Cheap fast food "enticing people to eat more because they think they're saving money when they're really buying heart disease"

"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease."

References:
10 Questions for Jillian Michaels. TIME, 2010.

Couple addicted to the internet let their baby starve to death while raising a virtual daughter online

From BBC:

A South Korean couple who were addicted to the internet let their three-month-old baby starve to death while raising a virtual daughter online, police said.

An autopsy showed her death was caused by a long period of malnutrition.

The couple had become obsessed with nurturing a virtual girl called Anima in the popular role-playing game Prius Online.

Some psychiatrists still have doubts if Internet addiction exists but it looks pretty much for real in this video:



References:

S Korea child 'starves as parents raise virtual baby'. BBC.

How do you blog?

A nurse writing a paper for school focusing on the value of blogs for advanced practice nurses asked me the questions listed below. It would be great if you can post your own answers in the comment section below.

How many blog post do read a week?

The blog posts and news items from the RSS feeds are about 2,000-3,000 per day = 20,000 per week.

You read blog posts about?

The big five among the general medical journals (NEJM, JAMA, Lancet, BMJ, Annals of Int Medicine) plus 10 allergy journals, plus Medscape, Reuters Health and WebMD.

How many new topics do you personally post under each sub heading, i.e. Endocrine, Cardiac, etc each week?

1-2 blog posts per day, for example, cardiac topics once a week, endocrine topics once a month.

Some helpful references:

5 Tips to Stay Up-to-Date with Medical Literature

How to deal with the information overload from blogs, RSS and Twitter?
Image source: public domain.

"I'm a Medicare doctor. Here's what I make"

From CNN:

Dr. Schreiber sees 120 patients a week - 30% of them are enrolled directly in Medicare, while another 65% have private insurance plans that peg their payments on Medicare's rates. Only 5% pay on their own.

Medicare pays between 63-72% of the costs for Schreiber's patients.

Four billing codes make up the "bread and butter" of claims submitted to Medicare:

- The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges.

- The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58.

- The last billing code is a complex visit. "This is where a patient comes in with many problems like heart disease, hypertension, diabetes," he said. Such a visit requires about 30 minutes of his time.

Schreiber charges $120 for these visits, and Medicare pays $88 of that.

References:

Medicare backlash: A primary care doctor lays out his costs. CNN.

Image source: United States one-dollar bill. Wikipedia, public domain.

"Doctors should blog with their real name." Agree or disagree?

From KevinMD:

"Martin Young still has "nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

My blog as an extension of who I am as a doctor, putting a carefully considered face to the experience of caring for the sick, as a means of drawing attention to issues that do not get into medical journals. As do most other doctors who host their own blogs.

I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and face to your thoughts?” My personal belief is that the anonymous person may lack conviction, confidence or courage.

I would not accept a referral from an anonymous doctor, or give advice to one. In the same way, I may read anonymous replies to my postings, but they carry much lower weight."

Although I encourage physicians to blog under their own name, I do not think we should "force" them to do so. They should not feel obliged to host their own blog either if they can use such perfectly reasonable free services such as Blogger.com by Google and WordPress.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any employee blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:

Why doctors should blog with their real name. KevinMD.
How to write a medical blog and not get fired?

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Image source: public domain.

Twitter comments:

@DrJenGunter (Jennifer Gunter): depends on blogging agenda.

@DoctorNatasha (Natasha Burgert): I blog and tweet with my real name because it keeps me accountable to my work, honest with my patients, and real with my intent.

@DrElizabethLee: I sign my name to anything I write.

@DrVes: Doctors need to understand the basics, and address the irrational fear of using social media.

Medical blog content and relationship with blogger credentials and blog host

A quantitative content analysis was performed on 398 blog posts from a constructed 1-week sample of posts in WebMD, Yahoo!Health Expert Blogs, and independently hosted blogs.

Most health and medical blog posts highlighted and provided commentary pertaining to medical issues found in external media such as books, television, Web sites, magazines, and newspapers

Only 16% contained actual health or medical information.

Distinct differences in patterns of content were evident between credentialed and noncredentialed bloggers, as well as different blog hosts.

References:
Health and medical blog content and its relationships with blogger credentials and blog host. Buis LR, Carpenter S. Health Commun. 2009 Dec;24(8):703-10.

Comments from Google Buzz:

Shabber Hussain - Now if I can some how know about those 16% medical blogs that "contain actual health or medical information", it should make my day. Feb 26

Arin Basu - I think (I just read the abstract perhaps a closer reading of the full text of the article might be more useful, @Ves, did you have a chance to read the full text?)

* The findings are not unexpected, at least that's what you expect based on "credentialing the blogger who has written the posts"

* There seems on first reading at leas the abstract that there may be quite a bit of bias in that study (just one week snapshot (too few blogs sampled), few selected sites (selection bias right there), and interpretation)

* Not surprised that most blogs contained commentaries published in popular press and journals.

I think that's what blogs should ideally do. Raise awareness, enable and alert people to read & interpret meanings. I'd not expect blogs to replace "actual" texts (well, that's my perspective)

* Which makes @Shabber's point very pertinent, what are those 16% saying, on a one week selective sampling?

All in all, a very interesting article. I think it needs to be closely read and discussed in medical blogosphere. Feb 26

Image source: public domain.

