Better Health: Smart Health Commentary

Featured

Shiver Yourself Thin?

January 30th, 2011 by RyanDuBosar in Opinion, Research

Tags: ACP Internist, American College Of Physicians, BAT, Brown Adipose Tissue, Brown Fat, Domestic Indoor Winter Temperatures, Energy Expenditure, Losing Weight, Obesity, Overweight, Physiological Thermogenesis, Public Health, Ryan DuBosar, Seasonal Cold Temperatures, Thermogenic Capacity, Weight Loss

British researchers are trying to causally link raising the thermostat to obesity prevalence.

“Domestic winter indoor temperatures” appear to be rising, the researchers wrote, as is obesity. They focused on a causal link, focusing on acute and long-term effects of being comfortable in the winter.

They write: “Reduced exposure to seasonal cold may have a dual effect on energy expenditure, both minimizing the need for physiological thermogenesis and reducing thermogenic capacity. Experimental studies show a graded association between acute mild cold and human energy expenditure over the range of temperatures relevant to indoor heating trends.”

They also look at brown adipose tissue (BAT), aka “brown fat,” the type of fat that actually consumes energy instead of stores it. We all have this fat as infants, to help us regulate our body temperatures until our bodies learn to do it on their own. The researchers suggest that “increased time spent in conditions of thermal comfort can lead to a loss of BAT and reduced thermogenic capacity.”

Determining a link “may raise possibilities for novel public health strategies to address obesity,” although I shiver to think what those strategies might entail.

*This blog post was originally published at ACP Internist*

When Money Isn’t Everything To Doctors

January 29th, 2011 by KevinMD in Health Policy, Opinion

Tags: Accountable Care Organizations, ACO, BMJ, British Medical Journal, Doctor Performance, Doctors and Money, Doctors' Pay, Dr. Aaron Carroll, Dr. Kevin Pho, Fixing American Healthcare, General Medicine, Healthcare Dollars, Healthcare Policy, Healthcare Politics, Healthcare reform, How Doctors Get Paid, KevinMD, Medical Practice Dollars, More Support For Doctors, Patient-Centered Medical Homes, Pay For Performance, Physician Reimbursement, Primary Care, Punishing Doctors, Team-Based Patient Care, Time Magazine, University of Indiana

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed:

Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t think many will propose more than a 25 percent bonus. It’s also possible that the benchmarks which define success were too low and therefore didn’t improve outcomes. There’s no scientific reason to think that the recommendations weren’t appropriate, however. More likely, it’s what I’ve said before. Changing physician behavior is hard.

So if money can’t motivate doctors, what’s next? Physicians aren’t going to like what Dr. Carroll has to say. Read more »

*This blog post was originally published at KevinMD.com*

Abortion Doesn’t Cause Mental Illness

January 29th, 2011 by Peggy Polaneczky, M.D. in Opinion, Research

Tags: Abortion, Contraception, Contraceptive Needs, Dr. Peggy Polaneczky, Emotional Health, Emotional Problems, Emotional Well-Being, First-Time Mothers, Mental Health, Mental Illness, New England Journal of Medicine, New Mothers, OB/GYN, Obstetrics And Gynecology, Parenting, Psychiatry and Psychology, TBTAM, Terminated Pregnancies, The Blog That Ate Manhattan, The New York Times, Unintended Pregnancy, Unplanned Pregnancy, Young Women

Here’s yet another study showing that abortion does NOT lead to future psychiatric problems. From The New York Times:

The New England Journal of Medicine has taken on one of the pillar arguments in the abortion debate, asking whether having the procedure increases a woman’s risk of mental-health problems and concluding that it doesn’t. In fact, researchers found, having a baby brings a far higher risk.

The study, by Danish scientists (and financed in part by the Susan Thompson Buffett Foundation, which supports research on abortion rights), is the most extensive of its kind to date. It studied 365,550 Danish women who had an abortion or gave birth for the first time between 1995 and 2007. Of those, 84,620 terminated their pregnancies and 280,930 gave birth.

In the year after an abortion, 15.2 out of 1,000 sought psychiatric help (defined as admission to a hospital or clinic), which was essentially the same as the rate of that group (14.6 per 1,000) in the nine months before the abortion. In contrast, among women who went on to give birth, the rate at which they sought treatment increased to 6.7 per 1,000 after delivery from 3.9 per 1,000 before.

Why do first-time mothers have a lower overall rate of mental illness both before and after pregnancy than those who choose termination? The researchers suggest that those who have abortions are more likely to have emotional problems in the first place. Compared with the group who give birth, those who have abortions are also statistically more likely to be struggling economically, and to have a higher rate of unintended pregnancies.

And why do first-time mothers seem to nearly double their risk in the year after giving birth? That is likely to have something to do with the hormonal changes, decreased sleep, and increased stress of parenting, which women who terminate do not experience.

Can we please talk about something else? Like maybe how to help these young women with the issues and unmet contraceptive needs that led to unplanned pregnancy in the first place?

*This blog post was originally published at The Blog That Ate Manhattan*

When A Surgeon’s Note Must Begin With “I Certify…”

January 28th, 2011 by DrWes in Better Health Network, Opinion

Tags: Claims For Medical Payment, Doctor's Certification, Dr. Wes Fisher, General Surgery, Medical Services Disclaimer, Medically Necessary Treatment, Operative Note, Payment For Medical Services

You know it’s bad when the attending surgeon has to write this at the beginning of his operative note:

“I certify that the services for which payment is claimed were medically necessary and that no qualified resident was available to perform the services.”

So there you have it.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

FDA Reports On Association Of Breast Implants And A Rare Form Of Cancer

January 28th, 2011 by Elaine Schattner, M.D. in News, Opinion

Tags: ALCL, Anaplastic Large Cell Lymphoma, Breast Cancer, Breast Implants, Cancer Treatment, Cosmetic Surgery, Dr. Elaine Schattner, FDA, Food and Drug Administration, Informed Consent, Lymphoma, Mastectomy, Medical Lessons, Oncology, Plastic and Reconstructive Surgery, Women's Health

The FDA [has] issued an alert about a pos­sible link between breast implants — saline or sil­icone — and a rare form of lym­phoma called anaplastic large cell lym­phoma (ALCL). These lym­phoma cases are exceed­ingly rare, but the asso­ci­ation appears to be significant.

The FDA iden­tified a total of approx­i­mately 60 ALCL cases in asso­ci­ation with implants, worldwide. Of these, 34 were iden­tified by review of pub­lished medical lit­er­ature from 1997 to May, 2010; the others were reported by implant man­u­fac­turers and other sources. The agency esti­mates the number of women worldwide with breast implants is between five and 10 million. These numbers translate to between six and 12 ALCL cases in the breast, per million women with breast implants, assessed over 13 years or so.

In women who don’t have implants, ALCL is an infre­quent tumor, affecting approx­i­mately one in 500,000 women is the U.S. per year. This form of lym­phoma — a malig­nancy of lym­pho­cytes, a kind of white blood cell — can arise almost any­where in the body. But ALCL cases arising in the breast are unusual. The FDA reports that roughly three in 100,000,000 women are diag­nosed with ALCL in the breast per year in the U.S.

These are very small numbers. Still, the finding of ALCL tumors by the implant cap­sules is highly sug­gestive. Almost all of the implant-associated ALCL cases were T-cell type, whereas most breast lym­phomas are of B-cell type. The lym­phomas arose in women with both sil­icone and saline-type implants, and in women with implants placed for pur­poses or aug­men­tation and for recon­struction after mastectomy. Read more »

*This blog post was originally published at Medical Lessons*