Better Health: Smart Health Commentary

Featured

Is It Tacky To Blog About Celebrities?

January 29th, 2008 by Dr. Val Jones in Celebrity Interviews, Opinion

Tags: Cancer, News

I’ve been wrestling for some time about whether or not it’s appropriate to blog about celebrity news (particularly health issues). On the one hand it seems like an invasion of privacy – what gives me the right to speculate on their health? Shouldn’t I leave the poor celebs their privacy, hen pecked as they are by the media? Yet, on the other hand, when the country is abuzz about an important health issue, there is a “teachable moment” in which doctors can perhaps influence patient lifestyle choices for the better, or encourage some preventive screening if needed.

I did decide to blog about Heath Ledger’s sad passing, and thought it might be important for people to know about autopsies and how they work. Although I had mixed feelings about the post, it was one of my most popular in a long time. So that led me to conclude that I shouldn’t shy away from celebrity news. Nonetheless, I confessed my squeamishness to a friend of mine, and his answer was so insightful that I thought I’d share it with you:

The other way I think
of it is this:  health is really personal.  Almost everyone who writes about
health does it from the perspective of a personal story – the most common health
blogs are health blogs by patients / survivors about their own experience, the
next most common is by doctors talking about patients.  You could have written
yesterday’s entry [Heath Ledger] about the death of a friend or a patient under unknown
circumstances.  The problem is that a blog that begins every time with, “I had a
friend who had ALS…” is very concrete to you – you know the friend – but not
concrete to the reader – they don’t know your friend.  The use of celebrities
creates a shared vocabulary – people we all “know” that we can converse about.

Put another way, in an
era before blogs, where health conversations were held around kitchen tables and
over the back fence, there was probably less discussion of celebrity health
because the discussants all shared a common stock of people about whom to chat:
Doris down the street has breast cancer; Trudy two doors down has a pregnant
teen; Francine on Maple Street has a mom with Alzheimer’s.  The internet and
blogs are an attempt to create a similar conversation with people all over the
country – the planet – who don’t know any people in common.  Celebrities are the
only folks we can all discuss, because they are the only folks we all
know.

What do you think? Is it ok to blog about celebrities? Should I do more of it? Less of it? Does my friend have a point? Please share your thoughts.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Dr. Val Talks to iHealthBeat about Consumer Driven Healthcare

January 26th, 2008 by Dr. Val Jones in Health Policy, Opinion

Tags: Consumer Directed Healthcare, Medicare, News, Relationships, Research

As patients increasingly turn to the Internet for health care information and online tools to manage their health, many companies, both new and old, are stepping up to meet the consumer demand.

It is still too early to tell which companies will be successful and how the Internet-savvy health care consumer will transform the patient-physician relationship, but the trend has captured the interest of many health care insiders.

Val Jones, senior medical director of Revolution Health and author of a blog called “Dr. Val and the Voice of Reason,” spoke to iHealthBeat about the online health care market, physician concerns about patients relying on the Internet and the role of medical blogs.

…

A recent Harris Interactive survey found that the percentage of U.S. adults who looked for health care information online increased from 72% in 2005 to 84% in 2007. Why do you think more and more consumers are turning to the Internet for health information?

I think it’s partially because more and more consumers are turning to the Internet for information, period. Online information is incredibly convenient, served up lightning fast and has revolutionized how we research everything from buying toasters to finding a doctor. Of course, health is much more serious and complicated than purchasing products, so consumers should be very wary of the source of their health information.

Do you see a generational divide in the people using Revolution Health?

We primarily appeal to everyone between the ages of 20 and 60, though women conduct more health searches than men. The only age gaps are related to the medical subjects being researched. Clearly, not too many 20-somethings are reading about menopause, and not too many 50-year-olds are reading about college stress. Otherwise, all of our community tools and groups are fair game for people of any age. We have 60-year-olds blogging and enjoying discussion groups, and 20-year-olds posting forum questions too. It’s wonderful to see the generations interacting online and learning from one another.

New York orthopedist Scott Haig in November wrote an essay in Time Magazine complaining about patients who research their symptoms, illnesses and doctors online before seeking treatment. What are the downsides to patients searching for health care information online?

I think Dr. Haig’s essay has been somewhat misinterpreted because he was focusing on a specific patient with a serious disorder. My favorite quote from Dr. Haig’s article is that “the role of the expert is to know what to ignore.” I think the major downside for patients searching for health information online is that it can be difficult to figure out what’s contextually relevant to them. Aside from that, the next major downside is that there are snake-oil salesmen out there preying on the frustrations that we all have about our broken health care system and promising “miracle cures” and fueling mistrust in doctors.

What can be done to ease concerns from physicians, like Haig, about consumers relying on the Internet for health information?

Educated patients are a pleasure to work with, but misinformed patients require lots of extra help. The hours we spend every week dispelling urban legends and Internet-fueled medical myths is really mind-boggling. Physicians are naturally protective of their patients and don’t want them to be duped or misled.

