November 18th, 2007 by Dr. Val Jones in Health Policy, Opinion
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A recent blog post at Terra Sigillata really disturbed me. The author describes how, in the face of increasing healthcare costs, Medicare now declines coverage of life saving medicines for lymphoma patients. This is one example of rationing healthcare that will become ever more common (as it is in other leading industrialized nations) as we move towards further cuts in government programs and funding. In Canada, expensive chemotherapies are not commonly covered by the national health plan, and in Britain, age is a determinant for transplant eligibility.
But what troubles me about the apparent capriciousness of denying coverage to certain types of cancer patients over others, is that government programs are – at the same time – allocating millions of dollars to researching implausible alternative medicine treatments while denying coverage of proven therapies to patients who will likely die without them.
Take homeopathy, for example. The National Center for Complementary and Alternative Medicine lists homeopathy as an eligible area of research, and boasts several ongoing studies in the area of stroke, dementia, fibromyalgia, and prostate cancer. And yet, there is no plausible mechanism of action to support its potential use as anything more than a placebo. Homeopathy operates on the assumption that water has memory, and that once it has been exposed to certain substances, such as arsenic, it obtains curative properties for illnesses that bear resemblance to poisoning from those very substances (though the water itself may no longer contain a single molecule of the substance).
Research into scientifically implausible theories should not be funded by our tax dollars at the expense of offering life saving treatments to cancer patients. It is time for scientists to stand up and point out that the Emperor has no clothes when it comes to homeopathy and other similarly flawed alternative medical treatments.
As we move towards rationing limited healthcare resources, we have a moral obligation to prioritize the money correctly. “Open-mindedness” is no excuse for poor stewardship.
Dr. Wallace Sampson sums this up in a provocative recent editorial. Here is an excerpt:
We now see accumulation of useless information in journals and information data bases — hundreds of clinical trials (RCTs) on implausible methods, such as homeopathy, unrefined plant products, prayer, and acupuncture. Initial plausibility retreats before two 20th-century development ideologies of relativism — a principle that all facts and opinions have equal or similar value, and postmodernism — that regards facts as social constructions.
Once thought to be too esoteric for relevance to medicine, these twin ideologies now mold the thinking of policy makers and granting agency officials. Ancient and traditional cultural practices are not diminished for lack of plausibility, but are investigated by RCTs because they are there.
Plausibility depends on prior reliable observations, physical and chemical laws, pharmacological principles, and advocates’ economic and legal misadventures. The National Center for Complementary and Alternative Medicine spends $100 million/year on implausible research and training grants. In performing RCTs on implausible proposals, clinical research has taken a wrong turn and departed from rationality.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 16th, 2007 by Dr. Val Jones in Humor
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I had a special lunch event scheduled today, so I went to a stylist to give my hair a little more volume. (My hair is pin straight and rather fine, so it takes a fair amount of work to make it look substantially different than this.)
A coworker arrives in my office. He looks at me, tilts his head to one side and says,
“Have you been outside today? Your hair is usually very sleek, but today it’s really messy and ‘all over the place.'”
“Um, no, I actually paid someone to style my hair today. That’s what’s different.”
Blank stare.
New topic.
Dudes.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 14th, 2007 by Dr. Val Jones in News, Opinion
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“Grow old along with me! The best is yet to be, the last of life, for which the first was made.”
— Robert Browning
As a rehabilitation medicine specialist I do a lot of work with cognitively impaired men and women. The brain is a fragile and fascinating organ, and perhaps the most perplexing one to treat. Alzheimer’s disease, of course, has no known cure – and those who contract it meander through a frustrating cognitive web towards a final common pathway of dementia, dependence and eventually death.
Former Chief Justice Sandra Day O’Connor has been in the news lately because her husband, an Alzheimer’s patient who requires nursing home assistance for activities of daily living, has forgotten who she is. But even more emotionally difficult is the fact that he has fallen in love with a fellow nursing home resident, and has been behaving like a love-sick teen – holding hands, staring into her eyes and kissing her tenderly.
