Health Blog - Health Information & Updates

Health Care Update News

2010-11-25T04:28:00.000-08:00

The Health 2.0 public option - Ano Lobb

Justmeans health writer and RAND researcher Sam Werthheimer recently reported on interesting trends from the Health 2.0 conference in San Francisco. Just because the conference was dominated by private ventures, however, doesn't meant that governments aren't also trying to apply web 2.0 to improve health delivery.

US health reform efforts are banking on effective health information technology (IT) as a means for improving the efficiency, quality, and value proposition of health care delivery.

Post continues:- http://www.justmeans.com/-Health-2-0-public-option/38379.html

Facebook triggers asthma - Ano Lobb

Can Facebook trigger asthma attacks? Apparently so. Italian doctors report in The Lancet on a new and previously unreported health risk associated with the ubiquitous social networking site: Asthma.

Sound crazy? Granted, the headlines are catchy and trying to ride the wave of social-media. But the details actually make sense. The case-report discusses an 18-year old man with asthma who was distraught after his girlfriend un-friended then broke up with him. After gaining access to her facebook page, he saw that she had friended several new young men, then had an asthma attack.

Post continues:- http://www.justmeans.com/Facebook-triggers-asthma/38149.html

Health 2.0 Company Launch Review Part 1 - Sam Wertheimer

The term "Health 2.0" describes the interface between web 2.0-inspired technology and health care. The sector is growing rapidly as patients search for ways to navigate the health care system and companies - both large and small - race to serve consumer needs. The annual Health 2.0 Conference in San Francisco (Health 2.0 SF) brings many of the key players under one roof. This year I joined the gathering to learn more about the entrepreneurs, innovators, and consumers doing good work in the Health 2.0 sector.

Among the highlights of the conference were launches of new Health 2.0

Post continues:- http://www.justmeans.com/Health-2-0-Company-Launch-Review-Part-1/38299.html

Health 2.0 Company Launch Review Part 2 - Sam Wertheimer

Sharecare is WebMD plus facebook. The site aims to help patients make healthy decisions by interacting through social media applications with registered health care "experts." These experts are vetted by Sharecare and include health care providers, advocacy groups, and corporations. Consumers can search the site by topic, enter particular health care questions, or browse their favorite expert's pet subjects. They can also use the facebook "like" button to endorse helpful health care advice and become friends with the experts who provide the tips.

Post continues:- http://www.justmeans.com/Health-2-0-Company-Launch-Review-Part-2/38304.html

Smart health care=Innovation - Ano Lobb

Basic sciences are increasingly being applied in innovative ways to address some fundamental health care problems. Applied chemistry has combined paraffin and dye to potentially double the effectiveness of blood tests used outside the clinic. Improving the accuracy of home-based health tests has benefits beyond the obvious improvements in accuracy: When appropriately used they also reduce demand on health care resources by potentially keeping people away from unnecessary clinical encounters, and by bringing the test to the person they are the embodiment of patient-centered care.

Post continues:- http://www.justmeans.com/Smart-health-care-Innovation/38338.html

Health Care Weekly Updates - Justmeans

2010-10-08T04:39:00.000-07:00

Commonwealth Games vs. Common Health goals in India - Ano Lobb

Along with the expected fanfare accompanying the opening of the Commonwealth Games in New Delhi, India this weekend there was a generous serving of controversy. While there are many good reasons for skeptics to raise concerns, this post will briefly consider three: Public health, dengue fever, and malaria.

Bluntly stated, health equals wealth. More specifically, greater inequalities in national distribution of wealth are correlated with worse measures of population health. Rapid economic gains in India have not been shared by all; one telling statistics is that the personal wealth of the richest 49 Indians accounts for a whopping 31% of India's entire gross domestic product, according to the newspaper Financial Express.

Post continues: http://www.justmeans.com/Commonwealth-Games-vs-Common-Health-goals-in-India/33533.html

Race (still) Matters: Innovation needed to tackle health disparities - Ano Lobb

A recent posting looked at a new study of health technology being overused in breast cancer care. Another study presented this month at the American Association for Cancer Research Conference sheds light on the importance that race plays in health outcomes, regardless of insurance status.

Assistant Professor Heather Hoffman and colleagues from George Washington University's School of Public Health performed a retrospective analysis of 983 women who underwent breast cancer examinations at six hospitals in Washington D.C. They measured diagnostic delay, the span of time between the detection of a breast abnormality and a definitive diagnosis, for women who were white, African American, or Hispanic, stratified by whether they were insured or not.

Post continues: http://www.justmeans.com/Race-still-Matters-Innovation-needed-tackle-health-disparities/33735.html

Is questionable medical information technology putting patients at risk? - Ano Lobb

There's been a lot of good news in cancer care lately: The American Cancer society recently reported a decrease in cancer deaths, medical information delivery harnesses technologies such as interactive patient-information kiosks, and nano-technology verges on a breakthrough for more targeted treatments. All of these, combined with more vigorous prevention and detection efforts and more effective standard treatments has helped to make cancer an increasingly survivable journey.

Technology, however, is not a panacea. A striking example is the increasing usage of computer-aided detection (CAD) for both screening and detection mammography. Rather than depending on the seasoned eyes of radiologists, CAD uses a computer program to analyze radiographic images.

Post continues: http://www.justmeans.com/Is-questionable-medical-information-technology-putting-patients-at-risk/33641.html

The Evolution of Primary Care: Part 4 - Sam Wertheimer

Delivery of primary health care services in the U.S. used to involve a physician and a patient. The physician would see the patient in a clinic, conduct an examination, enter notes in a paper record, prescribe a follow up appointment, and say goodbye until the next scheduled visit. Usually this process occurred within a 15-minute window arranged by the physician's front office staff. Although this type of health care visit still occurs, it is fast becoming an exception to the new rules of primary care. This column, the fourth in a series on the players changing primary care, focuses on non-physician health care providers.

One of the targets of change in the evolution of primary care is the 15-minute visit. This is because many find visits this short do not allow enough time to provide comprehensive health care.

Post continues: http://www.justmeans.com/-Evolution-of-Primary-Care-Part-4/33128.html

Health care conundrum: When cancers are harmless

2010-05-05T03:09:00.000-07:00

A new paper in the Journal of the National Cancer Institute raises an interesting health care conundrum for cancer care: up to 25% of breast cancers, 50 of lung cancers, and 60% of prostate cancers that are detected by screening may represent overdiagnosis. This is not a radical new finding made in haste, the authors, one of whom was my biostatistics professor in grad school, have in fact been studying this phenomenon for decades. But it is a finding that raises especially interesting challenges in how we perceive, screen for, and treat diseases.

What the paper found was that in those cases and frequencies mentioned above, cancers detected very early would, if left untreated, never develop to cause symptoms or threaten health, and the patient would die of some other, non-cancer related cause. How is this possible? Two forces conspire to create the quandary: The amazing power of our bodies, and the amazing power of technology. On the one hand, screening technologies are getting so good that we are able to locate ever-smaller abnormalities that fit the general definition of being “cancerous.” And yet we are finding that in many cases, the body is able to detect and destroy aberrant cell growth on its own in a not-insignificant percentage of cases. So we are increasingly able to detect and label as cancer abnormalities that the body is often able to neutralize on its own, or that would never grow to a life-threatening stage.

Is there harm in treating something, even if it wouldn’t have turned deadly? In short, yes. Cancer treatment is never a nice experience, and may involve radical surgeries, such as breast removal, and of course powerful chemical and radiation treatments. In some cases the treatments themselves result in death or new cancers. And there’s also the stress, fear and discomfort involved.

The health care conundrum occurs when deciding how to use this information. The authors of this new paper call for more research, as well as carefully informing patients of the possibilities and likelihoods that their cancer’s may not actually be life threatening. The trouble, of course, is that we can’t yet tell the harmful abnormalities from those that might kill us. What fascinates me is, even if informed of the possibilities that a potential cancer is harmless, how would I respond? How would you respond? Would this new knowledge give you some hope, sway you to opt for a less aggressive approach? Would it further confuse you and ad to the stress of the decision making process? We have been raised in a world that wages wars on cancer, and malignancies constantly rate among the most frequent causes of death. Is it possible that we know a lot less about this thing called cancer than we’d lke to admit? It appears so.

Photo credit: Annie Cavanagh. Wellcome Images

The best diet? Try changing your environment

2010-05-05T03:02:00.000-07:00

It’s no mystery that many of us struggle to lose weight on the quest for health. And its not that the knowledge or theory of weight lose is so difficult, it’s factors like discipline and convenience that generally sink our best intentions. For many, unhealthy eating verges on an addiction. After all most of us understand the numbers game of weight lose: Eat more calories than you burn, and you gain. Burn more than you eat, and you lose. Tomatoes: Good. French fries: Bad.

Now new research is putting some evidence behind a possibly more effective approach: Changing your environment. Researchers from the Cornell Food and Brand Lab performed a small study in 200 folks aiming to improve their health through weight loss. Participants were put into three groups and given instruction of either 1. Changing their environment, 2. Changing their eating behavior or 3. Changing their diet. After three months the winners were folks in group 1. In fact, they lost 1 to 2 pounds per month per “environmental change” tip. What kind of tips dropped the pounds? Simple things like using smaller plates, moving or removing candy dishes, rearranging their cupboards, abstaining from watching tv or surfing the internet while eating.

The single biggest key was consistency, and after sticking with a routine for 20 days, people were pretty much on track for the rest of the month. The researchers note that such behavioral changes are easier to follow than advice such as “eat more fruit” or “stop eating fried foods.” And another new study from the same researchers adds further support for our strange food choices we make in the name of health. In a separate study they found that people eating fattening foods such as cookies that were labeled “organic” underestimated their calorie count by 40%. They call this the “health halo,” the perception that a healthy label such as “vegetarian” or “organic” adds intrinsic healthiness to a food. Their advice when it comes to such healthfully labeled treats?

“Take your best guess at its calorie count. Then double it. You’ll end up being more accurate, and you’ll probably eat less.” Calorie counting may not always be the best way to lose weight, but when it comes to sweets and treats, its worth at least pondering how many minutes on the treadmill you’ll need to burn off those empty calories, since they provide no other meaningful benefits to human health.

Photo credit: The author

Obama Administration Discusses Lessons Learned from Swine Flu

2010-04-30T06:18:00.000-07:00

Public health officials did much to alleviate spread of swine flu in 2009, but more needs to be done.

Too many people still mistrust vaccines – health care providers included – and vaccine production technology needs a shot in the arm. That’s the takeaway from the swine flu experience of 2009, U.S. Health and Human Services Secretary Kathleen Sebelius said last week at the 44th National Immunization Conference in Atlanta. And while communication systems were strong during the early days of the swine flu outbreak, more needs to be done to reach out to some communities, especially minority communities, and above all physicians, Sebelius said.

“We shouldn’t have to convince health providers that vaccines are safe and that they work. But, despite the fact that we had more health providers than ever getting vaccinated last year, there was still a sizable number who did not. We need providers on the front lines. We need to make sure that the vulnerable people they work with aren’t at greater risk,” Sebelius said.

Sebelius’ address comes one year after the panic of last April, when public health officials were still puzzling out the new, aggressive strain of flu that had clearly invaded the New York City public school system. Later dubbed swine flu, the virus appeared to hop-scotch over typical influenza victims – the elderly and those with compromised immune systems – and instead was striking down and even killing young, otherwise healthy people and pregnant women with a vengeance.

The unknowns surrounding the swine flu – and the rapidity of its spread – created simultaneous panic over its origins and effects and suspicion over the vaccine that arrived on the scene. The World Health Organization declared an official pandemic in April of 2009, and has since had to defend itself against accusations that the declaration was motivated by a desire to enrich the pharmaceutical companies that were working on the vaccine. Too many people, including those whose medical conditions made them susceptible to swine flu complications, refused to take the vaccine out of fear it had been rushed and had not been properly vetted. Sebelius’ own agency, the HHS, had to admit that original estimates of the country’s ability to produce the vaccine had been overstated. This in particular is troubling to Sebelius, who used the confusion around vaccine production to illustrate the need for better vaccine production methods.

“This flu season has made us even more committed to ensuring that vaccine production—and all of our medical countermeasures—are state-of-the-art. Our experience with the ups and downs of the vaccine manufacturing process has made clear the need to enhance our country’s influenza vaccine manufacturing capability,” Sebelius said, adding the HHS was already working with vaccine companies to move past the “egg-based” technology, in which vaccines are basically grown in eggs, to more advanced and reliable method.

