DC Medical Malpractice & Patient Safety Blog

Dr. Mehmet Oz is everywhere—on TV, all over the web and often cited as an authority in news stories. You have to wonder why he’s so popular, given how often his advice is bad, and sometimes dangerous.

This isn’t the first time we’ve called Dr. Oz on the carpet, and our purpose is not to pile on—but when someone as prominent as he is also prominently wrong, you have to step up.

A few months ago, he addressed the problem of fatigue. Now that’s a big-tent complaint that can result from so many health problems only a simpleton would believe there’s a single, effective cure.

As an anonymous internal medicine physician blogging on WhiteCoatUnderground.com wrote,

“It’s rare to find a single cause (and therefore a single cure) for fatigue. Sometimes you get lucky and find a thyroid disorder or other simple problem, but more often it’s a mixture of factors such as overwork, depression, and stress. And it’s not always pathologic. If someone tells me that they’re fatigued, and they work 50 hours a week and are raising kids and taking care of parents, there’s not much to do except try to find ways to change circumstances or cope with fatigue.”

But medical science doesn’t stop Dr. Oz from championing the wonders of magnesium in a video in which he claims that 3 in 4 Americans are magnesium-deficient.

“It’s not remotely true,” said WhiteCoat. The blogger noted that medical literature finds such deficiency routine only among hospital patients, and that’s usually due to medication or illness.

The video wizard Oz explains that symptoms of magnesium deficiency are irritability, anxiety and lethargy, and offers Case Study Woman One describing an episode of these feelings, that, said White Coat, “sounds to my medical ear like a panic attack. … The guest is describing a real, treatable problem and is being fed fake solutions.”

Case Study Woman Two, according to White Coat, said: “I have five kids and I’m exhausted from the minute I get up to the moment I go to sleep. I need you to help me get my energy back!" White Coat's response:

"You can guess what the answer is. My answer is a bit different. The busy mom has a crazy life. She works hard. Working hard is exhausting. The cure for that sort of exhaustion is rest. …

“Selling a cure based on imaginary evidence isn’t just irresponsible,” continued White Coat, “it’s immoral and goes [against] a century of medical ethics. It’s behavior unsuited to a good physician, but probably a step up from your average carney.”

Then there was the story last month in the New York Daily News about a man in New Jersey who sued Oz after he followed his advice for better sleep and ended up with third-degree burns on his feet.

We can only imagine that it’s quite difficult to sleep when your feet are incinerating.

As promoted on Oz’s website, people seeking to boost their energy through better sleep were advised to make a “heated rice footsie”: “Simply pour rice into your socks, heat them in the microwave until they’re warm, then wear the socks for up to 20 minutes while lying in bed.”

The point, Oz said, is that a good night’s sleep depends on dropping your core body temperature slightly, and heating your feet diverts blood away from the core to those extremities.

Frank Dietl, a 76-year-old who suffers from diabetic neuropathy, diverted so much heat he ended up confined to bed for weeks. Neuropathy is a kind of nerve damage that results from poor circulation and high blood sugar; it is a common marker of diabetes. Because his damaged nerves, presumably, didn’t transmit the signal that his feet were burning, Dietl ended up with a serious injury.

As this blog is written, the Oz website still does not have a warning with its “toasty rice” recipe for slumber.

FindLaw’s Celebrity Justice blog sees the legal case this way: “Whether Dr. Oz may be liable may depend upon whether he even owes a duty of care to viewers like Dietl in the first place. While doctors clearly owe a duty of reasonable care to their patients, Dr. Oz is more a TV personality than Dietl's personal physician. Without a relationship between the two, Dr. Oz may be able to avoid liability completely.

“Then again, because Dr. Oz promotes himself and his expertise, an argument could be made that he owes a duty of care to all his viewers.”

As icing on this toxic cake, according to the Los Angeles Times, the "The Dr. Oz Show" website features a video, “Lisa Oz’s Guide to Family Health: Dr. Oz’s wife Lisa reveals the tips and tricks she uses to keep her family healthy and happy.”

We’ll take The Times’ word about the video—we didn’t have the stomach to spend any more time in digital Oz. The paper mentioned it only in context of a recent New Yorker profile of Dr. Oz called “The Operator: Is the most trusted doctor in America doing more harm than good?” that noted that Lisa Oz “has repeatedly expressed reservations about the value of some vaccinations,” including one released in 2009 to protect the public from the H1N1 swine flu. The couple’s children did not get the shot, a position the doctor disagreed with but explained to the New Yorker, “when I go home I’m not Dr. Oz, I’m Mr. Oz.”

Well, at least he’s consistent—bad advice for his family, bad advice for you.

Accidents happen. And it appears that the number of fatal accidents at home is rising. Between 2000 and 2008, more than 30,000 deaths occurred from unintentional injury at home. The most common causes of home accident death are poisoning, falls and fire/burn injuries.

So says a study in the American Journal of Preventive Medicine whose lead author, Karin Mack of the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention, said, "These injuries are predictable and preventable."

According to a report on ScienceDaily.com, the researchers supported interventions to make homes safer, such as smoke alarms, limited access to nonprescription drugs and closer supervision of children. Those are just common sense, not the result of laserlike scientific scrutiny, but too many people are not paying attention.

So the researchers call for a better way to spread the prevention messages to specific audiences, including health-care providers, educators, law enforcement, policymakers and media.

The study analyzed data from death certificates in the National Vital Statistics System, an inter-governmental public health database. New Mexico had the highest rates of unintentional home injury death during the study period; Massachusetts had the lowest.

Poison, which includes unintentional drug overdoses, was the leading cause of unintentional home injury deaths for people ages 15 to 59. Given recent news reports of the boom in opioid overdoses, it’s no surprise that the poison category ranks No. 1.

The study showed that more males died from home injury than females. Also filed under “no surprise” is the fact that people 80 and older had higher rates of injury-related in-home death than other people.

Falls are still the major source of fatal home injury in older adults, and suffocation is the leading cause for infants.

Although the number of fatalities increased during the period of the study, Mack was optimistic about efforts underway to broaden awareness of what constitutes a safer home. She pointed to two publications: the 2009 report, "The Surgeon General's Call to Action to Promote Healthy Homes," and a 2011 report from the American Public Health Association, "Healthy & Safe Homes: Research, Practice, and Policy."

Among the measures you can take to make your home safer, according to the surgeon general’s report, are:

• Install, maintain, and consistently use safety devices (smoke alarms; carbon
  monoxide alarms; stair gates in homes with young children; grab bars in bathrooms;
  adequate outside lighting; locks on cabinets that store medicines, cleaning solutions,
  automotive supplies, firearms and ammunition, pool chemicals and pesticides; four-sided isolation fencing with self-closing, self-latching doors around pools).


• Complete a fall-prevention checklist for homes with older adults.


• Prepare and practice an emergency fire escape plan.


• Set water temperature in your home below 120°F.


• Do not smoke; enforce smoke-free rules in the home. If you do smoke, do not smoke indoors or around children.


• Read product labels and follow directions for use and disposal. Some common products can be lethal, especially for children.


• Make sure that infants sleep on their backs on firm sleeping surfaces.

Sometimes, we read an article about health, medicine and/or patient safety that’s utterly fascinating but too long to summarize fairly in a blog post. So here’s a shout out to a few recent stories you might want to look up.

“Bitter Pill: Why Medical Bills Are Killing Us,” by Steven Brill. Time magazine’s exhaustive examination of how the medical industrial complex inflates the cost of health-care treatment and how reform efforts don’t begin to address the problem. Link here.

“The Cancer Tests You Need—And Those You Don’t,” in Consumer Reports. An examination of how the medical/health communities exaggerate the benefits of certain cancer screenings and minimize the harms Link here. (subscription required to access the full content).

“Alternative Medicines,” from the staff of The Scientist magazine. Experts discuss evidence or the lack of it for a variety of nontraditional treatments that some practitioners and facilities use for “integrated therapy,” which relies on both conventional and alternative treatments. Link here.

Worrisome findings about the work load of doctors who work fulltime in hospitals comes from a recent survey of hospitalists published in JAMA Internal Medicine.

Hospitalists are physicians who treat patients only while they are in the hospital. As their plight was described by MedPageToday.com, many hospital physicians feel overburdened to the extent that it negatively affects patient care, satisfaction and maybe even safety.

In the JAMA survey, nearly 1 in 4 respondents said that their excess workload prevented them from fully exploring and discussing treatment options for some patients, and from fully answering their questions. More than 1 in 5 said they had delayed admitting or discharging patients until a subsequent shift.

Four in 10 of more than 500 hospitalists surveyed said their heavy workload was unsafe for patients at least once a month; nearly that many said that it was unsafe at least weekly.

So, what’s “unsafe” about having more work to do than you think is reasonable?

More than 1 in 5 doctors reported ordering potentially unnecessary tests or procedures because they did not have the time to exam a patient thoroughly enough to assess his or her exact medical need or range of options. In other words, overwork caused them to default into a “do something, anything” treatment plan.

That’s not good for the patient, it’s a waste of resources and an abuse of the system. And, according the doctors surveyed, it “likely contributed” to patients being transferred, to increased morbidity (higher incidence of a disease or disorder) or mortality.

As the researchers noted, as many as 98,000 hospital patients die every year because of preventable medical errors. (See our blogs on preventable surgical and diagnostic errors.) “[F]or resident physicians,” they wrote, “workload so heavy as to result in physician fatigue is associated with increased medical errors and has led to the implementation of work-hour restrictions."

The survey also showed that:

• Nearly 1 in 5 respondents said they'd seen too many patients to the point where it adversely affected the quality of their hand-offs (communicating about patient status with the new doctors when one shift ends and another begins).


• One in 10 failed to note or act on critical lab results because of high patient volume.


• One in 10 failed to transfer a patient to a higher level of care.


• Nearly 1 in 5 said they thought their workload worsened patient satisfaction.


• Fourteen in 100 said their workload increased readmission rates (patients who are readmitted to the hospital within 30 days of being discharged).


• More than 1 in 10 said their workload worsened overall quality of care.

The researchers have a couple of suggestions for improving the situation: regularly evaluating workloads for attending physicians, and cutting health-care costs without increasing workloads to compensate for payment reductions.

In our opinion, the first is wish-list, perfect-world irony (who’s got the time to monitor people who don’t have the time not to need monitoring?), and the latter is an evergreen problem the system has long recognized and been unable to address.

The survey isn’t a conclusive diagnosis of the overworked doctor problem because its respondents chose to participate (it wasn’t a random sample), and, potentially, there are differences between someone’s perceived workload as it relates to a patient’s outcome versus an actual workload with actual outcomes.

Still. There’s a problem with doctors being able to do the best job they can with hospitalized patients. And at least for now, the best way to protect yourself and your loved ones is to monitor the care. Learn how by reading out two-part newsletter here and here.

Who hasn’t Googled some medical or health topic? And who hasn’t wondered if the information they found is true, useful and relates to them?

A recent survey by the Pew Internet & American Life Project asked more than 3,000 Americans about their online searches for information about their health issues to find out what they’re doing with the stuff they find.

As reported on MedCityNews.com, more than 7 in 10 telephone respondents were described as “online health seekers,” meaning they said they had looked for some kind of health information online in the last year. Of those who did, nearly 6 in 10 were described as “online diagnosers.” They weren’t just curious, they were goal-oriented—their reason for searching online was to figure out what medical condition they or someone they knew had.

According to the survey, about 35 in 100 U.S. adults are “online diagnosers,” and women are more likely to join that club than men.

That’s good in the sense that people need to be actively involved in their health care in order to get the most out of the system and to get the best outcome, but when does curiosity overtake good sense? What’s the risk of medical searchers serving as their own doctors?

Not much, the survey seemed to say.

Slightly more than half of the online diagnosers, MedCity News reported, said they consulted with a medical professional about what they found online. More than 4 in 10 said a medical professional confirmed or partially confirmed the information they found online. Nearly 2 in 10 said they consulted a medical professional who did not agree or couldn’t come to a conclusion.

Of course, said MedCityNews, “We can’t assume that everyone who claimed her doctor backed up his suspicions was truly able to ‘diagnose’ herself accurately using just information from the Web. …. We also don’t know that all of those physician diagnoses were accurate.”

Pew’s mission was to measure the scope of how medical information online is being used; its intention wasn’t to measure the quality of the information.

But the real message of the survey is that despite a robust interest in finding health info online and applying it—or not—to one’s own situation, 7 in 10 respondents still consulted a medical profession when they had a health issue.

And it’s interesting to note that since 2000, when Pew began tracking online health searches, half of the searchers aren’t online diagnosers—they’re looking for information on behalf of someone else.

And pay walls are significant barriers to searchers—1 in 4 respondents said they hit a pay wall during their search, but only 2 in 100 paid to get the information. The rest looked elsewhere or gave up.

The most popular topics for information seekers who weren’t online diagnosers were: specific medical treatments and procedures (See our blog, “Where to Go for Information About Medical Screening Tests”); weight loss; and health insurance. One in 5 reviewed specific drug information, doctors or hospitals.

Pew concluded that although the Internet is a popular and increasingly important tool for health-care consumers, most conversations about health and medicine still occur among live participants in a setting that’s real, not virtual.

Seven years ago, Australia was the site of the Congress on Disease Mongering. In 2010, Amsterdam played host to the Selling Sickness conference. And next month, from Feb. 20-22, Washington, D.C. is where like-minded folks will gather for Selling Sickness 2013: People Before Profits.

These confabs reflect the growing interest in many quarters to rein in the corrupt, misguided and patronizing elements of medicine and the delivery of health care. Reformers and drug industry critics meet to challenge anti-patient practices and to discuss strategies to overcome them.

Among the topics under discussion will be “disease mongering,” the inflation of a condition into a dire and treatable problem -- an issue we often cover—here, here and here--misleading journalistic standards (learn how to read medical stories with a critical eye at HealthNewsReview.org,), overtreatment and overdiagnosis, whistleblowers, new roles for advocates, clinical trials, new areas of conflict of interest areas, igniting citizen outrage and more.

Panels and workshops welcome not only researchers and activists, but students and anybody interested in being informed and active in the management of their health care and the health-care industry.

Among the many notable speakers are:

• Alan Cassels, pharmaceutical policy researcher at the University of Victoria, British Columbia and author of “Seeking Sickness: Medical Screening and the Misguided Hunt for Disease”


• Nancy Olivieri, professor of pediatrics, medicine and public health sciences at the University of Toronto, and renowned whistleblower about the potential dangers of a drug under study


• Gary Schwitzer, founder of HealthNewsReview.org and medical journalist/media watchdog


• Sidney M. Wolfe, Director, Health Research Group at Public Citizen , a nonprofit that lobbies for citizen rights and interests

For more information, link to the Selling Sickness site.

We like to promote our standard of living, but a recent analysis of health and longevity shows that compared with other developed nations, America’s collective health is decidedly suspect, especially for the young among us.

As widely reported last week, including in the New York Times, younger Americans die earlier and have a poorer quality of health than their peers elsewhere.

The U.S. hasn’t fared well for several decades in such comparative studies, but those generally focused on older people. The new one looks at a younger demographic and, as The Times says, “The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, France, Germany and Spain.”

The study was sponsored by the Institute of Medicine--the independent, nonprofit health arm of the National Academy of Sciences that provides unbiased, authoritative advice to decision makers and the public—and the National Research Council—the academy’s body for promoting the acquisition and dissemination of knowledge in matters involving science, engineering, technology, and health. This study went further than others in documenting all causes of death—disease, accidents and violence—and was based on a broad review of mortality and health studies and statistics.

The panel of experts called our higher rates of disease and shorter lives “the U.S. health disadvantage” that over the last 30 years has ranked the country at the bottom of life expectancy. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.

In the land of Newtown, Aurora, Tucson and many other scenes of violence, it will surprise no one that among developed countries, the U.S. has far higher rates of death from guns for people younger than 50. Also notable were the mortality numbers for car accidents and drug addiction.

Gun homicide was 20 times higher here than in the other countries; nearly 7 in 10 American homicides in 2007 involved firearms, compared with about 1 in 4 in other countries. The Times quoted one demographer and panel member as saying, “You can blame that on public health officials, or on the health-care system. No one understands where responsibility lies.”

