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CDC Outlines The Steps For Investigating Disease Outbreaks

With the release of the movie Contagion, I thought it would be appropriate to post my cheat sheet on how to investigate a disease outbreak. Aspiring disease detectives take notes!

Scientist in biocontainment suit examining a dead ratWhat do you think of when you hear the word “outbreak”?  Maybe you envision a population decimated by a terrible, novel, and incurable disease like in the aformentioned movie Contagion or you think of Dustin Hoffman roaming around California in a blue biocontainment suit with Rene Russo trying to protect folks from a tiny monkey and narrowly preventing an airstrike by the US military?

Hollywood has done their best to capture what an outbreak is…but here are the facts. An outbreak, or epidemic, occurs when there are more cases of disease than would normally be expected in a specific time and place.  The disease may be something doctors have already seen before just in a new form or abnormally high numbers, such as foodborne or healthcare-associated infections, or it may be an emerging disease that we don’t know much about like SARS.  Either way, we need to investigate to determine why it is happening and how to prevent other people from getting sick or dying. Several people in biocontainment suits collecting samples outside a building

Outbreaks are usually noticed by an astute clinician, such as those who first noticed AIDS in New York City and San Francisco, but there are also many high tech disease detection systems available to help us spot any increase in illness. PulseNet is a laboratory network that uses PFGE (pulsed-field gel electrophoresis) to help identify foodborne outbreaks by monitoring the genetic make-up of the bacteria causing what may otherwise look like unrelated illnesses. In the recent events of the Salmonella outbreak in ground turkey, PulseNet and the National Antimicrobial Resistance Monitoring System helped identify the cause of the outbreak as well as determine how widely it had spread. Programs such as Biosense and First Watch monitor the chief complaint or reason that someone called 9-1-1 or went to the hospital (aka syndromic surveillance).  We also monitor news media for reports of outbreaks and websites such as Google Flu trends, which tracks circulating viruses and illnesses. With new technology ordinary citizens can also increasingly report outbreaks in their communities too.

The Magic Formula

So how do you figure out the who, what, when, and where of a disease outbreak? Read more »

*This blog post was originally published at Public Health Matters Blog*

Research Finds Success In Small, Cheap And Strong Test For HIV And Syphilis

Researchers from Columbia University have developed a “lab on a chip” HIV and syphilis test, and are now reporting the first results from tests in the field conducted in Rwanda. The mChip, as it is called, is the size of a credit card and replicates all steps of an ELISA test, at a lower total material cost and within 20 minutes. After application of a blood sample, the chip is inserted into a $100 battery-powered handheld analyzer. It needs only 1 μl of unprocessed whole blood and does not require any user interpretation of the signal, providing a clear-cut yes or no result.

Right now, HIV testing in developing countries either relies on expensive laboratory testing taking a long time, or uses cheaper methods based on lateral flow, which, although very rapid, do not provide very reliable results. The mChip combines Read more »

*This blog post was originally published at Medgadget*

Why Should You Get An HIV Test? National HIV Testing Day

Note: Yesterday President Obama issued a statement on National HIV Testing Day

Thirty years ago, at the beginning of the HIV/AIDS epidemic, there was no test for HIV, the virus that causes AIDS. For many, there was only the long and worrisome wait for the signs of infection. Once those signs appeared, no treatment for the virus was available. I personally cared for many, many patients in this era, and I am thankful that those days are over. Today, HIV testing is accurate, widely available, and often free—and treatment can help people living with HIV enjoy long, healthy lives, especially when they get diagnosed early.

The good news is that more people are being tested for HIV than ever before. It is estimated that almost 83 million American adults between 18 and 64 have been tested for HIV, as of 2009. That’s an increase of more than 11 million from 2006 when the Centers for Disease Control and Prevention (CDC) recommended that HIV testing become a routine part of medical care for adults and adolescents.

However, more than half of American adults still have never taken an HIV test. That’s why we need to spread that message that HIV testing saves lives and why Read more »

*This blog post was originally published at Centers for Disease Control and Prevention (CDC)*

Tension Between Physician Autonomy And Adherence To Protocols

Doctors are professionals.  But are doctors cowboys or pit crews?  Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, Cowboys and Pit Crews, at Harvard Medical School.  Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago.  Yet, something else also occurred in the process.

“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”

Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be.  Doctors are not doing basic things.  The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go.

“We don’t have to look far for evidence. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Molecular Condoms And Controlling The Spread Of HIV/AIDS In Women

National Women and Girls AIDS Awareness Day, a nationwide observance that raises awareness and promotes action in the fight against HIV/AIDS, took place on March 10. As the nation turns its attention to this important cause, women and girls around the world continue to be affected by HIV/AIDS in high numbers. According to reports from the Joint United Nations Program on HIV/AIDS, HIV is the leading cause of death and disease among women of reproductive age across the globe.

HIV is a virus that can cause acquired immunodeficiency syndrome, or AIDS, a disease that diminishes the body’s ability to fight off infection. Unprotected intercourse is the primary way HIV is spread, but it can also be shared through IV drug use, blood transfusion or from mother to baby during pregnancy, childbirth or breastfeeding.

Despite the fact that HIV/AIDS-related deaths are significantly lower in the United States when compared with other regions of the world, the disease remains a serious public health issue. According to statistics from the Centers of Disease Control and Prevention (CDC) in Atlanta, roughly 280,000 women are affected by AIDS in the United States today. Read more »

*This blog post was originally published at Society for Women's Health Research (SWHR)*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

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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…

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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…

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