Sunday, February 28, 2010

Interested in the history of childbirth?

If so, I invite you to listen to Doctors Talk, tomorrow, 3-4 PM CST, when we interview Dr. Randi Epstein, author of GET ME OUT:  A HISTORY OF CHILDBIRTH FROM THE GARDEN OF EDEN TO THE SPERM BANK.  Should be interesting.  I'll also have a guest co-host on the air with me--an incredible nurse midwife named Mary.

If you live more than 500 feet from the coat hanger that broadcasts WHPKs signal, simply to the program live here on the station's web site.

The good news about the recession

Contrary to what you might have expected, population health actually improves during an economic recession.  Possible explanations include the increased time individuals have with their families during a recession, and the surprising fact that overeat, smoke, and imbibe less than when the economic times are good.  Despite my concern for population health, I am still ready for this recession (as well as this winter) to be over.

How would you like to be a TV star?

Or at least get paid to star in an advertisement for a prescription drug?  Frankly, it often puzzles me why patients put so much trust in specific medical advice from friends who have no medical training, or sometimes worse, little medical training.  In  almost all other countries, pharmaceutical direct to consumer advertising on TV is banned.

Should you care if your doctors' reimbursement is cut by 21%?

The absence of public awareness about the fact that their doctor will receive 21% less for service rendered to a Medicare patient compared to what they received in February is a bit troubling.  This may be a wake-up call for physicians.  If these payment cuts continue, it will only become harder to find a doctor who will see you if you have Medicare.

Will decreasing physician payments solve our healthcare problem?  One leading health economist explains that it physician salaries only account for 10% of healthcare spending in the US and that it would be much better to "pay them very well for helping us reduce unwarranted health spending elsewhere."  Sounds good to me.

How much will your health insurance premiums cost you in 2020?

Numerous groups suggest that if congress succeeds in doing nothing in terms of health insurance reform, as it seems to be doing quite well, you will have much less discretionary money because your insurance premiums will soar.  Specifically, "[t]he typical price of family coverage now runs about $13,000 a year, but premiums are expected to nearly double, to $24,000, by 2020, according to the Commonwealth Fund. That equals nearly a quarter of the median family income today.  -source.

If doing nothing will be so expensive to us, wouldn't it be nice if there was a bill that the Congressional Budget Office determined would be either budget neutral, or actually save us some money?  This is exactly what the CBO said about the bipartisan, Wyden-Bennett Healthy Americans Act.  Ezra Klein called this "The Idea that Could Save Health-Care Reform."  If this is the case, why isn't anybody talking about it?  We'll be talking about this on Doctors Talk tomorrow.  Let's start a grass movement effort here--call your representative (phone numbers here) and your senator (phone numbers) and insist that they give this bill a hearing.

When parents refuse to have their kids vaccinated

should pediatricians refuse to see these children?  Apparently, 16% of pediatricians fire the patient.  But doing so eliminates the possibility that the parents will change their mind after educational efforts.  Certainly an interesting case of patient autonomy vs. physician autonomy.

When I was growing up, we only needed warnings not to stick anything smaller than your elbow into your ear.

The FDA recently issued a warning about the risks associated with lighting a candle on fire and then sticking it in your ear.  Wow.  Dr. Roazen does a nice job of detailing why ear candling is just about as effective as picking your nose for the treatment of flatus and other disorders.  I'm not sure which is more about the future of the United States, that it is necessary to advise its citizens about the dangers of ear candling or this.

The lesson is clear:  the only thing you should regularly put in your ears is Doctors Talk.

Interesting phone call to my Congressman's office

Two days ago, I woke up and was telling my wife how disgusted I was with the federal government's response to the Wellpoint rate increases.  In a nutshell, individuals residing in California that are insured by Wellpoint were recently informed their insurance rates will be going up by 39%.  HHS's response has been to invite Wellpoint CEO to Washington to explain why they are increasing their rates on individuals.  My disgust with this is that the real reason Wellpoint is able to hike rates on individuals buying their possibilities is because under the current, archaic tax laws, there is little competition when it comes to individual policies because there is such a tremendous tax advantage to purchasing health insurance through an employer.  Eliminating this unfair advantage people get when they purchase insurance through their employer rather than as an individual would go a long way towards transforming our health care system.

