Navigating Healthcare – Patient Safety and Personal Healthcare Management

Rally in support of those imprisoned for expression

Posted in Blogging by drnic on April 28, 2009

Freedom of Speech – One of Our Great Liberties. I join others who are part of the blog rally for bloggers that are dying – it started here for Roxana Saberi – the NPR reporter incarcerated in Tehran.blue_ribbon_campaign_banner

The Universal Declaration of Human Rights states, “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference, and impart information and ideas through any media regardless of frontiers.”

Journalist Roxana Saberi has been incarcerated in Tehran’s Evin Prison, where she is spending her birthday on a hunger strike. Around the world, people continue to face similar violations of their rights to freedom of expression, free speech, and a free press. Let’s show the international community that we won’t be silenced by intimidation and tyranny – that we won’t stop believing in and fighting for these rights.

Freedom of the press is not a luxury. It lies at the heart of making this world healthier and more just. People without a voice and without a clear line of sight into the things that would threaten or corrupt their societies cannot hope for equitable growth and meaningful change.

A group of bloggers is holding a blog rally in support of journalists, bloggers, students, and writers who have dared to express their thoughts freely and have been imprisoned, abused, or killed.

Please consider “wearing” a blue ribbon online this week on your blogs, websites, and facebook / myspace / twitter pages, and invite others to do the same. Get the discussion going, and keep it going!


Benign Paroxysmal Positional Vertigo (BPPV) – or Dizziness

Posted in Healthcare Information, Personal Health Record by drnic on April 28, 2009

Dizziness that’s entirely treatable condition for 20% of sufferers where the condition is due to Benign Paroxysmal Positional Vertigo (BPPV). In a recent NPR story – Rock Slides Lead to Vertigo it was fascinating to hear that this was

really a success story in medicine. We’ve figured out the cause of this condition — and we’ve figured out how to treat it

It runs out that it is due to loose crystals or rocks (the proper name for these is otoconia) which are small crystals of calcium carbonate that are derived from an inner ear structure called the utricle:

What causes this is the dislodging of these “rocks” which can be caused by head injury, links to migraines and old age degeneration of the vestibular system. Viruses and other infections can also cause the rocks to dislodge.

The good news for suffers is that it is easily treatable with simple physical maneuvers that get the rocks back into place. The Epely maneuver is the main stay of treatment:

And there are others – you can find out more at this site
Simple care to treat dizziness.

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Mapping Your Genome

There are increasing numbers of genome mapping services for $399 at 23 and me (this has come down significantly form the original $1,000) and now the new kid on the block is the oddly named Knome (know thyself) that is approaching this opportunity with what they see as a more complete strategy that includes personalized services that is personalized, includes discussion and consultation and makes specific reference to the need for privacy. The privacy is especially important given the potential for insurance denial and rate increases upon the identification of proven (or even ravenously linked) genomic related conditions.

In fact the company is offering the service through eBay (an odd perhaps marketing driven idea) with bidding starting at $68,000 (anything below $99,000 is a bargain as this is the rack rate direct currently)

The NY Times featured a review of this recently in a piece “Mapping the Human Genome via an eBay Auction”.  As they point out the cost of these services will inevitably come down:

Scientists envision that in a few years it will cost only $1,000 to determine the sequence of virtually all 6 billion chemical units of DNA in a person’s 46 chromosomes. Someday, such personal genetic blueprints could be used to predict people’s risk of disease and what drugs might work best for them.

But there is still a question as to the value of this service even at the bargain basement price of $68,000. It is not clear the additional value offered at Knome since the New England journal cited in the NY Times piece states there is still limited knowledge and understanding of genetic traits of disease and how that contributes to the disease process. In fact in a recent presentation that ePatient Dave featured on his blog and I found riveting from the TED group (Ideas worth Spreading) on how Bacteria communicate is just scratching the surface on the complex interactions that we are still trying to understand

So should you take this on, is it worth the money. As is often the case that depends……. If you have a family history that is significant (significant can mean many things but this is not just the occurrence of a clinical condition but an unusual incidence that occurs earlier than expected adjusted for age, sex etc) then this may be worthwhile.