Sebelius is right. We need to learn the lessons provided in 2009 and then do it better next time. Some southern states are already showing swine flu activity, though it’s too soon to know if that will develop into a true outbreak. But if and when swine flu does return in greater numbers, we want there to be plenty of vaccine to give, and plenty of people willing to receive it.

Photo Credit: Justin Hourigan

Patents in health care: Fuel for innovation or secretive black box?

2010-04-27T02:32:00.000-07:00

Exclusive patents in the biotech, pharmaceutical and chemical realms of health care can foster collaboration, increasing the speed at which new products come to market. This according to an analysis of 200 exclusive patents by publicly traded firms just published in Strategic Management Journal. But there does appear to be at least one exception to this rule, according to other new research: Genetics.

Evidence supporting patents finds that rather than locking away potential innovations in a black box of exclusivity, such contracts encourage partners to throw their full weight behind projects, since they know that their efforts won’t be undercut by a faster moving competitor. The authors acknowledge that some discoveries can have multiple future applications, and recommend very narrowly crafted agreements that leave open the possibility of taking other product variations to market at a future date, perhaps with other collaborators.

Another new report published in Genetics in Medicine, suggests that the opposite is true for health care applications of genetic discoveries. After reviewing genetic tests for 10 conditions, the authors report that patent holders, who are generally academic entities supported by governmental research grants, were never the first to market with innovative applications of their genetic patents.

Of course, when it comes to genetic testing it might not matter when you consider that not a single genetic test has yet been shown to increase length or quality of life. They have been shown to land health care researchers in shaky political and cultural grounds, however. Academic researchers recently found them on the wrong side of a judge’s order after using genetic material gathered from a Native American tribe to link tribal ancestry to Asian populations. The tribe claims that they were not provided with adequate informed consent, and were outraged that genetics were used to disprove the creation myths that are central to their self-identity and that clearly identify their current tribal land as their place of origin. While the researchers fall back on the argument that they are merely increasing knowledge for the good of all humankind, accidently “disproving” a creation myth in the name of health care is at very least an exercise in poor public relations.

Genetic research unveils at least two fallacies of science: 1. That there is no opportunity cost. In other words, that we couldn’t use the resources being poured into “knowledge for knowledge’s sake” into practices proven to improve health; and 2. That not moving forward means moving backwards. While its argued that halting genetic research could miss chances to cure disease, leaving all of use worse off than we currently are, the fact is genetic research has to date not improved our lives. Then there’s the creepy sensation that you might get from the idea that a corporation can patent something that is naturally created in your body, and is fundamental to your identity as an individual.

Photo credit: The author

Volcanic ash cloud poses no health threat

2010-04-26T05:49:00.000-07:00

The volcano that has critically injured the airline industry poses no real threat to human health.

We like to celebrate good health news here at Justmeans, so I’m pleased to say that despite the billion or so dollars that pesky Icelandic volcano has caused the airline industry, it apparently isn’t causing a whole lot of health problems for humans. A report from the World Health Organization (WHO) says that because the bulk of the ash is so high in the atmosphere, it isn’t expected to cause a lot of trouble on the ground - unless winds shift and cause localized, regional problems.

According to the WHO, it’s the size of the particulate matter of the ash cloud that counts. The most dangerous particulates are those that are smaller than 10 microns in size, because they can reach deep into the lungs and embed there. That can potentially cause far-reaching health problems. About one-fourth of all the particulate matter of the Icelandic ash cloud is that small, according to Dr Maria Neira, Director of Public Health and Environment Department at WHO.

Still, the WHO is encouraging people, especially those with chronic respiratory conditions like asthma, emphysema or bronchitis, to keep a close eye on the ash cloud and an ear tuned to their local health authorities. "Since the ash concentration may vary from country to country depending on the wind and air temperatures, our advice is to listen to local public health officials for the best guidance for individual situations," says Neira. "If people are outside and notice irritation in their throat and lungs, a runny nose or itchy eyes, they should return indoors and limit their outdoor activities."

The ash cloud was born last week, when a volcano belched a mass of smoke and ash into the air. That cloud drifted over much of Europe and grounded thousands of flights. Analysis has shown that the ash cloud particles consist mostly of quartz and glass. Health authorities have also found aluminium, silica and oxygen, as well as some fluoride.

Officials with the World Health Organization say the concentration of particles that may reach ground level is likely to be low and should not cause serious harm. Most of the ash that might reach the ground is likely to be too big to inhale into the lungs, but could irritate eyes, nose and throat. Remaining indoors will diminish the risk of these symptoms, since closed doors and windows will partly prevent penetration of the larger, irritating particles inside buildings. How has the ash cloud affected you?

Photo Credit: NASA Goddard

Most people don't make health decisions based on athletes' behavior

2010-04-26T03:33:00.000-07:00

British researchers found that young people's alcohol consumption doesn't mirror the pro athletes they admire.

Whether it’s photos showing Michael Phelps smoking marijuana, doping allegations leveled at athletes like Marion Jones and Floyd Landis, the marital woes of Tiger Woods, or drunken driving charges for Charles Barkley; sports stars are frequently caught behaving badly. Each new incident seems to bring a collective finger-wag from the public, and charges that since young people look up to athletes, they should behave accordingly.

But a new study suggests that young people really don’t make health decisions based on athletes’ behavior – at least when it comes to alcohol consumption (Barkley might have been right way back in 1993 when he declared “I am not a role model.”). British researchers at the University of Manchester and the University of Western Sydney had more than 1,000 young sports fans and those who didn’t follow sports report how they perceived the drinking behavior of some famous athletes. The same group of young people was asked to report their own drinking habits according to the World Health Organization's Alcohol Use Disorder Identification Test.

"Our research shows that young people, both sporting participants and non-sporting participants, don't appear to be influenced by the drinking habits of high-profile sportspeople as depicted in the mass media,” said Dr. Kerry O'Brien, the lead researcher for the study.

Most recently, the Canadian women’s hockey team came under international scrutiny after they brought beer, champagne and cigars onto the ice to celebrate their Olympic gold medal win. Gilbert Felli, head of the Olympic Games for the International Olympic Committee, condemned the celebration, saying that athletes shouldn’t drink in public and that the team provided a bad image for sports values.

In the end, athletes are human. They take part in unhealthy behaviors the same way average Joes do. It’s understandable to admire their athletic accomplishments, and to want to mirror the dedication and perseverance that helped them achieve their goals; but ultimately, each person should make health decisions based on their instincts and their own sense of what’s best for one’s body; not on what a pro athlete is doing.

Photo credit: Scott LaPierre

Doctors, hospitals slow to make “meaningful use” of electronic health records

2010-04-19T02:08:00.000-07:00

Physicians have been slow to adopt the “meaningful use” of electronic health records required for incentives.

Despite billions of dollars in incentives for doctors and hospitals to adopt electronic heath records, researchers have found that actual, authentic and effective use of the records remains in its infancy. While a significant number of hospitals and doctors have made the upfront investment in electronic health records, they have been slower to use them in a way that translates into greater efficiency and improved health outcomes, the study’s authors found. For example, researchers found that the use of electronic health records to date have not led to improvements in patient mortality, surgical complications, nor length of stay and costs.

"We are still in the early days of electronic health record adoption, and there's little evidence for how best to implement the technology to make the greatest gains," study leader Catherine DesRoches, of the Mongan Institute, said in a statement. "Hospitals may not see the benefit of these systems until they are fully implemented, or it may take many years for benefits to become apparent." The study was published in the April issue of the journal Health Affairs.

The researchers analyzed data collected from 3,000 hospitals that responded to a 2008 survey of acute care hospitals belonging to the American Hospital Association. The health care institutions were asked whether they had put computerized systems in place for different functions, including medication orders, lab reports, specimen tracking and discharge summaries. What they found was that even among health care providers and facilities that invested in electronic health record software, not all were using their systems well.

Public health officials need to pay attention to this survey. The 2009 American Recovery and Reinvestment Act authorized approximately $30 billion in grants and incentives to support electronic health record adoption. Health care providers could receive bonuses through Medicare and Medicaid if they demonstrate "meaningful use" of electronic health records. Public health officials then had to define what "meaningful use" constituted, as they have begun to do.

But they’ll have to do more to get doctors and hospitals to really use the electronic health records. In addition to letting doctors know what meaningful use of the records is, public health officials may have to offer training. It does little good to offer incentives if those incentives aren’t translating into greater efficiencies and greater training. What suggestions do you have?

Photo Credit: npslibrarian

Sociology of health: When diagnoses are contagious

2010-04-19T00:32:00.000-07:00

Researchers, policy makers, and parents trying to untangle the causative factors for surging autism diagnosis may have just had another knot of confusion land in their laps. Researchers at Columbia University recently analyzed autism cases handled by the Department of Developmental Services in the state of California, which saw a staggering 636% increase in autism diagnoses between 1997 and 2003. Courts and researchers have put to rest the erroneous health-fiction that autism is increasing because childhood vaccinations are on the rise. But does this represent an epidemic of new disease, diagnostic criteria catching up with a wide-spectrum disorder, or over-diagnoses? It’s not clear, though researchers do not suspect it’s the latter. What is fascinating is the trend that they uncovered.

It turns out that proximity to another child who has already been diagnosed with autism significantly increases other children’s chances of being diagnosed. Children living within 250 meters of another child already diagnosed with autism are 42% more likely to also be diagnosed with the condition. Living 250 to 500 meters away reduced the likelihood to a still-noteworthy 22%. Since environmental factors were ruled out, the conclusion is that proximity breads awareness of the disease among parents, as well as a better understanding of available diagnostic and support services.

Its hard to know whether this study is good news or bad news. On the one hand, if there’s an epidemic of un-diagnosed autism, its great that parents are able to help each other identify and manage the condition. On the other hand, if the condition is ill-defined, and subject to over-diagnoses in cases where specialists feel pressured to appease insistent parents, it could signal a troubling trend. Without having some knowledge of the true underlying prevalence of disease, its impossible to know which one it is.

In the meantime it’s a fascinating study in the sociology of disease diagnoses. Do you find it surprising?

Photo credit: The author

Health technology: Mobile phones sniff out terrorists

2010-04-13T07:14:00.000-07:00

Fellow Justmeans.com blogger Alisa Ulfert discusses a way to “sniff out” asthma using an electronic nose that a person would breath into. On a more portable and personal level, cell phones are increasingly being used to transmit health information, such as child health tips, health reminders, or gather health data, such as how far someone walks during the day and how many social contacts they have. So what would happen if you could combine all of those features?

Apparently the US Department of Homeland Security has been pondering just that. They’ve developed an interesting, if somewhat spooky, chip that could turn a smart phone into an environmental sniffer. Actually a nose that’s so sophisticated, it transforms your mobile phone into a portable “weapons-of-mass-destruction-detector.” No joke, here’s how it works.

If a user chose to enable the service, a smart phone app would run constantly, sampling the air at predetermined intervals for dangerous chemicals. When a dangerous substance was detected two things would happen, the user would be alerted, and a call message would automatically be sent to a government monitoring station. If a single warning went out, its likely to be a false-positive, but if fifty alerts went out from the same place, it would indicate the need to investigate.

A consortium has brought together government and private expertise, and expects to have prototype phones available in about a year. Qualcomm is lending it miniaturization and marketing skills, while NASA engineers are working to perfect chemical sensing on a platform that sips very little electricity. Rhevision, meanwhile, is perfecting a tiny silicon nose that does the actual sniffing. Other interested partners are cell phone makers Apple, LG, and Samsung.

Does this type of technology set you at ease, or do you find it scary? Would you enable your tiny silicon nose to go sniffing for Uncle Sam if you had the choice? Let us know!

Photo credit: Ano Lobb

Protecting your health involves speaking up

2010-04-13T07:02:00.000-07:00

Communicating effectively with your doctor could make all the difference.

Each day brings with it news about how people can protect their health - whether it's drinking more coffee (or less, depending on the survey), consuming less salt, getting more exercise, getting preventative screenings for certain diseases, etc. But a couple recent health-related articles reminded me that sometimes, the best tools for protecting one's health can be your own intuition and your own voice. Patients sometimes believe that so long as you tell a doctor what their major symptoms are, the rest will sort itself out. That's not necessarily true.

