December 28th, 2009 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
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A friend sent me this interesting graph from the blog of the National Geographic.
You’ll have to click on it to see a bigger version. It captures a lot of data very elegantly on a single graph– Professor Tufte would love it.
What it shows is health care spending per person across a group of countries, along with life expectancies, average number of doctor visits per year, and whether a country has a system of universal health coverage. Although putting all of this data on one graph is novel, the graph makes what by now is one of the oldest political arguments for reform – for all the money they United States spends on health care we don’t get a good deal.
So why blog about this graph? Read more »
*This blog post was originally published at See First Blog*
October 19th, 2008 by drval in Expert Interviews
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Even though I live in DC it was my first visit to the Department of State. I was surprised by the level of security (I passed through 2 metal detectors to get to the conference) and the multitude of languages spoken by the attendees. Many were wearing headphones, which were connected to a translator service. The lectures were rapidly translated into the various languages of the audience members (the way it would for the United Nations meetings), though I enjoyed the ability to listen directly to the speakers in my native tongue.
I was able to interview a keynote speaker, Joe Harford, Ph.D., the Director of the Office of International Affairs, of the National Cancer Institute. Here’s what he had to say:
Dr. Val: Why is the risk of breast cancer (in the US) greater now than in previous generations?
Dr. Harford: The main cause of the increase is related to changes in reproductive patterns within the population as a whole. Women who have fewer children (and later in life) tend to have higher risk of breast cancer. This is associated with hormones - the breast is a hormonally responsive organ and breast cells that convert to tumor cells also have hormone receptivity. Pregnancy and breast feeding are protective for breast tissue. Women can check out their risk for developing breast cancer by filling out this
short, online assessment tool at the NCI.
Read more »
October 7th, 2008 by drval in Medblogger Shout Outs
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Thanks to Paul Levy, CEO of Beth Israel/Deaconess hospital in Boston, for hosting me at Running A Hospital. Here is an excerpt of my post:
I took a beginning Spanish course at the University of Zaragoza, Spain, about ten years ago. One day I was at a local grocery store, picking through some apples and oranges when I noticed several women looking at me with utter disgust. I couldn’t imagine what was bothering them and returned their gaze with an innocent shrug.
“Sucio!” [dirty] uttered one under her breath. And the women shook their heads and pushed their shopping carts away from me in a huff.
My mind went into overdrive trying to figure out what I could possibly have done that was so utterly distasteful…
To read the rest of the post, please click here.
May 26th, 2008 by drval in News, Opinion
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American physicians are appropriately frustrated about the high cost of medical malpractice insurance, and the frequency with which false and/or exaggerated claims are filed against them. In the Philadelphia region, a spine surgeon must pay upwards of $300,000.00 a year in malpractice insurance. The law allows Obstetricians to be sued for mishandling the birthing process until the “child” is 20 years old. In many states, there is no cap on the amount of money awarded in a true case of negligence, and juries set the pay out - which can exceed 20 million dollars per verdict.
Interestingly, Texas instituted a new policy in which firm caps were placed on malpractice claims. The cost of medical malpractice insurance dropped precipitously, and over 7000 physicians flooded into the state.
I recently interviewed Canadian Senator Michael Kirby about the medical malpractice process in Canada, and he laughed at how litigious the American system is. He said that keeping the malpractice system from being abused is quite simple: fine plaintiffs who bring forth frivolous suits, set caps on pay outs, and allow awards to be set by judges, not juries. You can listen to our discussion here.
However, there is a flip side to this coin - when providers are permitted to practice without any real legal recourse. I was astonished to learn (from my blogging colleague across the pond, Dr. John Crippen), that in New Zealand midwives are permitted to practice without any form of malpractice insurance. In fact, a recent case demonstrated obvious negligence resulting in the death of a newborn baby. What recourse did the mother have? Apparently, her legal actions resulted in a payout of $2,000.00 and a promise of closer oversight of the practices of midwives.
Wow.
On the spectrum of “reasonableness” for medical malpractice policy, I believe the Canadians win, followed perhaps by Texans. What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 15th, 2008 by drval in True Stories
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I spent my senior year of college abroad in Scotland. Between the fall and spring semesters I went on a ski trip to Austria, and in usual Val fashion did something klutzy out of enthusiasm. I was racing down a slalom course in a snow storm and was so excited to have finished without missing a wicket that I looked up at some bystanders to give them a thumb’s up and I tripped on a clump of snow and fell down. Unfortunately my binding didn’t release and I ripped some ligaments off my knee. I heard them pop too. It was quite gross.
Anyway, I was shipped back to Canada for a complex ACL repair procedure by the Olympic Ski Team’s surgeon (I was NOT Olympic material in case any of you had the slightest doubt - I was just in the right hospital at the right time). What followed my fine surgery was a not so fine follow up - in fact I didn’t get any physical therapy whatsoever, and had no idea about how to make my knee functional again. All I knew is that it hurt like heck and I didn’t want to move it. And I pretty much didn’t. Not for a month or so.
Now the healthcare professionals in the audience just winced at that. Not moving a limb for a month is highly inadvisable. My knee became contracted so that I couldn’t straighten it at all. I could barely bear weight on it and I relied almost solely on crutches. I didn’t know how long knees were supposed to take to heal so I figured everyone went through this crutch phase for months.
I returned to Scotland for my spring semester, and I can tell you that traveling alone with one functional leg, a pair of crutches, winter gear and two suitcases is no piece of cake. But the most memorable part of this whole debacle was when I received my new dorm room assignment: the room was on the 5th floor - no elevators. I pleaded with the dorm warden (a humorless, underweight Scottish man with extraordinarily greasy hair and snaggle teeth) to have pity on me and reassign me to a room on the first floor or maybe the second. He handed me the 5th floor room keys unflinchingly.
So it took me about an hour to drag myself and all my stuff up to the 5th floor. I was really in a lot of pain, and totally exhausted from the multi-stop flight overseas - hadn’t slept in about 36 hours. Of course the room was the last one at the end of the hall and no other students had checked in yet - the whole place was deserted because I’d come back early to see if I could get a more conveniently located room (thinking ahead).
When I got to my room I was nearly overwhelmed by the smell of vomit. Apparently the winter session kids had been using my dorm room for drunken partying and had puked on the mattress. I was so tired all I wanted to do was go to sleep but the options were the cement floor or the pukey mattress so I called down to the front desk. The warden picked up - I really couldn’t understand much of what he said in his thick brogue. I explained to him that I’d made it to my room but that the mattress was covered in vomit and I wondered if (now) I might be eligible for a different room. He said he’d come up to check on the mattress.
It took him about 40 minutes to show up. He made no eye contact with me as I limped after him into the room to show him the vomit. He looked at the mattress, smiled wryly, dragged it to the edge of the bed frame and flipped it over. Then he walked out of the room and went back down the stairs to retake his post at the front desk at the entrance to the building.
Now that’s cold.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 28th, 2008 by drval in True Stories
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I lived in Texas from 1990 to 1994. I haven’t spent much time there since, although I’ve had my eye on Houston’s unfortunate distinction as “America’s fattest city” for the majority of recent years (though Chicago won the honors in 2006 if I recall correctly). Armed with this knowledge, I arrived in Houston today hoping that I wouldn’t let down the members of my weight loss group as I entered the “lions den” of poor eating habits and sedentary lifestyles.
I had missed lunch, and opted for an early dinner at the hotel restaurant. The menu surprised me in two ways: first, it featured quail and wild boar (this particular hotel chain is not known for culinary artistry - let’s just say that their recent “upscale service campaign” involved an email to me the day prior to arrival, asking if I might like anything special in advance of my arrival - like a 6 pack of Budweiser waiting for me on ice. I kid you not.) Second, they had made an attempt to highlight “heart-healthy food choices” on the menu. One item was identified as heart-healthy. Only one.
So I resisted the urge to try the local southern fare (fried catfish and hush puppies) and decided on the heart-healthy option. Here’s how the conversation went:
Server: “Welcome to XXX. May I start you off with something to drink?”
