February 24th, 2008 by Dr. Val Jones in Book Reviews, Health Policy
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Dr. Richard Fogoros wrote a fascinating book called Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare. In the first two thirds of the book, he explains why our healthcare system is broken, and describes its dysfunction with exasperating accuracy.
One of the most important concepts in his book is that of “covert rationing.” As Dr. Rich explains, we Americans cling to two fundamental beliefs:
1. Everything that can be done for a sick person must be done, as long as there’s some small hope of beneficial outcome. (The belief in no spending limits).
2. Healthcare is an entitlement for all Americans. (The belief in universal access).
Since science and technology have provided us with incredible (and expensive) advances over the last several decades, doing all that’s possible for all who are sick is simply not financially possible. However, Americans are fundamentally opposed to rationing care, so the rationing occurs covertly, including cost-savings achieved by people being uninsured, by certain chemo drugs not being covered by Medicare, by physicians being coerced by HMOs to ration care, and countless other subtle and capricious ways.
Covert rationing is a little recognized but fundamental flaw of the current healthcare system, and it results in untold inequities in care. Dr. Rich believes that a fair system requires open rationing of resources, with rules agreed upon by tax payers. Would you agree?
In my next post I’ll discuss Dr. Rich’s thoughts on what’s really driving up healthcare costs…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 22nd, 2008 by Dr. Val Jones in Expert Interviews, News
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Some Hollywood celebrities are up in arms after having been notified of their exposure to hepatitis A through an infected bartender at a trendy New York City club. Those who come in contact with a known virus carrier may prevent infection if they’re vaccinated early. Hepatitis A causes less severe liver disease than its blood-bourne cousin, hepatitis C, but it’s still a formidable foe. (For more information about hepatitis A and its symptoms, check out this article.)
I interviewed Revolution Health consultant and world-renowned liver expert, Dr. Emmet Keeffe, about this outbreak:
Dr. Val: What is the likelihood that people could catch hepatitis A from an infected bartender?
Dr. Keeffe: The hepatitis A virus is transmitted between persons by the fecal-oral route (think unwashed hands after a bathroom break, or drinking water that has come in contact with human sewage). Also this particular virus is very hardy and can live on counter tops and surfaces outside the body for longer than many viruses. Because hepatitis A is found in very high concentrations in an infected persons’ stool, a tiny bit of stool on the hands actually contains large amounts of the virus and can therefore be quite infectious. Although previous outbreaks have primarily been associated with food handlers, there is no reason why a bartender might not also spread hepatitis A virus.
Dr. Val: Yuck. Would a vaccine be effective in preventing hepatitis A after someone’s already been exposed? How quickly after exposure should one get the vaccine?
Dr. Keeffe: The standard recommendation for individuals potentially exposed to hepatitis A is passive immunization using immune globulin administered within 2 weeks of exposure, which is 85% effective in protecting against illness. This is the recommendation for household or sexual exposure, but not generally recommended for “common source outbreaks” (like exposure to food handlers or bartenders), which are usually recognized only after they are well into their course. However, with early recognition, such as the NY case, immune globulin may make good sense. After hepatitis A vaccination, protective levels of antibodies to hepatitis A virus do not appear until 2-4 weeks after vaccination. Thus, active immunization with hepatitis A is used for preexposure prophyaxis, such as in international travelers to areas where hepatitis A is common, but not for postexposure prophylaxis.
Dr. Val: What is the hepatitis A vaccine exactly?
Dr. Keeffe: Hepatitis A vaccine is an injection, which is administered at baseline followed by a booster in 6 to 18 months. Two relatively similar and effective vaccines are licensed in the United States: Havrix and Vaqta.
Dr. Val: What should the bartender do if he has hepatitis A? Can he still work? When can he come back to work?
Dr. Keeffe: To protect the public, the bartender should not work until he has fully recovered. He is most infectious during the late incubation and early illness stage, when excretion of hepatitis A virus in feces is the highest.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 21st, 2008 by Dr. Val Jones in Uncategorized
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Sorry folks, I haven’t been blogging as frequently this week because I’m in the process of finishing up two great books:
1. Fixing American Healthcare, by Richard Fogoros, MD
2. When Good People Have Affairs: Inside the Hearts and Minds of People in Two Relationships, by Mira Kirshenbaum
The first book was sent to me by the author, a fellow blogger and kindred spirit. I have to tell you that Dr. Rich’s description of our dysfunctional health care system (and his explanation of how we got where we are) is crystal clear, compelling, and painfully accurate. If you like feeling righteous indignation, than hurry on over to his site and get the book! I’m hoping to summarize some of his key points here in this blog – but it may be challenging to explain things any better than he does…
The second book was sent to me by Mira’s publisher, who’d like me to read it and comment on the book for a potential back cover testimonial. So far it’s terrific, though I might relate to it a little more if I were personally struggling with a marital affair – and thank goodness that’s not one of Dr. Val’s issues. I’ll ask Mira if I can summarize some key thoughts from her book as well…
Thanks for your patience, o faithful readers. Lots of good discussion topics ahead!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 20th, 2008 by Dr. Val Jones in Expert Interviews
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I read a recent article about an ongoing debate in Great Britain: whether or not to include fluoride in the water supply. In the United States, we began adding tiny amounts of this naturally occurring substance to the water supplies over 60 years ago. In fact, as much as 75% of the drinking water in the US is artificially fluoridated, and the purpose is to improve the health of our teeth. I was wondering what the research shows about the need for additional fluoride in our diet, and if there are any risks posed by fluoridation of our water supplies. I asked Revolution Health dental expert, Dr. Andres Garcia, what he thought about this issue. Here are his thoughts:
Dr. Val: Is there compelling evidence that adding fluoride to our water system is beneficial for teeth?
