Now that the US Food and Drug Administration has been given the power to regulate tobacco products, one of its new powers is the right to change the health warnings on cigarette packs in the interest of public health.
So the first question is, are the current health warnings perfectly adequate? The answer to that one is clearly “no”. The boring small text warnings printed on the side of the pack have are almost perfectly designed to be ignored.
The second questions is, can we learn anything from the experience of health warnings in other countries? The answer here is a resounding “yes”. Numerous other countries have been using large mandated pictorial health warnings on cigarette packs for years and there is a growing body of research showing that these are much more impactful then prior text-only warnings. The warnings used in Canada present a good example to follow and can be viewed at:
However, I particularly like the style used in Australia, where they have, since 2006 also added the freephone number of the national stop smoking Quitline to the pictorial health warnings. Graphic images and explanatory messages cover 30% of the front and 90% of the back of the pack. The message “You CAN quit smoking. Call the Quitline 131 848, talk to your doctor or pharmacist, or visit www.quitnow.info.au” is also included on the back of all packs. The Quitline number is also “stamped” on top of the graphic image on the backs of packs.. A recent study by Dr C L Miller of the Cancer Council of South Australia concluded that introducing graphic cigarette packet warnings and the Quitline number on cigarette packets doubled demand for Quitline services, with likely flow on effects to cessation.
Other countries of the world (including the United States) that have not yet introduced large graphic health warnings on cigarette packs or the number to the national quitline should do so as soon as possible.
The research from Australia can be viewed at:
http://tobaccocontrol.bmj.com/cgi/content/full/18/3/235
Apparently, the Vacuum Tympan cures the most “desperate causes” of hoarseness and sore throat, massages vocal cords and gives immediate flexibility (to what?). Oh, and after it brings relief, “a permanent cure soon follows”.
Maybe it sucks out the phlegm. (Ewww…just writing that made me gag.)
It sort of looks like the old incentive spirometers we’d use for post-op patients.
Or maybe it’s a type of nebulizer.
Frankly, it looks like a bong.
********************
I’m at that age where certain tests involving scopes and colons are recommended, so I did my duty as the good custodian of my health and scheduled the pre-test appointment.
(Don’t worry, this will not be a case of “TMI”.)
I’m sitting there with the GI doc going over my health history, when he notices I’m on Protonix. Based on this fact (and the fact that my upper abdomen is sore on palpation – well, duh, you’re pushing on it!) he says “Well, you are going to be out anyway, I might as well take a look down there, too!”.
Say what? I’m here for a tube up one end and you want to put a tube down the other end, too?
I swear to (insert-your-own-deity-here), my first thought was “dude, you’re just trying to add a procedure to crank up the income.”
I’m not proud that was my first thought, but I’m being honest here. “Sure!” he said. It might be a structural problem, we can make sure you don’t have Barrett’s Esophagus (note to self: look that up) and basically just know what we are dealing with.
Well, okay. But I don’t have indigestion/heartburn when I’m on Protonix; I’m rather asymtomatic, actually.
“What kind of anesthesia would you prefer? We can use Versed/Fentanyl or if you want, we can use proprofol.
Propofol? Dude, you can stick a tube anywhere you want. Go for it!
*****
Easiest thing I’ve ever done. I have no idea why I waited so long. When I fell asleep Shania Twain was feeling like a woman and when I woke up, the Eagles were takin’ it easy and I wondered when the hell they were going to start!
I was done.
The procedure went well, the biopsies were taken (routine) and I would get my results by mail within two weeks.
*****
My colon rocks. No problems except divertiulosis and I can live without nuts and seeds.
It was the endoscopy that I almost refused that showed the problem.
The biopsies showed acid-induced esophageal and gastric inflammation.
What??? How??? I thought the Protonix was taking care of that!
*****
And then came the “treatment” boxes checked off.
“Keep taking your medicine for the next three months, then stop.”
Okay…if I have this inflammation now, why would I stop the medication? Won’t it get worse if I do?
