January 3rd, 2008 by Dr. Val Jones in Opinion
No Comments »
How has the Physician Quality Reporting Initiative (PQRI) been going? Some insights are offered from an internist in the trenches, (the only 1 of 20 physicians in his practice who was able to figure out how to comply with the PQRI rules), The Happy Hospitalist:
I found out today many docs may not have qualified because of the way the government PQRI computers crunched the data (imagine that). You see, if my quality indicator was for antiplatelet use in stroke, and I submitted to CMS stroke as the 4th ICD code, along with three comorbid conditions ( like DM, COPD, CAD), unless I submitted stroke as diagnosis #1, PQRI would reject my submission. So CMS accepts your E&M code with stroke listed as the 4th diagnosis to get paid, but when that claim makes it to the PQRI folks, because stroke was diagnosis #4 and not diagnosis#1, PQRI would reject the submission and doctors all over this country were dinged for not reporting on 80% of qualified patients…
I also found out that PQRI indicator #36 calls for rehab ordered for all “intracranial” hemorrhage. During my meeting today I found out that the only ICD codes linked to this quality indicator are “intracerebral” hemorrhage. Sub dural bleeds, which are intracranial, are excluded. So are subarachnoids. They have problems even defining what they are trying to measure.
January 3rd, 2008 by Dr. Val Jones in News
4 Comments »
A colleague of mine asked me what I thought about the recent New York Times article correlating household clutter with weight gain. It’s an interesting connection, so I thought I’d blog about it.
I think that clutter is probably a reflection of person’s emotional state, personality type, and upbringing. Some people seem to be more orderly by nature, others don’t focus on neatness as much. Some of us were trained to make our bed every morning, a few had a parent or nanny to do that. And still others have been “whipped into shape” by their spouse. Overall I think most of us prefer some degree of order over chaos, and given the choice would like to keep a fairly orderly home.
Now, what’s interesting to me is the emotional component in all this. We each have a certain level of baseline neatness, and we stray from that when we feel anxious, depressed, or exhausted. Think about what your house looks like now – is it at your natural baseline of orderliness? If not, are you more anxious, depressed, or tired than usual? I bet there’s a connection.
Many people gain weight when they’re anxious, depressed, or sleep deprived. So in a way, household messiness can be a marker for emotional distress. And it’s the emotional distress that fuels the weight problems. When a person is ready to lose weight, they’re probably motivated because they’ve managed to rise above their emotional concerns to achieve their goal.
So my point is this: take a look at your home to get a sense for how you’re doing emotionally. Are you anxious or depressed about something? Are you having relationship problems? Are you having difficulty sleeping?
Revolution Health has expert-led groups available to help you understand your emotions and how they influence your behavior. I think you will really benefit from getting into a discussion group and sharing your stories with others like you.
Here are some examples of groups that you can join right now (click to join):
Relationship Help – Mira Kirshenbaum, Counselor
Sleep Better – Steve Poceta, MD, Neurologist
Take Charge of Your Life – Ned Hallowell, MD, Psychiatrist
Lose Weight – Val Jones, MD, Rehabilitation Medicine
A Fit Family– Stacy Stryer, MD, Pediatrician
De-stress – Brad Jacobs, MD, Internal Medicine
Quit Smoking – Joe Scherger, MD, Family Medicine
Walk Your Way Thin – Jim Hill, PhD, Psychology
Maintain Your Weight – Chris Newport, Personal Trainer
Eat Right– Sandra Foschi, Nutritionist and Physical Therapist
Why not join a group? They may really help you to look and feel your very best this New Year. Not too many websites will offer this for free as Revolution Health does.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 27th, 2007 by Dr. Val Jones in News
2 Comments »
A hat tip to KevinMD’s guest blogger, JoshMD for this great link. The British Medical Journal offers a short historical analysis of 7 common medical myths, sometimes perpetuated by physicians themselves:
- People should drink at least eight glasses of water a day
- We use only 10% of our brains
- Hair and fingernails continue to grow after death
- Shaving hair causes it to grow back faster, darker, or coarser
- Reading in dim light ruins your eyesight
- Eating turkey makes people especially drowsy
- Mobile phones create considerable electromagnetic interference in hospitals.
To find out why each of these commonly held beliefs are either untrue or unsubstantiated, check out the original journal article. It’s a lot of fun.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 27th, 2007 by Dr. Val Jones in Book Reviews
No Comments »
This is my final post in a series inspired by Dr. Barker Bausell’s recent book, “Snake Oil Science: The Truth About Complementary and Alternative Medicine.” Since I began this series, the New York Times has published a rave review of Bausell’s book, which only further confirms the importance of Bausell’s contributions.
Although Bausell’s main thesis is that there are currently no large, randomized controlled trials (published in leading medical journals) demonstrating the effect of any CAM therapy beyond placebo, I have chosen to highlight some of his thinking about research methodology as it applies to the medical literature in general.