The New York Times reports that Ms. O’Connor is “happy for her husband” that he has found joy in the midst of his cognitive decline. I wonder if there truly isn’t part of her that mourns the loss of those kisses that were once for her.
My fondest hope is that I can grow old with my husband, and that we will enjoy our final years together, in possession of all our faculties. I hope that Robert Browning’s poem will ring true at the end, and that I never have to watch my husband forget who I am. Sadly, since my grandmother passed away from Alzheimer’s – I wonder if it will be my husband, and not me, who watches the other decline?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 13th, 2007 by Dr. Val Jones in Expert Interviews, News
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Sadly, four transplant patients in the Chicago area recently discovered that their new organs were infected with HIV and hepatitis C. This is the first case of infected organ donation in the past 20 years, with over 400,000 successful, healthy transplants completed in that time period.
I’m actually a little surprised that this is the only known case of infected organ transplants in the past two decades, since the tests to rule out HIV and hepatitis C rely on antibodies. It takes the body at least three weeks to produce antibodies to these viruses, and so people who are infected with HIV and hepatitis C have false negative tests for the first few weeks. So there is always the risk that an organ donor could have contracted these viruses within 3 weeks prior to his or her death.
I asked Dr. David Goldberg, an infectious disease specialist in Scarsdale, NY, to weigh in:
Are there any tests available now that can detect the viruses themselves, or only antibodies? How early after infection could we detect them?
Traditional serologies measure antibodies against the viruses which take weeks or months to develop, whereas there is a more rapid test, called “PCR,” that is a direct measure of the number of viruses in the blood.
HIV reproduces rapidly, so the virus can usually be detected in the bloodstream within 8 days of infection. By contrast, hepatitis C virus replicates more slowly, so the virus may not be detectable until as long as 8 weeks after exposure. So the use of the HIV PCR test in addition to antibody tests would pick up almost all cases of HIV, but the hepatitis C PCR might still miss a number of early infections.
How can we protect future organ recipients from such a tragic event?
PCR is not generally performed because the test is time-consuming and many organ donors are trauma victims, which leaves little time for testing. However, PCR testing could theoretically reduce the number of HIV infected organs that are transplanted (from recently infected individuals), but would not improve the odds in hepatitis C because of the slow growing nature of the virus. In the end there’s no perfect test or 100% guarantee that organ donors don’t have HIV or hepatitis C.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 13th, 2007 by Dr. Val Jones in Health Tips, News
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Diabetes is a tricky disease. Sugar build up in the blood stream can damage tiny blood vessels that supply nerve endings, resulting in skin numbness. The feet are at the highest risk for nerve damage (neuropathy) and folks with diabetes often cannot sense pain in their feet.
How many of us have gotten blisters from ill fitting shoes? Painful, right? Well imagine if you didn’t feel the pain of the blistering and kept on walking, oblivious to the injury. Eventually you’d have a pretty bad sore there. This is what happens to people with diabetes who don’t choose their shoes carefully. In addition, sores don’t heal well because of the decreased blood supply to the area (from the damaged blood vessels). And to top it off, the high sugar levels in the sores provides additional sustenance to any bacteria that might be lurking on the skin. It’s pretty easy for diabetics to develop infected wounds, which can grow larger and even require amputations of dead tissue.
A recent research study suggests that the secret to avoiding this downward spiral is in choosing shoes that fit well – though they estimate that as few as one third of people with diabetes actually wear optimal fitting shoes. This may be because there is a strange temptation for people with diabetes to choose extra small shoes due to their neuropathy. When normal sensation is lost in the feet, tight fitting shoes actually feel better because they can be sensed more readily by the brain. So even though spacious shoes that don’t cramp the toes or cause blistering are the best footwear, they don’t always feel as comfortable. However, patients with diabetes who are properly fitted for orthopedic shoes with the help of a physiatrist or podiatrist, may substantially reduce their risk of ulcers.
So the bottom line for people with diabetes: choose your footwear carefully, and get professional help to make sure that your shoes fit well. Proper shoes could help to decrease your risk for foot and leg ulcers and potential amputations.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
