November 20th, 2008 by Dr. Val Jones in Audio, Celebrity Interviews
3 Comments »
 |
|
Debi Mazar
|
You may know actor Debi Mazar from her work in the movie Goodfellas, and from her role as Shauna on the HBO hit TV show, Entourage. But I know Debi as a busy mom who struggles with insomnia. I caught up with her a few days ago to find out how she’s coped with those sleepless nights.
Listen to the podcast here:
[audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/11/debimazar.mp3]
Dr. Val: When did insomnia first become a problem for you?
Mazar: Insomnia is surprisingly common. It affects 60 million Americans: 40% of women and 30% of men. My struggle with insomnia began in my mid to late 20’s when my professional and love life went into full swing. I ate well and exercised, but started having trouble falling asleep every night. I went to see a doctor because I didn’t realize that there were many things that I could do about it on my own.
Dr. Val: What are some of the non-medical treatments that worked for you?
Mazar: Cutting back on caffeine, sugar, and alcohol, and exercising only early in the day, having a healthy sex life, and getting myself on a sleeping schedule. I also tried to reduce stress levels in my life by not going to bed angry, by unplugging from TV and the Internet, and I made my bedroom a very cozy, dark environment that would be condusive to sleep. When you’re a mom, sleeping pills aren’t a good option because you might have to get up in the middle of the night. I have a full list of insomnia tips at bedsidebriefings.com
Dr. Val: I bet that insomnia is a common problem in Hollywood. Has that been your experience?
Mazar: I don’t consider myself to be part of “Hollywood” I’m just an average mom who worries about the world we live in and our economy. The news can cause a lot of anxiety – regardless of what you do for a living. It keeps us all awake at night. Of course, chronic insomnia can increase our risk of depression, weight gain, diabetes and hypertension.
Dr. Val: What is the most important thing for Americans to know about sleep?
Mazar: Sleep is the time when your body repairs itself, so sleep is essential for good health. Without it, we all fall apart.
November 19th, 2008 by Dr. Val Jones in Announcements, Opinion
4 Comments »
Tom Daschle - Photo Credit: CBS News
I’ve had my eye on Tom Daschle for many months – and attended a healthcare conference in June ’08 in which he was the keynote. I blogged about his ideas previously, but thought it would be valuable to repost them here (h/t to The Healthcare Blog):
Tom Daschle, former Senate Majority Leader from South Dakota, was the keynote speaker at the Fighting Chronic Disease: The Missing Link in Health Reform conference here in Washington, DC. His analysis of the healthcare crisis is this:
US Healthcare has three major problems: 1) Cost containment. We spend $8000/capita – 40% more than the next most expensive country in the world (Switzerland). Last year businesses spent more on healthcare than they made in profits. General motors spends more on healthcare than they do on steel.
2) Quality control. The US system cannot integrate and create the kind of efficiencies necessary. The WHO has listed us as 35 in overall health outcomes. Some people ask, “If we have a quality problem, why do kings and queens come to the US for their healthcare?” They come to the best places like the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins. They don’t go to rural South Dakota. We have islands of excellence in a sea of mediocrity.
3) Access. People are unable to get insurance if they have a pre-existing condition. 47 million people don’t have health insurance. We have a primary care shortage, and hospitals turning away patients because they’re full.
His solutions are these:
- Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
- Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
- We must recognize the importance of continuity of care and the need for a medical home. Chronic care management can only occur if we coordinate the care from the beginning, and not delegating the responsibility of care to the Medicare system when the patient reaches the age of 65.
- We must focus on wellness and prevention. Every dollar spent on water fluoridation saves 38 dollars in dental costs. Providing mammograms every two years to all women ages 50-69 costs only $9000 for every life year saved.
- Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
- Best practices – we need to adopt them.
- We need electronic medical records. We’re in 21st century operating rooms with 19th century administrative rooms. We use too much paper – we should be digital.
- We have to pool resources to bring down costs.
- We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
- We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.
- We have to change our infrastructure. Congress isn’t capable of dealing with the complexity of the decision-making in healthcare. We need a decision-making authority, a federal health board, that has the political autonomy and expertise and statutory ability to make the tough decisions on healthcare on a regular basis. Having this infrastructure in place would allow us the opportunity to integrate public and private mechanisms within our healthcare system in a far more efficient way.
What do I think of this? First of all, I agree with much of what Tom said (especially points 2-7) and I respect his opinions. However, I was also very interested in Nancy Johnson’s retort (she is a recently retired republican congresswoman from Connecticut).
Nancy essentially said that any attempt at universal coverage will fail if we don’t address the infrastructure problem first. So while she agrees in principle with Tom Daschle’s aspirations and ideals, she believes that if we don’t have a streamlined IT infrastructure for our healthcare system in place FIRST, there’s not much benefit in having universal coverage.
As I’ve always said, “equal access to nothing is nothing.”
