Navigating Healthcare – Patient Safety and Personal Healthcare Management

Obesity Prevention – Why are we Failing

Posted in Healthcare Information, Nutrition, Preventative Healthcare by drnic on January 31, 2009

In one of the McKinsey interviews of 2008 with Toby Cosgrove CEO of the Cleveland clinic that focused on innovation item 1 in the list of things that need to be done he stated:

The first is prevention. The only thing we can do to reduce costs, while still improving quality, is to reduce the burden of disease. Forty percent of the premature deaths in the United States are caused by obesity, inactivity, and smoking, all of which ought to be preventable. Two-thirds of the country is overweight and a third is obese. Over the decades I have operated on a lot of patients with lung cancer, and every one of them was a smoker. So a natural starting point is to help people stop smoking and help them lose weight.

It might seem obvious but given the shocking statistics it clearly is not. It is a wonder why society as a whole has not managed to face up to this reality and change behavior adopting a more healthy life style. Hats off to the Cleveland clinic for “walking the talk” as he put it and they:

“stopped hiring smokers”

They received a lot of criticism and no doubt some attempts to combat this with law suits but have stood their ground. I can’t tell you the number of times I have entered a clinical facility through a back entrance past a line of employees, often still in surgical scrubs, smoking. It looks bad and as recently as yesterday I watched with disgust in what I see as concomitant behavior as one smoker tossed the still smoldering remainder butt onto the ground and walked off back into the facility – littering to boot.

But why is it that we still have according to paper prepared by Olivia Thornton, a high school graduate investigating the “Genetics vs. Social and Environmental causes of Obesity” do we still have over 30% of adults in the US obese and a tripling of of number of children who are obese since 1980. The problem is getting worse not better

according to the Center for Disease control (CDC,) 16%, over nine million people aged 6-11 are overweight

And it would be easy for other countries to sit back smugly and remain unconcerned but as the chart below shows this problem is worldwide and all the statistics suggest getting worse:

We are bombarded with adverts and marketing messaging to buy fast food and the circumstance and behavior reminds me of the sale and marketing of cigarettes and tobacco years ago. At that time people knew no better – turns out the tobacco companies did and even used the data to help create a more addictive product by adding and concentrating nicotine in their product. Years later the truth emerged and their complicit behavior was exposed and they have had their hands slapped.

We know that fast food is bad for us and parents around the world try hard ot encourage healthy eating. But I bet that many parents experiences are similar to my own that a home cooked ham burger just “doesn’t taste as good as a #insert favorite fast food brand hamburger here#”.

Here’s my jaundiced view of the problem and the fast food industry. They load everything up with sugar, its added to everything and they do this because sugar is addictive. If they add enough sugar they create an addict relationship with their consumers who find anything without the added sugar bland and unappealing.

Time will tell but it is hard to imagine why the addition of sugar is necessary and I have a hard time explaining the preference of my own family for fast food over better, more healthy and nutritious home cooked equivalents.

What do you think. Is it just my family that prefer fast food or do you have the same problems. Is it a conspiracy of the food industry or is the food industry just better at preparing tasty food. Let me know what you think.


Insisting on Antibiotics is not Always the Best Idea

Posted in Medication, Primary Care by drnic on January 26, 2009

Kevin’s Medical blog covered the tragic case of the Brazilian model Mariana Bridi da Costa aged 20who had her hands and feet amputated and then dies from Pseudomonas aeruginosa sepsis. She initially presented on December 30th, with kidney stones. She was apparently sent home, and presented again on January 3rd in septic shock

This is a critical situation and mortality (the number of people dying who are admitted with this condition) is in the order fo 40- 50%.

Inappropriate antibiotic use is a major culprit, but it’s a problem that’s often dismissed. So the next time you go to the doctor’s office thinking you need an antibiotic for a cold, think of Mariana Bridi da Costa.

I can’t tell you the number of times I saw this as a physician and felt the pressure to prescribe. It is in part the fault of physicians who have created the expectation and is also partly a result of time pressures – it is a lot quicker to write the prescription than have a 3 minute discussion/explanation on why this is not a good choice in this case. But patients need to help here as well not forcing the issue and accepting the guidance that the Upper Respiratory Tract Infection (URTI) is probably viral and antibiotics are not going to help….