Getting back to the ranting and raving with my wife--I told her I was going to call my Congressman and find out why he wasn't supporting such a reform plan.  I called Congressman Lipinski's office at about 8:15 EST, and I am pleased to tell you that I was talking to the Congressman at 9:00 AM EST.  At this point, my confidence in our government was already being restored.  He informed me that he was a cosponsor of the House version of the Healthy Americans Act, which would eliminate the unfair tax advantage.  By the time he told me that this bill had bipartisan support in the Senate, I was really starting to wonder why Americans weren't demanding more of a hearing of this approach.  I encouraged Congressman Lipinski to continue pushing this approach.  Do you think now is a window of opportunity for this approach to get a hearing?  Would you call your Senator and Congressman and demand a hearing of this approach?  By the way, the bill is only 170 pages long.

Tuesday, January 26, 2010

Why doesn't the CDC does not recommend routine HPV vaccinations for boys?

Because it costs too much.  More than $100K per year added.  By comparison, kidney dialysis costs about 85K per QUALY.

Is this a model for health care reform?

Duke's Prospective Health Program is trying to change medicine's emphasis on treating to disease to one of preventing disease or minimizing complications.   By working with patients individually to develop a unique approach to each patient, it seems to be working.

Saturday, January 23, 2010

Only thing you can say about this story is that it is quite disturbing...

Too sad to make any wisecrack about this one.

Everything you thought you knew about circumcision...

may be about to change.  Or, the more things change, the more they stay the same.

Would you prefer not to die of a heart attack?

Then please stand up while you're reading this article re the harmful effects of sitting still while reading.  But how are you supposed to avoid sedentary behavior if you have a desk job?  This may be the answer.

It's midnight. Do you know what your child's lipid levels are?

If your child is one of the 33% of obese children in the US, then the America Academy of Pediatrics recommends that lipid testing be done.  A recent CDC study revealed that 24% of boys and 14% of girls have at least one abnormal lipid level.  Lipid lowering therapy is recommended for persistently abnormal levels not responding to improvements in nutrition and exercise.  According to this study, "less than 1% of adolescents had lipid levels high enough to warrant drug therapy according to AAP guidelines."

Should animals be able to sue their owners?

Some have made this argument, which might prevent medical advances requiring animal research.
What do you think?

Friday, January 22, 2010

To me, this is sickening

I have read Paul Offit's book, The Cutter Incident, and found it to be an interesting book about how 40,000 children became sick, including 200 that were paralyzed, after receiving the polio vaccine when it was first released.  I also interviewed him on Doctors Talk when the show was broadcast on WJOB.  I was saddened to read in WIRED that he has received death threats for his pro-vaccine stance.  And now to find out that he is being sued because of some of his statements in that article--I am sorry, I think I have to go puke.

What can you do personally to address your state's fiscal crisis?

Call your state representative and recommend that your state's Medicaid program discontinue coverage for cosmetic procedures such as circumcision.  Currently, the American Academy of Pediatrics does not feel that the benefits of circumcision are enough to recommend that all boys be circumcised.  If that is the case, why are 34 states paying for this elective procedure?

Should people signed up be organ donors get priority over others?

Lifesharers gives priority to fellow organ donors.  What do you think?

Wednesday, January 20, 2010

Feb 1 episode of Doctors Talk

1.  an update on the world's smallest baby ever born in the world (that also went home)
2.  do antidepressants work?  we'll talk about a recent JAMA article re this question
3.  man on the street interviews
4.  are you smarter than an OB?  how about a pediatrician?  call in and compete with one of the hosts in answering questions....

Interested in a free trip to Mexico or Guatemala?

Times are tough for doctors, so there is no question I'd sign up to be a control in this vaccine study.  If you're willing to be a guinea pig, they'll give you a trip to Mexico or Guatemala if you put their vaccine patch on that might protect you against travelers diarrhea.  Adverse side effects?  They don't know--that's why they're doing the study.  Send me a postcard.