In the New York Times, one writer reports on a recent New England Journal of Medicine piece in which a doctor argues that "doctors, researchers, drug makers and regulators should pay more attention to patients’ firsthand reports of their symptoms while they take medicines, because their information could help to guide treatment and research, and uncover safety problems." The story goes on to detail how clinical phases of trials for new drugs - and sometimes even doctors and nurses themselves - don't give enough weight to patients' symptoms, concerns, complaints, etc. Sometimes this happens because patients don't speak up enough, or perhaps lie altogether out of shame or embarrassment over what's really going on with their bodies. But just as often it's likely because doctors get caught up and don't take the time to really listen, or delve into how a patient's symptoms are really affecting him or her.

The article nicely complemented another piece in the Los Angeles Times urging both doctors and patients to make an effort to communicate more effectively. It explained how certain circumstances likebeing upset at being made to wait, short appointments, or feeling like they're not getting enough attention on the patients' side; and having to deal with strong or unruly personalities, or patients who unnecessarily take up too much time by going off on tangents or focusing on details that don't matter on the doctors' sides, can hamper communication between the parties. Among the advice doled out to both sides, the author offered: "Physicians need to be willing to work collaboratively with patients, but patients need to carry out their end of the bargain. It's up to patients to follow through with the advice they're given. No one can take their medications for them or make the lifestyle changes necessary for good health in their stead."

It's just another good reminder that when it comes to your own health, you are responsible for voicing your pains, concerns and symptoms clearly, respectfully and reasonably.

Photo credit: U.S. Navy

New Health Care Technology can “Sniff Out” Asthma

2010-04-12T01:30:00.000-07:00

A new machine can “sniff out” asthma, leading to more accurate diagnosis and better health care outcomes.

Those with asthma, and their health care providers, know how drawn out the diagnostic process can be. First come the multiple colds and upper-respiratory infections, then the doctors’ visits and specialist referrals, then a bunch of lung function tests that involved exhaling to the point of passing out. It can take weeks for health care providers to puzzle out a diagnosis, months if you include all those colds and infections the adult-onset patient endures before realizing something more serious is in play.

The days of waiting might be coming to an end. Italian health care researchers have announced the development of an electronic breath-sensor device that may be more accurate in diagnosing new asthma cases than traditional diagnostic tools. The device, which health care researchers have called the “electronic nose,” detected nearly 90 percent of people with asthma compared to about 70 percent who were accurately diagnosed using the more common lung function tests. The “electronic nose” works by identifying certain compounds in a person’s exhaled breath. These compounds produce specific patterns in people with asthma. The Italian health care researchers studied 27 people with mild, allergy-based asthma and 24 healthy people. The research was published in the April issue of the journal Chest.

The “electronic nose” sounds intriguing. Asthma used to be a fairly unusual health care condition that many sufferers eventually outgrew. Not so anymore. The respiratory condition has been building in frequency and durability in recent decades, and ranks as a common ailment. Much of the increase may be environmental; the Rand Corporation has estimated in a different study that air pollution caused nearly 30,000 emergency hospital visits and admissions from 2005 to 2007 in California. Almost eight percent of Americans have asthma, according to the American Academy of Allergy, Asthma & Immunology, so finding a quick and accurate tool to diagnose the condition appears to be a good thing. But the electronic nose is likely a good ways away from appearing in a health care provider’s office near you. The practical costs are not yet known, and it’s not yet clear how well the device could work with people whose asthma isn’t allergy-related.

Don’t even think about trying to diagnose yourself. But if spring-time pollen is delivering some of the typical asthma symptoms below, the good folks at the National Institutes of Health suggest it might be time to talk to your doctor.

Coughing. Coughing from asthma is often worse at night or early in the morning, making it hard to sleep.
Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
Chest tightness. This may feel like something is squeezing or sitting on your chest.
Shortness of breath. Some people who have asthma say they can’t catch their breath or they feel out of breath.

Photo Credit: Mark Watson

Health Check Up: Data from the US’s Annual Physical

2010-04-05T06:34:00.000-07:00

The latest CDC check up on the health of the US population has arrived, and it’s a veritable gold mine of data on health and health care practices. Of special interest in this years report, “Health, United States, 2009,” is a new section on medical technology.

First, some of the good news: The three biggest killers are on the decline: Heart disease mortality by 66% and stroke deaths by 78% compared to the 1950s, and cancer deaths by about 16% since the 1990s. Having browsed these reports every year for nearly a decade, I was drawn to the new data on medical technology, and utilization of healthcare resources, much of which provides suggestive evidence that over-utilization of new technologies and unproven procedures, is a driving force behind ballooning expenditures in US healthcare. Among the findings, between mid-1990s and 2007:

Total knee replacements increased 70%
MRI, PET and CT scan usage tripled, even though doubts remain about their effectiveness
Hospitalization for cardiac care increased 64% while costs for those hospitalizations increased 174%
Spinal fusions, a procedure of especially dubious effectiveness, increased 82% while costs for the procedure increase 189%
Rates of prescription drug use have increased since the 1990’s: from 39% to 47%, including 9% of adults who now always or often use meds to help them sleep. The percentage of people taking three or more prescription drugs has increased from 12% to 21%
In 2007 (the most recent year available) Americans went to the doctor or hospital 1.2 billion times. Though most visits are to the physician’s office, 20% of adults had at least one emergency room visit. Those with households incomes at 200% of the poverty line or less were nearly twice as likely to go to the ER: 30% vs. 18%
Cost and lack of coverage led 8% of Americans to forgo needed care, 10% to forgo necessary prescription drugs, and another 10% to delay needed care.

The report also includes a section showing the massive variation in the amount of care provided for people at the end of their life, which comes from the Dartmouth Atlas of Healthcare. Your chances of having at least one stay in the intensive care unit during the last six months of life, for example, ranges from a high of 45% in California and Illinois and 49% in Florida, to a low of 23% in Vermont and North Dakota and 26% in Oregon. Those differences are attributable to differences in medical practice patterns, since they control for the health and age of the population (so its not simply caused by Florida being home to the elderly and sick, and Vermont being populated by spry young healthy folks.) ICU’s are invasive places, involving extensive treatment and testing which means that more time in the ICU results in greater expenses, and is extremely uncomfortable for patients. And since this measure of intensity only looks at folks who died, the ICU stays aren’t curing anyone of disease.

Should Unhealthy Eating be Treated as an Addiction?

2010-04-05T04:49:00.000-07:00

A new study suggests junk food addiction might be similar to drug addiction.

As America’s obesity epidemic continues, the government has launched many initiatives to help citizens gain better control over their waistlines: They’re working to improve school lunches so that children get nourishment and not diabetes; they’ve written provisions into the recent health care reform legislation requiring disclosure of calorie counts at restaurants and on packaging so that people understand what they’re putting into their bodies, etc. But now one study is suggesting that constantly eating junk food could actually be considered an addiction on the same level people are addicted to cocaine or alcohol. Will it affect how health officials approach regulating junk food and appealing to people to eat better?

According to TIME magazine, “researchers at the Scripps Research Institute in Jupiter, Fla., examined three groups of lab rats that were fed various diets for 40 days. One group was given typical rat chow only; a second group was offered rat chow, plus a buffet of bacon, sausage, cheesecake, chocolate frosting and other delectable goodies for one hour a day; and a third group was allowed extended access to the fatty buffet for up to 23 hours a day.

The extended-access group began consuming twice as many calories as the other rats, and, not surprisingly, became obese. The limited-access rats, meanwhile, developed a binge pattern of eating, consuming most of their daily calories during the single hour they were allowed in the junk food "cafeteria."

But what shocked the researchers was that extended-access rats also showed deficits in their ‘reward threshold.’ That is, unrestricted exposure to large quantities of high-sugar, high-fat foods changed the functioning of the rats' brain circuitry, making it harder and harder for them to register pleasure — in other words, they developed a type of tolerance often seen in addiction — an effect that got progressively worse as the rats gained more weight.”

Of course, there are limits to such studies, particularly when they’re not performed on actual humans. But reconsidering how to approach the obesity epidemic isn’t an absurd idea – certainly treating alcohol addiction as a medical condition is more effective than simply trying to shame people into not drinking, which is essentially the culture we have now with unhealthy eating.

Approaching overeating and junk food as a mental health issue isn’t entirely new territory – it brings to mind the infamous “Twinkie defense” used by Dan White, who was being tried for the murders of San Francisco Mayor George Moscone, and City Supervisor Harvey Milk – White’s lawyers alleged that White’s diet switch to junk food and sodas contributed to his incapacitated mental state at the time of the killings. He was convicted only of involuntary manslaughter.

Photo credit: Larry D. Moore

Movement on the mental health front

2010-04-05T03:12:00.000-07:00

The focus lately has been on health reform. But a different law is leveling the playing field for mental health.

So much attention has been focused in recent weeks on health reform, and rightly so: It is the largest single piece of social justice legislation passed in 40 years. But another bill that has the power to do for those suffering from mental health conditions what health reform does for the uninsured launched earlier this year and now is being put in place. It is the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

Passed as part of the stimulus package of 2008, the bill seeks to end discrimination against people who need mental health and substance abuse services. Historically, access to care – meaning prohibitive costs combined with health care insurance plans that didn’t cover such services – was the main reason people who needed the help went without, according to the Substance Abuse and Mental Health Services Administration, an arm of the U.S. Department of Health and Human Services.

In the past, health care insurance plans have often treated mental health and substance abuse treatment services differently than they have other medical benefits. The new parity law ends that practice in health care insurance plans offered by employers with more than 50 employees. Under the parity law, plans that offer both physical and mental health benefits must treat them equally. That means things like co-payments, deductibles, and out-of-pocket limits must be the same for mental health and substance abuse services as they are for other medical services like surgery and doctor visits. That also means that the number of visits allowed, duration of treatment, and other treatment limitations can’t be more restrictive for mental health and substance abuse services than they are for other services.

The new law comes at a time when more attention then ever has been focused on the need for mental health care, particularly in the military. Veterans returning from Iraq and Afghanistan are being diagnosed in increasing rates with Post Traumatic Stress Disorder and other mental health conditions. Suicides among military personnel are being scrutinized, as are acts of domestic violence.

And lawmakers in some states are taking notice. Coupled with health reform, which requires all Americans to have health insurance by 2014, and the Wellstone and Domenici parity law, states’ recent actions are creating a true safety net that can significantly increase access to mental health and substance abuse services. For example, last week the Iowa House of Representatives approved a bill that requires private health care insurers to provide veterans with mental health and substance abuse coverage (the bill must pass the Iowa Senate). Also last week, Texas Gov. Rick Perry announced $1.75 million in competitive grants for mental health programming for veterans. Perry’s office said the grants are for programs that help veterans access basic treatment. The grants are also intended to expand trauma therapy services, and promote support groups.

And while they didn’t target veterans directly, Montana’s Yellowstone County Commission agreed last month to ask voters to approve a specific tax for mental health services. County officials estimate that the proposed tax would raise approximately $873,000 annually to fund mental health services designed to keep the mentally ill out of hospitals and jails.

These are excellent developments, and they will go a long way toward both increasing access to mental health and substance abuse services and reducing the stigma associated with those conditions. What do you think?

Photo Credit: fmc.nikon.d40

Unsure about how health reform affects you? Start here

2010-03-29T00:34:00.001-07:00

Some great resources exist that make dissecting the health care bill much less intimidating.

If you've been paying attention the last week, you've probably quickly realized that just because health care reform became the law of the land, the myths and misunderstandings about the bill, and how it will affect people's lives, still remain. As the New York Times pointed out, “While some of the more outlandish rumors may dissipate, it is likely that misperceptions will linger for years, hindering substantive debate over the merits of the country’s new health care system. The reasons are rooted in human psychology.” People are inclined to believe things that confirm their already existing views, which is why if someone believes something about the health care bill – true or not – it's difficult to convince him otherwise.

But for people who really want to know what the bill entails, when certain provisions will go into effect and how it will play a role in their personal care, there are good resources out there that are worth seeking out.

Of course, the most official resource is the government itself, and the Department of Health and Human Services will play a key role in informing the public about the bill, and about how to obtain coverage for those who need it. At http://www.healthreform.gov, new updates and news should be available as it happens.

The Kaiser Family Foundation's health reform subsidy calculator is also a great tool. It “illustrates premiums and government assistance provided under the health reform bills originally passed by the House and Senate and the final legislation for people under age 65 who purchase coverage on their own in an Exchange and are not covered through their employer, Medicare or Medicaid.” If you're not receiving health insurance through an employer, it's a good way to get an understanding of how much you're likely to pay through the exchange.

