March 24th, 2007 by Dr. Val Jones in News
No Comments »
In my last blog post I was describing how adversity can be used for good, and as I was reading the medical news this morning I found another great example. While gardening, a British man was bitten on the neck by a spider. Now, the report doesn’t say exactly what type of spider this was, but judging from the outcome it was probably not a black widow or brown recluse. I’m assuming that the insect was some sort of common garden spider, though it must have had “fangs.” (Imagine my sister recoiling in horror here.)
As it turned out, the spider bit the man right next to a growth on his neck that he hadn’t noticed before. When he went to the doctor’s office to have the bite inspected, they found the growth and decided to biopsy it. The growth was cancerous, and the medical team was able to remove it before it had spread anywhere.
The little spider inadvertently saved a man from cancer. As he weaves his web, nestled between the coarse, hairy leaves of turnip plants, this tiny creature may never understand his contribution to humanity. Small actions can have a positive ripple effect, and a seemingly bad experience can save a life.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 21st, 2007 by Dr. Val Jones in News
No Comments »
As spring approaches, we can expect a new onslaught of pollen, bugs, and mud puddles. Mosquito eggs will hatch in stagnant water, and a new generation of hungry little disease vectors will be lurking in wooded areas, awaiting their first meal.
Luckily for those of us who live in North America, those annoying mosquito bites are unlikely to infect us with malaria.
A team of scientists committed to eradicating malaria (one of my personal favorite parasites) has taken a new approach to reducing transmission rates: creating a strain of malaria-immune mosquitoes.
I had been under the mistaken impression that mosquitoes lived in perfect harmony with malaria parasites, but apparently the organisms can make them quite ill as well. Not ill enough to die immediately (hence their ability to spread the disease) but ill enough to die prematurely.
So if we could create a malaria immune mosquito, we could give them a survival advantage over their peers, thus slowly influencing the mosquito population in favor of the new strain. This could result in a new population of mosquitoes who could not harbor malaria.
In humans, malaria parasites have learned how to attach themselves to red blood cell proteins and incubate inside the cells. In mosquitoes, the parasites latch on to a protein (called SM1) on the surface of epithelial cells of their gut lining. Through the miracle of genetic engineering, we’ve managed to alter the SM1 proteins in certain mosquitoes, making them immune to invasion by parasites they ingest through infected blood.
Although the immune mosquitoes are not ready for prime time release in malaria endemic countries (the research only showed that the scientists could genetically engineer resistance to one strain of malaria), it sure would be interesting to see if we could use mosquitoes themselves to fight a disease that claims the lives of over one million people per year.
This is a rare case of a problem becoming the solution!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 20th, 2007 by Dr. Val Jones in Medblogger Shout Outs
2 Comments »
I am opposed to millionaires, but it would be dangerous to offer me the position.
–Mark Twain
As we consider the wastefulness of the healthcare system, I have heard many people complain that physician salaries are one of the main culprits in escalating costs.
Dr. Reece compares the average income of some of the highest paid physician specialists, with that of hospital executives, medical insurance executives, and fortune 500 CEOs. Check this out:
Highest Paid Physicians
1. Orthopedic, spinal surgery, $554,000
2. Neurosurgery, $476,000
3. Heart surgeons, $470,000
4. Diagnostic radiology, Interventional, $424,000
5. Sports Medicine, surgery, $417,000
6. Orthopedic Surgery, $400,000
7. Radiology, non-interventional, $400,000
8. Cardiology, $363,000
9. Vascular surgery, $354,000
10. Urology, $349,000
Executive Pay for Massachusetts Hospital CEOs
1. James Mongan, MD, Partners Healthcare, $2.1 million
2. Elaine Ullian, Boston Medical Center, $1.4 million
3. John O’Brien, UMass Memorial Medical Center, $1.3 million
4. David Barrett, MD, Lahey Clinic, $1.3 million
5. Mark Tolosky, Baystate Health, $1.2 million
6. James Mandell, MD, Children’s Hospital, Boston, $1.1 million
7. Gary Gottlieb, Brigham and Women’s Hospital, $1 million
8. Peter Slavind, MD, Massachusetts General Hospital, $1 million
2005 Total Annual Compensation for Publicly Traded Managed Care CEOs
1. United Health Care $8.3 million
2. Wellpoint, Inc, $5.2 million
3. CIGNA, $4.7 million
4. Sierra Health, $3.4 million
5. Aetna, Inc, $3.3 million
6. Assurant, Inc, $2.3 million
7. Humana, $1.9 million
8. Health Net, $1.7 million
Top Corporate CEO Compensation
1. Capital One Financial, $249 million
2. Yahoo, $231 million
3. Cedant, $140 million
4. KB Home, $135 million
5. Lehman Brothers Holdings, $123 million
6. Occidental Petroleum,, $81 million
7. Oracle, $75 million
8. Symantec, $72 million
9. Caremark Rx, $70 million
10. Countrywide Financial, $69 million
But the real story here is the salary of our primary care physicians – those unsung heroes of the front lines. KevinMD pointed out a recent news article citing $75,000.00/year as the average salary of the family physician in the state of Connecticut, and that their malpractice insurance consumed $15,000.00 of that. Although this is certainly below the national average for pediatricians (they start at about 110,000 to 120,000), I’ve seen many academic positions in the $90,000 to 100,000 range.
Now I ask you, does it seem fair that the vast majority of physicians (the primary care physicians) are making one tenth of the average hospital executive salary? Should doctors really be in the cross hairs of cost containment?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 17th, 2007 by Dr. Val Jones in Opinion
3 Comments »
– continuation of previous post –
What does a PM&R doc do?
The foundational principle upon which rehabilitation medicine is based, is this: physical modalities (exercise, movement, muscle strengthening) are critical components of achieving the highest level of wellness and functionality. The goal of a PM&R specialist is to maximize a person’s functional ability within the constraints of their physical limitations. So that if a person is an amputee, or has had a spinal cord injury, or stroke – the goal is to make them as independent as possible, using prosthetics, orthotics, adaptive equipment, physical training or family assistance.
The rehab physician works tirelessly to enable the disabled. Whether the patient has temporary (such as after a broken bone) or permanent (such as a spinal cord injury) disability, the rehab doctor wants to seamlessly reintegrate the patient into society, into meaningful work, and into a joyful participation in life to the max.
PM&R physicians are the ultimate integrative medicine specialists – they practice a combination of physical and medical healing techniques, while leading a team of specialists to help their patients achieve their goals (nurses, social workers, physical therapists, occupational therapists, cognitive therapists and psychologists, speech & language pathologists, prosthetics & orthotics specialists, and more).
I guess I could sum it up like this: when the proverbial Humpty Dumpty “has a great fall,” the surgeons knit his bones back together, the internists maintain his vital signs, but the rehab doc finds him some crutches, teaches him how to walk again, gets him cognitive therapy and counseling, helps him reintegrate into society, and stimulates his progress towards physical independence and emotional wellness.
Why did I choose this “odd ball specialty?”
Well, truthfully, I didn’t hear much about PM&R during medical school. I happened to meet a group of exceptionally happy residents in the hallway one day, and I asked them why they were smiling. (My only experience with residents was that they were tired, bedraggled, ill-tempered and hen-pecked – and this group defied the stereotype).
They explained to me that they were “rehab residents” and that’s why they were happy. That seemed like a non-sequitur to me, so I investigated the specialty in more detail, and became convinced that there was no higher call than to care for the disabled. I had been a home health aid in college, taking care of young adults with cerebral palsy, and I spent my summers at a camp for disabled adults, sponsored by the March of Dimes, so this was familiar territory and seemed to be a good fit for my nurturing temperament.
As we look at Americans’ current medical needs, we don’t see hundreds of thousands of war amputees (though there is a steady trickle coming from the war in Iraq), or polio victims – but what we do see is a population disabled by obesity and its collateral damage: diabetes (with its amputations), heart disease, stroke, severe arthritis, and various pain syndromes.
I believe that Rehabilitation Medicine, as a specialty, should adapt to serve the needs created by this new obesity epidemic. We have always been the masters of physical exercise for healing – now we should apply those principles to help Americans lose weight and keep it off. I couldn’t agree more with Dr. Jim Hill, who believes that dieting leads to weight loss, but exercise leads to weight loss maintenance (the real key to long term health benefits).
As I have argued in the past, America needs to be rehabilitated. And I hope that my work at Revolution Health will contribute to improving the general wellness of our citizens.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 17th, 2007 by Dr. Val Jones in Opinion
2 Comments »
One medical specialty has managed to avoid (nearly completely) the public eye: Physical Medicine & Rehabilitation (or PM&R). Physicians who choose this specialty are referred to as “physiatrists” or “rehabilitation medicine specialists” or “rehab docs.” But the truth is that very few people understand what they do, and unfortunately the rehab docs haven’t made much of an effort to explain themselves to their peers or the world at large.
