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Are The Benefits Of Smoking Cessation Eclipsed By Obesity?

Epidemic by Tobyotter via Flickr and a Creative Commons license

Obesity is filling in for smoking as a cause of death in working class women, concluded researchers after reviewing mortality rates from a nearly 30-year study in Scotland.

In Europe, wealthier people either aren’t starting to smoke or are finding it easier to quit, which accounts for up to 85% of the observed differences in mortality between population groups, researchers noted.

Their analysis showed higher rates of being overweight or obese among those who’d never smoked in all occupational classes, with the highest rates in women from lower occupational classes. Almost 70% of the women in the lower occupational classes who had never smoked were overweight or obese, and severe obesity was seven times more prevalent than among smokers in higher social positions. Among women who had never smoked, lower social position was associated with higher mortality rates from cardiovascular disease but not cancer.

To investigate the relations between causes of death, social position and obesity in women who had never smoked, Scottish researchers conducted a prospective cohort study. They drew from the Renfrew and Paisley Study, a long term prospective community based cohort named for two neighboring towns in west central Scotland from which all residents then aged between 45 and 64 were invited to participate from 1972 to 1976.

Researchers reported their results online Read more »

*This blog post was originally published at ACP Internist*

Can Electronic Health Records Make Disparities Disappear?

According to Kendra Blackmon at and a new study published by the National Institute of Standards and Technology (NIST), the answer is maybe.

Earlier this year, NIST published a report – Human Factors Guidance to Prevent Health care Disparities with the Adoption of EHRs – which declares that “wide adoption and Meaningful Use of EHR systems” by providers and patients could impact health care disparities.

Making this happen, however, will require a different way of thinking about electronic health records (EHRs). While the report notes that EHRs primarily are used by health care workers, patients still interact with these systems both directly – such as through shared use of a display in an exam room – and indirectly. For patients to obtain the intended benefits of this technology, EHR systems should display or deliver information in a way that is suitable for their needs and preferences, the report says. Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

CDC: Americans Are Living Longer Than Ever

The U.S. age-adjusted death rate fell for the tenth consecutive year, to an all-time low of 741 deaths per 100,000 people in 2009, 2.3% lower than 2008, according to preliminary 2009 death statistics released by CDC’s National Center for Health Statistics.

The findings come from “Deaths: Preliminary Data for 2009,” which is based on death certificates from all 50 states, the District of Columbia and U.S. territories.

Life expectancy at birth increased to 78.2 years in 2009, up slightly from 78.0 years in 2008. Life expectancy was up two-tenths of a year for men (75.7 years) and up one-tenth of a year for women (80.6 years). Life expectancy for the U.S. white population increased by two-tenths of a year. Life expectancy for black men (70.9 years) and women (77.4 years) was unchanged in 2009. The gap in life expectancy between the white and black populations was 4.3 years in 2009, two-tenths of a year increase from the gap in 2008 of 4.1 years.
Read more »

*This blog post was originally published at ACP Internist*

AIDS In America: We Are Not Out Of The Woods Yet

Yesterday I introduced my friend Charles Roth. Charles was diagnosed with HIV/AIDS in 2003 and was already in bad shape. He had been tested as healthy the previous year, but the disease struck quickly, hospitalizing him for a week and keeping him out of work for a month and a half. He returned to work but repeated illnesses due to AIDS meant that by 2006, he was unable to work full-time. A bank executive, Charles still tries to find occasional contract work or odd jobs like résumé writing and tax preparation, but with the recession, these jobs are low-paying and hard to come by. For the most part he makes do with a tiny state disability check and food stamps.

So how typical is Charles’s case? We’ve all heard of success stories like Magic Johnson, who was diagnosed with HIV in 1991 and still has not developed AIDS. But clearly neither case tells the whole story. Read more »

*This blog post was originally published at The Daily Monthly*

Healthcare Disparities: The View From Harlem, NYC – Part 2

Stroke is the leading cause of adult disability in the United States and the third leading cause of death. Worldwide, stroke is the second leading cause of death. Like heart disease and cancer, serious stroke disparities persist in America. African Americans have a relative risk of stroke death that is 4 times higher that whites at ages 35-54, 3 times higher at ages 55-64, and 2 times higher at ages 65-74.