In summarizing the study’s finding, the panel’s leader, Dr. Steven Woolf of the Department of Family Medicine at Virginia Commonwealth University, told The Times, “This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”

On the disease front, the U.S. had the second-highest death rate from the most common form of heart disease, and the second-highest death rate from lung disease. U.S. adults have the highest rates of diabetes.

We also have the highest infant mortality rate among countries compared. Our youth have the highest rates of sexually transmitted diseases and teen pregnancy. Younger people here die earlier from alcohol and drug abuse than elsewhere.

Possibly most shocking of all is that Americans have the lowest overall probability of surviving to the age of 50. As The Times notes, the report’s second chapter takes four pages to enumerate all the health indicators for youths in which we rank near or at the bottom, including chronic disorders commonly associated with the elderly, such as heart disease.

But even a black cloud allows a little sun to shine through. Death rates from cancers detectable through diagnostic testing, such as breast cancer, were lower in the U.S. Adults were better at controlling their cholesterol and high blood pressure than those in other countries. And Americans older than 75 tend to outlive their counterparts.

What’s to blame for the poor performance? The panel noted that a highly fragmented health-care system, with a large uninsured population and limited resources for primary care were contributors. Not to mention America’s poverty rate, which is the highest among the countries studied.

Education was a factor, but a surprising one. Although Americans who didn’t graduate from high school die from diabetes at three times the rate of those with some college, even the college-educated and high-income earners scored poorly on many health indicators. In the other countries, the study noted, the more widespread availability of health-care programs that hedge against the consequences of poverty.

Then there’s the character issue, which wasn’t really studied scientifically, but which might be a factor in our lagging numbers. Americans are individualistic, and decry government interference (two words here: gun control). We’re also less likely to wear seat belts and motorcycle helmets, which obviously contribute to our higher rates of vehicle accident deaths.

We’re a bigger, more culturally diverse society than most countries, with greater economic inequality. Still, as the researchers note, we spend more, far more, on health care than any other country in the survey.

Clearly, we are not getting value for our money. Is anyone surprised?

Meningitis—a life-threatening inflammation of the membranes surrounding the brain and spinal cord—has seldom been more prominent in the news, and for all the wrong reasons. The contaminated steroid made and distributed by a compounding pharmacy has caused meningitis fatalities and widespread fear, and the story is developing daily.

So a warning letter sent by the FDA is particularly timely. As reported on AboutLawsuits.com, the letter was sent to Avalon Effect Inc., a company in Tennessee, because it has been advertising light emitting diodes (LED) to treat and cure the symptoms of fungal meningitis. In ghoulish exploitation, Avalon has targeted the people suffering from the disease they contracted from the dirty steroid injection.

The FDA letter warned Avalon Effect that the company’s Internet marketing information violates the Federal Food, Drug and Cosmetic Act.

Avalon claims that its Quantum Series Personal Wellness Pack, which promotes light therapy, treats and cures fungal meningitis, methicillin-resistant staphylococcus aureus (MRSA), concussions, Lyme disease and other ailments.

Yes, and it's a good overall pick-me-up nostrum, too. (Not!!!)

The FDA categorized the product as a medical device for treating and curing disease. Because such classification requires FDA approval prior to marketing, and because Avalon does not have that approval, it’s in violation of federal regulations.

Avalon has known for months that the FDA wanted it to clean up its act—the November warning letter is a follow-up to one sent in August, just as the meningitis outbreak was beginning.

The feds are not happy that a purported treatment for fungal meningitis that has not been approved or tested is being promoted purely for profit.

“Consumers should be aware that, especially during disease outbreaks or other public health crises, they may see opportunistic advertisements for products touted as cures or treatments,” said FDA official Steve Silverman in an agency news release. “Bogus medical claims can actually harm consumers by causing them to delay seeking treatments that have been proven to be safe and effective. Consumers should carefully evaluate and discuss the claims with their health care providers.”

Recent developments in the outbreak story include last week’s AP report that in 2002, the FDA advised that the New England Compounding Center (NECC), the outfit responsible for distributing the contaminated medicine, be “prohibited from manufacturing” because its operations were deemed shoddy. The feds deferred to Massachusetts state regulators, who reached an accommodation with the pharmacy to resolve those concerns. Now, you wonder, were they ever resolved? Were they temporarily resolved?

The meningitis outbreak also prompted a Congressional appearance by FDA Commissioner Margaret Hamburg last week. The committee wanted to know why the FDA hammer didn't fall harder on the NECC, and Hamburg said the agency's authority in the matter wasn't clear. The Democrats generally supported boosting FDA authority over compounding pharmacies, but Republicans said the agency has all the power it needs.

The Boston Globe reported that during Congressional hearings last week, Barry Cadden, the owner of the NECC, took the Fifth Amendment and declined to answer questions about the meningitis outbreak.

And, according to The Globe, it turns out that in 2002, Cadden was a member of a state task force charged with writing rules for compounding pharmacies at the same time NECC was being investigated by state and federal regulators. As the old saying goes, who guards the guards?

Health journalist/watchdog Gary Schwitzer is among our heroes, and here’s another reason why. In a recent post on his HealthNewsReview.org, he championed the efforts of British physician/writer Margaret McCartney, who introduced a new resource for patients seeking information about their care.

“Private health screening tests are oversold and under-explained,” she wrote in a British newspaper that Schwitzer quoted. “Health screening can cause more harm than it prevents, so companies have a duty to provide full information to customers.”

With that, she described PrivateHealthScreening.org, explaining that frustration and anger led her and a few doctor colleagues to establish the website to share information about screening tests and help people direct their thinking in making decisions whether or not to have them.

McCartney reported that one of this group of doctors, a neurologist, went to his local church for something called a Life Line Screening. He paid $230 for the test. In a story he published later in BMJ (British Medical Journal), he asked: “Why is this nonsense tolerated or allowed?” (See our recent post about commercial come-ons for medical screenings.)

Although the “ask first, test later” sentiment and its productive result were forged in Britain, U.S. consumers can benefit from the online service. As the site explains, “We are a group of doctors who are concerned about the safety and the ethics of private screening tests. We are worried that the companies who charge you for these tests are not giving consumers full and fair information about them.”

The site links to pages explaining their concerns, as well as to a page offering examples of misleading advertising, doctor and patient commentary and stories about screening offers and their results. Its Evidence Bank link provides a host of authoritative, scientific analyses of a wide range of specific screening tests for head and toe and everything in between.

All year, ProPublica, the public-interest investigative journalism organization, has been beefing up its service information for medical consumers. In recent months, we’ve covered its nursing home inspection reports, and its Facebook page for patients reporting medical harms.

Last week, ProPublica introduced a new site where medical consumers and medical providers can participate in ongoing conversations about patient safety, get updates and share opinions and personal stories.

It’s promoted as a central clearing house for information ranging from highlights of the Facebook patient harm group to links to reporting on health care quality to tools consumers can use to research health-care providers.

Among the offerings:

• six recommendations for what to do if you’ve suffered harm in a medical facility;


• an interview with cancer surgeon/Johns Hopkins School of Medicine researcher Dr. Marty Makary about why patient harm is one of the leading causes of death in America. His new book is “Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care”;


• advice about how to deal with the media in telling your story from Helen Haskell, founder of Mothers Against Medical Error;


• advice for finding unexpected allies as a patient advocate from Patty Skolnick, founder of Citizens for Patient Safety;


• a music video about being over-prescribed pills.

Another study reinforces the benefits of physical fitness: it might not lengthen your life, but fitness goes a long way toward helping you live better.

Published recently in the Archives of Internal Medicine, the study examined the association between midlife fitness and chronic diseases later in life. It followed 14,726 healthy men and 3,944 healthy woman for nearly 30 years and looked at eight chronic conditions (CCs)—congestive heart failure, ischemic heart disease, stroke, diabetes chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer disease and colon and lung cancers.

“In the present study, higher fitness measured in midlife was strongly associated with a lower incidence of CCs decades later,” the authors concluded.

The highest level of midlife fitness was associated with a lower incidence of CCs compared with the lowest midlife fitness as measured by treadmill times.

Even a moderate increase in fitness might reduce CCs in older age. Over five levels of fitness, the study said, improving only one level at age 50 was associated with a 20 percent reduction in the incidence of CCs at 65 and older.

And higher fitness levels of participants who died during the study were more strongly associated with a delay in the development of CCs than with survival. So even if they didn’t live longer, fitter people lived better.

In an accompanying commentary, Dr. Diane E. Bild of the National heart, Lung and Blood Institute cautioned that although fitness might be key to healthy aging, that’s a function of both exercise and genetics. To say that fitness equals the avoidance of disease is too simple.

Still, Bild concludes that research on healthy aging provides insight into living longer, healthier and more active lives and, potentially, reducing health-care costs.

If you’re a mid-lifer who has decided—really! truly! finally!—that it’s time to get into better shape, Harvard Health Publications has some advice.

The simplest way to begin is by walking, which most people can do without medical permission unless:

• You are extremely unsteady on your feet.


• You have dizzy spells or take medicine that makes you feel dizzy or drowsy.


• You have a chronic or unstable condition, such as heart disease (or several risk factors for heart disease), asthma or other respiratory ailment, high blood pressure, osteoporosis or diabetes.

• Physiatrists (or rehabilitation physicians) are board-certified and specialize in treating nerve, muscle and bone conditions affecting movement, such as stroke, back problems, Parkinson’s disease, neuropathy and debilitating arthritis or obesity.


• Physical therapists work to restore abilities patients have lost to injury or health problems. They focus on strengthening muscles, bones or nerves, and might address problems as varied as a sprained ankle or recovery from a heart attack. After receiving a bachelor’s degree, physical therapists must graduate from an accredited physical therapy program, pass a national exam and be licensed by their state. Some get board certified by completing advanced training.


• Physical therapy assistants provide services under the supervision of a physical therapist. They also must pass a national exam and, in most states, be licensed.


• Personal trainers are fitness specialists who help you perform exercises properly, teach new skills, provide motivation and workout variety. There are no national accrediting requirements, although standards for the accrediting fitness organizations that train them have been set by the National Commission for Certifying Agencies. Two well-respected such organizations with training programs are the American College of Sports Medicine (ACSM) and the American Council on Exercise (ACE). Others include the National Council on Strength and Fitness (NCSF), the National Strength and Conditioning Association (NSCA) and the National Academy of Sports Medicine (NASM). Their requirements for training and expertise differ. Some trainers specialize in working with particular populations—for example, older adults or athletes.

Our August newsletter about dietary supplements included some cautionary advice about some so-called “natural” supplements that can cause significant harm. One was Reumofan, a product manufactured in Mexico and marketed as a remedy for pain.

The FDA had issued a warning earlier this year about it after receiving several adverse event reports, including stroke, gastrointestinal bleeding, liver problems and worsening glucose control.

Last week, the feds raised the volume of concern about Reumofan after additional reports of bleeding, strokes and even death, according to AboutLawsuits.com.

The warning, “FDA issues new safety alert on Reumofan Plus and Reumofan Plus Premium,” says that these products contain drugs that are not declared on the labels. They’re also illicit.

The worrisome active ingredients are dexamethasone, diclofenac, and methocarbamol, a combination whose risk factors include severe injury or death, according to the regulators. Dexamethasone, a corticosteroid, is so powerful that the FDA advises people taking Reumofan products to consult their doctor before they stop using it. It must be discontinued under medical supervision because of a risk of withdrawal syndrome.

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID); methocarbamol is a muscle relaxant. The former can increase the risk of heart attack, stroke and gastrointestinal problems, and the latter can cause dizziness, low blood pressure and compromised mental and physical activity.

It is illegal for products billed as dietary supplements, which are not subject to the same regulatory scrutiny as drugs, to contain FDA-controlled medications.

If you use or recently used any Reumofan product, contact your doctor immediately. If you had a problem after taking Reumofan, contact MedWatch, the FDA’s adverse event reporting program, at (800) 332-1088 or online here.

We couldn’t have said it better than the Los Angeles Times: “ Television is great for sports, reality shows and reruns of ‘The Big Bang Theory,’ but if you're getting your health information from TV, you might not be as well-informed — or as healthy — as you could be.”

We would add that you also might be courting harm. See our newsletter, “Those TV News Doctors: Good Advisors or Fear Mongers?”

Whether it’s “Celebrity Rehab with Dr. Drew” or “The Doctors,” America can’t seem to get enough of practitioners giving medical advice, especially if they’re dishing dirt on famous people or strutting hunkily in their scrubs. They have medical degrees, they’re confident and articulate, and it’s a whole lot easier to flick on the TV than schedule a doctor’s appointment, and sit in the waiting room 30 minutes beyond the time you were supposed to be seen about your upset tummy.

There’s a problem with seeing doctor TV as an authority rather than entertainment, Dr. Steven Woloshin, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, told The Times. Sometimes, TV doctors who are accomplished in one field might be discussing topics beyond their areas of expertise or certification.

Dr. Mehmet Oz is a practicing cardiothoracic surgeon and a professor of surgery at Columbia University who gained media fame appearing on the Oprah Winfrey show. Photogenic and warm, he inspires responses from his audiences to his advice on how to keep a great head of hair as much as on ability to repair somebody’s heart.

Americans are desperate to lose weight, so nutrition is a frequent topic on these shows. But, "Just because someone's on TV, just because they're wearing scrubs, doesn't mean they're an expert on nutrition," Woloshin, a specialist in internal medicine, said.

Oz recently told his TV viewers that coconut oil is a "super food" that "helps you lose weight.” He got all science-y, demonstrating that the fatty acids in coconut oil dissolve easier than the saturated fat in meat. But Christine Tenekjian, a dietitian at the Duke University Diet and Fitness Center, pointed out that the considerable caloric load of coconut oil would override the modest benefits it might have on metabolism. “We have people who come in with all sorts of misconceptions that they heard on TV,” she told The Times. “They cling to it as gospel.”

In the spring, “The View” aired an episode with Dr. Steven Lamm, who, not coincidentally, was promoting his book, “No Guts, No Glory.” The professor of medicine at New York University championed several probiotic and nutritional supplements from a company called Enzymedica Inc., guaranteeing that "… in three to five years, everyone is going to be on a probiotic, everyone is going to be on a digestive enzyme."

He said these products are crucial to overall gut health. He must know something nutritional scientists don’t. "There's no evidence that probiotics improve your health if you take them every day," Lynne McFarland, a probiotic researcher at the VA Puget Sound Health Care System in Seattle, told The Times.

Some people, such as those with pancreatic disease, are prescribed digestive enzymes. But to pop them like cough drops is simply a fad.

We reported last week how Pinsky was paid by pharmaceutical company GlaxoSmith Kline to promote its antidepressant Wellbutrin. Guess who paid Lamm for his consulting services? Enzymedica. Although he told The Times that he has no financial stake in the company's products, don’t you think TV viewers deserve to know that his advice might have been less than objective?

As publisher of Health News Review, Gary Schwitzer is a frequent critic of shallow health journalism and how it engenders the gullibility of consumers. He said “The View” illustrated another problem with health-as-entertainment – the show's hosts constantly interrupted Lamm, so even if he had a helpful, coherent message he was given little opportunity to share it. "It's like getting your health information by listening to people talk on the train," he told The Times.

Sometimes, nutrition advice purveyed on TV isn’t just questionable, it’s dead wrong. “The Talk” is another daytime talk show directed toward a female audience. Early this year, it fed viewers’ celeb-and-weight-loss lust a segment featuring so-called “celebrity nutritionist” Cynthia Pasquella. She touted apple cider vinegar as “very alkalizing for the body, which promotes weight loss.”

Woloshin begs to differ, noting that all vinegars are acidic, which is the opposite of alkaline. And that even if you could “alkalize” yourself via salad dressing, there’s no evidence that it confers a benefit. Tenekjian agrees, saying no studies suggest that vinegar helps with weight loss.

