July 24th, 2007 by Dr. Val Jones in Expert Interviews
Tags: News, Pediatrics, Podcast, Relationships, Weight Loss
2 Comments »
A new study in the journal Sociology of Education suggests that obese girls are only half as
likely to go to college as non-obese girls.
I interviewed the study’s author, Dr. Robert Crosnoe, to learn more
about the relationship of weight, self-esteem, and peer popularity to the
education of young women.
Dr. Val: What did your study reveal about the impact of
obesity on the education of young girls?
Dr. Crosnoe’s response – audio 1
Dr. Val: How does popularity figure into the equation?
Dr. Crosnoe’s response – audio 2
Dr. Val: How do you explain the gender gap – that obesity
didn’t seem to influence whether or not boys went on to college?
Dr. Crosnoe’s response – audio 3
Dr. Val: What should we do based on the study results?
Dr. Crosnoe’s response – audio 4
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 6th, 2007 by Dr. Val Jones in Expert Interviews
Tags: Addictions, News, Psychiatry
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An important new study related to Americans’ use (and abuse) of alcohol was recently published in the Archives of General Psychiatry. I caught up with Revolution Health’s addictions specialist, Bruce Phariss, MD to get his perspective on this very common, yet often disabling addiction.
Dr. Val: Is there anything surprising or new
presented in this study? If so, what is it?
Dr. Phariss: It
isn’t necessarily surprising, but it is striking that 30% of Ameicans have an
alcohol problem at some point in their lives. Alcohol problems often develop
slowly and no one “notices” that it has become a problem until well after the
fact. That’s why it takes 10 years on average for those that get treatment to
actually get the treatment. The study also highlights the fact that a huge gap
exists between those needing treatment and those receiving treatment. We’re
still not doing a very good job in the treatment community of getting the word
out there that treatment is available and that treatment
works.
Dr. Val: Why do you think that only 25% of
people with alcohol abuse problems get treatment?
Dr. Phariss: Three things: First, denial and stigma keep many “unaware” that they have a
problem. The first step in the stages of how people change behaviors is
awareness. If you don’t know you have a problem, you can’t change it. Along
this same line, if alcoholism is viewed as a moral failing instead of as a
medical condition, then good, moral people don’t think they can be alcoholics.
That’s good logic, but unfortunately, alcohol is non-discriminatory and even
good, moral people develop alcohol problems. Fighting through that
generalization of stigma is too tough for many people and they never seek
treatment or attempt to change their behavior.
Second, our cultural still
galmorizes drinking and drugging. Although the hype surrounding the many young
starlets currently in rehab centers appears to say how tough these addictions
are to kick, the overall slant is to add cache to the celebrity. It’s cool to
need rehab, it’s cool to be that out of control with alcohol and substances,
it’s almost synonymous with celebrity of a certain type. Sadly, this message
influences the behavior of many Americans, especially the under 25 crowd, who
are the most venerable to developing addictive behaviors.
Third, many people stop on their
own without treatment. Almost anyone who does find their way into treatment of
any kind (AA, treatment programs, etc.) has tried to stop on their own at least
once, maybe a hundred times. Just think of the many times you’ve heard someone
say “New Year’s Eve is my last day of drinking” or “I’m going to give up booze
for Lent and not pick it up again” or, my favorite, “I can give it up any time I
want….” In fact, some of the 75% of the people who need to deal with their
drinking do deal with it on their own. But many others need help of some kind.
Breaking down barriers to treatment — access and psychological and financial
barriers — remains the goal of the treatment community.
Dr. Val: What sorts of interventions might be
most useful (on a personal and on a national scale) to reduce alcohol abuse and
dependence?
The debate on a national level as to how to intervene to reduce alcohol
abuse and dependence is ongoing and heated at times. However, many intervention
and prevention programs focus on underage, college age and the under 25-year-old
drinkers. If you don’t a drink until age 21 you are four or five times less
likely to develop an alcohol problem than someone who drinks before the age of
21. But underage and college age drinkers are becoming more numerous, not less,
so we must be doing something wrong. A few colleges have taken an approach I
like: in addition to providing counseling, supporting AA meetings by providing
space, a few colleges have taken to trying to change the “perceived norm” about
drinking on campus. Although in fact most kids on campus do not binge drink on
a regular basis, the perception by incoming freshman is that everyone drinks
more than they do. This holds true for the guy who drinks two six packs a day
(clearly way too much)….he actually thinks that the majority of students drink
more than he does. What is a motivating emotional factor for college students:
they want to be accepted, to be a regular, normal guy or girl. If the
perception is that normal is to drink a bucket, then as a group they will be
more likely to drink heavily. A few colleges have taken the simple step of
making the student body aware that, in fact, most students do not drink to
excess. That simple step has helped to curb the trend of more and more alcohol
on campus.
Dr. Val: What’s the take-home message to be
gleaned from this study?
