Friday, July 31, 2009
Lichen planus
The answer to yesterdays medical quiz was #4- oral lichen planus.It is an autoimmune condition that causes inflammation on the lining of the mouth. It can affect the gums, tongue and lips, but is usually seen on the inside of the cheeks.We see oral lichen planus during midlife, but it can occur any time and can last for years. Lichen planus can be found on the skin, scalp, nails and genitals.
BLOGSCAN - More on Senate Hearings on Industry Funded CME
There has been considerable coverage of the remarkable hearings by the US Senate Special Committee on Aging on industry funded continuing medical education (CME). See reporting by Dr Daniel Carlat on the Carlat Psychiatry Blog, and by the Prescription Project on their Postscript Blog. See also the comments by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog. Some key points were that the Senators failed to see why physicians cannot afford to pay for their own CME, and therefore must depend on corporate funding to support; and the Senators failed to buy the argument that medical progress vitally depends on health care corporations paying for and influencing the education physicians get.
Thursday, July 30, 2009
Tips To Overcome Insomnia To Prevent Acne, Hair Loss, Ulcer And Headache Problems
Are you suffering from acne problems, hair loss, ulcer attack or frequent headache? Or do you feel that you are constantly in stress? The most like causes of all these maybe perhaps be insomnia, or lack of sleep and rest. Today let us discuss how we can deal with insomnia.
If you have a rocky workplace, this can also be a good excuse for insomnia. You are going to be stressed and uneasy about a lot of things when you are worried about what is going on at work. You need to find out a way to work through these problems to make them better. Get help from your supervisor or manager to take this problem on. Once you get it sorted out, you will probably find that you can rest better at night and start sleeping through the night like you once did.
Do not overeat as heavy meals will drain out your energy. Instead of eating a large meal, you need to eat three smaller meals throughout the day. You need to have your blood sugar and your insulin levels more even. You will also find it easier to sleep at night if you eat this way. You need to keep watch of what you eat so that you can dream away at night. Eating rich foods will help you out a lot when it comes to dieting. Remember that overeating can not only cause insomnia, it can also cause unwanted weight gain too.
Next, are you finding hard to concentrate while you sleep? Do you know that there are as many as 100,000 car accidents and fifteen hundred deaths that are from accidents caused by people that are driving while drowsy. This is a serious problem and one that more and more people need to address. There are lots of people that are sacrificing their sleep to do other things in life. It is not going to help anyone if a person skips the sleep that they need in order to do something else.
Insomnia is a leading cause in the United States for decreased productivity. Each year insomnia will cost the United States over one billion dollars for the research and the lost work that is not getting done. This is a serious condition and one that has to be taken more seriously. There are more and more people under stress and hectic lives. They are not allowing themselves enough time for rest and relaxation and this is leading to more severe problems for them such as headache, acne problems, and even hair loss.
You should also eat a great breakfast. You need to eat foods that boost your metabolism and give the body energy to burn off. The brain will depend on the glucose for fuel and so carbohydrates for breakfast is a great idea. You should try to not skip any meals. It is important to eat healthy and to eat when you are hungry. Cereals and wholegrain bread is the best way to get a good start on your day and keep you awake.
Lastly, about a third of the average persons life is spent sleeping. This means that sleep is very important to our health and us. Healthy sleep is more important. It is vital to a human's body and it is going to be essential for the brain to function the way that it is intended. Other organs in the body also depend on the amount of sleep that a person gets to function properly.
Alright! You've now completed the easy part. From here, you have to start to plan a regular and healthier plan for your daily life. By changing your lifestyle for a better, healthier one, you will ultimately enjoy a healthier, happy life.
by: Christopher Wen
Beta-Glucan May Prevent Anthrax When Taken Orally
In a 2002 study, a group of researchers used oral Beta Glucan to treat mice infected with Bacillus Anthracites. With the high incidence of anthrax vaccine complications, an alternative preventative approach is sorely needed to deal with this frightening disease. Non specific immune stimulation methods, such as macrophage activation would be an excellent option.
The way that anthrax works is by secreting two toxins: edema toxin and lethal toxin. The first of these stimulates an outpouring of fluid into the lungs, while the latter inhibits nuetrophil phagocytosis and triggers destructive intracellular reactions, destroying macrophage cells. This is especially threatening because of the fact that the lethal toxin prevents the macrophages from releasing their immune messengers, including TNF-alpha.
The study in question showed that orally administered Beta Glucan greatly stimulates the levels of TNF-alph released from the macrophage, which overcomes the inhibition caused by the anthrax lethal toxin. Because of this, the mice that were treated with Beta Glucan experienced a significantly higher survival rate.
Beta Glucan was also shown to stimulate the effectiveness of neutrophils. In fact, one study indicated that the efficiency of neutrophils was increased as much as 50-fold by this powerful supplement, allowing for much faster and more precise immune reactions.
by: Jeremy Maddock
ADHD and Iron Deficiency
About 8% of children, ages 4 years and under, are deficient in iron. Between the ages of 5 and 12, the percentage rises to 13%, and then settles back to 8% in people above the age of 15. Anemia is the best-known repercussion of iron deficiency. However, even minor deficiencies in iron may weaken the immune system, affect the thyroid, and impair general physical performance. Iron deficiency has also been implicated in a number of psychiatric and neurological conditions, including learning disabilities and ADHD.
Iron is a co-enzyme in the anabolism of catecholamines. That means it is essential for the creation of certain neurotransmitters. It helps to regulate the activity of the neurotransmitter dopamine, which probably accounts for the association of iron deficiency with neurological problems. It makes sense that supplementing ADHD children, who have some level of iron deficiency, might have some effect on their ADHD. However, what makes sense in theory, does not always work in practice. Unfortunately, there have been very few studies done testing the effects of iron supplementation on ADHD.
One study, done in Israel, evaluated 14 ADHD boys for the effect of short-term iron administration on behavior. Each boy received iron daily for 30 days. Both parents and teachers assessed the behavior of the children. The parents found significant improvement in the behavior of the children. However, the teachers noticed no improvement.
In a second study, 33 iron-deficient, but otherwise normal, children were given an iron supplement. The children became less hyperactive. This study suggests that iron deficiency may cause hyperactive behavior in some children and that hyperactive behavior is reversible when the deficiency is treated.
A third study tested the affects of iron supplementation on a group of teen-aged high school girls who were determined to be iron deficient. At the end of the 8-week study, the researchers found that girls who received iron supplementation performed better on verbal learning and memory tests than those who did not.
This is about all the evidence we have. It’s not a lot and it’s not very impressive. None of the studies were double-blind studies, which means we cannot really rely on them all that much.
If this were the only consideration, I would say you should definitely try to treat your child for iron deficiency. The reason is that hyperactive children are more likely to be iron deficient than other children. Also, there is a possibility that your child has a higher than average iron requirement. That means that he might test normal on all the iron blood tests and still be iron deficient because he requires more than the average amount of iron.
So why not just give your child iron supplements and see what happens? Because iron functions in the body like a two edged sword.
Iron exists in the body in two chemical forms. There is the ferrous form, where the iron atom will bond to two electrons and the ferric form where the atom will bond to three electrons. Iron can go back and forth between these two forms. This is the property of iron that allows it to play a role in carrying oxygen as part of hemoglobin. However, it also makes iron an active player in oxidation-reduction reactions. What that means is that iron has the ability to act like a free radical and cause significant damage to tissues. Whenever iron is not bound to hemoglobin or to some other carrier protein, it travels around the body as free iron and can cause damage anywhere it goes. To further exacerbate the problem, excess iron is not eliminated well by the body. Most of the iron in the body gets recycled. Therefore, not only is excess iron toxic, but also once you have excess iron in your body, it is going to stick around for a long time. High amounts of iron have been ! found in the brains of people with Parkinson’s disease. It is very likely that excess iron can aggravate, if not cause, other neurological problems as well.
With that in mind we have to approach iron supplementation with caution. My feeling is that if your child turns out to be one of the 8-13% that is deficient in iron, it is worth giving iron supplements. I doubt that it will help much with his ADHD, but it should help with his general health. This advice applies to your non-ADHD children, also.
How should you test iron deficiency? The hemoglobin and hematocrit counts that come as part of the standard complete blood count (CBC) are good for diagnosing anemia. They do not really give you accurate information about the body’s iron status. The best test for iron status is the serum ferritin test, which measures how much iron is stored in your body. It will be low if you are deficient and high if you are overloaded.
If you find your child has an iron deficiency problem, there are several approaches to treat it. Probably the safest is by giving him more iron-containing foods. You can serve him red meat several times a week. Liver is an excellent source, if you can get him to eat it. You can enhance dietary absorption by supplementing with vitamin A (about 10,000 IU) and vitamin C (about 500mg) with the meals.
The most likely the reason that your child is deficient is because he is a poor eater; so, dietary intervention may not be practical. A second and far inferior source of iron is through supplements. The primary difficulty of iron supplements is that they do not get into the body. Fortifying foods with iron in general does not work. Many foods bind iron and, as a result, the iron is excreted rather than absorbed. The best form of supplemental iron is Ferrochel. Ferrochel is an amino acid chelated iron, which is highly bio-available and is not affected by foods that bind iron.
Most iron supplements have a ten percent absorption rate. That means if you take 10 mg of the supplement, your body absorbs 1 mg. Ferrochel is different. Ferrochel has a 75% absorption rate. That means 1.5 mg of Ferrochel provides more iron to your body than 10 mg of other supplements.
That is an interesting fact, but it is not why I am recommending it. The more important property of Ferrochel is that since it is already amino acid bound, it does not become free iron in the body. That means it does not have the dangers and side effects of other iron supplements. The FDA has given Ferrochel the designation of GRAS, (generally regarded as safe). No other iron supplement has this designation.
The take home message is that iron deficiency may be the cause of hyperactivity in some children. It is worth your while to have your child tested. If for some reason you suspect your child is iron deficient, the best approach is to increase your child’s iron intake through his diet. If that doesn’t work and you need to use supplements, the best supplemental iron is Ferrochel.
by: Anthony Kane, MD
Causes and Prevention of Diarrhea In Labrador Retriever
A healthy Labrador Retriever will normally defecate firm stools once or twice a day. However, if your Labrador Retriever passes semi-solid or liquid stools more often than usual, then he is probably suffering from canine diarrhea. Diarrhea is common in Labrador Retrievers because of their hearty appetites. They tend to eat anything, digestible and non-food objects alike, especially if their owners are not looking. With immediate attention and proper care, diarrhea caused by ingesting foreign objects can be treated within a day or two.