This New York Times graphic is also worth checking out – it is easy to follow and allows for multitude scenarios. Virtually everyone should be able to get a better understanding of how they'll be affected by checking it out.

As with any complex issue, (shameless plug for the journalism profession ahead!) it is a good idea simply to read about the developments every day (or close to it) in a publication you trust. You might not understand each provision, or each story every day, but ultimately you'll be creating for yourself a foundation of knowledge that will build over time.

Photo credit: White House

Federal health reform has passed. Now, states respond

2010-03-28T23:50:00.000-07:00

Some states are suing the federal government over health reform. Others are gutting health care programs for the poor. Seems like everyone’s in on the act.

You know times are strange when state lawmakers eliminate a wildly popular health care program for low-income kids in an election year. But these are extraordinary times, thanks to the political maelstrom of health reform and the financial strain of the recession tail. In Arizona, where former Republican presidential nominee Sen. John McCain is facing a tough primary challenge for re-election, state lawmakers have proposed eliminating the Children’s Health Insurance Program, a safety net for low-income families who can’t afford their own insurance yet earn too much to qualify for standard Medicaid.

Arizona Gov. Jan Brewer (R) has signed a budget that guts the program, which will leave nearly 47,000 low-income children without health care coverage. The state also will roll back Medicaid coverage for childless adults, which is expected to eventually drop 310,000 people from the rolls. Is this a partisan move, a retaliatory response to health reform and a precursor to the stated Republican strategy of “Repeal and Replace?” Brewer has said Arizona’s dire financial straits left no choice but to cut, and she hopes voters will approve a penny increase in the state’s sales tax that could soften those cuts. Indeed, if Brewer’s playing games, she’s likely betting against the house: Arizona could face further loss of federal dollars for failing to maintain a certain level of health care programs for the poor. And that could lead to more, not fewer, uninsured in Arizona despite the health reform law.

Not that (mostly) Republican attorneys general are content to let governors have all the action. More than a dozen GOP AGs and one Dem have signed on to a group effort to challenge the constitutionality of the health reform plan. Many legal scholars don’t give the challenge much of a chance, other than a chance to make a public point. The effort is being led by Bill McCollum, attorney general of my former home state of Florida. The top lawyers for those states claim Congress overstepped its powers to regulate commerce when it declared that every American must have health insurance or else risk federal tax penalties. Insuring the health of one’s one body, they say, is not commerce.

Meanwhile, Indiana Gov. Mitch Daniels (R) has said that his state will eliminate the Healthy Indiana Plan in light of the passage of the health reform bill. Healthy Indiana is a Medicaid waiver plan, the first of its kind to use Medicaid funds to provide a benefit package modeled after a high-deductible plan and health savings account to previously uninsured adults. The state plans to transition the 45,000 low-income residents currently enrolled in the program onto Medicaid, and Governor Daniels has announced he is capping enrollment for the program while the state phases it out. Daniels has been highly critical of the President Obama’s health reform plan, saying it left little room for innovative programs like Healthy Indiana. He has said the health reform bill forced him to dismantle the program.

It will be interesting to see what everything looks like after all the dust is settled. I understand why states are trimming their own programs in light of the passage of health reform. States have long complained about “unfunded mandates” from the feds when it comes to covering low-income Americans, and they will eventually have to chip in for some of the extended Medicaid under the health reform plan. I just hope health reform isn’t ending one “doughnut” hole – the one involving Medicare drug coverage – only to create another: tens of thousands (or more) of people who go uncovered in the time between the elimination of state health care programs and the expansion of federal ones.

Photo Credit: Marxchivist

Health decision making: New cancer treatment findings

2010-03-26T08:09:00.000-07:00

Several interesting studies being presented at the European Breast Cancer conference in Spain are highlighting the difficulties that many women face when trying to decide on the appropriate course of treatment, prevention, or screening.

The decision can be especially challenging for women who have tested positive for mutations in the “breast cancer genes,” known as BRCA1 and BRCA2. Such women face a 55% to 85% chance of developing the cancer sometime in their life. These genetic mutations are inherited, and many women with a long list of female relatives who have suffered from the cancer choose radical preventive approaches, such as prophylactic mastectomy, or removal of one or both healthy breasts, either before a first incident of cancer, or to prevent a recurrence. This is based on the assumption that removing healthy tissue will reduce the risk of new or recurrent cancer.

Two new studies looked at prophylactic mastectomy of the healthy breast in women recovering from the cancer, who had BRCA1/2 mutations. After following 138 women who opted for risk reducing mastectomies, and comparing them to 210 similar women who opted for routine surveillance without the operation, researchers found no difference in overall survival. In other words, women who opted for risk-reduction surgery did not live longer or die of cancer less frequently than those who did not have surgery.

The second study looked at the chances of cancer recurrence in women who opted for total mastectomies compared to less radical “breast conserving treatment,” or BCT. After 15 years, 23.5% of women who chose BCT had a second bout of cancer, compared with only 5.5% of women who opted for total mastectomy. However, women receiving adjuvant chemotherapy along with BCT had no greater risk than the mastectomy group. The researchers concluded that BCT with chemotherapy is a sensible option for women who do not want to undergo total mastectomy.

A third study being presented underlines the importance of clear risk communication to those suffering from or at risk of developing cancer. In a small study of 27 women being treated for cancer in one breast, a British surgeon reports that women who chose prophylactic mastectomy of their healthy breast did so, at least in part, because they overestimated the risk of developing future cancer by up to ten times. A small study for sure, and with not entirely unexpected results, but an important reminder that risk communication is both difficult, and important in helping patients decide which course of treatment is best.

Photo credit: The author

Gay patients sometimes excluded from clinical health trials

2010-03-22T02:29:00.000-07:00

A portion of the population could have health issues that are being ignored.

There are, unfortunately, many corners of our society that still exclude people who are gay. In most states, gay couples cannot marry; gay people cannot serve openly in the military, and some states even go as far as excluding gays from being able to adopt children. But scientists and doctors are now fearing that another type of exclusion is taking place - one that could have effects on those people’s health and wellness: clinical trials that examine diseases, drugs and medical treatments.

A letter published recently in the New England Journal of Medicine showed that 37 of 243 clinical trials studied that dealt with couples and sexual function barred people who were in same-sex relationships. Researchers at the Fox Chase Cancer Center in Pennsylvania who conducted the study worry that gay patients are routinely excluded from other studies as well, such as ones that study depression [http://www.justmeans.com/Is-Optimism-in-Young-Adults-Harmful-Mental-Health/7945.html] or cancer.

Doctors hoping to create a clinical trial to study a drug often develop a target demographic of people who are a certain age, have a certain disease, or participate in a certain kind of behavior associated with the drug in order to narrow down those who’d be most likely to use, and benefit from, the drug. It’s a vital element to creating a clinical trial. But if doctors, for whatever reason, universally exclude gay participants, then a whole segment of the population will inevitably have health issues that aren’t addressed or uncovered in such trials.

Brian Egleston, Michael J. Hall, and Roland Dunbrack wrote that not all clinical trials use exclusionary language, and that often, gay and lesbian patients might not even be aware that they’re missing out on certain trials:

“To ensure that we did not miss a general pattern of exclusionary language, we also examined eligibility criteria in 1019 studies that we identified by using the search term ‘asthma.’ Exploratory searches indicated that such studies did not have high rates of exclusionary language, and indeed, no asthma trials were found to exclude lesbians and gay men. However, we incidentally found a clinical trial of attention deficit–hyperactivity disorder that required that participants be ‘in a reciprocal relationship with a person of the opposite sex.’

Our results indicate that exclusion of lesbians and gay men from clinical trials in the United States is not uncommon, particularly in studies with sexual function as an end point. It is likely that most gay and lesbian patients are unaware that their sexual orientation is being used as a screening factor for participation in clinical trials. Researchers should be held to careful scientific reasoning when they develop exclusion criteria that are based on sexual orientation.”

Photo credit: Tom Varco

Health news: Media covers cancer stories poorly

2010-03-19T03:39:00.000-07:00

Don’t get me wrong, I prefer good health news. Its much more inspiring to hear of innovation, burgeoning cures, survival, getting better, being healthy. But in addition to shades of grey, health news is black and white: With the good news comes bad, the possibility of dying or being plain miserable.

The news media isn’t so good about covering that bad news when it comes to cancer. That’s the conclusion of a new paper in the Archives of Internal Medicine that analyzed 2228 cancer stories from 436 randomly selected American newspapers and magazines. Most articles focused on breast (35%) or prostate (15%) cancers, the most common gender-specific cancers in women and men, 20% addressed cancer more broadly. While interest in cancer is likely motivated by our fear of dying from it, only 7.6% of stories focused on death, while 32% were about survival and being cured, and only 2.3% dealt with survival and death. .

"It is surprising that few articles discuss death and dying considering that half of all patients diagnosed as having cancer will not survive," the authors write. "The findings are also surprising given that scientists, media critics and the lay public repeatedly criticize the news for focusing on death."

Stories of treatment and survival are certainly more uplifting, but even there most failed to provide the whole story: 57% focused on aggressive treatments, but only 13% mentioned that they’re not always successful or that some cancer is incurable. Adverse events of treatments, such as pain, nausea, and hair loss, where mentioned in 30% of stories. End of life (palliative) care was seldom covered: 0.5% of stories focused on it exclusively, and 2.5% mentioned it along side discussions of aggressive treatments.

It’s tempting to over-simplify health stories, assuming that a condition is treatable in all people who undergo a certain treatment for a certain amount of time. But it’s almost always more complicated than that. With cancer in particular, death is often a very real possibility, and while we try desperately to avoid death, it’s not a “bad” thing. Its part of the story of those things we call cancer.

Telling the whole story about health and disease is not just a hallmark of good journalism, it’s part of the larger picture of ethical, patient-centered health care. Over the years we’ve grown accustomed to waging “war” against cancer, where death equals defeat. And in war its considered poor form to plan for defeat. But cancer isn’t an enemy, and treatment isn’t war. We do our best to cure people, but must also be aware that some cancers aren’t curable, and sometimes the best treatment is to stop combating the cancer and focus on controlling symptoms, managing pain, coming to terms with mortality, and letting the natural progression of disease take its course. That’s not failure, that’s not defeat, it is part of being human. It’s also what palliative care provides, and it all begins, I believe, with telling the full story about cancer, health, life, and death.

Photo credit: The author

Erectile dysfunction predictor of health, and death

2010-03-19T03:28:00.000-07:00

Erectile dysfunction is more than an issue of sexual health. It is a strong predictor of death and cardiovascular health.

We’ve been lulled by the commercials into believing that erectile dysfunction is a mere annoyance, a minor blip on the sexual health screen that can be easily remedied by a pill in various convenient dosing options. But researchers warn that those sultry, idyllic, twin-bathtub-in-the-middle-of-nowhere images mask more sinister health threats associated with erectile dysfunction (ED). In fact, ED is a strong predictor of death from all causes and of heart attack, stroke and heart failure in men with cardiovascular disease, German researchers reported this month in Circulation: Journal of the American Heart Association.

Researchers found that men with cardiovascular disease and erectile dysfunction (compared to those without ED) were twice as likely to suffer death from all causes and 1.6 times more likely to suffer the composite of cardiovascular death, heart attack, stroke and heart failure hospitalization. More specifically, they were:

1.9 times more likely to die from cardiovascular disease;
twice as likely to have a heart attack;
1.2 times more likely to be hospitalized for heart failure;
1.1 times more likely to have a stroke.

As if that weren’t bad enough, researchers said, too many men with ED don’t realize how poor their heart health is and how great their risk of death is because they don’t know they also have cardiovascular disease. They don’t learn of the other condition because they are successfully treated for erectile dysfunction by their primary health care provider or urologist. They aren’t referred to a cardiologist for an evaluation until their cardiovascular disease is advanced.

“Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment,” study author Michael Böhm, M.D., lead author of the study and chairman of internal medicine in the Department of Cardiology and Intensive Care at the University of Saarland, Germany, said. “ED is an early predictor of cardiovascular disease.” Usually, though, that doesn’t happen, especially if the ED treatment was successful. “The medication works and the patient doesn’t show up anymore,” Böhm said. “These men are being treated for the ED, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk.”