Then there’s advice to boost your sex life. TV land found the perfect doctor to deliver this information in Travis Stork, the hunky ER doc on “The Doctors.” Last winter he told viewers about a “love potion” called Oxytocin Factor , an over-the-counter version of the hormone oxytocin. The ob-gyn doc on the show, Dr. Lisa Masterson, described oxytocin as the hormone that promotes the bonding of babies to their mothers and of women to their men. She put a few drops of Oxytocin Factor on pediatrician Dr. Jim Sears, who joked, “I feel like bonding right now.”

This isn’t medicine, this is sophomoric posturing. Commented Dr. David Feifel, a professor of psychiatry at UC San Diego, “[The segment] was pretty ridiculous and irresponsible, in my opinion." He told The Times that real oxytocin can promote bonding when delivered directly to the brains of people or animals, but had "no idea" where anyone got the notion that a few drops on the back of the neck would do anything at all.

A spokeswoman for Nutriceuticals Inc., manufacturer of Oxytocin Factor, said the doctors on the show didn't use the product as directed; it’s delivered via either nasal spray or oral drops.

Oh, that makes it better.

If you enjoy watching doctors on TV, stick to reruns of “ER,” where you know the stories and most of the medicine is fiction. If you want to see real doctors wearing their scrubs on a TV set rather than in an OR theater, fine—just don’t confuse what they say as medical advice to live by.

For approximately 1 million Americans every year, kidney stones easily outrank childbirth, migraine headaches and other kinds of hurt for the booby prize of “most pain I’ve ever had.”

Now those victims have some good news—new research by scientists at the Washington University School of Medicine in St. Louis has yielded information to explain why some people are more likely to develop kidney stones than others. That’s critical to developing tests for kidney stone risk and effective treatments.

The research was conducted on mice and the results published in The EMBO Journal, (the European Molecular Biology Organization). Human kidney function is similar to mouse kidney function.

Most kidney stones form when minerals in urine, such as calcium, crystallize and stick together. Risk increases with a diet lacking sufficient water and/or too much salt, which binds to calcium; the risk of developing stones also increases with age.

But the identification of a genetic component has been linked to an increased risk of as much as 65 percent.

Normally, kidneys process essential minerals from blood for transport back to the cells that perform the basic functions of life. Typically, the gene of note, claudin-14, is not active in the kidney, and when it is, appears to be the source of the problem. The new research shows that it can be neutralized by specific molecules, thereby enabling the kidney’s filtering system to work as it’s designed.

When people eat a diet high in calcium or salt and don’t drink enough water, claudin-14 prevents the calcium from re-entering the bloodstream. The excess calcium is expressed in urine, which leads to the formation of stones in the kidneys or bladder. When a stone gets stuck in the bladder, ureter or urethra, it can block the flow of urine and cause intense, seeing-stars pain.

Drugs that mimic the activity of the molecules that “turn off” claudin-14 could significantly reduce the likelihood that people with this genetic makeup would form stones. And a test could be developed to measure levels of claudin-14 in urine. If they are elevated, dietary modifications would be the first line of defense against developing stones.

Until treatment catches up with science, you should ensure sufficient hydration to help prevent the formation of kidney stones. The amount required depends on an individual’s activity level and the climate. The National Institutes of Health say that different kinds of kidney stones require different dietary modification. In general:

• If you’ve had a kidney stone, drink enough water and other fluids to produce at least 2 quarts of urine a day (eating fruit with a high water content, such as melon, can boost your fluid intake).


• If you work or exercise in hot weather, drink more to replace fluids lost through sweat.


• Avoid grapefruit and cranberry juices and dark colas, which have been found to increase the risk of stone formation.


• Ask your doctor about eating protein. Meat (especially organ meat such as liver), eggs and fish contain substances that break down into uric acid in the urine. Nonanimal protein (nuts, beans, etc.) can increase the excretion of calcium. Both encourage stone formation in some people.

A little knowledge is a dangerous thing.

So said the 18th century’s Alexander Pope in “An Essay on Criticism.” So said, in so many words, the 19th century’s T.H. Huxley in “On Elementary Instruction Physiology.” So said the 20th century’s Albert Einstein, who added a second sentence, “So is a lot.”

Each of these people turned up in a Google search as the author of that expression. If you Googled “dangerous knowledge” in the hope of finding out who who said it first, chances are excellent you would get a misguided result. You can find knowledge on the ‘net, but finding context and fact is a bit more daunting.

According to a Pew Research Center study, more than 6 in 10 adults search for health information online. Nearly 6 in 10:

• read someone else's commentary or experience about health or medical issues online;


• consulted rankings or reviews online of doctors or other providers;


• consulted rankings or reviews online of hospitals or other medical facilities;


• signed up online to receive updates about health or medical issues;


• listened to a podcast about health or medical issues.

• a specific disease or medical problem (49 percent, up from 36 percent);


• a medical treatment or procedure (41 percent, up from 27 percent);


• prescription or over-the-counter drugs (33 percent, up from 19 percent);


• alternative treatments or medicines (26 percent, up from 16 percent);


• depression, anxiety, stress or mental health issues (21 percent, up from 12 percent);


• experimental treatments or medicines (15 percent, up from 10 percent).

A recent study published in Psychological Science shed some light on the common consumer habit of matching one’s symptoms with disorders described on the Internet to make wholly misguided self-diagnoses. Got a headache, nausea and fatigue? Websites listing these symptoms prompt far too many people to conclude erroneously that they have brain cancer.

As explained in a story on The Daily Beast, the response is a Web-enabled hypochondria called “cyberchondria,” and it can be as complicating as it is helpful.

The Psychological Science researchers said the brains of cyberchondriacs are like those of gamblers. It’s about pattern recognition, and what can go wrong when the brain tries to impose order on chaos. Cyberchondriacs who see patterns in lists of symptoms make the same mistake as gamblers who see patterns in random events such as consecutive rolls of the dice. The latter might conclude, erroneously, that a positive result on one or two rolls will repeat. The former might conclude that experiencing some symptoms in a list of several means they must have all of the other symptoms as well.

The researchers made up a type of thyroid cancer for which they also made up six symptoms. They composed three differently ordered lists of the same six symptoms. One grouped the milder, more common symptoms (fatigue, shortness of breath) at the top, and the more severe and rarer symptoms (pain in the throat or neck, lump in the throat or neck) at the bottom. One list ordered the more severe symptoms first, followed by the milder ones. The third mixed all the symptoms.

Different groups of healthy subjects were shown one of the lists, told to check off their symptoms, then asked how likely they were to have that cancer relative to the average American. Both groups with the lists of mild symptoms separated from severe symptoms were far more likely to believe themselves at risk for this fake problem than the group with the randomly listed symptoms.

The gift of pattern recognition can undermine the basic logic of probability. Gamblers say they have a “hot hand”; cyberchondriacs believe they have “hot symptoms”—if they hit the first two in a list, they believe they must have the third one as well.

There’s nothing wrong with a little knowledge, but if you get it from the Internet, you must ensure your source is credible. Check out our newsletter, “Essential Tips for Doing Your Own Health-Care Research.” Other solid sources for medical information include scientific journal abstracts, university research summaries and articles from established centers of medical practice such as the Mayo Clinic and reports by government organizations such as the Centers for Disease Control and Prevention and the National Institutes of Health.

Knock yourself out with medical research, but refrain from self-diagnosing until you consult with a medical professional. You might have a brain tumor, but it’s far more likely that your eyeglass prescription has changed, your milk has gone a bit sour and you’re not getting enough sleep.

As Pope said:
“A little learning is a dang’rous thing;/Drink deep, or taste not the Pierian spring:/There shallow draughts intoxicate the brain,/And drinking largely sobers us again.”

In medicine, a culture shift may be underway in venture capital, which subsidizes the cutting-edge technology that keeps a culture moving forward.

As reported by Kaiser Health News (KHN) in conjunction with NPR and KQED, for venture capitalists, the bloom is fading from expensive medical gee-whizzery. These days, such deep-pocketed supporters are more in favor of improving medical efficiency than in staking a claim to such glitzy endeavors as robotic surgery, whose questionable benefits we recently covered.

Hospitals love boasting about their amazing new machines and surgeons love using them. Insurance companies don’t love paying for them, so their enormous costs are passed along to employers and patients.

As the recession took hold, however, and the Affordable Care Act (ACA) was passed, the financial engine behind high-tech R&D began to reassess where to put its fuel. As one Silicon Valley venture capitalist told KHN, “If you come in with [a device] that’s 10 percent better and twice as expensive, it’s hard to get anyone to care.”

Venture capitalists look for opportunity wherever it occurs, and these days it’s in areas such as helping hospitals figure out how to reduce readmissions. It’s expensive when a recently released hospital patient must be readmitted because of complications, and under the ACA, readmissions carry financial penalties.

Because the ACA will increase the number of people who are covered by high-deductible insurance plans, venture capital is funding a technology company that helps them choose the least expensive care. Another less-than-glamorous funding recipient, but one with an enormous impact, addresses the often torturous process of health-care billing.

“There’s a half a person per hospital bed on average that sits in the hospital doing coding and collections and trying to get paid,” according to one venture capitalist. His solution is to replace the labor-intensive manual coding with software that can understand repetitive charges and devise efficiencies that minimize repetitious functions.

That doesn’t mean new medical developments are all about process instead of product, but the products are simpler. Infections, notoriously borne by the widespread use of catheters, are being controlled better through the venture-capital development of a plastic device that kills microbes. The DualCap catheter costs less than a dollar.

Sometimes, the most thoughtful investment isn’t about the sexiest new surgical tool that helps 10 rich people find a place in medical history; it’s about helping millions of average patients gain access to competent, affordable care for the long run.

Rating things are all the rage, whether it’s semi-celebrities and their dance moves or food-truck burritos. Patients have always rated doctors, but until recently only in a casual, personal reference way.

Thanks to the changing landscape of health care and the increasingly important issue of cost-effectiveness, more codified attempts at consumer health care ratings are in order. As discussed on Wachter’s World, a blog written by Dr. Bob Wachter, chief of the Medical Service at the University of California, San Francisco Medical Center, consumers can check with Hospital Compare to see how certain hospitals are rated by patients.

Currently in development is a similar patient-feedback system for individual doctors.

Wachter believes that when data are gathered scientifically and professionally, everyone benefits. Unfortunately, the scientifically professional approach can’t compete with popular web-based ratings “in all their über-democratic, Yelpy glory,” Wachter says. And that makes some objections all the more righteous.

RateMDs, for example, was started by the fellow responsible for RateMyProfessors.com, which includes criteria such as “hotness.”

A more grown-up effort at doc-rating occurs in Britain, where the National Health Service hosts NHS Choices. It invites patients to rate practices and hospitals, but not individual doctors. Comments are screened (“inflammatory” comments are blocked) and practices are encouraged to post responses.

Reasonable objections to patient surveys of doctors include the fact that it’s human nature for the most disgruntled people to weigh in. That’s not a fair representation of whole-practice results. The fact that there was a relatively small number of responses by physicians skews the results even more.

But Wachter says the data reflect that most reviews are positive. Recently, of 386,000 physicians rated on RateMDs, nearly 1 in 2 was given a perfect 5 out of 5; only slightly more than 1 in 10 got 2 out of 5. And 2 in 3 patients responding to NHS Choices said they’d recommend a practice or hospital to a friend.

Another objection is that ratings would be insignificant—fluffy, not substantial. But that doesn’t seem to be supported by experience. In the RateMDs survey, board-certified physicians, those who attended highly rated medical schools and those who had never been sued for malpractice were rated higher.

Wachter was involved in a study of more than 10,000 patient ratings of hospitals for NHS Choices in which positive ratings correlated with lower mortality and readmissions rates. “While disentangling cause and effect is challenging,” Wachter writes, “these results support the notion that patient ratings are capturing other important elements of care.”

Wachter recalls a nurse’s recent New York Times commentary noting that, “[W]e hurt people because it’s the only way we know to make them better … which is why the growing focus on measuring ‘patient satisfaction’ as a way to judge the quality of a hospital’s care is worrisomely off the mark.”

But as Wachter notes, all medical practitioners have the capacity to hurt people on the road to getting them well, and some just do it with more compassion and grace than others. As he says, “I’d like to know who they are.”

What if people submit ratings only because they have an axe to grind? What if doctors write themselves glowing reviews?

Wachter says such concerns are legitimate, but that with large enough numbers, “the truth generally wins out. … The solution to problems with voting, it seems, is more voting.”

Wachter is most concerned about patients who would rate doctors poorly because they had refused to provide unnecessary or inappropriate care—for example, the patient who wants an antibiotic prescription for a sinus infection for which antibiotics are not the solution. “One hopes that future quality measures,” Wachter writes, “will include not only patient experiences but also other measures of appropriateness and evidence-based care designed to counteract this perverse incentive.”

“As we work our way through this new world of patient surveys and ratings,” Wachter concludes, “there will be some hazards to overcome and some unfair results to contend with. We’ll need to do all we can to anticipate these problems and mitigate them, and to try to bring some order to a chaotic marketplace. These seem like surmountable issues, and I am confident that the outcome of capturing the patient’s voice and giving it some real weight is sure to be better care.”

We agree.

The epidemic of overtreatment in U.S. health care is figuring ever more prominently into public policy and private care. We’ve repeatedly discussed how this country medically defaults toward testing, screening, prescribing and treating. We’ve shown how such “over care” isn’t the best practice, nor does it necessarily extend lives or reduce suffering.

A recent post on KevinMd.com perfectly illustrates this point, and makes another abundantly clear: the value of second opinions. Although some practitioners, patients and insurers question the wisdom of getting a second opinion, for serious or complicated diagnoses and procedures, clearly they save time, money and, sometimes, lives.

Writer Rosemary Gibson, author of “The Treatment Trap” and “Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans,” recounts an interview with a former employee benefits executive for a Fortune 100 company. Although his company’s routine second-opinion policy seems expensive and protracted, here are some of the benefits it reaped:

• cases in which transplants were recommended for people who were going to die soon from cancer whether the transplant was done or not;


• a hospital recommended a heart-lung transplant, but when the patient visited the Mayo Clinic (at the company’s expense) for a second opinion, it was discovered that neither transplant surgery was indicated;


• an employee was told he needed a heart transplant, and the surgeon said the patient shouldn’t fly anywhere for a second opinion in his condition. But the employee had flown to see that surgeon. He flew, at company expense, to Mayo, where the second opinion was a small blockage. It was treated successfully with a stent.

These patients were spared extensive, invasive, prolonged treatment. The company maximized its human resources and everyone saved money.

As Gibson writes, “So far, the work to shine a light on overtreatment is compelling.” She refers interested parties—patients, their caregivers, practitioners and insurers—to the “Top Five” good practices in several medical specialties developed by the National Physicians Alliance.

Wise choices are integral, she says, to medical professionalism. “We need to get to the high hanging fruit where real and immediate harm is occurring,” she writes.

Sometimes the wisest choice is doing more by doing less.

We gave some good advice for getting second opinions in a recent issue of our Better Health Care newsletter. We explained why many of us, even medically sophisticated consumers, hesitate to get second opinions. We discussed the multiple ways second opinions are helpful, even when they result in confirmation that the original plan was a good one. And we described ways to make the second opinion consultation more productive.

As health-care expert Lisa Zamosky points out on WebMD, you might not be able to control medical costs, but scrutiny of your medical bills can help you save money. The key, she says, is knowing when and how to take action.

Here are four things to watch.

1. Always review your medical bills. They’re notoriously riddled with errors. Be mindful of even minor charges, especially when it comes to hospital care. For example, one person reported that her grandfather was alone in the ICU and intubated (had a breathing tube and was unable to speak) when he was billed for making phone calls at 4 in the morning.

Make sure you’re billed only for the days you were in the hospital, and that there are no duplicate charges for things such as doctor visits and tests and medicine you didn’t receive. If you find errors or discrepancies, immediately contact your doctor’s office manager or billing department, or the hospital where you received care.

2. Confirm that your insurer paid the provider(s). If doctors or hospitals fail to bill the insurance company, if they do so improperly and/or you have more than one type of insurance, confusion can reign. Before paying anyone, find out if your providers have billed the proper insurance company for the procedure you received, then determine whom and how much the insurer(s) paid.