Diarrhea has many other causes aside from eating unsuitable objects. It can be caused by intestinal viruses, stomach viruses or intestinal parasites. Problems within the digestive tract such as ulcers, cancer, food allergies and toxins can trigger diarrhea. Health problems not related to digestive tract can also trigger diarrhea. Some of these health problems are liver disease, kidney disease, Addison's disease and anxiety. Always remember that diarrhea is not a disease, but is a symptom of various diseases. It maybe just a symptom but may become life threatening if not treated immediately.
For simple cases of diarrhea in your Labrador Retriever, home treatment is enough. Provide plenty of fresh water or oral rehydration fluids to drink provided he is not vomiting. You can also try giving him an ice cube or two every four hours to help him not drink so much water. It is also advisable to put him on fast for 24 hours to rest his irritated tract and feed him only if he appears better after a day. You can start feeding him with small amounts of bland diet every four hours. If your Labrador Retriever appears better after bland diet and small amounts of food, you can gradually return to his regular diet.
Severe cases of diarrhea, if it persists more than 24 hours, if there is any blood and if accompanied with vomiting, immediate veterinary care is needed to prevent your dog from dehydration. If there is blood in his vomitus or stool, if he has fever and if it persists for more than one to two days, it could be sign of infection or other diseases. Visit your vet immediately for medication. He will usually recommend drink with electrolytes and dietary supplements such as probiotics for it has beneficial bacteria helpful in restoring the health of the dog's intestinal tract. Serious cases of diarrhea due to infection or inflammation of the intestine may require antibiotics.
by: Richard Cussons
Acute and Chronic Sinusitis: What About?
We often experience sinus problems especially when it is cold. And sometimes we just disregard the signs and symptoms we experience knowing it is only a simple cold symptom, however from simple cold develops into a sinus infection. How hard to spot the difference isn’t it?
Here is a more specific presentation of the signs and symptoms of sinus infection depending upon which of the sinuses are affected and in cases where the infection is acute or chronic.
The following are the sinus infection cases under the Acute Sinusitis.
Frontal Sinusitis (located above the eyes in the region of the forehead) - In this case for sinus infection symptom there is severe ache in the forehead, fever, postnasal drip or nasal discharge and the sufferer is on a lot of pain when in a stretched out position but feels a bit better when the head is upright. Maxillary Sinusitis (located on either side of the nostrils in the cheekbones) - There is pain and pressure on one or both sides of the cheek; tenderness, redness and swelling of the cheekbone; pain is worse when the head is upright and feels better when in reclining position; pain across the cheekbone, under or around the eye or around the upper teeth; there is also nasal discharge.
Ethmoid Sinusitis (located behind the bridge of the nose and at the base of the nose between the eyes) - There is nasal congestion with nasal discharge; pain or pressure around the inner corner of the eye or on one side of the nose; headache in the temple or surrounding eye, pain or pressure symptoms worse when coughing, straining or lying back but better when the head is upright.
Sphenoid Sinusitis (located behind the ethmoid sinuses and the eyes) - The sinus infection symptom here are fever; nasal discharge; deep headache with throbbing pain behind and on top of the head, across the forehead, and behind the eye; pain is worse when lying back and bending forward; vision disturbances when pressure extends to the brain.
And for the sinus infection under Chronic Sinusitis here are the following symptoms.
Frontal Sinusitis –the sufferer will feel a constant low-grade headache in the forehead and accounted damage in the sinus area.
Maxillary Sinusitis - There’s pressure below the eye, chronic toothache, discomfort throughout the day with amplified cough at night are some of the effects.
Ethmoid Sinusitis - There is chronic sore throat that causes bad breath; chronic nasal discharge, congestion, and a bit of discomfort across the bridge of the nose; worse pain in the late morning and when wearing glasses, recurs in other sinuses.
Sphenoid Sinusitis - The sinus infection symptom in this sinus is low-grade headache.
Anyone can be a victim of this infection. It may sound impossible to prevent this but on the contrary you can get yourself be cured. Just be vigilant to detect such symptoms and be ready to prepare a proper medication if persist.
by: Marlon D. Ludovice
Is Colloidal Silver A Treatment For Bronchitis?
What is Bronchitis?
Bronchitis is defined...
as an inflammation of the bronchi. Bronchi are airways in the respiratory tract that bring air into the lungs. This inflammation is typically caused by viruses or bacteria, but it may also be caused by inhaled irritants, such as cigarette smoke or harmful chemicals.
Most cases of bronchitis cases involve a viral pathogen. The inflammation is usually the result of the mucus lining of the airways becoming swollen due to irritation. Anyone may contract bronchitis, but people with weak immune systems, such as children and the elderly, are particularly vulnerable.
What are the Symptoms?
Coughing up phlegm or spit, difficulty breathing, and wheezing are all common bronchitis symptoms. Patients typically seek treatment for bronchitis once the coughing becomes uncomfortable or painful. If the inflammation is particularly severe, fatigue, fever, or chest pains may arise. In rare cases, gastrointestinal bronchitis symptoms may arise.
How can you Prevent Bronchitis?
A vaccine for a Haemophilus influenza, which commonly causes bronchitis, was developed in 1985. However, since the vaccine only boosts immunity for six months, it is typically only administered to those most at risk.
Anyone who wants to limit their risk of bronchitis should stop or not start smoking. Even secondhand smoke may lead to bronchitis. Workers who are often exposed to dust or irritating chemicals should wear a dusk mask to prevent inhalation. Everyone who wants to decrease their risk should also limit their exposure to air and traffic pollution.
How is Bronchitis Treated?
There is no medical cure for bronchitis. Typically doctors will treat the symptoms to alleviate the pain and discomfort, and wait from the body to naturally correct the inflammation. Far too often, doctors will prescribe antibiotics. However, for the large majority of cases of bronchitis, this is inadvisable.
Most bronchitis cases are the result of a virus, and antibiotics are only designed to treat bacterial infections. Many doctors are aware that antibiotics are ineffective for bronchitis, but prescribe them anyway because they feel pressured by the patient to treat something besides the symptoms.
A study from 2002 titled “Azithromycin for acute bronchitis” published in the medical journal “The Lancet” referred to this pressure from patients, concluding that “Many patients with acute bronchitis require their physicians to 'do something.' “And that it should not include the “defensive use of ineffective antibiotics."
Immunologists have long warned that over prescription of antibiotics will only lead to stronger and more resistant bacterial strains. Unnecessary prescription of any medicine can be harmful, and patients who take antibiotics may suffer side effects such as vomiting, headache, and rash.
Since the immune system is the best (and in most cases, the only) way to fight the infection that causes bronchitis, patients might benefit from taking supplements that support and boost the immune system.
Many have claimed good results with taking colloidal silver for bronchitis. Colloidal silver can be taken orally or through a nebulizer.
If you would like to take colloidal silver for the treatment of bronchitis, it may be interesting to note that some patients have reported the best results with true colloidal silver versus inferior products that are mostly ionic solutions.
by: Wyatt McKinney
Bloggers Can Spread the Word, Just Not About the Sponsors' Competitors
The internet, social media, web 2.0 etc have changed how important health care issues are discussed. So, it is not surprising that big health care organizations are trying to use these new media to promote their messages. New media, however, are no more immune from the effects of conflicts of interest than are old media.
An article from corporate communications company Ragan.com about how the American Heart Association (AHA) is using bloggers to get people interested in a heart-healthy diet and exercise program illustrates how even "civilian" bloggers can get caught up in the web of conflicts of interest that pervades health care. The background is:
It did seem that the AHA went to considerable effort to make sure they had recruited just the right bloggers.
I would suspect that the explicit instruction not to favor Merck's competitors would also remind the bloggers not not do say anything that might make the giant pharmaceutical company unhappy.
This is an explicit example of the adverse effects of commercial funding of not-for-profit disease advocacy groups. Corporate sponsors may not expect anything as gross as advertising in return for their money. However, they may expect something more subtle, a generally favorable attitude toward the sponsor, at least the disinclination to say anything that might put the sponsor in a negative light. After all, politeness requires that we be nice to the people who are nice to us. But being nice to sponsors may not be so nice for the people that a health care not-for-profit organization is supposed to serve.
PS - for those who like science fiction, see the preview of the new version of "V," in which Anna, the leader of the Visitors, an invasion force disguised as human-appearing, benign aliens, warns her television interviewer,
An article from corporate communications company Ragan.com about how the American Heart Association (AHA) is using bloggers to get people interested in a heart-healthy diet and exercise program illustrates how even "civilian" bloggers can get caught up in the web of conflicts of interest that pervades health care. The background is:
Keeping track of the conversations on the array of social media networks can gobble up your workday. So why not find someone else to do it for you?
The American Heart Association did just that, approaching four established bloggers with a proposal: Write about our new campaign, Go Red For Women: BetterU, and we’ll link to your blog from our site. BetterU is a 12-week online nutrition and fitness program to improve heart health among women.
The blogs appear to be working. They’ve helped drive traffic to Go Red/BetterU since the program’s June 1 launch.
It did seem that the AHA went to considerable effort to make sure they had recruited just the right bloggers.
The AHA researched potential candidates with the help of agencies Edelman PR and Edelman Digital. After a month-and-a-half, they settled on four bloggers: Joshilyn, Nyasha, Stacey, and Nadia.More interesting was the values with which the bloggers were supposed to align, particularly those relating to the program's corporate sponsors (see the logos at the bottom right of the BetterU web-site).
The criteria: The bloggers had to be female, have an enthusiastic following, be diverse in age and ethnicity, and have a high Technorati rating. Most important, their content and advertising had to align with the association’s values, says Director of Marketing Anu Gandhi.
'You’re really ultimately picking a spokesperson for Go Red for Women and the larger American Heart Association,' [senior manager for cause communications Megan] Lozito says. 'That’s a really important process for us — that it be correct and that it be the right people. So we spent a lot of time getting to know those ladies and making sure our mission would be aligned.'
From there, the association brought the bloggers to the Dallas headquarters for a full health screening at The Cooper Institute, a photo session, a preview of the BetterU program, and some message training.