The reasons for this are the focus of my two blog posts.

Over the last decade, most of the research dollars spent on stroke has focused on treatment and recovery. Researchers have spent millions trying to come up with new blockbuster treatments that reduce stroke burden or reverse it’s disabling impact. Therapeutic clot-busters have emerged with narrow time-windows within which they must be administered. Relaxing these time constraints have been the subject of even more research, and stroke recovery laboratories explore brain re-learning, neuronal plasticity, and cellular regeneration.

While I believe that we must continue to remain leaders of new and innovative treatments of disease, there is no doubt in my mind that the best return for our healthcare dollars is prevention. It is the only thing that can reign in the runaway disparities in healthcare and reduce the physical and economic burden of disease among all Americans.

But prevention is complex. It is much more challenging than administering a clot-buster or taking a cholesterol-lowering drug. Prevention involves the entire community – the whole ecosystem. It involves the child or individual, his parents and grandparents, his schoolteachers, his neighborhood stores and local parks, his local government policies, his primary care physician, his local community clinic or hospital, his employment status, his wallet, and lastly, his genes. Compare this to treatment, which involves having access to particular medical interventions such as a drug or surgical procedure.

Stroke prevention can be subdivided into primordial prevention (preventing stroke risk factors like high blood pressure, diabetes, and obesity, from developing in the first place through healthy living), primary prevention (preventing a first stroke by treating identified modifiable risk factors like high blood pressure etc), and secondary prevention (preventing a second stroke from occurring by controlling risk factors and administering specific treatments like taking a daily aspirin or having surgery to open up clogged arteries in the neck).

For the purposes of this post, I will focus on primordial prevention. To begin, I will re-introduce the root causes of disparities outlined previously:

  • Educational status
  • Employment status
  • Insurance status
  • Income level

How do these factors influence primordial prevention? How do they interact to define ecological conditions within a specific community? How did they contribute to the young boy’s adolescent stroke? To begin, I will list factors endemic to the young boy’s environment:

1] Low Health Literacy – the “hidden dragon” of all treatable risk factors; so often underestimated and so dangerous to the beholder.

2] Unacceptable numbers of uninsured – the “crouching tiger” threatening to tear down the entire health system

3] Poor access to care – an unforgiving predicament.

4] Limited access to healthy and inexpensive food

5] Ubiquitous access to unhealthy and cheap food

6] Low levels of non-occupational physical activity or leisure-related exercise

7] High tobacco and alcohol consumption.

8] Chronic persistent stress levels that overwhelm coping mechanisms.

In a study by Mauricio Avendano and Maria Glymour, wealth and income levels were shown to be independent risk factors for stroke. Another study by Glymour, Avendano, Haas, and Berkman showed that childhood social conditions (southern state of birth, parental Socio-Economic Status or SES, self-reported fair/poor childhood health, and attained height) predicted stroke risk in black and white adults. Moreover, adjustment for adult SES, in particular wealth, nearly eliminated all the disparity in stroke risk between black and white subjects

The ecological conditions that shaped the young boy’s physical and limbic traits are examples of an uneven playing field. He was born into it – just like I was born into my little world. The sporadic binging on cheap ubiquitous fast food whenever his mom had a little money and the absence of playtime ultimately led to his childhood obesity. The complex conditioning of his limbic needs led to a psychological fragility that was encased by a shell of defensive behavior that in-turn caused truancy.  Substance abuse was around the corner waiting patiently for him. By age 15, the young boy was already a user; with open arms he was welcomed into “the hustle”. Mom was broken. One could see it in her eyes. She no longer worked. She no longer cared.  That is, until her son had a stroke when he was just 17-years-old – the day the drought ended, and she cried.

It was a hemorrhagic stroke. The high blood pressure in his brain arteries caused by accelerated atherosclerosis – the consequence of his substance abuse (tobacco, alcohol, cocaine), type-two diabetes, and undiagnosed hypertension – was what caused the stroke. The stroke was so large that it shifted half of his brain across the midline of his skull, crushing it against the inner-table on the other side.  Fortunately (some would say), the kid survived. Unfortunately, he wanted to die – 17-years-old and nursing home bound, unable to speak or swallow or move his right side.

The stroke was the final blow dealt by a cascade of disparities all too common in America.

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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