The study is an important reminder of how inter-related health conditions can be. Neglect one aspect of your health, and you may unwittingly make another worse. More importantly, too many people diagnosed with Condition A don’t realize their diagnosis puts them at significant risk for developing Condition B. While the link between ED and heart disease seems logical – both involve blood vessels, for instance – that’s not true for all linked conditions. Asthma and depression, for example. Some linkages may seem downright counter-intuitive, so it’s important to be an informed health care consumer.

Gentlemen, that goes for you: If you have ED, ask your doctor if a cardio workup is right for you.

Photo Credit: taberandrew

Depressed parents can pass on mental health problems to kids

2010-03-15T04:40:00.000-07:00

Kids with depressed parents often have anxiety issues; but studies show therapy helps.

Anyone who has ever flipped on a TV can tell you that depression is everywhere - commercials touting various anti-depressants emphasize the need to treat depression right away, lest it take an increasing toll on one’s life. Some drugs also play up the physical harm depression can create, manifesting itself in various aches and pains.

Indeed, researchers are now delving into the effects depression has on children who grow up with a depressed parent. It’s been a bourgeoning area of research for the last couple decades, and the Los Angeles Times reports that “evidence is mounting that growing up with a depressed parent increases a child's risk for mental health problems, cognitive difficulties and troubled social relationships.” One study found that depression in mothers can affect infants – they were found to cry more often. The effects can linger in kids as they grow up, too: Other studies have found that kids with depressed parents often have greater anxiety levels.

While postpartum depression can obviously play a big role in mother-child interactions, recent studies have found that depression in either parent can cause behavioral or mental health problems in children. One study, led by Vanderbilt University researcher Judy Garber, found that kids who have a depressed parent are at greater risk for having trouble in school, and for substance abuse and suicide. Of the 316 students who were the focus of Garber’s study, all of them said they had either experienced symptoms of depression in the past, or at the time the study began. Half of the teens were sent to group therapy sessions; and those teens reported fewer signs of depression after eight weeks.

A similar study by Johns Hopkins Children’s Center placed kids of depressed parents ages 7 to 12 in an eight-week course of behavioral therapy, and those children showed no signs of emerging anxiety problems a year later. But of the kids in a comparison group who did not receive therapy, 30 percent did get diagnosed with anxiety disorders. Though therapy has been shown in multiple studies to ward off or lessen depression and anxiety in children and teens, not many health insurance companies cover such treatments. But perhaps as health care reform inches closer to reality, and as continuing studies reveal the effectiveness of such programs, behavioral health therapy treatments will eventually become more readily available.

Photo credit: Hendrike

Childhood vaccines protect even the unvaccinated

2010-03-15T04:29:00.000-07:00

Giving children the flu vaccine can protect the wider community, study finds.

It’s obvious that giving a child the flu vaccine will protect him or her from the influenza. But a new study suggests the benefit of vaccinating children can extend well beyond the youngsters themselves. Results of a clinical trial conducted in a largely self-contained religious community during the 2008-09 flu season show that vaccinating children against the seasonal flu can significantly protect unvaccinated community members as well. The study was conducted to determine if children who received the vaccine could act as a barrier to limit the spread of the flu to the wider, unvaccinated community, a concept known as “herd immunity.”

According to the National Institutes of Health, researchers recruited volunteers from 46 Canadian Hutterite religious colonies that have limited contact with surrounding, non-Hutterite populations. (Hutterite communities have a lifestyle similar to the Amish and Mennonites). Of the close to 1,000 children participating in the study, roughly half were given the flu vaccine, while the other half were give the hepatitis A vaccine, which served as the control. The researchers found that the flu vaccine was 61 percent effective at indirectly preventing illness in unvaccinated people if they lived in a colony where approximately 80 percent of the children had received the flu vaccine.

The researchers further suggested that giving school-aged children the flu vaccine could be an effective way to stop the spread of the flu. In a statement provided by the National Institutes of Health, the researchers wrote “it may be advantageous to selectively immunize children in order to reduce community transmission of influenza.”

It’s not clear if the study gives license to assert the converse: Not giving your child the flu vaccine can actually harm others. But it’s certainly something to think about. I’m not ready to require that parents go out and get the flu vaccine for their kids as a requirement to attend public school. I do wonder if that might someday be the case for the swine flu, which cut a respectable swath of school closings across New York City last year. (In an open letter earlier this year to health care providers across the country, federal Commissioner of Food and Drugs Margaret A. Hamburg warned doctors of a “significant” chance that the swine flu will return later this flu season after showing recent signs of waning). We certainly do require other vaccines in order to attend school, despite some lingering fears among parents of their safety. In any case, I will take the opportunity here to suggest that taking care of yourself, which can include getting yourself vaccinated against the flu, is an act you owe not only yourself, but others in our society as well. I don’t want to legislate healthful habits, but I also think there’s something to be said for keeping healthy as a means of reducing health care costs and increasing productivity.

What do you think?

Photo Credit: UNICEF Sverige

Health care imaging that’s costly, risky, and overused

2010-03-15T03:45:00.000-07:00

The FDA has recently gone on the offensive against the overuse of health care imaging scanners such as CTs and MRIs, which can lead to unnecessarily high doses of radiation. While emphasis was placed on the responsibilities of device manufacturers to ensure safe usage of their products, and calling on the patients not to insist on imaging over their doctor’s protests, little emphasis was placed on perhaps the most important performer in the medical choreography that results in an imaging test: the physician. Doctors are, after all, the ones who order such procedures.

Now a new publication is calling for more rational use of imaging technology, and using the compelling example of pelvic and lower abdominal pain in women to make the case. Even though the standard means of visually evaluating female pelvic conditions is the ultrasound, CT scanners are increasingly being used. In addition to providing a massive dose of potentially cancer-causing radiation, CTs are vastly more expensive than ultrasound, which carries no cancer risk since it uses sound waves to create images. A further irony is that CTs frequently need to be followed up with ultrasound to confirm a potential diagnosis.

Harvard doctor Beryl Benacerraf, who wrote the commentary, calls on his fellow clinicians for a more rational use of imaging. Why, after all, choose the most expensive, less accurate option that carries health risks, when a cheaper, more reliable, and risk free alternative is available?

On a policy level, this is the type of physician behavior contributing to the paradigm that has emerged over 3 decades of health services research showing that regions of the United States that treat patients with more imaging, more procedures, and longer hospital stays, actually have worse outcomes, even when you control for the health of their populations. And they also spend significantly more. On an individual level, it’s compelling evidence for patients not to insist on imaging or testing when your doctor recommends against it.

Photo credit: The author

D.C. to Give Out Free Female Condoms for HIV Prevention

2010-03-09T02:55:00.000-08:00

The city, which has epidemic-level infection rates, will be the first to make female condoms available for free.

Though most of the clamoring surrounding the city of Washington, D.C. This past week was over same-sex marriage getting underway, the city also took the lead in unveiling a new health initiative too. D.C. will be the first U.S. city to distribute female condoms free of charge, starting in the next few weeks. The condoms will be handed out at places like schools, convenience stores and salons – with consideration to neighborhoods with especially high rates of HIV/AIDS infections. A 2008 study showed a 3 percent rate of HIV in Washington, an alarmingly high number that qualifies as an epidemic.

So far the District has stopped short of urging universal HIV testing throughout the city, a proposal introduced earlier this year by South African researchers who believe a “test and treat” approach could eradicate AIDS worldwide within 50 years. But the city is right to try and integrate new approaches to preventing infection. Though male condoms are widely available for free, officials in D.C. hope that by making female condoms also available, they can empower women to take precaution measures into their own hands. Obviously, male condoms ultimately put the burden on the man. HIV/AIDS is the No. 1 cause of death among black women ages 25-34 nationwide.

Female condoms have been on the market since the early 1990s, but never gained wide use or popularity. According to the BBC, “The initial version of the contraceptive was judged by US customers to be too expensive. However, a new version now being used in countries including South Africa, Brazil, and Indonesia will be distributed in Washington DC and offered for sale in pharmacies alongside male condoms.”

Washington has already had a program that distributes free male condoms in place since 2008. Shannon Hader, director of the D.C. Department of Health's HIV/AIDS administration,told the Washington Post that "Anywhere male condoms are available, female condoms will be available. … We're trying to make every effort count to build on what already exists... to expand options rather than limit them.” The World Health Organization favors a similarly inclusive approach to preventing the spread of AIDS, putting equal emphasis on education, treatment and prevention.

The District still has a long way to go to turn the tide of HIV/AIDS infections. A report by the D.C. Department of Health found that many heterosexual couples engage in several types of behaviors that put them at great risk of contracting the disease: “some heterosexuals in committed relationships often have sex outside of the relationship, often do not know their partner’s HIV status, and often do not protect themselves by using condoms. These factors result in ongoing risk for HIV infection.”

Photo credit: Dam Smith

Some “male enhancement” products can harm your health

2010-03-09T00:27:00.000-08:00

Some “all natural” male enhancement products contain undeclared ingredients that can harm your health.

You’ve seen the campy commercials: One member of a golf foursome scores a hole in one. Women at an office party scuffle for a chance to be near that certain man. But public health officials say beware: Many of the so-called all natural male enhancement products contain undeclared ingredients that can harm your health or even kill you. The federal Food and Drug Administration issued yet another warning this week about the products, many of which are sold online. The FDA says that despite its repeated warnings, consumption of these products is increasing – as are the reports of harmful health effects.

Public health officials say many of the products that are supposed to be all natural, dietary supplements actually contain various amounts of the ingredients found in prescription drugs such as Viagra, Cialis and Levitra. Public health officials warn that taking products that contain these kinds of ingredients can be particularly dangerous for people who are also taking prescription drugs that contain nitrates, such as nitroglycerin. That's because they can interact to cause dangerously low blood pressure. Furthermore, people with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. And since erectile dysfunction is common in men with these conditions, public health officials say they may seek out these sorts of products.

Rather than classifying these products as a drug – which of course would put them under much closer scrutiny – these products are marketed as “dietary supplements,” which are barely regulated. Plus, as public health officials point out, these so-called supplements are not likely to be made under the same quality controls as prescription drugs, so the identity or the amount of the Viagra-like ingredients could vary greatly. The FDA has actually found the prescription materials in much higher quantities in the so-called all natural products than what a doctor would prescribe in a regulated medication. Many of the male enhancement products that are catching the eye of public health officials are imported from other countries. Numerous shipment have been seized and tested, which is how officials know how much of the prescription medication has been found in the so-called natural products.

While steps have already begun to be taken, these warnings serve as a reminder why we need to beef up regulation of dietary supplements. And while I’m at it, let’s talk about setting real standards for organic foods so that people who are chemically sensitive don’t accidentally ingest harmful contaminants in foods that are supposed to be clean and organic. So many people take different supplements of different varieties in hopes of becoming better, faster, more energetic or simply to destroy free radicals. Yet it’s nearly impossible to know if you are getting the potency the supplement makers claim their product has – or even if it’s advisable to take that level of the vitamin. Please correct me if you disagree, but I have a hard time believing that taking 2,667 times the recommended daily dose of any vitamin or mineral is a good idea. What do you think?

Photo Credit: cygnus921

Health effects of plastics better understood

2010-03-08T10:45:00.000-08:00

A new study of Bisphenol A(BPA), which leaches from certain types of plastic bottles and food cans into their contents, increases our knowledge of the human health effects of this chemical. It has long been known that BPA behaves like the hormone estrogen in the environment, and previous research suggests that it has health risks. But now a study in mice is hinting at the mechanism by which BPA may cause permanent damage to women’s reproductive system.

Writing in FASEB Journal, researchers from Yale University School of Medicine report that fetal mice exposed to high levels of BPA during pregnancy experienced genetic mutations that caused their reproductive system to over-react to estrogen during adulthood. In humans, its feared that mothers who are exposed to BPA during pregnancy may give birth to daughters whose uteruses are programmed to be “hyper-responsive” to estrogen. Such hormonal sensitivity has a number of potential health effects, including problems with fertility, increased cancer risks, and abnormal puberty.

This new data adds to compelling reasons why manufacturers should stop using BPA. In addition to its known or suspected health risks, there are BPA-substitutes that do not have estrogenic effects. Manufacturers in Europe no longer use BPA in plastic bottles produced for that market, after public health regulators banned it. About 2.7 million tons of BPA-containing plastic is produced each year. Even if BPA has only mild hormonal effects, it is only one of many artificial, environmental estrogens contributing to a growing global burden of such substances. Now that we are learning it may alter the very manner in which we reproduce speaks volumes to the magnitude of the potential risks it poses to human health.