Although the BetterU bloggers got some message training in Dallas, Gandhi says AHA has been hands off when it comes to what they can and can’t say about the program.
The bloggers are asked to post once a week about BetterU and follow basic guidelines—no profanity, no defamation, no writing about nor condoning any medications or treatments. She says they also ask bloggers not to talk about competitors of AHA’s two national sponsors: Macy’s and Merck Pharmaceuticals.
I would suspect that the explicit instruction not to favor Merck's competitors would also remind the bloggers not not do say anything that might make the giant pharmaceutical company unhappy.
Eight weeks into the program, they haven’t had any problems.So the bloggers recruited by the AHA may be happy, since they now have a big organization's web-site driving traffic to their blogs. The AHA may be happy, since the bloggers can spread the word about their BetterU program. I imagine the marketers at Merck may be happy too, since the bloggers have been warned about the need to keep the corporate sponsors happy. However, what may be good for all the parties in this transaction may not be so good for the general public, as another opportunity for uninhibited, honest discussion of health care issues has been lost.
'There are things we don’t want them to write, like profanity, but that’s also part of the vetting in the beginning,' Lozito says. 'We wanted to find people who believe in our mission, who speak to the same type of audience, but at the same time we want them to have their own flavor and own tone, because it’s a blog.'
This is an explicit example of the adverse effects of commercial funding of not-for-profit disease advocacy groups. Corporate sponsors may not expect anything as gross as advertising in return for their money. However, they may expect something more subtle, a generally favorable attitude toward the sponsor, at least the disinclination to say anything that might put the sponsor in a negative light. After all, politeness requires that we be nice to the people who are nice to us. But being nice to sponsors may not be so nice for the people that a health care not-for-profit organization is supposed to serve.
PS - for those who like science fiction, see the preview of the new version of "V," in which Anna, the leader of the Visitors, an invasion force disguised as human-appearing, benign aliens, warns her television interviewer,
Just be sure not to ask anything that would put us in a negative light.
Lip Lesion - You Be The Doctor
This 76 year old woman had a long-standing sore on the border of her lower lip. It was not tender and she denied any trauma or known exposure. What is the diagnosis?1. Leukoplakia2. Squamous cell carcinoma3. Contact dermatitis to oral hygiene products4. Oral lichen planus5. Apthous stomatitisMake your diagnosis and the answer will be posted tomorrow.(from Consultant)
Wednesday, July 29, 2009
BLOGSCAN - Live-Blogging Senate Hearing on Conflicts of Interest and Continuing Medical Education
Dr Daniel Carlat is live-blogging the US Senate Special Committee on Aging hearing on conflicts of interest and continuing medical education on the Carlat Psychiatry Blog, and so is Prof Margaret Soltan on the University Diaries.
Polly Want a Million (Plus)
We have frequently posted about attempts to justify financial relationships among physicians and medical academics on one hand, and pharmaceutical, biotechnology, device and other health care corporations, on the other. Some defenders of such relationships now have gone so far as to start their own society, whose meeting was covered and commented on by fellow "pharmascolds," including Dr Daniel Carlat and Dr Howard Brody. The usual justification of these relationships is that they are necessary for "innovation" and the onward progress of medical science, education, and care. I have yet to see any logic or evidence to back up these assertions, nor have I seen anyone defend these relationships who does not also have personal financial relationships of their own with health care corporations. (See examples here, here, and here.)
Meanwhile, cases of individual physicians and academics whose lucrative relationships with industry seem to generate huge conflicts of interest continue to surface. The latest example ferreted out by investigators working for US Senator Charles Grassley (R - Iowa) is that of Dr David Polly. (Recall that Dr Polly was one of the strongest defenders of Dr Thomas Kuklo, who was accused of falsifying clinical research results in a way that seemed to favor the product of his own corporate benefactor [see post here].)
The main points were reported by David Armstrong and Thomas M Burton in the Wall Street Journal,
Although there have now been many reported cases of medical academics who collected large payments from health care corporations, the services they provided in exchange for the money have not always been very clear. Defenders of financial relationships among physicians and medical academics and industry have argued that most payments were for valuable research, education, or health care activities. However, Senator Grassley's office provided the details of Dr Polly's invoices, and several of the news articles so far described what he did for the money. Per the Wall Street Journal article,
An accompanying post on the Wall Street Journal Health Blog provided more information:
So did the $1.2 million Medtronic spent on Dr Polly's services inspire any "innovation?" Did it lead to any scientific progress or improved health care? I am not sure.
It is clear, however, that a good chunk of this money went to support marketing, advocacy, and lobbying. The items in bold italics above were clearly in support of marketing, advocacy and lobbying, not science, medical education, or patient care. (To give Dr Polly the benefit of a doubt, some other items listed above could have been related to research, education, or patient care, although this is not indisputable.)
So the case of Dr Polly corroborates my deep skepticism of the financial relationships among physicians and medical academics on one hand, and corporations that sell health care goods and services on the other. We "pharmascolds," - a preferable term might be health care skeptics - suspect that many of these relationships are really about stealth marketing and advocacy. The companies often pay to market their products and services, or advocate positions to the companies' advantage, but prefer that their salespeople and advocates are cloaked in academic guises, and wreathed in the rarefied aura of respected academic institutions. (Note that some of us are just as skeptical about relationships among academic institutions and other health care not-for-profit organizations on one hand, and such corporations on the other, for analogous reasons.)
While the leadership of our formerly distinguished medical academic institutions remains infiltrated, if not dominated by people earning many thousands of dollars from health care corporations, I must remain skeptical about how much of these institutions supposedly academic output is actually stealth marketing and stealth health policy advocacy.
At the very least, medical academics, medical academic institutions, and other health care not-for-profits or NGOs should reveal in detail what payments they get from companies selling health care products or services, and how these payments could relate to the companies' marketing or lobbying efforts. In the US, some such disclosure would be mandated by the proposed "Sunshine" legislation now being considered by the US Congress. (By the way, note that this problem is hardly confined to the US, and needs global, not just American attention.)
However, physicians (at least physicians in full-time private practice, academic positions, and employed by mission-oriented not for profit organizations) should go further, and consider whether receiving industry money is worth the ongoing damage it does to our professionalism and our professional reputations. Medical schools, universities, health care foundations, disease advocacy groups, and other health care not-for-profits and NGOs should also go further, and consider whether receiving industry money is worth the ongoing damage it does to their missions, and their institutional reputations.
See also comments by Prof Margaret Soltan on the University Diaries blog.
Meanwhile, cases of individual physicians and academics whose lucrative relationships with industry seem to generate huge conflicts of interest continue to surface. The latest example ferreted out by investigators working for US Senator Charles Grassley (R - Iowa) is that of Dr David Polly. (Recall that Dr Polly was one of the strongest defenders of Dr Thomas Kuklo, who was accused of falsifying clinical research results in a way that seemed to favor the product of his own corporate benefactor [see post here].)
The main points were reported by David Armstrong and Thomas M Burton in the Wall Street Journal,
In May 2006, University of Minnesota spine surgeon David Polly urged a Senate committee to fund research into the severe arm, leg and spine injuries suffered by soldiers in Iraq and elsewhere.
Dr. Polly told the committee he was testifying on behalf of the American Academy of Orthopaedic Surgeons and referenced his prior work caring for soldiers as a surgeon at the Walter Reed Army Medical Center.
What Dr. Polly didn't disclose during his testimony was that his trip to Washington was paid for by Medtronic Inc., the big medical-device maker whose bone growth product, called Infuse, has been used to treat soldiers, according to company records.Dr. Polly and colleagues in Minnesota subsequently received a $466,644 Department of Defense grant for a two-year study beginning in February 2007 to evaluate Infuse in cases where an injury is also infected, according to the university.
Dr. Polly was paid $1.14 million by Medtronic for consulting services from 2004 to 2007.
Details of Dr. Polly's consultant billing were provided by Medtronic to Sen. Charles Grassley, an Iowa Republican who has been scrutinizing the relationship between academics and industry.
Although there have now been many reported cases of medical academics who collected large payments from health care corporations, the services they provided in exchange for the money have not always been very clear. Defenders of financial relationships among physicians and medical academics and industry have argued that most payments were for valuable research, education, or health care activities. However, Senator Grassley's office provided the details of Dr Polly's invoices, and several of the news articles so far described what he did for the money. Per the Wall Street Journal article,
In total, Dr. Polly billed Medtronic for more than $50,000 in lobbying-related costs. He made trips to Washington in 2005 and 2006 and called on several members of Congress, according to the records.
According to billing records, Dr. Polly's billing rate was $4,750 for an eight-hour day in 2007, and he billed as many as 13,000 minutes a quarter -- or 216 hours over three months. In some months, he conducted at least some Medtronic business on nearly every day.
His consulting log indicates that on one occasion he spent one minute to wake up a Medtronic executive, although he listed 'no charge' for that service. He did bill Medtronic for the 30 minutes he spent in the car with that executive after waking him up.
An accompanying post on the Wall Street Journal Health Blog provided more information:
Did you ever wonder what doctors do to earn big consulting contracts from medical device companies and pharmaceutical concerns?
Records released by Medtronic to Sen. Charles Grassley, a longtime critic of the ties between academics and and health-care companies, provide a rare and detailed glimpse into the daily billings of a consultant — in this case, spine surgeon David Polly of the University of Minnesota.
Polly collected more than $1 million in four years of work for Medtronic, according to the records, which you can take a look at here.
The services he provided were many, but among them, Polly was paid to write articles for medical journals; write a chapter in a book and a book outline; recruit patients for publicity efforts; attend Medtronic national sales meetings; travel to conferences in Japan, Paris and elsewhere; lead training and educational sessions for physicians; and lobby Congress.
Polly also billed for at least two phone calls with Medtronic CEO William Hawkins as well as charging the company $2,000 when Mr. Hawkins visited an operating room. In October, 2003, he billed the company $12,000 for attending a medical meeting of the North American Spine Society, at $4,000 a day.
There are also scores of entries for work billed in five-minute increments, usually to send email or return phone calls. The bill for each five-minute charge? $49.48 a pop.
So did the $1.2 million Medtronic spent on Dr Polly's services inspire any "innovation?" Did it lead to any scientific progress or improved health care? I am not sure.
