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Revolution Rounds: The Best of the Medical Expert Blogs, 2.29.08

Happy leap year everyone! The Revolution Health experts have been blogging away furiously, and I haven’t done a Revolution Rounds in a few weeks (naughty) so without further ado – here’s a nice round up of the best of the Revolution Health blogs…

Health tips

Most vitamins and supplements are not necessary if you’re eating a healthy diet. Dr. Joe Scherger summarizes Harvard’s Men’s Health Watch and concludes that only Vitamin D supplements may be warranted for the general population.

Relationships require pruning. Mira Kirshenbaum suggests that if you’re in an unhealthy relationship, it’s best to get up the courage to cut it off.

Ever wonder which arthritis treatments work best? Dr. Jim Herndon has distilled the latest research.

Children need to be vaccinated against the measles. Dr. Stacy Stryer explains that measles can be deadly in 20-30% of the people who get it.

Calcium can strengthen your bones, but may clog your heart? Dr. Vivian Dickerson cautions women about taking too much of this vitamin.

Did you know?

Only one in four people recognize the symptoms of a heart attack. Dr. Joe Scherger describes how you can tell if you’re having one.

Restless legs syndrome might increase your risk of a heart attack. Dr. Steve Poceta explains why.

Stem cell research could be the key to unlocking the mysteries of how cancer develops. Dr. Heinz-Josef Lenz describes some promising new research.

Pit viper venom might be useful in reversing strokes. Dr. Olajide Williams explains that the venom can dissolve blood clots in the brain.

There is a real mind-body connection in health and disease. Dr. Joe Scherger explains how it impacts men with erectile dysfunction.

Nighttime anxiety might convey a survival advantage. Dr. Steve Poceta wonders if we worry more at night because the ancestors who did so, lived to procreate.

A hospital is being sued for denying a surgical procedure to a transgender female. Dr. Cole Brown is not sure that this is fair, since the procedure was not emergent.

Orthopedics Corner

Dr. Jim Herndon is a faithful friend and blogger. He has had a particularly fine week – so many of his posts are great that I thought I’d give you a little summary of them all in one place…

Americans spend as much on back and neck pain treatments as they do on cancer treatment. Jim discusses the incredible financial burden of back and neck pain and the disappointing efficacy rates of treatments.

Neck pain is fairly common and particularly resistant to treatment. Jim describes the prevalence of this condition.

Glucosamine does not seem to improve hip arthritis. Jim discusses the mounting evidence that the benefits of glucosamine are very limited if they exist at all.

Patients with spinal stenosis (narrowing of the canal that contains the spinal cord) may benefit from surgery.

About 10% of total hip and knee replacements require revisions. Before you have yours, be sure that your surgeon is experienced with revisions.

Kiddie corner

Dr. Stacy Stryer is also a faithful friend and excellent pediatrician and blogger. Her sound advice and empathic tone is a key to her success. Here’s what she has to say this week:

First of all, Dr. Stacy reports on the strange practice of a nursing mom on America’s Next Top Model TV show: she’s drinking her own breast milk. Yuck!

Studies show that parents spend more time with their first child. Stacy wonders if she’s been a neglectful parent of her younger child.

Measles is a fatal illness for up to 30% of children who get it. Sadly, measles is on the rise because parents have opted out of the MMR vaccine due to unsubstantiated fears of vaccine harm.

Depression in a parent might be a risk factor for poor health among their children.  Dr. Stacy  takes a fresh look at how to keep America’s children healthy.

Dr. Jim Hill explains why children who don’t exercise regularly may perform worse on academic tests.
And my final post of Revolution Rounds is from a couple of neurologists who relay a compelling story: they saved a woman’s arm from a mistake made by an orthopedist in Serbia!

This post originally appeared on Dr. Val’s blog at

Fixing American Healthcare: The Primary Cause of Rising Costs

In Fixing American Healthcare, Dr. Rich explains that the major cause of rising costs in healthcare is an aging population that requires more resources. Though some have proposed that fraud and waste/inefficiencies are the primary sources of costs spiraling out of control, the truth is that they likely play a minor role compared to the tremendous costs of providing cutting edge treatments to an older and sicker US population. Dr. Rich argues that we don’t hear that much about the escalating cost of caring for older Americans because it makes us squeamish, so we instead focus on curbing costs due to fraud and waste. However, when fraud and waste are not the primary cause of increasing costs, enhanced attempts to quash them do not actually move the savings needle. Since certain groups are tasked with reducing escalating costs due to fraud (in particular), and their work does not result in savings, they must strive harder to find and punish those accused of fraud, perhaps even seeing fraud where it doesn’t exist.

Dr. Rich argues that true fraud is fairly rare, and that the majority of “fraud” cases involve people not complying with rules they had no knowledge of (in many cases even after asking about the rules from the people who made them). Other cases of “fraud” involve retroactive application of rules and then fining hospitals for not being in compliance before the rules were made. His assessment of the PATH audit debacle is quite interesting.

Now, obviously we want to decrease fraud and waste as much as possible – but in the midst of our desperate attempts to curb healthcare spending, we’ll need to have some honest and frank discussions about the elephant in the room: America is sicker than ever before, and we have developed expensive ways to cure/treat those sicknesses – ways that we can’t afford to offer everyone.

What should we do? Dr. Rich suggests that we come together as a nation and decide on some rationing rules. He argues that we’re already rationing our healthcare dollars in covert ways – let’s bring it out into the open so that it’s fair to everyone. Now, I doubt that this will sit well with Americans – but our current “system” is so dysfunctional that maybe the time for a rationing discussion has come?

