Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

So you want to be a sperm donor?

In a recent article in the New York Times the process of sperm banking was described in a fairly whimsical way, but the real bizarreness of the business could be found between the lines. Apparently sperm banks compete with one another as they go to all kinds of lengths to tout the quality of their donors:

“It’s kind of an arms race,” explains William Jaeger, director of Fairfax Cryobank, in Fairfax, Va., which, along with California Cryobank, based in Los Angeles, is among the largest sperm banks in the country.

“One year someone adds a personality profile, the next year someone adds something else,” Mr. Jaeger says. “If one of your competitors adds a service, you add a service.”

Certain donor profiles are particularly popular, making it difficult for the supplier to keep up with the demand.

The most-requested donor is of Colombian-Italian and Spanish ancestry, is “very attractive, with hazel eyes and dark hair,” and, Ms. Bader adds, is “pursuing a Ph.D.”

The bank’s files have one man, Donor 1913, who fits that description.

Donor 1913, the staff notes in his file, is “extremely attractive,” adding in a kind of clinical swoon, “He has a strong modelesque jaw line and sparkling hazel eyes. When he smiles, it makes you want to smile as well.”

Donor 1913 is an all-around nice guy, they say. “He has a shy, boyish charm,” the staff reports, “genuine, outgoing and adventurous.”

He also answers questions, including, “What is the funniest thing that ever happened to you?”

Donor 1913 relates an incident that occurred when he asked his girlfriend’s mother to step on his stomach to demonstrate his strong abdominal muscles.

“As she stepped on top of my stomach, I passed gas,” he writes.

Is Don Juan the gas-passer also the most popular donor at Fairfax Cryobank?

The sperm banks say that they only accept 1-3% of donors, but the criteria that I could glean from the article seemed to be:

  1. You’re not overweight
  2. You’re tall (unless you’re a doctor or a lawyer, then you can be as short as 5’7” to 5’8”)
  3. You’ve got a college degree
  4. You have high SAT scores
  5. You are good looking
  6. You have healthy sperm

Apparently, the most requested sperm donor in one of the California banks is a tall man who was in college at the time of his donations, but who later dropped out and took up residence in a mobile home park and made a living walking other people’s dogs.

So, who were the other 97% who didn’t make the cut?

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

Electronic medical records: are we there yet?

In a happy coincidence, my favorite blog fodder feeder sent me a link to an article about Kaiser Permanente’s electronic medical record woes a day prior to Dr. Feld’s latest post on the subject of EMRs. Dr. Feld’s thoughts on the matter will certainly help to round out this discussion.

I’ve always been fascinated by technologies that are ahead of the curve. I blame this on my parents (take note – parents can be blamed for good things). Growing up in rural Canada our family was ahead of the tech curve – we had a satellite dish before there was scrambling, we had the very first Apple computers at home, and we built our own yogurt factory complete with an advanced digitally automated temperature gauge system, before the rest of the industry had moved beyond millimeters of mercury.

In college I was the first kid with a laptop in class, and in med school I was one of the first with a PDA. I took a portable printer with me to Europe in the late 80’s to go along with my Wordstar word processing program. I thought I was pretty cool, I guess! Stirrup pants, granny boots, permed hair and pink lip gloss.  Those were the days.

Cliff Bassett recently asked me why I was working at a new company (Revolution Health) that was so cutting edge rather than remaining in clinical practice. I had never thought about why I did it before – but now I see that it was part of my pioneering pattern. There’s nothing more fun than being ahead of the curve… but it can be aggravating as well.

Technologies are awkward for their first adopters – they aren’t streamlined, they can actually take more time rather than saving it, and they can make communications with others (who don’t use it yet) more difficult. But a few of us do it anyway – we jump in head first, believing by faith that the enterprise itself is worthwhile and that once we get to version 3.0 we’ll be sitting pretty.

But what do we do when we’re at version 1.0? Normally, we just tear our hair out and send lots of “bug alert” messages to developers. But when the technology affects someone’s health, the bugs are a lot more sinister. The recent article about Kaiser Permanente’s digital growing pains is disturbing indeed:

Kaiser Permanente’s $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees… Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.