It is clear, however, that a good chunk of this money went to support marketing, advocacy, and lobbying. The items in bold italics above were clearly in support of marketing, advocacy and lobbying, not science, medical education, or patient care. (To give Dr Polly the benefit of a doubt, some other items listed above could have been related to research, education, or patient care, although this is not indisputable.)
So the case of Dr Polly corroborates my deep skepticism of the financial relationships among physicians and medical academics on one hand, and corporations that sell health care goods and services on the other. We "pharmascolds," - a preferable term might be health care skeptics - suspect that many of these relationships are really about stealth marketing and advocacy. The companies often pay to market their products and services, or advocate positions to the companies' advantage, but prefer that their salespeople and advocates are cloaked in academic guises, and wreathed in the rarefied aura of respected academic institutions. (Note that some of us are just as skeptical about relationships among academic institutions and other health care not-for-profit organizations on one hand, and such corporations on the other, for analogous reasons.)
While the leadership of our formerly distinguished medical academic institutions remains infiltrated, if not dominated by people earning many thousands of dollars from health care corporations, I must remain skeptical about how much of these institutions supposedly academic output is actually stealth marketing and stealth health policy advocacy.
At the very least, medical academics, medical academic institutions, and other health care not-for-profits or NGOs should reveal in detail what payments they get from companies selling health care products or services, and how these payments could relate to the companies' marketing or lobbying efforts. In the US, some such disclosure would be mandated by the proposed "Sunshine" legislation now being considered by the US Congress. (By the way, note that this problem is hardly confined to the US, and needs global, not just American attention.)
However, physicians (at least physicians in full-time private practice, academic positions, and employed by mission-oriented not for profit organizations) should go further, and consider whether receiving industry money is worth the ongoing damage it does to our professionalism and our professional reputations. Medical schools, universities, health care foundations, disease advocacy groups, and other health care not-for-profits and NGOs should also go further, and consider whether receiving industry money is worth the ongoing damage it does to their missions, and their institutional reputations.
See also comments by Prof Margaret Soltan on the University Diaries blog.
Wyeth: Ghostwritten Papers Fake, But Accurate
It looks like Wyeth has lost its battle to keep secret its practices regarding ghostwriting of scientific papers. The issue in question is whether ghostwriting contributed to excessive prescription of post-menopausal hormones and increased the incidence of breast cancer:
How is evidence based medicine possible if just one drug company has sponsored ghostwritten articles in 40 medical journals and other publications? What is the "total mass" of questionable articles now infecting the literature?
There are several layers of dishonesty in this activity, including foreknowledge of scientific deception through fraudulent misrepresentation of authorship by the pharma, dishonesty of the physician who "signs off" as first author, and misrepresentation by the pharma, the writing company and the physician about provenance of the article to scientific publishers.
What business does a lawyer have lecturing the public that the articles were a dishonest marketing effort masquerading as legitimate science, but were "fair and scientific?" How does he know? In addition, the "fake but accurate" excuse is getting quite shopworn. Hopefully, Sen. Grassley will approach ending this ghostwriting practice with vigor.
In fact, this raises another issue. I have written that management of pharma by those lacking biomedical bona fides is, by definition, mismanagement. This is a case in point. Wyeth's President, Board Chair and CEO Bernard Poussot lacks biomedical credentials. Harry Truman said "the buck stops here", but a in the case of scientific ghostwriting, CEO's such as Poussot cannot vouch firsthand for the accuracy and fairness of their company's science. He lacks the expertise. The buck does not stop at his desk; he is dependent on scientific underlings in such matters.
This affair is another instantiation of my belief that pharma is best led by those with relevant scientific expertise such as Merck under clinician-scientist Dr. Roy Vagelos. (It is perhaps not coincidental that Merck became a shadow of its former self under non-scientist Raymond Gilmartin.)
How appropriate, as Pfizer is led by the former top lawyer for McDonald's and Boston Chicken, bringing to life my "If you've run McDonald's, you can run anything" metaphor. If a wise investor were to take a bearish position on a stock, this merged company would be an excellent candidate.
Finally, another ghostwriter of sorts recently died, Sandford Dody (1918-2009). Dody anonymously penned best selling autobiographies of actresses Bette Davis and Helen Hayes, among many other notables. Such ghostwriting is essentially victimless, as opposed to its counterpart in the scientific domain. However, Mr. Dody had an astute observation about the practice, even when there was no trail of diseased or dead bodies.
Per the WSJ article "A Ghostwriter Who Struggled to Accept Life in the Shadows":
In the case of biomedical ghostwriting, the conspirators all "die a little" in purveying their intellectual dishonesty on a trusting public.
It's too bad some of that same public also dies, and not just a little, as wages of professorial ghostwriting sins.
Posted on Sun, Jul. 26, 2009Of course, in addition to the violation of accepted practices of authorship, such as specified by NIH and the International Committee of Medical Journal Editors, among others, such lucky authors get to "count" such papers in their academic portfolios, presumably also in violation of their own institutional policies and guidelines for fair attribution and intellectual honesty, e.g., here. Ghostwriting may also skew the tenure process, providing advantages to the unscrupulous academic over the ethical scientist or scholar. (One wonders about the true percentage of the massive number of papers claimed by some medical academics actually written by the putative first author.)
Philadelphia Inquirer
Wyeth told to release documents on ghostwriting
Associated Press
LITTLE ROCK, Ark. - A federal judge has ordered the unsealing of thousands of pages of documents pertaining to the ghostwriting practices of Wyeth Pharmaceuticals, which is being sued over hormone-replacement drugs.
U.S. District Judge Bill Wilson ordered the papers unsealed Friday at the request of a medical journal and the New York Times. Plaintiffs' attorneys presented the papers earlier at trial to show that Wyeth routinely hired medical-writing firms to ghostwrite articles that appeared in seemingly objective medical journals but included only the name of a scientific researcher as the author.
The ruling came in a case that involves about 8,000 lawsuits that have been combined before Wilson. The lawsuits focus on whether Wyeth hormone-therapy drugs Prempro and Premarin, used to treat symptoms of menopause, have caused breast cancer in some women.
The New Jersey drugmaker, which has major operations in the Philadelphia area, had already turned over the documents, which it says concern about 40 articles in medical journals and other publications, to Sen. Charles Grassley (R., Iowa).
How is evidence based medicine possible if just one drug company has sponsored ghostwritten articles in 40 medical journals and other publications? What is the "total mass" of questionable articles now infecting the literature?
Grassley sought them last year without a subpoena as part of a congressional investigation into drug-industry influence on doctors.
The documents were shown to jurors at trial but have otherwise been unavailable publicly.
Plaintiffs say ghostwriting is when a drug company conjures up the concept for an article that will counteract criticism of a drug or embellish its benefits, hires a professional writing company to draft a manuscript conveying the company's message, retains a physician to sign off as the author, and finds a publisher to unwittingly publish the work.
There are several layers of dishonesty in this activity, including foreknowledge of scientific deception through fraudulent misrepresentation of authorship by the pharma, dishonesty of the physician who "signs off" as first author, and misrepresentation by the pharma, the writing company and the physician about provenance of the article to scientific publishers.
Drug firms disseminate their ghostwritten articles to their sales representatives, who present the articles to physicians as independent proof that the companies' drugs are safe and effective.
Wyeth attorney Stephen Urbanczyk acknowledged that the articles were part of a marketing effort. But he said that they were also fair, balanced, and scientific.
What business does a lawyer have lecturing the public that the articles were a dishonest marketing effort masquerading as legitimate science, but were "fair and scientific?" How does he know? In addition, the "fake but accurate" excuse is getting quite shopworn. Hopefully, Sen. Grassley will approach ending this ghostwriting practice with vigor.
In fact, this raises another issue. I have written that management of pharma by those lacking biomedical bona fides is, by definition, mismanagement. This is a case in point. Wyeth's President, Board Chair and CEO Bernard Poussot lacks biomedical credentials. Harry Truman said "the buck stops here", but a in the case of scientific ghostwriting, CEO's such as Poussot cannot vouch firsthand for the accuracy and fairness of their company's science. He lacks the expertise. The buck does not stop at his desk; he is dependent on scientific underlings in such matters.
This affair is another instantiation of my belief that pharma is best led by those with relevant scientific expertise such as Merck under clinician-scientist Dr. Roy Vagelos. (It is perhaps not coincidental that Merck became a shadow of its former self under non-scientist Raymond Gilmartin.)
Wyeth, the world's No. 12 pharmaceutical company by sales, is being bought this fall by No. 1 drugmaker Pfizer.
How appropriate, as Pfizer is led by the former top lawyer for McDonald's and Boston Chicken, bringing to life my "If you've run McDonald's, you can run anything" metaphor. If a wise investor were to take a bearish position on a stock, this merged company would be an excellent candidate.
Finally, another ghostwriter of sorts recently died, Sandford Dody (1918-2009). Dody anonymously penned best selling autobiographies of actresses Bette Davis and Helen Hayes, among many other notables. Such ghostwriting is essentially victimless, as opposed to its counterpart in the scientific domain. However, Mr. Dody had an astute observation about the practice, even when there was no trail of diseased or dead bodies.
Per the WSJ article "A Ghostwriter Who Struggled to Accept Life in the Shadows":
... Mr. Dody, who died July 4 at the age of 90, found the work spiritually destructive. "After all," he wrote, "how does one become a ghost without dying a little?"
In the case of biomedical ghostwriting, the conspirators all "die a little" in purveying their intellectual dishonesty on a trusting public.
It's too bad some of that same public also dies, and not just a little, as wages of professorial ghostwriting sins.
The acknowledgements are where minor contributions and reviews get placed in an ethically-attributed scientific paper. Anyone who does not understand this, or rationalizes "honorary authorship" or similar workarounds to meaningful attribution does not belong in science.
Tuesday, July 28, 2009
Ayurveda Epilepsy Treatments
Epilepsy (seizure disorder, fits) is a neurological disorder characterized by recurrent instances of seizure or tremors. These are due to abnormal excitation from brain. Epilepsy treatment methods are aimed at controlling the disease. Most cases of juvenile epilepsy don't pass over to adulthood.
Not all epilepsy cases are alike. Sometimes there can be apparent reasons like stress, brain injury, genetic conditions and parasitic infection of brain. It is also observed that instance of epilepsy can occur without any solid provable reason.