Oral Tolvaptan (Samsca) Is Safe and Effective Treatment for Chronic Hyponatremia

Vasopressin antagonists increase the serum sodium concentration in patients who have euvolemia and hypervolemia with hyponatremia in the short term (30 days), but their safety and efficacy with longer term administration is unknown.

In a study, 111 patients with hyponatremia received oral tolvaptan (Samsca) for 700 days.

The most common adverse effects attributed to tolvaptan were pollakiuria, thirst, fatigue, dry mouth, polydipsia, and polyuria.

Mean serum sodium increased from 130.8 mmol/L at baseline to greater than 135 mmol/L throughout the observation period.

Responses were comparable between patients with euvolemia and those with heart failure but more modest in patients with cirrhosis.

In conclusion, prolonged administration of tolvaptan maintains an increased serum sodium with an acceptable margin of safety.

Samsca (tolvaptan) Black Box Warnings

Appropriate Use

Initiate and re-initiate tx only in hospital with serum Na monitoring.

Monitor Serum Sodium

Osmotic demyelination may occur w/ rapid correction of hyponatremia (faster than 12 mEq/L/24h), resulting in dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma, and death; slower rates of correction advised in pts w/ severe malnutrition, alcoholism or advanced liver disease.

Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca)

Conivaptan is administered IV only, the average cost per day is $573.

Tolvaptan is administered PO only, the average cost per day is $300.

References:

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia. Journal of the American Society of Nephrology, 2010.

Samsca (tolvaptan) Black Box Warnings. Epocrates.

Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca) (PDF).

Lowest sodium I have ever seen http://goo.gl/QgJmf

Image source: Tolvaptan, Wikipedia, public domain.

Comments from Twitter and Facebook:

@kidney_boy: tolvaptan is safe for the patient but not their wallet at $250 per pill!

Neil Mehta: "It costs a king's ransom to keep the sodium level up! Maybe we should just say "Let them eat Salt"!"

Updated: 10/28/2010

TED Talks: A new strategy in the war on cancer

From TED Talks/TED Med: Traditionally, David Agus explains, cancer treatments have had a short-sighted focus on the offending individual cells. He suggests a new, cross-disciplinary approach, using atypical drugs and computer modeling.

Doctors use Facebook Pages to connect with patients

With a 500-million large audience, many practices find that creating a Facebook presence can be an easy -- and free -- way to stay in touch with patients or attract new ones.

Businesses, including physician practices, can create something similar: pages (previously "fan pages"). Anyone on Facebook who elects to "become a fan" or like your page receives, on his or her own home page, any updates, photos, videos or Web links that you post.

Rather than having patients "friend" you on Facebook, you can direct them to this page. Having a moderator is important, because having someone dedicated to responding to people makes them feel more connected and encourages respectful and on topic discussions.

References:
Amednews: How Facebook fan pages can connect with patients.

Facebook Pages Manual.pdf - File Shared from Box.net via @sandnsurf.

10 Easy Ways to Enhance Your Facebook Page. Web Worrker Daily, 2010.

Image source: Wikipedia.

Updated: 07/15/2010

New Treatment Effective in Killing Head Lice - benzyl alcohol lotion 5% (Ulesfia)

From WebMD:

A new prescription lotion (Ulesfia) with benzyl alcohol treats head lice and is effective and safe for children as young as 6 months. The study shows it works by suffocating lice, a method that has long been tried with limited success using messy substances like petroleum jelly, olive oil, and even mayonnaise.

Overnight "home remedies" such as mayonnaise merely appear to kill lice, but don't because the bugs are able to close their spiracles long enough to survive. This is called the "resurrection effect" because, after rinsing, the lice thought to be dead are able to open their breathing spiracles and start biting again.

Existing over-the-counter head lice treatments contain neurotoxic pesticides as active ingredients, resulting in potential toxicity and other problems, including lengthy applications, odor and ineffectiveness.

References:

New Treatment Effective in Killing Lice. WebMD.

Losing the Lice Without Losing Your Wallet. NYTimes, 2010.

Image source: Benzyl alcohol, Wikipedia, public domain.

Updated: 05/28/2010

Room-temperature plasma gases may replace hand disinfectants

From the NYTimes:

Instead of scrubbing, the workers would put their hands into a small box that bathes them with plasma — the same sort of luminous gas found in neon signs, fluorescent tubes and TV displays.

This plasma, though, is at room temperature and pressure, and is engineered to kills bacteria, including the drug-resistant supergerm MRSA.

References:
Hospital-Clean Hands, Without All the Scrubbing

Image source: Neon sign. Wikipedia, Rolf Süssbrich, Creative Commons Attribution ShareAlike 3.0 License.

Physically fit students score higher on tests than their less fit peers

Test scores dropped more than one point for each extra minute it took middle and high school students to complete a 1-mile run/walk fitness test.

65% of the students were below the state fitness standard. Compared with these students, students who met or exceeded fitness standards had higher average test scores. Overweight and obese students also scored significantly lower on tests.

Schools may have to reverse their recent disinvestment in physical education ostensibly for the purposes of boosting student achievement.

Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:

"Health Promotion" video: Benefits of exercise.

References:
Physical, academic fitness tied at the hip: study. Reuters, 2010.

The Journal of Pediatrics, published online January 25, 2010.

Metabolic pathway plays a role in susceptibility to stuttering

Stuttering is a disorder of unknown cause characterized by repetitions, prolongations, and interruptions in the flow of speech. Genetic factors have been implicated in this disorder, and previous studies of stuttering have identified linkage to markers on chromosome 12.

