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Should Surgery Be Considered For A Persistently Hoarse Voice?

I was informed about this interesting concept on ABC news

With many aging baby boomers tapping into cosmetic surgery in order to look younger, some are taking it a step further to “sound” younger as well with a “voice lift”.

For some, it’s not right to look 10-20 years younger after a facelift but still sound like 70 years old.

A hoarse voice with aging is not unusual, but a surgical “voice-lift” is not necessarily the first step that should be taken.

First things first… Read more »

*This blog post was originally published at Fauquier ENT Blog*

Behavior Vs. Disease: A New Way To Look At Health

What is the leading cause of death in the United States? Heart disease? Cancer? No, it’s smoking. Smoking? Yes, depending on how you ask the question.

In the early 90s, McGinnis and Foege turned the age-old question of what people die of on its head by asking not what diseases people die of but rather what the causes of these are. Instead of chalking up the death of an older man to say lung cancer, they sought to understand the proximate cause of death, which in the case of lung cancer is largely smoking. Using published data, the researchers performed a simple but profound calculation — they multiplied the mortality rates of leading diseases by the cause-attributable fraction, that proportion of a disease that can be attributed to a particular cause (for example, in lung cancer 90 percent of deaths in men and 80 percent of deaths in women are attributable to smoking). Published in JAMA in 1993, their landmark study became a call to action for the public health community.

When looked at the conventional way, using data from the 2004 update of the original study, heart disease, cancer, and stroke are the leading causes of death, respectively. This accounting may help us understand the nation’s burden of illness, but does little to tell us how to prevent these diseases and improve health. Through the lens of McGinnis and Foege we get the actual causes of death (e.g., the major external modifiable factors that contribute to death). This analysis shows that the number one cause of death in America is tobacco use, followed closely by poor diet and lack of physical activity, and then alcohol consumption. Read more »

*This blog post was originally published at BeyondApples.Org*

Medical Aspects Of “The King’s Speech”

Over the weekend I went to see “The King’s Speech.” So far the film, featuring Colin Firth as a soon-to-be-king-of-England with a speech impediment, and Geoffrey Rush as his ill-credentialed but trusted speech therapist, has earned top critics’ awards and 12 Oscar nominations. This is a movie that’s hard not to like for one reason or another, at least most of the way through. It uplifts, it draws on history, it depends on solid acting.

What I liked best, though, is the work’s rare depiction of a complex relationship between two imperfect, brave, and dedicated men. At some level, this is a movie about guys who communicate without fixating on cars, football (either kind), or women’s physical features. Great! (Dear Hollywood moguls: Can we have more like this, please?)

The film’s medical aspects are four, at least: The stuttering, the attitude of physicians toward smoking, a closeted sibling who had epilepsy and died at an early age (just mentioned in passing), and the king’s trusted practitioner’s lack of credentials.

At the start, Prince Albert (young King George VI) has a severe speech impediment. It’s said that he stutters, and on film Firth does so in an embarrassingly, seemingly extreme and compromising degree. He’s the second of George V’s sons, and might or might not succeed to the throne depending on events in history, his older brother’s behavior, and his capacity to serve the Empire at the brink of war. Being effective as the king of England in 1936, and especially at the start of war in 1939, entails speaking confidently.

Prince Albert’s been through the mill with doctors who’ve tried to help him talk. Some recommend he smoke cigarettes — these, they advise, would help him to relax because they’re good for the nerves, they say. One asks him to speak with a mouthful of marbles, on which this doctor watching the film worried he might choke. Eventually Albert’s wife, Elizabeth (Queen Mother to be), finds a speech therapist in London, Lionel Logue, who uses unorthodox approaches with, by rumor, exceptional results. Eventually Prince Albert — or “Bertie” as the therapist insists on calling him — trusts and accepts help from this peculiar Australian who, it turns out, developed his methods of assisting stutterers through his work with shell-shocked soldiers in WWI. Read more »

*This blog post was originally published at Medical Lessons*

The Link Between Oral Sex And Head And Neck Cancer

USA Today published a pretty accurate article regarding the rise of certain head and neck cancers with the increased popularity of oral sex and number of sexual partners.

The factor that creates this link is the human papillomavirus (HPV) which is associated with tonsil and tongue cancer. Alcohol and tobacco use is more highly linked with such oral cancers, but HPV does appear to be an independent risk factor.

A 2007 study in the New England Journal of Medicine found that younger people with head and neck cancers who tested positive for oral HPV infection were more likely to have had multiple vaginal and oral sex partners in their lifetime. Having six or more oral sex partners over a lifetime was associated with a 3.4 times higher risk for oropharyngeal cancer — cancers of the base of the tongue, back of the throat, or tonsils. Having 26 or more vaginal-sex partners tripled the risk. The association continued to increase as the number of partners in either category increased.

Of greater concern is that “French” kissing may also potentially be a mode of transmission.

The good news (if you’re a young non-smoker diagnosed with HPV-positive tumors) is that about 85 percent of non-smoking people with HPV-positive tumors survive. That number drops to 45 or 50 percent in people who smoke and are HPV-negative. Read more »

*This blog post was originally published at Fauquier ENT Blog*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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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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