September 7th, 2009 by Shadowfax in Better Health Network, Quackery Exposed, True Stories
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I saw one of the most disturbing things of my career recently — and that is really saying something.
This was a young woman, barely out of her teens, who presented with a tumor in her distal femur, by the knee. This was not a new diagnosis — it had first been noted in January or so, and diagnosed as a Primary B-Cell Lymphoma. By now, the tumor was absolutely huge, and she came to the ER in agonizing pain. Her physical exam was just amazing. The poor thing’s knee (or more precisely, the area just above the knee) was entirely consumed by this massive, hard, immobile mass about the size of a soccer ball. She could not move the knee; it was frozen in a mid-flexed position. She hadn’t been able to walk for months. The lower leg was swollen and red due to blood clots, and the worst of the pain she was having seemed due to compression of the nerves passing behind the knee. It was like something you see out of the third world, or historic medical textbooks. I have never seen its like before.
So we got her pain managed, of course, and I sat down to talk to her and her family.
What I learned was even more amazing. The patient had been seen by the finest oncologists in the region upon diagnosis. They had all recommended the standard treatment of a combined regimen of chemotherapy and radiation. She had, however, steadfastly refused this treatment. She preferred, she said, the “Gerson Protocol.” This is, she continued, “a way for the body to heal itself with a combination of detoxification and boosting the immune system.”
In a less grave situation I might have laughed and asked “So how’s that working for ya?” As it was, the tears from her only partially-controlled pain took any humor out of the situation. She was very frustrated that the Gerson therapy wasn’t working yet, but she did not perceive this as a failure of the treatment. Her theory was that the severity of her uncontrolled pain was keeping her immune system suppressed and preventing it from working. If, she hoped, she could just get her pain under control, she would finally start to get better.
I spent a lot of time with this young lady. Listening as well as explaining. She was dead set against chemo, which to her mind was equated with the “toxins” which had caused her cancer in the first place. She wrote off the oncologists as pushing chemo “because that’s all they know how to do, and it never works.” She had, in fact, burnt all the bridges with the various oncologists who had treated her, and was now left with only a pain specialist and a primary care doctor trying to do what little they could for her. She was equally frustrated by doctors in general, who “won’t do anything to help me.”
I could see why she felt that way; when a patient refuses the only possible effective treatment, there is not really much we can do to help her.
I did what I could. I talked to both her doctors, and I called a new oncologist. The oncologist, a wonderful man, promised to make time to see her in his clinic, even fully forewarned of the “baggage” she would be bringing with her. She was happy to receive the referral, though I warned her that the new oncologist would be recommending more-or-less standard treatments. Ultimately, she went home and I was left to reflect on the futility of the situation and the absolute wickedness of the charlatans and hucksters out there who promote this sort of thinking. From the late Dr Gerson, to his modern-day counterparts Andrew Wakefield and Jenny McCarthy.
Most woo is harmless — but that’s because most woo is directed at chronic, ill-defined, or otherwise incurable conditions. Think chronic fatigue or fibromyalgia. Wave a magnet at somebody, get them to do a lot of enemas and go on a special diet, and you get to write a book and go on Oprah and collect a lot of money. If the subjects of the “magical thinking medicine” think they are better from the intervention, then so much the better.
But the really pernicious thing about allowing fantasy medical theories and treatments into the mainstream is that when they gain enough credence among the masses, they will tend to be used in place of real medical treatments that work. Like vaccines. Even the anti-vaxxers have a limited and indirect harm — of the many thousands of children who go unvaccinated, only a very few get measles and even fewer die. It’s a real harm, but one which is easy to miss if you’re not affected personally. But when woo supplants real medicine against lethal diseases that actually have effective treatments, the harm is so much more severe and so apparent that it cannot be left unrecognized. Because of the practitioners of “alternative” medical treatments who irresponsibly and dishonestly teach people to distrust medicine and embrace unscientific treatments, this young woman is enduring incalculable pain, and may well lose her life.
It’s sad, and it’s an outrage.
*This blog post was originally published at Movin' Meat*
September 7th, 2009 by Happy Hospitalist in Better Health Network, Health Policy
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The time has come to change the rules. As you know the current insurance market is unsustainable. Whether you’re talking about The Medicare National Bank or your Blue Cross, they are all doomed for failure. Why? Because they treat everyone (group plans) the same . And as a result, the incentive towards health has been lost.
What if it wasn’t like that? What if your cost of insurance was 1/10 as much? What if you only paid $1000 a year in insurance, and carried an income based high deductible health policy? What if you were required to take care of the oil changes while your insurance, an affordable insurance, was there to protect you from disaster. An insurance you bought in the open market.
Is all this possible in the current insurance market? Not even close. If you are lucky enough to be employed by a big corporation, you are lucky enough to have deep premium discounts and a large population to spread the risk. If you work for a small business or are a small businessman, you are just one major illness away from catastrophic premium increases. Should you or one of your employees get sick, you’re all screwed.
