13 September 2013

Statins May Prevent Cataracts

Apparently, the drug companies are getting nervous about how long statins are going to survive on the market. With the side effects of causing diabetes, muscle wasting, and a few other problems, they should be. Now they are studying new areas in hopes that this will encourage people to remain on statins. Therefore, I read this article with a lot of skepticism and wondering if we will see more studies confirming this study. I would also call attention to this article in Medscape declaring statins linked to musculoskeletal injury and this article in WebMD linking statins to muscle/joint problems.

Of course the authors did not call for further studies and we are not told where or if the study was published since it may not be peer-reviewed. This makes me even more a doubter of the results of the study. Professor Kostis is the only person quoted in the article and no educational institution or information is given about this professor.

Professor Kostis states, “We therefore investigated the relationship of statins and cataracts in a meta-analysis of 14 studies selected after detailed review of the medical literature. To our knowledge, this is the first meta-analysis on the topic. The meta-analysis included 2,399,200 persons and 25,618 cataracts. The average duration of treatment was 54 months and average age was 61.”

Yes, this is a lot of people and cataracts, but I am not sure it is of value. The more I analyze the report the more I have doubts about the source, Stone Heart Newsletters.  Professor Kostis is never identified or associated with an institution. Is this a study and where was it published? None of this information is included in the article

I will still blog about this, but only from the standpoint of this being another poor example of research and coverage by a fair source. I made a comment to this at the bottom of the article, but I have been ignored and received no answer. Therefore, it is my belief that Big Pharma promoted the article and maybe even the research and they do not wish to have the results confirmed or denied. Sorry, but I can't accept the information as it is presented and have to view the information as unreliable and even possibly a farce.  I also wonder if the benefits will now outweigh the risks

12 September 2013

The Dehumanizing of Patients

When the first discussion took place in June 2012 and then when the Diagnostic and Statistical Manual (DSM5) was published in December 2012, I have been reading what has been published by other writers and psychiatrists and psychologists have been saying or writing. Finally, an author that I am able to understand and more importantly agree with has written a blog about topics covered in DSM. Much of the discussion on mental health really dehumanizes patients and throws medications at patients when this may not be the best.

I would ask that you read his blog for you own understanding, as I am biased and pleased that he sees his patients as humans and how they respond to positives given to them rather than just a diagnosis and another medication to solve the problem. Medications may be necessary for some mental health issues, but the wholesale prescribing of medications will only lead to dependence on medications and not a treatment, which will help the patient manage their lives in a positive way.

Because of the way Dr. Dan Peters describes things, much of the following will be quoted. “The questions that eat at me during my day as a psychologist and at night as a person searching for answers are:

#1. Is it possible to accurately identify mental health “issues,” “illness,” or “disorders?” versus extreme ranges within the sphere of the human condition?
#2. Even if it is possible to identify these conditions, does it determine the course of “treatment” or “intervention?”
#3. If so, is there a “treatment” for every identified “condition?”
#4. Does it mean there is a treatment that works?
#5. Do you need a diagnosis to get help?

Without going into detail about some of the changes in the newest edition of the DSM, some diagnostic categories have been added and some diagnosis “thresholds” have been lowered. This means that you need fewer symptoms to “meet diagnostic criteria.” Here are some examples of concerns with the new DSM-5:

#1. Temper tantrums will now be diagnosed as Disruptive Mood Dysregulation Disorder
#2. Normal forgetting will now be diagnosed as Minor Neurocognitive Disorder
#3. Gluttony will be diagnosed as Binge Eating Disorder
#4. Grief will be diagnosed as Major Depression
#5. First time substance users and college partiers will get a diagnosis of Substance Use Disorder
#6. Everyday Worry will be diagnosed as Generalized Anxiety Disorder”

The following is important and very meaningful. “And what’s the number one treatment for all of these diagnoses? Medication. In my 20+ years of working with children, adolescent, adults, and families, I have found some simple and profound truths. First, if you talk to people about what is wrong with them and causally assign diagnostic labels to explain them, they feel badly about themselves and it plays into their low self-esteem, self-confidence, and self-worth. Next, if you help them to better understand their strengths and weaknesses, and help them to develop tools to cope with life, all of the aforementioned increases. Lastly, if you focus on their strengths, rather than their “deficits,” “disorders,” and “illness,” they become aware of neglected and unknown aspects of themselves that they can and do use to navigate life and meeting their goals.” Bold is my emphasis.

I ask that all mental health and medical providers, educators, administrators, adults, and parents think critically when making or accepting a diagnosis.
Ask yourself:

#1. What is the purpose of making or accepting a diagnosis?
#2. Does it fit my or my client’s experience?
#3. How will I explain the diagnosis to my client?
#4. What does this diagnosis mean to me (client)?
#5. Will this diagnosis help my client (help me) achieve my goals?
#6. Does the diagnosis explain a normal human emotion or condition?
#7. What are all the possible helpful interventions? Can medication wait?
#8. What is right with my client? What is right with me (client)?