Epilepsy due to specific reasons like use of certain drugs, epilepsy as withdrawal symptom, seizure due to abnormal levels of sodium in blood are temporary cases and will be cured without any special treatments apart from the medicines and diet to return to normal health.
Epilepsy treatment in Ayurveda
Apasmara or apasmaram is the term used for epilepsy in Ayurveda. The reasons sited by Ayurveda scripts include stressful life, lazy life, poor diet and suppression of natural urges.
Each person is different and each case of epilepsy is also different. Thorough examination of the patient by an Ayurvedic physician is essential to identify the right treatment for a person.
Epilepsy in most cases is a vata disorder. However, it can also be caused by vitiation of pitta or kapha. Imbalances of all the three doshas are also not very rare.
Vata type seizure is mainly a mental problem. Stressful days, poor sleep and mental exertion are reasons. Digestive problems like gastritis, constipation etc. can also be reasons.
Rest, normalized diet and specific time to take food can help such persons control epilepsy. Abhayanga or Ayurvedic oil massage, shirodhara (pouring of medicated oil over head), thalam (retaining medicated oil on head) helps in pacifying mind. Nerve tonic herbs like Aswagandha (Withania somnifera), Brahmi (Bacopa monniera), Jatamamsi (Nardastachys jatamansi), Shanka pushpi (Evolvulus alsinoides) etc are used to pacify nervous system and to reduce instances of abnormal brain functioning.
Inflammations inside head due to diseases like Encephalitis cause pitta type seizures. Exposure to heat is a high risk factor in such cases of seizures. Kapha type epilepsy is due to blocks in central nervous system. A sedentary or highly secluded life can lead to this condition.
Kapha type epilepsy is also characterized by excess salivation. Tulsi (holy basil), Acorus calamus, etc are the type of herbs beneficial in kapha epilepsy.
Prevention of Epilepsy Ayurveda way
Regulate the lifestyle with Ayurvedic daily routine (dinacharya).
Stay as much positive about the day and life as possible. Don’t allow tensions to creep in to your mind. Don’t get excited at anything. Start practicing yoga meditation.
Keep your daily diet fully nutritive. Don’t eat late at night. If possible go for five or six small meals a day, instead of one or two big meals.
Massage your soles with coconut oil or sesame oil before going to bed. This give your head a cooling effect.
by: Dev Sri
What is the Best Hemorrhoids Medicine
These following products are some of the best hemorrhoids medications. Here we'll go ahead and provide a brief summary of each of the characteristics of each treatment.
After reading this article, you should have a better understanding of these treatments and maybe be able to recognize which one is more suitable for you.
H Miracle Guide
As it turns out, one of the best treatments for hemorrhoids is actually a guide on how to treat hemorrhoids and make them go away once and for all.
If you want to get rid of your hemorrhoids naturally, this is the way to go. The H Miracle System doesn't just talk about 2 or 3 ways of treating hemorrhoids. Instead, it provides a plethora of hemorrhoid treatments so you can benefit. The many treatments will be useful because not everyone will be able to cure their hemorrhoids with the same treatment.
Preparation H
There is a wide array of Preparation H products including creams, gels, suppositories, and wipes. Hemorrhoid sufferers use this products extensively and are very popular. These products work by tackling the swollen veins to reduce inflammation and itchiness. The actual cause of hemorrhoids is left unattended by this product and so in the long run the problem of hemorrhoids cannot be cured by Preparation H.
Venapro
Venapro uses herbal ingredients to treat hemorrhoids. Venapro comes in bottled capsules with the ingredients. The results vary from hours to days before people see results. No results at all can happen since some haven't had any change in their condition. Vanapro is designed to be taken during a period of time, such as for a month for example.
by: Michelle Perkins
Are the Health Plans of the Very Rich Different from Yours and Mine?
Yesterday, the New York Times published an intriguing story about "Cadillac" (that is, expensive) health insurance plans,
It was not clear from this article how many top corporate executives have such plans, and whether leaders of other kinds of organizations, like large not-for-profits, also have them.
My main concern about such plans is not how much they contribute to top corporate leaders' compensation packages. Such packages are generally already so outrageously huge that providing $40,000 rather than $13,000 worth of health insurance is a trivial increase. My concern is not that plan recipients' demands for health care will collectively increase health care costs, because they include only a tiny portion of the population.
My main concern, instead, is how much these plans further insulate already cocooned top executives from the vicissitudes of daily life, particularly related to coping with our current dysfunctional health care system. What benefits executive health care plans provide is not clear, but presumably they insulate executives from having to deal with the managed care/ health insurance bureaucracy which frustrates patients seeking particular services, but not necessarily the most expensive, or least beneficial services. Such executives might thus not have gut level appreciation of how dysfunctional the health care system has become for even insured patients. Since top executives often are disproportionately influential members of the "superclass," their disconnection from the realities of dysfunctional health care is likely to translate into little real support by the powers that be for meaningful health care reform. There support may be further retarded by the influence of their fellow superclass members whose personal fortunes depend on the status quo in health care.
Real improvement of health care may depend on finding leaders who have better understanding of the plight of real people.
Goldman Sachs is one of the nation’s richest banks, and hundreds of top Goldman employees have a health care package to match — one of the 'gold-plated Cadillac' plans cited by those involved in the health care debate in Washington.
Goldman’s 400 or so managing directors and its top executive officers participate in the bank’s executive medical and dental program as part of their benefits, according to documents filed with the Securities and Exchange Commission. The program generally costs the bank $40,543 in premiums annually for each participant’s family.
Those taking part in the plan include the company’s chief executive, Lloyd C. Blankfein, and four other top officers, as well as managing directors, whose base salary is $600,000.
Goldman’s medical coverage entered the health care discussion on Sunday when David Axelrod, senior adviser to President Obama, cited the Goldman program as an example of the expensive benefits the administration might consider taxing to help pay for its health care program.
'The president actually was asked this the other day by Jim Lehrer, and what he said was that this was an intriguing idea to put an excise tax on high-end health care policies like the ones that the executives at Goldman Sachs have, the $40,000 policies,' Mr. Axelrod said.
A proposal by Senator John F. Kerry, Democrat of Massachusetts, would impose an excise tax on the insurers that issue policies like Goldman’s, with the expectation that the insurers would pass along most, if not all, of the cost to employers who buy the plans.
Leaders of the Senate Finance Committee, which is working on bipartisan version of the health care legislation in Congress, had long expressed interest in taxing some employer-provided benefits — a move many budget experts say would help slow the steep rise in health costs.
Negotiators have not yet determined the value of the plans that would set off a tax on the insurance companies; the numbers under discussion range from $20,000 to $40,000 annually, a senior administration official said.
The lower end of that range would increase the amount of money the tax would raise but would also hit some middle-class workers, whose unions in some cases negotiated robust health benefits in lieu of pay increases. Typical employer-provided plans cost $13,000 to $20,000 per family, depending on the location and the age of the plan participants.
A health care package costing $40,000 or more a year would generally have no co-payments or deductibles, according to Paul Fronstin, an analyst at the Employee Benefit Research Institute, a Washington nonprofit that studies benefits. It would also have no limits on doctors or procedures, no restrictions on pre-existing conditions and no requirements for referrals.
Few people have such policies, Mr. Fronstin said. 'It would only be top executives who run big businesses, mainly people in the C suite,' said Mr. Fronstin, referring to companies’ chief officers.
It was not clear from this article how many top corporate executives have such plans, and whether leaders of other kinds of organizations, like large not-for-profits, also have them.
My main concern about such plans is not how much they contribute to top corporate leaders' compensation packages. Such packages are generally already so outrageously huge that providing $40,000 rather than $13,000 worth of health insurance is a trivial increase. My concern is not that plan recipients' demands for health care will collectively increase health care costs, because they include only a tiny portion of the population.
My main concern, instead, is how much these plans further insulate already cocooned top executives from the vicissitudes of daily life, particularly related to coping with our current dysfunctional health care system. What benefits executive health care plans provide is not clear, but presumably they insulate executives from having to deal with the managed care/ health insurance bureaucracy which frustrates patients seeking particular services, but not necessarily the most expensive, or least beneficial services. Such executives might thus not have gut level appreciation of how dysfunctional the health care system has become for even insured patients. Since top executives often are disproportionately influential members of the "superclass," their disconnection from the realities of dysfunctional health care is likely to translate into little real support by the powers that be for meaningful health care reform. There support may be further retarded by the influence of their fellow superclass members whose personal fortunes depend on the status quo in health care.
Real improvement of health care may depend on finding leaders who have better understanding of the plight of real people.
Medical Grand Rounds
Head on over to Captain Atopic to read the best of the medical grand rounds on the blogosphere. Good random reading on a number of health related subjects.
Monday, July 27, 2009
Clouded Vision - Cataracts
When the normally clear lens of the eye have a painless clouding, it is called cataract. If you do not treat it in time, it causes blindness. Surgical treatment can however, cure it in time. Most of the people over 60 do suffer from some clouding of the lens. But you can prevent them or treat them by following the simple home remedies below.
If you have cataracts or want to prevent them, do the following simple home remedies to take care of the situation:
• Drink orange juice: Increasing your intake of Vitamin C will reduce the risk of developing cataracts. It is recommended that you take two times the recommended dietary allowance of Vitamin C to protect against the occurrence of cataract. That means you should include 11/2 cup of strawberries, 1 cup of orange juice or 2 oranges.
• Take beta-carotene and Vitamin E: Research has shown that increasing the beta-carotene and Vitamin E intake offer some protection against cataract. Have more of orange and yellow vegetables like carrots, squash and sweet potatoes for beta-carotene and almonds, fortified cereals, peanut butter and sun flower seeds for Vitamin E.
• Use sunglasses or hat: Covering your eyes by sunglasses or hats while out in the sun has shown to reduce the incidences of cataracts. Choose sunglasses that have UV protection. There is no need to spend a lot of money on designer glasses. You can purchase sunglasses from the local shops too.
• Look away from harmful radiation: Whenever you are near a microwave, oven or x-ray, always look away. Though many manufacturers claim that their microwaves are safe, it is always better to avoid looking at them in order to protect the eyes. The same holds true for x-rays.
• Control your drinking habits: Having occasional drinks will not harm your eyes. But prolonged drinking will certainly harm your eyes. This is because alcohol interferes with the nutritional supplies to the lenses and thus leads to cataract formation. Even the alcoholics having good diets can have cataracts due to the interference of the alcohol with the nutrient supply to the eye.