If three of Happy’s hospitalists suddenly became gravely ill with H1N1 and were left on the ventilator for weeks and accrued hundreds of thousands, perhaps millions of dollars of health care bills, the cost of my premiums would rise dramatically, as a consequence of the large risk in a small pool of people, Happy’s private hospitalist group. While big business is able to spread that risk over hundreds, sometimes thousands of employees, they too are finding that they can’t keep up with the cost of health care inflation.
Why? Why does it have to be so difficult? When people are put in control of their health care dollars, they have a skin in the game that can’t be appreciated by the third party insurance model. Few people realize that the $12,000 in premiums their employer is paying, on their behalf, is $12,000 that is coming out of their pocket.
Many liberals want to claim that middle class wages were stagnant during the Bush years. Hardly, when you account for the health care premiums their employers paid on their behalf, the numbers don’t look so bad. These are stealth wages, wages which might as well be cash in your pocket.
Unfortunately, the current rules of the land have created a completely irrational playing field. Why should my choices be limited to what my employer offers or what my state says is right for me? Why should I be straddled with massive rises in insurance premiums because three of Happy’s partners had an unlucky run in with a virus? It shouldn’t have to be that way.
That’s why I see market choice and responsibility as the way out of this fiscal disaster. If premiums have doubled in the last 10 years to $12,000, how many businesses big and small can afford $25,000 in ten more years? The answer is almost none. Obama’s proposals do nothing to address this factor. The solution is not more insurance. The solution is not Universal insurance. The solution is to change the rules of the game. Rules your government created. Rules which brought us where we are today. The current insurance model does not work because our insurance has become an inflated currency of trade. A currency which is not allowed to follow the rules of supply and demand. Look only to the expansion of health care jobs in the worst recession in over 50 years and ask yourself how that is possible. And ask yourself if that is sustainable.
I do not want to be paying $25,000 a year a decade from now. $25,000 a year for taking care of myself and doing what’s right for my body.
- Don’t smoke,
- Engage in 3 1/2 hours a week of exercise.
- Eat a diet high in fruits and vegetables and low in read meat
- Don’t become obese (BMI >30)
If you do these four lifestyle actions, your odds of falling ill with one of these top four life changing or life ending diseases is slashed by 80%. That is an amazing fact. To a major degree you have the ability to decide your destiny of health by the actions you choose.
That’s the insurance pool I want to be a part of. Read more »
*This blog post was originally published at A Happy Hospitalist*
September 7th, 2009 by Toni Brayer, M.D. in Better Health Network, News
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Finally, a study that many women can like. The British Medical Journal published a study out of Denmark that looked at the association between thigh circumference and the incident of cardiovascular disease and mortality. Why anyone would even think of thigh circumference being of importance is beyond me, but the Danes seem to think it was important. They found people with thin thighs had more risk of developing heart disease or premature death.
The study looked at 1436 men and 1380 women and examined them for height, weight, hip, thigh and waist circumference. The results showed that small thigh circumference (below 60cm or 23 inches) was associated with more cardiovascular disease and mortality. They did not find the same association with waist size and the findings were independent of percentage body fat mass or obesity. Small thighs were a disadvantage to health and survival for both sexes.
Twenty three inches is not a very small thigh, and in fact, more than half of the men and women aged 35-65 have thigh circumferences below that size. Maybe it has to do with muscle mass (less exercise, less mass). I can’t imagine any other reason this strange finding should occur.
I think this study will probably not hold up to analysis and further investigation. There are just too many variables and I don’t think people with large thighs should feel they are immune to heart disease.
But the idea that, for once…the skinny models and actresses don’t have the advantage is kind of heart warming.
*This blog post was originally published at EverythingHealth*
September 7th, 2009 by DrWes in Better Health Network, Health Policy, Health Tips
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“I don’t know what could be more clear,” said Representative Bruce Braley, Democrat of Iowa, who has read aloud from a section of the House bill with the title “No Federal Payments for Undocumented Aliens.”
“Heath Care Debate Revives Immigration Battle,”
New York Times, 6 Sep 2009
From House Bill 3200, page 143:
SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
4 ALIENS.
5 Nothing in this subtitle shall allow Federal payments
6 for affordability credits on behalf of individuals who are
7 not lawfully present in the United States.
* * *
Taxpayers are concerned whether they will have to foot the bill for illegal aliens in the upcoming health care bill. Many ask good questions, like how will health care workers know who’s an illegal alien? If they are included, how will it be paid for? These are important questions that we would hope could be dealt with squarely, openly and with full transparency.
But this is a sensitive topic for Congressmen interested in securing reelection.
During the summer recess, many Congressmen were barraged by questions to this effect. So it was interesting reading this New York Times piece this morning on whether illegal aliens will be covered under the new health care plan before Congress. On one hand we have Congressmen placating his constituents by assuring voters that “I don’t know how it could be more clear” as they suggest taxpayers will not fund illegal aliens, but careful inspection discloses that illegal aliens will just not be eligible for federal subsidies to reduce their payments for federally-supplied health insurance.
