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Aqua Pencil

June 11th, 2009 by Paul Auerbach, M.D. in Better Health Network

Tags: Aqua Pencil, Diving, Gadget, wilderness medicine

At Beneath the Sea I had the opportunity to walk the show floor and check out some new products intended for divers. One that immediately caught my eye was the Aqua Pencil, which is an innovative underwater pencil designed for divers, kayakers, boaters and researchers who will be underwater or wet. Because of its properties, it can be used when one needs to write in the rain, sleet or snow, such as out in the field or during a rescue. I tested it and it performs as advertised.

The Starter Kit includes an Aqua Pencil, Tether, Lead Pack (writing leads) and Eraser. The tethers are available in different colors, and the pencil is advertised to work well with any slate and to write well on waterproof paper.

According to the company, which is named Xit 404, it was formed to fulfill the need for specialized products and to develop ideas that are overlooked by other companies.

The Aqua Pencil Kit retails for $21.95.

This post, Aqua Pencil, was originally published on Healthine.com by Paul Auerbach, M.D..

Steven Pearlstein Joins The Doctor-Hater Club

June 10th, 2009 by EvanFalchukJD in Better Health Network

Tags: Anti-Physician, Doctor-Hating, Healthcare System, Physician, Steven Pearlstein, Washington Post

Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?

Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?

Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.

“It’s the doctors, stupid,” he begins his column today.  At once, he recycles the tiredest of political phrases and tells his readers exactly what he thinks of them.  But it’s not the column that is most telling, it’s the live web discussion that followed.  I participated in it, and can share with you the highlights.  It’s a revealing insight into the thinking of a mainstream DC columnist.

To save you the trouble, here’s a summary of Pearlstein’s views:  Doctors learn a craft that they owe to the rest of us as a public good.  But instead of doing this, they take advantage of knowledge to make as much money as they can.  They do it willfully – like an insider-trading stock broker – but they also do it because they just aren’t all that competent at what they do.

Think I’m making this up?  Read:

On medical school debt:

I think we allow doctors to make too much of their debt. . . In major metropolitan areas, that debt looks pretty small when compared to the lifetime earnings that doctors accumulate in private practice over many years.  They more than make up for their investment, as it were.  But they use this debt to justify their elevated incomes for the next 30 years — and make no mistake about it, doctors in the U.S. do make ALOT more than docs elsewhere, on average. . . . My suggestion is that we socialize the cost of medical education, that is have the government pay for it, in exchange for a couple of years of community service.  That way, we get the community service and we eliminate the No. 1 reason given by docs to justify getting paid more than docs everywhere else.

According to the Bureau of Labor Statistics, a freshly minted family care doctor has a median wage of less than $140,000 a year.  According to the AMA, these same doctors have, on average, about $140,000 in educational debt.  Thirty years seems about how long it would take to pay off that debt, and you can forget about buying a house, a car, or paying for your own kids’ school under those circumstances.  I’m sure many medical students would love the Joel Fleischman plan, but we should do that because maybe it will help more people become doctors, not because we think doctors are exaggerating the impact of debt equal to 100% of your gross pay.

On how our system ought to allocate medical resources:

There is no reason why people can’t travel an hour to a big hospital to have a baby, for example, in a big modern maternity ward that does lots of deliveries and has enough volume to be able to afford all the latest equipment in case something goes wrong.  I mean how many times in your life do you have a baby that you can’t drive an hour to have it done, rather than insisting that every community hospital have its own maternity ward.  It’s just one example of the inefficiency built into the system by people — that would be you and me — who insist on things that, in the end, don’t have ANY impact on the quality of care.  In fact they have negative impact.

I don’t know if Pearlstein has ever had a baby before, but just being an hour away from a hospital is unthinkable for most expectant moms in the weeks prior to delivery.  And what is someone to do who lives an hour away and has a complication during the pregnancy?  Pearlstein’s prescription seems to be that they should eat cake.

