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Grand Rounds, Vol. 8, No. 7: Myth Buster Edition!

As regular readers of the Better Health blog already know, I am opposed to health misinformation. In fact, I started this very blog because of my disappointment with the sheer volume of false claims, misleading stories, and pseudoscience actively promoted to patients.

It was my hope that gathering together key medical blogger “voices of reason” would promote health sanity on Google. You could argue that we’re tilting at windmills, but tilt we must – and I’m proud to say that our membership now includes contributions from the CDC, the American College of Physicians, Harvard Health publications, Diario Medico (Spain’s premier MD website) and over 100 independent bloggers who are standing with us in an attempt to provide smart health commentary to patients and providers alike.

And with that, let us begin our terrific Grand Rounds tradition (now in its eighth year – which in blog years is about 120) of highlighting this week’s best of the medical blogosphere… (And yes, that’s me with Mythbuster’s TV host Adam Savage, circa 2009).

Adam Savage & Dr. Val Jones

Myth #1: Coca-Cola will turn teenagers into homicidal maniacs.

Toni Brayer, M.D. of the Everything Health blog, finds the connection between drinking Coca-Cola and teenage violence laughable. Junk science is scarfed up by the media before the truth can get its wrapper opened. For more amusement, check out the newspaper headline on her blog: “Bananas As Good As Drugs For Treating HIV, Say Scientists.” Were these the scientists from the Planet of the Apes? Just sayin’.

Myth #2: Popular dietary supplements deliver on all their promises.

Jessica Berthold at ACP Hospitalist discovered a fascinating evidence graphic for vitamins and supplements during a presentation by Dr. Brent Bauer. “Which supplements work?” You may ask. Follow the bouncing bubbles. This site  has an interesting, interactive graphic that illustrates both the number of Web search hits for health supplements like fish oil and garlic, and the evidence that the supplements work. (The bubble size illustrates # of hits, and the position of the bubble shows strength of evidence.)

Myth #3: Drinking cold water will make you lose weight.

Ryan DuBosar at the ACP Internist, offers the cold, hard truth about water and weight loss. Does drinking cold water really help you lose weight? It’s an urban myth with some truth to it. While it’s probable that drinking water before a meal induces satiation sooner, the number of calories that it takes to warm up a liter of ice water is fairly small and is unlikely to induce weight loss.

Myth # 4: Health screenings are not necessary.

Elaine Schattner, M.D. at Medical Lessons blog, is concerned about one-sided reporting on the downsides of mammograms. She reminds us that epidemiologists are not oncologists, and that the Dartmouth data may not offer the whole picture regarding cancer prevention and mammography. An ounce of prevention is worth a pound of cure – and for now, mammograms are our best hope.

Rich Fogoros, M.D. at the Covert Rationing Blog, deconstructs the latest prostate screening recommendations, arguing that what’s good from a public health standpoint isn’t necessarily what’s best for the individual. Prostate cancer screenings can save the lives of those whose aggressive cancer is detected early. The question is how to find the people who would benefit. Dr. Rich believes that people should be able to choose for themselves if they’d like to be tested, but worries that it will become exceedingly difficult to do so with the new USPSTF recommendations.

Myth #5: Just because two people have the same disease means they have a lot in common.

The Afternoon Napper (from The Afternoon Nap Society), an anonymous blogger with a rare chronic disease (intimal fibromuscular dysplasia) takes a look at the intricacies of interpersonal relationships in the patient advocate community. In the Napper’s post, “Just Because I Have The Same Disease As You That Doesn’t Mean I Like You—But That’s OK” we discover that having likes and dislikes in common can draw you closer than sharing the same disease or condition.

Myth #6 Sleep is not a key ingredient of a safe hospital stay.

Rita Schwab at Supporting Safer Healthcare, explains why disturbed sleep can make patients sicker. But better yet, she offers practical solutions for reducing noise in the hospital setting.

Myth #7: It’s ok to give enemas to anyone who is constipated.

Joel Topf, M.D. at the Precious Bodily Fluids blog explains why people with impaired kidney function could die if they’re given a  Fleets (sodium phosphorous) enema. Citing some pretty horrific case studies, Dr. Topf notes: “Look at that phosphorous! A phosphorous over fifty is like a traffic accident, can’t tear your eyes away. Here’s a simple rule: If the medicine is supposed to go in the butt, don’t feed it to your patient.” Read the rest for some nightmare-inducing lab values.

