettling the hospital experience, the better.
Source: Arora, Vineet, et al. "Ability of Hospitalized Patients to Identify Their In-Hospital Physicians." Archives of Internal Medicine. 2009 Jan 26;169(2):199-201.
Posted by Anthony Lee
We all want to be healthy and have the best treatments available for any medical problem. However, it's often easy to believe the claims of an advertisement for a medical treatment without careful evaluation.
This happens a lot with the prescription drugs advertised on television and in print. There are other examples, though. Printed ads may claim benefits of certain complementary and alternative medicine therapies. A renowned physician may promote a new procedure or medical device that is not yet widely accepted.
If you ask your doctor about such advertised products or services, he or she might say that they're not proven. The reason is not to deny treatment. Rather, it's to make sure that you don't waste time and money on something that does not work and/or results in complications. That's why medicine is evidence-based. Studies have to demonstrate safety and efficacy of any new treatrment before it becomes standard of care.
So always be wary of advertisements for medical treatments. Don't be afraid to take a step back and evaluate them objectively.
Posted by Anthony Lee
The latest issue of the New England Journal of Medicine published a study about surgery and safety outcomes. It found that, in over 3,000 patients at eight hospitals from around the world, the introduction of a surgical safety checklist significantly reduced the rate of death and the rate of complications. This checklist includes items to confirm before and after the surgery, such as patient identification, preoperative marking of the surgical site, and counting all surgical tools and sponges to ensure that nothing is left inside the patient.
This study is important in light of the major issue of medical errors. You have probably heard of at least one news story where someone accidentally received a medication overdose or suffered from some other type of preventable medical mistake. Efforts should be made to minimize the occurrence of these mishaps, and surgical errors are no exception. In my opinion, the results of the study in NEJM are quite convincing and remind us of the importance of checking things carefully.
Source: Haynes, Alex B., et al. "A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population." New England Journal of Medicine. E-published January 14, 2009.
Posted by Anthony Lee
The degree of illness from influenza can range from none, particularly with flu vaccinations, to severe, especially for the most susceptible individuals. For people in the latter category, certain antiviral medications are available to treat the flu. One of these drugs is Tamiflu, whose efficacy is notable and makes it a popular choice among physicians.
Unfortunately, influenza has developed resistance to Tamflu. It's the latest example of an unwanted but familiar phenomenon.
In general, bacteria and viruses reproduce very often and, therefore, undergo mutations in their genes. These genetic changes are passed onto the new pathogens. The result is alteration of a structure in the pathogen such that a medication against it no longer works. That's how pathogens develop resistance, a likely event whenever a single medication is used extensively against the pathogen.
In such cases, the medical community must find a new treatment for people who truly need it. At the same time, physicians must be careful not to overuse one antibiotic or antiviral agent. Otherwise, drug resistance makes it tougher to combat infectious diseases.
Let us hope that new options for treating the flu can be developed soon.
Posted by Anthony Lee
As I've preached many times in my previous blogs, living a healthy life comes from making the right choices. In many cases, preventive medicine is the best medicine. Medications are there for situations where disease occurs beyond one's control.
Often, I cannot help but notice how many individuals would take medications in place of preventive measures that are not entirely impossible. For example, some obese people may have not made efforts to change their diet and activity habits, yet they continue to take medications for diabetes, hypertension, and hypercholesterolemia. It makes me wonder. Is dependence on medications getting out of hand?
Having too many medications can involve unnecessary inconveniences and financial consequences. Furthermore, there is the problem of drug interactions. The bigger the medication regimen, the greater the likelihood of two or more drugs influencing each other's effects or producing unwanted side effects. These problems can be especially significant for elderly patients.
So when a list of medications gets long, consider how important each one is. Chances are that you'll find some that could be removed, making the list more manageable.