On the freedom of patients to choose their medical care:

The emphasis on being able to choose your own doctor in every instance is another, as if most of us have a clue as to who are the best docs and who aren’t.  These are the kinds of irrational things we need to try to work out of the system, because they wind up being very costly.

Yes, for goodness’ sake, let’s get rid of the irrational desire of a sick person to want to pick their own doctor.  Even Senator Kennedy’s “American Choices Act” guarantees the right of patients to choose their own doctor.  I don’t know where Pearlstein is on the political spectrum with this view, except perhaps a certain territory between China and South Korea.

On how doctors are hopelessly conflicted in giving medical advice by their desire to make money:

But first we need the evidence to show that it isn’t a good idea.  Then, once we have the evidence the doc has to follow the protocol and explain to the family why it’s not a good idea and not merely blame the big, bad insurance company for being so heartless–which, by the way, a lot of docs do, so they can look like the good guys.  Of course they’d love to do the surgery in many cases because they’d like the business and the extra income, so they are hopelessly conflicted. . . . .

[B]uying medical care is not like buying lawn furniture. . . in medical care you rely to an extraordinary extent on the advice of the doctors (i.e. the sellers).  And its also not an area where you are inclined to be very price-sensitive — is anyone going to go the the Wal-Mart of surgeons if they think their life may depend on it. . . . But it is NOT true that a well-informed consumner will always make the right choice about medical options — they still need the advice of doctors, who under the current system have a very noticeable conflict of interest.

I’m actually not sure that Pearlstein has even been inside of a Wal-Mart.  Because they consistently have high quality merchandise at the lowest prices.  In fact, if more hospitals worked like Wal-Mart the problems that plague our health care system today probably wouldn’t exist.

Responding to a commenter who said that the notion that defensive medicine is a large expense is “totally false:”

Indeed.  But doctors don’t believe this, no matter what evidence you present them.

Yes, evidence is like kryptonite to doctors.

I asked Pearlstein if a doctor ran over his dog or something.  He didn’t directly respond, simply saying “Maybe you should talk to Atul [Gawande].”

Now that’s the only sensible thing he said.

How Much Protein Do You Really Need?

June 10th, 2009 by admin in Better Health Network

Tags: Food and Nutrition, Protein, RDA

Have you ever thought about how much protein you are supposed to get each day? The answer to that question is not as black and white as you may think.

The Recommended Dietary Allowance (RDA) for protein is set at 0.8 grams (g) per kilogram (kg) of body weight. In order to figure out your weight in kg, divide your weight in pounds by 2.2. So if you weigh 150 pounds (68.2 kg), you need about 55 grams of protein. You can also use 0.36 grams per pound of body weight if you don’t want to convert to kg.

The RDA is set at a level of what you need to prevent deficiency. But many researchers believe that we actually need more than that for reasons of muscle building and for optimal satiety (to keep us full).

Here are some other recommendations:

Pregnancy/lactation: 1.1 g per kg body weight (0r 0.5 grams per pound). You can use pre-pregnancy weight for the calculation. The point is you need significantly more protein when pregnant. Add 25 grams more per day if you are carrying multiples. This extra protein is especially important in the second half and third trimester. You can also use 0.55 grams per pound body weight to calculate.

Endurance athletes: 1.2-1.4 g per kg body weight (or 0.55-0.65 grams per pound). Endurance athletes often think of carbs, carbs, carbs, and they ignore protein. But you are using your muscles quite a bit and need extra protein to repair them. Endurance athletes would be runners, bikers, long distance swimming, etc.

Strength athletes: 1.6-1.7 g per kg body weight (or 0.73-0.77 grams per pound). Strength athletes are pushing their muscles to the extreme and need more protein to build and repair those muscles. But don’t skimp on carbs because your body will break down protein for energy if you don’t get enough carbs. Strength athletes are people who do a signficant amount of strength training and may lift very heavy weights.