From Google to Microsoft, companies are beginning to recognize an opportunity in the online health care market. Is there enough room for all of these companies? What will make successful ventures stand out from the rest of the pack?

There’s as much room as consumer demand will fuel. However, only the largest and most innovative companies will ultimately survive long term. While we’re all waiting for the government to create standards for health information and the creation of interoperability rules, successful companies will meet the needs of today’s consumer. Small but practical tools and innovations will keep the companies solvent while we work toward the holy grail of a common health information platform for all the stakeholders.

Medical blogs seem to have taken off in recent years. Who do you think the intended audience is?

Actually, while there are an estimated 70 million blogs out there, only a few hundred doctors are blogging. That’s a huge discrepancy, and I don’t think we’re even at the beginning of the wave of medical blogging that will inevitably occur as doctors enter the Web 2.0 world. The first pioneers of the medical blogosphere are writing mostly for their peers, though patients find their blogs very engaging and read them as well. Very few medical bloggers write specifically for consumers.

What are your predictions for the online health care market in 2008 and beyond?

With decreasing access and increasing patient loads, I think we’re going to see the consumer-driven health care movement take center stage. Patients are going to need to “do it themselves” a lot of the time (meaning manage their own health information, teach themselves about disease management and make financial plans to take care of their own needs if the government cannot afford to do so).

Another trend I have my eye on is the retainer medicine movement. As primary care physicians continue to be squeezed out of existence by decreasing Medicare reimbursements, they are beginning to join an “off-the-grid” group of providers who simply do not accept insurance.

As more PCPs create retainer practices, I think IT solutions will really take off. Online tools that simplify their practices and speed up their patient communication will be welcomed and encouraged.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Is It Hip To Be Fat?

January 22nd, 2008 by Dr. Val Jones in Opinion

Tags: News, Weight Loss, Women's Health

The New York Times reported on a growing number of bloggers who identify themselves as “fat” and are proud of it. Their message is clear: accept yourself as you are, be proud of your body, and don’t feel forced to conform to the “thin is in” crowd. The Times continues:

Smart, sassy and irreverent, bloggers with names like Big Fat Deal, FatChicksRule and Fatgrrl (“Now with 50 percent more fat!”) buck anti-obesity sentiment. They celebrate their full figures and call on readers to accept their bodies, quit dieting and get on with life.

The message from the fatosphere is not just that big is beautiful. Many of the bloggers dismiss the “obesity epidemic” as hysteria. They argue that Americans are not that much larger than they used to be and that being fat in and of itself is not necessarily bad for you.

And they reject a core belief that many Americans, including overweight ones, hold dear: that all a fat person needs to do to be thin is exercise more and eat less.

What do I make of this? I think that the so-called fatosphere has hit on some important issues: discrimination against the obese, media pressures to be rail thin, and excessive yo-yo dieting are all unfortunate and perhaps dangerous aspects of our culture. Self-esteem can be rapidly eroded by unrealistic beauty ideals, and young women are particularly vulnerable. I whole heartedly agree with the fatosphere’s rage against the collateral damage of anorexic values. But I also think that the fatosphere goes too far in arguing that obesity is not a health problem and that some people are unable to lose weight and should stop trying.

First of all, there is no scientific doubt that obesity contributes to increasing type 2 diabetes and heart disease rates. Now, it’s true that some people’s bodies can handle extra fat without becoming diabetic or perhaps having a heart attack, but why take the risk?

Second, I agree that the jury is still out regarding how “dangerous” being overweight is (as opposed to being obese), and that people with BMIs <30 may indeed be physically fit with no obvious increases in morbidity and mortality. Yes, there is one controversial study that suggests that a little extra fat may actually be protective. But let’s not exaggerate those findings. It was a “little extra fat,” (i.e. being overweight) not obesity.

Third, I don’t believe that people are “doomed” to be obese. The National Weight Control Registry keeps a running list of thousands of Americans who have lost over 30 pounds of fat and kept that weight off for at least 5 years. Long term weight reduction is possible, and believing that it IS possible is important for success. So what do these successful folks have in common? No surprise here: long term, consistent calorie reduction and regular physical activity.

I have been cheering on my friend and blogger, Fat Doctor, as she works towards getting her weight out of the obese range. I do think that her voice is very much needed in the fatosphere: she acknowledges that weight loss is very difficult, she is honest about her struggles, she does not support discrimination against the obese or the pursuit of excessive thinness, but she knows that she must lose weight for her health, and she is getting medical help to achieve her goals.

If any of you out there would like to follow in Fat Doctor’s footsteps, there’s a weight loss group right here at Revolution Health (led by yours truly – and yes, I have some weight to lose!) that may help to get you back on track with regular exercise and healthy eating. Sixty percent of Americans are overweight or obese, which makes chubbiness pretty trendy. But we are not doomed… we can reverse this trend one person at a time. Let’s do it!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

VH1’s Celebrity Rehab Reality Show: Unlikely to be Addicting

January 11th, 2008 by Dr. Val Jones in Opinion

Tags: Illicit Drugs, News, Parenting, Psychiatry

Last night I watched the premier of VH1’s new “Celebrity Rehab” reality show with Dr. Drew Pinsky, an M.D. and popular TV and radio personality. Before turning on the TV, I had my own reservations about making a spectacle out of alcohol and drug addiction. But I hoped that the show would help to unglamorize the Hollywood drug culture and dissuade young men and women from idolizing bad behavior. As a physician who helped run a detox unit in New York City, I was also curious to see whether or not this “rehab” resembled real-world drug rehabilitation.

