August 28th, 2007 by Dr. Val Jones in Health Tips, Medblogger Shout Outs
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I was a bit tired today, thinking about how nice the long weekend will be. A colleague wrote me an email reminder to slow down… he said, “go home and have a nice glass of wine and relax.” I guess research supports drinking in moderation – it’s good for the heart, right?
But then, I noticed this poem in Paul Levy’s blog – and I realized that we docs could all use a little slowing down…
ENCOUNTER ON THE STAIRS
By Warner V. Slack, MD
Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the dayThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 27th, 2007 by Dr. Val Jones in Opinion, Quackery Exposed
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On the recommendation of several members of the blogosphere, I’ve been watching a new British TV Series called “The Enemies of Reason” hosted by Richard Dawkins, a noted atheist and evolutionary biologist at Oxford. The series offers a skeptical review of the claims of alternative medicine practitioners, strung together with Michael Moore-like skill, and designed to showcase the fringiest believers as they concoct wild, pseudoscientific explanations for the mechanism of action of their therapies. It is entertaining and whimsical – though Dawkins himself appears dogmatic and cold as he ultimately builds a case for science as a religion.
Although I agree with Dawkins on many points, I think his approach is somewhat superficial and unnecessarily adversarial. Instead of unmasking kookiness and labeling people as “enemies of reason,” I think it would be more interesting to ask: why are people seeking out pseudoscience? What is the deeper need that scientific medicine is not satisfying? Why are billions spent on alternative therapies? (Please note that the “alternative therapies” that Dawkins evaluates include things like quantum homeopathy, magnetic healing, angelic guidance, and other treatments that don’t have evidence-based underpinnings.)
I think that at the very heart of the matter is that we humans want to feel in control. For millennia we’ve been conjuring up bizarre theories in order to believe that we can influence our destinies and our health. Just take for example the elaborate Egyptian religious myths (health was controlled by one’s ka which required regular food and drink offerings – not to mention all the elaborate embalming rituals to influence a good afterlife). All of these rituals provided the Egyptians with a sense of control over their lives, deaths, and reincarnations. I’m not entirely sure that we humans today are much different in our desire to control our lives. We just manifest it in other ways.
Ironically, science feeds pseudoscience – the more we know, the more definitive we can be about a disease or its prognosis – and the greater the desire to buck against that. And so as we advance in medical understanding, it is not surprising that there is renewed interest in magic as a means of influencing our clinical course as the inalterable progression becomes clearer and clearer. Add to that the fact that the physician-patient relationship has been undermined by a series of unfortunate historical circumstances (the rise of health insurance middle men, decreasing reimbursements, administrative red tape, etc.) and you have a group of dissatisfied patients with chronic diseases that have predictable complications – all seeking alternative outcomes at the hands of any compassionate person who promises to give them some control back. Of course, our “quick fix” culture also gives rise to a preference for simple solutions, rather than complex (though effective) ones. Is there any wonder that snake oil has emerged as a major player in this climate?
Dawkins makes the convincing argument that certain alternative medicine practices rely entirely upon the placebo effect. If this is the case, practitioners of these therapies cannot admit that their remedies are placebos – in so doing they would undermine their potential effects. Therefore, one cannot expect a rational response from them when confronted with evidence that their strategies do not work or are implausible. For the remedies to have a perceived effect, they only need to be believed in by the recipient. The millions of dollars spent by the National Health Service and National Institutes of Health attempting to uncover the mechanism of action of implausible therapies (such as homeopathy) will not influence the millions of faithful believers who turn to such practices for their health. I suppose that once the placebo effect has been scientifically proven, only the skeptics will be convinced by the data.
In the end however, Dawkins’ “war” is not between the evidence based medicine camp and the placebo based medicine group, it’s really an internal battle that each of us faces about our own mortality. The process of coming to terms with health and disease is uniquely personal – some want to be (as Dawkins puts it) coddled, others want the cold hard facts. As for me, all I want is for patients to be able to make informed decisions, not to be misled about therapeutic safety or efficacy, and not to be guided away from known effective treatments and towards known ineffective treatments. I suspect that this is what most people want as well.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 26th, 2007 by Dr. Val Jones in Opinion
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The Wall Street Journal’s Health Blog recently featured a heated
debate about the utility of online physician ratings. On the one hand, some physicians are worried
that their reputations will be harmed by poor ratings given by a select minority
of disgruntled patients. Some have gone
so far as to ask that their patients sign an agreement not to participate in
online physician ratings. On the other
hand, many physicians view online ratings as a welcome form of constructive feedback
– believing that the ratings will further showcase their already good work.