Dr. Phariss: The take-home message is that the medical profession has a long way to go in
de-stimatizing treatment for alcohol use disorders and that the substance abuse
treatment community remains too distant, too inaccessible and too timid in
announcing that treatment works. As the AA slogan says: “It works if you work
it, so work it, you’re worth it.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 25th, 2007 by Dr. Val Jones in Expert Interviews, News
Tags: Breast Cancer, Cancer, News, Obstetrics And Gynecology, Oncology, Research
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This is the weird correlation of the week: women who suffer with symptoms of morning sickness during their pregnancies may be less likely to develop breast cancer later on in life. A group of epidemiologists in Buffalo recently reported this finding at a scientific meeting (Society for Epidemiologic Research). No one is sure what this means, and I dare not speculate… but perhaps there’s some kind of link between a woman’s hormone levels produced during pregnancy, the nausea they cause, and the hormonal milieu that is the background for breast cancer? Or maybe this study has turned up a false association. Only time – and a lot more research – will tell. Of course, if anyone should speculate on this, it’s the breast cancer oncologists like Dr. Gluck. So I dropped him an email to ask him what he thinks.
Dr. Gluck said that first of all, the association between morning sickness and decreased breast cancer risk is relatively weak. So here’s what the numbers mean: For the average 50 year old woman, the standard risk for developing breast cancer is about 2% (one in
50). According to this study, that same woman (if she had severe morning sickness at some point during pregnancy), is about 1.4% (~30%
less).
Dr. Gluck speculates (and this is quite fascinating) that women with morning sickness are subjected to a hormonal milieu that may result in permanent alterations in their breast tissue. The breast tissue (having been exposed to surges of hormones, insulin, and changing blood pressure and blood sugar levels) might be less vulnerable to the genetic mutations that cause cancer.
We’ve known for a long time that women who have children are at lower risk for breast cancer than women who don’t… now it seems that there might be something about women who are really sick when they’re pregnant and decreased risk of breast cancer as well.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 20th, 2007 by Dr. Val Jones in Expert Interviews
Tags: Gastroenterology, News, Pharmaceuticals, Podcast, Weight Loss
2 Comments »
There has been a lot of buzz about the new diet pill,
Alli (Orlistat). Gastro Girl and Dr. Val
decided to interview the incoming president of the American College
of Gastroenterology, Dr. Brian Fennerty, about the weight loss drug. He had lots of interesting things to say –
check out these 6 podcast links:
1. Who is a good candidate for Alli?
Answer
2. What should patients know about Alli?
Answer
3. What about oily stool?
Is that a worrisome side effect?
Answer
4. What about people with IBS?
Can they take Alli?
Answer
5. Is there a link between Alli and colon cancer?
Answer
6. What’s the bottom line about Alli?
Answer
Would you like to see more podcasts with experts on this blog? Let me know!
P.S. Want to see what another expert is saying about Alli? Check out James O. Hill, PhD’s blog post.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 15th, 2007 by Dr. Val Jones in Announcements, Expert Interviews
Tags: Consumer Directed Healthcare, Grand Rounds, Hospitals, Journalism, Medical Training, News, Relationships, Research, Technology
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I was recently interviewed about my blog (and this week’s edition of Grand Rounds) by Dr. Nick Genes at Medscape. For the curious among you – here is the full Medscape interview with Nick Genes (prior to editing). It gives you a little more information about Revolution Health…
1. You’ve
been involved in writing since medical school, for various audiences. Who are
you trying to reach with your new blog, and how have you found blogging to be
different than the other media you’ve worked in?
The best part about
blogging is that it’s a dialogue rather than a monologue. I find the interactive discussions and
heartfelt responses to be touching and engaging. My previous writing was more academic because
of the medium (medical journals) but now I’ve found that blogging is where I
can really be myself – there is no team of reviewers to scrub my words. So what you read is what you get!
2. I’m
very curious about Revolution Health, your role as Senior Medical Director, and
where you think this is all going. But all revolutions have their origins
somewhere, and yours seems to start… on a yogurt farm. Please share a little
of what that was like, and maybe what early influences have given you such an
interesting background. From small towns to New York City, from theology to medicine, it
seems like you’re living a very rich life.
Yes, I guess you could
say that my origins as a revolutionary are firmly rooted in dairy farming. Although it may not be immediately apparent
how the two are related, Internet startups and cattle herding have their similarities. First, you have to wear many hats – there is
no job too small or too large. If the
cows need milking, and the electric machines are broken, you do it by hand. If a cow breaks through the fence and wanders
off into town, you lure her back with short feed. If a large batch of yogurt curdles, you’ve
got yourself a gourmet meal for your pigs… you get the drift. In a large start up, all manner of unexpected
events happen – but the trick is to handle them quickly and efficiently, and
make sure the outcome is a win-win.
As far as my other
life detours… I guess you can say that I’ve been a victim of my own
curiosity. There are so many interesting
things going on, I just can’t help but want to try them out. In the past I’ve held jobs in the following
capacities:
A protestant minister,
NYC bartender, bank spy, food critic, doctor, cartoonist, computer sales
associate, yogurt mogul, nanny, motivational speaker, biophysics researcher,
graphic designer and revolutionary medical director.
