January 5th, 2008 by Dr. Val Jones in Uncategorized
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Welcome to 2008’s first edition of Revolution Rounds, my biweekly round up of the best Revolution Health expert blog posts. Not surprisingly, there’s a decidedly New Year’s theme in this collection of posts. If you’re looking to stick to a New Year’s resolution, be sure to check out the Revolution Health groups section of the site. Whether you’d like to lose weight, quit smoking, or improve your relationships – there’s a group of like minded souls out there resolving to do the same!
Health tips
Dr.
Stacy has 20 New Year’s resolutions for kids. She has even organized them
by age group for you.
New
Year’s resolutions are more likely to succeed if you follow this advice. Mira Kirshenbaum has some great tips for adults.
Would
you like to lose weight effortlessly? Sandra
Foschi suggests that good sleep habits can contribute to
weight loss.
Reading
the right blog could save your life. Dr. HJ Lenz describes how one woman
learned about certain treatment options from his colorectal cancer blog, and it
changed her life.
Would
you like to stop snoring? Dr. Steve Poceta
has some excellent tips.
The best treatment for autism may not be a drug, but human caring.
Robin Morris discusses the findings of some recent research.
Do
you struggle with jet lag? Dr. Vivian Dickerson has some suggestions for
reducing your symptoms.
Pedometers
can encourage increased exercise. Dr. Jim Herndon suggests that a pedometer
might be an excellent addition to your weight loss resolution!
In
case you need another good reason to quit smoking: Dr. Mark Perloe reminds
us that smoking a pack a day can increase the risk of erectile dysfunction by
40%.
Think
you know how to insert eye drops? Think again. Dr. Jackie Griffiths has
some special advice for those of you who need eye drops regularly.
Did you know?
San
Francisco’s mayor has proposed a soda tax. Dr. Jim Hill explains that this
money is unlikely to put a dent in the obesity epidemic.
In
some cultures childhood epilepsy is treated by burning the feet with hot coals.
Dr. Jide Williams describes this horrific practice in rural Africa.
Snowblower
injuries are still quite common even though manufacturers have been working for
over 30 years to make the machines safer. Dr. Jim Herndon explains.
It
is possible to create embryos for the purpose of treating certain diseases, not
strictly for procreation. Dr. Mark Perloe discusses some of the ethical
dilemmas associated with stem cells.
Fitness
is more important than fatness. Dr. Vivian Dickerson explains.
Excess
weight in childhood is linked to adult heart disease. Dr. Jim Hill suggests
that fitness and weight control should begin early to promote good health in
adulthood.
Many
physicians need to work on their empathy. Dr. Mike Rabow explains that
younger physicians may be more empathic than older ones.
Your
emotional state can dramatically affect your physical health. Dr. Joe Scherger discusses this mind-body connection.
Demanding
parents may cause their childrens’ teachers to burn out. Dr. Stacy Stryer
describes this unfortunate phenomenon.
Skim
milk consumption may be linked to prostate cancer. Dr. Julie Silver raises
the question of whether or not skim and low fat milk are over-rated in their
health benefits.
You
don’t need both eyes to have good depth perception. Dr. Jackie Griffiths,
Revolution Health’s ophthalmologist, explains.
Newer
isn’t automatically better. Dr. Mike Glode bemoans the fact that we have
the tendency to rush after the latest medical technology without stopping to
analyze the cost benefit ratio.
Personal Stories
One
woman had an unpleasant surprise on her 40th birthday: a massive
stroke with left hemi-neglect! Dr. Olajide Williams describes the event
with poetic language.
Laughter
is the best medicine. Dr. Stacy Stryer describes how she puts this axiom
into practice in her family.
Dr.
Julie Silver was prompted by her daughter to become one of Charlie’s angels.
You’ll have to read the post to get the reference.
Vitamin
hawkers exaggerate their product’s benefits without recourse. Dr. Mike
Glode describes one interesting example of this phenomenon.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 19th, 2007 by Dr. Val Jones in Book Reviews
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Have you ever been surprised and confused by what seem to be conflicting results from scientific research? Have you ever secretly wondered if the medical profession is comprised of neurotic individuals who change their mind more frequently than you change your clothes? Well, I can understand why you’d feel that way because the public is constantly barraged with mixed health messages. But why is this happening?