This study shows that variants of proteins that guide hydrolases to the lysosome are associated with stuttering. This unexpected finding implies a metabolic pathway in susceptibility to stuttering.


Video: Biology Homework about Lysosomes.

References:

Mutations in the Lysosomal Enzyme–Targeting Pathway and Persistent Stuttering. NEJM, 2010.

Health benefits of chocolate

The health benefits of chocolate may include:

- Reduction of blood pressure by eating 6 grams of dark chocolate per day. Probably due to the flavonol epicatechin
- Reduction of platelet and endothelial cell activation
- Reduction of inflammatory mediators
- It can also inhibit oral caries
- It can cross the blood brain barrier and increase cerebral blood flow in humans

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

References:
The Essence of Chocolate. Dr Shock MD PhD, 2010.
Chocolate could lower blood pressure but the required dose may be too much - BMJ http://goo.gl/uoBN
Chocolate linked to substantial reduction in risk of cardiometabolic disorders but evidence not of best quality. BMJ, 2011.

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi

Image source: Wikipedia, public domain.

"Blogging fame does not pay the bills"

From Social Media Examiner:

Wendy Piersall provides some insights into the "dark side" of being popular online:

- Fame does not pay the bills
- Being on the front page of Digg does not bring you success
- It takes lots of work to get internet fame and even more work to maintain the internet fame

See the video interview at Social Media Examiner.

References:
The Dark Side of Blogging Fame (a Wendy Piersall Interview). Social Media Examiner.

Image source: public domain.

Antibiotic use for respiratory infections could be reduced by 40% by procalcitonin (PCT) test

Procalcitonin (PCT) is a precursor of the hormone calcitonin, which is involved with calcium homeostasis, and is produced by the C-cells of the thyroid gland.

In healthy people, procalcitonin (PCT) concentrations are low, but in those with bacterial infection it occurs at high concentrations in the blood as early as 3 hours after infection. In people with viral infections, procalcitonin (PCT) levels rise only marginally, if at all.

A PCT-guided strategy applied in primary care in unselected patients presenting with symptoms of acute respiratory infection reduces antibiotic use by 41.6 percent without compromising patient outcome.


The FDA Approved an Automated Procalcitonin (PCT) Test in 2008.

References:
Simple test could cut excessive antibiotic use. Reuters, 2010.

Sign of the times

One more sign of the increasing geriatric population - in 2009 the adult size diapers outnumbered the baby diapers at the U.S. waste sites for the first time.



From Twitter:

@drwalker_rph Who counted the diapers???

Osteoporosis Drug Lasofoxifene May "Fight" Several Diseases But Increases Risk of Blood Clots

Lasofoxifene is a part of a class of drugs known as nonsteroidal selective estrogen-receptor modulators (SERMs). It has already been shown to decrease the bone loss associated with osteoporosis, like other SERMs, including tamoxifen and raloxifene. But until now its effect on other health conditions commonly experienced by postmenopausal women was unknown.

The women who took lasofoxifene had an 81% lower risk of estrogen-receptor (ER) positive breast cancer, a 32% lower risk of heart-related events like heart attack, and a 36% lower risk of stroke. "This is the first SERM that reduces the risk of all of these conditions at once."

However, not all the results were positive. As with other SERMs, women taking lasofoxifene had double to nearly three times the risk of experiencing a serious blot clot of the deep veins.

References:
Osteoporosis Drug May Fight Several Diseases. WebMD, 2010.

NEJM -- Lasofoxifene in Postmenopausal Women with Osteoporosis.

Image source: Flickr, Creative Commons license.

What is the oldest medical blog?

Medical Blog Anniversaries

Dr. Rob explains why he has been blogging for 4 years http://goo.gl/seKp. Then, he decided to go on hiatus at the end of 2010. If I remember it correctly, Dr. Rob has done that before and then came back to blogging. We hope he reconsiders and returns to blogging later in 2011 or 2012.

Dr. Bates has been blogging for 3 years, leading to over 1,000 posts and many new friends http://goo.gl/eB1e

I have maintained medical blogs since 2004 but never thought about blog anniversaries - blogging seems such a mundane task of daily life.

What is the "life expectancy" of a medical blog?

The studies are ongoing but the current record is around 8-10 years... http://goo.gl/5LRx

In the medical blogging world, the physician bloggers who produce high volume of original content often quit after 1-2 years. There is too much to handle. Medical blogging is a difficult task that requires a lot of time and mental energy (scientific accuracy, HIPAA compliance, ethics, etc.), and the financial rewards are nonexistent or negligible.

What is the oldest medical blog?

As pointed out in the comments, the "oldest" medical blog probably is Family Medicine Notes, followed by GruntDoc.

Related reading:

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Twitter comments:

@gruntdoc (GruntDoc): That's why I'm pacing myself - @DrVes: You know it best - you were there at the beginning and the only one still blogging... :)

@Doctor_V (Bryan Vartabedian): Would love to see post from @gruntdoc (one of the oldest medblogs) on longevity. He's seen lots. Seen patterns.

@giustini (Dean Giustini): Moving to microplatforms Twitter & Facebook (from blogs) in medicine is trendy but they tend to cut off discussion & cause an exodus - @DrVes: Agree, but this is different. High-volume medbloggers used to quit after 1-2 years even before FB/Twitter... :)

@DrOttematic (Jessica Otte, MD): I only do a few posts a month unless spectacularly inspired. It's natural and not too demanding that way. I can't imagine how the high-outputters even last a year at it - @DrVes: Doctors are dedicated people. If you want to know "How Doctors Think", don't read books - read their blogs.