I believe that physician ratings are not a perfect measure of
quality care, but they can offer a legitimate and enlightening patient
perspective on bedside manner, office efficiency, and communication skills. Many patients have nothing more than a health
insurance company’s list of “in network professionals” from which to choose a
provider. Online physician ratings sites
now give them a little bit more information to guide their selection process.
The potential for inappropriate or libelous postings depends
upon how carefully the ratings company reviews the comments. Open message boards may degenerate into gripe
sessions, but closely monitored ratings like those at Revolution Health, are much less risky. Even more valuable will
be the fusion of consumer ratings, peer reviews, hospital, and health
plan ratings of an individual physician all in one place. This kind of rating system is not far off.
The bottom line is that online physician ratings are here to
stay – and the best way for the ratings to fairly reflect the average patient’s
experience is to have physicians encourage all their patients to rate them
online. In that way, the rare
disgruntled patient’s review will be seen in the context of the majority of
satisfied customers. If the majority of
comments are still cautionary, then it becomes more likely that the physician
him or herself has some work to do.
Since the American Board of Medical Specialties is now
recommending demonstration of patient satisfaction as part of the recertification
process for many specialties, online physician rating sites may actually become
a great (and cost effective) way for physicians to collect such qualitative
data. So my advice to physicians is to
embrace physician ratings and make them work for you and for the benefit of
your future patients. Give the audience
some credit – they won’t judge you on one outlier comment… unless perhaps that’s
the only comment they see.
Your views and dissenting opinions are welcome.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 24th, 2007 by Dr. Val Jones in Opinion
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A new study in the American Journal of Public Health reports that teens can expect a 50% reduced risk of developing chlamydia and gonorrhea if they use condoms from their very first sexual experience. Starting to use condoms later on can certainly protect against disease – but it seems that there is something important about using them from the beginning. In other words, people who use condoms from day 1 are more likely to keep using them regularly, and are therefore less likely to contract sexually transmitted infections (STIs).
I could enter into some awkward speculation about why this is true (maybe it’s easier to get used to the sensation of wearing a condom if it’s all you’ve ever known? Maybe using condoms from the start is more likely to make it a habit?) but more importantly, a 50% reduction in sexually transmitted infections is an incredibly huge margin of success. Sadly, sex education programs for youth have had mixed success in increasing consistent condom use. This study seems to suggest that for those students who receive the message, and use condoms from their first experience, there is a much greater chance of avoiding STIs. Early sex education, therefore, may have more benefit than sex education offered after an adolescent is sexually active.
Of course, like Dr. Stryer, I feel a bit concerned about over-exposing elementary school kids to sexual messaging. But since kids are already exposed via TV, the Internet, and various other media, it behooves us to arm them with age-appropriate information at the earliest point possible. Abstinence is the only 100% guarantee of an STI-free adolescence – but since ~50% of teens are sexually active (regardless of beliefs, sex education, or parental controls) it might be best to teach them that condoms are an inextricable part of all sexual intercourse. Sexually transmitted diseases can mean the difference between fertility and infertility, long life, or earlier death for our kids. With stakes this high, consistent condom use should be our mantra.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 23rd, 2007 by Dr. Val Jones in News
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I’ve always thought that bats got a bad rap. Just because one type of bat sucks blood from unsuspecting cattle, a whole vampire legend has unfolded, spun by Hollywood executives looking to feed upon a new movie blockbuster. But what about the other 700 species of bats who are vegetarian or eat mosquitoes and other bug pests?
Well, it’s getting harder and harder to defend these cuties, especially since two very incriminating reports were released recently. Apparently, rabid bats are turning up in Illinois, and certain fruit bats are carrying an ebola-like virus in Africa. So what’s a human to do? Basically, you should avoid bats – don’t touch them or play with them. And if you encounter one in your attic, it’s best to presume that it could carry the rabies virus and call in professionals to remove it. I would be especially wary of bats in sub-saharan Africa (for all those of you who frequent that part of the globe) since the Marburg virus they carry is quite lethal.
There have been recent cases of bat-bourn rabies in Canada so although it’s really rare – it’s something to keep in mind.
Here’s to bat free living…
Addendum: just today a woman in Chicago was bitten by a rabid bat when trying to remove it from her home. Guess she didn’t read my blog. 
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