The answer is complex, and I’d like to take a closer look at a few of the reasons in a series of blog posts. First, the human body is so incredibly complicated that we are constantly learning new things about it – how medicines, foods, and the environment impact it from the chemical to cellular to organ system level. There will always be new information, some of which may contradict previous thinking, and some that furthers it or ads a new facet to what we have already learned. Because human behavior is also so intricate, it’s far more difficult to prove a clear cause and effect relationship with certain treatments and interventions, due to the power of the human mind to perceive benefit when there is none (placebo effect).
Second, the media, by its very nature, seeks to present data with less ambiguity than is warranted. R. Barker Bausell, PhD, explains this tendency:
1. Superficiality is easier to present than depth.
2. The media cannot deal with ambiguity, subtlety, and diversity (which always characterizes scientific endeavors involving new areas of investigation or human behavior in general)
3. The bizarre always gets more attention than the usual.
I really don’t blame the media – they’re under intense pressure to find interesting sound bites to keep peoples’ attention. It’s not their job to present a careful and detailed analysis of the health news that they report. So it’s no wonder that a research paper suggesting that a certain herb may influence cancer cell protein expression in a Petri dish becomes: herb is new cure for cancer! Of course, many media outlets are more responsible in their reporting than that, but you get the picture.
And thirdly, the scientific method (if not carefully followed in rigorous, randomized, placebo-controlled trials) is a set up for false positive tests. What does that mean? It means that the default for your average research study (before it even begins) is that there will be a positive association between intervention and outcome. So I could do a trial on, say, the potential therapeutic use of candy bars for the treatment of eczema, and it’s likely (if I’m not a careful scientist) that the outcome will show a positive correlation between the two.
There are many reasons for false positive results (e.g. wrongly ascribing effectiveness to a given therapy) in scientific research. “Experimental artifacts” as they’re called, are very common and must be accounted for in a study’s design. For fun let’s think about how the following factors stack the deck in favor of positive research findings (regardless of the treatment being analyzed):
1. Natural History: most medical conditions have fluctuating symptoms and many improve on their own over time. Therefore, for many conditions, one would expect improvement during the course of study, regardless of treatment.
2. Regression to the Mean: people are more likely to join a research study when their illness/problem is at its worst during its natural history. Therefore, it is more likely that the symptoms will improve during the study than if they joined at times when symptoms were not as troublesome. Therefore, in any given study – there is a tendency for participants in particular to improve after joining.
3. The Hawthorne Effect: people behave differently and experience treatment differently when they’re being studied. So for example, if people know they’re being observed regarding their work productivity, they’re likely to work harder during the research study. The enhanced results therefore, do not reflect typical behavior.
4. Limitations of Memory: studies have shown that people ascribe greater improvement of symptoms in retrospect. Research that relies on patient recall is in danger of increased false positive rates.
5. Experimenter Bias: it is difficult for researchers to treat all study subjects in an identical manner if they know which patient is receiving an experimental treatment versus a placebo. Their gestures and the way that they question the subjects may set up expectations of benefit. Also, scientists are eager to demonstrate positive results for publication purposes.
6. Experimental Attrition: people generally join research studies because they expect that they may benefit from the treatment they receive. If they suspect that they are in the placebo group, they are more likely to drop out of the study. This can influence the study results so that the sicker patients who are not finding benefit with the placebo drop out, leaving the milder cases to try to tease out their response to the intervention.
7. The Placebo Effect: I saved the most important artifact for last. The natural tendency for study subjects is to perceive that a treatment is effective. Previous research has shown that about 33% of study subjects will report that the placebo has a positive therapeutic effect of some sort.
So my dear readers – if the media wants to get your attention with exaggerated representations of research findings, and the research findings themselves are stacked in favor of reporting an effect that isn’t real… then how on earth are we to know what to make of health news? Luckily, R. Barker Bausell has explained all of this really well in his book and I will attempt to summarize the following principles in the next few posts:
1. The importance of credible scientific evidence
2. The importance of plausible scientific evidence
3. The importance of reproducible scientific evidenceThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 12th, 2007 by Dr. Val Jones in True Stories
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A few months ago I wrote about my dear friend who was diagnosed with stage IV colon cancer just after having her first baby. Her optimism and positive focus was inspirational to me, and I marveled at her ability to live life unencumbered by prognosis.