I also think of it this way: imagine you own a theme park like Disney World and you have thousands of people clamoring at the gates to enter the park. One option is to remove the gates (e.g. universal coverage) to solve consumer demand. Another option is to design the park for maximal crowd flow, to figure out how to stagger entry to various rides, and to provide multiple options for people while they’re waiting – and then invite people to enter in an orderly fashion.
Obviously, this is not a perfect analogy – but my opinion is that until we streamline healthcare (primarily through IT solutions), we’ll continue to be victims of painful inefficiencies that waste everyone’s time. It’s as if our theme park has no gates, no maps, no redirection of crowd flow, no velvet-roped queues, and the people who get on the rides first are not the ones who’ve been waiting the longest, but the “VIPs” with good insurance or cash in the bank. It’s chaotic and unfair.
Quite frankly, I think we could learn a lot from Disney World – and I hope and pray that next year’s healthcare solution is not simply ”remove the gates.”
What do you think?
November 18th, 2008 by Dr. Val Jones in Uncategorized
1 Comment »
Today marks a new phase in my medical career – I’ve been sent a bottle of ketchup for my consideration. Until now I’ve received pharmaceutical pitches and drug samples for my patients… but I’ve now entered a new phase in my life. I am a target market for condiments.
And how did this purveyor of organic ketchup find me online? I was blogging about how difficult it is for patients with diabetes to avoid high fructose corn syrup these days (it seems to be a required ingredient from spaghetti sauce to peanut butter) and I explained that I was a carb conscious person myself, and had recently purchased some unsweetened ketchup as part of a sugar-avoidance strategy.
The next day a nice man asked if he could send me a sample of his own brand of ketchup, sweetened with agave nectar instead of corn syrup or cane sugar. I said it’d be fine for him to send it along, and a few days later there it was: Wholemato brand organic agave ketchup.
So I did a little taste test, comparing my Westbrae Natural Vegetarian Unsweetened Ketchup to the Wholemato brand. The Wholemato guy was right – it was head and shoulders above the other brand in terms of flavor and sweetness. Of course, it has 3g of sugar/serving, while the sugar-free version has 1g/serving. My organic Heinz ketchup has 4g/serving, and parenthetically – I went to the Heinz site and found that they have a new marketing campaign around customized ketchup labels. Kind of quirky. Who knew?
It seems that agave nectar contains ~90% fructose (if you can trust the sources online) which means that it’s “sweeter” than glucose-based cane sugar (which is 50/50 glucose and fructose, and high fructose corn syrup is 55/45 fructose and glucose). So what does this mean? Correct me if I’m wrong here but I just interviewed Penny Kris-Etherton about corn syrup and she told me that it’s the FRUCTOSE that is the real problem in terms of increasing blood lipid levels and requiring more insulin output.
So I feel really badly about the nice agave man who sent me the delicious ketchup – but the nutritionists are saying that agave is actually much WORSE for you than corn syrup if you’re a diabetic.
I don’t think that small amounts of any kind of sugar is worth fretting about (unless you have diabetes) – but trying to avoid cane sugar and high fructose corn syrup by switching to agave syrup is kind of like getting out of the frying pan and into the fire.
And with that blog post I think I’ve ended my career as a condiment tester unfortunately. Of course, I do like the taste of agave nectar. 😐
November 18th, 2008 by Dr. Val Jones in Opinion, Quackery Exposed
20 Comments »
The internet, in democratizing knowledge, has led a lot of people to believe that it is also possible to democratize expertise.
– Commenter at Science Based Medicine
Regular readers of this blog know how passionate I am about protecting the public from misleading health information. I have witnessed first-hand many well-meaning attempts to “empower consumers” with Web 2.0 tools. Unfortunately, they were designed without a clear understanding of the scientific method, basic statistics, or in some cases, common sense.
Let me first say that I desperately want my patients to be knowledgeable about their disease or condition. The quality of their self-care depends on that, and I regularly point each of my patients to trusted sources of health information so that they can be fully informed about all aspects of their health. Informed decisions are founded upon good information. But when the foundation is corrupt – consumer empowerment collapses like a house of cards.
In a recent lecture on Health 2.0, it was suggested that websites that enable patients to “conduct their own clinical trials” are the bold new frontier of research. This assertion betrays a lack of understanding of basic scientific principles. In healthcare we often say, “the plural of anecdote is not data” and I would translate that to “research minus science equals gossip.” Let me give you some examples of Health 2.0 gone wild:
1. A rating tool was created to “empower” patients to score their medications (and user-generated treatment options) based on their perceived efficacy for their disease/condition. The treatments with the highest average scores would surely reflect the best option for a given disease/condition, right? Wrong. Every single pain syndrome (from headache to low back pain) suggested a narcotic was the most popular (and therefore “best”) treatment. If patients followed this system for determining their treatment options, we’d be swatting flies with cannon balls – not to mention being at risk for drug dependency and even abuse. Treatments must be carefully customized to the individual – genetic differences, allergy profiles, comorbid conditions, and psychosocial and financial considerations all play an important role in choosing the best treatment. Removing those subtleties from the decision-making process is a backwards step for healthcare.