So my life has
certainly been an adventure!
3. How did you get involved with this company? Did Steve
Case find you, or know you from before — or was there an application process?
Is the mingling of medical and computer technology folks going smoothly? Is it a
mix of hospital culture vs. laid-back internet start-up culture? (Foosball and
mountain bikes, or suits and meetings?) Can you make comparisons to your time
with MedGenMed?
A friend of mine had
interviewed at Revolution Health for an executive position and thought that the
company would be a great fit for me.
When I heard who was involved (including Colin Powell, Steve Case, Carly
Fiorina) and that the goal was to create a website to help patients navigate the health care
system, I thought – gee, this sounds serious, challenging and worthwhile. So I sent in my resume, got offered an
interview, put on a bright red suit and announced that I’d heard that there was
a revolution afoot and wondered where I could sign up. They hired me that same day (May 8, 2006) and
it’s been the most exciting job I’ve had to date!
About the “mingling”-
a very interesting question. There is a
hint of Foosball/mountain bike in the mix, but I think we’re a little more hard
driving than that. Since Revolution
Health is in its start up phase, there is simply too much work to do for people
to be playing Foosball. When I started,
there were 30 employees, now there are closer to 300. We are all working long hours on cutting edge
projects that I believe will make a big difference in supporting the
physician-patient relationship, streamlining the process of healthcare delivery
and improving accessibility to the uninsured and underinsured. Revolution has attracted some of the
brightest minds in the tech industry – and they are building products I could
never have dreamed of on my own. Since I have such an unusual background,
I’m bilingual in both techie speak and
physician speak, and this helps a great deal.
Because I understand what physicians and patients need, and can translate
that for the “creatives” we can build some really meaningful tools and products
together.
My time at MedGenMed
was wonderful, primarily because Dr. George Lundberg is a dear friend and
mentor. He has done fantastic work
creating a pure platform (no pharma influence or fees for readers or authors)
for open-access publishing. He taught me
to speak my mind, follow my gut and never compromise my ethics. His book, “Severed Trust” galvanized me into
action – to do my part to improve the damaged physician-patient relationship
that is at the core of our broken system (caused by middle men, volume
pressures and decreased time with patients).
After reading his book, I wanted to do something big – so I joined a
revolution.
3. Revolution
Health has some bold ideas about improving care for its members — getting
appointments with specialists, patient advocacy in dealing with insurance, and
of course, sharing information. What’s your job entail, as medical
director? Do you think you’ll find yourself making policy decisions that
could affect, directly or indirectly, chunks of the population? Could
you find yourself in a position where some specialists are not recommended
based on their insurance? Will Revolution Health have a formulary, will it
be evidence-based — or could could care be rationed ?
My job is incredibly
challenging and fun, and I rely on both halves of my brain for much of what I
do. We have 146 medical experts most of
whom I’ve personally recruited, I’m responsible for coordinating the medical
review of all the content on our portal (so that it conforms with
evidence-based standards), I facilitate relationships with major hospital
systems (such as Columbia University Medical Center), spearhead new product
initiatives (such as Health Pages for physicians), monitor and promote our 30+
expert bloggers, participate in writing press releases, creating podcasts, radio interviews,
identifying new partnership opportunities and much more.
I do think that
Revolution Health will greatly influence vast “chunks” of the population. And this is what’s particularly exciting
about working here. We really are
building a brand new navigational system for healthcare – and this will empower
patients to take control of their health and provide them with better
information and guidance in living their best.
I believe that Revolution Health will become the new virtual medical
home for physicians and patients, just the way that AOL grew to be America’s
Internet home. You log on first to AOL
to get your email, check your news, and get plugged in before surfing the
net. You’ll log in to Revolution Health
to track your health, connect with your lifestyle coach or physician guide, get
involved with a community of others like you, or track your loved ones’ health
issues through Care Pages. This is a 20
year project, so all of our plans and programming may not be apparent yet, but
the trajectory is amazing and I wouldn’t want to be anywhere else as a
physician today.
5. What are some of your favorite posts — something that
struck a nerve with readers, or captured something you wanted to express?
Please provide links!
My absolute favorite
post is the story of how my mom, a strong patient advocate, saved my life as a
baby. She refused to accept the
misdiagnosis I was given, and continued to nag the medical team until they
realized what was wrong and took me to the O.R.
If it hadn’t been for her persistence (or the incredible skill of the
surgeon who ultimately took care of me), I wouldn’t be here today. And maybe that’s why I’m passionate about
both good medical care AND patient empowerment!
Other posts that have
been well received are true stories from my medical training days. Some are controversial (like this one about
end of life issues and my first day as a doctor),
and others are warmer reflections. But ultimately, I just share what’s on my
heart and let the audience take away what they can from it.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
