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Online Physician Ratings: Embrace The Inevitable

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The Wall Street Journal’s Health Blog recently featured a heated
debate about the utility of online physician ratings
.  On the one hand, some physicians are worried
that their reputations will be harmed by poor ratings given by a select minority
of disgruntled patients.  Some have gone
so far as to ask that their patients sign an agreement not to participate in
online physician ratings.  On the other
hand, many physicians view online ratings as a welcome form of constructive feedback
– believing that the ratings will further showcase their already good work.

I believe that physician ratings are not a perfect measure of
quality care, but they can offer a legitimate and enlightening patient
perspective on bedside manner, office efficiency, and communication skills.  Many patients have nothing more than a health
insurance company’s list of “in network professionals” from which to choose a
provider
.  Online physician ratings sites
now give them a little bit more information to guide their selection process.

The potential for inappropriate or libelous postings depends
upon how carefully the ratings company reviews the comments.  Open message boards may degenerate into gripe
sessions, but closely monitored ratings like those at Revolution Health, are much less risky.  Even more valuable will
be the fusion of consumer ratings, peer reviews, hospital, and health
plan ratings of an individual physician all in one place.  This kind of rating system is not far off.

The bottom line is that online physician ratings are here to
stay – and the best way for the ratings to fairly reflect the average patient’s
experience is to have physicians encourage all their patients to rate them
online.  In that way, the rare
disgruntled patient’s review will be seen in the context of the majority of
satisfied customers.  If the majority of
comments are still cautionary, then it becomes more likely that the physician
him or herself has some work to do.

Since the American Board of Medical Specialties is now
recommending demonstration of patient satisfaction as part of the recertification
process for many specialties, online physician rating sites may actually become
a great (and cost effective) way for physicians to collect such qualitative
data.  So my advice to physicians is to
embrace physician ratings and make them work for you and for the benefit of
your future patients.  Give the audience
some credit – they won’t judge you on one outlier comment… unless perhaps that’s
the only comment they see.

Your views and dissenting opinions are welcome.

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

Condoms & Sex Education: Start Early

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A new study in the American Journal of Public Health reports that teens can expect a 50% reduced risk of developing chlamydia and gonorrhea if they use condoms from their very first sexual experience.  Starting to use condoms later on can certainly protect against disease – but it seems that there is something important about using them from the beginning.  In other words, people who use condoms from day 1 are more likely to keep using them regularly, and are therefore less likely to contract sexually transmitted infections (STIs).

I could enter into some awkward speculation about why this is true (maybe it’s easier to get used to the sensation of wearing a condom if it’s all you’ve ever known?  Maybe using condoms from the start is more likely to make it a habit?) but more importantly, a 50% reduction in sexually transmitted infections is an incredibly huge margin of success.  Sadly, sex education programs for youth have had mixed success in increasing consistent condom use. This study seems to suggest that for those students who receive the message, and use condoms from their first experience, there is a much greater chance of avoiding STIs.  Early sex education, therefore, may have more benefit than sex education offered after an adolescent is sexually active.

Of course, like Dr. Stryer, I feel a bit concerned about over-exposing elementary school kids to sexual messaging.  But since kids are already exposed via TV, the Internet, and various other media, it behooves us to arm them with age-appropriate information at the earliest point possible.   Abstinence is the only 100% guarantee of an STI-free adolescence – but since ~50% of teens are sexually active (regardless of beliefs, sex education, or parental controls) it might be best to teach them that condoms are an inextricable part of all sexual intercourse.  Sexually transmitted diseases can mean the difference between fertility and infertility, long life, or earlier death for our kids.  With stakes this high, consistent condom use should be our mantra.

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

Should You Go Organic?

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I returned from Trader Joe’s with several bags full of
organic produce and frozen goods today.
It cost me substantially more than it would have at a regular grocery
store, but I figured it was worth it since the food was probably of higher
quality.  It also seemed that I might be
helping small farmers by purchasing goods there, which pleased me.  And yet I had this nagging feeling that maybe
this was a marketing ploy… that the “experience” of Trader Joe’s was what I was
really buying.