3. Don’t accept an insurance company’s denial of coverage without a fight. “No” doesn’t always mean “no”; sometimes it means “How willing are you to fight?” Thanks to the national health care reform of 2010, everyone has the legal right to appeal coverage denials. If the insurance company rules against you, it must explain why and provide information about how to obtain an independent review of your case. This right does not apply to grandfathered health insurance plans, which are explained here.

There’s evidence that appeals work: The Government Accountability Office (GAO) found that nearly 6 in 10 health insurance appeals were decided in favor of the patient. About 4 in 10 independently reviewed appeals were reversed in the patient’s favor.

4. Negotiate. Most people are uncomfortable haggling over prices, whether it’s for heirloom tomatoes at the farmers’ market or health services from your doctor. But prices for medical care are not rigid. If you need a break, if you believe the cost is too high and especially if you have a high deductible or lack insurance altogether, seek financial relief directly from the source. Your case is stronger if you research in advance fair prices for the relevant medical service in your area. Many health insurers have website pricing features. The Healthcare Blue Book is another pricing resource.

Isn’t it refreshing to read about a medical adventure in which all parties got it right?

“Doing Things Right: Why Three Hospitals didn’t Harm My Wife” is the tale told by Michael L. Millenson on the Kaiser Health News website earlier this month.

“My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted,” he begins. “We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.

"The anxiety when a loved one is injured is compounded when you know just how risky making things better can get. As a long-time advocate for patient safety, my interest in the topic has always been passionate, but never personal. Now, as Susan was being rushed into the emergency room, I wanted to keep it that way. ‘Wife of patient safety expert is victim’ was a headline I deeply hoped to avoid.”

Millenson, a visiting scholar at the Kellogg School of Management, wrote “Demanding Medical Excellence: Doctors and Accountability in the Information Age.” So if this patient-safety expert is happy with the outcome of a medical emergency that could have gone wrong in so many ways, what these providers did should serve as a model for everybody.

Susan, who suffered a fractured vertebra at the base of her neck and broken bones in her elbow and hand, was treated at a 50-bed community hospital, a large teaching hospital and a large community hospital. As Millenson says, “There were plenty of opportunities for bad things to happen—but nothing did. As far as I could tell, we didn't even experience any near misses.”

Millenson notes that preventable errors kill 44,000 to 98,000 people in hospitals every year. His wife wasn’t among them, nor among the tens of thousands more who are needlessly damaged beyond their injuries because of what he calls three variables: consciousness, culture and cash.

1. If a hospital is conscious of its errors and what caused them, it’s less likely to repeat them. When patient advocates (in this case, Millenson) are involved, and ask appropriate questions, mistakes are less likely to occur.

2. Sustained consciousness requires a supportive culture. Hospitals with programs that enumerate efforts to improve outcomes and publicize them are sustaining conscientious efforts on the behalf of patients. Common examples are surgical safety checklists and infection-control procedures.

3. It’s difficult to change an unacceptable culture without money. No surprise that the lowest-rated hospitals often claim the poorest patient populations. Millenson’s wife was lucky to be treated at hospitals in affluent areas.

Not every accident victim has the relative good fortune to experience an emergency in a good place, nor with the perfect patient advocate. But Millenson’s story has helpful take-home messages for anyone who wants to be prepared, just in case.

If you believe your care provider has caused serious harm by negligence or malpractice, consult an attorney about legal relief. But that’s using a machete, and sometimes the job requires a butter knife.

If you have a medical procedure – surgery, a screening test – whose outcome is not what you were led to expect, or has made you worse off, there are several ways to lodge complaints. Many of these options recently were spelled out in an article in the Los Angeles Times.

Often, as simple a gesture as writing a letter can have the desired effect, especially if your primary objective is to have your problem acknowledged. If you’ve expressed concern, for example, about enduring, post-procedure pain that hasn’t been addressed, a letter to your doctor seeking the name of another practitioner who can evaluate your symptoms, review the procedure that caused them and suggest how to treat it can be a wake-up call.

As The Times reported, a doctor no longer interested in treating a patient is legally required to notify him or her in writing. The doctor also is obliged to provide references to another physician, and instruct the patient or new provider how to access the records relevant to your treatment.

If you’re trying to get, say, a surgeon, to accept responsibility for an adverse outcome, Dr. Michael Carome, deputy director of the Health Research Group at Public Citizen in Washington, D.C., outlines what to do. “Failure to do so,” he said in The Times, “amounts to patient abandonment, an infraction that would justify an investigation by the state medical board.”

Most state medical boards – the agencies responsible for licensing medical practitioners, monitoring their behavior and imposing discipline – have similar provider requirements. Jennifer Simoes of California’s Medical Board said that a patient should file a complaint if he or she “believes the quality of care that they received was poor or not the standard of care they should have received."

Other state agencies also are appropriate places to report medical mistreatment and misadventure, such as state insurance commissions, which monitor health-care coverage by private insurers. Complain to your insurance company via letter, and copy your state insurance commission.

Medical societies, which range from all-encompassing organizations such as the American Medical Association (AMA) to groups whose membership is limited to certain medical specialties, such as the American Academy of Orthopedic Surgeons (AAOS), are concerned about their reputations. It’s in their best interest to ensure their members are responsive to patient needs and complaints.

To find a state medical society, visit the AMA’s website and click on the “Patients” tab to link to the Medical Societies Directories.

If your problem relates to a surgery or procedure performed in a hospital, file a complaint with that facility’s patient advocate and, if it has one, the ombudsman. Many hospitals are accredited by the Joint Commission, about which we recently wrote. It’s an independent, nonprofit organization that accredits and certifies U.S. health-care organizations and programs.

The Joint Commission also accepts patient complaints, and its Office of Quality Monitoring uses consumer complaints to help assess if a hospital meets its accreditation standards. In The Times’ story, Michael Kulczycki, executive director of the Joint Commission's Ambulatory Care Accreditation Program, said of patient complaints, "We would focus on the continuity of care and appropriate follow-up to the patient."

File complaints at http://www.jointcommission.org. Click on Report a Complaint About a Health Care Organization in the Action Center box on the home page. After reviewing a complaint, the Joint Commission can present your issue to the hospital and ask it to review the doctor’s actions to see if additional action is necessary.

Medicare patients have additional avenues to voice complaints. Contact your regional Medicare Quality Improvement Organization (QIO), which reviews medical care and helps consumers who complain about the quality of their care. Locate a QIO near you at http://www.ahqa.org. Click on QIO Locator.

As always, you have legal rights to safe and responsible medical care. Don’t be reluctant to exercise them if you’re not getting the attention, professional courtesy and resolution you believe you deserve. As Carome said in The Times, "Ultimately another way physicians are held accountable is through litigation."

You can find out more about non-lawsuit options for making a complaint about a doctor, nurse, hospital or other health care provider by reading the Health Care Advocates' Power Kit on Patrick Malone's law firm website. It contains addresses of all the relevant agencies and tips on how to make an effective complaint.

The question will never be answered with any certainty. But it's worth thinking about, because many of us will eventually be required to make our own hard choices about what kind of treatment to get for a scary disease.

The known facts about Jobs are these. He had an unusual form of slow-growing cancer of the cells in the pancreas that make insulin. His kind of cancer is called an "insulinoma" or an islet cell cancer. When the cancer was first found in 2003, he put off surgery to cut it out for nine months, while he tried dietary treatments advocated by his friend and diet doctor Dean Ornish.

Ornish is a controversial physician with one foot in the camp of scientific medicine but the other dipping deep into the stream of unproven, "alternative" therapies. He advocates a vegan diet that most people find very difficult to adhere to.

Did the delay in surgery doom Jobs to an early death? The best answer seems to be, "Hard to say, but it didn't help him any in the long run." A blog called Science-Based Medicine, written by oncologist David Gorski, has some interesting thoughts. I enjoyed his piece, and especially his back-and-forth with a commenter on his site who identified himself as a medical oncologist. Here is Gorski's bottom line about the allure of "magical thinking:"

Just eat this root, do these colon cleanses, let this healer manipulate your energy fields, and everything will be fine. No nasty invasive surgery that will permanently alter your body and how it functions. No poisonous chemotherapy. Unfortunately, reality doesn’t work this way, no matter how powerful the reality distortion field. Ultimately, reality intrudes, as it did for Jobs. When it did, when a followup scan apparently revealed that his insulinoma had grown, Jobs realized he had made a horrible mistake and tried to correct his course by undergoing surgery right away. It’s not clear whether his time in his self-created medical reality distortion field ultimately led to his demise or whether his fate was sealed when he was first diagnosed. Again, there’s just too much uncertainty ever to know for sure, and even if Jobs did decrease his odds of survival significantly it’s impossible to say whether the delay meant the difference between life and death in his specific case. What is clear is that no reality distortion field can long hold cancer at bay. Reality always eventually wins over magical thinking, no matter how much it might appear that magical thinking is winning at any given time.

My own take is this:

Cancer is scary, and even brilliant patients like Steve Jobs can become desperate, and tempted into trying an unorthodox treatment – remember laetrile? And although many cancer treatments have terrible side effects, at least they are based on science, not wishful thinking. Before you or a loved one decides to depart from what established medicine recognizes as the best practice for your diagnosis, learn about the science, not the magic, involved in those choices.

To help separate reality from fantasy, consult Quackwatch.com, a nonprofit resource that addresses health-related frauds, myths, fads and questionable therapies.

It’s a widely, if grumpily, accepted fact that primary care physicians spend less time with patients than either would like. There are only so many minutes in the day, and there’s always more paperwork than time to address it.

No medical practitioner is more overburdened than a primary care physician, because in many health plans, he or she is the so-called “gatekeeper” to specialized care. Patients must see one in order to warrant a referral to someone else – a dermatologist, a cardiologist, a psychiatrist, a surgeon.

So no wonder that the American Medical Association recently asked the Centers for Medicare & Medicaid Services (CMS) to reimburse network physicians in fee-for-services health plans for phone calls, counseling and other efforts they expend to coordinate care for chronically ill patients.

No question that the labyrinthian nature of the U.S. health-care system demands much of people obliged to navigate it on behalf of others, and these professionals deserve to be compensated, according to independent health-care journalist Merrill Goozner.

But with shrinking coverage, strained budgets and the inexorable increase in the cost of health care, how will these merit pay raises be funded? How about, Goozner suggests, by the medical establishment reassessing and realigning its priorities? How about by embracing a rational sense of proportion?

There’s an ocean of difference in what providers are paid. Specialists often receive two or three times the fees paid to a primary care doc. Goozner says it’s difficult to justify that the “relative value” of back surgery or angioplasty is so much more than other kinds of treatment involved in gate-keeping. These two specialties, he says, are exemplary of “the most expensive and overused procedures in medicine, incentivized by the extraordinarily high fees earned by the surgeons who do them.”

Whether or not you agree with the politically driven Congressional mandate that any new spending must be offset by federal budget cuts – known as the “pay-for” rule – maybe Medicare should adopt the same policy. If Congressional Republicans find it acceptable to charge emergency flood relief with a pay-for, if President Obama is OK with sending the bill for his jobs package to the nation’s millionaires, maybe medicine should cover the coordination of care pay-for with a reduction in the inflated fees for specialist care.

“Congress needs to come up with nearly $300 billion over the next decade simply to hold physician salaries where they are,” Goozner writes. “The permanent fix would set a cap for total physician pay; and allow it to rise over time for inflation. But why not require that CMS adjust payments to the various specialties to meet that cap? Otherwise, in a few years we’ll be right back where we are today: a permanent fix that wasn’t permanent at all, with new services inflating the total tab beyond the cap.”

Bo, the presidential family pooch, might be a real sweetie, but he can still make some people sneeze.

According to the New York Times, the notion that certain dog breeds--such as Portuguese Water Dogs, of which Bo is a member--are less likely to stimulate an allergic response seems to be misguided.

A study in American Journal of Rhinology and Allergy found no difference in the quantity of allergens in homes with supposedly low-allergy pets—poodles, Wheaten terriers, schnauzers, Bo--and those not identified as being hypo-allergenic.

It’s possible that some breeds do produce less dander (tiny bits of fur and skin), but it’s more likely a trait of an individual dog. Researchers acknowledged that how much time you spend in a room with a dog could be critical to your allergic response, and that information was not tested.

Here boy! Roll over! Sit! Fetch me a tissue!

At its annual meeting last month, the American Medical Association's House of Delegates adopted several new policies, including one that recognizes that bisphenol A (BPA) interferes with human hormones, one that decries the practice of competitive eating and one calling for more research on full-body scanners used in airports.

The AMA says BPA is an endocrine-disrupting agent and wants products with the potential to increase human exposure to the chemical to be clearly identified. Studies have shown that BPA may be linked to male sexual dysfunction, cardiovascular disease, diabetes and liver abnormalities.

BPA is used to soften plastics in baby bottles, cups and plastic packaging. In 2008, the FDA said there was evidence to connect commonly used levels of BPA to some health issues, but its conclusions were questioned by an advisory panel.

Competitive eating, in which contestants speedily ingest the most food possible within a certain time limit, is a practice the AMA finds deleterious to gastrointestinal health (and thinking people everywhere find disgusting and offensive in a world where millions starve every day.) The AMA's Young Physicians section noted that speed eaters are in danger of vomiting, reflux, choking, stomach rupture, diabetes and tooth enamel erosion.

Calling for more research, the AMA determined that there aren't enough data on potential health risks of the new full-body scanners used at some airports. Radiation experts and medical physicists agree that the full-body backscatter scanners that create an anatomically accurate image produce minuscule levels of radiation that pose no real health risks. But questions remain: What effects will the low-dose X-rays have on skin and what would happen if a machine's "on" mechanism jammed and delivered a dose of radiation that is exponentially higher than intended?

Making physicians aware of the cost of regular lab tests cuts the daily bill for those tests by as much as 27%, according to a new study.

The study, published in the May issue of Archives of Surgery, first monitored the baseline daily per-patient cost for two common lab tests - complete blood count and total chemistry panel – among surgical patients at Rhode Island Hospital in Providence. Once the baseline was established, researchers made weekly scripted announcements to the physicians-in-training who order most of the tests and to their attending physicians about the cost of those tests, but doctors were never told when or when not to order a particular test.

When the program began, the daily cost per non-intensive care patient was $147.73. Over the 11 weeks of the study, that dipped as low as $108.11 in the eighth week. There were a couple of weeks where the cost of tests went up from the previous week, but those corresponded with a new influx of intern physicians who were hearing the announcement for the first time.

Over 11 weeks, the official total saved was $54,967. (In practice, of course, the true amount saved would be less, as the official savings is based on the sticker price of the tests, not the amounts actually paid by Medicare or negotiated with third-party insurers.)

Study co-author Elizabeth Stuebing says the results show what can happen merely by giving physicians information they don’t usually get. “We never see the dollar amount of anything," she says. "The first week I stood up and said that in the previous week we’d charged $30,000 of routine blood work and I could hear gasps from the audience.”

Source: The Wall Street Journal

You can read an abstract of the study here.

Patient safety advocates like me have long dreamed of cracking open for the public the vast trove of data the government collects on doctors, so patients could figure out who gets the best outcomes and guide their doctor choices accordingly. Medicare was supposed to start down that path with its new "Physician Compare" website, but alas, it has a long way to go.

One critic says the new site "is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency ... has produced a consumer tool that practically shouts, 'We couldn't care less whether any consumer ever uses this.'"

The quotation is from Michael L. Millenson, President of Health Quality Advisors LLC, writing on the Kaiser Health News website.

The Medicare site has basic information about doctors, like their practice address, but misses out on many tidbits that consumers want to know:

* Hospitals they practice at

* Malpractice history

* Where they trained

* Board certification.

Those kinds of things can be found at commercial sites like healthgrades.com for a small fee. Or you can search one of the sites that lists doctors' board certifications, like
the American Board of Internal Medicine, which certifies internists.

The quality information that consumers really crave, such as surgeons' complication rates or incidence of wound infections, lies off in the future somewhere. Medicare says it will begin adding quality data to the site in 2012, with a formal launch date in 2013. Don't hold your breath.

Meantime one surgical specialty group, the Society of Thoracic Surgeons, has collaborated with Consumers Reports to publish quality data on heart and chest surgeons. Read our blog entry on this here.

