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5 Avoidable Air Travel Health Risks

For those of you planning air travel to your next medical conference (and ACP Internist isn’t too shameless to plug Internal Medicine 2011 — we hope to see you there), TIME reports that there are five health risks that are rare yet have recently happened. Tips on avoiding these maladies include:

E. Coli and MRSA on the tray table. Microbiologists found these two everywhere when they swabbed down flights. Bring your own disinfecting wipes.

Bedbugs in the seat. British Airways fumigated two planes after a passenger posted pictures online about her experience. Wrap clothes in plastic and wash them.

Sick seatmates. Everyone has experienced (or been) this person. Wash your hands.

Deep vein thrombosis (DVT). Tennis star Serena Williams experienced a pulmonary embolism, possibly related to recent foot surgery. But DVT can happen to anyone restrained to a cramped position for long periods of time. Move around in-flight (but not during the beverage service, of course.)

Dehydration. Dry cabin air may make it more difficult to fight off infections. Drink more water.

*This blog post was originally published at ACP Internist*

Lying: A Way Of Life In The Medical Profession

In his last post, DrRich analyzed whether the young Wisconsin doctors who stood out on street corners proudly offering fake “sick excuses” to protesting teachers were engaging in an act of civil disobedience. DrRich respectfully kept an open mind on this question, but after careful deliberation concluded that it is very unlikely that their actions constituted classic civil disobedience as espoused by Thoreau or Gandhi.

Instead, these doctors were, in a professional capacity, lying. They did not lie in any truly malicious way, however. They lied because they have been trained to believe in a higher cause than mere professional ethics, namely, the cause of social justice. They lied in full confidence that telling lies to advance such a noble cause is a natural duty of the medical profession. They never expected to be criticized for it (except perhaps by Rush Limbaugh and sundry teabaggers and the like), and they almost certainly will be stunned into indignant incoherence if they end up actually receiving the full punishments their actions allow.

But what really interests DrRich is the near-perfect silence we have seen from the mainstream news media regarding this sad episode. While it’s easy to find stories about the phony sick excuses all over Fox News and conservative websites, major outlets like the New York Times, Washington Post, CNN, CBS and NBC — sources one might expect to express at least some sympathy for these doctors and their work to advance a just cause – have reported next to nothing about it. When a left-leaning mainstream outlet does report on the episode (for instance, this article appearing in the Atlantic), rather than expressing any support for the Wisconsin doctors, they express at least mild dismay. It seems plain to DrRich that the mainstream media wish the whole thing hadn’t happened, and that perhaps their silence might help it go away as soon as possible.

So here we’ve got a small cadre of youthful and idealistic physicians, behaving in a manner entirely consistent with what they’ve just learned during their medical training, and not only are they facing formal investigations and potential punishment, but also the very people and organizations whom they were surely counting on for support have retreated into an embarrassed silence, or worse, criticism. What gives? Read more »

*This blog post was originally published at The Covert Rationing Blog*

Healthcare Reform Continues As Judge Relents

A federal judge who’d ruled healthcare reform was unconstitutional and that his decision as a federal judge was the equivalent of an injunction has relented. Healthcare reform can continue in the states, pending appellate and Supreme Court review.

“The sooner this issue is finally decided by the Supreme Court, the better off the entire nation will be,” wrote federal judge Roger E. Vinson, who’d decided that the healthcare reform act’s mandate that people buy insurance or face penalties overextended Congress’ powers under the commerce clause of the constitution.

One reason for granting a stay, despite his previous clear intent that healthcare reform cease, includes his statement (on page 18) that:

“Can (or should) I enjoin and halt implementation of the Act in a state where one of its federal courts has held it to be Constitutional? In addition, many of the plaintiff states have publicly represented that they will immediately halt implementation of the Act in light of my declaratory judgment, while at least eight plaintiff states (as identified by the defendants in their motion and reply) have suggested that, in an abundance of caution, they will not stop implementing the Act pending appeal. In addition to these apparent disagreements among the plaintiff states, there is even disagreement within the plaintiff states as to whether the implementation should continue pending appeal. For example, while the plaintiffs (a group that includes the Attorney General of Washington) have requested that I enjoin the defendants from implementing the Act, the Governor of Washington has just filed an amicus brief specifically opposing that request.”