• Stop smoking: Research has shown that smokers are more likely to develop cataract than non-smokers. Toxic substances from the smoke of a cigarette damage the lens nucleus and thus cause cataract. When you quit smoking, you have the risk of developing cataracts.
• Take pain relievers: People who take pain relievers like aspirin, ibuprofen and acetaminophen have a reduced risk of developing cataracts. This is due to the fact that these drugs, the rate at which your body uses glucose and lesser the blood sugar, lower is your risk of developing cataract. This is also one of the reasons why diabetics are more prone to cataracts.
by: Sharon Hopkins
How to Deal with Baby's Fever
My baby Rian was 1 1/2 years old when she had a fever because of her teething. This is one of the most painful times for mommy’s when you know that your baby is hurting. It becomes harder when you don't know how to deal with your baby fever .
However, I think it is much worst when you know what to do but you simply cannot do anything because you are at work while your baby is not well at home. This is one of the times when I wish I could just stay home to take care for our baby but of course this is not possible due to financial concerns. Well enough with my wishes in life, let me impart to you how I am dealing with my baby's fever:
As I have said, I was at work when I got a message from my husband that says my baby have a fever @ 38.5 degrees. I replied to him to wash her whole body with wet hand towel and give her Paracetamol 2 ml every 4 hours (this was the last dosage given to her during her last check-up to her pediatrician). At 12:00 noon, my husband called me asking me to go home since my baby's fever continues to go up by 39.8 degrees. Even I wanted that time to go home I simply cannot. I am working in a manufacturing company and I need a shuttle service before I can go the nearest bus going to our house. I got another phone call from my husband and this time he was almost crying on the phone telling me that he is bringing our baby to the hospital since our baby vomited due to very high fever and so I said ok and I said again to continue wiping her wet towel, this will help to lower down her fever. My husband was very nervous it was his first time to take care of our baby with very high fever since most of the month in a year he is abroad working.
Fortunately, a shuttle was available at 2:30 PM and so I got home at 4:00 PM in the afternoon and they just arrived as well from the hospital. My baby was prescribed also with paracetamol but this time with higher dosage to 5 ml every 4 hours. When I saw my baby she was wearing a pajama, t-shirt and socks very hot with fever and crying. I immediately take off her socks and wrap her with wet body towel. I also put wet face towel on her forehead. I rocked my baby until she fell asleep. I took her temperature and it reads 38.9 degrees still bad. After 30 minutes, she woke. We changed her clothes to dry one then gave her paracetamol. After that I ask again for a wet towel; but this time I removed her clothes then wrap her again with wet towel for 20 minutes. After that I dressed her with her dry clothes then checked again her temperature and still her fever is 38.9 degrees. I repeat the same routine a couple of times more. At 6:00 PM when we checked again her temperature, it was now 37.4 degrees thank God. She started playing. By 7:00 PM, her fever was then down to 36.8 degrees she was back to her normal activities running with glee.
At night my husband said, "I thought our baby will be advised to be confined at the hospital" and I said we'll I wasn't actually expecting that, our baby was in a much worst condition. She's a strong baby; she can deal with fever without being confined in the hospital. You just have to be strong as well to be able to take care of her at you best. My husband said well I'll know better next time; I'll know how to deal with your baby fever .
by: Sheila Hernandez
However, I think it is much worst when you know what to do but you simply cannot do anything because you are at work while your baby is not well at home. This is one of the times when I wish I could just stay home to take care for our baby but of course this is not possible due to financial concerns. Well enough with my wishes in life, let me impart to you how I am dealing with my baby's fever:
As I have said, I was at work when I got a message from my husband that says my baby have a fever @ 38.5 degrees. I replied to him to wash her whole body with wet hand towel and give her Paracetamol 2 ml every 4 hours (this was the last dosage given to her during her last check-up to her pediatrician). At 12:00 noon, my husband called me asking me to go home since my baby's fever continues to go up by 39.8 degrees. Even I wanted that time to go home I simply cannot. I am working in a manufacturing company and I need a shuttle service before I can go the nearest bus going to our house. I got another phone call from my husband and this time he was almost crying on the phone telling me that he is bringing our baby to the hospital since our baby vomited due to very high fever and so I said ok and I said again to continue wiping her wet towel, this will help to lower down her fever. My husband was very nervous it was his first time to take care of our baby with very high fever since most of the month in a year he is abroad working.
Fortunately, a shuttle was available at 2:30 PM and so I got home at 4:00 PM in the afternoon and they just arrived as well from the hospital. My baby was prescribed also with paracetamol but this time with higher dosage to 5 ml every 4 hours. When I saw my baby she was wearing a pajama, t-shirt and socks very hot with fever and crying. I immediately take off her socks and wrap her with wet body towel. I also put wet face towel on her forehead. I rocked my baby until she fell asleep. I took her temperature and it reads 38.9 degrees still bad. After 30 minutes, she woke. We changed her clothes to dry one then gave her paracetamol. After that I ask again for a wet towel; but this time I removed her clothes then wrap her again with wet towel for 20 minutes. After that I dressed her with her dry clothes then checked again her temperature and still her fever is 38.9 degrees. I repeat the same routine a couple of times more. At 6:00 PM when we checked again her temperature, it was now 37.4 degrees thank God. She started playing. By 7:00 PM, her fever was then down to 36.8 degrees she was back to her normal activities running with glee.
At night my husband said, "I thought our baby will be advised to be confined at the hospital" and I said we'll I wasn't actually expecting that, our baby was in a much worst condition. She's a strong baby; she can deal with fever without being confined in the hospital. You just have to be strong as well to be able to take care of her at you best. My husband said well I'll know better next time; I'll know how to deal with your baby fever .
by: Sheila Hernandez
How To Treat Baby's Diarrhea
If you see these signs in your baby, you must treat her by giving as much fluid as you can. You can give either breast milk or formula (if your baby is not more than 6 months old). Water and soup are other alternatives for older babies.
There are also special fluids designed to replace water and salts lost during your baby's diarrhea. According to American Academy of Pediatrics, these fluids are very useful in home management of mild to fairly severe illnesses.
However, you should not prepare these fluids by yourself because you may make bad liquids for you baby, which of course can worsen her condition. You can easily get the fluids in nearby pharmacies.
When should you take your baby to a doctor?
You should take her see a doctor if these conditions below occur:
- You find blood in your baby's feces. This can be a sign of bacterial infection.
- There are changes in your baby's behavior, like she cries most of the time and you can't calm her down or she refuses to eat and drink.
- Your baby has a high fever, which is above 39°C.
Nonetheless, no need to be worried if:
- your baby acts normally as usual.
- your baby has no fever.
- your baby still wants to eat.
Generally, diarrhea recovers by itself without medicine. You just need to be patient and not to worry too much. Always observe your baby's condition and examine whether her feces get solid or not and whether there's blood in them.
The key is to keep give her as much fluid as you can. If she refuses, try to give the drink in small amount but do it frequently.
by: Adwina Jackson
There are also special fluids designed to replace water and salts lost during your baby's diarrhea. According to American Academy of Pediatrics, these fluids are very useful in home management of mild to fairly severe illnesses.
However, you should not prepare these fluids by yourself because you may make bad liquids for you baby, which of course can worsen her condition. You can easily get the fluids in nearby pharmacies.
When should you take your baby to a doctor?
You should take her see a doctor if these conditions below occur:
- You find blood in your baby's feces. This can be a sign of bacterial infection.
- There are changes in your baby's behavior, like she cries most of the time and you can't calm her down or she refuses to eat and drink.
- Your baby has a high fever, which is above 39°C.
Nonetheless, no need to be worried if:
- your baby acts normally as usual.
- your baby has no fever.
- your baby still wants to eat.
Generally, diarrhea recovers by itself without medicine. You just need to be patient and not to worry too much. Always observe your baby's condition and examine whether her feces get solid or not and whether there's blood in them.
The key is to keep give her as much fluid as you can. If she refuses, try to give the drink in small amount but do it frequently.
by: Adwina Jackson
Cancer Screening Tests
I sat with non-medical friends last night and the discussion turned to "health", as it often does. One guy related the terrible story of a woman who went to her doctor with a certain pain which turned out to be cancer that had spread and she died within a week. The inevitable question; "How do you detect early cancer, so you can catch it and cure it?"The answer I gave was less than satisfactory
Sunday, July 26, 2009
Causes of Bronchitis and Ayurvedic Home Remedies
Bronchitis – causes and Ayurvedic home remedies for bronchitis.
Bronchitis is inflammation of bronchi or air passages that carry air to lungs. People suffering from bronchitis see a heightening of this disease in damp climate.
In Ayurveda, bronchitis is termed as kasa roga (casa roga). According to Ayurveda concepts, germs cause this disease. However, accumulation of phlegm in the digestive tract after indigestion is the primary reason for bronchitis.
Thus treating bronchitis primarily aims at treating abnormalities in digestive system. The medicines also have curative powers to treat lung diseases.
Herbal remedies for Bronchitis
Tulsi (Holy Basil Ocimum sanctum), adathoda (Adathoda vasika), linseed, etc are used in the treatment of bronchitis.
You can chew two or three fresh tulsi leaves daily to keep yourself free from almost all of the diseases that affect you. Tulsi leaves also form constituent of several Ayurvedic preparations aimed at treating bronchitis. The other herbs are used in the concoctions (Ayurvedic preparations). They give the best results when used in the right proportions in the combination.
Precautionary measures include avoiding exposure to humidity, dust and other allergens.
You should also take care of your food and diet. Include a lot of fresh fruits and vegetables in your daily diet. Avoid smoking, alcohol and other addictives. Canned foods items are also best avoided. Easy to digest food items should form the main meals. Eat lots of fibrous food items and avoid the chances of constipation. Problems in digestion are the beginning point of bronchitis and you need to take extreme care in ensuring you have smooth digestion.
by: Dev Sri
Sinusitis Causes Headaches
Anyone who’s ever suffered from sinusitis will confess to having had bouts of headaches. However, it may not always be caused by sinusitis.
An interesting case was written by a certain “DP” to Doctor Vincent Martin detailing the hardships “he” bore in connection with headaches seemingly caused by sinusitis. The patient has consulted with different specialists but still the condition persists.