An overdose of news media hype has long been a problem for consumers who want high quality health care but don't want to bounce from health fad to health fad. Naive and uncritical journalists who write about health care issues are a huge source of the hype overdose. So it's great to learn about a Web resource that systematically and thoroughly reviews health news and rates the quality of the stories.

The site is the somewhat stodgily named HealthNewsReview.org. With a foundation grant, it employs a team of medical journalists and physicians to critically review health news in major publications. The stories get rated on a scale of one to five stars, based on how well the following issues were addressed:

* What's the total cost?
* How often do benefits occur?
* How often do harms occur?
* How strong is the evidence?
* Is this condition exaggerated?
* Are there alternative options?
* Is this really a new approach?
* Is it available to me?
* Who's promoting this?
* Do they have a conflict of interest?

The site says its goal is: Holding Health and Medical Journalism Accountable. And it lives up to that by naming names and taking no prisoners on current health news.

A recent Wall Street Journal piece that suggested Vitamin B12 as a potential cure-all got a low two-star rating for putting out a series of unsubstantiated claims with loose anecdotes and little evidence.

A Denver Post article on an "anti-gravity treadmill" scored a lowly one star for glorifying an unproven product.

NPR and CNN Health scored highly for their well done columns on the recent research about antibiotics for kids with middle ear infection.

I give the site five stars for being a very useful resource. It asks the right questions about medical news and gives straight answers. I'm particularly keen on conflicts of interest and other things that tend to get underplayed in much coverage: for example, the hidden harms of touted new medical devices.

Article first published as Hype Busters: Helping Patients Get Better Health Care With a Dose of Skepticism on Technorati.

Tired of reading doctor report cards and not knowing which ones to believe? Now there's an organization that reviews the plethora of health care report cards available online in order to provide you with clear choices about the sites that really do provide accurate and useful information.

The Informed Patient Institute provides detailed analysis of online health report cards – covering nursing homes and physicians for now and other health areas in the future – to show consumers where they can find the best information.

An independent, non-profit organization funded by foundations and individual donors, IPI provides guidance to other consumer-focused organizations, such as Consumers Union, to “facilitate access to credible online information about health care quality and patient safety,” but not by rating individual health facilities or professionals. Instead, IPI evaluates the usefulness of the wealth of online report cards and advocates making more -- and more useful -- health care quality information available to consumers.

Among the best features of IPI's system:

1. It uses a clear rating system. Organizations can receive an A through F grade, with explanations for what each means. IPI always tells you “what we like” and “what we don’t like.” For example, the New York State Health Department’s Nursing Home Profile received one of the few A grades. IPI praises the site for providing a “wide range of information including state survey results, complaints and quality of care provided,” but also notes that it doesn’t “have information on costs, nursing home staffing, or resident or family satisfaction with the home.”

2. It allows for exceptions to the rules. If a site has “unique content” but doesn’t quite make the grade in other criteria, IPI gives the site a “U.”

3. It simplifies users’ options. If you click on a state like Alabama, you will see that the only option for you to click is “Physicians” because there is no nursing home content related to Alabama. California, by contrast has sites that cover both. All the areas that IPI hopes to cover in the future are included in the drop-down menu, but only the topics that have content are clickable.

4. It provides good context. For each state, on the right side of the screen, you will see a Top 10 ranking of the sites IPI has reviewed that contain content about that state.

Source: Reportingonhealth.org

To visit the Informed Patient Institute web site, click here.

Ambulatory surgery centers (ASCs) that specialize and have high case volumes have better patient outcomes, according to a study by researchers at four U.S. universities.

The researchers found that the more a facility specialized in its services –and the higher its case volume for those services, the higher its patient quality scores. The researchers defined quality performance as the likelihood that an ASC patient undergoing surgery would avoid unplanned hospitalization within 30 days after the procedure.

To perform the study, which examined potential associations among ASCs organizational strategy, structure and quality performance, the researchers obtained claims data for arthroscopy and colonoscopy procedures performed from 1997 to 2004. “Quality performance” was determined by the likelihood that an ASC patient undergoing surgery would avoid unplanned hospitalization within 30 days after the procedure.

Ambulatory surgery, or outpatient surgery, is provided for patients requiring less than a 24-hour stay. ASCs have become more common across the country because (a) advances in surgical technology and anesthesia have made surgery easier on patients and so consequently more in demand; and (b) the cost of providing the same procedure in an ASC is often considerably less than hospital outpatient surgery.

According to a KNG study, the specialties with the highest percentage of Medicare-certified ASCs in 2007 were ophthalmology (19%) and gastroenterology (18%), followed by pain management (8%), orthopedics (7%) and dermatology (4%). Multiple specialty ASCs comprised 35% of the total.

Source: Medical Care Research and Review

You can view the KNG study here.

On November 17, 2009 in Washington, D.C., Consumers Union hosted a forum of patient activists, advocates, doctors, nurses and others who want to reform the dangerous safety practices in the U.S. medical industry. (I attended as a medical malpractice attorney and patient safety advocate.)

You can watch a webcast of the forum here.

The forum included a moving panel of three women -- Helen Haskell, Patty Skolnik and Lori Nerbonne -- who recounted their experiences losing loved ones and what they have done since to try to achieve more openness, honesty and safety in American medicine.

Several journalists gave their perspectives, including

* Maggie Mahar, the author of Money-Driven Medicine and the Health Beat blog,

* Charles Ornstein of Pro Publica, who headed a team of investigative writers who exposed dangerous complacency in the California Board of Nursing, which allowed known dangerous nurses to continue to practice for years.

* Cathleen Crowley, chief writer for the Hearst newspaper project, "Dead by Mistake."

I attended the forum and was both inspired at the obvious dedication of the patient safety advocates in the room, yet frustrated with the lack of traction the safety movement is having in the health care reform in Congress.

Web sites are proliferating that offer candid -- sometimes brutally so -- reviews by patients of doctors. The sites include Angie's List, RateMDs, Yelp, DrScore and Vitals.com.

Now some doctors burned by reviews are striking back. A growing number of them are asking new patients to sign up-front agreements promising not to post anything about them on-line, or in any other media, "without prior written consent," according to an article by Sandra Boodman in the Washington Post.

The ethics and legality of such "gag orders" are questionable. But to my lights, they serve a useful purpose: Any doctor who would be so sensitive to criticism that he or she would ask me to sign such an agreement is not a doctor whom I would want to trust with my life. Period.

As for the web sites themselves, they have varying amounts of useful information. RateMDs, for example, one of the biggest, covers some 200,000 physicians across the country, but most of the doctors have only one or two reviews. It's not fair to make a judgment about a doctor based on such a limited survey. I would want to see at least ten or more reviews of a doctor, and see how consistent the ratings were among the responders, before thinking this was useful information.

The popularity of these web sites is a sign of how hungry patients are for reliable information in making the important choice of a doctor. And the fact is that there is very little reliable objective information on which patients can make informed decisions. I devoted a chapter of my book, "The Life You Save," to finding a top primary care doctor, and another to finding a top surgeon. I believe there is no easy shortcut for the hard work of:

* Checking credentials to make sure the doctor is board-certified by one of the officially recognized boards (Michael Jackson's live-in doctor, for example, was not certified in anything).

* Experiencing the doctor's care, at least once, to gauge his or her listening skills and empathy. These are important not just for making patients feel good, but for making accurate diagnoses and giving patients confidence in the care plan the doctor develops.

* Making sure the doctor has adequate backup for when the doctor is out of town.

* Learning that the doctor is on staff at a good nearby hospital.

A detailed discussion of how to find top doctors and surgeons can be found in Chapter 5, Chapter 6 and Chapter 10 of "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

Patrick Malone's new book was featured on the Today show in an interview with Matt Lauer. Click here to see the video and read Chapter 2 of the book. The book is "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

Topics discussed on the Today show interview included why you need to read your own medical records, guidelines for finding a top primary care doctor, and the importance of second and third opinions at every major medical crossroads.

Many elderly patients suffer protracted, and expensive, deaths as health care providers pummel them with technological fixes for bodies that have already worn out. The dilemma is that while no doctor wants to give futile care that tortures more than it heals, no one also wants to be guilty of euthanasia or abandoning their patient.

A group of Roman Catholic nuns at a convent near Rochester, New York, has a new/old answer to this dilemma: Involve the patient in a warm and loving community where the patient's wishes are always paramount, but death is faced with realism, and care goals are clarified long before any final crisis. As Jane Gross reported in a beautiful article in the New York Times:

A convent is a world apart, unduplicable. But the Sisters of St. Joseph, a congregation in this Rochester suburb, animate many factors that studies say contribute to successful aging and a gentle death — none of which require this special setting. These include a large social network, intellectual stimulation, continued engagement in life and spiritual beliefs, as well as health care guided by the less-is-more principles of palliative and hospice care — trends that are moving from the fringes to the mainstream.

For the elderly and infirm Roman Catholic sisters here, all of this takes place in a Mother House designed like a secular retirement community for a congregation that is literally dying off, like so many religious orders. On average, one sister dies each month, right here, not in the hospital, because few choose aggressive medical intervention at the end of life, although they are welcome to it if they want.

“We approach our living and our dying in the same way, with discernment,” said Sister Mary Lou Mitchell, the congregation president. “Maybe this is one of the messages we can send to society, by modeling it.”

I recommend reading the entire article, which is one more example of a spirit that I have tried to imbue in my book, “The Life You Save: Nine Steps to Finding the Best Medical Care — and Avoiding the Worst.” When patients become actively involved in understanding their own health care, they can make decisions that best fit their own values.

Elderly patients are different. They are more sensitive to some drugs, less to others, have unusual presentations of common conditions, and otherwise are not that easy to diagnose and treat when the doctor is used to dealing with younger patients.

Bemoaning the lack of required geriatric training in medical schools, geriatrician Dr. Rosanne Leipzig gave this example in a recent op-ed piece she wrote in the New York Times:

Often even experienced doctors are unaware that 80-year-olds are not the same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and difficulty breathing; an 80-year-old with the same illness may have none of these symptoms, but just seem “not herself” — confused and unsteady, unable to get out of bed.

She may end up in a hospital, where a doctor prescribes a dose of antibiotic that would be right for a woman in her 50s, but is twice as much as an 80-year-old patient should get, and so she develops kidney failure, and grows weaker and more confused. In her confusion, she pulls the tube from her arm and the catheter from her bladder.

Instead of re-evaluating whether the tubes are needed, her doctor then asks the nurses to tie her arms to the bed so she won’t hurt herself. This only increases her agitation and keeps her bed-bound, causing her to lose muscle and bone mass. Eventually, she recovers from the pneumonia and her mind is clearer, so she’s considered ready for discharge — but she is no longer the woman she was before her illness. She’s more frail, and needs help with walking, bathing and daily chores.

This shouldn’t happen.

Dr. Leipzig co-authored an article for medical educators listing 26 areas of competency in treating elderly patients that medical students should have to demonstrate before getting out of school; the list is nicknamed the "Don't Kill Granny" list.

For the rest of us, the takeaway lesson is that when we're advocating for an elderly relative with a new doctor, we need to find out if the doctor has deep experience in treating elderly folks, and if not, ask for a second opinion from a doctor who does. This can make a huge difference in quality of medical care -- and quality of health for our relatives' twilight years.

More tips on being a patient advocate can be found in Patrick Malone's new book, "The Life You Save."

In a study published this week in The Lancet, a British research team found that surgical stockings given to stroke patients for prevention of blood clots do not work, reports Sam Lister of UK’s Times.

The compression stockings provide graduated pressure and should reduce swelling in the legs. Studies have shown that, for patients immobilized after surgery, these stockings effectively reduce formation of blood clots, which can be deadly when the clots travel up to the heart or lungs and obstruct blood flow.

However, in the new Lancet paper, scientists followed 2,500 stroke patients in Britain, Italy and Australia, and found that the use of compression stockings made no significant difference in the occurrence of DVT (deep vein thrombosis, the blood clots in the deep veins of the legs that can travel to the heart or lungs). Patients who wore the stockings actually suffered additional symptoms that include skin breaks, ulcers and blisters.

The results of the study were also presented at the European Stroke Conference on May 27 in Stockholm. Researchers believe this study conclusively shows compression stockings should not be recommended to stroke patients.

When someone over age 55 develops memory problems, it is often diagnosed as Alzheimer's, or another type of dementia, or perhaps Parkinson's disease, all of which are progressive and non-reversible. But families should be aware of one condition that can masquerade as any of these but if accurately diagnosed, can be treated successfully. The condition is called normal pressure hydrocephalus, or NPH, and as Jane Brody reported in the New York Times, because it is so frequently missed, no one is sure how many people have it, but estimates are up to 375,000 people in the United States.

Hydrocephalus involves a buildup of pressure inside the brain from lack of drainage of the cerebrospinal fluid that bathes and cushions the brain and spinal cord. Every person makes about two soda cans' worth of the fluid every day, and if it is not reabsorbed into the blood stream, pressure can build and cause damage to nerves and structures inside the brain.

Typically NPH presents first with a walking disorder -- the victims walk slowly with feet wide apart. It then progresses to urinary incontinence and loss of memory. These three issues are considered a "classic triad" for NPH.

If NPH is suspected, imaging of the brain will reveal one or more enlarged ventricles, the holes inside the brain that are filled with cerebrospinal fluid. The treatment is to put a tube into the ventricle to drain off the accumulated fluid and divert it into the abdomen. This surgically implanted shunt is reported to benefit 70 to 80 percent of patients with NPH. The manufacturer of a programmable shunt has a web site with more information: www.lifenph.com.

Strokes cause more disability than just about any other disease, but they don't have to. Effective treatments are known for the most common type of stroke; delivering them to the right patients has proven to be difficult. Now a group of researchers is proposing some changes in how stroke care is organized, with the hope of matching reality to the promise and greatly improving stroke outcomes.

In 1995, a landmark study was published showing that the impact of stroke on the human brain could be greatly diminished by using clot-busting drugs to dissolve the clots that kill brain cells in ischemic stroke. (Ischemic stroke is responsible for about four of five strokes. In ischemic stroke, brain tissue dies because blood clots or narrowed blood vessels block flow of oxygen-rich blood to brain tissue. In hemorrhagic stroke, which affects about one in five stroke patients, brain tissue dies because a burst blood vessel causes bleeding in the tissue.)

Today, though, it is estimated that fewer than one in ten victims of ischemic stroke are treated with either intravenous tPA, the main clot-dissolving drug, or other effective treatments, such as breaking up the clot with a mechanical device inserted inside the blood vessel.

The accepted convention is that tPA does not work unless the i.v. is started within three hours of the onset of stroke symptoms. Most patients don't get to the hospital that quickly, and even when they do, time is eaten up by the necessity to give everyone a CT scan to make sure they are not having a bleeding stroke, for which use of the clot-dissolving drugs could be a disaster.

A new article by Drs. Reza Hakimelahi and R. Gilberto González, "Neuroimaging of Ischemic Stroke With CT and MRI: Advancing Towards Physiology-Based Diagnosis and Therapy," advocates these changes to help deliver more of these proven treatments to more patients:

* Doctors need to recognize that the three-hour window for treatment sometimes is much longer in patients who have blockages of smaller vessels in the brain with some temporary compensation through "collateral" vessels. Better imaging studies can identify these patients who have an "ischemic penumbra" that would benefit from clot-dissolving drugs.

* Many patients can benefit, even after the three hours has expired, by direct intervention with mechanical devices to break up clots from the inside of the vessels. Because this requires expertise in interventional neuroradiology, a field with only a few hundred practitioners in the United States, the authors recommend cross-training for doctors in related fields who know how to use tiny tubes inside blood vessels to deliver treatments. These include interventional cardiologists.

* Hospitals that are recognized as expert in care of acute strokes could be divided between advanced and general levels of expertise. On the general level, any such hospital needs to have 24-hour CT scanning and the ability to give clot-busting drugs in the emergency department. To qualify as an advanced stroke center, the hospital would have to have the ability to do interventional treatments inside blood vessels ("endovascular therapy"), a neuro-intensive care unit, and a team of doctors from multiple specialties that work together to decide the best treatment for each patient.

(NOTE: To read this article, you have to sign up for a free membership at Medscape.com.)