In this climate of unlimited treatments and limited resources, the best option is to stay healthy as long as possible. That’s why I believe in preventive medicine, healthy lifestyle changes, and doing all that we can to avoid getting sick. In many cases (but certainly not all) eating healthy foods, exercising regularly, controlling our weight, getting our vaccines, and sleeping well each night can go a long way to keeping us out of the hospital. It’s not easy to get Americans to take care of themselves in this way, but I’d rather spend my efforts trying to get us fit than to have to debate rationing rules. In the end, however, we may need to do both. What do you think?This post originally appeared on Dr. Val’s blog at

Fixing American Healthcare: The Problem of Covert Rationing

Dr. Richard Fogoros wrote a fascinating book called Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare. In the first two thirds of the book, he explains why our healthcare system is broken, and describes its dysfunction with exasperating accuracy.

One of the most important concepts in his book is that of “covert rationing.” As Dr. Rich explains, we Americans cling to two fundamental beliefs:

1. Everything that can be done for a sick person must be done, as long as there’s some small hope of beneficial outcome. (The belief in no spending limits).

2. Healthcare is an entitlement for all Americans. (The belief in universal access).

Since science and technology have provided us with incredible (and expensive) advances over the last several decades, doing all that’s possible for all who are sick is simply not financially possible. However, Americans are fundamentally opposed to rationing care, so the rationing occurs covertly, including cost-savings achieved by people being uninsured, by certain chemo drugs not being covered by Medicare, by physicians being coerced by HMOs to ration care, and countless other subtle and capricious ways.

Covert rationing is a little recognized but fundamental flaw of the current healthcare system, and it results in untold inequities in care. Dr. Rich believes that a fair system requires open rationing of resources, with rules agreed upon by tax payers. Would you agree?

In my next post I’ll discuss Dr. Rich’s thoughts on what’s really driving up healthcare costs…This post originally appeared on Dr. Val’s blog at

Hepatitis A Spread by a Bartender in New York City?

Some Hollywood celebrities are up in arms after having been notified of their exposure to hepatitis A through an infected bartender at a trendy New York City club. Those who come in contact with a known virus carrier may prevent infection if they’re vaccinated early. Hepatitis A causes less severe liver disease than its blood-bourne cousin, hepatitis C, but it’s still a formidable foe. (For more information about hepatitis A and its symptoms, check out this article.)

I interviewed Revolution Health consultant and world-renowned liver expert, Dr. Emmet Keeffe, about this outbreak:

Dr. Val: What is the likelihood that people could catch hepatitis A from an infected bartender?

Dr. Keeffe: The hepatitis A virus is transmitted between persons by the fecal-oral route (think unwashed hands after a bathroom break, or drinking water that has come in contact with human sewage). Also this particular virus is very hardy and can live on counter tops and surfaces outside the body for longer than many viruses. Because hepatitis A is found in very high concentrations in an infected persons’ stool, a tiny bit of stool on the hands actually contains large amounts of the virus and can therefore be quite infectious. Although previous outbreaks have primarily been associated with food handlers, there is no reason why a bartender might not also spread hepatitis A virus.

Dr. Val: Yuck. Would a vaccine be effective in preventing hepatitis A after someone’s already been exposed? How quickly after exposure should one get the vaccine?

Dr. Keeffe: The standard recommendation for individuals potentially exposed to hepatitis A is passive immunization using immune globulin administered within 2 weeks of exposure, which is 85% effective in protecting against illness. This is the recommendation for household or sexual exposure, but not generally recommended for “common source outbreaks” (like exposure to food handlers or bartenders), which are usually recognized only after they are well into their course. However, with early recognition, such as the NY case, immune globulin may make good sense. After hepatitis A vaccination, protective levels of antibodies to hepatitis A virus do not appear until 2-4 weeks after vaccination. Thus, active immunization with hepatitis A is used for preexposure prophyaxis, such as in international travelers to areas where hepatitis A is common, but not for postexposure prophylaxis.

Dr. Val: What is the hepatitis A vaccine exactly?

Dr. Keeffe: Hepatitis A vaccine is an injection, which is administered at baseline followed by a booster in 6 to 18 months. Two relatively similar and effective vaccines are licensed in the United States: Havrix and Vaqta.

Dr. Val: What should the bartender do if he has hepatitis A? Can he still work? When can he come back to work?

Dr. Keeffe: To protect the public, the bartender should not work until he has fully recovered. He is most infectious during the late incubation and early illness stage, when excretion of hepatitis A virus in feces is the highest.This post originally appeared on Dr. Val’s blog at

Some Great Books

Sorry folks, I haven’t been blogging as frequently this week because I’m in the process of finishing up two great books:

1. Fixing American Healthcare, by Richard Fogoros, MD

2. When Good People Have Affairs: Inside the Hearts and Minds of People in Two Relationships, by Mira Kirshenbaum

The first book was sent to me by the author, a fellow blogger and kindred spirit. I have to tell you that Dr. Rich’s description of our dysfunctional health care system (and his explanation of how we got where we are) is crystal clear, compelling, and painfully accurate. If you like feeling righteous indignation, than hurry on over to his site and get the book! I’m hoping to summarize some of his key points here in this blog – but it may be challenging to explain things any better than he does…

The second book was sent to me by Mira’s publisher, who’d like me to read it and comment on the book for a potential back cover testimonial. So far it’s terrific, though I might relate to it a little more if I were personally struggling with a marital affair – and thank goodness that’s not one of Dr. Val’s issues. I’ll ask Mira if I can summarize some key thoughts from her book as well…

Thanks for your patience, o faithful readers. Lots of good discussion topics ahead!

This post originally appeared on Dr. Val’s blog at

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