Myth #8: Hydrochlorothiazide is a good anti-hypertensive medicine.

But wait, there’s more from our nephrologist blogger, Dr. Topf explains how a journal article from NEJM in 2008 changed the treatment of his patients with high blood pressure. He enthusiastically exclaims that:

“I avoid hydrochlorothiazide wherever possible. This usually requires re-jiggering a number of medications but a common switch will be to move patients from a list that looks like this:

  • Lisinopril HCT
  • Amlodipine

To a list that looks like this:

  • ACEi CCB combination pill
  • Chlorthalidone

This results in significant improvement in blood pressure control.”

A word to the wise who are managing high blood pressure: check out the ACCOMPLISH trial. It trumps ALLHAT.

Myth #9 Rapid fluid correction in kids with fever and impending shock (caused by infection) is the best way to save their lives.

Paul Auerbach, M.D. at Healthline reviews some interesting new data from a NEJM study suggesting that child mortality actually increases with aggressive IV fluid resuscitation. It is unclear if this remains true for other causes of shock, but as Dr. Topf explained earlier – one must think very carefully before putting large volumes of any fluids in any orifice (or vein) of any patient.

Myth #10: Teens are irredeemably bad drivers and cannot be helped.

Louise Galaska at the CDC Injury Center: Director’s View Blog offers some sobering statistics about teen driving, both regarding how dangerous driving can be (one in three teen deaths is caused by a motor vehicle accident) but in how much safer they can become when a graduated driver’s licensing system (GDL) is implemented.  Research suggests that GDL systems are associated with reducing injury crashes by up to 40 percent in 16-year-old drivers. In the end though, there’s no substitute for an engaged parent.

Myth #11: Patient advocates will be quickly and easily integrated into the research design process.

Jessie Gruman, Ph.D., patient advocate extraordinaire at the Center for Advancing Health, is concerned about “patient-centered rhetoric.” In her post, “Getting the Patient’s Perspective in Research: Will PCORI Deliver on its Promise?” she describes the challenges of integrating patient advocates into the research design process.

“Including the patient perspective in research remains a foreign concept to most scientists and as a result, our views may be sought but ignored as the other participants continue doing business as usual.  Jargon abounds.”

Jessie’s courage and candor are the reality check needed for PCORI’s success.

Myth#12 My doctor recommended an open hysterectomy because that would be best for me.

David Williams at The Health Business Blog interviews a surgeon who suggests that the type of procedure chosen is not always because it would be best for the patient, but rather more convenient for, or more familiar to, the surgeon. Check out all the hysterectomy options in this recent interview and podcast.

Myth #13: Cutting physician Medicare/Medicaid payments will help us do more with less.

David Harlow at the HealthBlawg describes some of the intricacies of upcoming legislative battles as congress and CMS try to negotiate a way to decrease healthcare spending by instituting “value-based modifier codes” to incentivize quality care while cutting physician reimbursement rates. Do not read this post if you are already depressed and confused. I numbered it “myth 13″ for a reason!

Myth #14: Discount drug coupons save money.

Dr. Ed Pullen at Dr.Pullen.com argues that they may save money in the short-term – but watch out- it may be a ruse to keep patients from switching to less expensive generic drugs, and saving money long-term.

Myth #15: There’s a pill for everything.

Fisher Qua at the Health 3.0 Blog describes the creation of a new disease label (Female Sexual Dysfunction) primarily driven by companies hoping to discover and sell a new women’s blockbuster equivalent of Viagra. Funny how the label didn’t stick when there was no pill discovered to treat it?

Alright dear readers, that’s all the myths we can bust this week. Please check out Grand Rounds’ next host, the Sharp Brains blog so bring your A game!


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2 Responses to “Grand Rounds, Vol. 8, No. 7: Myth Buster Edition!”

  1. Elaine Schattner, MD says:

    Thanks so much for putting this together, Dryden and Val. Wish myth-busting were easy. .

  2. Toni Brayer, MD says:

    Great grand rounds. Can’t wait to read all of the myths and great writing on the health blogosphere!!!

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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