Photo credit: The author

Tracking health with social and new media

2010-03-03T04:55:00.000-08:00

News of the Chilean earthquake carries greater resonance coming so soon on the heals of the devastating health and human costs witnessed in the aftermath of the Haiti earthquake.

As you watch coverage of this and other health disasters, some social and new media outlets can offer interesting insights not available from the main stream “old media” outlets, i.e. television, radio, and newspapers. I’m using one such service called Trendrr.com to track the number of Twitter and Google News postings that contain the words “Chile” and “Earthquake.”

Trendrr provides “real-time social & digital media tracking.” A subscription service, you can get a limited number of searches for free. They are a powerful tool for anyone interested in how new and social media (web-enabled information sharing) is informing users about health, disasters, or other social phenomenon.

For example, the number of Google News stories about the Chilean earthquake swiftly went from 2057 on the morning of the event to over 16,000 the next day, and near 24,000 by the third day. Twitter postings about the subject went from 6225 an hour at noon EST on Saturday up to 9196 four hours later, then declined to 449 within 24 hours.

Meanwhile, Trendrr data also shows that even as old media coverage of Haiti has all but disappeared, the number of new fans on Partners In Health’s (PIH) Facebook page continues to grow. PIH is the preeminent health NGO in Haiti, and continued growth in their fan base indicates that at least among Facebook users, there is continued interest in the Haiti story.

Why might we care? It informs us about how social media users are engaging with and sharing health-related information. Such users are not necessarily the same as non-users, so what we learn may not apply to the rest of the population. But interesting hypothesis can still be generated. Coverage of disasters in the old media fades rapidly, and journalists claim that this reflects fading consumer interest. But it could reflect short attention span among journalists, or industry inability to reductions in the number of journalists have reduced media capacity to concurrently follow multiple long-term stories? Social media research, using tools such as Trendrr, raises the spectacle that perhaps social media users are the types of information seekers that desire both instant access to news on the ground, as well as long term coverage of stories. The approach of the old media, meanwhile, is geared towards satisfying an audience who is tolerant of slow, short term, and generally shallow coverage of complex events.

We may also learn of potential new applications for social media. Could Twitter be a format that allows lay-sentinels to report unusual health events, raising a red flag for disease surveillance experts to investigate? Tools like Trendrr allow comparison between old and new media responses. I’m currently doing just that, and will let you know what I find.

Have you used social marketing tracking for interesting health-related research? Let us know which services, and what you’ve found!

Lawmakers hear health risks and benefits of radiation treatments

2010-03-03T01:18:00.000-08:00

Rep. Henry Waxman

A House committee listens to doctors, experts and patients on radiation exposure

Earlier this month, I wrote about the FDA's announcement [http://www.justmeans.com/FDA-Aims-Crack-Down-on-Radiation-Overexposure/8581.html] that manufacturers of medical scanning equipment might need to incorporate new controls in order to prevent patients from receiving too much radiation exposure. CT scans, for example, emit as much as 400 times the amount of radiation as a regular X-ray.

At the time, the director of the FDA's Center for Devices and Radiological Health, Dr. Jeffrey Shuren, said, "The amount of radiation Americans are exposed to from medical imaging has dramatically increased over the past 20 years. The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks."

This week, the issue received a hearing in Congress, where lawmakers talked with experts about how to address radiation exposure in patients. The hearing by the House Energy and Commerce Committee's Subcommittee on Health was called “Medical Radiation: An Overview of the Issues.” Henry Waxman, D-Calif., chair of the Committee on Energy and Commerce, opened the hearing, saying,

“As we move forward, I would hope that we can all agree on at least two basic premises. First is the enormous medical value of our various radiologic technologies. I mentioned this earlier, but want to underscore the point again: Both diagnostic and therapeutic radiology interventions save lives. We want them. We need them.

Second is the obligation to ensure that these interventions are as safe as they can be – and that everything is being done to make that a reality. Patients are entitled to nothing less.

With these principles in mind, I believe our job today is simple and straight forward – to understand how to lower the risks associated with radiation in medicine to make it as safe as possible without reducing its many benefits to patients and researchers.”

Testifying at the hearing were a number of doctors, health officials, and experts, from organizations like the American Society for Radiation Oncology, the American College of Radiology, and the American Society of Radiologic Technologists. Also testifying were patients who had experience with radiation therapy. Suzanne Lindley, for example, said radiation saved her after she was sure her cancer would kill her:

“Together, these advanced radiation therapy technologies have allowed me to watch my daughters grow up - to see them walk across the stage for their graduations, to start college, to become adults. Today they are 19 and 22. These technologies have also allowed me to walk hand in hand with my husband and will, hopefully, allow us to share our rocking chair days together.”

But just as compelling was the testimony of James and Donna Parks, who told the committee about the ordeal of their son, who died after accidentally being over-exposed to radiation in a hospital. James Parks pleaded with lawmakers to implement safeguards that might have protected his son: “We ask that medical equipment manufactures of deadly machines develop fail-safe interactive expert systems that can interact with human technicians to reduce, or eliminate human errors. ... It is outrageous that any untrained and unskilled personnel can get anywhere near such dangerous equipment.”

Public health panel recommends flu vaccine for everyone

2010-03-02T10:16:00.000-08:00

Global experiences with swine flu convince health panel to change recommendation and urge everyone to get flu vaccine.

An advisory panel to the nation’s chief disease tracker is urging all people above the age of 6 months to get the regular flu vaccine starting with the 2010-2011 flu season. Right now, the official flu shot recommendation is for children age 6 months to 18 years, the elderly, and anyone in between who is otherwise at risk for complications, such as people with asthma or HIV. The new recommendation would be for all persons 6 months and older to get the regular flu vaccine regardless of the otherwise healthiness and hardiness of their immune system. The recommendation needs official approval from the directors of the Centers for Disease Control and Prevention and the Department of Health and Human Services, which is expected to happen next month.

Members of the advisory committee who voted for the change were particularly concerned about the need to protect people 19 to 49 years of age, who were hard hit by the 2009 swine flu pandemic. Another reason panel members gave for universally recommending the flu vaccine is that many people who are considered “higher risk” are unaware of their vulnerability or that they are recommended to get the vaccine. The panel also said that the world’s experience with the 2009 swine flu pandemic taught them that some people who don’t currently fall into one of the specific recommendation categories for the vaccine may also be at higher risk of serious flu-related complications, including those people who are obese, post-partum women and people in certain racial or ethnic groups.

But lastly, and perhaps most importantly, the vaccine advisory panel said it is important to issue a “simple and clear” message about the importance of the flu vaccine in order to “remove impediments” and encourage more people to protect themselves. This is a good thing, especially after a year of watching, awe-struck, as young and healthy people not historically considered at risk for flu complications were struck down and hospitalized within hours of contracting swine flu. Seasonal and swine flu are different creatures, but the experience appears to have taught public health officials not to assume the relative immunity of healthy people against the flu.

We need less confusion surrounding the need for flu shots; we also need more flu shots. Any confusion eased by the new recommendations will just be compounded if public health officials fail to make enough vaccine to cover the people they recommended for the shot. Last year it took longer that expected to create the swine flu vaccine, which led to long angry lines of people and even panic. Many people were turned away, some tearfully, by public health officials who were forced to ration to the shots for the most vulnerable populations. Those people were assured that more vaccine on the way, and indeed it eventually arrived.

In releasing the news of its new recommendation, the advisory panel acknowledged that more doses will be required to cover all adults. However, the panel said more licensed types and brands of seasonal flu vaccines will be available in the 2010-11 flu season than has ever been available before.

Let’s hope so. Will you get the shot?

Photo Credit: alvi2047

Flipping a (light) switch on teen health

2010-02-22T03:49:00.000-08:00

Businesses and schools should take note of the importance of natural light and how it affects health and performance.

A new study by researchers at the Lighting Research Center, part of the Rensselaer Polytechnic Institute helps shed light, so to speak, on young students' body clocks, which in turn affects their ability to function in early morning classes.

As part of the study, “Dim light melatonin onset (DLMO) was measured in eleven 8th-grade students before and after wearing orange glasses, which removed short-wavelength light, for a five-day school week. … DLMO was significantly delayed (30 minutes) after the five-day intervention, demonstrating that short-wavelength light exposure during the day can be important for advancing circadian rhythms in students.” According to the scientists, “The results ... are the first to show, outside laboratory conditions, that removal of short-wavelength light in the morning hours can delay DLMO in 8th-grade students.” Not being exposed to enough morning light “can reduce sleep duration in adolescents required to awake early for a fixed school schedule. The absence of short-wavelength (“blue”) morning light, which helps entrain the circadian system, can hypothetically delay sleep onset and decrease sleep duration in adolescents.”

For insight on this topic, I turned to the writing of an expert close to home: my brother, Brian Libby. He's actually written about the effectiveness of natural light on improving student health and performance, and even has reported on other findings made by the Lighting Research Center. Writing in the New York Times in 2003, he reported: “The center has drawn from previous studies of the relationship between seasonal depression and natural light, particularly those of Dr. Alfred Lewy of Oregon Health Sciences University, to determine that human performance is improved by natural light. … While the benefits of natural light may seem obvious, planners have sometimes been reluctant to provide it in their buildings. Many school classrooms, for example, have been designed without windows, in some cases to eliminate distractions and in others to cut costs.”

My brother also visited several school buildings throughout Oregon that had been sustainably built, and that intentionally harnessed the power of natural light. The results, according to school officials, weren't just students being more alert and attentive – which they were – but fewer students calling in sick, as well. Reporting for Metropolis magazine in 2003 on these findings, Brian wrote: “According to the Heschong Mahone Group, a nonprofit organization that promotes building efficiency, a national study of elementary school students found that test scores rose by more than 20 percent in significantly daylit buildings. The number of sick days also tends to go down when natural light is combined with TKTK.”

Businesses should take a cue from the schools that have incorporated natural light into their building plans. While some companies have recently tried misguided health incentive plans [to promote employee health and reduce health care costs, simply letting a little sunshine in could likely do even more good.

Health care experts warn against “ear candles”

2010-02-19T05:18:00.000-08:00

Using hot wax to cure ear ailments is dangerous and can harm your ear, health care officials warn.

Does dripping hot wax into your ear sound dangerous? American and Canadian health care officials thinks so, and they have teamed up to warn consumers against so-called “ear candles.”

These candles, which are hollow cones about 10 inches long and made from fabric soaked in beeswax or paraffin, are being marketed as treatments for a number of ear ailments. Yet health care agencies, including the American Food and Drug Administration (FDA), say they have received a number of reports of people, including children, being burned or suffering ear injuries from the devices. In at least one case surgery was required.

In an era when technology is changing the way we care for our health, ear candle companies claim their products are a solid alternative to traditional health care techniques and can treat a variety of ear problems. These conditions include ear-wax buildup, sinus infections, hearing loss, headaches, colds, flu, and sore throats. Ear candling involves placing the candle in the outer ear, usually while the ear ailment sufferer lies on his or her side. It is also done with the person sitting upright. Then, the end of the “candle” is lit. Marketers claim that the warmth of the flame produces suction that draws wax and other impurities out of the ear canal.

"Some ear candles are offered as products that purify the blood, strengthen the brain, or even 'cure' cancer," says Eric Mann, M.D., Ph.D., clinical deputy director of FDA's Division of Ophthalmic, Neurological, and Ear, Nose, and Throat Devices. Some of the manufacturers even suggest the candles be used on children – who are particularly vulnerable to ear infections. But Mann warns that the candles can cause serious injury even when used exactly according to the package directions. Also, Mann added that there is absolutely no scientific evidence to back manufacturers’ claims of health care benefits.

Specifically, the FDA warns that ear candle users are at risk for

starting a fire,
burns to the face, ear canal, eardrum, and middle ear
injury to the ear from dripping wax
ears plugged by candle wax
bleeding and puncture of the eardrum
delay in seeking needed medical care for underlying conditions such as sinus and ear infections and other ear problems

The FDA is teaming up with other agencies, including the Canadian public health regulatory agency Health Canada, to act against manufacturers of ear candles. The two health care agencies have issued import alerts, injunctions, and warning letters. They also have seized shipments of the product.

New measurement may answer a health paradox

2010-02-18T23:07:00.000-08:00

Which group do you think would come closest to meeting national physical activity health goals of at least 30 minutes of moderate activity five days a week, or 20 minutes of vigorous activity at least three days a week: Whites, blacks or Mexican-Americans?