Today I am happy to report that she has completed her 7th round of chemotherapy (with avastin, oxaliplatin, 5FU, and leukovorin) and her liver tumors have already shrunk by two-thirds. She is bothered by neuropathy (burning sensations in her hands and feet – a known side effect of this drug regimen) and has lost the ability to taste food fully, but otherwise she is maintaining her weight and her blood counts are good. She told me that her plan is to complete 12 rounds of chemo and then meet with a liver surgeon to consider surgical removal of the remaining tumors. Miraculously, her doctors believe that she may be a candidate for liver resection and eventual cure.
This couldn’t be any better news and I am so pleased to be able to celebrate my friend’s success. I have learned a great deal myself about the journey, and about how many people are willing to reach out and help those who are struggling. As for my friend, she has greatly benefited from:
1. CarePages – an online gathering place where friends and family can find out the latest news about her progress, and leave well wishes and virtual gifts. CarePages is part of the Revolution Health family.
2. The Colon Cancer Alliance (CCA) – this wonderful non-profit organization linked my friend up with a mentor who has been through a similar treatment regimen and diagnosis and can speak to her about what to expect. The CEO of CCA has even taken time out of his busy schedule to make sure that my friend gets the best support available and has put her in touch with top liver surgeons.
3. Dr. Lenz’s Colon Cancer Blog – Dr. Lenz is a leading medical oncologist and Co-director of both the Colorectal Center and the Gastrointestinal (GI) Oncology Program at USC/Norris Comprehensive Cancer Center in Los Angeles. He also prepares 3 fresh blog posts per week here at Revolution Health, to make sure that cancer patients have access to the latest research and information about colon cancer.
With incredible advances in evidence-based cancer therapies and these terrific online resources, colon cancer patients have a brighter future than ever before. I’m so pleased that my friend is doing well, and I’m grateful for the many people and organizations that have touched her life. Expect another update on her progress in March!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 18th, 2007 by Dr. Val Jones in Health Policy, Opinion
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A recent blog post at Terra Sigillata really disturbed me. The author describes how, in the face of increasing healthcare costs, Medicare now declines coverage of life saving medicines for lymphoma patients. This is one example of rationing healthcare that will become ever more common (as it is in other leading industrialized nations) as we move towards further cuts in government programs and funding. In Canada, expensive chemotherapies are not commonly covered by the national health plan, and in Britain, age is a determinant for transplant eligibility.
But what troubles me about the apparent capriciousness of denying coverage to certain types of cancer patients over others, is that government programs are – at the same time – allocating millions of dollars to researching implausible alternative medicine treatments while denying coverage of proven therapies to patients who will likely die without them.
Take homeopathy, for example. The National Center for Complementary and Alternative Medicine lists homeopathy as an eligible area of research, and boasts several ongoing studies in the area of stroke, dementia, fibromyalgia, and prostate cancer. And yet, there is no plausible mechanism of action to support its potential use as anything more than a placebo. Homeopathy operates on the assumption that water has memory, and that once it has been exposed to certain substances, such as arsenic, it obtains curative properties for illnesses that bear resemblance to poisoning from those very substances (though the water itself may no longer contain a single molecule of the substance).
Research into scientifically implausible theories should not be funded by our tax dollars at the expense of offering life saving treatments to cancer patients. It is time for scientists to stand up and point out that the Emperor has no clothes when it comes to homeopathy and other similarly flawed alternative medical treatments.
As we move towards rationing limited healthcare resources, we have a moral obligation to prioritize the money correctly. “Open-mindedness” is no excuse for poor stewardship.
Dr. Wallace Sampson sums this up in a provocative recent editorial. Here is an excerpt:
We now see accumulation of useless information in journals and information data bases — hundreds of clinical trials (RCTs) on implausible methods, such as homeopathy, unrefined plant products, prayer, and acupuncture. Initial plausibility retreats before two 20th-century development ideologies of relativism — a principle that all facts and opinions have equal or similar value, and postmodernism — that regards facts as social constructions.