2. An online tracker tool was created without the input of a clinician. The tool purported to “empower women” to manage menopause more effectively online. What on earth would a woman want to do to manage her menopause online, you might ask? Well apparently these young software developers strongly believed that a “hot flash tracker” would be just what women were looking for. The tool provided a graphical representation of the frequency and duration of hot flashes, so that the user could present this to her doctor. One small problem: hot flash management is a binary decision. Hot flashes either are so personally bothersome that a woman would decide to receive hormone therapy to reduce their effects, or the hot flashes are not bothersome enough to warrant treatment. It doesn’t matter how frequently they occur or how long they last. Another ill-conceived Health 2.0 tool.
When it comes to interpreting data, Barker Bausell does an admirable job of reviewing the most common reasons why people are misled to believe that there is a cause and effect relationship between a given intervention and outcome. In fact, the deck is stacked in favor of a perceived effect in any trial, so it’s important to be aware of these potential biases when interpreting results. Health 2.0 enthusiasts would do well to consider the following factors that create the potential for “false positives”in any clinical trial:
1. Natural History: most medical conditions have fluctuating symptoms and many improve on their own over time. Therefore, for many conditions, one would expect improvement during the course of study, regardless of treatment.
2. Regression to the Mean: people are more likely to join a research study when their illness/problem is at its worst during its natural history. Therefore, it is more likely that the symptoms will improve during the study than if they joined at times when symptoms were not as troublesome. Therefore, in any given study – there is a tendency for participants in particular to improve after joining.
3. The Hawthorne Effect: people behave differently and experience treatment differently when they’re being studied. So for example, if people know they’re being observed regarding their work productivity, they’re likely to work harder during the research study. The enhanced results therefore, do not reflect typical behavior.
4. Limitations of Memory: studies have shown that people ascribe greater improvement of symptoms in retrospect. Research that relies on patient recall is in danger of increased false positive rates.
5. Experimenter Bias: it is difficult for researchers to treat all study subjects in an identical manner if they know which patient is receiving an experimental treatment versus a placebo. Their gestures and the way that they question the subjects may set up expectations of benefit. Also, scientists are eager to demonstrate positive results for publication purposes.
6. Experimental Attrition: people generally join research studies because they expect that they may benefit from the treatment they receive. If they suspect that they are in the placebo group, they are more likely to drop out of the study. This can influence the study results so that the sicker patients who are not finding benefit with the placebo drop out, leaving the milder cases to try to tease out their response to the intervention.
7. The Placebo Effect: I saved the most important artifact for last. The natural tendency for study subjects is to perceive that a treatment is effective. Previous research has shown that about 33% of study subjects will report that the placebo has a positive therapeutic effect of some sort.
In my opinion, the often-missing ingredient in Health 2.0 is the medical expert. Without our critical review and educated guidance, there is a greater risk of making irrelevant tools or perhaps even doing more harm than good. Let’s all work closely together to harness the power of the Internet for our common good. While research minus science = gossip, science minus consumers = inaction.
November 17th, 2008 by Dr. Val Jones in Announcements
4 Comments »
I was a panelist at Edelman’s CHPA New Media Summit today in New Brunswick, NJ. Matthew Holt (of the Healthcare Blog and Health 2.0) was the keynote speaker, and I participated on a panel discussion with Dr. Roy Poses. It was exciting to meet Roy in person for the first time, as I’ve been following his policy blog for some time.
Matthew presented a very rosy picture of Health 2.0 (consumer-driven healthcare), more or less suggesting that it could provide a large part of the solution to our current healthcare crisis. I countered with a more cautious view, explaining that expert engagement would be critical to Health 2.0’s success.
Matthew argued that sites like Patients Like Me were enabling patients “to do their own clinical trials online,” and that this was opening a whole new avenue for research. Dr. Poses and I were fairly concerned about this suggestion, primarily because we understand how easy it is to draw false conclusions from data, especially when the data are not collected in a systematic fashion.
I explained to the audience that association does not prove causation (E.g. Do matches cause lung cancer? No, though it’s true that people who smoke are more likely to carry matches). I also described a case in which a Health 2.0 principle went terribly awry: a group of consumers were asked to rate their medications for efficacy by disease/condition. This was supposed to leverage the “wisdom of the crowds” to determine which medicines worked best (by popular vote). Of course, the result was that every pain syndrome (low back pain, headaches, fibromyalgia, etc.) resulted in a narcotic pain medicine as the highest ranked treatment option. Do you really need Oxycontin for that tension headache of yours? Obviously, narcotics are popular among users – but are a last resort for pain management in the real world. The “wisdom of crowds” rarely works in healthcare.
Matthew agreed to disagree with me on a number of issues – but we certainly found common ground on the primary care crisis. He and I both believe that a shortage of primary care physicians is going to result in a catastrophic shortage of care for Baby Boomers in the next decade. Dr. Poses added that primary care physicians make the same salary as school teachers in his home state of Rhode Island.
I think we have to agree with KevinMD – the way forward is not going to be pretty.
