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Humorous interlude about health insurance…

I’m doing my best to prepare my weekly round up of the best of Revolution’s expert blogs… but it’s taking a little longer than usual, so here’s a funny little excerpt from a Dave Barry calendar to tide you over…

In the 1950s, medical paperwork was simple: The doctor gave you a bill. That was it. Whereas today, if you get involved with the medical care system in any way, you will spend the rest of your life wading through baffling statements from insurance companies. I speak with authority here. At some point in the past, some member of my family apparently received medical care, and now every day, rain or shine, my employer’s insurance company sends me at least one letter, comically titled, EXPLANATION OF BENEFITS. It’s covered with numbers indicating my in-network, out-of-pocket deductible; my out-of-network, nondeductible pocketable; my semi-pocketed, nonworkable, indestructible Donald Duckable, and so on. What am I supposed to DO with this information?

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

Good news for celiac disease sufferers – biopsies may not be necessary for diagnosis

In a recent study published in the British Medical Journal, researchers found that blood tests and a history of patient symptoms might be all that’s needed to diagnose the majority of individuals with celiac disease. Until now, a diagnosis required a biopsy of the intestinal wall.

It is estimated that celiac disease (caused by an autoimmune reaction to wheat gluten) remains undiagnosed in a whopping 85% of cases. This may be due to the fact that symptoms are often non-specific (diarrhea and constipation, fatigue, anemia, tooth enamel defects, weight loss, and dry skin are some of the symptoms).

The researchers report:

We devised and evaluated a clinical decision tool that used a combination of pre-endoscopy serological testing (for tissue transglutaminase antibodies) and assessment of symptoms to identify patients with coeliac disease. This decision tool might help increase the detection of coeliac disease in patients attending for gastroscopy without the need to perform routine duodenal biopsy.

As efforts are underway to increase awareness in the primary care community about the disease, it is good to know that diagnosis may no longer require an invasive test!

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

Herbal Remedy May Reduce Urinary Tract Infections?

The number one Google news item today is a report of a mouse study (published in Nature Medicine, but apparently still embargoed to the public as it is not listed on their website) that suggested that an herbal supplement could (in combination with antibiotics) “eradicate” urinary tract infections.

In usual fashion, the buzz preceded the science, and now we have thousands of people on the lookout for forskolin (a root extract of coleus) tablets from the local health food store. Do these have any possible merit?

A recent review of the literature about this herb was conducted by the good docs at Harvard, and turned up “no conclusive evidence for its [forskolin’s] use for any health condition.”

My friend Dr. Charles also read the reports of this “miraculous” new cure – which posits that recurrent urinary tract infections are caused by pockets of bacteria that hide inside bladder walls. Dr. Charles rightly points out that there are many different points of entry for bacteria, and that an herb which (and we don’t know that it even does this) relaxes bladder walls would surely not affect the alternate routes of entry, hence it cannot be curative in all cases.

So my friends, I’m sorry to say that there is little justification for enthusiasm yet. But we will follow the research with interest, in case human subjects do indeed show benefit in the future.

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

Made in America: The Institute of Medicine

I had dinner with a small group of people recently – and Harvey Fineberg, President of the Institute of Medicine, was our dinner speaker. A few things struck me as he reviewed the history of this 37 year old institution.

First of all, The British Medical Journal published a thought-provoking article about the top 5 things that Britain and the US could learn from one another’s healthcare systems. Of all the possible things that they could highlight about US Healthcare, the Institute of Medicine was listed in the #1 slot.

Well, my goodness – is that the very best of what US medicine has to offer? The IOM?

Maybe so. Here’s the Reader’s Digest version (forgive me Dr. Fineberg) of the history and purpose of the IOM.

President Lincoln founded the National Academy of Sciences back in 1863 for the purpose of advising the public in an objective manner on matters of science.  The NAS has expanded to include 3 newer organizations: the National Research Council (1916), the National Academy of Engineering (1964), and  the Institute of Medicine (1970).