@giustini (Dean Giustini): Physicians are good at 'pattern recognition' after observing - daily blogposts are onerous / intellectually unsatisfying. I find that time & effort in blogging does not equal reward/recognition systems in medicine; partly true in my field too - @DrVes: True. Only printed publications count in academic promotion as of 2010... :) -

@giustini (Dean Giustini): This is why I think your blog is a standout. Has your publishing output decreased since starting your blog? what about presentations? - @DrVes: I publish more blogs than ever before (medicine, allergy, peds, etc.). Fewer presentations and conferences.

@giustini (Dean Giustini): Have you considered writing a book like "Medical pioneers in the web 2.0 era"? A review of blogging/ experiences; quotes from others? -- @DrVes: I have considered some book ideas (not this one in particular) but unfortunately have little time to do it. May be later, in 2012 - @giustini (Dean Giustini): We should write it sooner. The end of 2010 marks a natural demarcation line between web 2.0 and web 3.0.

@erinrbreedlove (Erin Breedlove): I'm an undergrad student and "baby" med blogger but hope to make your list someday. So rewarding. :) - @DrVes: I don't have a list. If you have a reflection of your blogging anniversary, I will reference it in the blog post... :) - @erinrbreedlove (Erin Breedlove): I knew that...no anniversary yet! May! Have a neat series I think you'd like, though. Working on it now. http://bit.ly/dFNkP2

@geeners (Gina Rybolt): I think I am the oldest nursing blog :) Just turned 8 in December 2010 - @rlbates: Impressive! Glad you're still active.

@DrVes: Why blogs are "better" than Twitter - it's difficult to have a discussion on Twitter but it works as a commenting system. Check the comments above, for example.

@gruntdoc: Your comments here prove the value of blogs. Twitter immediate & ephemeral.

Related reading

Diagnostic Accuracy in Pharyngitis http://goo.gl/OFnyP - Do you know who devised Centor score? Medical blogger Robert Centor at medrants.com.

12 years of blogging about medicine, technology and their intersection. DocNotes, 2011. Including a 6-year break.

7.2% Decrease in Work Hours of U.S. Physicians Between 1996 and 2008

After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 55 hours per week in 1996-1998 to 51 hours per week in 2006-2008.

Excluding resident physicians, whose hours decreased by 9.8% due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7%.

Physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours.

A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees.

References:
Trends in the Work Hours of Physicians in the United States, February 24, 2010, Staiger et al. JAMA 303 (8): 747.

From Happy Hospitalist:

"That means your doctor earns 25% less today than they did just a decade ago. If you went to college and joined a company that said up front you would be paid 25% less in a decade than you were paid on the day you were hired, would you join them?

Why are physicians working fewer hours, a trend unique to doctors? The conclusion was reduced pay. Physicians just don't seem inclined to spend long hours in the office and hospitals to sacrifice their family life for the life of their patients when the the economic reward of doing so just isn't there.

I've talked with many subspecialists at Happy's hospital about the declining payment for their efforts. They all tell me exactly the same thing. They are going to work less and limit their hours as payment reductions come down the pipeline."

Image source: sxc.hu

Video: Cleveland Clinic Model of Medicine

ClevelandClinic — May 12, 2010 — "Innovation has made Cleveland Clinic a world leader in medicine, and is the only true long term solution to high quality affordable healthcare. The founders of Cleveland Clinic launched a revolutionary model of medicine, collaborative, patient centered, dedicated to innovation."

Being obese at age 40 reduces life expectancy by 7 years for women and 6 years for men

In Scotland 68.5% of men, 61.8% of women, 36.1% of boys, and 26.9% of girls are classified as overweight or obese.

Being obese at age 40 reduces life expectancy by 7.1 years for women and 5.8 years for men.

The article summarises the most recent recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on the management of obesity.

References:
Management of obesity: summary of SIGN guideline. Logue et al. 340: c154. BMJ, 2010.

Comments from Google Buzz:

Luke Rosenberger - thanks! looks like original source of the life expectancy data (according to footnote) is actually a 2003 article from annals of internal medicine - http://www.ncbi.nlm.nih.gov/pubmed/12513041

Ves Dimov, M.D. - Looks correct. That's why I always say that we need a medical librarian on board... :)

For Google Buzz and Twitter, I typically link to the source where the text appeared when I first saw it. It's very nice to trace it back to the original source however. Thank you so much.

Luke Rosenberger - makes sense to me. you know us librarians, always reading the footnotes first ;-)

Image source: Wikipedia, public domain.

TED video: CIO of Cleveland Clinic talks about electronic medical records (EMR)

Video - TEDxCLE - Dr. C. Martin Harris, CIO of Cleveland Clinic talks about EMR. The Cleveland Clinic uses Epic Systems EMR and, although the system costs millions of dollars to purchase and maintain, it has been perceived as very useful by both physicians and patients.

Disclaimer: I was a Clinical Assistant Professor of Medicine at the Cleveland Clinic until 2008.

Related:

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9

Hospitalist evolution? "Extensivist" = hospitalist who prevents readmissions by seeing patients after discharge

"On a typical morning, Sandip Patel, MD, a hospitalist employed by a health plan in Southern California, rounds on patients at the hospital, then meets with case managers and a medical director to review care plans and decide which patients will stay or go.