“Please avoid Aspirin, Naprosyn, and Motrin. Tylenol is okay.”
Aw man, Motrin is my best friend, my right hand! It’s gotten me through many a rough shift; 12 hours in the ER can make you ache. Tylenol isn’t worth the powder it is printed on.
I took a swig of my Diet Pepsi.
“Avoid fatty foods…”
Okay, doing that already with ol’ Richard Simmons’ plan.
“…chocolate, peppermint, spearmint and smoking”
Bah – I don’t smoke and I can live without chocolate and who wants spearmint anyway?
Took another swig of Diet Pepsi.
“…alcohol…”
No biggie, I only have two Bud Lights a month, during Nascar races, and that’s only to support Kasey Kahne’s sponsor (and I know you all just doubled that to four per month…).
“Avoid caffeinated beverages…”
Uh oh.
Took a tiny swig of Diet Pepsi.
“Decaffeinated coffee…”
That…means…ohh nooooo…
*****
Oh HELL no.
I will NOT give up Starbucks.
Damn it!
I don’t smoke, I barely drink, I don’t do drugs, my diet has more fiber that corrugated cardboard, I’ve lost close to 30 pounds and I’m working on the other 25.
My only “vice” is a total addiction to Starbucks and the goal of someday mainlining Diet Pepsi.
It will be a cold day in hell before I give those up.
*****
I’m giving them up.
I know the effects of chronic esophageal and gastric inflammation can lead to bigger problems.
And in the scheme of things, given the impact a diagnosis can make on a life, this borders on laughable.
But we all talk about how the patient has to take responsibility for their health. I could keep on downing Starbucks twice a day and Diet Pepsi in my sleep and then whine because my Protonix isn’t working.
Or I can make the changes suggested and see if they will make a difference.
But how ironic that the main problem was found in a test I didn’t even know I needed; and how scary that I was essentially asymptomatic, but the inflammation was still there!
Kudos to the doc for being interested enough to find out why I had needed to be on Protonix to begin with.
I shudder to think what things would have looked like had I been on no medication.
*****
Who knows?
Maybe I can go off Protonix if these changes work.
And I can still go to Starbucks, only my new drink will be a Grande Skinny Vanilla Steamed Milk.
With a little cinammon on top.
Hey, a girl’s gotta have something to look forward to…
*This blog post was originally published at Emergiblog*
My health club’s outdoor pool’s hot tub has a new sign:
“No children under 12 allowed in the hot tub…this includes dangling feet and dipping toes!”
It’s very large and placed in front of the entrance to the hot tub at the stairs. Not only can you not miss it, you can’t miss reading it – the letters are huge and neatly written.
You only have to be at the club for a few minutes to see why the need for the sign:
1. This week, the high heat: in this weather, kids will dehydrate quickly and put themselves at risk for heat-related illnesses. Just not worth the few minutes in the very hot water. Kids may already be relatively dehydrated if not drinking enough in heat waves so time in hot water will hasten the onset of heat illnesses in that situation.
2. Parents were already ignoring the smaller posted signs.
3. Hot tubs are really grown-up venues and actually have a therapeutic function. They are not toys or meant as recreation so shouldn’t be used or fostered as such.
Adults, too, shouldn’t be in a hot tub for very long when the outside temperature is in the mid 80’s and above with high humidity. We, too, can become dehydrated and put ourselves at risk for heat exhaustion and heat stroke. However, sometimes us adults need the hot tub for therapeutic reasons, such as after exercise, to aid in the healing of injury, arthritis, etc. That’s how I use the hot tub and why I found myself sitting in it for a few minutes on an 85 degree, very humid day. My healing back needed a few minutes of intense heat and those jets after my usual swim. I kept my eye on the time and after 10 minutes got out and downed some cold water.