Overall, I was sorely disappointed. The only realistic part of the show involved actor Jeff Conaway (of “Grease” and “Taxi” fame), who was the most impaired and ill of the group. His speech and behaviors were typical of a man so wracked by drug and alcohol addiction that he needed a wheelchair for mobility. It was tragic to see him in such a self-destructive state, and witnessing his condition was a real wake-up call for anyone considering starting down that path. As for the rest of the stars, they seemed to be more interested in getting attention from the camera than turning their lives around and breaking their addictive behaviors.

The good

“Celebrity Rehab” may have some “shock value,” as it offers viewers some footage of individuals whose addictions have destroyed their lives. Although Jeff Conaway’s situation is certainly tragic and unappealing, the other stars still maintain some degree of  “coolness” -which may be counterproductive for a young audience.

The bad

Overall, the dialogue is quite dull – which comes as no surprise since the individuals being videotaped were often inebriated or high on cocaine. The desire for true change does not come through in the celebrity stories, as best evidenced by a conversation between Dr. Drew and former professional wrestler Chyna (aka Joan Marie Laurer). Dr. Drew asks Chyna why she has come to “Celebrity Rehab,” and she responds with a shrug and says: “I don’t know.” Not compelling television.

I had the feeling that empathetic counseling is not Dr. Drew’s forte. In his attempt to show tough love mixed with detailed history taking, he comes off as aloof and uncaring. He is neither believable nor inspirational as a change agent. This disconnect makes it hard to believe that “Celebrity Rehab” is going to turn anyone’s life around.

Of course, the plush set, the comfortable celebrity quarters and the trendy clothing bear no resemblance to real drug rehab centers, where facilities are bare-bones and clinical and all patients wear standard uniforms. The lack of case managers, nursing staff and therapists was also notable – as the normal team approach was spun unconvincingly as a one-man Dr. Drew show. And of course, inpatient drug rehabilitation centers in the real world are NEVER co-ed.

The ugly

Some of the footage was so clearly contrived as to be annoying. Provocative pseudo “conflicts” were created in an attempt to maintain viewer interest. At one point, porn star (and attention-grabbing yet unrealistic 2003 California gubernatorial candidate) Mary Carey makes a fuss about having her dildos confiscated and then asks fellow patient Seth Binzer (lead singer of the rap-rock band Crazy Town) if he’ll have sex with her. This type of interaction really devalues the show and further undermines the credibility of the ongoing rehabilitation. Parents should wonder if exposure to this sort of material is more of a harm than a help to their tweens and teens.

In the final analysis, “Celebrity Rehab” has all the makings of a failure “me-too” reality show, relying on sensationalism to lure viewers. Recycled reality TV celebrities prance about the show in low-cut dresses while Dr. Drew makes uninsightful therapeutic gestures in a rehabilitation setting that’s not designed to truly affect change. I believe that drug and alcohol addiction deserves a more sincere and thoughtful analysis — something that an experienced documentary producer could achieve more effectively. I fear that the screenwriter’s strike will result in even more poor quality reality shows in the near term.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Healthcare Red Tape Of The Week: PQRI

January 3rd, 2008 by Dr. Val Jones in Opinion

Tags: CMS, Dr. Val Jones, Happy Hospitalist, healthcare, Internal Medicine, Physician Quality Reporting Initiative, PQRI, Quality

How has the Physician Quality Reporting Initiative (PQRI) been going? Some insights are offered from an internist in the trenches, (the only 1 of 20 physicians in his practice who was able to figure out how to comply with the PQRI rules), The Happy Hospitalist:

I found out today many docs may not have qualified because of the way the government PQRI computers crunched the data (imagine that). You see, if my quality indicator was for antiplatelet use in stroke, and I submitted to CMS stroke as the 4th ICD code, along with three comorbid conditions ( like DM, COPD, CAD), unless I submitted stroke as diagnosis #1, PQRI would reject my submission. So CMS accepts your E&M code with stroke listed as the 4th diagnosis to get paid, but when that claim makes it to the PQRI folks, because stroke was diagnosis #4 and not diagnosis#1, PQRI would reject the submission and doctors all over this country were dinged for not reporting on 80% of qualified patients…

I also found out that PQRI indicator #36 calls for rehab ordered for all “intracranial” hemorrhage. During my meeting today I found out that the only ICD codes linked to this quality indicator are “intracerebral” hemorrhage. Sub dural bleeds, which are intracranial, are excluded. So are subarachnoids. They have problems even defining what they are trying to measure.