Medicine


10 years ago the International Diabetes Federation Diabetes Atlas indicated that just over 150 million people had diabetes worldwide.  Now, less than 10 years later the survey shows 285 million worldwide cases, more than half of those aged between 20 and 60.

To put this rise in perspective in 1985 it was estimated there were 30 million worldwide cases.  India and China lead the way in cases but are followed closely by the US.  About 9% of the US population is found to have been diagnosed with diabetes (26.8 million) at a rate of $198 billion a year.  This is 52.7% of worldwide spending on diabetes, an incredible number!

At this growth rate the number should reach above 435 million by 2030 (US population today is 303 million).  As I’ve said before, if we really want to cut down on health expenditures this is a major area of public health we have to target and not just by paying it lip service.  Since a majority of cases are type II (insulin resistance with obesity and diet as contributors) we need to target the food and food services industries and the way the consumer is informed of their decision.

Of course a huge problem is getting people to realize the long term health affects of diet and exercise which is very difficult.  Incremental weight loss and an abstract number like fasting glucose levels are difficult means to motivate people into life altering habits. This has been proven with the massive diet industry which peddles unnecessary measures to lose weight.  This is easily seen by the yo-yo effect from people losing weight off of a diet and then gaining the weight back, only to have to find another diet.  I’ve seen family members go from diet program to diet program to find one which will “keep the weight off” but the only way to keep the weight off is to change your eating and exercise habits,  dirty secret the industry wishes to keep from you.

I guess I got way off topic but the obesity and diabetes problems are closely related, so there’s my diatribe for the day…

This has been going around the interwebs for a week or more but I keep coming back to it, what great insight in such a humorous post.  This is what happens when lawyers run the way medicine is delivered…

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below:

  • Spilling 200
    • Spilling, Water – 210
      • Spilling, Water, Hot – 211
        • with blisters 211.1
        • without blisters 211
      • Spilling, Water, Warm – 212
      • Spilling, Water, Cold – 213
  • Spilling, Coffee – 240.1
    • Spilling, Coffee, Hot – 240.11
        • with blisters – 240.121
        • without blisters 240.122
      • Spilling, Coffee, Hot, With Cream only – 240.12

      • Spilling, Coffee, Hot, With Regular Milk only – 240.13
      • Spilling, Coffee, Hot, With 2% milk only – 240.14
      • Spilling, Coffee, Hot, With Skim Milk – 240.15
      • Spilling, Coffee, Hot, With Soy milk only 240.16
      • Spilling, Coffee, Hot, With Sugar only – 240.17
      • Spilling, Coffee, Hot, With Artificial Sweetner (of any type, including, but not limited to Nutrasweet, Spenda, Sweet ‘n Low) – 240.18

    • Spilling, Coffee, Hot, With Cream and Sugar 240.16

To see the whole post head on over to Dr. Wes, always good writing and insightful views from the inside of medicine.

In what can be considered a minor victory for medicine and public health Dr. Christine Daniel was brought up on fraud charges.  Daniel pushed crazy remedies on those who were in the most desperate phase of life.  Facing life-threatening cancers these patients were looking for any answers they could get and Daniel was willing to provide them with very expensive advice.  Too bad none of that advice was based on any sort of science or evidence based medicine and ended any chance that these people had of living.

Take Minna Shakespeare, who contacted Daniel in December 2002 after seeing her on TBN’s “Praise the Lord” TV program espousing the effectiveness of her herbal treatment.  Daniel told Shakespeare to stop her chemotherapy “because it doesn’t work” and to pay her $13,000 for her herbal cancer treatment.  Shakespeare told Daniel she didn’t feel that the treatment was working so Daniel told her to go back on the chemotherapy.  But I thought that chemotherapy was ineffective Dr. Daniel?  I don’t understand the change of heart.  Of course what Daniel doesn’t want to say is that she knows the chemo is effective and had a chance to keep Shakespeare alive longer. If Shakespeare stays alive longer then Daniel can charge for her herbal treatment longer and continue raking in the profit.