The sign did keep away most people and most older kids and adults did respect it. But, a few blatantly did not. One mom actually read the sign for a good few minutes and then when her toddler tossed a fit because she wanted to go in she finally relented but said “only your toes…that’s allowed.” Well, actually not. The sign specified no toes specifically so I’m not sure how she made the leap that her daughter’s toes were the exception.
Her daughter didn’t dip for long before a lifeguard came over and shooed her away. The mom looked miffed but hopefully will be wiser next time and not attempt to pull one over on the staff or the rest of the people there to have fun and were willing to follow the rules.
Safety aside, the ultimate issue here, the other important issue is teaching our kids that rules are meant to be followed. If we break the rules and don’t follow them ourselves, our kids will grow up thinking they, too, can break rules, that they are “above the rules”. Those are the kids who tend to get themselves into all sorts of trouble as teens. The seeds of risk taking and bad behavior do start young and are often planted by watching us.
So, have a blast this summer but follow the posted rules. You’ll not only keep your kids safe today…but tomorrow, too.
For more information on heat illness in kids, click here.
*This blog post was originally published at Dr. Gwenn Is In*
I just wrote about a new feature at ResearchGATE that helps us determine which journal we should choose for publication. Now Bill Hooker from the Open Reading Frame shared JANE with me.
Have you recently written a paper, but you’re not sure to which journal you should submit it? Or maybe you want to find relevant articles to cite in your paper? Or are you an editor, and do you need to find reviewers for a particular paper? Jane can help!
Just enter the title and/or abstract of the paper in the box, and click on ‘Find journals’, ‘Find authors’ or ‘Find Articles’. Jane will then compare your document to millions of documents in Medline to find the best matching journals, authors or articles.
*This blog post was originally published at ScienceRoll*
For this week’s episode of CBS Doc Dot Com, I went back to camp. OK, it wasn’t my camp – Camp Algonquin in Argyle, New York – now defunct, where I spent many an idyllic summer growing up. It was Camp Shane in Ferndale, New York, listed on their website as “The original, longest running weight loss camp in the world” at 41 years and counting.
This is a tough time to be overweight or obese. Last week the Centers for Disease Control announced that obesity-related diseases account for 147 billion dollars in medical costs every year in the United States.
About a quarter of Americans are obese and two thirds are either obese or overweight. Over the past twenty years, obesity in teenagers has increased from 5 percent to almost 18 percent. Obese children and adolescents are more likely to become obese adults. Which brings us back to Camp Shane.
I spent an hour talking to about a dozen kids ranging from ages 11 to 17 who had been gathered into a group by Camp owner David Ettenberg and his wife, Zipora. They came in all shapes and sizes but shared a common sentiment – they felt safe at camp, surrounded by people who accepted them for who they were. It brought tears to my eyes to hear how supportive they were of each other, how open they were about their emotions and fears.
In school other kids often mocked them. There’s no way that would be tolerated at camp – not just by the staff but, more importantly, by the campers. “We’re all in this together,” one boy offered. A girl added, “It’s a safe zone for us.” A teenage girl said “You can wear a bikini without being made fun of.” I asked, “What would happen if you wore a bikini at home?” She answered, “You’d most likely get made fun of and like pushed in a pool. Ah ha, you’re fat.”
A boy told me that kids at his school would ask him, “‘Why are you so massive?’ And like usually I’d just laugh it off but sometimes it does get a little annoying. I’m like, how long until I get back to camp?”
The kids all said they had lost varying amounts of weight at camp through portion control and exercise, a program supervised by pediatrician Dr. Joanna Dolgoff. The challenge has been trying to stay on track once they leave camp and return home.
If they can do it at camp, they can do it at home. But not without the support of parents and schools who have been educated about how to help their children make healthy choices. My good friend, Dr. Mehmet Oz, has launched a wonderful organization called HealthCorps “to help stem the crisis of child obesity through school-based health education and mentoring, as well as community events and outreach to underserved populations.” Click here to see the HealthCorps website.
Click here to see this week’s CBS Doc Dot Com about my trip to Camp Shane.
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I hope you can read the print on this.
