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This is a healthcare, not a healthcure, website. It's
about all the things you can do to keep yourself and your community healthy. We will
try to combine common sense with current authoritative data.
This is how you stay healthy, not how you get healthy.
Some of it is about what you do (get thin, stop smoking, consume vegetables, run for
20 minutes). But a lot is what we must do to our politicians (beef up disease
prevention centers, cut water and air pollution, use airwaves for a host of public health
information to enable our citizenry, target dollars at bigest disease conditions, expand
charters of lower-rank and lower-paid health professionals).
163. -new-
Arsenic
Aplenty
In our
“Ninety Degrees of Uncertainty,” we touched upon the widespread arsenic
contamination of water supplied in both the United States and abroad.
Environmental Health Perspectives, June 2005, looks broadly at the
extent of this problem and at new tools for remediation, commenting also on
the range of illnesses—cancers as well as cardiovascular and neurological
complaints—that can result from this pollution. See
http://
ehp.niehs.nih.gov/docs/2005/113-6/toc.html. We have come such a long
ways from 1910 when Paul Ehrlich introduced salvarsan (arsenic based) for
syphilis in those days before antibiotics, a time when venereal disease
sufferers had no effective remedy for their complaints. Now arsenic itself
is the hidden scourge.
(8/3/05)
162. The Ultimate
Sunscreen
“Mexoryl
SX, made by the Paris-based skin-care giant L’Oreal, is an illegal sunscreen
in this country, one that is thought to be particularly useful in preventing
wrinkles.” It is sold on the side, in any event, by some druggists on the
Upper East Side of Manhattan. “The Canadian website
feelbest.com “sells a three-ounce tube
for a little over $20,” well under what U.S. druggists peddle it for. In
particular, mexoryl blocks the full range of sun rays effectively, not only
the UVB rays to which we attribute sunburn, but the equally harmful UVA
rays. So far the FDA has approved only zinc oxide, titanium oxide, and
avobenzone (Parsol) for UVA protection. UVA rays (320 to 400 nanometers vs.
290 to 320 for UVB) have a longer wavelength. Here, we are reminded of the
problem we have had in the microwave area, where, traditionally, American
devices only offered protection for a narrow part of the spectrum, and waves
that were actually more dangerous long term were allowed free range. See
the New York Times, June 9, 2005, p. E3. (7/27/05)
161. Anti-Scar
Drug
Mark
Ferguson and Sharon O’Kane of Manchester University have formed a
well-funded, venture-backed company called Renovo to develop, test, and
market a drug they have developed called Juvista, a synthetic version of
TGFbeta3, a protein that acts to both prevent and remedy scarring. In the
1980s, Ferguson discovered “that wounds an alligator suffered as an embryo
would not result in any scarring,” due, as it turned out, to presence of
“transforming growth factor beta 3.” Now in final stage clinicals, the drug
should go to market in a few years. “Scarring of the skin affects an
estimated 42 million patients in the U.S. … Renovo has three other
anti-scarring drugs in advanced clinical trials and an additional 13 in the
pipeline.” The thought, too, is deal with internal scarring as well. See
Business Week (May 30, 2005, p. 89) and
www.renovo.com. (7/13/05)
160. Gene Tests and Coumadin Safety
Scientists
at the University of Washington in Seattle and Washington University in St.
Louis report that an understanding of the genetic makeup of patients who
require coumadin as an anti-clotting agent will eventually provide guidance
to physicians trying to establish a proper dosage for this very tricky
drug. Our conversations with conservative physicians indicate that this
would not be their drug of choice, because it is difficult to keep its
presence or density in the proper range for effective treatment and yet
avoid possible side effects. We should note here that new drugs are
beginning to enter late-stage trials that are safer and actually dissolve
clots, rather than inhibiting the formation of new ones, which is all that
coumadin achieves. “Dr. Rieder said his team knew that variations in a gene
controlling an enzyme known as CYP2C9 accounts for about 10 percent of the
differences among patients in their response to warfarin. But doctors
seldom test for the gene, in part because the finding involves relatively
few patients. In this study, the team focused on another gene known as
vitamin K epoxide reductase (VKORC1). The gene makes a protein that breaks
down warfarin in the body.” The latter gene accounts for 25 percent of the
variation in warfarin (coumadin) doses in patients under study. See the
New York Times, June 2, 2005 and “Effect of VKORC1 Haplotypes on
Transcriptional Regulation and Warfarin Dose,” The
New England
Journal Of Medicine,
June 2, 2005. (7/6/05)
159. Artery Disease in Seniors
For people
over 60 and for those particularly at risk for strokes, artery screening is
critical, according to Dr. Eric J. Topol, cardiovascular chief at the
Cleveland Clinic. “Stroke is the leading cause of disability in the U.S.
and the third-leading cause of death after heart disease and cancer.” See
the Wall Street Journal, September 24, 2004, p. B3. “Despite being
two decades old, the carotid ultrasound and ankle-brachial test are
overlooked exams.” In a test population of 8,000 the American Vascular
Association found that 7% had carotid blockage of greater than 50%.
“One-tenth of the people tested had an abnormal ankle-brachial score.” At
the same time, seniors should be tested for abdominal aortic aneurysms,
which are all too common and for which GPs also generally do not test. See
more on this in
“Abdominal Faults” below. By and large, hospital outpatient services
overcharge for screenings of this sort, often by a factor of 10 or more,
even if the WSJ pushes hospital testing. Unless one has a clear
medical problem, an over-sixty should look around for mobile units that
provide a battery of perfectly adequate tests for $125 to $200. One, for
instance, is Life Line Screening at
www.lifelinescreening.com. (6/15/05)
158. My First Year of Cancer
Silicon Valley executive Stephanie Day has given us her first thoughts
about coming down with breast cancer—the discovery and all that rush of
things that occurs from the moment you know that it has become your close
companion. She—and others—such as Brian McBain who takes us through his
years of heart disease in letters of
April 7 and
April 14,
2004—tell us what we already know. No doctor, no nurse, no healthcare
employee really know a disease. Only the patient knows. And the
lonely patient, amply informed, is his or her own best doctor. Please go
here for a full transcript of
“My First Year Living with Cancer.” (6/8/05)
157. Alcoholism Drug?
Vivitrex,
a drug from Alkermes (www.alkermes.com)
of Cambridge, Massachusetts, has in one study reduced heavy drinking days by
25% in test subjects. The study was performed by James G. Garbutt of UNC
Chapel Hill, employing 624 alcohol-dependents adults. An advantage is that
the drug only has to be injected once monthly. Traditionally, of course,
with alcoholics, the problem is that they eventually fail to take drugs
provided them, however administered. See the Wall Street Journal,
April 6, 2005, p. D4. (5/4/05)
156. Promising Prostate Vaccine
Provenge,
from Dendreon in Seattle (www.dendreon.com),
has shown promising trial results in advanced prostate cancer sufferers.
Apparently it provides roughly double the impact (months of survival) of
Taxotere from Sanofi-Aventis, the only approved treatment for those whose
cancer is spreading out of control. Less toxic than chemo treatments,
Provenge attempts to activate the body’s immune system to fight the cancer.
Hence that is why it is called a vaccine. To follow various prostate cancer
therapies, see the Prostate Cancer Foundation at
www.prostatecancerfoundation.org/site/pp.asp?c=itIWK2OSG&b
=46403. New York Times, February 17, 2005, p. C5. (4/27/05)
155. Peripheral Artery Disease
Some 11,000,
000 Americans are afflicted by PAD (Peripheral Artery Disease), but we hear
little about it and treatments for it are of mixed value. One can undergo a
bypass, leading ultimately to leg amputation. “Current treatments for
peripheral arterial occlusions include angioplasty, stents, surgical bypass
and, in 25% of acute cases, clot-dissolving thrombolytic drugs, such as
Abbott Labs’ Abbokinase or Genentech’s Activase.” Nuvelo’s Alfimeprase, an
experimental drug, is safer, faster, and acts directly to dissolve the clot,
which is at the heart of the disease. Before approval, Nuvelo must take the
drug through satisfactory late stage trials. Forbes, January 31,
2005, p. 74. (4/13/05)
154. Wound
Water
Oculus
Innovative Sciences has “developed a kind of superwater that kills bacteria,
viruses, mold and spores at rates comparable to any antiseptic, but without
toxic side effects. The liquid called Microcyn also appears to be a fast
wound healing agent for burns, chronic wounds, even diabetic sores. It is
now approved as disinfectant in several countries, but in Canada only, for
woundcare. Zapping water with electricity, the company has created a lot of
free ions which invade and damage bacteria cell membranes. Hoji Alimi, an
Iranian, originally licensed the technology from the Japanese who had been
looking into a nuclear reactor application, in his search for a cancer
cure. See “Holy Water,” Forbes, February 28, 2005, p. 62. See also
www.oculusis.com. (4/5/05)
153. Moving Towards Electronic Health Records
Laura
Landro, in The Wall Street Journal, February 9, 2005, p. D5, cites 5
innovations which are helping the advent of electronic medical records for
patients: Computerized Physician Order Entry, Clinical Decision Support
Systems, Electronic Prescribing Systems, Patient Tracking and Verification
Systems, and, finally, National Health Information Infrastructure. She
recommends the following to find out more about the electronic initiative:
The Markle Foundation/Connecting for Health (connectingforhealth.org),
The Foundation for E-health Initiative (ehealthinitiative.org),
The Healthcare Information and Management Systems Society (himss.org),
The National Committee on Vital and Health Statistics (NCVHS.hhs.gov),
and the National Health Information Infrastructure (aspe.hhs.gov/sp/nhii).
(3/30/05)
152. Intransigent
Fats
“Partially hydrogenated fat has been the food industry’s favorite cooking
medium for decades. … But scientists contend that trans fat, a component
of the oil, is more dangerous than the fat it replaced. Studies show trans
fat has the same heart-clogging properties as saturated fat, but unlike
saturated fat, it reduces the good cholesterol that can clear arteries. A
small but growing body of research has connected it to metabolic problems.”
See The New York Times, February 13, 2005, pp. YT 1 and 23. “At
least 30,000 and as many as 100,000 cardiac deaths a year in the United
States could be prevented if people replaced trans fat with healthier … oils
… according to a 1999 joint report by researchers at the Harvard School of
Public Health and the Brigham and Women’s Hospital in Boston.”
(3/16/05)
151. National Cancer
Institute
We have put up for you on Global Sites
Cancer
Resources, which provides you with endless links to sites that may help
you with your particular brand of cancer. The problem, of course, is that
this does not really give you guidance or interpretation. For that you may
want to explore the National Cancer Institute at
http://cancer.gov as well as the NCI Cancer Bulletin, which can be found
at the same site. It has a lot of bureaucratic stuff but occasionally
mentions a new trend in treatments. This site gets into treatment, clinical
trials, etc.—all the things you want to know as you move beyond
understanding what you’ve got to looking for what to do about it.
(3/16/05)
150. Hospitals
that Do Care
If we are to believe Philip Longman, and we do, Veterans
Hospitals, reviled just a few short years ago, are “producing the highest
quality care in the country. ... In 2003 ... the prestigious
New England Journal of Medicine published a study that compared veteran
health facilities on 11 measures of quality with fee-for-service Medicare.
On all 11 measures, the quality of care in veterans facilities proved to
be ‘signicantly better.’”
Other studies show that the VA comes in at the top of
the heat on countless measures, including quality of cardiac and diabetes
care, two critical areas. Critical was the work of Kenneth Kizer who in
1994 came to head the system: he thoroughly shook the place up.
One of the
keys has been the use of thoroughgoing information technology to root out
errors (the lesser hospitals actually kill a fair number of patients because
of mistakes), to improve diagnoses, and to implement coordinated
evidence-based care. See “The Best Care Anywhere,” The
Washington
Monthly, January 1, 2005.
As
interesting as this article is, we think it does not capture the true
breadth of the VA achievement. For instance, a hefty number of beds and
other kinds of facilities were closed down, and, at the same time, the VA
built up its outpatient capability. We suspect the re-allocation of
resources was as important to VA success as the retooling of the information
systems. As it happens, our medical system generally provides a vast amount
of expensive care we don’t need, and fails to provide enough daily support
activity outside the hospital to deal with chronic patients. (3/16/05)
149. Herbal Malaria Cure
A
plant called Qinghao, and named Artemisia Annua by western botanists, is
proving effective against malaria, but is in short supply and rising sharply
in price. Its key ingredient, artemisinin, has been extracted from the
plant and chemically converted to derivatives with heightened powers against
malaria. When combined with lumefantrine, it has been shown to be very
effective as a one-two punch in 90% of those treated. ACT, as the
combination is called, has become more important as traditional drugs become
less effective. WHO is trying to get the developing world to broadly shift
to this treatment. While widespread, the most effective varieties occur in
a couple of provinces in China plus Vietnam, leading to a supply shortage:
farmers realize they can now ask more for the plant. Chinese producers are
now trying to cultivate the plant rather than simply relying on wild
varieties. Additionally synthetic varieties of artemisinin are being
developed in labs which would reduce the cost of treatment substantially.
See The Economist, November 20, 2004, pp. 81-82. (2/23/05)
Update:
Malaria
Drug Alternatives
Meanwhile, there is a panoply of initiatives and drug development efforts to
try to bring malaria to heel. Dr. Jay Keasling, a California biochemist, is
trying to genetically alter bacteria to artificially produce artemisinin,
using a $43 million grant from the Bill and Melinda Gates Foundation.
Medicines for Malaria Venture, located in Geneva, is testing 2l drugs, with
the most likely winner being Oz (OZ277), a synthetic trioxolane. “Virtually
all malaria experts agree that new malaria regimens must consist of more
than one drug. .. Though there are many malaria drugs, virtually all are
from one of three classes: artemisinins, quinines, and antifoliates.” The
thought is that cocktails involving more than one class will overcome
malaria mutations proving resistant to any one class of drug. See “Millions
of Lives on the Line in Malaria Battle,”
New York Times,
January 25, 2005, p. D6. (4/5/05)
148. Poison Pills
“The number of deaths linked to prescription drugs rose fourfold in Utah
from 1991 to 2003 … [a] sharp increase in prescriptions for powerful
painkillers.” The culprit was painkillers: but, of course, death is the
ultimate painkiller. (See The New York Times, January 25, 2005, p.
D6.) “The study was published…in The Morbidity and Mortality Weekly Report,
a journal of the Centers for Disease Control and Prevention.” (2/15/05)
147. Ranking Doctors and Hospitals
Atul Gawande’s “The Bell Curve,” New Yorker, December 6, 2004,
pp.82-91 examines the effort to evaluate institutional (hospital) and
physician effectiveness. In general he looks into a study of cystic
fibrosis care and found the Fairview-University Children’s Hospital program
to consistently obtain the best results. Run by Warren Warwick, who had
earlier studied CF care, it succeeds because it focuses so heavily on what’s
necessary to keep the lungs open, doggedly doing whatever it can with each
patient to pursue that single goal. As Gawande notes, this kind of study of
results, widely applied, would shake the medical profession and hospitals,
as it would point out that the performance of so many is average at best.
Boston’s Institute for Health Improvement, run by another pediatrician
called Don Berwick, is broadly pursuing an agenda that calls for careful
measurement of results and their wide dissemination. In fact, today,
healthcare processes and evaluation do not anchor themselves in outcomes, at
great cost to patients and the economy.
146. Spice and Life
A somewhat neglected older study, ”Antimicrobial Functions of Spices:
Why Some Like It Hot,” by Jennifer Billing and Paul W. Sherman from Cornell
in the March 1998 issue of the Quarterly Review of Biology documents
the importance of spices, particularly in hot climates, for controlling food
diseases, long serving as preservatives and bug killers particularly before
refrigeration came along. Billings did most of the hard slog work, looking
at 4,570 recipes from 93 cookbooks for the cuisine of 36 countries.
“Garlic, onion, allspice and oregano … were found to be the most all-around
bacteria killers,” according to a Cornell press release about their work.
See The Economist, “Antibiotic Spices,” May 19, 1998. To get a list
of top 30 spices with Microbe Fighting Ability ranked by effective, see the
fairly detailed Cornell Release at
www.news.cornell.edu/releases/March98/
spice.hrs.html. Dr. Andrew Weil, incidentally, theorizes that tumeric
may offer some help against Alzheimer’s and other diseases, noting that
India where it is widely used enjoys lower rates of the disease than other
major nations, suggesting that spices with a low ranking as a germicide may
be terribly important in other regards.
145. The Sweet
Life: La Dolce Far Niente
In several places on the Global Province, we have reported on
rising stress in the workplace. Dan Seligman, a retired Fortune
editor who does occasionals for Forbes,
is much
enjoying his life in the slow lane but is quick to report that stress in the
workplace is declining not rising. Just for balance, we include his
thoughts here. Though Americans work long hours, he notes that Bureau of
Labor Statistics show us that hours on the job have been in a “long, steady
decline.” Similarly the BLS, he finds, shows hours lost because of stress
to have declined 25% from 1992 to 2001. For the same period, the National
Opinion Research Center reports a big drop in the number of workers claiming
to be stressed. See Forbes, October 18, 2004, pp. 118-20. Well,
maybe the stressless are all clustered in those red states we don’t visit
enough of the time. But we’re blue and find it hard to take Mr. Dan too
seriously.
144. Not
Quite So Fat?
Dr. Jeffrey
Friedman of Rockefeller University maintains that the real weight of
Americans has remained remarkably constant, but that our statistics are
skewed by the truly obese who are growing ever fatter. “Only with the
massively obese, the very top of the distribution, is there a substantial
increase in weight, about 25 to 30 pounds.” Other experts, of course,
disagree. See The New York Times, June 8, 2004, p. D5. Friedman,
who discovered leptin, a hormone released by fat cells, believes weight is
genetically driven, and we can only exert control over our weight within a
10 or 15 pound range. He thinks the hyperbole devoted to obesity and the
fat “epidemic” is much overdone.
143. Alchoholics
Anonymous
As we have said elsewhere, Alchoholics Anonymous is one of the most worthy
non-profits in our society. It operates on a very low budget (basically it
is sustained by passing the hat at its meetings), is by far the most
successful remedy available in the world for those who have lost control of
their drinking, and, as importantly, depends on the ongoing participation of
its members to succeed. That is, the members who have stopped drinking help
initiates who are still getting off the sauce, and help themselves by
immersing themselves in the ideology of sobriety. The group is a model for
our society and should be the basis for dealing with most addictive problems
and for groping with a wide range of chronic diseases. To our regret, we
have never read its core text called “Alchoholics Anonymous,” and we intend
to get a copy. It is also referred to as the Big Book or the group’s
Bible. In any event, it is authored by Bill Wilson, and sums up the
philosophy he and Robert Smith, another founder, originated, which roughly
says that only one drunk—on the wagon—can help another. Wilson’s master
draft was slated to be sold at auction by Sotheby’s in mid-June 2004. See
our letter,
“Giving” (February 25, 2004).
142. Slicing Medicaid Costs
The UCLA/Johnson & Johnson Healthcare Institute has published a study based
on a pilot experiment with 400 families who had children in the Head Start
program. It shows that parents who are trained in health matters will stop
taking their children to the Emergency Room or a physician’s clinic for
minor complaints such as ear aches or sore throats. Basically those trained
and provided with a health reference book cut their visits in half. See
The Wall Street Journal, April 27, 2004, p. D4. We have previously read
correspondence from hospital employees asking why so many unwarranted
Medicaid hospital visits were allowed. In general, assorted studies of
Medicare and Medicaid activity around the country suggest that about 1/3 of
the costs of such programs could be averted with better clinical controls
and better patient education. Systematic healthcare education and cajoling
seems to be the only antidote for our healthcare crisis.
141. Better Healthcare Costs Less
“In the fall of 2001, Pitney Bowes Inc.’s corporate medical director, John
Mahoney, proposed an unusual experiment: Slash the amount that employees
pay for diabetes and asthma drugs, and see what happens.” “Since 2001, the
median medical cost for a Pitney Bowes employee with diabetes has fallen 12%
from about $1,000 a year. The median cost for a patient with asthma has
dropped 15% from $900 annually. Overall, the company says it will save at
least $1 million in 2004, with continued savings in future years.” See
The Wall Street Journal, May 10, 2004, p. R3. In some measure, this
cuts across the notion that the way to save money is to ratchet up employee
co-pays. To some extent, co-pays help contain company healthcare costs,
forcing workers to move to low-cost generics. But “predictive modeling” has
shown that getting diabetics and asthmatics (and others with chronic
conditions) to take the right drugs regularly will have a better, sustained
impact on costs. Pitney employed Medical Scientists Inc. in Boston (www.medicalscientists.com/index.htm),
a predictive modeling firm, to look at this question and render advice.
Later, Medstat, a medical data firm in Stamford, Connecticut, looked at
Pitney’s results: the $1 million a year that Pitney pumped into this new
program was more than offset by savings elsewhere.
140. Healthcare and the Economy
American wages are more than competitive with those in other developed
economies. But structural costs, which add 22.4 percent to the cost of
doing business in the United States, threaten the competitiveness of
American business. “One of the main culprits is health care.” See “Whose
Problem is Health Care,” The New York Times, February 8, 2004, p. BU
6. After corporate taxes, benefits cost are second largest cost for
American manufacturers. Because of funding out of general government
revenues, private sector expenditures for health in Canada are only 2.8 % of
gross domestic product as opposed to 7.7% in the U.S. Major business
associations are proposing that the federal government pick up the tab for
retiree health care, though so far they have stopped short of advocating the
same for their active workforces. Over the long haul, it would seem, the
government will displace private insurance as much to help the economy as to
nurture health. Best of all, of course, would be an attempt on the part of
large corporations to attempt the painstaking public health measures that
would slice their health and absenteeism costs.
139. Shrinking Americans
Burkhard Bilger in “The Height Gap” (The New Yorker, April 5, 2004,
pp. 38-45), speculates on “why Europeans are getting taller and taller—and
Americans aren’t.” It appears that, on average, their nutrition is better
than ours, accounting for the difference. “The Netherlands, as any European
can tell you, has become a land of giants. In a century’s time, the Dutch
have gone from being among the smallest people in Europe to the largest in
the world. The men now average six feet one---seven inches taller than in
van Gogh’s day—and the women five feet eight.” In the United States, “Tall
men, a series of studies has shown, benefit from significant bias. They get
married sooner, get promoted quicker, and earn higher wages.” “Biologists
say that we achieve our stature in three spurts: the first in infancy, the
second between the ages of six and eight, the last in adolescence. Any
decent diet can send us sprouting at these ages, but take away any one of
forty-five or fifty essential nutrients and the body stops growing.” During
the last half of the 20th century America was the richest country in the
world, but it has faltered by other indicators. “But by another set of
numbers—longevity, income inequality, and crime—it is now trailing Northern
Europe and Japan.” Versus Europeans, Americans suffer most growth-wise in
infancy and adolescence, suggesting that post and pre-natal care as well as
fast foods have the most to do with the American height gap.
138. Fat
Forward
There’s small evidence of progress on the fat front, not only here but
abroad. For the first time in years, Americans dropped a little bit of
weight last year. In Britain, “the average man got thinner in 2002 … for
the first time since body-mass-index records began; women’s BMI was
static.” See The Economist, “Fat of the Land,” March 6, 2004, pp.
51-52. In both America and Britain, there are various schemes being
proposed to impose a “fat tax” on the foods that put on the pounds, and an
effort to ban junk food advertising for children. Sales of chocolate in
Britain (the Brits are notorious consumers of sweets) have been falling 2% a
year, and food companies are edging into healthier foods. Salads are moving
faster on lunch menus, and exercise clubs are increasing their membership at
a healthy rate.
The
question, even so, is whether governments should intervene in the
marketplace and how. Kelly Brownell, chairman of Yale’s psychology
department and director of its Center for Eating and Weight Disorders,
believes that obesity is a public health prevention problem and that
government should be active in combating the “toxic food environment.” In
his book
Food Fight, he makes clear that individual dieting alone
won’t work when one is surrounded by signals that drive you to consume the
wrong things. Whatever the role of government, it seems clear that
overweight individuals are still fighting an uphill battle in trying to
reduce in a stressful atmosphere that goads them to consume and does not
afford them enough leisure to exercise properly. Nonetheless, a general
change in consciousness about health and obesity in many societies already
is leading to a loss of weight at the margins. For more on Dr. Brownell’s
views on government and obesity, see Yale Alumni Magazine, “The Belly
of the Beast,” March/April 2004, at
www.yalealumnimagazine.com/. Also see his vita at
www.yale.edu/psychology/FacInfo/Brownell.html.
137. 117 Auto Deaths Each Day
New York
Times
journalist Nicolas Kristof ranks for us America’s real killers. Automobile
accidents kill nearly 43,000 people a year, flu and pneumonia 36,000, guns
26,000, food illness 5,000, and terrorism usually under 1,000. Sweden,
through innovative measures (seat belts, use of traffic circles, flexible
guard rails, high use of helmets on motorcyclists) has achieved one of the
lowest fatality rates in the world. Kristof clearly thinks the auto risk
deserves much more attention. See The New York Times, March 13,
2004, p. A23. As interesting, we think, is the implication that we need to
better focus on our biggest risks in any event. In the same vein, decisions
on funding of disease research are not driven by the incidence of any one
disease in the population, but by interest groups plumping for their
favorite diseases. When we pay attention to risks, we will be pouring
vastly more funds into the prevention of obesity which taxes our health as
much as smoking.
136. McFilm
At the Sundance Film Festival in Park City, Utah, one of the hits this year
was Super Size Me. “It’s a film by Morgan Spurlock about his
decision to eat nothing but McDonald’s food for one month to see what effect
it would have on his body.
“Both he
and his doctors were amazed to find that after just 20 days, the 33-year-old
Mr. Spurlock, who started in supreme physical condition, was almost at liver
failure. They encouraged him to abandon the diet, but he continued through
the month, gaining a total of 25 pounds and finding himself depressed and
listless.” “The doctors who monitored his progress are now writing a
medical paper about the effects….” See the New York Times, January
24, 2004, p. A27.
135. Alternative
Provider
WholeHealth
MD.com is an outgrowth of American WholeHealth Networks, which provides
alternative health services to sundry custom health-insurance plans. See
www.wholehealthmd.com. We frankly don’t know a lot about it, so caveat
emptor. That said, it’s a reasonable place to find out more about
acupuncture, massage therapy, special nutrition, herbal and chiropractic
medicine, etc. Conventional medical centers have been slow to provide
clinical research on alternative techniques, and sometimes, as we learn from
hearsay, only alternative options provide relief for some conditions. Some
allergies, for instance, simply do not respond to any drugs now on the
market.
134. En Garde
We have long advised chief executives that they are really their own
investment bankers and that they must press all the levers to get a deal
done, whether it is a financing, a merger, or the sale of an unwanted unit.
The boys in the Street are simply overpaid technicians whose main expertise
is extracting excess fees from unwitting companies.
So too, you must understand you are your own best
diagnostician. This was recently re-confirmed in an article by Kevin
Helliker in the Wall Street Journal (December 23, 2003, p. D1) about
Karen Murray and her son. Her young son Michael was born with a rare
condition, although it is five times more common than cystic fibrosis.
Afflicted with a clutch of symptoms, Michael was taken to a bevy of New York
pediatric specialists and an orthopedist, an occupational therapist, a
joint-disease specialist, and a neurosurgeon. At best, the bunch came up
with “hypotonic,” meaning he had bad muscle tone. But a real breakthrough
did not come until his fifth birthday.
Murray surfed a CD that came with a computer she had
just bought her son. It had one segment called Family Doctor. There she
found out about Marfan’s Syndrome, a connective tissue disorder where all
the symptoms matched Michael’s. She had her suspicions confirmed at Mt.
Sinai and Michael was put on beta blockers to prevent further enlargement of
his aorta. Affecting some 200,000 Americans, it is treatable, and if caught
early, one’s lifespan can be extended from 40 to about 70. Ms. Murray,
president of menswear for Liz Claiborne, has since become a very active
fundraiser for the National Marfan Foundation (www.Marfan.org).
We would
caution parents and patients that this is not an unusual situation. No one
better represents a patient’s interests than an informed patient or informed
parent who will do all the random detecting that pernicious conditions
demand.
133. Abdominal Faults
Apparently 2
million Americans have abdominal aortic aneurysms, 90% of which are
undetected. Ruptures can result in death, and, indeed, some 15,000 people
pass away from this complaint yearly. A $200 ultrasound will identity the
problem, but it is not a standard part of yearly physicals. Treatment
involves a wrenching operation, a long hospital stay, and a six-week
recovery period. Now surgeons are performing endografts, which are much
less invasive, and where recovery occurs much faster. Instead of replacing
damaged sections, the surgeons insert a stent in the weakened area. See
Forbes, March 1, 2004, p. 111.
132. Norway
Is Top Breastfeeder
“Today, more
than three decades after bottle feeding peaked in the late 1960s, 99 percent
of mothers here nurse their newborns in the hospital. Six months later, 80
percent are still nursing, a rate that compares with 20 percent in Britain
and 32 percent in the United States….” “Studies have shown that babies who
are breast-fed are generally healthier, suffering fewer colds, ear
infections and stomach distress than babies who are given only infant
formula.” See The New York Times, October 21, 2003, p. A3.
131. Each to His Own
Poison
Before antibiotics, salvarsan (a dose of arsenic) was perhaps the best
treatment for syphilis, a discovery of Nobel prize winner Paul Ehrlich.
Some 19th-century scientists made much of the beneficial effects
of small amounts of certain other poisons as aids to human health. Poison,
as a way to health, eventually lost favor in the scientific community, but
is now slowly staging a comeback. For instance, articles now claim that
radon, in small amounts, may remedy various complaints.
Of late, Professor Edward Calabrese of the University
of Massachusetts has been further upending the canons of toxicology, as he
discovers more and more cases that seem to prove that low dosages of many
chemicals not only do not hurt the recipient but help promote growth,
longevity, or better health. “Hormesis is winning converts, however, as
scientists decipher the mechanisms that underlie it. Organisms respond to
poisons by unleashing molecular repair crews.... Exposed to x-rays that
tear DNA, cells produce enzymes that stitch it up.” See The Wall Street
Journal, December 19, 2003, p. B1.
130. The Good Stuff
Back in the 1990s Roger Newton led the Warner-Lambert team that put together
Lipitor, which today is the blockbuster anti-cholesterol drug (it is the
market leader in statins) that has propelled Pfizer to the top of the
pharmaceutical leagues. Now he and others are pushing drugs that put good
cholesterol into the body, instead of fighting bad cholesterol. In fact,
his company, Esperion Therapeutics, has just been acquired by Pfizer, which
is at pains to protect its cholesterol franchise. Statins only remove new
accumulations of cholesterol on artery walls, but don’t do much about the
plaque that’s already accumulated. Other firms playing in the arena include
Lipid Sciences, which is not as far along in its development, yet some claim
its approach is ultimately more promising. See Forbes, November 24,
2003, pp. 273-74. In any event, the use of HDL or good cholesterol to put
the coronary system to rights intuitively makes a lot more sense than the
uncritical application of the much over-used statins. At least in health,
doing good is still a sounder premise than fighting evil.
129. One
Patient File
Increasingly,
there are signs that your patient records will travel electronically with
you from doctor to doctor, facility to facility, so that physicians will
have a more adequate history when rendering your treatment. A
well-developed history, incidentally, is probably the key tool good
physicians must have to reach an adequate diagnosis, to avoid wasting time
and expense, and to avert fatal areas in several areas, to include drug
prescription. Afoot now is the CCR project (Continuity of Care Record),
which is a cooperative project of the American Academny of Family Physicians
(www.aafp.org),
the Massachusetts Medical Society (www.massmed.org),
ASTM International (www.astm.org),
and the Healthcare Information and Management Systems Society (www.himss.org)
wherein the standards have been set for recording medical information and
the information protocols have been established that will permit
transmission of information from institution to institution. We ourselves
would hope that such a record would also avert some of the promiscuous
over-testing that we have observed at various facilities that lack data to
understand what kinds of procedures and observations are merited. See
“Easy-to-Share Medical Records Gain Support, Would Cut Errors,” Wall
Street Journal, November 20, 2003, p. D3. On the one hand, we are
enthused to read about such portability. On the other, we wonder if this
will discourage physicians in the healthcare chain from doing the long,
adequate histories from which insight arises and which separates excellent
doctors from the also-rans.
128. Finally Fatties
Feeding Fresh
Americans are
beginning, finally, to eat fruits and vegetables, according to study by NPD
Group. See Wall Street Journal, October 14, 2003, pp. B1 and B7.
And the number of people exercising vigorously is also rising. Meanwhile
and even more importantly, employers appear to be stepping into the battle
against fat. See “Fight Against Fat Shifts to the Workplace,” New York
Times, pp. 1-18. Sprint has a fitness center, forces employees to walk
long distances from their cars to the office, and has slow elevators to get
people to walk from floor to floor. Union Pacific is providing employees
with weight loss drugs to see if that would help in the battle of the bulge.
127. ADEAR
There are a
few Alzheimer’s sites around, but we find this one as useful as any. It is
the Alzheimer’s Disease Education and Referral Center, an effort of the
National Institute on Aging. We learn that it is not only helpful for the
afflicted and their families, but that some healthcare professionals use it
to stay abreast of certain developments in the field. See
http://www.alzheimers.org/. So you can find out about ongoing clinical
trials or relevant conferences if you are an investigator. But families of
patients can discover the 29 Research Centers around the nation. You also
can reach it at 800-438-4380.
126. Yoga on the
March
As yoga gains
more adherents in the West, particularly in leading edge urban areas, there
are signs that at least smaller firms are beginning to make it part of the
workplace. See Wall Street Journal, October 14, 2003, p. D4. This
seems to include design studios, marketing boutiques, and the like. Most
interesting is the addition of regular sessions of yoga in the counseling
section of the New York Fire Department, the staff of which has become
particularly stressed because of the fallout from 9/11 and thereafter.
WSJ cites interesting growth numbers from the Yoga Journal: it
claims 15 million people are now active practitioners, with another 35
million claiming they want to try it over the next year. Almost invisibly,
a little bit at a time, a healthcare infrastructure seems to be growing up
outside of our formal healthcare system to deal with the new hazards of an
urbanized, technocratic, digital society.
125. Stress Ain't
All Bad
Well, you know about the business executives that seem ageless and thrive on
16 hour workdays, but who drop dead a year into retirement. It’s not clear
that many of us do well when we give up the grind. We have long known, when
we have our wits about us, that both the mind and body need constant
exercise (stress) to the end of our days if we are to have a life worth
living.
So it’s
refreshing to read Gina Kolata’s (no, this is not a coconut drink) “May Your
Days Be Long and Stressful,” New York Times, September 21, 2003, p.
WK 12. She comments on Dr. Mark Mattson, chief of the laboratory of
neurosciences at the National Institute of Aging in Baltimore, who has been
on a low calorie diet for 20 years, his regimen of no breakfast, light
lunch, and consistent exercise keeping him at a light 120 pounds. High
stress, he says, kills, but mild stress is beneficial. “Astonishingly,
there is some evidence that even the stress of low-level radiation seems to
make cells hardier, Dr. Warner (director of the biology of aging program at
the National Institute of Aging) said, not that he or anyone else is
advocating that you subject yourself to x-rays for your health.”
124. Breath and Chip
Testing
“Researchers
recently discovered that tiny molecules found in a single puff of your
breath may help screen for a range of conditions, including asthma, cancer,
and even schizophrenia.” Michael Phillips, professor at New York Medical
College in Valhalla, New York has been particularly active in this area, and
he hopes to take his ideas commercial through his company, Menssana Research
(www.menssanaresearch.com),
in Fort Lee, New Jersey. Aerocrine (www.aerocrine.com/)
of Sweden now is out with FDA approved test for asthma. Ekips Technologies
(www.breathmeter.com/index.xml)
in Norman, Oklahoma also offers an asthma breath test using lasers. See
Wall Street Journal, October 1, 2003, p. D10. Meanwhile, the Genome
Institute of Singapore (www.gis.a-star.edu.sg/homepage/default.jsp)
has announced that it is working on a microchip it hopes to ready by January
2004 to test for SARS, dengue fever, and flu. Nasal fluid or sputum would
be put on the chip, and the chip would correctly identify the specific
infection (Reuters, October 5). Tests for many severe afflictions promise
to become much less invasive and vastly less time consuming.
123. Ah,
Dark Chocolate
The docs occasionally lend aid and comfort to our worst tendencies. Our
household likes dark chocolate, and there is some reportage every year or so
that says it helps prevent heart disease, raising antioxidant levels in the
blood. Keep out the milk, say the researchers, because that gets in the way
of the active health ingredient—the flavonoids in chocolate. Most recently
both Nature and the Journal of the American Medical Association
(see August 27) talked of studies suggesting possible heart benefits,
though skeptics about chocolate’s efficacy do abound. See the Wall
Street Journal, August 28, 2003, p. D15.
122. Meditation
for Body and Soul
Richard Davidson, a neuroscientist at the University of Wisconsin-Madison
had been hard at work demonstrating that meditation not only calms the
emotions but that it also vastly helps one’s physical health. More powerful
brain scans show how the brain looks amidst meditation but also reveal
“enduring changes in brain activity months after a prolonged course of
meditation.” It is particularly worth following Matthieu Ricard, a French
monk and molecular biologist, who both investigates this area and
participates in experiments relating to the impact of meditation. (See
www.beliefnet.com/author/author_43.htm.) “Some experiments have … shown
that greater left-sided prefrontal activation is associated with enhanced
immunological activity by natural killer cells and other immune markers.”
“Since founding the Stress Reduction Clinic at the University of
Massachusetts Medical School in 1979, Kabat-Zinn and colleagues have treated
16,000 patients and taught more than 2,000 health professionals the
techniques of ‘mindfulness meditation,’ which instructs a Buddhist-inspired
‘nonjudgmental,’ total awareness of the present moment as a way of reducing
stress.” See “Is Buddhism Good for Your Health,“ The New York Times
Magazine, September 14, 2003, pp. 46-49.
The Massachusetts Institute of Technology held a recent
conference on “Investigating the Mind,” which included participation by the
Dalai Lama, Davidson, and sundry other scientists. See
www.investigatingthemind.org/about.sponsors.html. This conference on
September 13 and 14, 2003 was littered with interesting people such as
Jerome Kagan, Daniel Kahneman, Eric Lander, and Matthieu Ricard.
121. End to Annual
Physicals?
We don’t think so. A silly, but well meant, article in the New York
Times, August 12, 2003, p. D1 and D5, “Annual Physical Checkup May Be an
Empty Ritual,” nonetheless provokes some other thoughts. Because our own
cancer was discovered at an annual physical, we are happily aware of the
value of such checkups. The article cites studies and also quotes doctors
who question the value of these physicals and the ritual over-testing that
goes with them. In our eyes, all this merely indicates that internal
medicine is much out of date, and the doctors need to be severely retooled
to be more effective. Recent articles about family practices in desolate
agricultural areas reveal, for instance, that such visits allow sensitive
doctors to practice a little cheap, informal counseling. This is not
inconsequential in a nation where the incidence of depression is
skyrocketing. Furthermore, the cost of tests should and can be brought down
severely, and they can be administered elsewhere on a cheap, production line
basis: there is new equipment coming on line that can cost cuts severely,
eating into the inflated fees charged by the labs. Even in situations where
all is nominally well, the doctors, as a result of testing and interviews,
should afford each patient a written health plan at the end of the session
(this could be computer generated as variables are typed in) that gets to
the 2/3 of the nation that is overweight, the 80% that is working too much,
etc. By and large, the annual physical needs to be translated into an
experience that prevents illness, not one that looks for the cows after they
are out of the barn. The same physical needs to be plugged into a
continuous care regime that is mostly administered by less highly paid
health workers.
120. Weighty
Matters
As we have said here umpteen times, the nation’s biggest epidemic is
obesity. We’re steadily getting fatter, based on an obnoxious national
diet, a lack of exercise since suburban living and land use design in newer
areas of the country have taken walking out of our life, and compulsive
overworking which throw all our good habits out the window. The schemes
abound for taking off our pounds, as everybody horns in with ideas for
slicing off our flesh. To get up to date on some of these, read “Obesity is
the Target,” USA Today, May 8, 2003, pp. 1D & 2D. Taxes on bad
foods, hyper walking programs, more portion control, better food labeling,
etc. are all ideas being bruited about. As effective as anything is more
conversation between those trying to take off a pound or two. We ourselves
find that we eat better, exercise more, etc. as we talk about the pounds
with family members and with distant friends who are trying to melt away the
flesh. Again and again, we think, it has been demonstrated that addictive
behavior, such as the panoply of bad habits that go into gaining weight, is
best controlled by small, informal, close-knit personal networks in which
all share a common problem and the common goal of getting out of the ditch
and never returning.
Interesting, however, is the
effort of some agile companies to make their employees more fleet footed.
Abby Ellin in “Shed Some Pounds (and Get a Bonus),” New York Times,
August 13, 2003, shows how various companies have incentivized their
employees to lose weight. VSM Abrasives formed 20 or so five member teams:
the team that lost the most weight “won $100 and a day off with pay for each
team member.” “At the Adventist Media Center in Simi Valley,” each employee
got rewards for each mile walked or for every 20 minutes of exercise.
Richard Zanetti, “president of Yonkers Avenue Dodge … doubled employees’
monthly bonuses if they lost at least 10 percent of their body weight.”
We are currently advising companies that the only way to reduce their
healthcare costs in the American setting and to achieve major employee
productivity improvements is to promote on-the-job, all-encompassing health
programs that get at weight and other health problems in a major way. Only
preventive health measures will really get at our health costs, although
continuous health programs for chronically ill patients that is rendered
outside the hospital environment can also mitigate health expense.
Treatment programs, however, need to be divorced from preventive health
programs.
119. Half
Right
A
recent team at Rand interviewed 13,000 patients and looked at 6,712 medical
records at a cost of $6.5 million over a two-year period to determine that
patients get the correct care only 55% of the time. Inappropriate measures
were widespread, involving heart and diabetes patients who would clearly
benefit from more appropriate intervention. Their projections surmised that
perhaps 10,000 pneumonia deaths could be averted annually if vaccinations
were given, and that good screening could prevent 9,600 colon cancer deaths.
See The Wall Street Journal, June 26, 2003, p. D3. For the
Rand release on this study, go to
www.rand.org/hot/press.03/06.25.html.
118. Less
Prostate Surgery?
A new
scanning technique in which patients are injected with an iron oxide agent
has been shown to be much more sensitive than conventional MRI scans in
tracking the spread of cancer into lymph nodes. With prostate and other
forms of cancer, the form of treatment is very much dictated by the degree
to which the cancer has spread. More precise mapping of the cancer can lead
to more elegant treatments that are based on less guesswork. The
manufacturer of this agent, called Combidex, is Advance Magnetics (www.advancemag.com),
which is still awaiting final approval from the FDA. See The Wall
Street Journal, June 19, 2003, pp. D1 and D3.
117. Tara's
Tests
Tara
Parker-Pope of The Wall Street Journal has come out for 5 tests she
thinks are lifesavers, even if your insurer won’t pay for them.
Transvaginal Ultrasound. Ovarian cancer is a big killer of women,
particularly because it does not show early symptoms and there’s no
regular, generally approved test for it. Early detection results in cure
rates of 95%. Expanded Cholesterol Testing. The usual testing does
not directly measure LDL, which is the bad kind of cholesterol. Nor will it
look at the characteristics of your HDL and LDL, which are better predictors
of heart disease. She thinks the best test comes from Berkeley HeartLab of
Burlingame, California. EBT Heart Scan. This test looks at calcium
build up, another great predictor of severe heart problems. Spiral CT
Scan. This is the right way, even with false positives, to look for
lung cancer, even though it is not completely clear that detection will
improve your chances of survival. Aneurysm Scan. This will spot
abdominal aortic aneurysms, which are surprisingly common. See The Wall
Street Journal, June 24, 2003, pp. D1 and D4.
116. Cholesterol Only Half the Story
For years physicians who look harder at the data have told us not
to over-rate cholesterol numbers in trying to find out if patients were at
risk for heart disease. Now, finally, some medical personnel are demanding
tests that go beyond the standard lipid-profile numbers which may exaggerate
or gloss over the heart risk of this or that patient. But now we learn as
well that one should pay a lot more attention to “inflammation of blood
vessels.” “Americans’ arteries are not just clogged—they’re swollen. …
Half of all heart disease patients don’t even have high cholesterol. …
Swelling of vessel walls causes cholesterol plaques to rupture. A clot
forms around the loose gunk, creating a blockage that starves the heart of
oxygen….”
“But one
company, the tiny AtheroGenics, has a pill that promises to save lives by
reducing the swelling.” This “experimental drug, AGI-1067,” is finally in
late-stage clinical trials. What appears to happen is that the drug
prevents LDL (bad cholesterol) from oxidizing and sticking to vessel walls.
It is the adherence that seems to produce the undesirable inflammation. See
Forbes, June 23, 2003, pp. l68-69.
115. Watch Out for Paxil
“British drug regulators” have warned that GlaxoSmithKline’s “popular
antidepressant Paxil causes depressed children to become more suicidal and
should not be prescribed for them.” See New York Times, June 11,
2003, p. W1. Glaxo is not providing warnings on the drug in the United
States, where it is authorized for use with obsessive-compulsive children.
Paxil is part of a class of drugs such as Prozac and Zoloft in which such
side effects seem to be a problem. We note, in general, that there often is
not enough test data, positive or negative, for children on the application
of a wide range of drugs for sundry psychological problems.
114. Dealing With Stress Now
There’s a shift in thinking about how to
handle stress. The temptation is to postpone relief, as we tell ourselves
we will relax this week end or go to yoga tomorrow morning. The problem,
say researchers, is that you must deal with stressful events as they happen
if you really want to minister to your health. For instance, some companies
now provide biofeedback equipment that allows you to test your stress level
at any moment: with practice, some employees can bring down their stress
numbers in minutes when they have reached unacceptable levels. Other helps
for immediately dealing with stress apparently include more calming office
furniture, breathing exercises, appropriate snacks, and philosophical
training that breeds a better, more relaxed attitude towards shattering
events. See the Wall Street Journal, March 11, 2003, pp. D1 and D5.
113. Beyond Statins
Amongst the most profitable drugs in the
armories of the pharmaceuticals are statins, which have proven terribly
effective in lowering lipid profile (cholesterol) numbers in major segments
of the population in the developed world with relatively minor side affects
(apparently). We ourselves helped one statin developer bring its product to
market. That said, we remain worried about the side effects not yet
discovered, theorizing that anything that has so dramatic an effect on the
blood must be having other bodily effects we have not gauged. Of course,
our heart man (we have one, even though we have no apparent heart problems)
thinks it is silly to worry about this when you get old enough: one will be
under the sod from something else long before the hidden problems in statins
can do their worst.
Niacin does offer some hope for those with elevated cholesterol, but it does
not have the dramatic impact on one’s numbers that ensues when you take the
statins. We are trying out a natural supplement called policosanol about
which we should caution you: there is simply not enough data to say that it
is either effective or safe. Some of the houses that peddle it make some
giant-sized claims about the good things it will do for those who use it,
and these endorsements have to be discounted. On the other hand, we know
doctors who are using it and who are convinced of its merits. You can read
about it at
www.lef.org/magazine/mag2001/june2001_cover_policosanol.html?GO.X=7\&GO.Y=15
and can find other things about it at the
www.lef.org website. But, again, we caution you that it has not been
accepted by cardio doctors, and we need a lot more data before we can weigh
its merits.
112. Kicking the Habit
The
Internet now offers a number of sites that help people trying to kick the
habit. Very structured is
Smokeclinic.com. The most popular apparently is
Quitnet, the members of which turn out to be quite supportive to those
trying to pass up the smokes. Other sites are
Lungusa.org and
Trytostop.org. See Wall Street Journal, April 22, 2003, p. D1.
111. Sheer Waste
If
you can bear the dense writing, you will find some eye-opening insights in
these articles on Medicare. We refer you to “The Implications of Regional
Variations in Medical Spending, Parts 1 and 2,” The Annals of Internal
Medicine, 18 February 2003, Volume 138, Number 4, pp. 273-299. Also see
the relevant editorials in the same issue, pp. 347-351. “Regions with
higher expenditures did not provide better quality of care on most
measures.” “Regional differences in Medicare spending are due almost
entirely to use of discretionary services that are sensitive to the local
supply of physicians and hospital resources….” “If the United States as a
whole could safely achieve spending levels comparable to those of the
lowest-spending regions, annual savings of up to 30% of Medicare
expenditures could be achieved.” “Most important, the second of the two
articles by Fisher and colleagues … demonstrates that patients in
high-spending regions had no better survival (if anything, slightly worse)
than those in lower-spending regions.” In other words, there is something
like a quarter of a trillion dollars we could be spending on something
useful if we could get the make-work out of the Medicare system.
110. Fat and Cancer
“Losing weight could prevent one of every six cancer deaths in the United
States, more than 90,000 each year…. Researchers for the American Cancer
Society spent 16 years evaluating 900,000 people…. The researchers
concluded that excess weight might account for 14 percent of cancer deaths
in men and 20 percent of those in women.” See New York Times, April
24, 2003, p. A23. “The study doesn’t answer the question of why there is a
link between obesity and death from cancer…. [I]nvestigators have been
unable to pinpoint a biological mechanism clearly linking obesity to most
forms of cancer.” See Wall Street Journal, April 24, 2003, p. D3 and
current New England Journal of Medicine. Eventually we will have to
understand whether the cancer is caused by weight in itself or by certain
noxious elements in the kind of foods we eat.
109. Take Tea and See
A
component in tea, L-theanine, has been found to bolster the body’s immune
system, warding off bacteria, viruses, and fungi. Dr. Jack Bukowski,
researcher at Brigham and Women’s Hospital in Boston, said five cups of tea
a day strengthened the body’s disease defenses. “The health effects of tea
have been extensively studied. It has been linked to lower incidence of
heart disease and cancer risk through the action of flavonoids, a type of
antitoxidant. Other studies have linked tea to helping combat osteoporosis,
the brittle-bone disease, and to relieving some allergy symptoms.” See
Wall Street Journal, April 22, 2003, p. A12.
108. Down and Out
On this section of our website, we largely make the argument that
health in these United States and around the world can improve by leaps and
bounds if we can implement decent preventive health measures either through
public health channels or through motivated private sector initiatives. We
think private foundations probably will not get much done about health,
whether we are talking about the Rockefellers or the Melissa and Bill Gates
Foundation: they mean well but they suffer from whom they are. Putting all
this aside, some think that large-scale improvements in health are more
driven by initiatives in the social and political sphere that seem unrelated
to healthcare than by all our tinkerings with health policy. If this is
true, we would focus less on health policy and more on issues like income
distribution, public infrastructure, etc.
This view comes down to the idea that down and out
people don’t have much of a chance to be healthy. On the one hand, in
societies that consume too much and that are torn by income disparencies,
there is little resource left over for health. And, on the other, the poor
and stressed lack family cohesion and social amenities that are part of the
fabric of health, particularly as relates to mental wellbeing.
This is well related in
The Health of Nations by Ichiro Kawachi and Bruce P. Kennedy,
published in 2002. For the stressed and depressed who have no time to read,
we would particularly recommend a review of this book we caught in the
New England Journal of Medicine (January 2, 2003) by Stephen Bezruchka
at the University of Washington School of Public Health and Community
Medicine:
“The Health of Nations
presents evidence from many disciplines that political policies that widen
inequalities in income may harm a nation's health. Kawachi, an internist
turned social epidemiologist, and Kennedy, an educational psychologist
present arguments to show that one's relative position in society is more
important than absolute wealth or income, not only when it comes to general
well-being, but in terms of mortality as well.”
“We work harder and longer
just to keep up with our 1973 standard of living. This additional work
translates into 5 to 10 more weeks of work each year for members of the
American labor force than for their European counterparts. Politicians
preach about "family values," but how can families prosper without time for
maintenance? As a result of the orientation toward individual rather than
family needs, some people see children as obstacles to individual growth.
The authors point out that higher rates of crime occur when the high
cultural value placed on competitive achievement clashes with widespread
disparities in actual living standards within a society. Inequality is
harmful, and we pay the ultimate price for it with premature deaths.”
“To improve health in the
United States or elsewhere in the world, we must address factors that affect
the health of populations but have only indirect relevance for patient
care.”
We ourselves probably regard this point of view as interesting but a
distraction for health care professionals. We do think the decline in the
standard of living the nation has suffered since the Vietnam War and the
rise in stress occasioned by every employee doing the job of two have
brought low the health and welfare of the American community. Nonetheless,
we feel that massive, direct changes in the healthcare system could ratchet
American health upwards even with the societal problems cited by the
authors.
107. Executive Checkups Pay Off
A study of Bank One executives in the August issue of The Journal of
Occupational and Environmental Medicine found that executives who had
systematic deluxe checkups had 20 percent fewer health claims and 45 percent
fewer workday losses than those who didn’t. Lillian Vernon Company in Rye,
New York has noted a drop in executive absenteeism since it instituted these
exams, and finds that the checkup is also a good talking point when trying
to attract new talent. Lincoln Plating in Lincoln, Nebraska calculates that
lower claims costs, etc. more than pay for the examination program. In
2002, moreover, the company had no increase in health insurance premiums and
now is expecting only a 15 percent bump, less than the 25 percent jump many
companies are experiencing. See New York Times, March 25, 2003, p.
BU12.
106. Time Out Saves Lives
“A lack of vacations was a predictor of heart attacks and early death among
740 women studied over 20 years, says a landmark study published a decade
ago in the American Journal of Epidemiology.” See Wall Street Journal,
March 27, 2003, p. D1. Sundry other surveys and research, says the article,
show vacations have a big health payoff. Moreover, the U.S. and Japan have
mandated vacations that are as short as 10 days, with Denmark on the other
hand putting its workers out to pasture for 30 days. Incidentally, even the
animals at the Copenhagen Zoo get a vacation, since they are sent to a
retreat outside town to get away from peering people: this fact is not
cited in the article.
105. The Hidden Costs of Sickness
Dr. Ronald Kessler and his colleagues at the Department of Health Care
Policy, Harvard Medical School, are exploring the true costs of illness of
our working people. There are estimates that the cost of bad health is 2 to
3 times the expenditures employers expend for health benefits We even think
the cost is much higher. In any event, those tracking the costs of bad
health will want to read Dr. Kessler’s “The Effects of Chronic Medical
Conditions on Work Loss and Work Cutback,” The Journal of Occupational
and Environmental Medicine, Volume 45, Number 3, March 200l. The
methodology for researching such questions is difficult and such an inquiry
does not even cover all the incidental costs outside of benefits that are
related to employee illness. Be that as it may, “the estimated average per
capita number of work-impairment days in the total sample is 1.5 per month.
This is equivalent to an annualized national estimate of over 2.5 billion
work-impairment days in the age range of the sample.” Apparently the
estimates here are not out of line with other informed guestimates about the
same sort of questions. What this implies is that new efforts to deal more
systematically with chronic illness, while affecting the national health
bill positively, are not draconian enough to deal with the employer’s
dilemma. With all these indirect costs, only continuous, intensive wellness
programs will really get to the meat of the matter. No smart employer will
simply focus on benefit costs and ignore the true dimensions of its
healthcare bill: the forward-looking company must struggle with absenteeism
and lost productivity as well.
104. Ancel Keys and More
Henry Blackburn’s “On the Trail of Heart Attacks in Seven Countries” is an
absolutely fascinating tale about Ancel Keys of the University of Minnesota
who put together a multi-country team to study habits and heart disease in 7
countries. Certainly this has to be the best read on any public health
website anywhere in the country. See
www.epi.umn.edu/epi_pages/research/Foreword and
www.mbbnet.umn.edu/firsts/
blackburn_h.html. When Keys posited to the
potentates of the heart community that altering behaviors was the right way
to get at heart disease, all the wise men of the cardiology community
scoffed. Stunned, he went into action and put together a team that looked
at the relationship of eating habits, smoking, exercise, etc. to heart
disease. Lo and behold, the study uncovered all we know today yet have been
so slow to apply. Getting a few things right can massively lower coronary
problems, as best evidenced by Finland where very intensive public health
activities have sliced heart rate problems by twenty percentage points or
so.