In the afternoon, Dr. Patel may see recently discharged patients—those coded "red" or "yellow," based on medical complexity—at an integrated-care center, which is also owned and run by the health plan. Then he might head to a nursing home to check on patients discharged a week ago.

Dr. Patel considers himself an "extensivist" with a goal to reduce readmissions. "Lowering readmission rates is within the purview of the hospitalists."

References:
Health-plan hospitalists cut readmissions—by sometimes leaving the hospital. Today's Hospitalist, 2010.
Median adult hospitalist compensation up slightly to $220,619 in 2010 http://goo.gl/D9rHp

Image source: sxc.hu

A NYTimes skeptic doubts that decreasing salt intake would have any benefits (it may even hurt)

From the NYtimes:

"The harder the experts try to save Americans, the fatter we get. Officials responded by advising Americans to shun fat, which became the official villain of the national dietary guidelines during the 1980s and 1990s. The anti-fat campaign definitely made an impact on the marketing of food, but as we gobbled up all the new low-fat products, we kept getting fatter. Eventually, in 2000, the experts revised the dietary guidelines and conceded that their anti-fat advice may have contributed to diabetes and obesity by unintentionally encouraging Americans to eat more calories.

“When you reduce salt, you reduce blood pressure, but there can also be other adverse and unintended consequences. As more data have accumulated, it’s less and less supportive of the case for salt reduction, but the advocates seem more determined than ever to change policy.”

References:

Findings - When It Comes to Salt, No Rights or Wrongs. Yet. - NYTimes.com.

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death
Sweat Bees prefer sweaty people because the human diet is so salty that their perspiration is saturated with that essential nutrient. WSJ, 2012.

Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

Açaí, a Global "Super Fruit", Is Regular Dinner Meal in Brazil

From the NYTimes:

Virtually unknown outside of the Amazon two decades ago, and not exported from Brazil — the major producer — until 2000, açaí berries have become famous around the world, riding the wave of the antioxidant craze and rain-forest chic.

Just a few years ago, farmers had trouble getting rid of the açaí that grows.

Diego Lopes, a 21-year-old açaí processor in Brazil, says he has açaí with lunch and dinner every day. “Fifteen years ago, it was like beans for us,” he said. “Now, it’s more expensive than beans."

“Think of it as a cheeseburger,” Mr. Lopes said, explaining to an American reporter. “You can’t have a meal there without a cheeseburger, right?”

The velvety texture of the thicker varieties is wonderful, but the taste is more — how to put this? — earthy. O.K., it tastes like dirt. Making matters worse, the manioc flour that’s often mixed in to thicken it has the consistency of sand.

References:

Açaí, a Global Super Fruit, Is Dinner in the Amazon. NYTimes, 2010.
NYT Slideshow

Is Açaí the Next "Superfood"?

Image source: Wikipedia, public domain.

The Barefoot Professor says barefoot running could minimize injuries

NatureVideoChannel — January 27, 2010 — Harvard professor Daniel Lieberman has ditched his trainers and started running barefoot. His research shows that barefoot runners, who tend to land on their fore-foot, generate less impact shock than runners in sports shoes who land heel first. This makes barefoot running comfortable and could minimize running-related injuries. Find the original research here: http://dx.doi.org/10.1038/nature08723

Humans have engaged in endurance running for millions of years1, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes.

Related reading:

The Barefoot Running Revolution - INFOGRAPHIC  http://goo.gl/7SUGs

Childhood diabetes associated with increasing birth weight - 7% increase in risk for every 1000 g in weight

Childhood onset diabetes is associated with increasing birth weight, equivalent to a 7% increase in risk for every 1000 g in weight.

Caesarean section increases the risk by around 20%.

The risk of childhood onset diabetes increases with maternal age: 5% for each five years of age.

References:
Maternal age and diabetes in childhood. BMJ 2010;340:c623.

Image source: Wikipedia, GNU Free Documentation License.

Warfarin Sensitivity Genotype Test - Mayo Clinic Video

Thomas Moyer, Ph.D., from Mayo Clinic's Department of Laboratory Medicine and Pathology, describes the four basic categories of patients as identified through this test, and how the doses of the blood-thinner warfarin would typically be adjusted to reflect differences in patients' metabolism of warfarin and also their sensitivity, to prevent stroke or hospitalization due to excessive bleeding.

Back and forth: Study fails to show link previously found between virus and chronic fatigue syndrome

A UK study analysing samples from patients with chronic fatigue syndrome has found no evidence of a link with a retrovirus (XMRV). The virus was first described in 2006.

Patients with chronic fatigue syndrome, also known as myalgic encephalomyelitis, often report that their condition—a mix of symptoms including extreme fatigue—began after an otherwise normal viral infection.

The xenotropic murine leukaemia virus-related virus (XMRV) was found in 67% of patients with chronic fatigue syndrome in a study reported last year (Science 2009,326:585-9).


The Gift of Time is a short film about the doctors who discovered the XMRV virus and the breakthru potential for prostate cancer.

References:

Study fails to show link previously found between virus and chronic fatigue syndrome. BMJ 2010;340:c1033.

Farm-raised salmon has 16 times the polychlorinated biphenyls (PCBs) as wild-caught salmon

According to the Environmental Working Group (EWG), farm-raised salmon has 16 times the polychlorinated biphenyls (PCBs) as wild-caught salmon. That’s because farm-raised salmon are often fed contaminated fish meal, which builds up in salmon’s fatty tissue.