An upper limit of protein has not really been established, but many researchers believe that the body cannot use much more than 1 gram of protein per pound body weight.

This post, How Much Protein Do You Really Need?, was originally published on Healthine.com by Brian Westphal.

Fetus Sonogram Cufflinks Make a Fashion Statement

June 10th, 2009 by Medgadget in Better Health Network

Tags: Cuff Links, Fashion, Fetal Ultrasound, Radiology, Ultrasound

Continuing this week’s streak of medical fashion coverage, we found these custom sonogram cufflinks that are advertised as a perfect present for an expecting father. It would probably be out of taste to present a cardiac patient with cufflinks featuring echocardiography scans of his mitral regurgitation or aortic insufficiency from endocarditis.

Product page: Sonogram Photo Cufflinks

(hat tip: BoingBoing)

*This blog post was originally published at Medgadget*

Is This Really How We Should Measure Physician Quality?

June 10th, 2009 by EvanFalchukJD in Better Health Network, Health Policy

Tags: Massachusetts, Misdiagnosis, Physician, Quality, Quality Measures, Screening

The OSHA-ization of health care quality continues.

A research group and a consulting firm have been hired by the state of Massachusetts to head up a new initiative to publish cost and quality information on Massachusetts doctors.  But the quality measures they will use are the same old ones we have seen for a long time.  They mean very little to most patients, and even less to doctors as a measure of how good their work may be.

To understand what I mean, look at what is being measured.

For the category “Adult Diagnostic and Preventative Care,” there are only four quality measures.  They are:

• rates of colorectal screening tests
• the number of patients in an insured population who lowered their blood pressure in a given year
• correct imaging test use for lower back pain
• rates of use of a spirometry test for COPD

The good news is Massachusetts doctors do better than the national average on these measures.  The bad news is it’s hard to say what that means as far as how good any doctor is who is measured this way.

Maybe it’s better in women’s health.  There, the four quality measures are:

• rates of breast cancer screening for women 40-69
• rates of cervical cancer screening for women 21-64
• rates of chlamydia screening for women 16-20
• rates of chlamydia screening for women 21-25

Hmm.  So if I am a 30 year-old woman trying to figure out how good my doctor is, the only thing that is being measured is whether he does a cervical cancer screening on me or not.  How about pediatrics?

• rates of well visits
• correct antibiotic use for upper respiratory infections
• follow-up with children starting medications for ADHD

I could go on, but there’s a pattern.  All of these “quality” measures are crunching medical billing data and styling it as a quality metric.  And so every metric is going to be focused on things that are easily measurable by a review of those bills.

But there’s a more disturbing pattern.  The information is simply not valuable to consumers.  Worse, I think it is deeply misleading.  A medical group that does chlamydia screenings on 100% of its patients may be good or bad – or it just may be smart enough to know that if they do the state of Massachusetts will rate them with five gold stars.  But consumers won’t be able to tell the difference. All they will know is that practice A is “high quality,” while practice B isn’t.  Some doctors are starting to sound the alarm about this.

And this is the larger point.  Our health care is organized in a way that systematically undervalues the thinking, processing and deciding aspects of medicine- the things that really matter to you when you’re a patient who is sick trying to get help.  Our system treats medicine as an assembly-line process amenable to assembly-line metrics.  But it’s not.

Doctors, like others in professions requiring judgment and reflection, need time to think, and ought to be judged by how well they do that. Since the leading cause of misdiagnosis is a failure of synthesis – a failure by the doctor to put together available information in a way that leads them to the right conclusion – our system ought to be built around helping make sure this happens each and every time.

So, instead of a web site where you could see how often a medical practice does chlamydia screenings, imagine you could find out how often doctors at a hospital got their patients the right diagnosis and treatment?  Now that would be a useful way to measure quality.

*This blog post was originally published at See First Blog*