As these ideas are debated in the medical industry, the best strategy for patients is to have some advance knowledge and basic planning. Knowing how common strokes are, and how urgent the timeline is ("Time Is Brain" in stroke treatment) once stroke symptoms start, here is what I advocate:

* Know the basic symptoms of stroke, and don't rationalize your way out of a trip to the hospital if the symptoms seem mild or go away after a few minutes. Here is a basic list from the American Stroke Association:
* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden, severe headache with no known cause

* Know which hospital in your area has advanced stroke treatment staff and machines. Ask if they have a multi-disciplinary team. (It should include both neurosurgeons and endovascular therapists.) Ask if they have a neuro-intensive care unit (an ICU that treats only patients with brain or spinal cord problems).

* If a loved one suffers stroke symptoms, do not let the rescue squad take them to the nearest emergency room UNLESS the same hospital has advanced stroke treatment abilities.

* A multi-disciplinary team is important because conflicts of interest can drive doctors to advocate for therapy they can do when a safer, more effective treatment might be available from a doctor with different training. Having doctors work together to help the patient and family decide treatment is the best approach.

In his new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, Patrick Malone discusses one tragic case in which a patient needed a teamwork approach to her neurological problem but didn't get it because the hospital had no effective team in place. The book discusses the questions to ask to make sure your doctors are working together and not as competitors for your health care business.

An Institute of Medicine report released on April 28, 2009, denounces the adverse effects that the health care system suffers from the free gifts regularly pumped into hospitals, medical schools, and doctors’ offices, writes New York Times’ Gardiner Harris. The report strongly advises doctors to stop accepting the gifts. The report says that accepting gifts would “create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy.”

When doctors accept gifts from drug companies – which may be money, drug samples, office supplies or food – they change their prescribing habits. This change may or may not be conscious, but the “reciprocity instinct” that prompts people to return a favor is part of human nature that has been recognized by psychologists and anthropologists. And when this happens, the patients are the real victims: their doctors may prescribe new drugs that are yet to be tested for their safety or effectiveness, or drugs that patients can easily replace with diet or lifestyle changes.

In his new book, The Life You Save: Nine Steps to Finding the Best Medical Care – and Avoiding the Worst, Patrick Malone discusses steps patients can take to avoid being victims of such conflicts of interest. He also explains how an average patient can dissect statistics on drug performance to determine if a particular drug is really as effective as it’s marketed to be.

On May 1, 2009, the FDA issued a warning for consumers to immediately stop using dietary supplements containing Hydroxycut, which has been linked to dozens of serious health problems including jaundice and liver damage. The dietary supplement is also responsible for one death from liver failure. Other reported health problems include seizures, muscle damage and cardiovascular disorders.

Patients who reported health problems were taking recommended dosage of Hydroxycut products, dietary supplements for weight loss. Therefore, the FDA urges consumers to stop taking Hydroxycut products immediately to avoid risks, many of which can involve permanent damage to your health.

The agency also advises consumers to consult a doctor if they experience these symptoms: jaundice (yellowing of the skin or whites of the eyes), brown urine, nausea, vomiting, light-colored stools, excessive fatigue, weakness, stomach or abdominal pain, itching and loss of appetite.

Manufacturer of the dietary supplement, Iovate Health Sciences of Ontario, agreed to recall the products.

Diet supplements are promoted for their health benefits. Their “natural” ingredients are supposedly safer for a host of benefits like losing weight and gaining energy. The truth is that for most supplements, the benefits are unproven and untested, and the safety of these products is questionable.

Under federal law, diet supplements, unlike drugs, do not have to prove their safety and effectiveness before being sold to consumers. The supplement manufacturers are supposed to keep track of their own safety with very little government oversight until tragedy strikes.

Ironically, though, the diet supplements contain ingredients that mimic the actions of drugs and in some cases even contain actual prescription drug ingredients. Spiking a supplement with any prescription drug is illegal, and the FDA has been on a campaign to identify these products. Since December 2008, it has listed 70 brands of supplements that contained hidden and potentially dangerous drugs.

Another problem is that once reports start coming in of consumers sickened or injured after taking a supplement, it is often hard for safety officials to pin down what ingredient of the supplement was the culprit. Hydroxycut, for example, has a blend of a number of substances, the formula of which has changed over time. And for any of these products, because they are derived from plant materials, the strength can vary from batch to batch.

The best advice for consumers: Don’t be fooled by “natural.” When you’re taking a diet supplement, you are really ingesting a bunch of pharmacologically active substances, some of which won’t hurt you but won’t necessarily help you either. And sometimes, as with Hydroxycut, you can be hurt.

Getting a loved one home from the hospital is always a relief for both patient and family, but the weeks immediately after hospital discharge are fraught with peril, as many families don't discover until the patient has to be readmitted for a new problem. This is especially common with Medicare patients: an alarming one in five Medicare patients are back in the hospital within thirty days, and one in three are readmitted within ninety days. Fully half of the non-surgical patients who have to be readmitted in the first month after going home had no followup visit with any doctor during that same month. That means the patients were basically set adrift to fend for themselves. These numbers come from an analysis published in the New England Journal of Medicine, as reported in an editorial in the New York Times.

Leaders in the health care field freely admit that hospital readmissions come about from poor discharge planning and inadequate communication with family members about what they need to do to keep the patient healthy. The president of the American Hospital Association said in a letter to The Times about the editorial: "Most unplanned readmissions can be traced back to our fragmented delivery system, and to the lack of social support programs for many elderly and sick patients."

What is the answer?

Family members who are assigned by hospitals to take care of a loved one at home need to be very clear on what they are supposed to do. Do not let a family member be dumped on your lap without a clear, written list of everything they need, including medications, therapies, and appointments for return visits. Family members need a lifeline they can call on when things don't seem to be going right.

The leaders of our health care system are talking about extending Medicare benefits so that nurse managers can coordinate the transition from hospital to home, or teams of caregivers can conduct house calls on recently discharged patients. These are promising ideas, but what is needed right now is for anyone who has a family member coming home from the hospital to speak up and insist on clear instructions and advice. Being forceful and clear can help the caregivers help you to make sure there is a well thought out plan and that you can realistically carry it out.

Patrick Malone's new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, has a chapter on how family members can become effective patient advocates when they have someone in the hospital. The chapter includes a list of key checkoff points that you need to understand when a loved one is discharged to your care. You need to have at a minimum:

* A written set of discharge instructions.

* A specific appointment with the doctor in charge for a followup visit.

* A list of bad things to watch out for, and the contact person to relay this information to.

* Written lists of all medications that need to be taken, when and how; plus all therapies that need to be done with similar detailed instructions.

In a newly released Thomson Reuters survey, one in five respondents say they have delayed medical care, and one in four of those who did listed financial cost as the primary reason, reports Maggie Fox of Reuters. The survey also predicted that in the next three months, one in every five adults in America will have difficulty paying for health insurance or health care.

The data show a significantly higher number of Americans putting off healthcare than in 2006, when the same question was asked in a survey. Leaders of the study associate this increase with growing number of Americans losing employer-sponsored health insurance.

The study leader Gary Pickens predicted that America’s “collective well-being” will be hurt if people continue to delay necessary treatments.

If you find yourself unable to afford healthcare or health insurance, check with your state and local agencies to see if you are eligible for Medicaid or other forms of financial assistance. Pharmaceutical companies often have programs for uninsured patients. Additional resources may be available: Walgreens, for example, recently announced that its Take Care program will offer free routine clinic services for the uninsured and unemployed.

One of the true pioneers of modern medicine is Dr. Thomas Sarzl, who performed the first liver transplant and who developed many of the procedures that have made transplantation a safe lifesaving treatment for thousands of people.

Dr. Sarzl is still active at age 83. He was interviewed recently by another transplant surgeon, Dr. Pauline Chen, for her column in the New York Times.

From his many years of experience, Dr. Starzl gave three nuggets of advice to patients, which I am reprinting because I think he is right on target:

"As for the patients," he told Dr. Chen, "I would give this advice — I followed it myself. That is to get a practitioner of general medicine to take care of you, somebody who is not a narrow specialist. And have that person take care of yourself and the people you care for most, your family. The second is to be constantly learning so you can be informed and have some judgment about advice you are given. And then the third item would be to get a second opinion if some really significant thing happens that requires drastic therapy. Those decisions are so important that I think you should get a second opinion if you come to a point where you need the treatment required for cancer or transplantation or catastrophic indications."

My new book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst," makes some of these same points. For example, Step Three of my "nine steps" says: "Team up with the best primary care doctor you can find." And Chapter 9 is titled: "The Second Opinion: Always Your First Choice."

Everybody knows that close friendships can be wonderful, and medical researchers are now coming up with tangible evidence that friendship can pay off in longer and healthier lives as well.

"Friendship has a bigger impact on our psychological well-being than family relationships," says sociologist Rebecca Adams of the University of North Carolina, Greensboro. She was quoted in an article by Tara Parker-Pope in the New York Times.

Ms. Parker-Pope's article was inspired by a book, "The Girls from Ames: A Story of Women and a 40-Year Friendship." Author Jeffrey Zaslow documents how eleven childhood friends from Iowa continued to nurture and sustain each other, including two of them who recently learned they had breast cancer.

Researchers have found that friendship has an even greater effect on health than being married or having family members nearby. No one is quite sure what it is about friendship that sustains people, but perhaps what we all take heart from is the idea that "we're all in this together."

If you are pregnant and experiencing fatigue, dry skin, sleep loss, or weight loss, it may be worthwhile to find out whether you are a candidate for a thyroid test – these symptoms, while common in pregnant women, may be caused by underactivity (hypothyroidism) or overactivity (hyperthyroidism) of the thyroid gland.

If untreated during pregnancy, both conditions have been shown to result in higher risks for miscarriage, premature birth, preeclampsia, and even impaired intelligence in the child (in the case of hypothyroidism). But does such risk necessarily warrant a universal recommendation for thyroid tests in pregnant women? Ingfei Chen explores an ongoing debate on this issue in a New York Times article.

The thyroid gland produces hormones that regulate many important aspects of our bodies, including metabolism, body weight and heart rate. When there is too much of this thyroid-stimulating hormone (TSH), the pregnant woman suffers from hyperthyroidism and experience poor sleep, weight loss, and nervousness after giving birth. On the other hand, when the thyroid gland is underactive, the resulting hypothyroidism causes fatigue, weight gain and dry skin. Both conditions are manifested in very subtle symptoms but are risk factors for dangerous pregnancy complications.

While both an overactive and an underactive thyroid spell trouble for pregnant women, hypothyroidism is the more common and worrisome condition. Hypothyroidism, affecting 10 to 20% of women of childbearing age, is often undiagnosed but hampers fetal brain development. A study done 10 years ago reports that 19% of children born to women with untreated hypothyroidism had an IQ of 85 or lower, whereas the same measure was only 5% for those born to mothers with a healthy thyroid.

Although risks of an imbalanced level of TSH are known, the medical field is currently split on whether there is sufficient existing evidence for the benefits of treating the condition, and subsequently, of recommending universal screening. Studies are underway to track pregnant women with healthy and underactive thyroids, and their children will be tested for IQ. Until scientists arrive at conclusive results, the general clinical policy is to recommend a thyroid test to high-risk women (for example, a woman with family history of thyroid problems). However, more doctors have begun recommending the test to normal-risk expecting mothers, and many think that evidence for universal screening will soon be available, according to Dr. Stagnaro-Green, an endocrinologist at Touro University College of Medicine in New Jersey.

Many people nowadays have never seen a bed bug, a blood-sucking insect assumed to exist only in underdeveloped countries and impoverished neighborhoods. However, more and more Americans are now finding themselves aghast with the sight of real bed bugs infesting their homes. An article published in the Journal of American Medical Association in April discusses the consequences of bed bug bites, and ways to prevent them, Jane Brody writes in the New York Times.

Authors of the newly published article attribute the resurgence of bed bugs in developed countries to “international travel, immigration, changes in pest control practices, and insecticide resistance.” The critters hitchhike with travelers from continent to continent, resulting in significantly higher numbers of infestations in the United States, Canada, and Australia in recent years.

While most victims of bed bugs do not react, about 30 percent of those bitten will have “small, pink, itchy bumps” that resemble mosquito bites. These bumps can be treated with oral or topical anti-itch product, such as antihistamine or calamine lotion. More sensitive people may develop intense itching and infections. Other more extreme reactions include asthma, generalized hives and a life-threatening allergy that should be treated immediately.

So how should we prevent these bugs from entering our homes? Authors of the article suggest careful inspection before buying second-handed mattresses, sofas, cushioned chairs and similar furnishings. They also advise against picking up discarded furnitures. And if you must take the clothes left out by your neighbors, you should wash them immediately in hot water or have them dry cleaned. Travelers should also be vigilant when packing and unpacking, searching for bugs that may have climbed into their luggages.

Lastly, if your home has already been infested by bed bugs, it’s recommended that you hire a professional exterminator, which costs more than home remedies but is much more effective in warding off the pests.

As if there is not already a multitude of problems awaiting those who lead an inactive lifestyle, researchers recently found yet another inactivity-related condition that threatens human health, a condition called non-alcoholic fatty liver disease (NAFLD), according to Medical News Today.

In an article published in The Journal of Physiology, Dr. John Thyfault of the University of Missouri reports his research group’s findings that established a link between low aerobic fitness level and fatty liver disease. His group carefully bred two groups of rats of different levels of intrinsic aerobic capacity, so that after 17 generations the rats in the “fit” group can run 1500 meters, whereas the “unfit” rats can undertake only 200 meters.

Rats in the “fit” group normally live healthy lives, even though they are not more active than those in the unfit group. However, those in the “unfit” group often display clear symptoms of NAFLD, including fibrosis, which is a form of liver damage seen in alcohol abuse patients.

Fatty liver disease causes fat deposit in patients’ livers and elevated levels of fat in their blood. The “unfit” rats in Thyfault’s study also were found to have poor fat processing power. These effects together result in high fat retention in patients, making them prone to obesity and its related risks of heart disease, strokes and diabetes.

Salmonella, which causes serious gastrointestinal illnesses that can be life-threatening, was found in pistachios last week, according to the Los Angeles Times. The FDA has issued warnings for consumers to stop eating all foods containing pistachios, while investigations are underway.

Although salmonella contamination in pistachios is yet to be confirmed, Setton Pistachio of Terra Bella Inc., the nation’s second-largest pistachio processor, has voluntarily recalled more than 2 million pounds of nuts that it shipped out last fall. Kraft Foods Inc. and Kroger have also recalled some of their pistachio products.

Consumers are advised to stop eating pistachio products and monitor the investigations as more reports become available.

Never underestimate the ingenuity of the pharmaceutical industry in promoting its products to the American public. The latest example: The "Real Age" questionnaire that millions of people have filled out on the Internet, to tell them if their "real age," based on lifestyle and family history, is younger or older than their chronological age.

It turns out that the company that sponsors the Real Age web site sells to pharmaceutical companies the detailed information it receives from patients who fill out the 150 questions in its survey. The actual names and email addresses of patients do not get transmitted to the drug companies, but Real Age sends emails to patients on behalf of the drug companies, and these emails are targeted to what a drug company thinks that patient might be interested in, based on the patient's responses to the Real Age questions.

All this happens, according to a report by Stephanie Clifford in the New York Times, whenever a patient clicks "yes" to the multiple opportunities offered during the Real Age questionnaire to "become a member" of the Real Age community. Once a patient says yes to membership, his information becomes part of a database that is then combed to see what pharmaceutical drugs might appeal to the patient.

"It's free," as the Real Age web site keeps reminding people.

But is it really? Patients who are drawn toward a drug by "direct to consumer" pitches like this are likely to sign on for a prescription they may not really need, and every prescription drug carries side effects that may outweigh the drug's benefits. In the early years of a drug's marketing, when manufacturers are most keen on pushing their products, the risks are not fully known to the medical community. That's because the studies done on drugs to win FDA approval are usually limited to a few thousand carefully selected patients.

The safest approach to using prescription drugs is explored by Patrick Malone in his new book, The Life You Save. See chapter 7.