Chilean-farmed fish had lower levels of toxins than fish raised in the U.S., Scotland, Canada and Norway. Those tested from Scotland had such high levels that the EWG recommended it be eaten no more than once per month.

References:

360-5.com in collaboration with the Cleveland Clinic.
Image source: Amazon.com, used for illustrative purposes only - NOT a suggestion to purchase any products.

Bloggers, too much sitting can offset the benefits of regular exercise

From the NYTimes:

Wrong: Sitting at your cubicle. Better: Walking while clicking and talking.

Your chair is your enemy.

It doesn’t matter if you go running every morning, or you’re a regular at the gym. If you spend most of the rest of the day sitting — in your car, your office chair, on your sofa at home — you are putting yourself at increased risk of obesity, diabetes, heart disease, a variety of cancers and an early death.

In other words, irrespective of whether you exercise vigorously, sitting for long periods is bad for you.

"Health Promotion" video: Benefits of exercise.

References:

Stand Up While You Read This! - Opinionator Blog - NYTimes.com
How to Exercise WHILE Blogging or Doing Other Computer Work

17% of food-related asphyxiations were caused by hot dogs - "the perfect plug for a child's airway"

From Consumer Reports health blog:

Small toys and foods that are choking hazards should carry warning labels - and some hot dog brands already do.

About 17% of food-related asphyxiations were caused by hot dogs. In total, 41% were caused by food items including:

- hot dogs

- grapes

- carrots

- hard candy

Food manufacturers should design new foods and redesign existing foods to avoid shapes, sizes, textures and other characteristics that increase choking risk to children, to the extent possible.

"If you were to take the best engineers in the world and try to design the perfect plug for a child's airway, it would be a hot dog," says statement author Gary Smith. "I'm a pediatric emergency doctor, and to try to get them out once they're wedged in, it's almost impossible."

References:

Hot dogs under fire: Doctors push for stronger labeling
http://www.aap.org/advocacy/releases/feb2210studies.htm

Image source: Wikipedia, GNU Free Documentation License.

Related:

Kinder Surprise egg seized at U.S. border - banned by law as a choking hazard to young children http://goo.gl/UNUoG - Sold around the world.

Barbara Walters, US TV Anchor, to Undergo Heart Surgery to Replace a "Faulty Valve" - Sounds Like Aortic Stenosis

Walters announced that she will undergo surgery to replace a "faulty" heart valve later this week.

"You know how I always say to you how healthy I am. ... I've never missed a day's work," she began. "Later this week, I'm going to have surgery to replace one faulty heart valve."

From her description, the valve defect sounds like aortic stenosis. For a variety of reasons, mitral stenosis is a less likely possibility in the differential diagnosis.

Best wishes for successful surgery and speedy recovery!

References:
Barbara Walters to Undergo Heart Surgery. ABC.

Barbara Walters' Heart Surgery. WebMD.

Can a Midday Nap Make You Smarter? Adults Who Nap for 90-minutes at 2 PM Learn and Perform Better at Tests

According to a new study, if you devote your lunch hour to a nap, you may perform and learn better in the afternoon.

Napping at midday, when the brain's ability to learn may have deteriorated, may clear the brain's memory "storage area" and make room for new information.

In the study, the nap group was given the chance for a 90-minute siesta at 2 p.m.; the no-nap group was asked to stay awake.

People in the group which didn't nap had a 10% reduction in their learning capacity. The people who had a nap improved their ability to learn by 10% (not much).

References:

Can a Mid-Day Nap Make You Smarter? WebMD.

Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

Eating chocolate with high flavanol levels can protect the skin from UV light

Cocoa beans fresh from the tree are exceptionally rich in flavanols. Unfortunately, during conventional chocolate making, this high antioxidant capacity is greatly reduced due to manufacturing processes.

The researchers evaluated the photoprotective potential of chocolate consumption, comparing:

- conventional dark chocolate
- specially produced chocolate with preserved high flavanol (HF) levels.

A double-blind in vivo study in 30 healthy subjects was conducted, 15 subjects were randomly assigned to either a high flavanol (HF) or low flavanol (LF) chocolate group and consumed a 20 g portion of their allocated chocolate daily.

The minimal erythema dose (MED) was assessed at baseline and after 12 weeks.

In the high flavanol (HF) chocolate group the mean MED more than doubled after 12 weeks of chocolate consumption, while in the LF chocolate group, the MED remained without significant change.

The authors concluded that regular consumption of a chocolate rich in flavanols confers significant photoprotection and can thus be effective at protecting human skin from harmful UV effects. However, conventional chocolate has no such effect.


Video: Chocolate Rain by Tay Zonday.

References:
Eating chocolate can significantly protect the skin from UV light. Williams S, Tamburic S, Lally C. J Cosmet Dermatol. 2009 Sep;8(3):169-73.
Link via @DrShock.

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi
Chocolate linked to substantial reduction in risk of cardiometabolic disorders but evidence not of best quality. BMJ, 2011.
Image source: Wikipedia.

Related:

Video: A life cycle in 90 seconds

From the British tabloid Daily Mail:

"Sometimes we forget just how short and precious our time on this planet really is. It's for this reason that John Lewis's new television ad seems to have struck an uncharacteristic chord.

You won't find many people admitting to crying over the usual flood of formulaic adverts on our screens - yet this 'moving' ad has got Britain talking - and sobbing into their breakfast bowls.

