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Gastric Bypass Surgery – Gain Weight To Get It?

In Britain, the National Health Service used to pay for gastric bypass for individuals with BMIs greater than 35, but a new rule has raised the qualifying BMI to 45 and above. So many people were having gastric bypass, that it was overburdening the system. In response, some people are trying to gain weight to qualify for the surgery!

Here’s what a couple of British folk have to say:

“It’s grossly unfair and incredibly short-sighted. There are hundreds of other people like me who can’t afford private surgery, and the message seems to be pay up or pig out.”

“Instead of surgery and rehabilitation my only option is McDonalds and ice cream”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Homeopathy or Big Pharma – Choose Your Poison?

Wow, this was one of the best rants I’ve heard in a while (thanks to Kevin MD for linking to this article in his blog) – looks as if this writer is neither friend to homeopathy nor big pharma:

“Some homeopaths [say] that their cures are not amenable to scientific proof. That’s fine, if you want to call the multimillion dollar industry what it is: faith healing…

Homeopathy rests on three unproven tenets: First, ‘Like treats like.’ Because arsenic causes shortness of breath, for example, homeopaths prescribe its ‘spirit’ to treat diseases such as asthma. Second, the arsenic or other active ingredient is diluted in water and then that dilution is diluted again and so on, dozens of times, guaranteeing—for better and worse—that even if the dose has no therapeutic value, it does no harm. And third, the potion is shaken vigorously so that it retains a ‘memory’ of the allegedly curative ingredient, a spirit-like essence that revives the body’s ‘vital force.’

So what about the fact that some homeopathic patients get better? Part of the effect comes from the ritual of consultation with a practitioner who treats the patient like a person rather than a body part on an assembly line. And just taking anything can help; the placebo effect is real. In gold-standard, double-blind studies, placebos presented as possible cures sometimes rival pharmaceuticals for effectiveness, or beat taking nothing at all.

Nor are the effects simply psychological. When volunteers took a placebo that they were told contained painkillers, they experienced relief, while researchers watching PET scans of the subjects’ brains tracked increased levels of the body’s own pain-relieving endorphins. In other studies, research subjects given placebos instead of antidepressants also showed chemical changes in their brains. FDA data for six top antidepressants showed that 80 percent of their effect was duplicated in placebo control groups.

Which brings us to the patient’s dilemma: Have faith in 19th century magic or rely on a pharmaceutical industry that suppresses negative outcomes (including death), promotes drugs for nonexistent diseases, repackages old drugs in new bottles to circumvent patent expirations, bribes doctors with perks and cash and hires ghost writers to author favorable studies? Given the hype, toxicity, and expense of many drugs and Big Pharma’s snake-oil tactics, the side effects of water (laced with “memory”) start looking pretty damn good. If your condition is relatively minor, self-limiting or untreatable, you may be a lot better off drinking homeopathy’s Kool-Aid-less Kool-Aid.”

Ouch. What do you think of Mr. Allen’s remarks?

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

Medical errors may be reduced by redundancy?

One of the great advantages of electronic medical records (EMRs) is that they can reduce unnecessary repeat testing. Without an EMR that is accessible to all physicians taking care of a single patient, there’s no way for them to know what the other one is prescribing. Expensive tests like MRIs are often ordered by two different physicians (a neurosurgeon and a rehabilitation medicine specialist for example) because one didn’t know that the other had already ordered it. Alternatively, they may be affiliated with institutions that don’t share data, so previous MRI images are not available for viewing by the new specialist – so she just orders another one.

However, an interesting question is raised by Dr. Perloe’s post to my last blog entry: what if all specialists taking care of a patient had access to one medical record – and there was a lab error? They would all rely on the same erroneous record, and this could spark a whole host of inappropriate tests and procedures. Even second opinions (based on one single record) would be less helpful – because they would be misled by false results.

So, the irony is that the redundancy in our system has its benefits. We should be mindful of the checks and balances that we are unwittingly removing with EMRs. Occasional lab errors will always be with us – let’s make sure we catch them early, and not commit them to a permanent record relied upon by all.

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

Medical errors – apologies required

Our Chief Privacy Officer sent me an interesting article today about how hospitals are promoting “disclosure and apology” (by physicians to patients or their families) when a medical error is committed.  The report suggests that less money will be spent in malpractice suits if physicians fess up to their mistakes instead of trying to hide them.

Another study suggests that 99% of physicians believe that it is morally right to confess errors to patients and family members, but that only about 33% report doing so.  The article says that the number one reason why they don’t report errors is fear of being sued.