But from here, it gets even more byzantine:
… the report finds that the House bill would not prohibit illegal immigrants from enrolling in a health insurance exchange. The exchange would allow participants to buy coverage from one of several plans, including a public option offered by the federal government.
At the same time, illegal immigrants would not be exempt from the obligations in the House bill. According to the research service, most illegal immigrants in the country would be required to buy health insurance or face tax penalties.
And since they would be barred from subsidies, they would have to pay for coverage at full rates, regardless of their income level.
So here we have illegal aliens, already strapped for cash, paying their “full payment” and if they don’t, the tax man will come after them (which is confusing to me, because I didn’t know that illegal aliens pay taxes).
So what is wrong with the public? How could they possibly be confused?
Here’s a thought: the only real way out of these shameful machinations is to deal with the immigration and health care issue separately, incrementally, and without this shell game. Doesn’t the American public deserve a more thorough discussion of this issue, rather than shoving it in to our upcoming health care legislation?
My personal sense of it is that such an issue will never be decided at the Emergency Room door. Rather, it is part of a systemic immigration control and reform question that involves our borders, employee verification, and a decision about existing illegal immigrants.
What we’re observing instead, is a Congress is too scared to deal with this issue honestly.
*This blog post was originally published at Dr. Wes*
September 6th, 2009 by Dr. Val Jones in Book Reviews
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Preamble
I’ll never forget the day when I argued for protecting parents against misleading and false information about the treatment of autism. I was working at a large consumer health organization whose mission was to “empower patients with accurate information” so that they could take control of their health. My opposition was himself a physician who requested that our organization publish an article that advised parents of children with autism to seek out DAN! practitioners and chelation therapy.
I prepared my remarks with the utmost care and delivered them to a committee of our lay executives. I cited examples of children who had died during chelation treatments, explained exactly why there was no evidence that chelation therapy could improve the symptoms of autism and in fact was based on the false premise that “heavy metals” in vaccines were implicated in the etiology of the disease. I concluded that it would be irresponsible for the company to publish such misleading advice/information for parents, and would in fact be counter to our entire mission.
My physician opponent suggested that it was our company’s duty to inform parents of all their options, that we should not be judgmental about treatments, and that I was part of a paternalistic medical establishment that tried to silence creative thinking.
The committee ended up siding with my opponent. I was flabbergasted and asked one of the committee members what on earth they were thinking. She simply shrugged and said that my opponent was more likable than I was.
This experience marked the beginning of my journey towards fighting fire with fire – understanding that being right is not the same as being influential, and that “winning” an argument (where lives are on the line) requires a different skill set than I learned in my scientific training.
Book Review
And so it was with great interest that I picked up Randy Olson’s book, Don’t Be Such A Scientist: Talking Substance In An Age Of Style. I was pleased to see that other scientists had experienced the same revelation – that we need to be more communication-savvy to become more societally-influential.
Olson’s book outline is simple: four “don’ts” and one “do.” Don’t be so cerebral, literal-minded, poor at telling stories, or unlikeable. Do be the voice of science. He begins his book with a captivating story: a marine biologist goes to Hollywood and is shredded by an acting teacher for being incapable of raw emotion. Most scientists will get a good chuckle out of this narrative and will relate to Olson’s culture shock.
As the book winds along, the reader is introduced to a series of the author’s former girlfriends. He reminisces:
She would listen to me talk and talk and talk to the old folks and finally, by the end of the day, she would have had enough. So her favorite thing to do in the evening was, when I was done talking, to look deeply, romantically, lovingly into my eyes and say in a soft and seductive Germanic voice… “You bore me.”… p.82
Another girlfriend developed an affectionate nickname for me, “Chief Longwind,” which she would abbreviate when I’d get going on something and just say, “That’s enough for tonight, Chief.” p.83
Unfortunately, as these ladies noted, Olson’s strong suit is not compelling dialog – a tragic irony for a book written to inspire more effective science communication. Nonetheless, since scientists are rarely deterred by boredom, I think that there are some conceptual gems worth unearthing.
These are my top 5 take-home messages:
1. Communicate in a human way – be humorous, tell stories, don’t feel as if you have to present all the details. The goal is to get people curious enough to ask more questions.
2. Broad audiences prefer style over substance – learn to be bilingual (to speak with academics versus a general audience).
3. Marketing is critical for influence. The creators of Napoleon Dynamite spent a few hundred thousand dollars on production and $10 million on advertising/marketing. The movie grossed $50 million. Scientists who wish to be influential (or get their message across broadly) must bow the knee to the marketing gods.
4. Some people are naturally good communicators, others are not. Find the good ones and make them spokespeople. “The strongest voice is that of a single individual.” p. 166
5. Likability trumps everything. People make snap judgments about whether or not they like you, and your message’s impact is dependent upon your likability factor. Likability is related to humor, emotion, and passion. p. 148
And so, Don’t Be Such A Scientist offers some great food for thought – and I suppose if it hadn’t been written by a scientist it might also have been a more engaging read! But who am I to say, I’m still trying to bend my mind around the idea that Americans don’t care about facts.