At 91 seconds long, and costing £6 million, the ad shows the the life cycle of a woman from birth to old-age - infancy, a girl's birthday party, a clumsy kiss in a university corridor, marriage, pregnancy, parenthood and the path into old age."

High-risk profession: Suicide rate of U.S. doctors is one per day

More than a quarter of primary care doctors reported being "burnt out," in part due to worsening time pressures and a chaotic work pace, which were "strongly associated with low physician satisfaction."

The United States loses the equivalent of at least one entire medical school class (approximately 400 physicians) each year to suicide.

In other words, 300-400 doctors in the United States kill themselves every year, or roughly 1 per day. Male doctors have suicide rates 1.4 times that of the general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.

References:

Help for Today's Tense, Frustrated Doctors. Medscape, 2009.
http://www.medscape.com/viewarticle/710904

Doctors have higher rates of suicide than the general population: 40% higher for male doctors, 130% for female doctors http://goo.gl/ckTm

Doctors are quietly opting out of medicine http://goo.gl/emmTA

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

How to Subscribe to "What's New" Specialty Page of UpToDate? No Feed, No Problem for Google Reader

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. These selections are changed with each major release of UpToDate, in March, July and November. See these updates by clicking on the specialty you are interested in.

The page does not provide RSS feed for the different specialties. One solution is to copy/paste the URL address of each subspecialty page you are interested in the Google Reader "Add a subscription" field (top left corner). Google Reader will automatically create a RSS feed from this "feedless" page.



References:
UTD Contents: What's New

Are You Dependent on UpToDate for Your Clinical Practice?
5 Tips to Stay Up-to-Date with Medical Literature
Image source: UpToDate.

Benefits and Dangers as Doctors Start to Use Social Media

From Medscape:

"Dr. Choi has more than 3000 Facebook friends, many of whom are patients and colleagues.

But he draws the line at talking about cases with colleagues or sending diagnoses or test results to patients on networking sites. "I can't do any patient care using their messaging or using the site because it's not HIPAA-compliant," Dr. Choi says. "I'll pick up the phone to discuss a case."

Because doctors can be hesitant to share their e-mail addresses -- and regular e-mail is not secure to HIPAA standards -- it's not unheard of for people to find their doctors on Facebook. But the doctors interviewed generally say they avoid making diagnoses or communicating test results over the Internet."

References:

Doctors and Social Media: Benefits and Dangers. Medscape, 2010.
http://www.medscape.com/viewarticle/711717

Diet: For every 1% increase in omega-3 intake, HDL levels rise by 2.5 mg/dL

HDL levels lower than 40 mg/dL are considered a risk factor for heart disease, while levels of 60 mg/dL or higher are thought to be optimal.

Omega-3 fats, for instance, have been linked to lower risks of age-related vision loss and dementia among older adults.

Fish Oil Comes from “The Most Important Fish in the Sea”: Menhaden

Nearly every fish a fish eater likes to eat eats menhaden (shown here). Bluefin tuna, striped bass, redfish and bluefish are just a few of the diners at the menhaden buffet. All of these fish are high in omega-3 fatty acids but are unable themselves to synthesize them. The omega-3s they have come from menhaden.

References:

Diet changes improve older adults' cholesterol too | Reuters.
http://www.reuters.com/article/idUSTRE61I49N20100219

Fish Oil Comes from “The Most Important Fish in the Sea”: Menhaden

Monounsaturated fats found in vegetable oils, nuts and avocados increase "good" HDL cholesterol levels by 12% http://goo.gl/GBQa5
How We Eat: Analyzing Half a Million Meals - 5 INFOGRAPHICS

Image source: Menhaden B. tyrannus from the Chesapeake Bay. Wikipedia, Brian.gratwicke, Creative Commons Attribution 2.5 License.

How do you keep up with health news?

Steve Rubel asks How do you keep up with industry news - RSS, email newsletters, Twitter, Facebook or other (elaborate)? He now primarily uses newsletters, Twitter and Facebook to follow several dozen sources. He uses his RSS reader as an archive:

http://www.facebook.com/steverubelstream

This does not work very well for me. Google Reader is still one of my primary sources for health information - I channel Twitter feeds, YouTube subscriptions, Flickr and podcasts through it as well.

The RSS reader collects all rich media in one place - a true "inbox for the web". The disjointed approach described by Steve Rubel above can be confusing to many and a time-waster to even more. Everybody has their own preferences, of course.

For example, Steve abandoned his popular blog MicroPersuation to move to life-stream, then Facebook. Alternatively, I decided to stay with my blogs and send their updates to Twitter and Facebook. My blog is still my home on the web. You can build a professional profile on LinkedIn, Google and (may be) on Facebook but I decided to keep a separate website just for profile information. You can build it for free on Blogger.com by Google, control every aspect of it, and the only expense is the fee for domain registration ($10).

Comments from Google Buzz:

Tim Sturgill - I've started to use GR as you are for Twitter. I wish Twitter had RSS for direct messages as well.

Vamsi Balakrishnan - I use Google Reader for my news sites (both tech and health). And, for the individual people I follow, like you, I'd use my Buzz. Every few days I log on to Twitter to check messages / replies / etc.

Lakshman Swamy - GR and buzz!

