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Latest Posts

How The Swedish Mammography Study Should’ve Been Analyzed

We reviewed four stories on the Swedish mammography study that appeared in the journal Cancer last week. Three of the four stories gave a pretty clear indication that there were methodological concerns about the Swedish research (of the four reviewed, only HealthDay offered no such hint):

• 4th paragraph of AP story: “The new study has major limitations and cannot account for possibly big differences in the groups of women it compares.”

• 1st paragraph of LA Times blog story: “Critics charged that the study was poorly designed and potentially vastly misleading.”
• 2nd sentence of NY Times story: “Results were greeted with skepticism by some experts who say they may have overestimated the benefit.”

But none of the stories did a very complete job of explaining those potential limitations. Because of the confusion that must be occurring in the minds of women — especially those in their 40s — this is a time in which journalism must rise to the need and do a better job of evaluating evidence and helping readers make sense of what appear to be conflicting findings.

I was in Chapel Hill, North Carolina, when the study was published and had the chance to talk about it with former U.S. Preventive Services Task Force member, and a recognized thought leader on issues of prevention and especially of screening tests, Dr. Russell Harris, Professor and Director of the Health Care and Prevention Concentration of the University of North Carolina (UNC) School of Public Health. Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

An Obesity-Causing Virus?

Finally, the answer to the obesity epidemic. [According to the LA Times], it’s a virus:

New evidence indicates that children who are exposed to a virus called adenovirus-36 are more likely to be obese than those who are not exposed to it, and to be heavier than other obese kids who were not exposed to it, researchers said this week. The virus…is one of 10 bacteria and viruses that have been associated with a propensity for putting on plural poundage.

Maybe this explains why I and two of my sisters all became fat in the same year. Well, that — combined with the fact that we had just moved to a new neighborhood where there were no kids we knew to play outside with, and we started taking a bus to school instead of walking, and “Dark Shadows” had just started, leading us to spend every afternoon after school snacking in front of the TV. But I like to think it was a virus.

*This blog post was originally published at tbtam*

Debunking Fake Diseases

Ever heard of adrenal fatigue? Wilson’s temperature syndrome? If not, there’s a good reason: They exist only on the Internet.

The Hormone Foundation, an affiliate of the Endocrine Society, recently issued two fact sheets for patients debunking these so-called conditions, which were “apparently conceived only in an effort to sell products promoted to treat them,” the LA Times reported. No medical evidence supports either faux disease and there are no tests or treatments for them, but patients still try to alleviate them with supplements, some of them potentially dangerous, the Times said.

Adrenal fatigue is characterized by such “symptoms” as having salt and sugar cravings and needing coffee to get you through the day, while the man who discovered Wilson’s temperature syndrome also coincidentally promotes a product to treat it, according to the Times. (Hormone Foundation, LA Times)

*This blog post was originally published at ACP Internist*

Rectal Cancer Becoming More Common In Younger People

Rates of rectal cancer in those younger than 40 have been increasing, the LA Times reported recently.

Researchers studied data from the Surveillance, Epidemiology and End Results (SEER) Registry and looked at the change in rectal and colon cancer incidence in those under 40 from 1973 to 2005. Overall rates were low, but while colon cancer incidence remained constant, rectal cancer incidence increased by an average of 3.8 percent annually, the authors reported in the journal Cancer.

The authors didn’t advocate routine screening in those under 40, but did recommend that physicians be more alert to the possibility of rectal cancer in those presenting with symptoms such as rectal bleeding, according to the Times. (LA Times)

*This blog post was originally published at ACP Internist*

Facebook: Should Hospitals Block It?

A recent piece in the LA Times created quite a kerfuffle in the social health infosphere. The article When Facebook goes to the hospital, patients may suffer detailed some of the issues facing hospitals that have chosen to flirt with Facebook. Stories of nurses posting images of dead patients. Lawsuits and employee rights. An interesting read. It offered up a serving of fresh red meat for those health professionals looking to keep their heads squarely in the sand.

A few thoughts:

Blocking Facebook won’t stop stupidity. Read Paul Levy’s most recent post on the issue. He reminds us that administrative legislation will not stop ignorance. It’s the messenger, not the medium. As healthcare administration’s most vocal advocate for social adoption, I’d recommend you check out Paul Levy. His point of view is remarkable.

Good employees may not understand privacy. We need to go to the next step and address the fact that many hospitals have employees who don’t understand the privacy laws. We still have a responsibility to protect patients from the misinformed. While it’s suggested that you “can’t stop the conversation,” it’s important that hospitals take responsibility and educate their employees regarding what’s appropriate and what isn’t. Many health professionals I know innocently believe that by simply excluding an individuals name you’ve protected their privacy. We have work to do. Read more »

*This blog post was originally published at 33 Charts*

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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