Dr. Clark
directed me towards this interesting, if not controversial blog about organic foods.  In it, the author explains the “real story”
behind Trader Joe’s:

Trader Joe’s is a
supermarket chain specializing in organic, vegetarian, and alternative foods
with hundreds of locations throughout the United
States, centered in organic-happy Southern
California. Shoppers appreciate its image of healthful food in a
small-business family atmosphere. Really? In 2005 alone, Trader Joe’s racked up
sales estimated at $4.5 billion. The company is owned by a family trust set up
by German billionaire Theo Albrecht, ranked the 22nd richest man in the world
by Forbes in 2004. He’s the co-founder and CEO of German multi-national ALDI,
with global revenue in grocery sales at $37 billion. According to Business
Week, the decade of the 1990’s saw Trader Joe’s increase its profits by 1000%.… Trader Joe’s customers are willing to pay
their premium prices to get that healthful image. But they should not kid
themselves that they’re striking a blow at big business and supporting the
little guy.

Ok, so maybe I’m not
helping the little guy.  But isn’t it
healthier to eat organic food?

From Canada’s
Department of Agriculture
(hat tip to Moof for finding this reference):

·  Some studies have shown traces of pesticide
residues in both food sources, regardless of production method.

·  Nutritional value of plants depends on
genetics, availability of water, amount of sunlight, maturity when picked, how
long it took to come to market and whether it was properly handled and
refrigerated. Numerous laboratory tests have not found any substantial
nutritional differences in organically and conventionally grown produce.

·  In blind taste tests, consumers generally
cannot differentiate between organically and conventionally grown food.

·  Organic produce is marketed as pure and
healthy. Conventionally produced goods are equally safe and nutritious due to
strict regulations and guidelines.

In a recent
article in the Chicago Tribune
, raw foods were not found to be as healthy
as initially suspected.  The natural
sprouted plant enzymes that are supposed to be really good for you are actually
destroyed by stomach acid and never absorbed in the body.  A raw food diet lacks Vitamin B12, which can
cause dangerous deficiencies.

A study by the Center for Global Food Issues found that
although organic foods make up about 1 percent of America’s diet, they also account
for about 8 percent of confirmed E. coli cases.
For a long list of organic food contaminations, check out the Canada Free Press.

What about hormones
given to animals to increase milk production or bulk them up?

In theory, this is the most concerning and potentially
convincing reason to preferentially select organic meats.  I could imagine that eating animals pumped
with hormones could have a negative impact on humans – though the research I
found from the WHO and Cornell
University
did not support my initial fears.  They write:

Studies indicate that
if correct treatment and slaughter procedures are followed, the levels of these
hormones may be slightly higher in the treated animal’s meat or milk, but are
still within the normal range of natural variation known to occur in untreated
animals.

FDA scientists have
concluded that eating foods with slightly higher levels of rbGH would not
affect human health. This is because the amount of rbGH that is in milk or milk
products as a result of treatment of the animals is insignificant compared to
the amount of growth hormone that is naturally produced by our bodies. Also,
rbGH is a protein hormone and is digested into smaller fragments (peptides and
amino acids) when eaten. The rbGH hormone used on dairy cattle is effective in
promoting growth in cows, but does not work in humans. Scientists know that
rbGH is not recognized as a hormone by human cells.

Well, isn’t organic
farming better for the environment?

The Canadian Department of Agriculture states that organic
farming methods lead to increased soil erosion, lower crop yields (which
require more acres to produce the same amount of food), and require more
pesticides.  Although regular farming
methods use different pesticides than the organic variety, neither types of
pesticides are particularly safe for humans.
Organic pesticides such as
rotenone
may be a risk factor for developing Parkinson’s Disease – though
more research is needed to fully elucidate this risk.