"Physicians - grumpy and getting grumpier"

By the numbers:

According to Sermo.com and their Physician Sentiment Index℠ (PSI):

- 64% of physicians cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care

- Only 22% are optimistic about the ability of the American physician to practice independently or in small groups

- 59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve

- 53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid

Comments from Google Buzz:

Nicholas Genes - Sigh. This poll was comprised of 1000 docs on Sermo, which might very well be a self-selecting group of grumpy physicians. Also, this poll was sponsored by Aetna, an insurance organization with perhaps a vested interest in sabotaging health insurance reform and publicizing physicians' negative perceptions of health care. I wouldn't put too much weight on these results.

Ves Dimov, M.D. - Exactly. The title catches some of the sentiment of many doctors though.

References:
http://www.thehealthcareblog.com/the_health_care_blog/2010/03/the-numbers-tell-the-story.html

Image source: sxc.hu

Can You Tell Your Life Story In 6 Words?

Larry Smith and Rachel Fershleiser talk to NPR about the fun and the challenge of capturing real-life stories in six little words.

Some examples related to medicine:

Alzheimer's: meeting new people every day.
Phil Skversky

After cancer, I became a semicolon.
Anthony R. Cardno

Normal person becomes psychotic on Twitter.
Robin Slick

Yale at 16, downhill from there.
Anita Kawatra

References:

Can You Tell Your Life Story In Exactly Six Words? NPR, 2010.
FDA Approves "Alzheimer's CT scan" by Eli Lilly - radioactive agent florbetapir tags clumps of sticky amyloid in brain. WSJ, 2012.

U.S. Hospital Social Media List Includes More Than 600 Hospitals

280 YouTube Channels
382 Facebook pages
470 Twitter Accounts
82 Blogs

Twitter is the easiest and blogs are the most difficult and time-consuming social media channel, respectively. This explains the difference in numbers to some extent - 470 Twitter Accounts vs. only 82 Blogs.

Australian hospitals lag behind U.S. in social media use: only 13% of them are on Twitter, 11% Facebook, 10% YouTube http://goo.gl/eKZWW

References:

Hospital Social Media List Update. Found In Cache.
http://ebennett.org/hsnl_03_28_10
Map of U.S. Hospitals with Official Social Media Accounts

Image source: OpenClipArt.org, public domain.

Approach to evaluation and management of syncope in adults - BMJ Review

Syncope is common in all age groups, and it affects 40% of people during their lifetime, usually described as a "faint" or "blackout".

Neurally mediated syncope, which is benign, is the most common cause

Cardiac syncope as a result of arrhythmias or structural cardiopulmonary disease is more common with increasing age. Cardiac syncope is associated with increased mortality and must be excluded.

Brain imaging, carotid Doppler ultrasound, electroencephalography, and chest radiography are often not needed in patients with syncope.

References:

An approach to the evaluation and management of syncope in adults. BMJ 2010;340:c880.
http://www.bmj.com/cgi/content/short/340/feb19_1/c880

Image source: Illustration of the human brain and skull. Wikipedia, Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006.

Tiotropium for COPD: A good foundation therapy for most patients

From a BMJ Editorial:

Tiotropium is a once daily, inhaled, long acting anticholinergic drug (LAMA) that provides 24 hour improvement in airflow and hyperinflation in patients with chronic obstructive pulmonary disease (COPD).

Clinical trials have consistently shown that these physiological effects translate into improvements in:

- lung function

- exercise tolerance

- health related quality of life

- fewer exacerbations

References:

Tiotropium and chronic obstructive pulmonary disease. BMJ, 2010.
http://www.bmj.com/cgi/content/short/340/feb19_1/c833

Image source: Wikipedia, public domain.

Some nurses paid more than family doctors - CNN

Primary care doctors were offered an average base salary of $173,000 in 2009 compared to an average base salary of $189,000 offered to certified nurse anesthetists, or CRNAs.

It's the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor.

Comments from Google Buzz:

Jeffrey Benabio, MD - And soon doctor of nursing programs will graduate nurses who call themselves "doctor" in clinic. Physicians have been asleep at the wheel.

http://en.wikipedia.org/wiki/Doctorate_in_Nursing

Francesco Diana - without words

Anne Marie Cunningham - Both of these are very high salaries. As @scanman points out, they are unobtainable for most people working in health in India and countries. Can we tolerate such global inequality?

How should salaries in any part of the world be determined? Are both these groups paid too much?

At the moment there is a great deal of uncertainty on how the role of a doctor differs to the role of a nurse. Professor Alan Maynard suggests that professions are bad for healthcare. http://www.healthpolicyinsight.com/?q=node/458 What do you think?

References:
Specialist nurses paid higher salaries than family doctors - Mar. 11, 2010. CNN.
Infographic of the Day: The Best Jobs in America
http://www.focus.com/images/view/7362

Image source: OpenClipArt.org, public domain.

Turning medical residents away from copy-and-paste culture facilitated by EMR

From MedCityNews:

Cleveland VA is trying to cut out the burgeoning subculture of “copy-and-paste”: A phenomenon made possible by electronic medical records in which physicians copy old information about a patient and paste it into a new section of the chart.

The practice is seen by medical residents as a time-saver but the attendings consider it an “egregious problem” because the practice has the potential to perpetuate mistakes. For example, someone might copy and paste information from a patient’s medical history without verifying that the information is correct. Any errors that might exist will be repeated.

EMR can’t just disable the copy-and-paste function, since such a move would impact other programs.

References:

Turning medical residents away from copy-and-paste culture. MedCityNews.

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.