New research measuring physical activity with electronic devices, instead of the standard survey-based approaches usually used, has found that 27 percent of Mexican-Americans reach those physical activity goals, compared with 20 percent of whites and 15 percent of blacks. This is somewhat different than self-reported surveys, which have found that 36 percent of whites, and 25 percent of blacks and Mexican-Americans reach those goals. Findings are based on data from 10,000 people who underwent extensive health interviews, and were fitted with accelerometers to measure their physical activity levels on a typical day.

While those overall figures may seem low, they may also provide an answer to a long pondered health paradox: Why Mexican-American populations are healthier than their socio-economic status would indicate. It has long been known that poor Mexican-American populations are healthier than equally poor populations of other races or ethnicities, and that in many cases poorer Mexican American populations are healthier as a group than wealthier populations from other groups. Based on these new findings, exercise may be responsible for this “Mexican-American health paradox.”

In a further twist off irony, much of the increase in physical activity among Mexican-Americans came from their work: Compared to whites and blacks they are more likely to be employed in positions of manual labor. Could it be that these low-status, generally undesirable jobs are helping keep them healthier than many of their social counterparts?

This study also underscores the importance of accurate measurement, using suitable technology where possible, when attempting to understand health behaviors and social realities. Previously I’ve mentioned the innovative use of the iPhone for gathering such data. What other promising technologies exist to help us better understand healthy behavior?

The Fight Over Fighting Obesity

2010-02-15T00:16:00.000-08:00

Only in the U.S. could a campaign to boost kids' health and wellness cause so much controversy.

Only in America could a program designed to improve the health and wellness of the country's youngest citizens be something that would attract a political firestorm. But that's what has happened to First Lady Michelle Obama's newly unveiled Let's Move program, which will target the ongoing childhood epidemic “through a comprehensive approach that builds on effective strategies, and mobilizes public and private sector resources.”

Not all of the criticisms that have so far been leveled at the program are illegitimate. Some believe that the initiative has overstated both the seriousness of the childhood obesity problem, and the laziness of children that the program says needs to be addressed. Certain statistics, for example, show that childhood obesity numbers are actually starting to decline. And many researchers have already pointed out the flaws in using the Body Mass Index (BMI) scale to measure obesity, saying it has many flaws and doesn't take certain crucial factors into account. Others worry that the Let's Move program might harm the very children it's trying to help by creating a culture of shame around body image and heaviness – possibly even encouraging eating disorders and other unhealthy behavior as kids try to avoid being fat at all costs.

Then there are the very unreasonable critiques of the program, most notably from FOX News channel host Glenn Beck. Beck used his show to throw out some wildly unreasonable charges of what the Let's Move program could lead to, saying:

“So now going all out to have government limit the food choices available at our kids’ school, to make sure that grocery stores pop up in what they are calling — and I’m not kidding you — food deserts. There’s no salad bars; it’s a food desert. Then we are going to put the grocery stores instead of fast food businesses.

They’ll limit what we can watch on TV, what ads we can run and how long we can watch. No doubt we’ll start mandating certain kind of activities as part of this wonderful government campaign.”

Clearly, the government plans to do nothing of the sort – and even if it did, it would have pesky things like laws and courts standing in its way. So, what does the program intend to do? Here are a few pieces of its mission toward boosting kids' health and wellness: revamp the food pyramid and help put new dietary guidelines into practice; serve healthier food in schools; promote front-of-label calorie listings to encourage healthy eating choices and purchases; educate doctors, nurses and parents about obesity; increase public awareness about obesity through public service announcements; and reauthorize the Child Nutrition Act, which would increase the quality and numbers of participant in the National School Lunch and Breakfast programs.

Artistic cures for health problems

2010-02-14T23:27:00.000-08:00

It may be low-tech and sound like folklore, but a growing body of research is pointing to the value of artistic expression as a means of fighting deadly diseases. A new study has reviewed the evidence for a number of different forms of expression. Among the findings:

Soothing notes: Cancer patients who listen to relaxing music experience increased sense of control and wellness in hospitalized patients, reductions in pain, anxiety, psychological and physical symptoms, compared to similar patients who don’t “tune-out”. A small study of heart attack patients found that listening to music reduced stress, as measured by heart rates and temperature readings. And a second small study in coronary patients found that 20 minutes of music reduced heart and breathing rates, the heart’s demand for oxygen, and anxiety for at least 1 hour.

Enjoying the view: Creating visual art may provide an expressive outlet for fears or stressors, itself linked to lowered rates of chronic stress and associated poor health. Several studies of breast cancer patients have found that visual-art therapy increases a sense of optimism, self-confidence, and physical activity levels, while reducing pain and sleeplessness. Just being in the presence of art may help: critical care and surgery patients in rooms with landscape pictures on the walls required less pain control medication, and left the hospital sooner than equivalent patient in drab surroundings.

Writing from experience: Creative writing improves mood and health, this may in part be due to the pressure-outlet it provides for health-harming stress. But there may be more at play: Two randomized trials of patients in pain clinics found that patients who wrote about their experiences developed more control over their pain and depression. And a trial of HIV patients found that an emotional writing program led to measurable, clinically significant and sustained reductions in viral load over the course of the 6-month study.

This is just a sampling of the literature supporting the curative powers of the creative. Though they are of course far from conclusive, using art as an adjunct to regular therapies makes sense. There’re of course no side effects, and chronicling the way that an illness effects our experiences and perceptions can be a worthy exercise. On the best of days, creative expression helps define our individuality, and when disease threatens identity, reducing you to nothing more than a patient, creative expression can be existentially edifying. The potentially-curative powers of art also remind us that there are many dimensions to wellbeing, and we are well served by attending to the many faces of health.

What creative outlets make you feel healthy?

Shoveling can be hazardous to your health

2010-02-12T00:49:00.000-08:00

Public health officials warn of heart attacks and other cold-weather hazards.

As if all the white stuff falling from the sky in the eastern United States weren’t annoying enough, public health officials offer one more reason to hate it: It can kill you, or at least harm your health. Officials with the U.S. Department of Health and Human services issued a release Thursday reminding the not-so-young among us that certain winter activities, especially shoveling, should be left to the very fit. Muscle strain, including that of the cardiac muscle, can result when people who haven’t left the couch since November suddenly rise and take a shovel to the double-digit snowfall totals that have plagued parts of the U.S. in the last few weeks.

"If you're not a regular exerciser or you're in poor physical shape, your body won't be prepared for the stress of shoveling snow and you increase your chances of sustaining muscle pulls, back injuries and strains. Snow shoveling can also strain the heart and cause potentially life-threatening injuries, such as a heart attack," Dr. Susan Wainwright, vice chair of the physical therapy department at University of the Sciences in Philadelphia, said in a news release highlighted by public health officials.

Wainwright added that men and women over age 45, especially those who aren't physically active or have a history of a heart condition, should leave the shoveling to someone else. "The heart is a muscle just like any other muscle in your body and when it gets strained, it shuts down because it can't handle the increased load. Older adults who aren't active tax their cardiovascular system when they start to shovel and this often results in heart attacks," Wainwright explained.

Wainwright and other public health officials offered these tips to avoid injury and protect your health:

Warm up before you shovel, just as you would for any other rigorous exercise. Jog around. Jump rope. Stretch.
Buy an ergonomically correct snow shovel. These types of shovels are designed to reduce bending and decrease lifting.
Push the snow instead of lifting it. If you must lift, use your legs and not your back. Don’t twist your back when you deposit the snow.
Take a break every 15 minutes or so.

In addition to the joint warning by Wainwright and the Health and Human Services Department, the U.S. Centers for Disease Control and Prevention (CDC) have offered their own cold-weather warnings. Public health officials there want you to be aware of hypothermia, frostbite, trench foot and chilblains. Hypothermia and frostbite require medical treatment; trench foot and chilblains can be self-treated if they are not too severe. Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature drops. Early symptoms include shivering, fatigue, loss of coordination and confusion. Frostbite is an injury to tissue caused by freezing, Symptoms include numbness, aching, tingling and sometimes a blue or waxy cast to the skin. Trench foot occurs after prolonged exposure to cool, damp or wet conditions. Early symptoms include reddening of the tissue and swelling; advanced symptoms can include gangrene. Chilblains are damage to capillaries caused by repeated exposure to cool temperatures. They can cause itching and inflammation.

What’s your winter-related health horror story?

Photo Credit: ktylerconk

Accountability and measurement in health care: Does it matter?

2010-02-09T02:44:00.000-08:00

Health care and public health lacks a culture of accountability. In particular, we need to foster a culture that seeks out meaningful measures of success, monitoring and reporting of outcomes, and constant quality improvement as part of its everyday practice. Without measurement we have no idea if what we are doing is working, meaningful or the right thing.

Following the Haiti earthquake, I’ve been pondering two aspects of disaster response: Charitable giving and direct medical response. Specifically:

Does giving without accountability equal giving for the benefit of the donor, and not the recipient?
Are doctors who provide services in Haiti (or Havana, Honolulu or Honduras for that matter) without measuring their outcomes in fact serving their own interests more than their patients’?

First, charitable giving. For the individual who writes a check to the Red Cross or Partners in Health, there is the presumption of knowledge. They likely chose an entity based on information indicating that the majority of their dollars will be well-spent providing meaningful services to a certain population. They may even do research to make sure the charity is worthy, based on the percentage of money that reaches recipients, and other measures. The same may not always be true for larger donors: While they require annual reports about the use of their funding, they are not always linked to meaningful measures that assess the value of service provided. Is a nutrition program being evaluated by how much food it distributes, or by how it impacts the underlying nutritional status of a population? The former is easy to assess but has little meaning. The later is challenging, but has meaning for the population being served.

What about doctors? Medical history is full of well-intentioned practices that later turned out to be harmful. Think about blood-letting, using arsenic and mercury as medicine, or more recently the use of hormone replacement for post-menopausal women. Applying the scientific method is the only way to know how treatments and practices work, even crude methods that can be used in a battlefield or post-disaster environment. And assuming that what worked in one scenario will work elsewhere is not good enough. The context in which medicine is practiced impacts the outcomes of that practice, and will change as the context changes. So when docs practice medicine without an eye towards measuring results, they may be providing salve for their own professional and spiritual needs, but not the needs of their patients.

In health care cost-effectiveness sounds cold, a business metric better applied to manufactured goods. But consider that “cost” means resources, including the patient’s time and energy. When patients spend their time seeking a service, there is a commensurate opportunity cost to those other services they are NOT seeking. So the patient may be “paying” in more ways than one.

Accountability requires measurement. We must measure to know whether we are succeeding or failing. Not to try to know may be the greatest failing of all.

Silly adults, vaccinations aren't just for kids

2010-02-07T21:56:00.000-08:00

A new report finds an alarmingly low rate of vaccinations among U.S. adults and seniors

Vaccines have been bombarding the news cycle as of late. First, there was the announcement that the Bill and Melinda Gates Foundation would give $10 billion over the next decade toward developing and delivering vaccines. Most explosive was the news that a high-profile study linking vaccines to autism was being retracted. Both stories inevitably focus on vaccines in young children. The money being donated by the Gates' is specifically being put toward vaccinating children in the developing world; the autism-vaccine link is a concern for parents of young children. But now comes vaccine-related news geared specifically toward a much older demographic.

Public health officials are troubled by how few American adults are receiving recommended vaccines. The biggest cause of concern is seniors who are not immunized for pneumonia, a condition to which senior citizens can be particularly vulnerable. A report by the Trust for America's Health (TFAH), the Infectious Diseases Society of America (IDSA), and the Robert Wood Johnson Foundation found that more than 30 percent of adults over 65 hadn't been immunized for pneumonia; under 2 percent had been immunized for shingles, a very painful disease that causes a blistering skin rash; and under 70 percent had received the pneumococcal vaccine, which is far short of the CDC's goal of a 90 percent vaccination rate for seniors.

Since people's immunity weakens over time, adults need to receive both vaccines and “booster” shots for diseases they were immunized from as kids. As people grow older, they become increasingly vulnerable to conditions like heart disease, diabetes and liver disease, and those conditions in turn make them more susceptible to the flu or pneumonia, diseases that vaccinations can protect them from. But for myriad reasons, adults get immunized far less than children. Some people have limited access to places that provide vaccines; or can't afford them because insurance companies don't tend to provide much preventative care for adults. Others believe the same misinformation about children and vaccines applies to adults, also: that they're unsafe or ineffective. Whereas the U.S. has several programs in place to ensure that infants and children receive vaccinations, few such campaigns are targeted at grown-ups.