Still, 90% of physicians use paper records, making it difficult to share information – and this is no doubt contributing to the IOM’s estimated 98,000 error related deaths/year. Dr. Feld explains the complexity of a fully functional electronic medical record:

However, a paperless chart is in reality worth little unless the information entered is usable in a relational data base format rather than word processing format. Only then, can patient care be enhanced…An effective Electronic Health Record must consist of five components

Electronic Medical Records
Personal health records (PHR)
Continuity of Care Record (CCR)
Electronic health record (EHR)
Financial Management Record (read more…)

So, the bottom line is that the EMR is in version 1.0 at Kaiser Permanente, and only a twinkle in our government’s eye. It is complicated to create, nearly impossible to coordinate, dangerous if implemented half-way, and yet utterly necessary for ultimate cost savings and patient safety.

What can we do between version 1.0 and 3.0? Prayer and vigilance come to mind… it will be up to the foot soldiers (the docs, nurses, and hospital staff) to keep patients safe while juggling paper and digital until digital can fly on its own.

How do you think we can minimize our digital growing pains?

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

The strength of weakness

An excellent blog post was forwarded to me for comment – an Internal Medicine physician reflects on his patients’ common underlying condition: isolationism.

Today I saw patients with the following problems:

  • A person who had attempted suicide over the weekend
  • A person who was possibly acutely suicidal and was abusing narcotics I was prescribing
  • A person who is in an abusive relationship and has a severe eating disorder
  • A terribly depressed woman in a dysfunctional marriage
  • A pre-teen child whose father had suddenly died

My observation from today is that most of these people are isolated.  They have difficult situations to face and the people who normally surround them are somewhat uncomfortable, not knowing what to say…

Western culture is obsessed with avoiding suffering.  We entertain ourselves to avoid having to face the harsh realities of life.  People die and suffer daily, and we are obsessed with the latest TV show, the latest political soapbox, or the latest self-help tool.  We feel that the goal of society is to create happy and secure individuals.  This is not true.  The goal of society is to function as a unit in a healthy way – with the weak parts supported by the strong ones…

What I emphasized to the people I spoke with today was the need to find people who had gone through the same things.  Those in the eye of the storm need to hear from people who have gotten to the other side that it is OK to feel the way they feel.  Those who have gone through hard times have something huge to offer those who are going through them now – experience.  You lose the pat answers when you have suffered yourself.

It is my hope that those who are struggling will find others online here at Revolution Health who can support them, and that those who have made it through to the other side will reach out to help others through our online community. Suffering is not meaningless if you harness it for good – your wounds can heal others.This post originally appeared on Dr. Val’s blog at

More germs found on desk tops than toilet seats

Microbiologist Charles Gerba has made a career out of scaring people with news of how dirty seemingly innocent surfaces can be.  Dr. Gerba has taken media on germ tours of kitchens, bathrooms, and offices, and now in his new research study he finds that office desks have 400x more bacterial colonies than toilet seats.  Moreover, he found that women’s desks generally have 4x more bacteria than men’s.  He attributes this to women having more makeup and food products in their desks, as well as having greater contact with small children.

Well, before we all become totally grossed out and paranoid, lets think for a minute about this.  If there are so many bacteria all around us (even on our desks) and we’re generally not sick, then I guess we shouldn’t all rush out to buy bleach and sanitizers.  Other studies suggest that sanitizers disrupt the natural ecosystem around us, creating resistant organisms that are harder to kill.

Personally, I think that precautions should be taken to reduce transmission of viruses and bacterial infections (especially in the hospital environment) but that it is unreasonable, and perhaps even harmful, to wage an indescriminate war on all bacteria everywhere.

If your loved ones are sick, minimize your exposure to their droplets, wash your hands frequently, and sanitize surfaces that they are in direct contact with.  Otherwise, if you’re feeling well, I wouldn’t worry too much about bleaching your desk surface.

As one microbiology lab says,

“Support bacteria.  It’s the only culture some people have.”This post originally appeared on Dr. Val’s blog at

Subway workers hand out condoms in NYC

A new initiative funded by the health department resulted in the distribution of 150,000 free condoms to unsuspecting subway riders in NYC. The condoms were colorfully labeled with a subway themed wrapper, and handed out by city workers and volunteers in all 5 boroughs.

Condoms are critical for the prevention of sexually transmitted diseases, but I wonder if the candy wrapper marketing and non-selective distribution methods are contributing to an over-sexualization of society?

Now, I know a lot of you will think I’m being prudish, but I worry about children being over-exposed to sexual content all the time.  What does it say to them that subway staff are handing them condoms?  Is it just me, or does anyone else think this is a bit much?

Go ahead, let me know!This post originally appeared on Dr. Val’s blog at

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »