Category Archives: General Health

Ordering Tests and Good Health

Posted on by

A provocative article from the NY Times discusses the fact that more testing does not always lead to good health outcomes.  Here’s an excerpt:

A cadre of test skeptics at Dartmouth Medical School specialize in critically examining our test-based approach to well adult care. If you are confused about mammography, colonoscopy or the PSA test for prostate cancer, these folks deserve much of the blame: They have repeatedly demonstrated that these tests and many others do not necessarily ameliorate a healthy person’s health, any more than standardized testing in grade school improves a child’s intellect…

… systems that rate doctors by how well their patients’ blood pressure is managed are likely to invite trouble. Doctors rewarded for treating aggressively are likely to keep doing so even when the benefits begin to morph into harm…One study found that nursing home residents taking two or more effective blood pressure drugs did remarkably badly, with death rates more than twice that of their peers. In another, dementia patients taking blood pressure medication with optimal results nonetheless deteriorated mentally considerably faster.

Yet no quality control system that I know of gives a doctor an approving pat on the head for taking a fragile older patient off meds. Not yet, at least. Someday, perhaps, not ordering and not prescribing will mark quality care as surely as ordering and prescribing do today.

Related blog posts:

Medical Marijuana -Update

Posted on by

While medical marijuana is not a frequent concern of many pediatric gastroenterologists, our nurses have been getting questions with the recent passage of legislation.  In Georgia, as in many states, marijuana is allowed for certain medical conditions. “Georgia’s medical marijuana law [Haleigh’s Hope Act] does not legalize the production or sale of marijuana, it simply decriminalizes its possession by certain qualified individuals.” –GeorgiaCann Website

in Georgia the patient must suffer from one of these qualifying illnesses:

  1. Cancer, when such diagnosis is end stage or the treatment produces related wasting illness, recalcitrant nausea and vomiting.
  2. Amyotrophic Lateral Sclerosis (ALS), when such diagnosis is severe or end stage.
  3. Seizure disorders related to diagnosis of epilepsy or trauma related head injuries.
  4. Multiple Sclerosis, when such diagnosis is severe or end stage.
  5. Crohn’s Disease
  6. Mitochondrial Disease
  7. Parkinson’s Disease, when such diagnosis is severe or end stage.
  8. Sickle Cell Disease, when such diagnosis is severe or end stage.

While I will not be recommending medical marijuana for my patients, here is a link for How to Legally Obtain Medical Marijuana Oil in Georgia (thanks to AM for information).

Also, Georgia Department of Public Health -Low THC Oil Registry Page

Related blog posts:

From CNN:

University of Chicago

University of Chicago

Complex Medicine and Informed Consent

Posted on by

A recent review (Grady, C. NEJM 2015; 372: 855-62) stresses some of the emerging challenges of informed consent, particularly in the research setting.

Key points:

  • “Research participants have deficits in their understanding of study information, particularly of research methods such as randomization.”
  • “Reasonable people disagree about the adequacy of the information presented on the consent forms.”

Trends Which Challenge Current Informed Consent Process:

  1. Learning Health Systems. “Should informed consent for these activities be more similar to research informed consent or clinical informed consent?” “Is it ethically acceptable for a patient or research participant to provide consent for an unspecified or broad range of activities?”
  2. Adoption of Complex Technologies, like genetic sequencing. “How should information be presented [with]..complex information, substantial uncertainty…incidental findings, and implications for blood relatives?”
  3. Consent for Future Use of Clinical Data or Biologic Specimens. “How specific does the information provided in the consent process need to be regarding future uses of data or specimens?”
  4. Demographic Changes/Diminished Capacity in Elderly. “Older age, diminished mental capacity, and dementia per se do not indicate that a person is incapable of consenting…there is a need for respectful and efficient tools and processes for assessing capacity.”

Bottomline: In order to treat patients in a respectful manner, continued efforts at addressing these questions are needed to promote informed choices of patients while advancing medical science and clinical care.

Related blog post: According to the study which you would never qualify for …

Empathy vs. Sympathy

Posted on by

A short animated video from Brene Brown/Katy Davis (thanks to Kayla Lewis for this link) helps explain the difference between empathy and sympthany.  Here’s the link: Short Video on Empathy (the animation is not that great but the message is important)

Key points:

  • Empathy brings people to together and sympathy often drives people apart.
  • Empathy never begins with “at least” …it wasn’t worse
  • Sometimes empathy means saying ‘I don’t know what to say but I’m glad you told me.’

Harrison Ford defines Sympathy in 42 – YouTube.  In the movie “42,” Harrison Ford’s character describes sympathy as being derived from the Greek word to suffer together.  In many cases, sympathy can be difficult to distinguish from pity; this is one reason why empathy can be much more helpful.

Unrelated (but interesting): Comic Version Graphic Points Need for Discussions DNR

Here’s one frame:

From Annal of Intern Medicine Twitter Feed

From Annal of Int Med Twitter Feed

NPR: “Should You Trust That New Medical Study?”

Posted on by

A quick read from NPR: “Should You Trust That New Medical Study?”  No.

Here’s an excerpt:

As historian of science Naomi Oreskes says …, “What makes it news is that it’s new…My view would be that brand new results would be the most likely to be wrong.”

… We should infer the efficacy of a new drug or the benefits or harms of foods from a sample of studies, not a single new one. Of course, most people don’t have the time or the inclination to go through the exercise. When it comes to health, we want to believe in a new cure, for obvious reasons. Our skepticism must be doubled precisely to prevent being misled by hope. (Although hope and a positive attitude are known contributors to healing.) The responsibility, thus, rests with scientists and the media to promote the news carefully — and with the general consumer to keep the news in perspective.

Unrelated link: Nuts Associated with Improved Longevity (from NY Times)

Baseball Season!

Baseball Season!

Related blog posts:

“Why Health Care Tech is Still So Bad” -NY Times

Posted on by

Here’s the link on this thoughtful article: “Why Health Care Tech is Still So Bad”

This article highlights the problems including physicians distracted from patients due to data entry, problems with workflow, and alert fatigue. The author argues that we need to keep working on electronic health records; “the digitization of health care promises, eventually, to be transformative.”

Related blog posts:

 

NPR: “Craptastic Voyage” and Fart Analysis

Posted on by

Surely a story for every gastroenterologist: “Before The Gas is Passed, Researchers Aim to Measure it in The Gut.”

An excerpt:

Kalantar-Zadeh and his colleagues propose in a paper in Trends in Biotechnologyonline Thursday two new devices that could keep a vigilant eye, or a nose in this case, on what’s going on deep in the gut….

The jar is pretty straightforward. A spoonful of poop goes in and a technician squeezes on a lid containing a sensor that detects the molecules of gas fuming inside and at what concentration…but he’s most excited about their other invention.

It’s a robotic pill that sniffs its way along a craptastic voyage through the gut. As the pill tumbles through, a membrane on the pill lets gasses pass onto a small molecular sensor inside that serves as its nose. The membrane blocks the other stuff sloshing around in the gut.

The pill notes the gasses that gut microbes produce, including oxygen, methane, hydrogen and hydrogen sulfide, which smells like rotten eggs. The pill’s sensor figures out how much of each gas is present, and beams the information out of the patient’s body through a tiny antenna…

The researchers aim to detect changes in gas content. As people’s health waxes or wanes because of stress or disease their intestinal ecosystems change too. Certain microbes may thrive in the new conditions while others struggle. As the populations shift, so will the concentrations of their distinctive gassy waste products.

My Take: This story reminds me about the joke I heard from a mentor about how can you tell if a person is an optimist.  An optimist is a person who finds a pile of manure under the tree on Christmas morning and declares: ‘Oh boy, I’m getting a pony.’

This story shows us that some researchers are true optimists as well; they see a lot of opportunity in studying stool and intestinal gases. Will this research will be useful or wind up being a pile of stool?

Also on NPR: Why Is Insulin So Expensive in the U.S. -summarizes recent commentary (N Engl J Med 2015; 372:1171-1175). This article is important for anyone concerned about escalating medicine costs.

Related blog post: “There is No ‘Healthy’ Microbiome” | gutsandgrowth

Can Apple Make Research Cool?

Posted on by

For anyone who has looked at Apple’s March presentation, there is big news with regard to research (thanks to Seth for this information).  Here’s a link to the March announcement –around minute 16 there is the research presentation: Apple March Event

Screenshot: Rationale for Apple iPhone for Research -Large Research Pool

Screenshot: Rationale for Apple iPhone for Research -Large Research Pool

The presentation makes it clear that Apple wants to dramatically increase the participation in research studies by leveraging 700 million iPhone users.  Using an app called, “ResearchKit”, Apple has partnered with leading academic centers to help study Parkinson’s, Diabetes, Asthma, Cardiovascular disease, and Breast Cancer.  For the GI community, I hope that someone will work collaboratively to add inflammatory bowel disease to the list.

Besides increased participation, iPhone-based research has the ability to lower research costs, collect data at frequent intervals, and allow a wider demographic representation.

A shorter ~4 minute video on a separate area of the website explains ResearchKit: ResearchKit video

Screenshot: Research Kit


Screenshot: ResearchKit

NBC News provides a condensed summary along with the caveat that there will be concerns about accuracy of data collected with ResearchKit.  That being said, most critics have not always appreciated the impact of previous Apple innovations.

Has someone from our national organization (NASPGHAN) or from ImproveCareNow started working with Apple? If not, this looks like a great opportunity.

Lost Decade from Smoking

Posted on by

A recent study (NEJM 2015; 372; 631-40) showed that smoking is more deadly than previously estimated.  Key points:

  • Deaths per year due to smoking: a new analysis suggests the true figure may be closer to 575,000.  That equates to 1 death in every 5 in the United States.
  • Smoking is thought to shorten life expectancy by more than one decade!
  • The 21 causes of death that have been officially blamed on smoking accounted for only 83% of the actual deaths among smokers

Here’s a link to a summary of the article:  Cigarette Smoking is Even More Deadly Than You Thought (from LA Times)

Related blog post:

From NPR: Enormous Ice Formations at Niagara Falls:

From NPR

From NPR

How to Reduce Suffering

Posted on by

A recent NY Times article (yesterday) discussed ways to reduce patient suffering and improve physician/hospital evaluations: Doctors Strive to Do Less Harm

  • Minimize waking patients up at night.  Eliminate waking patients up for vital signs and blood draws.
  • Reduce waiting times.
  • Spend more time listening.

Related blog posts: