Saturday, July 26, 2008

High Gas Prices Save Lives, Kitchen Countertops Can Kill

Unintentional deaths are the leading cause of death for those under thirty-five with the most common due to motor vehicle accidents. Newspapers around the country noted that high gas prices have decreased the number of traffic deaths. Naturally one could assume that the number of those injured from accidents have probably fallen as well. This means that if healthcare costs should rise less than expected next year could it be because of decreased utilization of emergency rooms and doctor visits because of fewer motor vehicle accidents?

Of course in other news, more people as a result of high fuel costs are biking, taking golf carts, or scooters, as their mode of transportation. Is it possible the number of lives saved may be simply shifting to other ways of getting around? Too early to tell.

Certainly none of us expect our kitchen countertops to kill us, but an article from the NY Times found that inferior types of granite contained high levels of the radioactive substance uranium. Not only is the element radioactive, which in of itself is a concern, but it also emits the carcinogenic gas radon, which has been a risk factor for lung cancer. With homes sealed for energy efficiency, it could make levels even higher. Could this be the reason why many non-smokers are developing lung cancer?

Who would have thought it was more dangerous to be at home in the kitchen rather than on the road?

Sunday, July 20, 2008

Newer Isn't Better. It's Unproven and Expensive.

There is a small trend among the media which is actively questioning the latest medical treatments and therapies on whether there is enough scientific evidence that would justify all of the increased costs. In an excellent piece in the NY Times titled - The Evidence Gap - Weighing the Costs of a CT Scan' Look Inside the Heart, Alex Berenson asks a simple, yet hard to answer question - is using heart CT scans worth it? The timing of the article was coincidental but was at the same time of Tim Russert's unexpected passing. Unlike many articles since Mr. Russert's death, this one asks us to think before we blindly believe that newer is better. Is there evidence-based research that says these procedures will save lives? From the article:

  • Increasing use of the scans, formally known as CT angiograms, is part of a much larger trend in American medicine. A faith in innovation, often driven by financial incentives, encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older techniques. Patient advocacy groups and some doctors are clamoring for such evidence. But the story of the CT angiogram is a sobering reminder of the forces that overwhelm such efforts, making it very difficult to rein in a new technology long enough to determine whether its benefits are worth its costs.
  • Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care.
  • No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments.
Bottom line? You and I are paying more for very expensive therapies that may not be better for us, but certainly appear cooler and sexier because they are newer. Those doctors and patients who dare to ask for proof will feel shunned. The former will be unable to make a living because the public demands these newer tests and will take their business to those who they perceive are giving them the best care even though there nothing to support that belief. The latter will feel like something is amiss even as their colleagues and friends flock towards these treatments even though it won't make a difference in their health, except for making them poorer. The pressure not to follow through is intense.

What to do? Be very skeptical. Align yourself with doctors who don't tout the latest therapies, except in the case of cancer treatment where the newest can be the difference between life and death. Seek out information. Hope that reporters like Mr. Berenson and authors like Shannon Brownlee can make their voices heard loud and clear, because it is unlikely that doctors as a group can avoid the seduction of new technologies, particularly since it drives more business and revenue.

Because if the media can't get enough of us to ask these important questions, is newer better, is it proven, you and I will simply pay more thinking we are getting better care, when in fact we are simply wasting money and getting no better care.

Monday, July 14, 2008

Tim Russert's Legacy on Heart Disease

Tim Russert's untimely death from heart disease has appeared to have many focus on decreasing their risks by quitting smoking, exercise, decreasing blood pressure and taking cholesterol lowering medications. Kudos to being unbiased in reporting that many of the fancy hi-tech scanners don't help determine whether a future heart attack is imminent. As the reporter correctly pointed out, no test is perfect.

The report also clarifies that Mr. Russert had everything humanly possible to decrease his risk from America's number one killer.

Saturday, July 12, 2008

Medicine Loses Cardiovascular Surgeon Legend - Dr. Michael DeBakey

The world of medicine lost one of its legends, Dr. Michael DeBakey at age 99. He was the creator of many inventions and surgical techniques, including one named after him, which continue to save lives today. He benefited from his own surgical technique when he had an aortic aneurysm dissection repaired at age 97. The fact he received surgery when so many others at that advanced age would have never been offered the chance speaks to his greatness and the tremendous pressure as well as loyalty and obligations his surgical colleagues felt that something needed to be done. To be fair, Dr. DeBakey worked into his 80s and was in good health at the time of his aortic dissection.

Probably hundreds of thousands of patients, if not more, have directly benefited from his ideas which are the standard for cardiothoracic surgeons.

There is no one like him in medicine today. There will be no one like him for generations to come.

Monday, July 7, 2008

Executive Physicals - Not Worth Your Money

FORTUNE recently published an article about executive physicals. These are where companies have sent their top executives to get health screenings done by prestigious institutions like Mayo Clinic and Stanford. If you get a free "executive physical", then you should take it, but let's not fool ourselves, it isn't "the Best Checkup You'll Ever Get" (Fortune June 23,2008). While some tests are cool and interesting, i.e. pulmonary function tests and ankle-brachial index, they provide no additional value to patients who have no symptoms. The vast majority of tests offered are the standard of care. The challenge is as patients we need to demand them because they are routinely offered in this country only 55 percent of the time (including the ultrasound to scan for an abdominal aortic aneurysm for men over age 65 who have ever smoked).

For thousands less, you can get the same care, if you have time to research what to get and when to get it. Otherwise if we don't have the time or the expertise, we outsource whether hiring a financial advisor or having an executive physical.


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