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Interview With Paul Levy: How To Protect Yourself In The Hospital

My friend and fellow blogger, Paul Levy, is the CEO of Beth Israel Deaconess Medical Center (BIDMC) in Boston. He was recently listed as one of the “top 9 people to watch in healthcare” – thanks to his pioneering efforts on behalf of patient safety and transparency of hospital quality data.

I recently interviewed Paul to get his take on how patients can plan for a safe hospital stay, and what Paul is doing at BIDMC to advance quality care for all. Many thanks to Johnson & Johnson for the unrestricted grant that allowed me to create the videos.

Check out Johnson & Johnson’s YouTube Health Channel for more great videos.

Child-Proofing Grandma’s House

If you are a family with kids and have grandparents or great grandparents alive, you likely enjoy visiting with your relatives from time to time. While your small children may not always get much out of these visits, especially while very young, they do wonders for our older relatives who so enjoy visits from family and delight in seeing us become parents and expand our families.

I remember vividly visiting my grandparents as they aged, as a child, a teen, a young adult and when I became a parent with my own infants and toddlers. I recall well their delight…and the vivid images of their aging lives: durable medical equipment like canes and walkers in the corner of the room. And, the kitchen counter with rows of medication bottles that made the counter appear like the pharmacist’s counter at the local pharmacy. Given all of my grandparents had arthritis towards the end of their lives, none of those bottles had child-resistant tops.

Whether at home, an assisted care facility or a nursing home, the issue I worry about with small kids are floors and medications. Even if someone is handing an older person their medication, a pill can fall to the floor without being noticed and later found by a toddling child who mistakes it for a piece of candy. That’s what happened last week when 15 month old boy found a shiny pink pill on the floor of his grandmother’s house and didn’t think twice about tossing it in his mouth. Thankfully, it was bitter so he spit most of it out but it was a blood pressure medication so we had to given him activated charcoal, a lot of it, and then observe him in the emergency room for 6 hours.

This story had a happy ending but could have been a disaster had it been a different type of pill or a higher dose, or a group of pills. It’s very, very important that we all take a moment to think about the pill safety of our older relatives – for their sake and the sake of the small children in their lives.  In addition to products that can help dispense pills more safely, making sure floors are clean before visits and supervising kids during visits are essential.

As an aside, the moral to this story can be extended to hotels and homes we may visit that we are not as familiar with. Pills can easily fall out of pockets, purses and luggage. When traveling anywhere with small kids, get on the ground and look under beds, chairs, sofas, pillows and be sure there are not any pills or other small items that we wouldn’t want our small children, or even older children, to touch, or worse – eat!

BTW, can you find the pill in this picture? Hint: it’s blue.

See On The Edge Of Something blog for the “before” shots showing the pill in a spoon on the floor.

Not so easy, huh? Unless, of course, you are a very small child with the eye sight of a falcon and live close to the ground routinely. Now do you get the point?

*This blog post was originally published at Dr. Gwenn Is In*

Is Soy Safe?

I have had several people recently ask me about whether eating foods from soy is harmful. Some have asked because they have a thyroid problem and heard that soy interferes with their synthroid, others are worried about breast cancer, and most recently I guess some negative press has been writing about men and soy. Let me try to set the record straight.

What is soy?
All soy foods come from soybeans. Soy has a high protein content as well as carbs, fiber, vitamins, minerals, and some healthy fats. Soy is an excellent source of plant-based protein because it is known as a “complete protein” meaning it contains all of the essential amino acids. Whole soy is best, meaning it has been minimally processed and you are getting the naturally occurring nutrients found in the soybean. Foods that contain whole soy are edamame, soynuts, and surprisingly a bar called SOYJOY. Tofu and soymilk are also great sources of soy.

Health Benefits/Dispelling Myths
Numerous health benefits of soy have been very well documented in literature. In addition, many myths about soy have been dismissed with research studies.

Heart health: Soy is cholesterol free, low in saturated fat, and contains healthy fats. Some evidence also shows that it helps to lower LDL, or “bad” cholesterol.
Breast cancer: A high soy intake during puberty has been shown to reduce breast cancer risk, but consuming it as an adult has not been linked to lowering risk. Some animal studies have connected soy isoflavones with breast cancer growth, but no data on humans has supported this. In fact, some studies show a favorable impact on breast cancer outcomes with soy. Check with your physician before taking a soy isoflavone supplement. The American Cancer Society suggests that up to 3 servings of soyfoods per day is safe for a breast cancer survivor.
Bone health: Soybeans and calcium-fortified soyfoods are good choices because of the soy isoflavones as well as calcium and Vitamin K which can help bone mineralization.
Menopause: Over 50 studies have examined whether soy can relieve hot flashes in menopause and the consensus is that it may for many women but it depends on hot many hot flashes you get and how much soy isoflavone is taken.
Reproduction: No human data shows that consuming soy causes abnormal testosterone or estrogen levels. Several studies found no affect on sperm or semen when consuming soy isoflavones.
Thyroid: A comprehensive review of literature concluded that soy does not adversely affect thyroid function. Researchers recommended that thyroid function be reassessed if there is a large increase or decrease in soy intake, but normal day-to-day variations are unlikely to affect normal thyroid function.