The TFAH, IDSA and Robert Wood Johnson Foundation included in its report several recommendations to turn the tide toward more vaccinations for adults. The groups are urging the government to create a “Vaccines for Uninsured Adults” program, that would include, among other things, coverage for preventative vaccines to everyone receiving Medicare benefits. The government should also ramp up funding for state and local governments to get the word out about vaccination campaigns. Programs at the local level often have the most success, the groups write. Adults often put so much care and attention toward getting their kids vaccinated, it's hard to believe that so many of them don't take similar time to protect themselves.

Black and Hispanic infants far more likely to contract HIV

2010-02-05T04:53:00.000-08:00

Although overall cases of infant HIV are down, Black and Hispanic rates of infection still outpace that of whites.

Rates of HIV infection in infants are still significantly higher among blacks than whites, and public health officials need to act to close that gap, a new study says. Although the number of HIV-infected infants has declined overall, the rate of perinatal HIV infection among black babies is still 23 times higher than the rate for whites. (Perinatal infections are transmitted to babies at birth). The study, published in Thursday’s issue of the Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention, also found that the rate of infection was four times higher for Hispanic babies than for whites. Yet not all was bad news: researchers noted that overall the number of perinatal HIV infections has dropped 90 percent since 1990. The study analyzed data from 34 states from 2004 to 2007, and noted that transmission from an HIV-infected mother to her child can be significantly reduced through preventive measures. “To further reduce perinatal HIV transmission and racial/ethnic disparities, HIV-infected pregnant women, and particularly black and Hispanic women, should receive timely prenatal care, early antiretroviral treatment, and other recommended interventions,” researchers said.

The CDC report coincides with the release of another report Thursday that analyzes public health officials’ efforts to reduce HIV transmission among African Americans, particularly men. That report gave credit to community-based organizations for providing front-line services to individuals and feedback to federal agencies on the need for those services. However, the report found that African Americans continue to account for an inordinately high number of new HIV cases, and that efforts to reach members of the African American community have fallen short of where they need to be. Most of those new cases are triggered through sexual contact, especially among men having sex with men (MSM), while fewer cases are being spread through intravenous contact, according to the report.

“Blacks and Hispanics in the United States have been disproportionately affected by HIV and AIDS, compared with non-Hispanic whites, since the early days of the epidemic...Although the CDC’s efforts to combat HIV/AIDS among Blacks have achieved some success, more must be done to address this crisis,” CDC officials wrote in the report.

Meanwhile, other agencies are doing what they can to destigmatize the disease and reflect its growing status as a disease that can be managed, rather than an automatic, if eventual, death sentence. Last month the CDC and the federal Department of Health and Human Services removed HIV from the list of communicable diseases that prevent non-citizens from entering the United States.

Have public health officials done enough to protect at-risk populations from the spread of HIV? What do you think?

What is public health?

2010-02-01T12:54:00.000-08:00

Public health tackles non-clinical factors that influence health. Which is practically everything: The natural and built environments, education, housing, transportation, business, food and nutrition, recreational activities, the list goes on. The focus is on health promotion and disease prevention, since the best treatment is to never get sick or injured. That sounds reasonable enough.

But public health is criticized for placing population health over individual health. For example, reductions in breast cancer screening might be better for the population in that they reduce costs and the burden of over-diagnoses, but that reduction could lead to harm in some women who have high-risk cancers despite being in low-risk, un-screened groups.

I wanted to share some stories from the front lines of public health. Just like doctors, public health professionals work one-on-one with individuals. We are not just population specialists, but struggle to balance sympathy for individuals with their legal rights and responsibilities, threats to the public’s well-being, and our sometimes limited powers of enforcement or mitigation.

I serve as the local town health officer, probably the smallest unit of public health in terms of population impact. My small town community is sandwiched between a small city and more rural countryside. There is a tired history of agriculture and granite quarrying, education and income levels are low, and the housing stock is old.

Some typical calls:

Chickens being raised on a paved driveway in a residential neighborhood. Neighbors complain of early morning rooster crowing, and worry about excrement attracting flies and running off onto their property when it rains. But mitigation is complicated by an agricultural heritage that supports micro-farming, and no local ordinances prohibiting the raising of chickens in that setting. So the egg laying continues.

Tenants complain that their drafty apartment is sickening their child, and their doctor agrees. But temperature readings on a cold day find the unit warm enough. Landlord and tenant are in open conflict, and I leave having done very little but encourage both sides to work it out.

A trailer with countless health and fire code violations, tenants not paying and landlord not complying. Hygiene is frightening for the young parents and children. Even after we haul off a ton of maggot-infested garbage, the smell of the unit is gagging. Eventually the tenants move out, but the troubled unit remains.

Neighborhood cats turn a daycare center’s playground into their litter box. But we don’t know the offending cats. So the unsatisfied owner is told to take pictures of the offending creatures.

A grandparent worried about the care of their grandchild. The discussion unearths potential parenting problems, and all I can do is recommend that a report to state child protective workers.

We could go on for several pages. Some common themes? These are everyday small scale people-problems that plague the planet. They certainly aren’t sexy (no Grey’s Anatomy episode fodder here), and frequently come down to negotiation and the sense that even when the problem is addressed, it may never really be fixed.

A $10 Billion Push to Make Vaccines Even More Accessible

2010-02-01T10:57:00.000-08:00

The Bill and Melinda Gates Foundation announced it would step up its efforts to bring life-saving vaccines to every corner of the world.

Late last year, the World Health Organization (WHO), United Nations and World Bank issued a report finding that 106 million infants under the age of 1 were vaccinated in 2008, and also trumpeted the news that 120 new vaccines had been developed to battle diseases like measles and meningitis. But the report wasn't all rosy: It found that despite all the good vaccines were doing; 24 million infants – mostly in poor and remote areas in Africa and Asia - weren't getting vaccines during that crucial first year that babies in developed nations commonly receive.

It's unsurprising that the Bill and Melinda Gates Foundation, the organization responsible for much of the joyful news regarding successful vaccinations, is stepping up again to address these shortcomings. This week Bill Gates announced at the World Economic Forum in Switzerland that the charity would be pledging another $10 billion over the next 10 years to address caps in vaccination coverage, hopefully increasing that coverage to 90 percent. The money will also be put toward delivery of the vaccines, since many children who miss out on immunizations do so because they live in poorly served areas where access is difficult.

The Gates' charity helped establish the GAVI alliance, a public-private partnership that helps channel money to poor countries to purchase vaccines. The partnership also includes several drug-making companies like GlaxoSmithKline Plc, Novartis AG, Crucell NV, Merck & Co. Inc., Sanofi Pasteur and Wyeth. It also includes organizations like UNICEF, the WHO and World Bank. Before the partnership began, prior to 2000, immunizations were in a downward spiral. Now, the push for immunization is considered one of the factors (in addition to clean water and sanitation) responsible for the first documented drop in yearly deaths among children to under 10 million.

Gates noted that the new money would be critical in the push for new vaccines aimed at stopping pneumonia and rotavirus diarrhea, two deadly conditions for children in developing nations. Reuters noted that the plan could prevent up to 8 million child deaths over the next 10 years. Last year, the partnership pledged $1.5 billion toward a pneumococcal vaccine for developing nations. Pneumococcal diseases can cause meningitis and pneumonia, and kill about 800,000 children each year.

Though he announced the vaccines money in front of a horde of reporters covering the World Economic Forum, the news also coincides with Gates opening a Twitter account, where he's quickly amassed close to 400,000 followers, and has been sending out bits and pieces of “cool things,” like vaccine-related updates. One update directs followers to a video of the $10 billion announcement; another talks about his meeting with German Chancellor Angela Merkel prior to the announcement.

Public health panel urges routine obesity screening for children

2010-01-29T00:08:00.000-08:00

One in six American children is overweight, and all kids, beginning at age six, should be checked.

Kids entering the first grade can now add a new test to the vision and hearing tests many schools require them to get: an obesity test. Public health officials want doctors to screen all children for obesity beginning at age six, and to refer overweight children to “intensive” weight management programs. The recommendation was announced this week by the U.S. Preventative Services Task Force, the same group that caused an outcry late last year when it urged baseline mammograms for women beginning at age 50 instead of 40.

The health policy panel said doctors should use height and weight measurements to calculate children’s body mass index (BMI). Kids whose BMI is over the 95 percentile for their age and gender are considered obese and should receive weight management treatment, members of the task force said. That treatment should include three parts: counseling, physical activity and behavioral management training for goal-setting and self-monitoring.

One possible problem, public heath officials acknowledged, is that there aren’t many juvenile weight management programs that are both effective and affordable. The existing programs that are comprehensive enough to help kids change eating and activity patterns generally are private and can be quite expensive. Still, the growing problem of childhood obesity has led more hospitals and other health care facilities to offer weight management programs for kids.

Public health experts have called childhood obesity everything from an “impending catastrophe” to a “massive tsunami” threatening the American health care system. Already, obese children and very young adults are showing signs of developing Type 2 diabetes, hypertension and high cholesterol. Approximately 15 percent of kids age 6-15 are overweight, according to the National Center for Health Statistics, and a 2005 report in the New England Journal of Medicine suggested obesity could shorten the lifespan of today’s kids by two to five years.

Worried that your kids are in danger of becoming overweight? Here are some things you can do:

Involve your kids in meal planning and preparation. There are plenty of cookbooks for kids available, and many emphasize healthful eating. Tape the food pyramid to the refrigerator, and then have your kids plan a meal a week. Also, have your kids pack their own lunches based on the pyramid guidelines.
Look for community programs, such as the YMCA, that offer after-school sports, recreation and sometimes even nutrition programs. Go for a family walk or bike ride after dinner. If you’re having trouble tearing your child away from the computer screen, consider investing in one of the popular video game exercise programs.
Talk to your child’s doctor. He or she can refer you to a nutritionist for help on meal planning and a counselor for tips on how to support your child emotionally during the weight management journey.

What ideas do you have for helping kids achieve and maintain a healthy weight and attitude?

Military humanitarians: Public health saviors or invaders?

2010-01-24T01:41:00.000-08:00

Involving the military in humanitarian response has long been controversial, and recent events in Haiti raise many questions about the effectiveness, and appropriateness of using soldiers and weapons of war in such situations. With the devastation of the local UN mission, which would normally have spearheaded the coordination of response efforts, The US military’s role has become central in Haiti.

The military specializes in logistics, moving people and supplies in difficult terrain with ships, aircraft and other vehicles. They can rapidly deploy established chains of command, coordination, and communication. But many of their strengths may also be weaknesses in the humanitarian context. For example:

Coordinating the efforts of multiple organizations is always challenging, and strong command and control within an organization does not equal good coordination with others. The military has certain ways of doing things, and perceived priorities that may not align with other humanitarian organizations, or humanitarian principles and practices in general. Not only may they lack the ability to allow others into the command and control structure, but they may be loathe to assume the appropriate mindset of humanitarian responders.
The military’s law-and-order role is a case in point. US military assets are being tasked with certain peacekeeping operations, alongside the distribution of relief supplies. But tasks such as stopping looters may not be essential. While the vision of people hauling stolen food, electronics, home supplies and auto parts from damaged stores may appear unsightly under normal situations, after a disaster of this scale we may be better off simply letting folks vent their frustrations (and satisfy their hunger) with “stolen” goods. The need for “peace keepers” also implies an element of danger that may not be real, but may still hamper relief efforts as organizations consider security needs. Generally, soldiers deployed after disasters are only there as a show of force. Look closely and you usually notice that their weapons are unloaded.
What are the unintended consequences of military efficiency? This may apply to other responders as well, but the news that the military had recently distributed 150,000 bottles of water and 100,000 prepackaged military meals raised a couple of questions. Are 1 liter bottles the most efficient means of mass-distributing water? And what happens to those 150,000 bottles once they are emptied? Since the meals are also packaged in heavy plastic, we are talking about introducing mass amounts of extra plastic into an environment already overburdened with the detritus of mass destruction.
The military answers to their government, meaning that their efforts are inherently political in nature, intimately tied to the interests of the flag they work beneath. To maintain legitimacy, shouldn’t humanitarian efforts be largely un-political? This seems necessary to ensure that effectiveness and distribution isn’t at least perceived as being influenced by the political palatability of recipients.

While its certainly handy to have the tools of the military at your disposal, it can also look a lot like an invasion when soldiers dominate the landscape of humanitarian response.