Dr. Garcia: Numerous studies by the ADA have shown that a decrease in cavity exposures of 20-40% can be expected when water is fluoridated in communities. In 1999, the CDC listed fluoride as one of the ten great public health achievements of the 20th century. The current goal by the USPHS (U.S. Department of Health and Human Services) is to have 75% of the drinking water in the U.S. fluoridated to optimum levels by 2010.
Dr. Val: how do people get the benefits from fluoridated water exactly?
Dr. Garcia:You get the benefits from drinking fluoridated water in two ways, systemically and topically. Systemically, small children ingest fluoride as the teeth are forming. The fluoride is incorporated into the enamel and causes the enamel to be stronger and more resistant to decay. After the teeth have erupted, fluoride has a topical action. Fluoride from toothpaste, water, or other sources bathe the teeth, and the fluoride ions reverse tooth damage from decay and harden the enamel to resist further decay. The optimum fluoride intake is a combination of ingestion of fluoride before the teeth erupt and subsequent topical application after eruption.
Dr. Val: Is there any risk associated with too much fluoride?
Dr. Garcia: Fluoride toxicity can occur if people are exposed to high concentrations of the substance over long periods of time, though the water supply is closely monitored to ensure that the concentrations are well within acceptable limits. Fluoride toxicity is called “fluorosis.” If toxic amounts of fluoride are ingested when a child is young, the teeth will be weakened when they form. (This is counter intuitive because small amounts of fluoride strengthen the teeth, but large amounts weaken the teeth.) When the teeth erupt into the mouth, the enamel is very thin and breaks easily. The teeth are also prone to cavities. They will have a brown “mottled” appearance. Bones are also susceptible to fluorosis. Excess fluoride is stored in the bone, and the bones can be brittle and more prone to fractures.
Dr. Val: So if small amounts of fluoride are good for us, why are the British so hesitant to add it to their water supplies?
Dr. Garcia: Many European countries, such as Britain, have been slow to adopt fluoride supplementation due to high levels of other natural sources providing an adequate amount of fluoride in the diet. Tea has been shown to contain from 1ppm to 6.5ppm fluoride concentration. In the U.S., the recommended concentration of fluoride is 1.0-1.2ppm/day as recommended by the USPHS. So regular tea drinkers get enough fluoride naturally. There is also strong anti-fluoride opposition in the public with fears of “forced immunization” and possible adverse health side effects.
Dr. Val: Should people living in areas where the water supply is not fluoridated take additional steps to get more fluoride?
Dr. Garcia: Areas that lack fluoridated drinking water should seek other sources for optimal fluoride intake. The best way is to contact your dentist or pediatrician. Supplements in the form of pills or topical gels can be prescribed to supplement a lack of fluoride. Care must be taken to avoid over supplementation. If the community receives its drinking water from an underground source, they may already be ingesting a higher level of fluoride than is necessary. Toothpaste is also a good source of fluoride. Care must be used in infants as they swallow the toothpaste unknowingly.
Dr. Val: What about those additional fluoride treatments that I had as a child? Are those really necessary?
Dr. Garica: Fluoride should only be used in individuals at high risk for cavities. Kids with braces, a high caries rate, adults with xerostomia, these are ideal candidates for fluoride use. I have all patients learn about fluoride and they make a choice for themselves. I personally will not use anything stronger than an OTC toothpaste for myself and family. Fluoride is a known toxic substance that irreversibly binds to the hard tissues of the body. I am wary of the long term effects of any non essential diet supplement. It is equal to taking antibiotics constantly to stave off a possible infection. Good oral hygiene will keep an individual cavity free. Only in rare cases is someone genetically predisposed to cavities. It is usually a consequence of diet (refined foods) and poor oral hygiene that causes the decay.
For more information, check out Revolution Health’s Dental Health Center
.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 18th, 2008 by Dr. Val Jones in News
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As an animal lover, I was saddened to read that little brown bats are dying in droves in New York State. It appears to be related to warmer temperatures, causing a fungal overgrowth in the caves, which is making them sick. In addition, the poor little creatures wake up from their hibernation early, only to find that there are no insects to eat yet. They burn through the last bits of winter fat looking for their first meal, and end up dying of starvation.
In our delicate ecosystem, the loss of the bat population is a boon for mosquitoes that can spread the West Nile Virus to humans. So although warmer winters may seem like a welcome change, there are other animals who don’t adapt so well. So this summer if the extra mosquito bites drive you batty – you’ll know why.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