There is evidence linking sinus infections to the headaches being felt by people who suffer from the disorder. Headache specialists agree that sinus infections can trigger headaches.
A number of mechanisms are responsible for triggering this effect. Chronic nasal or sinus disease are said to lead to headaches through these mechanisms theoretically. One of these would be through the obstruction of the nasal passage when the membranes of the nose swell or through abnormalities in the bone structure of the nose. There are instances when the drainage of our sinuses are also plugged making way for changes in the air pressure in the sinuses and this causes the pain we perceive as headaches. This is the other mechanism which contributes to the headache effect of sinus infections.
There are reports that people who suffer from this headache found an improvement after having been treated of their nasal and sinus disorders. These are the ones who have undergone treatments that included antihistamines, decongestants and nasal sprays containing steroids. These medications often improve nasal congestion and/or drainage of the sinuses.
However, I have to agree with Doctor Martin that the sinus infection per se is not the real cause for these headaches. There may be instances when it will be the cause but oftentimes they only serve as trigger for the headaches which might be caused by other disorders. Fact is, these headaches that are attributed to sinus infections may be migraine or other forms of vascular or "tension" headaches that also give pain in the forehead and around the eyes
Undergoing a comprehensive diagnosis with a competent physician will yield an accurate assessment of your condition. Great is the discomfort suffered by people afflicted with sinus infections and seeking medical help as soon as possible is very much advised.
by: Paul Hood
Understanding Osteoporosis in Women
Osteoporosis is a bone disease that is prevalent in women after their menopausal period. It is characterized by a reduction in bone density and leads to an increase in the risk of having bone fracture. In osteoporosis, the mineral content in the bones as well as the structure of the bone itself is greatly altered, making the woman susceptible to bone injuries and their complications.
Detecting Osteoporosis
By itself, osteoporosis has no specific symptoms. The risk or presence of the disease is only detected if the woman becomes injured or suffers bone fractures in circumstances that healthy people would normally not suffer the same fate. In this case, the situation is described as fragility fracture because the injury is greatly due to the weak structure of the bone.
In the more advanced cases of osteoporosis, vertebral collapse is also noted. This is a condition that indicates that the vertebra is no longer able to support the woman’s body weight. This is also accompanied by severe back pain, and regular and stinging pain caused by nerve compression. Fractures may also occur in other body parts, and depending on the severity and state of health of the patient, surgery may be recommended.
A very delicate situation is when a hip fracture occurs. In this case, prompt surgery is required because the condition brings with it deep vein thrombosis and pulmonary embolism with fatal consequences.
Treatment of Osteoporosis
Thanks to modern technology, there are now varied means for treating osteoporosis:
*Medication is the most common and a readily available form of treatment. In medication for osteoporosis, bisphosphonates are the most commonly used drug and is the first-line treatment for women who are affected with osteoporosis. However, the drug has a record of poor absorption. In order to maximize the potency of the drug, the patient must not take anything for at least 30 minutes after taking the medication. Another drug commonly used is teriparatide. The teriparatide drug is given to women with confirmed cases of osteoporosis or those who have already suffered bone fractures. Moreover, it is also used as an alternative to bisphosphonates especially when the patient cannot tolerate the latter. Teriparatide is administered in small injections.
* Another treatment that holds the future for the treatment of osteoporosis is hormone replacement. Although this process holds a lot of promise, its application as treatment for osteoporosis is not strongly recommended unless there are other uses for it.
* Nutritional factors. Calcium and Vitamin D are two very important nutrients a woman must have to effectively counter osteoporosis. Calcium is essential for bone growth, bone healing, and for maintaining bone strength. Calcium supplements are easily available in the market and it can contribute much toward countering osteoporosis. On the other hand, vitamin D helps reduce the incidence of fractures in women.
* Exercise. The proper amount and regular exercise are also very vital in ensuring that osteoporosis is treated and the woman’s bone health restored to top condition.
by: James Pendergraft
Detecting Osteoporosis
By itself, osteoporosis has no specific symptoms. The risk or presence of the disease is only detected if the woman becomes injured or suffers bone fractures in circumstances that healthy people would normally not suffer the same fate. In this case, the situation is described as fragility fracture because the injury is greatly due to the weak structure of the bone.
In the more advanced cases of osteoporosis, vertebral collapse is also noted. This is a condition that indicates that the vertebra is no longer able to support the woman’s body weight. This is also accompanied by severe back pain, and regular and stinging pain caused by nerve compression. Fractures may also occur in other body parts, and depending on the severity and state of health of the patient, surgery may be recommended.
A very delicate situation is when a hip fracture occurs. In this case, prompt surgery is required because the condition brings with it deep vein thrombosis and pulmonary embolism with fatal consequences.
Treatment of Osteoporosis
Thanks to modern technology, there are now varied means for treating osteoporosis:
*Medication is the most common and a readily available form of treatment. In medication for osteoporosis, bisphosphonates are the most commonly used drug and is the first-line treatment for women who are affected with osteoporosis. However, the drug has a record of poor absorption. In order to maximize the potency of the drug, the patient must not take anything for at least 30 minutes after taking the medication. Another drug commonly used is teriparatide. The teriparatide drug is given to women with confirmed cases of osteoporosis or those who have already suffered bone fractures. Moreover, it is also used as an alternative to bisphosphonates especially when the patient cannot tolerate the latter. Teriparatide is administered in small injections.
* Another treatment that holds the future for the treatment of osteoporosis is hormone replacement. Although this process holds a lot of promise, its application as treatment for osteoporosis is not strongly recommended unless there are other uses for it.
* Nutritional factors. Calcium and Vitamin D are two very important nutrients a woman must have to effectively counter osteoporosis. Calcium is essential for bone growth, bone healing, and for maintaining bone strength. Calcium supplements are easily available in the market and it can contribute much toward countering osteoporosis. On the other hand, vitamin D helps reduce the incidence of fractures in women.
* Exercise. The proper amount and regular exercise are also very vital in ensuring that osteoporosis is treated and the woman’s bone health restored to top condition.
by: James Pendergraft
How To Manage Your Osteoporosis
According to the National Osteoporosis Foundation (http://www.nof.org) : “Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.”
While any bone can be affected, of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
If you look at healthy bones you will see that there are small holes between the bone cells. In osteoporosis those pores are larger making the bones brittle and easy to break. The best way to prevent osteoporosis is to prevent bone loss in the first place. In Rio Del Mar, California, there are many people who have homes there so they can easily get exercise walking on the beach. Rio Del Mar beach homes are favored by many, but one of the advantages they have over other Santa Cruz beach homes is a very nice long beach and easy access to the sand. This invites exercise which helps strengthen bones.
Children and teenagers form new bone faster than they lose the old bone. This means their bones get denser and denser until they reach what experts call peak bone mass, which happens around 20 years old. After you reach peak bone mass, the balance between bone loss and bone formation might start to change. In other words, you may slowly start to lose more bone than you form. In midlife, bone loss usually speeds up in both men and women. For most women, bone loss increases after menopause, when estrogen levels drop sharply. In fact, in the five to seven years after menopause, women can lose up to 20 percent or more of their bone density.
The best ways to prevent that massive loss of bone is to make sure you keep your calcium levels up. Taking a multivitamin can be helpful, but for menopausal/post menopausal women a higher dose of calcium may be needed. Calcium is nice on its own, but it is only part of the story. Vitamin D helps your body to absorb calcium.
The NOF recommends 1,200 mcg of calcium and 1,000 mcg of vitamin D each day. If you have a severe deficiency of vitamin D you may need to take as much as 100,000 mcg per week.
The third aspect of preventing and treating osteoporosis is exercise. Bones are like muscles-- they strengthen as they are used. Here are some exercises that can be done: some are high impact and others are low impact for those who cannot do the high impact exercises.
High Impact Exercises
• High-impact aerobics
• Hiking
• Jogging/running
• Jumping Rope
• Stair climbing
• Tennis
• Dancing
Low Impact Exercises
Elliptical training machines
• Low impact aerobics
• Stair-step machines
• Walking (treadmill/outside)
The best approach to preventing osteoporosis is really three-pronged: keeping up levels of calcium, vitamin D, and exercise. Some of the calcium can be taken from your diet, so can the vitamin D. Leafy green vegetables are often good sources, such as spinach, kale and others. Exercise is a necessary evil for every age group, but is especially important for those of us who are over 50. Getting out and walking is an easy way to start your exercise. While you don’t need a Rio Del Mar beach house, to start, a walk around the block is a great way to start.
by: Gregg Camp
While any bone can be affected, of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person's ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
If you look at healthy bones you will see that there are small holes between the bone cells. In osteoporosis those pores are larger making the bones brittle and easy to break. The best way to prevent osteoporosis is to prevent bone loss in the first place. In Rio Del Mar, California, there are many people who have homes there so they can easily get exercise walking on the beach. Rio Del Mar beach homes are favored by many, but one of the advantages they have over other Santa Cruz beach homes is a very nice long beach and easy access to the sand. This invites exercise which helps strengthen bones.
Children and teenagers form new bone faster than they lose the old bone. This means their bones get denser and denser until they reach what experts call peak bone mass, which happens around 20 years old. After you reach peak bone mass, the balance between bone loss and bone formation might start to change. In other words, you may slowly start to lose more bone than you form. In midlife, bone loss usually speeds up in both men and women. For most women, bone loss increases after menopause, when estrogen levels drop sharply. In fact, in the five to seven years after menopause, women can lose up to 20 percent or more of their bone density.
The best ways to prevent that massive loss of bone is to make sure you keep your calcium levels up. Taking a multivitamin can be helpful, but for menopausal/post menopausal women a higher dose of calcium may be needed. Calcium is nice on its own, but it is only part of the story. Vitamin D helps your body to absorb calcium.
The NOF recommends 1,200 mcg of calcium and 1,000 mcg of vitamin D each day. If you have a severe deficiency of vitamin D you may need to take as much as 100,000 mcg per week.
The third aspect of preventing and treating osteoporosis is exercise. Bones are like muscles-- they strengthen as they are used. Here are some exercises that can be done: some are high impact and others are low impact for those who cannot do the high impact exercises.