So far I have explained why most research (if not carefully designed) will lead to a false positive result. This inherent bias is responsible for many of the illusionary treatment benefits that we hear about so commonly through the media (whether they’re reporting about CAM or Western medicine), because it is their job to relay information in an entertaining way more so than an accurate manner (i.e. good science makes bad television).Then I explained a three step process for determining the trustworthiness of health news and research. We can remember these steps with a simple mnemonic: C-P-R.
The C stands for credibility– in other words, “consider the source” – is the research published in a top tier medical journal with a scientifically rigorous review process?
The P stands for plausibility– is the proposed finding consistent with known principles of physics, chemistry, and physiology or would accepting the result require us to suspend belief in everything we’ve learned about science to date?
And finally we arrive at R – reproducibility. If the research study were repeated, would similar results be obtained?
This third and final pillar of trustworthy science is a simple, but sometimes forgotten, principle. If there is a true cause and effect relationship observed by the researcher, then surely that cause and effect can be demonstrated again and again under the same conditions. Touching a hot stove burner always results in a burned hand. No matter how frequently you test this causal relationship, the result will be similar.
Sometimes conflicting results are obtained by repeating a study. When this happens, the reader should be careful in interpreting the conclusions – there may be a flaw in the study design, or it may be that the conclusions drawn were inaccurate. There could have been a false positive result, or no appreciable effect of the treatment under consideration, therefore leaving the results to chance. Flipping a coin gives you heads one minute and tails the next. Yet a person unfamiliar with coins could conclude (after one flip) that it has a head on both sides. In the end, therefore, one can be more confident in a study’s result if it is born out by other studies.
And so as we conclude this series, I hope that you now feel well equipped to perform CPR (credibility, plausibility, reproducibility checks) on health news. A little healthy skepticism can protect your brain from all the mixed health messages that barrage us each day. At the very least, now you’ll appreciate why most health news reports include an expert quote stating something to the effect of “it’s too early to know for sure if these findings are relevant.” That statement may be the most trustworthy of the entire report.
***
Next up: Shannon Brownlee’s book “Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer.” Shannon and I corresponded about this book two years ago, so I’m looking forward to seeing how it has turned out. Once I’ve finished it I’ll give you my thoughts here in this blog.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 20th, 2007 by Dr. Val Jones in Book Reviews
No Comments »
Which news source do you trust more: The New York Times or The National Enquirer? Which news reporter would you trust more: Charlie Gibson or Jerry Springer? As it turns out, medical journals and science researchers run the gamut from highly credible and respected to dishonest and untrustworthy. So as we continue down this road of learning how to evaluate health news, let’s now turn our attention to pillar number one of trustworthy science: credibility.
In medical research, I like to think of credibility in three categories:
1. The credibility of the researcher: does the researcher have a track record of excellence in research methodology? Is he or she well-trained and/or have access to mentors who can shepherd along the research project and avoid the pitfalls of false positive “artifacts?” Has the researcher published previously in highly respected, peer reviewed journals?
2. The credibility of the research: does the study design reflect a clear understanding of potential result confounders and does it control for false positive influences, especially the placebo effect?
3. The credibility of the journal that publishes the research: top tier journals have demonstrated a track record of careful peer review. They have editorial boards of experts who are trained in research methodology and are screened for potential conflicts of interest that could inhibit an objective analysis of the research that they review. The importance of careful peer review must not be underestimated. Some say that the quality of a product is only as good as its quality control system. Top tier journals have the best quality control systems, and the articles they publish must undergo very careful scrutiny before they are published.
So as a lay person, how do you evaluate the credibility of a health news report? In practical terms, here’s what I’d recommend:
1. Look at the name of the journal reference – where was the research published? Is it from a top tier journal? R. Barker Bausell considers the following journals to be “top tier:” The New England Journal of Medicine (NEJM), The Journal of the American Medical Association (JAMA), Annals of Internal Medicine, Nature, and Science. I might cast a slightly larger net, but no one will argue that these are certainly some of the most respected journals in medicine and science.
2. Look at the study design described in the research article abstract. Was it a randomized, controlled, double-blind, placebo-controlled trial? Were there more than 50 subjects in each group? Did the authors overstate their conclusions? This sort of analysis is challenging to the lay person – so do it if you can, but if it proves too difficult, fall back on credibility check #1.
3. Look at the primary author of the research. Search for his/her name in the National Library of Medicine’s Medline database and see what other research he or she has done, and where it was published.
If the news report is based on credible research, you may feel confident in taking the results more seriously (so long as the media is representing them accurately). But before you hang your hat on a journal’s reputation, let’s take a look at the other 2 pillars of trustworthy science: plausibility and reproducibility. These two will help you navigate your way through the vast gray zone, where the credibility check doesn’t pass with flying colors – or maybe you’re dealing with neither Charlie Gibson nor Jerry Springer.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