For the average individual this coud be an interesting exercise but is statistically unlikely to reveal  any earth shattering news. Anybody that has used it and wants to comment on the usefulness, the process or other aspects of these services (are there others) please fire away and leave your comments below

Patients and Doctors Need to Reform Too

Posted in Healthcare Information, Personal Health Record by drnic on April 13, 2009

There is much discussion and commentary on the Healthcare Reform, new clinical systems and the investments being made through the stimulus package. But not so much has been written about Patient reform. The NY Times piece A Hurdle for Health Reform: Patients and Their Doctors focused on the issue of patient and physician behavior and the all to frequent insistence on treatment can be a poor choice. It is a poor choice for economic reasons – why pay for a treatment that has little or no effect. And why start using a drug that has no demonstrable improvement in outcomes vs an older well tried and tested drug. Apart from the fact that we already pay 77% more for comparable drugs – in no small part due to the effective lobbying and marketing drug industry machine. But we also find our treatments based on Physician Pillows (they reflect the most recent impression left on them – often by drug companies) for a newer supposedly better drug but:

when it comes to comparative effectiveness, the track record of the American public and their doctors is not encouraging. Even when such comparisons are available, we tend to ignore them. In 2002, for example, one of the largest government-financed clinical trials ever found that generic pills for high blood pressure worked better than newer drugs that were up to 20 times as expensive. But most hypertension patients still use costlier drugs marketed by pharmaceutical companies

Of and by the way – the side effects for these newer drugs are by the very nature of their recent introduction as yet undiscovered, so the American public is providing a great service to other countries and their patients testing out new drugs on their behalf! If you’d like to read more I can recommend this book by Marcia Angell, a senior lecturer at Harvard Medical School “The Truth About the Drug Companies: How They Deceive Us and What to Do About It“. Shocking insights into the industry that is there to make money. The first recommendation on Amazon is pretty compelling

I should start with a disclaimer. I’m a Vice President within one of the largest drug companies in the world and I have spent close to twenty years marketing drugs. So I guess I’m not supposed to like this book. But the truth is I thought it was fantastic. First, for those of you who are not familiar with the healthcare industry, you should know that Ms. Angell is better capable of writing this masterpiece than any other author. She used to be Editor-in-Chief of The New England Journal of Medicine, which is considered the most prestigious medical journal in the world.

But this volume is much more than simple entertainment. It is quite possibly one of the best analyses of the state of the U.S. drug industry today, complete with footnotes backing up every statement the author makes. You will learn not only that in 2002 the top ten drug companies made a higher profit than the other 490 businesses together on the Fortune 500 list. You will also understand how the drug industry has been able to achieve such a business success and how this success, as is often the case throughout history, will likely be their downfall

Yikes – and this from a Drug Company employee!

So what to do – start with more education, include and understanding of what works and what does not and above all else, don’t take the treatment you receive as gospel. Would you pay for “Synthetic” oil for an oil change that is more expensive without understanding why it is worth spending that extra money – if indeed it is. I hope not. The same should be true for your health and with the availability of information, support groups and tools to analyze healthcare will be a much more inclusive process involving the patient and the whole team in making decisions than it has in the past.

Do you have your own experience of good or bad choices;  if so please share them and let me know what you think f the current state of healthcare today

Vaccination – Essential part of Child Healthcare

Posted in Healthcare Information, Preventative Healthcare by drnic on April 2, 2009

It is in the words of Victor Meldrew (don’t know who he he is here’s a link to this famous BBC British Comedy character and the series One Foot in the Grave) “unbelievable” that Time magazine would give ink to the delusional rantings (Autism and Vaccines) of an individual who appears hell bent on a mission to return our countries childhood back to the dark ages of killer measles epidemics and chicken pox for the masses. But wait, she used to be a Playboy model so this obviously provides the essential scientific background to debate the pros and cons of vaccination….or could it be a simple eye candy decision for the photo cover. Whatever it is I agree with Orac in his post “I really wish this were an April Fools Joke” where as he highlights

Jenny thinks it’s acceptable that infectious diseases will return because of her efforts and those of her fellow antivaccinationists

Her unscientific belief that vaccines cause autism – there are numerous studies (here, here and here for example and this Hollywood Mom Amanda Peet and her support of public service campaign ) showing no, repeat NO epidemiological evidence for a causal association of vaccinations and autism. Correlation does not equal causation (simple statistics) and promoting this as science is like the snake oil salesmen in the wild west…. marketing hype). This is someone who can’t even remove expletives from her conversation with a journalist……

If the vaccine companies are not listening to us, it’s their f___ing fault that the diseases are coming back

Right! As Orac says

No matter how many studies exonerate vaccines as a cause of autism, you don’t believe them

And if science disproves your latest hair brained idea you’ll find something else to blame as in the Toxin gambit as we moved off Mercury as a cause. This is no longer about  science or science- and evidence-based medicine this is McCarthgeddon and reminds me a lot of the McCarthy from the 1950’s and his hunt now seen through the clarity of history as a modern day witch hunt….interesting they share the same name.

If you were wondering – get your kids vaccinated….for everything. Follow the science.