This is absolutely despicable and a good example of what happens with cancer quackery and all types of medical woo.  Daniel even claimed that her herbal medicine could treat and cure multiple sclerosis, hepatitis, and Alzheimer’s and Parkinson’s disease.  There is absolutely no feasible biochemical mechanism that could explain how an herbal extract, even one that contains tons of different chemicals, could cure that many different mechanisms.  In fact, there is no single medication, herbal or otherwise, that can cure “cancer” as it is hugely wide range of diseases that fall under one category of cancer.

I’m glad to see this type of action taken against a quack as these people offer hope that is not there and cost desperate people tons of money for treatments that don’t work.  True, conventional treatments cost a lot of money as well, but there is proven science behind them that they may cure your disease, or at least extend your life.  The report says Daniels made $1.1 million from 55 families, a fortune for any person.  This is pretty sick, but it will not stop many of the quacks out there and the patients that seek them out.  I hope that this sets a precedent of prosecuting fraudulent activity and actively spreading medical lies.  I’m sure it won’t set off a firestorm of prosecutions, but one can always hope.

I think this was a pretty smooth move on the part of St. Vincent Health System.  Instead of mandating their workers to get the seasonal flu vaccine or letting them have full discretion of whether or not to get it they gave the workers a choice.  Either get the vaccine or wear a mask while you’re at work.  Only 6 employees opted for the mask while all others got the stick.

This was a really innovative way to incentivize the vaccination decision as well as meeting an ethical standard of minimizing exposure of both patients and staff that are in the hospital.  I think that the healthcare industry does have an obligation to protect their patients from all potential exposures and the flu is no different.

Another obligation of the hospital is to have enough healthy staff to serve their patients, this is a step in that direction for the coming flu season and considering the population of hospitals (old, sick, and very young) it seems a good idea to put these measures into practice.

This idea is a great way to maintain the autonomy of the healthcare workers while putting a leading foot forward for the patients and other staff that are at the hospital.

Hattip to Effect Measure

What a brilliant piece of writing.  The National Journal Magazine has published a great perspective on how the health care industry works and why other industries would fail in this model.  Please go read it here.  My favorite part of the piece:

“Great, thank you, I’ll be happy to make that booking for you. That’s one flight from Washington Dulles to Chicago O’Hare on October 26. Will there be anything else?”

“Wait, hold on. Chicago? I’m going to Eugene. It’s in Oregon.”

“Yes, sir. The Eugene portion of your trip will be handled by a western specialist. We’ll be glad to bring you back from Chicago to Washington, though.”

“You mean I have to call another carrier and go through all this again? Why don’t you just book the whole trip?”

“Sorry, sir, but you do need to make your own travel appointments. We would be happy to refer you to some qualified carriers. May I have your fax number, please? Before I can confirm the booking, we’ll need you to fill out your travel history and send that back to us.”

Today KevinMD discussed the article published online today at the New England Journal of Medicine about imposing a tax on soft drinks and sugary drinks.  The massive quantity of these drinks sold in the US are definitely a health problem but as with most industry issues this attempt is doomed to fail.  A massive lobby group representing the corn industry will not allow this to pass.

With government subsidies artificially increasing the production of corn there have been multiple avenues to rid ourselves of this surplus.  One highly effective way the corn and food industry uses these massive amounts of corn is through the use of High Fructose Corn Syrup (HFCS).  The amount of sugar additives and caloric sweeteners in our drinks continue to rise as HFCS is used in not only the most popular soft drinks but also fruit juices.

I think it is a good proposal that would help to curb consumption of these drinks that are leading to an epidemic of American obesity but it is up against a lot of clout and money that is entrenched in Washington (especially with a Midwest President).  This type of strategy worked with the cigarette tax as our nation’s rate of smoking continues to fall from a high above 30% in the 1980’s to below 16% in 2007.  The increased tax rate was well associated with this fall in cigarette consumption as shown by this graph.

screen-capture

For the public health’s sake I hope that we can see this same kind of decrease in soft drink consumption.  From 1977 to 2001 the rate of consumption in the US has risen 135% according to researchers at UNC.  Taken with the information that fructose is more taxing on our cardiovascular health we should take this as a burgeoning public health crisis.