The decision gives the Obama administration seven days to file an appeal against his decision, which a U.S. Department of Justice spokesperson said the administration intends to do. Read more »

*This blog post was originally published at ACP Internist*

CDC Campaign Hasn’t Slowed Inappropriate Antibiotic Use

issue brief 2011 02 coverHigh rates of inappropriate antibiotic use continued despite a 15-year campaign by the Centers for Disease Control and Prevention (CDC) aimed at Michigan physicians and consumers on the dangers of antibiotic overuse.

The Center for Healthcare Research & Transformation (CHRT) released an issue brief detailing overall antibiotic prescribing for adult Blue Cross Blue Shield of Michigan (BCBSM) members. (The project is a non-profit partnership between the University of Michigan and BCBSM.)

While antibiotic prescribing in adults decreased 9.3 percent from 2007 to 2009, it increased 4.5 percent for children during the same time period. The studies found significant differences in prescribing patterns between rural southeast Michigan and the rest of the state, particularly for children. Children in rural southeastern Michigan were prescribed an average of .93 antibiotics per year, while elsewhere children were prescribed an average of 1.0 per year.

“The continuing high rate of antibiotic use for viral infections in children and adults — particularly outside of southeast Michigan — is of great concern, as is the increase in the use of broad spectrum antibiotics in children,” said Marianne Udow-Phillips, CHRT’s director. “Using antibiotics when they are unnecessary — or treating simple infections with drugs that should be reserved for the most serious infections — are practices that contribute to antibiotic resistance, making future infections harder to treat.”

Nearly half (49.1 percent) of antibiotic prescriptions in the study population were for broad spectrum antibiotics in 2009, compared to the national rate of 47 percent. Between 2007 and 2009, prescriptions for what the National Committee for Quality Assurance calls “antibiotics of concern” declined slightly in adults, decreasing 0.4 percent during that time period. In the same time period, antibiotics of concern prescribed to children increased 3.4 percent, from 44.9 percent to 46.4 percent.

One possible explanation for the rising rate in children is a rise in resistant pathogens in ear infections, according to the study brief. Other possible reasons are that kids get different infections than adults, and that some drugs that are used in adults are not used for pediatric patients. Read more »

*This blog post was originally published at ACP Internist*

Doctors’ Garments And Bacterial Contamination

This colorized 2005 scanning electron micrograph depicts numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, magnified 2,390 times. Content provided by CDC/Jeff Hageman, MHS, via the CDC's Public Health Image Library (PHIL)Bacterial contamination of physicians’ newly laundered uniforms occurs within three hours of putting them on, making them no more or less dirty than the traditional white coats, researchers reported.

Researchers sought to compare bacterial and methicillin-resistant Staphylococcus aureus contamination of physicians’ white coats to freshly laundered short-sleeved uniforms, and to determine the rate at which bacterial contamination happens. They reported results in the Journal of Hospital Medicine.

ACP Internist‘s blog recently took up the debate as well. The issue has cropped up over the years, assessing not only the cleanliness but the professionalism inherent in the white lab coat.

Researchers conducted a prospective, randomized, controlled trial among 100 residents and hospitalists on an internal medicine service at Denver Health, a university-affiliated public safety-net hospital. Subjects wore a white coat or a laundered, short-sleeved uniform.

At the end of an eight-hour workday, no significant differences were found between the extent of bacterial or MRSA contamination of infrequently-washed white coats compared to the laundered uniforms. Sleeve cuffs of white coats were slightly but significantly more contaminated than the pockets or the midsleeves, “but interestingly, we found no difference in colony count from cultures taken from the skin at the wrists of the subjects wearing either garment,” researchers wrote.

And, there was no association found between the extent of bacterial or MRSA contamination and the frequency with which white coats were washed or changed. Colony counts of newly laundered uniforms were essentially zero, but after three hours they were nearly 50 percent of those counted at eight hours.

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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