Do you agree – are you an offender (patient or doctor) . Click the comment button to the right and let me know

Useful Advice for Weight Loss Without Breaking the Bank

Posted in Healthcare Information, Nutrition, Preventative Healthcare by drnic on January 26, 2009

Over 50% of weight loss success is done by individual work and not based on some expensive program or system. Personal experience can attest and saving your money for other purposes seems wise

The February issue of Consumer Reports reveals the secrets of successful dieters who lost weight without the aid of a diet program, medical treatment, books, or pills.

The pages are stocked full of sound advice and a simple 6 basic strategies:

  1. Watch portions. Carefully controlling portion size at each meal correlated strongly with a lower BMI. Successful losers were especially likely (62%) to report doing this behavior at least five days a week. So did 57% of the always thin, but only 42% of failed dieters.
  2. Limit fat. Fifty-three percent of successful losers and 47% of the always thin restricted fat to less than one-third of daily calorie intake five days a week or more, compared with just 35 % of failed dieters.
  3. Eat fruits and vegetables. Forty-nine percent of successful losers and the always thin said they ate five or more servings a day at least five days a week, while 38% of failed dieters did so.
  4. Choose whole grains over refined. People with lower BMIs consistently opted for whole-wheat breads, cereals, and other grains over refined (white) grains.
  5. Eat at home. As the numbers of days per week respondents ate restaurant or take-out meals increased, so did their weight.
  6. Exercise, exercise, exercise. Regular vigorous exercise — the type that increases breathing and heart rate for 30 minutes or longer — was strongly linked to a lower BMI.

Along with tips for healthful meals on a budget – this is a great report and resource.

More details from the Consumer Health Reports Diet and Nutrition Pages:

Six secrets of the slim
Realistic expectations
What you can do
Healthy and cheap
Stay-thin strategies
Downturn diet

Patient’s Like Me

Posted in Personal Health Record, Preventative Healthcare by drnic on January 9, 2009

Patient’s Like me is an interesting an excellent concept of shared experiences in true Web 2.0/Social Networking methodology

The Web Site can be reached here and currently offers links for patients suffering from:

  • ALS/Motor Neurone Disease
  • Devic’s NMO
  • Fibromyalgia
  • HIV
  • Mood Conditions
  • MS
  • MSA
  • Parkinsons
  • PSP

There may be those that think this potentially feeds conditions and symptoms (much like medical students often find symptoms and signs of diseases they are studying) but even if this effect is apparent the benefit of shared experiences and learning far outweighs the downside and I believe this is very much the way of the future set of tools to help manage your own personal healthcare

Vitamins Do Not Prevent Cancer or Heart Disease

Posted in Healthcare Information, Nutrition, Preventative Healthcare, Uncategorized by drnic on January 8, 2009

You just can’t eat your way to a longer life – so says a report in USA Today based on studies released yesterday in the:
Journal of the American Medical Association
Effects of Selenium and Vitamin C on Prostate Cancerr, and
Vitamin E & C in Prostate Cancer)

and from previous studies in the
Journal of the National Cancer Institute
Beta Carotene, C and E in Cancer and
– the editorial on Vitamin Supplements and Randomized Controlled Trials

and from the American Hearts Association meeting in November that featured

Vitamins C and E not preventing heart disease and E causing an increased stroke risk
and B-12 and folic acid not preventing heart disease

So what does it all mean – well the basic premise of eating healthy and in moderation remains the same but the idea that you can encapsulate this ideal into a pill or two just won’t work. Better to work on good balanced diet, reduction in meat and fat consumption and regular exercise.
Taking pills to supplement does not seem to hold a lot of promise based on the recent results released. Overall the best strategy is probably summarised by Peter Gann:

…health-conscious consumers should focus on getting their vitamins from plant foods, such as vegetables and whole grains, which contain precise mixtures of hundreds or even thousands of compounds. Many of these compounds may work better in the combinations selected by nature.