The PSA screening test for prostate cancer causes far more men to undergo unnecessary and harmful treatment than it saves lives, according to two large new studies. As reported by Gina Kolata in the New York Times, one study that followed 77,000 American men for a decade found zero benefit in lowered death rates, while the other study, which followed 182,000 Europeans for nine years, found that only seven lives were saved for every 10,000 men screened with the blood test.

And for every one of those saved lives, forty-eight men were told they had cancer and underwent unnecessary treatment. That treatment can cause impotence or incontinence if it involves surgery, or problems with bowel elimination if it involves radiation.

The problem is not so much the test but the disease. Prostate cancer is usually very slow to grow, and in the cases where it is aggressive, it may already be too late to save the patient when it is discovered.

Both studies were published in the New England Journal of Medicine.

The same issue, on a less dramatic scale, applies to mammography screening for breast cancer. According to Dr. Michael Barry, who wrote an editorial in the NEJM accompanying the research studies, about ten women receive a diagnosis of breast cancer and undergo needless treatment for every one woman whose life is saved after having a mammogram. Breast cancer is much more dangerous than prostate cancer, so screening can still be warranted.

What doctors need, and still do not have, is a way to sort out cancers that would be deadly without treatment from those that would not.

The bottom line for patients is to ask careful questions of your doctor and understand the numbers before you decide whether cancer screening is right for you. Patrick Malone's new book, The Life You Save, has a chapter that helps patients sort through the statistics of cancer screening.

A study published in February 2009 in the Journal of the National Cancer Institute reports that low levels of alcohol consumption may be responsible for about 5% of cancers in American women (or 30,000 cases a year), Thomas Maugh writes in a Los Angeles Times story. This newfound risk of low or moderate consumption of alcohol may offset its cardiovascular benefits.

For more than seven years, the British-led research followed more than 1 million women between ages of 45 and 75. That is one in every four U.K. women in their age group. The study found that “[h]aving a daily drink was associated with 11 additional breast cancers per year per 1,000 women, one additional cancer of the oral cavity and pharynx, one additional cancer of the rectum, and 0.7 additional cases each for esophageal, laryngeal and liver cancers.” Two drinks a day doubles the cancer rates, and a third drink triples the figure.

Leader of this research, Naomi E. Allen of the University of Oxford, thinks it’s too soon to draw a conclusion on whether women should abandon their daily drinks. Allen is working on a separate study of potential cardiovascular benefits using the same group of study subjects, which she and other scientists hope will bring the overall benefits and risks of alcohol consumption to light.

It's always intimidating to undergo an MRI scan or CT scan. The machines are loud and enormous and seem to swallow your body. For all the trouble and expense, patients deserve the very latest scanning equipment and should have their images read by only the most highly qualified doctors. Alas, there is a quiet scandal in the $100 billion/year medical imaging industry. Patients cannot count on the best unless they insist on it.

As quoted by Gina Kolata in the New York Times, radiology leaders say, in the words of one: "The system is just totally, totally broken." That from Dr. Vijay Rao, chair of radiology at Thomas Jefferson University Hospital in Philadelphia. One big problem is that insurers pay standard rates for scans, even if a scan on a 10-year-old machine produces a blurry image and results in patients undergoing unnecessary surgery or missing a diagnosis. There is also no financial incentive for scanning facilities to have the images interpreted by sub-specialists with more expertise in the body part being studied. But there is a big financial incentive for doctors to own their own scanning equipment, and that results in many unnecessary referrals for scans when the doctor's judgment about the patient's needs is clouded by financial conflicts of interest.

Wise patients should ask pointed questions before submitting to any imaging scan. Here is a list, adapted from Patrick Malone's new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, available at Amazon.

1. Is the scanning machine the latest generational available? If not, is there another facility nearby that has the latest generation? (In MRI scans for example, the stronger magnets on newer machines make for crisper images.)

2. Does the doctor who wants me to have this scan own the scanning equipment or the scanning facility? (If so, get an opinion from another doctor with no financial interest about whether you need the scan at this facility.)

3. Who will interpret the images? Is that doctor a sub-specialist in what's being studied? (Examples of radiology sub-specialties include musculo-skeletal, neuroradiology (brain and spine), abdominal and chest.) If not, can we get a second reading from a sub-specialist?

4. Is the scanning facility accredited by the American College of Radiology? (This ensures that basic standards are met, such as the technologist who runs the scanning machine being certified and the machine being regularly inspected for proper functioning.)

Involved patients will also want to sit down with the doctor and look at the images together. You will notice how much more detail comes out when the scan has been done on an up-to-date machine by well-trained personnel. In the New York Times article, you can see in a knee scan how the ligament is blurry on the left-side image but comes out clearly in the image on the right -- a slanting striated structure that connects the middle of the top of the tibia to the back of the femur.

Watch for this buzzword to become important in health care quality and safety over the next few years: "Comparative effectiveness research."

The $787 billion economic stimulus package that was signed into law in February 2009 will fund federal research on comparative effectiveness of treatment options, according to The New York Times’ Robert Pear. The research is aimed at saving money; health care in America totaled $2.2 trillion in 2007. But it could also provide a big boost toward higher quality health care.

Too few studies have been done to compare different treatments for a given illness, and as a result, doctors don’t really have solid information about what works for which patients. The gap in evidence translates into patients’ risk of getting ineffective or unnecessary treatments at billions of dollars each year. The new research projects will seek the most efficient and cost-effective treatments available to patients, and, in the process, reduce Americans’ spending on health care.

This new government effort in healthcare reform is a step toward improving quality of care. The studies of medical effectiveness already done have punctured many myths about medical treatments, proving over and over that what seems logical and reasonable does not always translate into proven benefits for patients.

One small example from the Patrick Malone law firm's experience shows how tragic injuries can come from unnecessary medical treatment. Our 13-year-old client suffered a head injury when she fell off her bicycle. She developed bleeding on the surface of the brain which was successfully drained by drilling a small hole in her skull. She was on her way toward uneventful and complete recovery when her neurosurgeon prescribed, on her way home from the hospital, a six-month course of Dilantin to prevent possible seizures. Over the course of the next several weeks, she developed a severe allergic reaction to the Dilantin that caused permanent damage to the corneas of both eyes, leaving her legally blind. When we investigated the case, we discovered that researchers had published a comprehensive study in one of the leading medical journals, the New England Journal of Medicine, proving that Dilantin is ineffective in preventing seizures after head injury in patients who don't spontaneously develop seizures in the first place. The surgeon was following traditional practice when he prescribed the drug to our client and was simply not aware of this research showing that the drug just didn't work. (The study showed that when patients after a head injury were randomly assigned to either receive Dilantin or a dummy pill, the ones who got the Dilantin actually had a few more seizures in the following months than the ones on the dummy pill.)

With the government behind a push to expand effectiveness research and give more publicity to the results of such research, patients will benefit by receiving only treatments that are proven to work and not those that are dangerous because they are worthless and come with side effects such as the one our young client experienced.

Do large doses of vitamins really help ward off health problems, including insomnia, fatigue, digestive disorders, and impaired immune system? A number of recent scientific studies challenge the long-held popular belief in the disease-preventing power of vitamin pills, which cost Americans $23 billion a year, Tara Parker-Pope reports in a New York Times article.

A study published last October showed that taking vitamin E or selenium does not prevent prostate cancer. In a separate study in November, scientists found that neither vitamin E nor vitamin C reduces the risk for cardiovascular diseases for men. Most recently, Women’s Health Initiative released a report in February 2009 that found no connection between vitamin usage and prevention of cancer or heart disease in women.

Not only have scientists discovered that, contrary to public belief, vitamins generally do not prevent or treat diseases, they found harmful effects of vitamin pills – beta carotene users are at greater risk for lung cancer, and those who take folic acid are more likely to have precancerous polyps than those who don’t.

If high doses of vitamin pills aren’t proven to prevent diseases and can potentially be harmful to our health, where else do we turn to avoid vitamin deficiency? Dr. Peter Gann, professor and director of research at the University of Illinois at Chicago, suggests a healthful and balanced diet that includes whole fruits or vegetables, since “[there] may not be a single component of broccoli or green leafy vegetables that is responsible for the health benefits.”

The American public should not throw out their vitamins just yet. Researchers are still studying the benefits of high doses of some promising vitamin extracts, for example, Vitamin D’s potential in reducing risks for cancer. But they again warn that “[w]e should wait for large-scale clinical trials before jumping on the vitamin bandwagon and taking high doses.”

In a recent initiative against contaminated weight-loss products, the FDA finds 69 drugs to be contaminated with prescription drugs and chemicals, and expects the list of brands to grow even longer in the next few weeks, reports Natasha Singer of the New York Times. A complete list of the tainted drugs found so far is available on FDA’s website.

One of the best known drugs on FDA’s list is StarCaps, endorsed by many celebrities, which was found to be tainted with bumentanide, a powerful diuretic that can give rise to serious side effects. FDA’s Michael Levy said that many of the products “either contain dangerous undeclared ingredients or…have no effect at all.”

These weight-loss products are not only illegal – FDA considers a supplement unapproved if it contains an undeclared active pharmaceutical ingredient – they also pose dangerous risks for consumers. For one thing, the ingredients on their own can cause problems like elevated blood pressure or seizures. Worse, the hidden ingredients can have toxic interactions with other medications, making it difficult for doctors to diagnose patients or manage their illnesses.

Although many of the distributors of these 69 drugs have voluntarily recalled the products, others continue to sell them on the internet. Consumers taking weight-loss supplements should monitor FDA’s growing list of products they should avoid and consult their doctors for a healthy and safe weight management plan.

One of the less common forms of cancer, oral cancer was diagnosed in about 35,300 Americans last year and caused the death of 7,600 people. Although oral cancer is one of the easiest to detect and diagnose, the five-year survival rate is only 59%, and more than 60% of cases are diagnosed in the late, incurable stages – which may be a result of people not regularly visiting their dentists or not asking to have visual exams, reports Laurie Tarkan of the New York Times.

The most effective way to screen for oral cancer is to carefully look for it. The dentist or dental hygienist should examine the cheeks, the gums, the floor of the mouth, the area behind the teeth, the palate and the tonsil area (pulling the tongue forward), and should feel the lymph nodes of the neck. Such visual exams are found to reduce mortality by 34% in a study done in India. Emerging on the market are alternative tests and devices that may be more sensitive than the traditional visual exams. However, no decisive study has been done to prove that the more expensive tests are necessarily better.

Dentists encourage patients to get a thorough visual exam every year, and they recommend it not only to the high-risk groups (smokers and heavy drinkers) but to every adult, because oral cancer has recently been linked to oral HPV, which is transmitted through oral sex.

An international research team has shown that death and complication rates from surgery can be dramatically improved by using simple checklists to make sure that safety measures are taken before, during and after each operation.

The research project, involving nearly 8,000 patients at eight hospitals around the world, was done as part of the World Health Organization's program called Safe Surgery Saves Lives. The results were published in January 2009 in the New England Journal of Medicine.

When the surgical teams at the hospitals used the checklists, they found that death rates were cut in half and non-fatal complications by one-third.

The nineteen items on the surgical safety checklist include basic items like verifying that the team has the correct patient and the correct surgical site, making sure the pulse oximeter (which measures oxygen in the blood) is working, making sure antibiotics have been given within one hour before the start of the surgery to prevent infection, and confirming that x-rays needed for the case are on display in the operating room. One other item on the checklist is to have all members of the surgical team introduce themselves by name and role; this is intended to give permission to lower-status team members to speak up at a later time if they notice something wrong. Click here for the entire checklist from the WHO (which is part of the United Nations).

The Patrick Malone law firm has prosecuted many lawsuits against hospitals where these basic preventive steps were not done and their absence led to tragedy. Examples include non-functioning pulse oximeters, surgery done on the wrong body part, and failing to prepare for known possible risks like heavy bleeding.

Patrick Malone discusses steps that patients can take to make sure their surgeons follow safe practices in his new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, available at Amazon.

The convenience of the Internet allows consumers to evaluate and compare their experiences with anything from piercings and dog walking to a visit to their doctor’s office. Although the website ratings may be helpful in an initial survey of local doctors, patients should not look to them as their sole source of information when determining to whom they’ll entrust their health care, says Dr. Pauline W. Chen in a New York Times article.

Dr. Chen noted that on a particular consumer reviews website, doctors are evaluated in five categories (price, quality, responsiveness, punctuality and professionalism) and given a grade according to user input. She found that doctors who are “warm, concerned and focused” receive A’s or B’s, whereas the less friendly may be given failing grades.

While these ratings correctly reflect the fact that patients feel more at ease with compassionate and caring doctors, one would be hard-pressed to find in these report cards an evaluation of the doctors’ medical skills. Such is not the case in consumers’ evaluation of other trades, such as roofing or body piercing, where they are quick to comment on the quality of services or craftsmanship.

Dr. Chen suggests that, instead of simply relying on some generic grades that could very well be a mere personality assessment, patients should find out about their doctor’s “training, board certification, experience, membership in a respected professional society, safety records and hospital affiliations.”

The American College of Surgeons found this year that more than a third of patients did not review the credentials of the surgeons who operated on them, but on average they spend 10 hours researching a job change or 8 hours on a new car.

Patients should not blindly trust their doctors. “[M]edicine and surgery are team sports,” said Dr. Thomas Russell, executive director of the American College of Surgeons. Patients make the ultimate decisions about who will give them health care and, in that capacity, they have an important role in the team. They should be diligent in educating themselves.

Dr. Russell’s book, “I Need an Operation…Now What? A Patient’s Guide to a Safe and Successful Outcome,” encourages patients to equip themselves with knowledge of their illnesses and doctors and be more effectively involved in their own treatment plan.

Patrick Malone has written a book on how consumers can be pro-active in their medical care. The book is: The Life You Save: Nine Steps to Finding the Best Medical Care and Avoiding the Worst. Read about the book here. It can be pre-ordered here on Amazon. Several chapters detail the steps needed to find both top primary care doctors as well as specialists.

A torn meniscus that shows up on the MRI scan may not be the reason why your knee is hurting. For Cheryl Westein, who demanded an MRI and saw a torn cartilage on the scan, the culprit behind her painful knee was actually arthritis. Gina Kolata in a New York Times article reports recent scientific findings that further support what many physicians already believe: radiological imaging is a presurgical tool and “does not help with a diagnosis.”

Dr. Felson and Dr. Modic, in their separate studies, found that abnormalities in scans are common and are not conclusive evidence of a diagnosis. For example, 60 percent of healthy people who do not complain of back pain will turn out to have degenerative changes in their spines. Many abnormalities go away on their own in a few months, requiring no medical intervention.

Relying on scans for diagnoses can lead referring physicians to recommend “unnecessary or sometimes even harmful treatments, including surgery.” If the root cause of the knee pain is arthritis and not the torn meniscus, the pain will return even after a surgery repairing the meniscus, as the arthritic bones continue to wear down the cartilage.

It is important for patients to know that getting radiological imaging is often not the best way to find out what is causing their discomfort. More importantly, since scans reveal abnormalities that may not be “catastrophic findings”, doctors could be misled to recommend harmful regimens that result in extra expenses.

Seroquel is an atypical antipsychotic drug used to treat mental illnesses, such as bipolar disorder and schizophrenia. But patients who take Seroquel are 70% more likely to become diabetic than those who don’t take this drug, a risk that the drug manufacturer AstraZeneca was aware of as early as 2000. Joe Schneider and Margaret C. Fisk of Bloomberg.com report AstraZeneca’s release of its internal studies that suggested causal links between Seroquel and “diabetes and related conditions.”

Not only should patients watch out for the increased risk of diabetes that Seroquel and similar drugs (they are in a class called “atypical antipsychotics,” including Abilify, Zyprexa, and others), they need to be aware of the mental illnesses that these drugs are approved to treat. A Reuters article reports that an AstraZeneca sales representative marketed Seroquel as a depression-treating drug to a physician, which is an unapproved use of the drug. Although it is not clear from the article what dangers are associated with treating depression with Seroquel, it is safest to limit use of these powerful drugs to what they're approved to treat.

Despite reforms in medical training, many resident doctors are still sleep-deprived and therefore more likely to make mistakes than well-rested doctors in training, according to an Institute of Medicine study, as reported by Tara Parker-Pope of the New York Times.