A dear friend and mentor once asked me, “why did you choose such an odd ball specialty?” This rather direct question forced me to ponder my career decision, and to determine how it came to pass that PM&R was given the unhappy reputation of “odd ball specialty.” I’ll begin with a little background about the specialty and then explain why I chose to devote my life to it.
The history of PM&R
PM&R really traces its roots back to the American Civil War (1861-1865). This gruesome battle resulted in over 620,000 casualties and over 60,000 limb amputations. The modern specialty of general surgery developed through life saving trial and error on the battlefield. Massachusetts General Hospital, for example, was performing an average of 39 surgeries/year before the civil war, and this increased to 2,427 in the late 1800’s.
But physicians and surgeons were not prepared for the aftermath of war – tens of thousands of maimed and partially limbless now trying to live out their careers in a disabled condition. One confederate soldier, James E. Hanger, lost a leg in the war, and subsequently created America’s first prosthetics company, still in operation today. Unfortunately for the disabled, though, there was no guarantee that appropriate accommodations would be made for them to be fully reintegrated into society.
With the rise of surgery came a major realization: patients did not do well after surgery if they remained in bed. Conventional medical wisdom suggested that bed rest and inactivity were the most effective way to recuperate, but now with thousands of post-operative patients in full view, it became painfully clear that the patients who did the best were the ones that got up and returned to regular physical activity as quickly as possible.
Following this realization, the University of Pennsylvania created (in the late 1800’s) an orthopedic gymnasium for “the development of muscular power with apparatus for both mechanical and hot air massage, gymnastics and Swedish movement.”
A young Canadian gymnast trained in Orthopedic Surgery, Dr. Robert Tait McKenzie, was recruited to U. Penn to develop a new field in medicine: “Physical Training.” Dr. McKenzie created a medical specialty called “Physical Therapy” and he was the first self-proclaimed “Physical Therapist.” He wrote a seminal book on the subject called “Reclaiming the Maimed” (1918) and continued to practice orthopedic surgery until his death in 1938.
Other major medical institutions followed U. Penn’s lead, creating “Medicomechanical Departments” at Mass General and the Mayo Clinic. Technicians were trained to assist in helping post-operative patients to become active and reclaim their range of motion – these technicians were known as “physiotherapists” and formed the first physiotherapy training program at the Mayo Clinic in 1918.
World War I (1914-1918) resulted in millions of additional amputations, thus flooding the health system with disabled veterans. In response, the army created two medical divisions: The division of orthopedic surgery and the division of physical reconstruction. By 1919, 45 hospitals had physiotherapy facilities, treating hundreds of thousands of war veterans.
And then there was polio. Suddenly a viral illness created a whole new wave of disabled individuals, further stimulating the need for orthotics (leg braces and such) and rehabilitative programs.
World War II (1940-1945) resulted in yet another influx of disabled veterans. All the while the medical community was developing innovative programs to maximize veterans’ functionality and integration into society and the work place through the burgeoning field of Physical Medicine & Rehabiltiation.
Key players in the development of the specialty:
Dr. Frank Krusen developed the first physical medicine training program at the Mayo Clinic in 1935 and the “Society of Physical Therapy Physicians” (now the American Academy of Physical Medicine & Rehabilitation) in 1938. He coined the term “physiatrist” to describe the physicians who specialized in physical modalities for rehabilitating patients.
Dr. Howard Rusk founded the Institute for Physical Medicine & Rehabilitation in 1950 at NYU. Excellent research in the field ensued.
Dr. Henry Kessler founded the Kessler Institute for Rehabilitation, in New Jersey, 1949. More medical research was developed.
Mary E. Switzer successfully lobbied for the enactment of Public Law 565 which mandated that government funds be channeled towards rehabilitation facilities and programs for the disabled.
What’s in a name?
So as you can see, there is some good reason to be confused about the modern specialty of PM&R. It has undergone several name changes, molded by historical circumstance. Today, physiotherapists (they still go by that name in Canada) or physical therapy technicians have become a well known and respected profession: Physical Therapy.
Physicians who specialize in Physical Medicine & Rehabilitation are called rehabilitation medicine specialists or “rehab docs” or “physiatrists.”
-See Next Post for the rest of the story –
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