103. Murdered Sleep; Stealing Naps
“William Dement, founder and director of the Stanford University Sleep
Research Centre, reckons that people on average now sleep one-and-a-half
hours a night less than they did a century ago, at great cost for their
health and safety….” Experts seem to think most of us need around 7 hours a
night. “Several great men who claimed to need little sleep, including
Napoleon, Edison and Churchill, got by on their ability to nod off briefly
whenever they had the chance.” It’s felt that short naps, of perhaps a half
hour, may be very beneficial. We know more than a few executives who keep a
couch in the office and sneak a respite during the day. In this tiring
world, we ourselves see naps as the only realistic solution to the fact that
we must burn the candle at both ends. See “And So to Bed,” the Economist,
December 21, 2002-January 3, 2003, pp. 111-113. And to catch up on Dr.
Dement, go to
www.sleepquest.com/index.html. We like him best for his endorsement of
dreaming: “Dreaming permits each and everyone of us to be quietly and
safely insane every night of our lives.”
102. The North Karelia Project
Thirty years ago North Karelia, a poor area of Finland, suffered from twice
as much heart disease as the rest of the country. Then a public health
official, Dr. Pekka Puska, took it in hand and proved that miracles do
happen. To the people of Karelia he pounded home the virtues of eating more
vegetables and getting rid of the fat, of exercising lots more, and of
cutting back on smoking. Over the last 3 decades, the province has slashed
the number of heart attacks, the number dying from heart disease, and the
number dying from lung cancer by about 70%. For men eight years have been
added to life expectancy, and six years for women. The program has been
expanded to the rest of the country with equally dramatic results. Read
more about this under Finland Power in our Big Ideas section and in our
Letters from the Global Province, 5 March 2003, “My Favorite Year.” Puska
has moved onto WHO, so we hope he can begin to work his magic around the
world.
See the
Wall Street Journal, January 14, 2003, pp. Al and A16.
101. Pollution Centers
“During the last decade, the country’s pollution center has shifted from the
industrial Northeast and Midwest to the South. Thirteen Southern states,
stretching from North Carolina to New Mexico, were responsible for producing
nearly half of all toxic releases known to produce cancer.” Obviously, this
article in the Wall Street Journal, January 23, 2003, p.D3, should
have said South and Southwest. The U.S. Public Interest Research Group at
www.uspirg.org has led the effort to single out high pollution zones,
zip code by zip code, and codify the link to human disease. There are bills
before Congress to track chronic diseases and to relate their occurrence to
environmental factors such as pollution. To get specific readings on
pollutant dispersals in your state, go to
http://uspirg.org/uspirg.asp?id2=8822&id3=USPIRG&.
100. Open for Business
Almost a decade ago, Heineken operations in Rwanda were ravaged by
genocide growing out of tribal warfare between the Hutus and the Tutsis.
Half its brewery staff was killed, and it took 3 year to put things right.
Now HIV/AIDS threatens to close the brewery again, as the death toll
mounts. Trained, literate workers are hard to come by. In self defense,
Heineken has guaranteed anti-retroviral drug coverage for workers and their
dependents. Heineken operations in Africa enjoy very high margins, and the
company can ill afford the loss of revenues and profits garnered there. See
Forbes, February 3, 2003, pp. 64-66. Africa demonstrates in stark
clarity what is just as true in Western developed countries: if unmanaged,
health costs and related absenteeism saps the profitability of
multinationals at virtually all their locations. For this reason, Disease
Management Programs are growing at employers throughout the United States,
enjoying exceptional growth in 2002. For more on this, see Business Week,
October 14, 2002, pp. 122-24.
99. Fat City
Houston again tops the fattest city list. Every year Men’s Fitness
ranks the cities that will make you fat, and those that will make you fit.
Bummers are Houston, Chicago, and Detroit. Blessed are Honolulu, Seattle,
and San Francisco. For a complete list, see
www.mensfitness.com/mens/superfeat/010203/ranking.html. In general the
West is the place to be, while the South and Southwest do a good job of
fattening you up for slaughter. We ourselves noticed how easy it was to
gain weight when we moved from the West to East Coasts, or even from the
Southwest to the South. It’s largely a function of exercise and diet,
though some cities have special aspects of their culture that put pounds on
or take weight off. As we have shown elsewhere, where you live has a lot to
do with how healthy you are.
98. Drugs from Monsters
Useful substances are now being gathered from some of nature’s frightening
creatures—gila monsters, bats, scorpions, puffer fish, leeches, and
poison-dart frogs. Insulin regulation, blood clotting, pain relief, and a
host of other benefits apparently can flow from the poisons of these
unattractive creatures. See “Medicine’s Wild Kingdom,” Business Week,
February 3, 2003, pp. 70-71. Here is yet another example of where nature
provides remedies that would save lab researchers a lot of work.
97. Richard II
Richard Saul Wurman, creator of Access Guides to sundry cities,
re-organizer of the Yellow Pages for the Bell companies in San Francisco,
and, most of all, impressario for TED (Technology, Entertainment, Design), a
conference where he brought out media and Silicon Valley moguls to brag
about their wares and charged very hefty ticket prices to attendees, is now
on to his next act. Do we call it Richard II, III, IV, or V—who knows?
Now it’s to
be TEDMED, scheduled for June 11 to 14 in Philadelphia. The grand goal is
to make medicine, especially new trends in medicine, understandable to us
all. So he’s going to take complicated diseases and make them simple.
Obviously, he is on to something, because a host of clever people believe
that health information is the key to better healthcare at lower cost, be it
timely information accessibly stored for doctors, or well-presented
information understandable to all patients about disease and disease
treatments, or better exchange of data on billing throughout the whole
cumbersome healthcare administrative apparatus. In fact, he’s the latest
participant in this burgeoning information market. See Forbes,
January 6, 2002, pp. 160-161.
96. Body Mass
As if
you did not know, you are probably overweight. But here’s how you get your
Body Mass Index straight, according to The New York Times, December
17, 2002. Divide your weight in pounds by the square of your height in
inches. Multiply the result by 703. If you get a figure of 25 or above,
you are merely overweight like me. If, however, it is 30 or higher, you are
obese and probably should worry about it. Ostensibly your risk of stroke,
for men anyway, increases 5 or 6% for every additional point on the BMI.
If you are lazy like me, which is probably the reason why we
are both overweight, then go to this site of the National Heart, Lung, and
Blood Institute. You can come up with your mass without doing weighty
calculations. In other words, you will not have to do the complicated math
we laid out in the paragraph above. Just plug in a couple of numbers, and
presto. See
www.nhlbisupport.com/bmi/bmicalc.htm.
95. Self-Help in China
Dr.
Hong Zhaoguang has a self help health message that has captured the mind and
hearts of China’s millions and China’s ministers. His books are
bestsellers; his lectures 3 or 4 nights a week are attended with rapture,
and he is now joint chief lecturer for 11 ministries. A cardiologist by
training, he has put together his own formulary of preventive medicine which
basically consists of telling people to take care of themselves in very
simple language. For instance, there are four bests: the best doctor is
you; the best medicine is time; the best state of mind is peace; and the
best exercise is walking. See The New York Times, December 21, 2002,
p. A4. In China, too, there is a growing realization that the only
prescription for a growing healthcare crisis is to change people’s behavior
by motivating individuals to take up the cudgels for their own health.
94. Unhealthy Vaccines
A Danish study at the University of Aarhus appears to document a
connection between treatment with vaccines and autism in children. See the
Wall Street Journal, November 7, 2002, p.D4. Even more disturbing,
Neal Halsey, a physician and scholar at John Hopkins and onetime chairman of
the American Academy of Pediatrics’ committee on infectious diseases, who
has long been a strong vaccine advocate, is now rather persuaded of its
dangers. The culprit may be thimerosal, a preservative that apparently
contains more mercury than a child should have to tolerate. See “The
Not-So-Crackpot Autism Theory,” New York Times Magazine, November 10,
2002, pp. 66ff. Now the mercury has been removed from vaccines, which are
crucial to any kind of public health effort and are the best hope, actually,
for lowering health costs in large populations, particularly with the advent
of many new vaccines, such as those for cancer. There is acute resistance,
we should note, in both the scientific and medical community to the idea
that vaccine formulations could be the basis of autism or neurological
disorders. Nonetheless, it only leads one to suspect that several of the
neurological complaints that tax broad numbers of people as they grow older
may often have a chemical basis stemming from substances ingested into the
body in one manner or another.
Fortunately
this and other problems with vaccines probably will not put a damper on
vaccine growth, as R & D and new products pick up. The economics of
vaccines have become compelling, not just for the big pharmaceuticals, but
for public health administrations around the world trying to get a grip on
healthcare costs. It’s simple: preventing a problem is a whole lot cheaper
than trying to cure it. Global sales of vaccines have been limping along at
$6 billion annually, a drop in the bucket. Merck’s HPV vaccine, Glaxo’s
herpes preventive (now in development), and Wyeth’s Prenar for pneumococcal
bacteria promise to bump up vaccine sales considerably, according to
Business Week, December 9, 2002, pp.40-42 in “Vaccines are Getting a
Booster Shot.” Despite the fact that the number of companies selling
vaccines has shrunk to 4, more than 100 vaccines are working their way
through the labs. If we can secure better global distribution of vaccines,
thereafter, it bodes well for global health. We ourselves remain passionate
vaccine advocates—with a wary eye.