In 2003, the Accreditation Council for Graduate Medical Education capped resident doctors’ working hours at 80 per week. Before that, young medical school graduates could average 110 hours a week. But even now, with the hours capped at 80 hours a week, the Institute of Medicine report reveals that there are common violations of the 80-hour cap, although residents rarely complain. Eighty hours itself is a demanding routine even without the excess hours.

Consequences of sleep deprivation are many – including irritability, impaired judgment, and inability to concentrate – and each of these can debilitate the doctors in performing and thinking through their tasks. For better patient care and the health of the resident doctors, the Institute of Medicine recommends allowing an uninterrupted nap time for up to five hours.

It's not clear from this latest study how reform will be instituted and who will pay for it. Leaders in the field acknowledge that it will be expensive to put in place the same kind of mandatory rest periods that workers in other industries, like truck drivers, have.

Millions of people with normal cholesterol levels in their blood could be started on cholesterol-lowering statin drugs based on a new research study, but if patients understood the numbers behind the study, they might not move so fast to put statins in their medicine cabinet. Every patient can benefit from a closer understanding of how statistics work in medicine to push people toward treatments that they may or may not really benefit from.

The latest study involves people who were put on cholesterol-lowering statins because they had a high result on a blood test called C-Reactive Protein, even though the same people did not have high cholesterol.

As reported by Tara Parker-Pope in the New York Times' "Well" blog, here are the key numbers:

* The researchers reported an impressive sounding 50 percent reduction in heart attacks in the group treated with statins, as compared to patients in the same study who got a sugar pill (placebo) instead.

* But the real numbers of actual patients helped by the statins were only around nine in every 1,000 people treated -- less than one percent.

How do those numbers fit together? In the placebo group, 18 of every 1,000 patients suffered a heart attack or some other serious heart event during the study. In the group taking the statin drug, nine of every 1,000 patients had a serious heart event. That's how the researchers could report that the risk had been cut in half -- from eighteen to nine -- although the actual numbers of patients were few. Comparing eighteen to nine is called a relative risk ratio. Comparing 18/1,000 to 9/1,000 is called comparing the absolute risk. The absolute risk number is usually more meaningful.

Another important number for patients to understand in figuring out if a new medicine is for them is called the "number needed to treat." How many patients need to be treated with the new drug for one patient to benefit?

According to a New England Journal of Medicine editorial which analyzed the new study, 120 patients would need to be treated with statins over two years for just one of those patients to benefit.

That number might be enough to persuade some patients to take the drug. But it's a lot different than fifty percent. Bottom line: to make intelligent choices about treatments, patients need to understand how many patients like them are really expected to benefit from the treatment.

Tara Parker-Pope recently wrote two articles discussing fundamental rules for doctors and for patients.

The rules for doctors can be boiled down to respect for the patient's feelings and understanding that they did not come to the office in order to waste the doctor's time for the sheer pleasure of it. Dr. Robert Lamberts, who blogs under the name of "Dr. Rob," is the physician who initially invented the rules for doctors quoted by Parker-Pope. His original article can be found on his blog, Musings of a Distractible Mind.

Dr. Lamberts also wrote the rules for patients, which mostly focus on the importance of being honest and open with your doctor, maintaining the lines of communication between you and the doctor and finding a doctor you can trust.

Both lists are worth reading in their entirety.

It is instructive and interesting to read about Senator Edward Kennedy's treatment for his brain tumor.

The linked article describes the change in direction between May 20th of this year, when Kennedy's brain cancer was first disclosed and surgery was not discussed as a possible treatment, and two weeks later, when neurosurgeons performed a "successful" surgery on his brain.

Why the change? From the article:

Precisely why Mr. Kennedy’s treatment course changed is not known; he and his doctors are not talking to reporters.

What is known is that a few days after Mr. Kennedy learned he had a malignant brain tumor in the left parietal lobe, he invited a group of national experts to discuss his case.

The meeting on May 30 was extraordinary in at least two ways.

One was the ability of a powerful patient — in this case, a scion of a legendary political family and the chairman of the Senate’s health committee — to summon noted consultants to learn about the latest therapy and research findings.

The second was his efficiency in quickly convening more than a dozen experts from at least six academic centers. Some flew to Boston. Others participated by telephone after receiving pertinent test results and other medical records.

As the article notes, Senator Kennedy called similar conferences of experts when one of his children was diagnosed with bone cancer and the other with lung cancer. He has been known to advise his colleagues in the Senate to use this method when dealing with an illness in the family.

Obviously, powerful senators can do things the rest of us cannot. Again, from the article:

Mr. Kennedy can tap leading doctors for answers in a way few patients could. His celebrity status aside, he has spent a career promoting insurance and other ways to improve the health of Americans. And he has had a track record of being thorough and diligent in researching medical options when relatives or friends have fallen ill.

Nevertheless, despite Kennedy's power and influence, there are ways in which the average person can imitate his example and seek second and third opinions on their medical care:

Several doctors not connected with Mr. Kennedy’s case said in interviews that they admired his resourcefulness in getting more opinions simultaneously. At the same time, these doctors said many average patients gained competent advice, without a command performance, by sending pertinent records to experts for their opinions.

Many patients search the Internet for medical information and ask that their scans and other data be sent electronically or by overnight services.

Then such patients visit, call or write the consultant.

The potential negative consequence of all this opinion-shopping is that people may focus on what they want to hear and disregard everything else. This is partly why the doctors quoted in the article strongly recommend actually meeting physicians whose advise you intend to take (rather than just sending records and receiving written responses). That way the physician can make sure your expectations are realistic and address your specific concerns.

Tara Parker-Pope recently had an article on how fewer and fewer patients trust their doctors.

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of “what your doctor won’t tell you” books promising previously withheld information on everything from weight loss to heart disease.

What are the reasons for this new distrust? Several factors appear to be involved:

(1) Patients often don't understand what is going on with their health care because doctors and nurses are too rushed to explain things to them. Dr. Sandeep Jauhar, cardiologist and author of Intern: A Doctor's Initiation, is quoted in the article with a story of a patient who was transferred from one hospital to another with no explanation for why. He blamed a "broken system" for such failures to communicate.

(2) There has been greater coverage in the news of medical error, the power of the drug industry and the flaws in health care administration.

(3) The Internet makes information much more available, so patients can be informed skeptics. Drug companies also market directly to patients, so they come into the doctor's office with their own desires and opinions on what medications they should take. The upside to this is that patients have the information to challenge a doctor's errors. The downside is that many end up taking a drug commercial, for instance, at face value and will not listen to a doctor's reservations about the efficacy of a drug.

Again, from the article:

“Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is demystified,” said Dr. Robert Lamberts, an internal medicine physician and medical blogger in Augusta, Ga. “When patients come in with preconceived ideas about what we should do, they do get perturbed at us for not listening. I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.”

The whole article is worth reading. In addition, the article's page also has an embedded video clip of interviews with people discussing their attitudes to their doctors.

Starting October 1, 2008, Medicare will no longer pay for eight hospital-acquired conditions that could be prevented if hospitals followed the proper guidelines.

Those eight conditions are bed sores, objects left inside the patient during surgery, falls that occur when the patient is in the hospital, blood incompatibility, air embolism, mediastinitis (infection of the area between the lungs, which can happen after a heart bypass surgery), catheter-associated urinary tract infections, and certain bloodstream infections. In addition, several other conditions have been proposed as additions to the list.

The purpose of this change is to provide an incentive for hospitals and health care providers to avoid errors and prevent neglect of patients. If both Medicare and the patient refuse to pay for treatment of a hospital-acquired condition, then the hospital is stuck with the costs, and most hospitals would obviously wish to avoid that.

This is a long-overdue incentive for hospitals to reduce the incidence of these events and injuries which should never happen.

Tara Parker-Pope discusses a New England Journal of Medicine study that compared a Mediterranean diet, an Atkins diet and a diet with about thirty percent fat based on American Heart Association Guidelines.

The study had obese participants, who lost (on average) only 6 to 10 pounds over two years. From the article:

The biggest weight loss happened in the first five months of the diet — low-fat and Mediterranean dieters lost about 10 pounds, and low-carbohydrate dieters lost 14 pounds.

By the end of two years, all the dieters had regained some, but not all, of the lost weight. The low-fat dieters showed a net loss of six pounds, and the Mediterranean and low-carbohydrate dieters both lost about 10 pounds.

Researchers said the results sound modest, but they said the small weight loss had resulted in improvements in cholesterol and other health markers.

The obvious lesson to take from this study is that diets are not very effective when it comes to significant weight loss, but have good consequences for health overall. A focus on weight loss may lead people to ignore other important elements of health. The whole article is worth reading, as the study has many nuances.

Unsurprisingly, there are wide global disparities in survival rates of cancer patients. This is partly because of the relative wealth of different countries. However, there are huge disparities within the United States as well:

In the United States, the lowest survival rates are in New York City, except for rectal cancer in women, where Wyoming scores worse. The best survival rate for cancer in the United States is in Hawaii, the researchers found.

Idaho also has a high survival rate for rectal cancer, and Seattle has the highest survival rate for prostate cancer.

But, there's a big disparity in cancer survival rates between whites and blacks in the United States, and it favors whites. The differences range from 7 percent for prostate cancer to 14 percent for breast cancer. This disparity is most likely due to differences in the stage of cancer when it is diagnosed, the researchers said.

We have discussed the impact of race and region on health care quality before on this blog. Unfortunately, not everyone can count on getting the appropriate kind of service from their health care providers depending on their circumstances, as this new study re-affirms.

The American College of Sports Medicine suggested at a recent conference that walking is the most effective form of exercise because of its accessibility and simplicity.

From the article:

"There are certainly many forms of cardiovascular exercise that improve health and fitness, such as running, cycling, and swimming," said Catrine Tudor-Locke, Ph.D., FACSM, one of the session leaders. "But from the perspective of finding a great exercise program for the most number of people, walking is the best bang for your buck."

A good way to keep track of how much you walk, the article points out, is using a reasonably-priced pedometer. One of the greatest barriers to exercise is cost and convenience: maintaining a gym membership and making the time to go to the gym is expensive and can be inconvenient. Walking eliminates the cost problem, if not the issue of time.

The New York Times has an interesting article about the recent decision of some scientists to refuse payments from the pharmaceutical and medical device industry. From the article:

No longer will they be paid for speaking at meetings or for sitting on advisory boards. They may still work with companies. It is important, they say, for knowledgeable scientists to help companies draw up and interpret studies. But the work will be pro bono.

The scientists say their decisions were private and made with mixed emotions. In at least one case, the choice resulted in significant financial sacrifice. While the investigators say they do not want to appear superior to their colleagues, they also express relief. At last, they say, when they offer a heartfelt and scientifically reasoned opinion, no one will silently put an asterisk next to their name.

The entire article is worth a read. If more and more scientists do this, then patients researching their conditions and curious laypeople will have one less cause for skepticism about what they're being told.

What is Anesthesia Awareness, also known as Unintended Awareness? It is when a patient wakes up during surgery. When this happens, the patient experiences extreme pain but cannot move or cry out. The patient often also remembers parts of the surgery. This can have long-term emotional and psychological effects.

A new study shows that Anesthesia Awareness is more common than experts had previously thought. What can be done about this? From the article:

The position of the anesthesiologists group has been that brain wave monitoring should not be done routinely, but may be helpful for certain patients at high risk of awareness. Widespread use would be very costly.

Patients should talk to their doctors to determine their risk, if any, of awareness.

Out of nineteen industrialized nations, the U.S. has the most deaths that could have been prevented by access to timely, effective medical care.

Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine performed the study, looking at deaths before the age of seventy-five caused by numerous diseases and complications. They found that France performed the best by this measure--though France, and other countries that ranked higher than the U.S., spends less money on health care than the U.S. does.

Not only was the U.S. the worst in these rankings, but we Americans are also ranked four places lower than we were in the last study (which covered 1997 and 1998). We are getting worse and spending more money.

If you're accustomed to taking many pain-killers for your headaches, and if your headaches have been increasing in frequency and intensity, then over-medication might be the cause.

At any given time, more than three million Americans are suffering from headaches they are inflicting on themselves, according to Dr. Stephen D. Silberstein, a professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. “If a patient’s headaches have grown markedly worse or more frequent, the problem is almost always medication overuse,” Dr. Silberstein said.

The pattern seems to be that a patient starts getting headaches, takes too many pills to cope and as a result keeps getting more headaches thanks to the side-effects of the pills.

Which head-ache medications are causing this? Those that include caffeine and butalbital. The worst offenders seem to be those that contain both, Aspirin, caffeine and butalbital is the generic common combination of drugs found in many headache treatments--Fiorinal, for example, or Floricet. But, as the doctors cited in the articles note, any pain-killer can be taken to excess. It may be difficult for headache sufferers to cut back on pain-killers but research suggests that doing so will reduce tension headaches in the long run.

Other resources on the subject of these treatments and their side-effects:

Medline: Aspirin, caffeine and butalbital

RxList: Floricet and Floricet Side-effects

Medicine.net: Side-effects of butalbital/acetaminophen/caffeine

The President's Cancer Panel--consisting of Lance Armstrong, Dr. Margaret Kripke and Dr. LaSalle D. Leffall--says, in its new report, that the U.S. government should be doing more to promote environments and lifestyles that prevent cancer and other diseases.

Part of the report's argument is that most federal funding for cancer research goes towards genetic and microbiological solutions, and that macro-solutions involving environmental and social factors are neglected. This is part of a general problem in the philosophy of health care in the U.S., the report says: we are overly focused on treatment rather than prevention.

Of course treatments are important, but the report is right in its criticism of the neglect of the concept of a healthy lifestyle in U.S. health care. Making such lifestyles possible would require social changes as well as personal changes--which may be one reason why the government and our society finds it more convenient to focus on treatment, as treatment will not require systemic overhaul of society. It is more tempting to try and simply patch people up with treatments rather than take the time and effort to ensure that fewer people get sick in the first place.

Here are some examples of environmental and social factors that the report considers responsible for poor American health: lack of fresh food access, lack of access to healthy food in general (for those in poorer socioeconomic conditions), large subsidies to producers of corn and so which are processed into foods that contribute to various diseases, lack of opportunity to exercise and lack of health insurance.

A diagnosis of cancer puts a patient in an extremely frightening and vulnerable position. Unfortunately, there is often little aid for people in this situation. Instead, they are presented with bureaucratic hurdles and confusion about whose advice to follow.

For an example, one could look at the July 29th, 2007 New York Times Magazine section which had an article describing the story of one such cancer patient named Karen Pasqualetto.

There are several insights that can be gleaned from such experiences. First, there is the need for patients to seek second and third opinions—a need that usually goes unfulfilled because most people do not have the insurance or financial resources to cover this.

Second, patients need to educate themselves on standards of care, because otherwise they probably will not be getting it—particularly if they are not white or are low-income. See the National Healthcare Disparities Report from 2005 for disparities related to race and socioeconomic status. The ScienceDaily also has an article about racial bias resulting in poorer treatment for African-American patients.

Third, there are enormous advantages to having a team of doctors who speak to each other rather than a bunch of disconnected specialists who offer competing and contradictory advice. Patients should encourage communication between doctors as much as possible.

Fourth, visiting centers for the study of particular kinds of cancer can be extremely helpful, especially when dealing with the more obscure varieties of the disease. These centers have the aid and cooperation of several doctors, so the opinions given there are more likely to reflect a consensus of experts.

A recent Millennium Research Group analysis found that medical errors cause up to 98,000 deaths annually, making them the fifth-leading cause of death in the U.S. The findings are described in Medical News Today.

A senior analyst at MRG says that miscommunication, transcription errors and incomplete patient records are often the causes of such mistakes.

According to MRG, this has resulted in increased demands for patient safety improvements. Clearly such improvements are badly needed.

The FDA also has information on the issue of medical errors, including the factors that prevent improvement in the system. One such factor is the culture of secrecy that leads medical personnel to cover up errors rather than admit to them, even when the stakes are extremely high.

For more details, check out the 2000 Report to the President on Medical Error by the Quality Interagency Coordination Task Force.