Good for the Planet
Soy is environmentally friendly. The amount of fossil fuel to process soybeans is estimated to be 6-20 times less than that used to produce meat.

Bottom line
Soy foods can be part of a healthy diet for men and women. Eating 2-3 servings per day of soy foods is safe and very healthy. Soy contains important protein, amino acids, fiber, calcium, potassium, zinc, iron, and folic acid.

For more information:

This post, Is Soy Safe?, was originally published on by Brian Westphal.

Does the Flu Vaccine Increase Hospitalizations?

The Centers for Disease Control (CDC) currently recommends that children 6 month to 18 years old receive an annual flu vaccine. There are two types of flu vaccines used in the US: a live attenuated virus (LAIV) and a trivalent inactivated virus (TIV) vaccine. Both are safe and effective  – while efficacy varies from year to year, they are 70-90% effective in healthy adults. Efficacy is young children appears to be slightly less, about 66%.

There remains, however, many sub-questions about the flu vaccines and by the time researchers have thoroughly explored them vaccine technology is likely to have progressed, and therefore any new vaccines will have to be tested all over again.

One of those sub-questions about vaccine safety and efficacy is the net effect of the flu vaccine in children with asthma.  Some have raised concerns that the vaccine may exacerbate asthma, a 1-2% increased wheezing and 3% increased hospitalizations have been reported, although so far the bulk of the data suggests that both types of flu vaccines are safe in children with asthma.  There is evidence to suggest that the LAIV may be superior to the TIV in children, particularly with asthma.

A new study, presented but not published, further explores the safety and efficacy of the TIV in children.  Study author, Avni Joshi, M.D., of the Mayo Clinic, reports:

“The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine’s effectiveness has not been well-established.  This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization.”

The study is a retrospective study of 263 children who presented to the Mayo clinic with laboratory confirmed influenza. They found that children who had recieved the TIV vaccine had a 3 times greater risk of hospitalization than those who were not vaccinated. These results raise concerns about the safety and effectiveness of the TIV in children with asthma.

Dr. Joshi concludes:

“While these findings do raise questions about the efficacy of the vaccine, they do not in fact implicate it as a cause of hospitalizations.  More studies are needed to assess not only the immunogenicity, but also the efficacy of different influenza vaccines in asthmatic subjects.”

That may seem like a curious conclusion given the results of this study, but it is accurate. The key to understanding the implications of this study is that it is retrospective. That means it looks at children who have the flu and then looks back to see who was vaccinated and who wasn’t. This in turn means that children were not randomized to either be vaccinated or not, and this opens the door to any number of variables that cannot be controlled for in the study.

The authors did look as obvious factors, such as severity of asthma and insurance status, and found that they did not correlate with risk of being hospitalized. But what other factors might there be? The flu vaccine is optional, which means that parents decide whether or not to vaccinate their children, perhaps with advice from their pediatrician. It is likely that sicker or more frail children are more likely to get vaccinated. It is also likely that children who had a bad reaction to the flu in the past are more likely to get vaccinated. The flu vaccine is recommended especially for those who are at high risk for complications if they get the flu.

Therefore while this study raises important questions, it is not designed to answer them definitively. A prospective trial is required for that, and that is what Joshi means by “more studies are needed.”  In general, retrospective studies are useful to find correlations and generate hypothesis, but are not capable of determining causation – there are simply too many variables that are not controlled for.

As expected, the anti-vaccinationists have already jumped on this study and misinterpreted its significance.  They did not recognize its retrospective nature nor put it into the context of existing research on the safety and efficacy of the flu vaccines.

Clinical trials are complex, and there are many types that each have their own strengths and weaknesses. Often, many independent lines of basic science and clinical evidence need to be brought together to form a reliable conclusion about a specific intervention. That is the essence of science-based medicine. Individual studies typically only provide a tiny slice of information, but are often presented to the public as if they are definitive. This creates a constant background noise of misinformation about medical questions.

It also provides a rich source of data from which to cherry pick, allowing proponents to support almost any notion by shopping from the vast store of often conflicting medical research. This reinforces the need to look thoroughly at the totality of scientific evidence on any claim or question.

When that is done on the question of the flu vaccines, it is clear that both types of vaccines are safe and effective. However, there is also much room for improvement in the vaccine technology itself, as well as evidence-based recommendations for who, exactly, should get which type of vaccine.

This current study adds incrementally to our knowledge on this question, and suggests questions for future research. It is not the kind of evidence, however, that should lead to changes in the current recommendations.

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

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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