Dr. Val: [Shivering and somewhat surprised that the AC would be on so high] Well, yes, I think I’ll have some hot tea. Do you have green tea? It’s quite cold in here, isn’t it?
Server: “It’s not cold. The lights above will warm you up real quick.”
Dr. Val: [Looking up towards the track lighting above me, wondering if they could function as a sort of heat lamp.] “Oh, ok.” [Server leaves to put a tea bag in a mug of hot water and returns with it on a napkin.]
Server: “Have you decided what you’d like to order?”
Dr. Val: “Well yes. I think I’ll have the heart-healthy fish, but I was wondering if I could have a side of greens with that?”
Server: “What kind of ‘greens?’”
Dr. Val: “Well, maybe a green salad or some broccoli?”
Server: “Did you see the salads on the menu?” [I can tell she thinks I'm one of those "high maintenance Yankee women" as her voice begins to tighten.] “We have spinach salad or perhaps a Caesar?”
Dr. Val: [Now fully aware that I'm being irritating but desperately wanting to make a healthy choice.] “Yes but those are entree-sized salads and they have bacon, egg, and cheese on them. Do you have something more plain? Or maybe some steamed vegetables…” [My anxiety grows as she stares blankly at me].
Server: “Well did you see the string beans side dish?”
Dr. Val: “Yes, but they’re wrapped in bacon, and [trying hard to help her to understand my quandary] I was hoping to order something healthy… you know what I mean?”
Server: Blank stare.
Dr. Val: Nervous stare.
Server: Sighing, “well I can ask the chef to make the beans without the bacon. Not sure if he can do it, though.”
Dr. Val: “Oh that would be great, thanks so much!”
Server: [Fake smile, whisks menu from my hand, waddles toward kitchen.] 10 minutes pass.
Runner: [Appearing with a huge plate on his shoulder] “Did you order the fish?” [Surprised that anyone ordered the heart-healthy dish].
Dr. Val: “Yes, I did.”
Runner: “Ok, here you go.” [Places gigantic plate in front of me with a separate bowl holding about a half gallon of stir-fried green beans in oil. The fish has cream sauce on top of it, about a quarter inch deep.]
Dr. Val: [Remembering the phrase "Texas-sized." I scrape off cream sauce and cut green beans into bite sized portions. I think to myself: how can anyone eat out in this state and hope to maintain a reasonable weight? I promise myself to go to the hotel gym after my meal...]
Yes my friends, the next 9 days at this conference are going to be interesting. I’ll keep you updated as I rekindle my cultural connections to Texas. And I have the utmost sympathy for Americans who live in places where eating out regularly can be hazardous to your health. Losing weight can be a fight, every step of the way, can’t it?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 27th, 2008 by drval in Quackery Exposed
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In my roaming around the blogosphere I found some fairly humorous tidbits. It’s amazing what people will believe, or what crazy “cures” are being sold on the Internet. I thought you enjoy some choice samples:
1. Demi Moore uses leeches to “detoxify her blood.” Dr. Ramona Bates offers a great summary of the potential medical uses of leeches along with some caveats (like a 20% chance of infection with leeches… and a way to keep them from wandering too far afield. Tie a string to their tails? Yikes.) If blood letting is good for detoxification, why not donate blood instead?
2. One snake oil site promises to cure “shock” and cardiac arrests with an herbal liquid that turns out to be mostly brandy. This cure is “also helpful for animals who have experienced mild trauma.” Funny stuff.
3. An Indian magician who claimed to be able to kill people with a magic incantation was unable to do so during a TV show segment. The host of the show offered to be killed though the incantation was unsuccessful. Reminds me of the guy who swore he could make his arm impervious to harm by a sharp sword. That didn’t work either.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 12th, 2007 by drval in News
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The short answer is: yes. The longer answer is that Tasmanian devils (TDs), those feisty black and white Australian marsupials, are the first to suffer from it. In an enlightening story about the plight of these little guys, I learned that they are prone to a certain type of mouth cancer that they pass to one another through biting. Now, since biting is part of their mating rituals, this cancer has spread through the TD population like wild fire, even putting them at risk for extinction.
