Some researchers say that America has “sitting disease” because (on average) we spend 56 hours a week in a seated position. I had the chance to talk to the ABC news team in Washington, DC, about the importance of daily activity to keep our bodies from losing muscle mass. I encouraged us to think of activity not just as going to the gym, but as the daily commitment to NEAT (non-exercise activity thermogenesis, described by Dr. James Levine at the Mayo Clinic). And yes, I confessed to having sitting disease myself… and have made a clear New Year’s resolution to address this problem!
Swimmer’s ear (otitis externa) is an affliction that affects scuba divers, swimmers, windsurfers, surfers, kayakers and many others who spend considerable time in the water. The prevailing opinion is that the most effective measure to prevent swimmer’s ear is to dry out the ears after each entry into the water, to eliminate the moisture that promotes maceration of skin and proliferation of infection-causing bacteria. This can be done mechanically by blowing warm air into the external ear canal, or by instilling liquid drops (such as a combination of vinegar and rubbing alcohol) that change the pH within the ear canal and evaporate readily, leaving behind a relatively dry environment. It is generally advised to not stick any foreign object, such as a cotton-tipped swab, into the ear, avoid traumatizing the external ear canal or, worse yet, the eardrum. Read more »
Last night, President Obama made a pitch for preventive care in his address to a joint session of Congress on health care:
“And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.”
As a doctor who has held the hands of patients dying from totally preventable illnesses, I couldn’t agree more. The largest number of deaths in the United States are caused by two preventable causes – tobacco smoking and high blood pressure – killing an estimated 467,000 and 395,000 people respectively in 2005. The list goes on and on, including obesity, physical inactivity, and poor diet.
When I was working in the emergency room as a medical resident, it was heartbreaking to see a patient with poor routine medical care roll into the emergency room with a devastating stroke that could have easily been averted with regular office visits and blood pressure medication – both relatively inexpensive compared to the cost of caring for the stricken patient.
We’re not preventing enough deaths by the types of cancer screening tests mentioned by President Obama. One reason is the technology is still not good enough. We need to develop better screening tests that pick up problems early but don’t lead to an unacceptable number of unnecessary biopsies, procedures, and further tests. And not enough patients are screened. Only about about 60 percent of women get mammograms and about 50 percent of men and women get routine colonoscopies.
Lack of insurance coverage is certainly a big reason why some patients don’t undergo screening. Another reason is patient fear and misunderstanding. In order to educate the public about the risks of colon cancer and the benefits of screening exams, Katie Couric underwent a colonoscopy on national television in March, 2000. Three years later, researchers at the University of Michigan found that colonoscopy rates jumped by 20 percent across the country following Katie’s procedure, calling the rise the
“Katie Couric Effect.”
It’s almost 10 years later and we’re still not screening enough patients. Although the death rate from colon cancer has dropped in recent years – likely mostly because of screening efforts – colorectal cancer still strikes almost 150,000 Americans every year and kills about 50,000.
As a gastroenterologist, I have seen patients’ lives saved by the removal of polyps and early cancers found by colonoscopy. I have also taken care of patients whose colon cancers were found too late to save them. Over the years, I must have heard every excuse for ducking a colonoscopy. The top four (and my answers):
I have no symptoms (most colon cancers start small and have no symptoms until they grow larger.)
I have no family history of colon cancer (that’s true in about 70 percent of patients with colon cancer.)
I’m afraid it will hurt (that’s why we use sedation and, if needed, anesthesia.)
I can’t do the prep (we’ll figure out a way to clean out your colon that you can tolerate.
And even if you have a tough night, it sure beats chemotherapy.)For this week’s CBS Doc Dot Com, I follow Katie’s lead and undergo a colonoscopy with cameras rolling in an attempt to remind people that a screening colonoscopy can save your life. I had the benefit of a house call the night before by my office nurse, Debbie Fitzpatrick, who held the video camera and offered advice and encouragement as I had a taste of my own medicine: the colon cleanout solution. The colonoscopy was performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
For more information about the Jay Monahan Center,click here.
For more information about screening for colon cancer, click here.To watch my colonoscopy, click below:
It used to be that we’d get all our kids settled back to school and then enjoy a bit of a pause before the other shoe fell with the inevitable concern over another flu season. With Swine Flu, Influenza H1N1 not taking a summer vacation and showing no signs of letting up, we didn’t have that luxury this year.
I went onto My Fox Boston this morning and talked with Keba Arnold about this very unique flu season with 2 influenza strains traveling among us and offered some practical tips to not only prevent the flu but be ready should it impact your town’s schools:
Don’t try and absorb everything at once. Focus on prevention today and I’ll help keep you informed as we learn more about the flu shots your family will need, when they will be available, and any breaking CDC alerts that are important for your family’s well being during the flu season.
*This blog post was originally published at Dr. Gwenn Is In*
Preventable disease is a terrible burden, made all the more tragic by the fact that it can be avoided.
Policymakers in Washington take this a step further, claiming that we can save huge amounts of money by systematic programs to prevent disease and encourage wellness. The document explaining the Republicans’ new “Patient Choice Act” says that wellness and disease prevention can save trillions of dollars(.pdf). President Obama seems to agree, saying these programs like these can create “serious savings” that represent “huge amounts of money in the long term.”
There’s one problem: study after study says it’s not true.
Earlier this year, the prestigious journal Health Affairs published a study on this topic. The author reviewed the results of nearly 600 studies (abstract at link, full article requires subscription) on the cost-effectiveness of various prevention programs. The findings are overwhelming – less than 20% of these programs saved money, while more than 80% actually added more to medical costs than they saved. How can this be?
It isn’t that complicated when you think about it. Take high blood pressure. If every American with high blood pressure took blood pressure medication, we would have lower rates of heart disease and stroke, and of course, eliminate the costs associated with those avoided conditions. But as the study points out:
the accumulated costs of treating hypertension are nonetheless greater than the savings, because many people, not all of whom would ever suffer heart disease or stroke, must take medication for many years.
Studies have shown similar results for other chronic diseases, like diabetes and asthma. There is also important data showing that even screening programs for cervical, breast and colon cancer cost more than they save.
Does this mean we shouldn’t do these things? Of course not. For each life that is touched by avoiding a chronic disease, finding a tumor early on, staying out of the hospital, there is enormous value. But the value is not financial. It’s something we do because it’s right, and it’s inherently good. There are no formulas to measure this.
Health care is very expensive, and the burden of that cost affects us all. But to talk seriously about this problem we need to confront an inconvenient truth: there is more to health care than just dollars and cents.
*This blog post was originally published at See First Blog*
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…
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…
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…
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…
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…
