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“Just In Case” Heart Tests: Can They Do More Harm Than Good?

Here’s an important equation that all of us — doctors include — should know about healthcare, but don’t:

More ≠ Better

“More does not equal better” applies to diagnostic procedures, screening tests meant to identify problems before they appear, medications, dietary supplements, and just about every aspect of medicine.

That scenario is spelled out in alarming detail in the Archives of Internal Medicine. Clinicians at the Cleveland Clinic describe the case of a 52-year-old woman who went to her community hospital because she had been having chest pain for two days. She wasn’t having symptoms of a heart attack, such as shortness of breath, unexplained nausea, or a cold sweat, and her electrocardiogram and other tests were fine. The woman’s doctors concluded that her chest pain was probably due to a muscle she had pulled or strained during her recently begun exercise program to lose weight.

To “reassure her” that she wasn’t having a heart attack, the emergency department team recommended she have a CT scan of her heart. This noninvasive procedure can spot narrowings in coronary arteries and other problems that can interfere with blood flow to the heart. When it showed a suspicious area in her left anterior descending artery (a key artery nourishing the heart), she underwent a coronary angiogram. This involves inserting a thin wire called a catheter into a blood vessel in the groin and deftly maneuvering it into the heart. Once in place, equipment on the catheter is used to make pictures of blood flow through the coronary arteries. Read more »

*This blog post was originally published at Harvard Health Blog*

Reassuring Patients About CT Scans And Radiation Risks

Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine.

“Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.”

Researchers surveyed 1,168 patients with non-traumatic abdominal pain. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point scale. Then, to assess cancer risk knowledge, participants rated their agreement with these factual statements: “Approximately two to three abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors,” and “Two to three abdominal CTs over a person’s lifetime can increase cancer risk.” Read more »

*This blog post was originally published at ACP Internist*

New Recommendations For Vitamin D

Vitamin D has been talked about as the vitamin — the one that might help fend off everything from cancer to heart disease to autoimmune disorders, if only we were to get enough of it.

“Whoa!” is the message from a committee of experts assembled by the Institute of Medicine (IOM) to update recommendations for vitamin D (and for calcium).

The IOM committee’s report, released this morning, says evidence for many of  the health claims for vitamin D is “inconsistent and/or conflicting or did not demonstrate causality.” The exception is the vitamin’s well-documented (and noncontroversial) benefits on bone growth and maintenance.

The IOM panel’s report also says most North Americans (Canadians as well as Americans) have more than enough vitamin D in their blood to achieve the desired effect on bone. The committee said a blood level of 20 nanograms per milliliter (ng/mL) is sufficient for most people.

The panel set 600 International Units (IU) as the recommended daily intake for children and for adults ages 19 to 70. People ages 71 and older are supposed to get an additional 200 IU, or 800 IU a day.

That’s a fairly sizable increase over the previous recommendations of 200 IU per day through age 50, 400 IU for people ages 51 to 70, and 600 IU for people ages 71 and older. Read more »

*This blog post was originally published at Harvard Health Blog*

Unscientific Medicine: What’s The Harm?

Any promoter of science-based medicine often faces the question: “What’s the harm?” What is the harm if people try treatment modalities that are not based upon good science, that are anecdotal, or provide only a placebo benefit? There are generally two premises to this question. The first is that most “alternative” placebo interventions are directly harmless. The second is that direct harm is the only type worth considering. Both of these premises are wrong.

The pages of Science Based Medicine (SBM) are filled with accounts of direct harm from unscientific treatments: Argyria from colloidal silver, death from chelation therapy, infection or other complications from acupuncture, burns from ear candleing, stroke from chiropractic neck manipulation — the list goes on. You can read anecdotal accounts of such harm on the website, whatstheharm.net.

Of course, as we often point out, harm and risk is only one end of the equation — one must also consider benefit. It is the risk-benefit ratio of an intervention that is important. But generally we are talking about interventions that lack any evidence for benefit, and therefore any risk of harm is arguably unacceptable. Read more »

*This blog post was originally published at Science-Based Medicine*

Doctors And “Alarm Fatigue”: Potential For Patient Harm?

The hospital is never a quiet place. Walk through the wards on a typical day and you’ll hear a cacophony of alarms, bells, and other tones coming from both computers and medical equipment.

American Medical News recently discussed so-called “alarm fatigue.” They cite a study showing find that “16,934 alarms sounded in [a medical] unit during an 18-day period.” That’s astounding, and for those who are wondering, that’s about 40 alarms an hour.

It’s not surprising that doctors become desensitized to these alarms, and that has potential to harm patients, as physicians may miss legitimate, emergent findings. Read more »

*This blog post was originally published at KevinMD.com*

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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How To Be A Successful Patient: Young Doctors Offer Some Advice

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

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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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