So should you go
organic?

If you enjoy the flavor or the food quality of certain
produce (and don’t care about price) then purchase it gladly.  Make sure you wash it well (organic or not)
and peel the skin if you have any doubts about remaining pesticides.  Buy food directly from local farmers when you
can, support free range farming (it’s so much kinder to the animals), and don’t
believe the hype about organic foods automatically being healthier or more
nutritious for you.

Conclusions: organic food is not necessarily more
nutritious, it still may contain harmful pesticides, it is more likely to
contain harmful bacteria, there’s no convincing evidence to suggest that
hormones or antibiotics given to cattle have a negative impact on meat eaters,
and one thing’s for certain: organic food costs at least 20% more than
non-organic.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Face Transplants: Ethical Challenges

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You may remember the horrifying story of a young French woman who passed out after taking some sedatives, and her dog tried to wake her up by gnawing on her face.  She was the first recipient of a face transplant, and is on immunosuppressant therapy to this day to prevent rejection of the donor tissue.  This immunosuppression puts her at greater risk for cancer and infections and raises the issue of whether the benefits (a closer approximation of a normal appearance than reconstruction of her face from her own body tissue) outweigh the risks (a shortened lifespan and potential hospitalizations for infections, eventual tissue rejection, and perhaps cancer.)

Many people suffer severe facial disfigurement from accidents and burns every year.  Face transplants could give them a chance at a relatively normal appearance – but American doctors are unwilling to put them at risk for what is in essence a cosmetic procedure.  However, Harvard physicians are now offering face transplants to those who are already on immunosuppressants for organ transplants they’ve previously received.  As you may imagine, the number of people who qualify for face transplants is rather small – as you’d have to have had an organ transplant and then coincidentally sustained severe trauma and tissue loss to the face.

The Boston Globe ran an interesting story on a man who was severely disfigured by facial burns and could have been eligible for a face transplant in France.  He chose to undergo reconstruction from his own tissues, which requires no immunosuppression.  He says that he is glad that his body is healthy, that he requires no medications, and that the risks of a face transplant are not worth the benefits, though he remains severely disfigured.

I think it’s interesting that the French took a different stand on this issue – allowing people to choose to have a cosmetic procedure at the expense of general health, longevity, and risk for life-threatening illness.

I have known patients who decline limb amputations for fear of disfigurement – even though the gangrene in the limb is sure to result in sepsis and eventual death.  A person’s appearance and personal identity are sometimes inextricably linked – so that some would choose death over disfigurement (even of a limb).  Is this choice pathological, or is it their right to choose?  Given the choice between disfigurement or death, I’d choose disfigurement.  I’d also not choose a face transplant over reconstruction from my own tissues, even if the aesthetic outcome is inferior.  Still, I’m hesitant to say that those who’d rather live a shorter, less healthy life with a more natural face are unilaterally making the wrong choice for them.  For the time being, though, people who wish to make that choice will need to do so outside of the US.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Organ Donation: Europe vs USA

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Many European countries have “presumed donor policies” where (unless otherwise stipulated) the untimely demise of one of its citizens results in potential organs for those on organ transplant waiting lists.  In other words, the default assumption is that you want to be an organ donor should you die in an accident.

Britain is now undergoing internal debate over whether or not to institute a presumed donor policy. On the “no” side is Scotland and the Conservatives – suggesting that the government has no right to an individual’s remains.  On the “yes” side are the Liberals and the British Medical Association – reminding the “no’s” that people are free to opt out, and that studies show that 70% of people have not formally registered to donate their organs even though they state that their wish would be to donate their organs in the event of sudden death.

Spain has been very successful with their presumed donor policy – doubling organ donations after enacting it into law.  Austria quadrupled their organ donations after following suit.

I think that Europe’s presumed donor policy is a good idea and I would personally endorse a similar policy in the US, so long as next of kin had veto power.  What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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