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Managing Diabetes In “Real Time”

The cost of managing chronic diseases is the largest portion of healthcare expenditures in developed countries. For example, the prevalence of adult acquired diabetes has been rising in the United States, in concert with increasing rates obesity. The CDC has termed it an “epidemic,” especially in light of the massive costs incurred by the healthcare system due to diabetes.

The deleterious health effects of many chronic conditions can be diminished by behavior modifications. While few would underestimate the difficulty of having patients lose weight or exercise more, good management of blood sugar in diabetes is both objectively measurable and strongly correlated with reduced end-organ damage.

This is among the reasons why Research2Guidance has recently nominated diabetes as the condition most likely to be most targeted by mobile medical software and devices (mHealth). This finding is part of their recently published Global Mobile Health Market Report 2010-2015. This is the same report that also predicted that, in the future, medical apps are likely to be distributed by physicians and healthcare institutions.

This time Research2Guidance is highlighting the portion of the survey where they looked into where mobile devices have the most potential to affect health outcomes. While other chronic conditions such as hypertension and obesity have larger populations, the market researchers felt diabetes had the largest market potential due to the huge cost saving potential, the demographic and geographic overlap between smartphone users and people with diabetes, and the real potential to improve blood sugar management using mobile devices. Read more »

*This blog post was originally published at iMedicalApps*

Head Lice: FDA Approves New Treatment

Good news for parents, teachers, pediatricians, and others engaged in the ongoing battle against lice: The Food and Drug Administration (FDA) just approved a new treatment for head lice in children age four and older. Called Natroba, it’s a liquid that is rubbed into the hair and allowed to sit for 10 minutes before being rinsed off. Natroba is a useful addition to the anti-lice arsenal, since some head lice have become resistant to permethrin and pyrethrins, the active ingredients in over-the-counter anti-lice products such as Nix and Rid.

Head lice are tiny insects that go by the big name Pediculus humanus capitis. They thrive in the warm tangle of human hair, feeding off blood in the scalp and breeding with abandon. A female lays eggs called nits that she attaches to strands of hair. Nits hatch after about eight days, become adults in another week or so, feed for awhile, then begin to make more lice.

CDC photo of the stages of the life of a head louse, with a penny for size comparison.

What To Do

First off, here’s what not to do: Don’t shave your or your child’s head, or coat it with petroleum jelly or mayonnaise or anything else designed to “suffocate” the parasite. You’ll probably end up with greasy, smelly, lice-infested hair.

Current guidelines from the American Academy of Pediatrics call for the use of an over-the-counter product containing permethrin or pyrethrins as a first salvo against head lice. Shampoos and rinses made with these substances are generally effective. Most treatments for head lice need to be used twice, seven to 10 days apart, along with combing wet hair with a fine-toothed nit comb. Some lice are resistant to pyrethrin and permethrin. Stronger prescription drugs, such as malathion and lindane, also work but aren’t as safe for humans. That’s where Natroba comes in. Read more »

*This blog post was originally published at Harvard Health Blog*

Pain Contracts: Do They Threaten The Doctor-Patient Relationship?

Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.”

Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk. But how does that affect the doctor-patient relationship?

Indeed, a contract is an adversarial tool. Essentially, it states that a patient must comply with a strict set of rules in order to receive medications, including where and how often they obtain controlled substances, and may involve random drug testing. Break the contract and the patient is often fired from the practice. Read more »

*This blog post was originally published at KevinMD.com*

Decline In Stroke Deaths Reinforces “Brain Attack” Prevention

Stroke killed 2,000 fewer Americans in 2008 (the last year with complete numbers) than it did in 2007, the Centers for Disease Control and Prevention (CDC) said yesterday in its latest annual Deaths report. That dropped stroke from the third leading cause of death in the United States to the fourth.

Good news? Yes and no. It’s always good news when fewer people die. The reduction suggests a payoff for efforts to prevent stroke and improve the way doctors treat it.

Yet the drop from third to fourth place is due largely to an accounting change. The CDC reorganized another category, “chronic lower respiratory diseases” (mainly chronic bronchitis and emphysema), to include complications of these diseases such as pneumonia. The change substantially increased the number of deaths in this category, which had long trailed stroke as the fourth leading cause of death.

More worrisome is that the decline in deaths from stroke isn’t matched by a decline in the number of strokes. On the rise since 1988, stroke now strikes almost 800,000 Americans a year, and that is expected to grow. Read more »

*This blog post was originally published at Harvard Health Blog*

A New Superbug?

newNYCfashion 300x199 New Superbug AlertScientists have discovered a new, highly-transmissible gene that could, quite easily in fact, open a frightening new front in the ongoing global war against superbugs.

The antibiotic-resistant gene, NDM-1, was first identified in 2008 a Swedish patient that had received hospital care in New Delhi. NDM-1 produces an enzyme that allows bacteria to destroy most antibiotics. It exists on plasmids, which are pieces of genetic material that are easily shared between bacteria including E coli and other species that can cause pneumonia, urinary tract infections, and blood stream infections.

NDM-1 probably evolved in parts of India where poor sanitation and overutilization of antibiotics provide a perfect environment for the creation of antibiotic-resistant bacteria.

The gene has been identified in three U.S. patients. All had received medical treatment in India, and all recovered from their infections. It has been found sporadically in Britain, Australia and nearly a dozen other countries as well. Most affected patients were “medical tourists” — that is, people seeking less expensive medical care in India.

“We need to be vigilant about this,” said Arjun Srinivasan, an epidemiologist at the CDC told the Washington Post. “This should not be a call to panic, but it should be a call to action. There are effective strategies we can take that will prevent the spread of these organisms.” Read more »

*This blog post was originally published at Pizaazz*

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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