The IOM consists of members elected by peers in recognition of distinguished achievement in their respective fields. It has about 1,200 members. But here’s why this organization is so unique: all of the members VOLUNTEER their time! Can you imagine another organization that could get 1,200 doctors to work for free? Yes, they volunteer – and they do so gladly because it is an honor to be part of the task force to advise the public in an objective manner on matters of medicine. The IOM gets no money from the government, it survives on donations and volunteerism.

The IOM is uniquely positioned to formulate unbiased assessments of important medical questions. It is medicine in its purest form – the facts and the data are the only foundation of their analyses. No government funding, no pharmaceutical intervention, no personal agendas. Just the pursuit of truth.

Apparently the IOM produces 1 report per week! The most famous of which may be their “To Err Is Human” (2000) report which uncovered the shocking frequency of medical errors, and included recommendations for new patient safety initiatives.

A lesser known report actually debunked lie detector tests…

And so, as I considered Dr. Fineberg’s description of the IOM I began to realize why other industrialized nations are jealous of our institute. I am so glad that President Lincoln had the foresight to create an objective, “collective wisdom” vehicle for advising the nation. The question now becomes: does the nation hear what they’re saying?

I think it would be wonderful for the IOM to allow Revolution Health to be an outlet for disseminating their information to the public. After all, our mission is to empower consumers with the most credible health information available… and my friends, after hearing Dr. Fineberg’s speech, I don’t think it gets any better than the IOM.

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

Easter exercises

My parents are strong believers in the idea of purposeful exercise. They couldn’t imagine working out in a gym, laboring on a treadmill with nothing accomplished at the end beyond sweating. No, for them, activity is critical – but it has to result in a tangible, quantifiable product.

And so it may come as no surprise that they left Manhattan in the early 70’s to raise their kids on a farm in Canada, where we were kept very busy herding cows, lifting milk crates, feeding pigs, fishing on the nearby ocean, and weeding our very large organic garden.

But as Manhattanites, my parents made sure that I read the New Yorker (we grew up with Calvin Trillin’s children), attended summer school in Paris and ski camp in Switzerland. We took a family vacation each winter to some tropical island, where I played with vacationing city kids.

But this strange combination of “country mouse, town mouse” occasionally produced some rather bizarre traditions – my favorite of which is the annual, December “Easter egg hunt.”

My parents would take us to a rather exclusive golf course on one of our vacation islands, sign up for a round in the late afternoon when most golfers were finishing up, then find us an empty bucket for golf balls. Then we’d walk off in the direction of the 9th hole, and my mom would tell us that there were golf ball “Easter eggs” hidden in the rough patches around the golf course, and that it was our job to fill up the bucket with as many balls as we could find. For young kids, I can tell you, such a challenging and large Easter egg hunt was really exciting.

So I searched fairly systematically through all the patches of rough, proudly announcing each new egg that I had uncovered: “Mom, I found one!” I’d beam, “and this one is bright orange!”

My younger sister wasn’t as successful at locating golf ball eggs. She tended to try to pick them off the fairway, where they were sitting targets. Of course my parents would have to reel her back in, explaining that the Easter eggs were only hidden in the deeper grass.

And we would spend hours and hours on our Easter egg hunts, until the sun set and the crickets drowned out the sound of the ocean waves. We often found an annoyed golf course crew waiting for us to return so they could close their pro-shop. My sister would hand them a bucket brimming with golf balls, saying “we found all these Easter eggs!” And the cuteness of her innocent glee would melt their annoyance as they put the bucket behind the counter, eyeing my parents suspiciously.

But those were good times – where exercise was effortless and fun. Where a common goal drove an entire family to activity, and kids maintained interest in something beyond the TV set.

Now as the real Easter approaches, I imagine what it would be like to return to my childhood activities at a local golf course. I suspect that my physician colleagues would frown upon me collecting stray golf balls at their respective courses. But to tell you the truth, I think that would be more fun than actually playing a round, don’t you?

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

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