While these statistics don’t reflect well on physicians, I think there’s some murkiness here that’s worth reviewing.  First of all, what constitutes an error?  When a young resident physician performs a procedure in an inferior manner due to lack of experience, is that an error?  When a code team is not called soon enough because a patient doesn’t appear gravely ill initially, is that an error?  If an unconscious patient arrives in the ER and is treated with a medicine that causes a life-threatening allergic reaction, is that an error?  I think that many times physicians perceive some “errors” as unfortunate and regrettable aspects of the natural practice of medicine and don’t report them formally.

Another reason why physicians may not report errors is because it’s unclear that the error has a specific adverse effect – perhaps a patient’s Tylenol was given at the wrong time of day.  That’s an error – but is it worthy of formally reporting it to the patient?  What about when the lab loses the tube of blood drawn from a patient?  Should the patient be told about it or should the labs be added to the next day’s scheduled draw?

The majority of “errors” that I’ve witnessed are in the realm of sub-optimal care due to inexperience, inattentiveness, or misinterpretation of test results.  However, errors of the sort that result in death and serious harm appear to be alarmingly frequent (some studies argue that there are 40-90 thousand of these errors per year).

I think that physicians should always tell patients the truth about their care, the risks associated with certain procedures, and the full range of choices that are available to them.  I do believe that patients value (and deserve) to know the truth – even when it makes the physician or hospital seem less than perfect.  In the cases of errors that result in serious consequences – honesty is the best (and only) policy.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

My medical heroes

On New Year’s Eve when many people are drinking champagne and worrying about who they should kiss at midnight, Dr. Brian Fennerty, Section Chief of Gastroenterology at Oregon Health & Science University is fighting to keep patients alive in the Intensive Care Unit. Severe internal bleeding has put these patients’ lives in jeopardy, and Dr. Fennerty stays with them all night, ordering blood transfusions and tamponading their bleeding.

Dr. Jack Cook, US Navy veteran and former submarine commander, is under a mountain of medical charts. At 67, he is spearheading the transition from paper records to an electronic medical records system for his group practice of primary care physicians in Virginia. He wants his patients to have the opportunity to experience chart portability – something he believes might save their lives in cases where they are brought to the ER in an unconscious state. Although this project will take his group 2 years to complete, and cost untold hours in lost wages (with no clear reimbursal benefit for his practice) he is making the investment for his patients’ sakes.

In the middle of a teleconference, Dr. Iffath Hoskins, Chair of Ob/Gyn at Lutheran Medical Center in Brooklyn, excuses herself to perform an emergency C-section on a young woman with a complicated pregnancy. Against all odds she saves both mother and baby, and reschedules the teleconference for late that evening so she can complete her interview on time for a feature article at Revolution Health.

Just returning from Africa, Dr. Leo Lagasse, Vice Chairman of Ob/Gyn at Cedars-Sinai Medical Center, is preparing for his next mission’s trip with medical residents and faculty. His non-profit organization, Medicine for Humanity, has been behind countless trips to Afghanistan, Kenya, and Eritrya – serving impoverished women with medical problems. Dr. Lagasse takes time out to explain to me the link between smoking and cervical cancer for an article I’m preparing.

Dr. Charlie Smith is spending the afternoon with his son Jordan in Arkansas. Jordan was accidentally shot in the chest by a child with a BB gun, tearing a hole in his heart that caused him to go into cardiac arrest. He was rushed to the hospital where surgeons resorted to cardiac massage to keep him alive – he survived the ordeal, but his brain never fully recovered from the temporary lack of oxygen. He was rendered permanently bed-bound, and raised at home by his loving parents. Dr. Smith created a company called eDocAmerica to allow him to work from home and spend more time with Jordan. eDocAmerica is devoted to answering consumer medical questions via email.

At Harlem Hospital, Dr. Olajide Williams works tirelessly to raise awareness of stroke symptoms in a high risk inner city population. He organizes outreach through musical youth initiatives, lectures nationally to narrow the racial gap in quality care, and declines all prestigious medical recruitment offers. He is steadfast in his devotion to his community – no matter what the cost. Dr. Williams spends part of his weekends preparing blog entries for Revolution Health.

These are only a handful of the wonderful physicians associated with Revolution Health. I hope you’ll enjoy getting to know them through their blogs, articles, and future contributions. They are here for you… to support your need for credible information, to answer your questions, and to help guide you towards optimum health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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