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How Contagion Shows Us The Importance Of Science In Today’s World

Contagion is a thriller about a virus that rapidly spreads to become a global epidemic. There aren’t enough coffins. Gangs roam neighborhoods like ours because police have abandoned their posts, fearful of exposure. Garbage fills the streets because sanitation workers are dying. As scientists work feverishly to understand the virus and develop a vaccine, public panic unravels the fabric of civil society, fueled by terror and rattled by false claims of a homeopathic cure promoted by a charismatic charlatan.
The movie has grossed $76 million worldwide since it opened on September 9th.  It has all the elements a successful movie needs: a just-believable dystopian vision of the future, flawed good guys, an evil schemer, suspense, heroic action…the works.

And while it’s an action-thriller first and foremost, you don’t have to concentrate hard to notice that it also shows:

  1. Why the Federal government is necessary: its authority to communicate, negotiate and work with other nations to solve a global problem; its ability to exert authority across state lines and to marshal resources immediately to protect its citizens from peril with no expectation of profit.
  2. How scientific research is iterative and complicated, not bumbling or malicious. Research is conducted by scientists—normal people with normal lives—who are Read more »

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

Vaccination Rates For Health Care Workers At A Dismal Level

A 3D graphical representation of a generic influenza virion’s ultrastructure, by CDC/ Doug Jordan, M.A. Health care workers’ fear of flu shots has risen as an issue again.

Refusing flu vaccination has risen among health professionals again and again. And again. And again and again.

Vaccination rates for health care workers stands at 35%, which is “a dismal rate,” according to Margaret C. Fisher, MD, a pediatric disease subspecialist and the medical director of The Children’s Hospital at Monmouth Medical Center. She spoke about vaccinating adults and health care workers at Internal Medicine 2011.

The issue is as annual as the flu itself, and this time, a physician at London’s Imperial College NHS Trust has jumped into the debate, tackling misinformation given within his country’s own health service. He said: “A very interesting question for me is Read more »

*This blog post was originally published at ACP Internist*

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*

Some Young Europeans Are Starting To Eat Like Americans

For years I have touted the health benefits of the “Mediterranean Diet” and encouraged patients to eat like the Europeans.   Fresh farm vegetables, olive oil, fish and red wine have been linked with longevity and good health.  I just read in NPR news that young Italians are forgoing the eating patterns of their elders and are imitating the “U.S. diet”.  The result is soaring obesity, just like in the United States.

According the the article, young Italians ages 6-12 are sitting in front of the TV and are eating fast foods and soda.  In just three generations, the eating habits and activity of kids has changed from their healthy grandparents.  Italian health officials say obesity is reaching epidemic proportions.

Part of the diet changes are a result of Read more »

*This blog post was originally published at EverythingHealth*

More Bad News About The Obesity Epidemic In America

A report released recently by the Robert Wood Johnson Foundation and the Trust for America’s Health issued some grim warnings about the current and future state of the U.S.’s obesity epidemic.

Bluntly titled “F is for fat: How obesity threatens America’s future 2011,” the report found that obesity rates rose in 16 states since 2010 and that more than 30% of people are obese in 12 states, compared with one state just four years ago. The South is still the worst-faring region—nine out of 10 states with the highest obesity rates are located there.

The report compared today’s data with data from 20 years ago, when no state’s obesity rate exceeded 15%. Now, only one state—Colorado—has a rate below 20%. The report also points out that despite the increased attention paid to obesity by government (not to mention the media), no states posted a decrease in rates over the past year. Diabetes and hypertension rates have also risen sharply over the past two decades, the report said.

Recommendations to address the problem include preserving and in some cases restoring federal funding for obesity prevention and implementing legislation to improve nutrition in schools, among others.

Meanwhile, two researchers are making headlines for proposing a more extreme solution: Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

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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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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