Why am I telling you this? Because it’s quite fascinating that cancer can be contagious. Sure we know that the human papillomavirus (HPV), for example, can be spread through sexual contact and may stimulate the body to produce cervical cancer cells eventually, but this is a more direct and faster method of transmission. Researchers have found that cancer cells in the mouth of the animal doing the biting slough off in the wounds on the other animal, and the cells grow into a new cancer in the injured animal.
So you may ask - can I get cancer from a TD? Not unless YOU’RE also a TD. The reason why the cancer cells can survive in the victim is because TDs have become so genetically similar to one another that foreign cells from another animal are not recognized and attacked by their immune systems. Human immune systems would recognize the TD cells as foreign and attack and kill them quite quickly.We humans can’t even accept an organ transplant from a family member without being on strong immunosuppressive medications.
Nonetheless, this case of contagious cancer is interesting - and makes me wonder if immunosuppressed humans could one day be vulnerable to developing cancer from another person’s cells. But that risk seems rather remote. For now, we should just feel sad for our furry friends down under. I know that at least Dr. Rob, the llama lover, will understand the grief.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 16th, 2007 by drval in Health Policy, News
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I was glad to to hear from Wendy from wendysbattle.com … like my friend, she is battling stage IV colon cancer. Unlike my friend, she lives in Ontario and has no assistance to pay for her chemotherapy. In a jaw dropping video from a cancer press conference in Ontario, Wendy and 2 other colon cancer patients testify about being denied coverage for standard of care colon cancer therapy. Wendy says that Ontario has valued her life at less than $18 thousand dollars.
In a recent interview with Senator Mike Kirby, I learned that one of the major problems facing the Canadian healthcare system is the cost of expensive new drugs. The universal system was designed to have patients pay out of pocket for their medicines and have the government cover almost everything else. When this health insurance strategy was created, drugs were very inexpensive. However, with all of the technological advances in medicine - diseases like HIV/AIDS and cancer have become chronic, manageable illnesses with expensive treatment price tags. And now, the lack of drug coverage is shifting unmanageable costs directly to the patient. Sadly, Wendy is one of many victims of lack of drug coverage in Canada.
All this to say that the grass is not really greener in Canada - especially for cancer patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 5th, 2007 by drval in News
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Like most of us, this headline made me squirm - visions of the Minotaur, mermaids, and Dolly the sheep with a human face, danced in my head. But as much as this form of experimentation seemed ethically wrong, I decided to figure out what exactly they were proposing.
The Human Fertilisation and Embryology Authority (HFEA) ruled that British scientists could now use animal eggs to host human stem cells. Because there is a shortage of human eggs to use for experimentation, they asked that rabbit or cow eggs be used.
Stem cells are the first kind of cells created when an egg is fertilized and divides. They are capable of developing into any kind of human cell - and are therefore quite interesting in terms of their potential to heal. (Transplanting these cells into damaged tissue can actually repair the tissue to some extent - no matter if its brain, heart muscle or other tissue). But these stem cells have to incubate inside an egg (kind of like a tiny soft shell) if they are to divide.
So the scientists are asking to use animal egg shells (without the nucleus that contains the majority of their DNA) as mini incubators for human stem cells. The HFEA approved that use - but has NOT approved mixing human and animal DNA in a human egg. Such a blend would serve no useful scientific purpose.
Ultimately, the goal of this human-animal embryo experiment is to allow for the creation of many more human stem cells without harvesting human eggs to do so. It also may help scientists to understand what these egg “shells” do to influence the growth of stem cells - if we knew how that worked, we may not need to use human eggs to retrieve stem cells, but could create them from any cell in the body.
So, although this embryo experiment sounds alarming at first - it’s actually a way to do stem cell research without using so many human eggs. Now, that doesn’t mean that I necessarily condone the idea - but it helps put into perspective what the scientists are proposing. Rest assured that there will be no Minotaurs resulting from these particular experiments.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