Once thought to be too esoteric for relevance to medicine, these twin ideologies now mold the thinking of policy makers and granting agency officials. Ancient and traditional cultural practices are not diminished for lack of plausibility, but are investigated by RCTs because they are there.
Plausibility depends on prior reliable observations, physical and chemical laws, pharmacological principles, and advocates’ economic and legal misadventures. The National Center for Complementary and Alternative Medicine spends $100 million/year on implausible research and training grants. In performing RCTs on implausible proposals, clinical research has taken a wrong turn and departed from rationality.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 8th, 2007 by Dr. Val Jones in True Stories
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Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from their renal resting place and scrape their way down her ureters.
My friend is a stoic person who also doesn’t like to cause trouble for others – so when she was awoken at 4am with that same familiar pain, she decided not to call an ambulance but rather drive herself to the ER. She also chose not to call her doctor out of consideration for his sleep needs.
She managed to make it to the triage desk at her local hospital and was relieved to see that the ER was quite empty. There were no ambulances in the docks, no one in the waiting area, and no sign of any trauma or resuscitations in the trauma bay. She approached the desk trembling in pain and put her health insurance card, driver’s license, and hospital card on the desk and let the clerk know that she was in incredible pain.
The clerk responded,
“Lady, I saw you walk yourself in here. There’s no way you’re in that much pain. Sit down and fill out this paper work!”
My friend replied in a soft voice,
“Please, can you help me fill out these forms? I can barely see straight and can’t concentrate well. I have a kidney stone and it’s excruciating.”
Tears fell softly from her face as the clerk rolled his eyes at her.
“Yeah, I’m sure you do. And I bet you’re allergic to everything but Demerol.”
My friend started becoming frightened, realizing that she was being pegged as a “drug seeker” and would be punished with a long wait time for pain medication. “Please let me just speak to the triage nurse.”
“Sure, sweetheart,” hissed the clerk. “I’ll get him when you’ve finished your paperwork.”
And so my friend sobbed as she tried to fill in her address, phone number, insurance information, etc. on the paper form at a hospital where she had been treated for over 7 years for ovarian cancer. All of that information was in their EMR, but the registration process would not be waived.
The triage nurse slowly emerged, still chewing a bite of his steak dinner. “What have we got?” He said to the clerk looking out into a waiting room populated only by my sobbing friend.
The clerk replied to him under his breath. The nurse rolled his eyes and sighed heavily. “Alright lady, let’s get you back to an examining room. Follow me.”
My friend followed him back to the patient rooms, doubled over in pain and was put on a stretcher with a thin curtain dangling limply from the ceiling.
She couldn’t control her tears. She couldn’t get comfortable and she moaned softly as she took short breaths to explain her past history. She handed him her business card, explaining who she was and that she was not faking her pain. The nurse made no eye contact, jotted down some notes in a binder, and prepared to leave the room.
“Listen, your crying is disturbing the other patients,” he said, yanking the curtain across the front of the room to block her visually, as if the curtain would make her disappear.
Hours passed. My friend had no recourse but to writhe on the stretcher and cry out occasionally when the pain was too intense too bear. She asked for them to order a CT scan so they could see the stones. The nurse ordered it, a physician never came to examine her.
Four hours later my friend was greeted by a physician. “You have kidney stones. One is in your right ureter, and there are others sitting in your left kidney. Do you need some Dilauded?”
“Yes please!” said my friend, hoping that some relief was in sight.
“Alright, the nurse will be here shortly.” Said the doctor, glancing at her chart without completing a physical exam.
The shift changed and a new nurse came in to place an IV. She was gruff and complained that my friends veins were too small. “I’ve never seen anyone with a kidney stone need this much pain medicine” she snapped with a suspicious tone.
Five hours after her arrival at a virtually empty ER my friend received pain medicine for her kidney stone. She is a cancer survivor and national spokesperson for patient advocacy. In her time of need, though, she had no advocate to help her. No, she received nothing for her years of service, for her selfless devotion to helping others, for her tenderness to patients dying of a disease with no cure.
That night, my friend did not even receive the benefit of the doubt.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