High Impact Exercises
• High-impact aerobics
• Hiking
• Jogging/running
• Jumping Rope
• Stair climbing
• Tennis
• Dancing
Low Impact Exercises
Elliptical training machines
• Low impact aerobics
• Stair-step machines
• Walking (treadmill/outside)
The best approach to preventing osteoporosis is really three-pronged: keeping up levels of calcium, vitamin D, and exercise. Some of the calcium can be taken from your diet, so can the vitamin D. Leafy green vegetables are often good sources, such as spinach, kale and others. Exercise is a necessary evil for every age group, but is especially important for those of us who are over 50. Getting out and walking is an easy way to start your exercise. While you don’t need a Rio Del Mar beach house, to start, a walk around the block is a great way to start.
by: Gregg Camp
Saturday, July 25, 2009
Costs Skyrocket for Pharmaceuticals
I just heard from one of my patients that the cost of "Advair" (an inhaler commonly used for asthma) at the pharmacy was $160.00. That is the discounted price the patient pays WITH HEALTH INSURANCE.I suspect the pharmaceutical companies are gouging as much as they can just in case health care reform comes along and changes things. How strong do you think the legislature will be against the
BLOGSCAN - Reports from the ACRE Meeting
The proceedings at the first meeting of the benignly titled Association of Clinical Researchers and Educators (ACRE) was chronicled on the Carlat Psychiatry Blog here, and on Postscript, the Prescription Project blog here. ACRE, founded by Dr Thomas Stossel (see relevant post here on the sorts of arguments Dr Stossel has made), was founded to defend academics who are paid on the side by drug, biotechnology, and device companies from the complaints of the "pharmascolds." What I found most troubling was that the conference was officially opened by Dr Jeffrey Flier, the Dean of the Harvard medical school, implying a medical school endorsement of this group, and featured presentations by the presidents of the American Association of Clinical Endocrinologists, and the American Society of Hypertension, implying endorsement by these medical societies. But also see the comments by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog that there may be a silver lining to this cloud.
Friday, July 24, 2009
Medical Marijuana
In medicine, we say things come in "threes". Sure enough, I have written three prescriptions for medical cannabis within the past 2 weeks. One was for a patient to help manage chronic pain, one was for a patient who was losing weight with metastatic cancer and the third for a patient with multiple sclerosis and spasticity. Medical marijuana has been found to be effective in all three of these
How "Independent" a Source of Health Care Reform Data?
This week, a Washington Post article discussed who provides the data being cited in the ongoing US debate about health care reform.
But how independent is the Lewin group?
Is it only an appearance of conflict, and how objective is the Lewin Group's work?
So, in summary, a group providing ostensibly "independent" data and opinions about an important health care policy debate is actually a subsidiary of a commercial managed care organization/ health care insurance company which clearly has vested interests in certain policy options. While the consulting group apparently struggles to be objective, its top leader reported that is fashions its reports at the behest of its clients, and that clients can "bury" reports that offend them, possibly because they do not serve their vested interests.
It is not surprising that participants in the current, noisy debate about health care reform, like many other health policy debates, have vested interests, and that their positions are likely to promote these interests. However, what should at least be disturbing is how often those with vested interests try to appear to be disinterested and independent. Should we trust "independent" voices that actually are conflicted, or those who cite "independent" views that actually come from interested parties?
By the way, we first posted about the Lewin Group's actual status as an Ingenix, and hence UnitedHealth subsidiary here in January, 2009, and first posted about how its contribution to the current health care reform debate was being touted as independent here in April, 2009. That a news organization with the status of the Washington Post is now picking up this story suggests a little optimism that the anechoic effect might be weakening.
The political battle over health-care reform is waged largely with numbers, and few number-crunchers have shaped the debate as much as the Lewin Group, a consulting firm whose research has been widely cited by opponents of a public insurance option.
To Rep. Eric Cantor (Va.), the House Republican whip, it is 'the nonpartisan Lewin Group.' To Republicans on the House Ways and Means Committee, it is an 'independent research firm.' To Sen. Orrin G. Hatch (Utah), the second-ranking Republican on the pivotal Finance Committee, it is 'well known as one of the most nonpartisan groups in the country.'
But how independent is the Lewin group?
Generally left unsaid amid all the citations is that the Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers.
More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied UnitedHealth and other insurers with data that allegedly understated the 'reasonable and customary' doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.
In January, UnitedHealth agreed to a $50 million settlement with the New York attorney general and a $350 million settlement with the AMA, covering conduct going back as far as 1994.
Ingenix's chief executive, Andrew Slavitt, said the company's data was never biased, but Ingenix nonetheless agreed to exit that particular line of business. 'The data didn't have the appearance of independence that's necessary for it to be useful,' Slavitt said.
Lewin Group Vice President John Sheils said his firm had nothing to do with the Ingenix reimbursement data. Lewin has gone through 'a terribly difficult adjustment' since it was bought by UnitedHealth in 2007, he said, because the corporate ownership 'does create the appearance of a conflict of interest.'
'It hasn't affected . . . the work we do, and I think people who know me know that I am not a good liar,' Sheils said.
Is it only an appearance of conflict, and how objective is the Lewin Group's work?
Lewin's clients include the government and groups with a variety of perspectives, including the Commonwealth Fund and the Heritage Foundation. A February report by the firm contained information that could be used to argue for a national system known as single-payer, the approach most threatening to insurers, Sheils noted.
But not all of Lewin's reports see the light of day. 'Let's just say, sometimes studies come out that don't show exactly what the client wants to see. And in those instances, they have [the] option to bury the study,' Sheils said.
So, in summary, a group providing ostensibly "independent" data and opinions about an important health care policy debate is actually a subsidiary of a commercial managed care organization/ health care insurance company which clearly has vested interests in certain policy options. While the consulting group apparently struggles to be objective, its top leader reported that is fashions its reports at the behest of its clients, and that clients can "bury" reports that offend them, possibly because they do not serve their vested interests.
It is not surprising that participants in the current, noisy debate about health care reform, like many other health policy debates, have vested interests, and that their positions are likely to promote these interests. However, what should at least be disturbing is how often those with vested interests try to appear to be disinterested and independent. Should we trust "independent" voices that actually are conflicted, or those who cite "independent" views that actually come from interested parties?
By the way, we first posted about the Lewin Group's actual status as an Ingenix, and hence UnitedHealth subsidiary here in January, 2009, and first posted about how its contribution to the current health care reform debate was being touted as independent here in April, 2009. That a news organization with the status of the Washington Post is now picking up this story suggests a little optimism that the anechoic effect might be weakening.
Physicians Down Under Get Direct About Danger of Bad HIT
Too often, physicians acquiese to demands by hospital executives that they adjust to and use health IT, even if that health IT is flawed. This is despite the fact that liability for patient care resides with the physicians, not the HIT vendor or executives.
Several physicians Down Under have had enough:
Such discrepancies between one hospital and the next regarding HIT require critical evaluation - erring on the side of patient safety, not IT vendor convenience. Considering the aforementioned UK House of Commons report and the "near miss disasters" mentioned by the Australian physicians, such due diligence is mandatory in my opinion.
Further, American physicians can probably learn from these Australian counterparts in being vocal about HIT problems.
-- SS
Several physicians Down Under have had enough:
Doctors issue deadly warning
Daily Examiner, Grafton, Australia
David Bancroft | 23rd July 2009
It seems incredible that a patient record system that aims to improve treatment could kill people [not so incredible to the informed - e.g., see "Bad Informatics Can Kill" - ed.], but that is a claim being made about a new system that is almost certainly going to be introduced into the Grafton Base Hospital next week.
Earlier this month, leading health officials from the Lismore Base Hospital wrote to the North Coast Area Health Service (NCAHS) claiming a new Surginet electronic medical record system that had been operating in the hospital for several months would 'inevitably' lead to the death of patients.
But the health service said changes had been made to the Surginet electronic medical record (EMR) system since the concerns were raised by the four senior clinicians on July 2, and the system had been operating 'satisfactorily' in Sydney without patient concerns being raised. ["Without concerns raised" does not mean they do not exist - ed.]
In their letter to NCAHS chief executive officer Chris Crawford, which was copied to the Minister for Health John Della Bosca, the four medical specialists said there had been recurring problems over several months and 'these have not improved'.
“This has resulted in unnecessary compromise of patient safety,” they wrote.
“There have been repeated well demonstrated cases of near miss disasters due to these problems. [Will patients be as lucky the next time? - ed.]
“We believe that negative patient outcomes, including death, will inevitably result from the continuing use of this system.
“Surginet is fundamentally flawed.
“New technology should: improve the quality of our work; help us to be more efficient, and; make routine tasks easier.
“EMR Surginet does none of these; in fact it has had the opposite effect.
“We believe that the Surginet EMR system is unsafe and will result in patient morbidity and mortality.”
Surginet was to be implemented at the Grafton Base Hospital yesterday, but after concerns were raised with the area health service, implementation was delayed until next Wednesday.
A health service spokesman said the implementation had been delayed so the software producers, Cerner [an American company behind the HIT products that caused difficulty in the UK - see the UK House of Commons report here, esp. points 5 and 6 - ed.], could speak with Grafton surgeons and anaesthetists prior to the implementation about any concerns they may have.
“NCAHS takes any concerns raised about patient safety seriously and is addressing these,” the spokesman said.
“It should be emphasised that Surginet is operating satisfactorily in Sydney hospitals without patient safety concerns being raised. [Again, that does not mean they do not exist; clinicians may be afraid to speak out and working furiously to establish workarounds to problems - ed.]
“It is a system used worldwide that can be adapted to accommodate local work practices in NSW hospitals. ["Can be adapted" - anything "can be adapted". But has this application actually been adapted to the culture in NSW hospitals? - ed.]
“Arrangements are being made for discussions to be held with the department heads by representatives of the EMR project team and Cerner.”
The spokesman said Surginet had recently been introduced at the Maclean Hospital and there had been no complaints and the NCAHS had actually received a letter of thanks from the hospital. [A letter of thanks from whom at the hospital, exactly, and based on what substantive claims? - ed.]
Such discrepancies between one hospital and the next regarding HIT require critical evaluation - erring on the side of patient safety, not IT vendor convenience. Considering the aforementioned UK House of Commons report and the "near miss disasters" mentioned by the Australian physicians, such due diligence is mandatory in my opinion.
Further, American physicians can probably learn from these Australian counterparts in being vocal about HIT problems.
-- SS
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