93. More Back Up on Back Pain
We have just put up one note on back aches (see item number 90). This is an
affliction which deserves quite a bit of study, since the costs for society
are huge. You will discover that back afflictions account for a stupendous
number of medical visits when you look at medical plan statistics. Well,
the Wall Street Journal has cultivated a resident backologist in the
person of Ms. Tara Parker-Pope, who has written convincingly on the topic on
more than one occasion. We can only suspect that upright chairs at Dow
Jones or the stresses of life have knotted up her own back. At any rate, it
is worth consulting her Health Matters column of September 30, 2002, p. R6,
which is authoritative and does cover a range of options. She notes that
250,000 spinal fusions are done each year, and that only 50% work.
Moreover, as she says, 90% of all back problems get better in 3 months, so
one should not rush to extreme treatment. Among the options she discusses
are injections, therapy and exercise, heat procedures, less-invasive fusion
surgery, and total disk replacement. As interesting is a follow up on
November 12, 2002, p. D1, entitled “In Excruciating New Cure for Back Pain,
Doctors Tell Patients to Hit the Weights.” Here she comments, “A number of
recent studies show back-pain sufferers who use aggressive exercise are far
more likely to return to work, have less pain and are less likely to seek
additional back treatment than those who use more traditional treatments.”
We are discovering that benign neglect and/or exercise deal with many of
the body’s painful complaints.
92. A Better Hospital Stay
Laura Landro’s “The Informed Patient” should be a regular read for those
managing their own healthcare. Ms. Landro has had a couple of bouts of
illness herself and knows whereof she speaks. A recent column, “Sick of the
Hospital Treatment? New Forums Let You Rate Care” (Wall Street Journal,
August 1, 2002, p. D3) gives some very sensible advice on how to be a
successful advocate if you are hospitalized. She says: Have a friend with
you as often as possible to see that the right things are done; request all
the information on your case to include charts and clinical data; don’t
leave the hospital without clear instructions as to how to care for yourself
at home; find out if the hospital has a patient ombudsman in case you do
have to complain.
91. For 80 Cents More
A recent experiment in Tanzania showed that extraordinarily small
additions to the public health budget could net tremendous benefits, as
outlined in a special report in the Economist (August 17th,
2002, pp.20-22). In part this is due to the fact that so little of
the national health budget actually goes into patient care. For instance,
for every $100 spent on drugs, patients actually only received $12 in
benefits for a host of reasons. But, as importantly, the budgets often are
targeted on the wrong diseases and conditions. Malaria, for instance, often
accounts for 30% of the problems, but only gets 5% of the funding.
Tuberculosis is only a 4% problem, but may get 22% of the budget in some
regions. Oddly enough, the data seems to show that vaccinations also
swallow too much of the budget. In the districts where the test was
conducted, the results were spectacular with infant mortality numbers
falling some 28%, for example. Incidentally, this failure to prioritize is
just as much of a problem in developed nations where, again and again,
resources are not allocated well enough to chase the biggest problems.
Here and there, these days, there is a effort to intelligently segment
populations by kinds of health problems in various parts of the United
States in order to better understand how medical dollars should be focused,
region by region.
90. Oh, My Aching Back
One of the areas where a more rational health system might achieve
substantial savings is in the care of backs. A huge percentage of the
population has back pain, and its cost to employers and insurers, when you
include medical expense and missed work days, may range as high as $45
billion. We still don’t know how to deal with it, but it is at least
interesting to know that one should be restrained about treatment since
outcomes are uncertain and that one should realize that treatment options
have evolved a great deal over the last ten to twenty years. Forbes
(August 12, 2002, p.123) has a very good short article about some of the
options, including a newish heat treatment that, in effect, eliminates
problematic discs. Most importantly, the article notes, “nine out of ten
sufferers will get better in six to eight weeks by exercising and taking an
occasional pain pill.”
89. Celexa (Cipramil)
“A CEO and His Son” is the remarkable story of how Howard Solomon of
Forest Laboratories (NYSE:FRX; www.frx.com), seeking a cure for his son’s depression, brought a Danish
anti-depressant to America, which has turned out to be a blistering
commercial success. See Business Week, May 27, 2002, pp. 72-80.
Probably this is the most affecting story that Business Week has ever
written. Historically it has been a boring business magazine, even though
it has been pretty good at early spotting significant trends and important
commercial developments. Susan Berfield, the writer, includes sidebars on
how depression has affected famous persona such as Winston Churchill, Cole
Porter, and Abraham Lincoln. Snippets from his son Andrew’s movingly
candid book about depression—The
Noonday Demon: An Atlas of Depression—lend extra dimension, even
irony, to this business success story. Howard Solomon had taken a small
company out of vitamins and candy and into generics. But in 1995 he
contacted H. Lundbeck, a company in Copenhagen, whose drug had seized a 50%
market share in Sweden, yet had failed to penetrate the U.S. market. With
single-minded dedication, Forest captured a big chunk of the American
anti-depression dollar, accounting for 17.5% of new prescriptions today,
with Celexa becoming the fast-growth drug in its category. What sets it
apart from Zoloft, Prozac, and all the rest is that “it is well tolerated,”
its “side effects are minimal.” While this is not a trivial distinction, it
makes one realize that the success of the drug is due more to the focus and
agility of a small company that had to succeed than to its therapeutic
properties. Andrew, incidentally, does not take Celexa, having found a
cocktail of other drugs that works well for him. Again and again with
medical problems, we find that something new and different happens when a
sufferer with smarts, or somebody related to a sufferer, takes up a disease
and determines to do something about it.
88. Wash Your Hands of It
“The second-biggest killer of children in the world is neither malaria, nor
tuberculosis, nor AIDS. It is the runs. Diarrhoea [sic] kills the
equivalent of a jumbo-yet full of children every four hours” (Economist,
July 6, 2002, p.80). Even in rich countries, young and old do not wash
their hands as often as they should. Valerie Curtis at the
London School of Hygiene and Tropical Medicine thinks hand-washing could
cut diarrhea-like diseases 43%. The problem is to get people to wash. A
partnership between the public sector (sanitation experts) and the private
(soap-makers and the like) is producing some results. “The health experts
are bowled over by the marketing prowess that the companies are bringing to
the project.” This is the problem of the public health sector in
microcosm. It knows many things people should do in order to stay or to get
healthy. But neither public health officials nor the medical establishment
knows how to sell its well-researched ideas. In fact, so much of health is
a consumer marketing problem, a process not understand by non-profits.
87. Bored to Death
“People who struggle to stay alert in boring, passive jobs are 33% to 35%
more likely to die prematurely than those who have more active jobs….” This
conclusion is offered by Benjamin Amick of the University of Texas after
studying data on 5,000 families collected between 1968 and 1992. Stress
arising from boring jobs apparently leads to drinking, smoking, lack of
exercise, and other bad health habits. See Business Week, July 1,
2002, p. 16.
86. Doctors Online
Medem, Inc., a for-profit outfit out in San Francisco, now offers online
visits with doctors, with payments made immediately by patients via credit
card. Apparently this service has backing from the American Medical
Association. What’s different is that the consult is with a doctor already
known to the patient; the online feature just adds flexibility to an
existing relationship. Other services have offered chats with doctors
previously unknown to the patients. Whatever the merits or demerits of this
service, it is clear that retail, online health services with some sort of
regulatory controls are vital if we are to control medical costs and
simultaneously offer patients something they clearly want. Consumer use of
the Internet for health inquiries is rocketing.
85. Migraines—Nerves,
Not Blood
For years doctors have theorized—wrongly, it seems—that migraine headaches
stem from constricted or dilated blood vessels. This is a matter of some
consequence, since migraines affect a large part of the population,
particularly women. Dr. Peter Goadsby at the Institute of Neurology in
London, in brain imaging studies, appears to have shown that “nerve cells
in such areas as the visual cortex” “fire off wildly,” with headaches
resulting. Anti-convulsant drugs such as valprorate and gabepentin are
being pressed into service, as a consequence, with good results, though the
search is on for better drugs with less side effects. See the Economist,
June 8, 2002, p. 75.
84. Obese in America
The Wall Street Journal (June 13, 2002, pp. B1 and B9) has begun a
chain of stories on obesity, noting that companies with fat foods are
beginning to realize they may become targets for disease prevention experts
and others. Further the WSJ posits that the Federal Government may
have to revise its food pyramid which still may put the wrong foods in our
diet. “Obesity resulted in 300,000 deaths and some $117 billion in
healthcare costs in 2000.”
83. Siesta
Researchers at Harvard seem to have proven that worker performance
improves dramatically when a midday nap is included in the daily schedule.
Short nappers did as well on perception tests in the afternoon as in the
morning. Long nappers (60 minutes or so) actually improved in the
afternoon. This is a reinforcement of what we learned a half century ago
with Bell’s telephone operators: their performance improved when they were
given timely breaks from the job. Likewise, even the best of runners do
better when they interrupt their runs with walking sessions, a healthy idea
for new runners and for marathon runners who are in training. See the
Economist, June 1, 2002, p. 76.
82. Evidence-Based Medicine
The New York Times Sunday Magazine (May 5, 2002) tucked a very
useful, very well-authored article about evidence-based medicine in its
Medicine 2002 issue called "What Doctors Don't Know (Almost Everything)” by
a practitioner named Kevin Patterson. It appears in the context of an
American society that overpays for overtreatment, excess hospitalization,
and reckless over-pill prescribing. What the doctor says is that received
tradition has doctors pushing the wrong treatment for several illnesses, not
paying attention to the strong medical evidence at hand. Increasingly the
same evide |