And we’re not helping our kids in school.  As I’ve written about previously, the nutrition of public school lunch and beverages is bad.  We send our kids to school to learn and this is exactly what they’re learning.

This weekend I was reading about how two nurses from Kermit, Texas were indicted with a third-degree felony for “misuse of official information.”  The real charge should be “victim of a witch-hunt” as these two nurses did nothing but hold up the Nurse’s Code of Ethics.

A physician at their hospital was encouraging patients to purchase dubious herbal “medicines” that he happened to profit from because he was the seller.  They also thought it was improper that the physician tried to steal materials from the hospital to test patients at their home (the hospital administrators stopped this before it happened).  Once the physician found out a complaint had been launched against him he filed a harassment charge to the Winkler County Sheriff’s Department.  Through what may have been the most thorough investigation in the history of the county’s sheriff’s department the two nurses were identified and charged with a crime that could result in 2-10 years in prison and up to a $10,000 fine.

The Texas Nurses Association has created a legal defense fund in support of the two women and the Texas Medical Board has written a letter to the attorneys detailing the impropriety of prosecuting the nurses.  From what I’ve read the trial should be happening this month but I can’t find much information about it.

There have been some excellent state commentaries on this situation as well as national coverage on the well read medical blog “Science Based Medicine”.  Here are some of my favorite excerpts from the reports.

From the Austin American Statesmen:

The Texas Medical Board sent a letter to the attorneys stating that it is improper to criminally prosecute people for raising complaints with the board; that the complaints were confidential and not subject to subpoena; that the board is exempt from federal HIPAA law; and that, on the contrary, the board depends on reporting from health care professionals to carry out its duty of protecting the public from improper practitioners.

This situation shouldn’t happen anywhere, but it especially shouldn’t happen in Texas, which hassome of the toughest whistle-blower and patient advocacy protections for nurses in the nation, thanks to the leadership of Texas Nurses Association.

ADVANCE for Nurses:

Jim Willman, general counsel/director of government affairs for TNA, cited a Texas case in 1983, Lunsford v. Board of Nurse Examiners, 648 S.W.2d 391, 395 (Tex.Civ.App. 1983), where the court held that “[a] license to provide medical services is a covenant to serve the people.” The judgment determined “nurses have a duty to act in the best interest of their patients, and . this duty is not superseded by hospital policies,” explained Willman.

TNA fears the legal precedent the nurses’ indictment sets. The message it sends to nurses and other healthcare practitioners will have adverse affects on the health and safety of patients, Willman added.

The two nurses had concerns about whether a physician was practicing below the accepted standard of care and reported those concerns to the TMB,” he said. “The NPA recognizes their right to report and their duty to patients requires them to do so. The criminal indictment cannot help but discourage other nurses from reporting a physician, another nurse or a hospital for unsafe patient care.”

The TMB also objected to the criminal prosecution of the nurses, and sent a letter to the Winkler County district attorneys stating the nurses’ complaint was allowed under state and federal law. The board argued “it is improper to criminally prosecute people for raising complaints with the TMB.” It also noted since the complaints were confidential they were not subject to subpoena and that “under federal law TMB is exempt from HIPAA requirements.”

“In my 8 years with the board, I have never seen a complainant charged with a felony for making a complaint to the board,” said Mari Robertson, JD, TMB executive director. “I don’t know that I’ve ever seen a criminal prosecution for providing information to the medical board.”

And from SBM:

This case is bad. Real bad. Nurses and other health care professionals are reluctant enough as it is to report a bad doctor or a doctor peddling dubious therapies as it is. What makes this case particularly outrageous is not only because it appears to be a horrible abuse of power by Sheriff Roberts, but, even worse, it sends the clear and unmistakable message to nurses in Texas: Don’t get out of line or the medical powers that be will make you pay. They will find out who you are, no matter what it takes to do so, and then they will do everything in their power to retaliate. They’ll even try to throw you in jail if they can figure out a rationale to do so, legal or not.

Next Page »