Those of us in the field of mental health and medicine have a minimal obligation to do no harm. Further than that, we have an obligation to improve the life conditions of our clients. Our current mental health and insurance system makes this very hard, but nothing in life that is worth anything is easy.”

I am very thankful he included “do no harm” in the above paragraph and from the tenor of his blog, I understand him to mean just that. Many of his colleagues may not care when they find it easier to pass out pills. Don't misunderstand me, some mental health issues do require medications, but as Dr. Peters points out, medication does not solve all problems or should it be the end-all for all mental health issues.

11 September 2013

Are Laws Needed to Control Diabetes?

With the ever growing population of people developing diabetes, some are turning to legal remedies for stopping the tide and the role that law can play in serving as an effective health tool. Honestly, I had never thought legal remedies would be applied, but the more I read about this study the more I realized that some of the most useful legal remedies are not even mentioned in the press release. When the American Diabetes Association has legal tools available to use against discrimination, why should there not be other legal tools available.

I may be criticized for this, but without legal remedies to force doctors to become current in their knowledge, prevention, and diagnosis of diabetes, patients will continue to bang their heads against the wall. Doctors are the first line of defense and as long as they continue to ignore diabetes, this diabetes epidemic will continue. If stiff legal penalties are required to bring doctors into the twenty-first century, so be it.

The law can be a critical tool for health improvement as long as it does not jeopardize our freedom rights. Assessments reported in a new study published in the American Journal of Preventive Medicine indicates that federal, state, and local laws give only partial support to guidelines and evidence-based interventions relevant to diabetes prevention and control. Bold is my emphasis.

It is sad indeed that nearly 26 million people in the US have the disease and about one-fourth are not aware they have diabetes. Facing about 30 percent (about 1 in 3 people) having diabetes by 2050, it is time for action. Risk factors for type 2 diabetes include limited access to nutritious food, limited opportunity for physical activity, socio-economic conditions, and genetic disposition. While many well-crafted guidelines and recommendations for diabetes intervention exist, the incidence and prevalence of diabetes continues to escalate.

Lead author, Anthony D. Moulton, PhD, Laboratory Science, Policy and Practice Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, states, "Laws, including statutes, ordinances, and government agency rules and regulations, can support interventions to prevent and control disease in various ways."

Dr. Moulton continues, "Laws can help shape environments to reduce exposure to some type 2 diabetes risk factors and encourage preventive behaviors, and laws can authorize or require provision of prevention-oriented information designed to change the behaviors and cultural norms that affect risk."

Investigators analyzed the laws further to determine whether they contained provisions that require, incentivize, or encourage healthcare providers, insurers, employers, schools, child care centers, restaurants, government agencies, and others, to take action consistent with a given guideline.
Investigators concluded that:
  • Implementation of guidelines for evidence-based interventions for diabetes prevention and control is incomplete
  • Many opportunities exist for exploring uses of law to improve adoption”

Dr. Moulton's conclusion is also worth quoting, "Laws that are demonstrated to be effective, designed to support proven public health and clinical interventions, and well implemented can give crucial support to strategies that address public health priorities and to wider adoption of evidence-based guidelines. Law is a key tool for scaling and sustaining effective interventions at the national level. Public health practitioners and policymakers nationally can intensify their exploration and evidence-based application of law to help slow and potentially reverse the accelerating threat posed by the diabetes epidemic."

Dr. Moulton does not state this, but I think until doctors educate themselves about diabetes and step up to the challenge, we will not achieve any reduction in the diabetes epidemic. Doctors that make statements, such as – “Watch what you eat, your blood sugar is a little high,” or “Curb your sugar intake,” should be penalized for not making a diagnosis or giving a complete description of what the blood glucose readings mean for the patient. ONLY then will we see a possible slowing of the number of diabetes cases. The 15 minute office visit or less, will do nothing to slow the diabetes epidemic and blaming the patient needs to end.

10 September 2013

Obstructive Sleep Apnea When Having Surgery

If you suspect you have obstructive sleep apnea (OSA), and you are facing surgery, be sure to make this known to the anesthesiologist. This will alert this person to the possible complications you could develop from anesthesia. The following questions should give you some guidance to determine if you may have sleep apnea.

Answer the following questions truthfully. Remember that you will be the person suffering from anesthesia and unless you wish to spend time in the intensive care unit (ICU), it is wise to answer honestly and discuss this beforehand with the anesthesiologist. Going into an operation under anesthesia is a poor time to let vanity get the better of you.

#1. Do you snore loudly (loud enough to be heard through closed doors)?
#2. Are you often tired, fatigued, or sleepy during the daytime?
#3. Has anyone observed you stop breathing during your sleep?
#4. Do you have or are you being treated for high blood pressure?
#5. Is your body mass index > 35 kg/m2?
#6. Are you over 50 years old?
#7. Is your neck circumference > 40 cm?
#8. Are you male?

A person is considered to be at high risk for OSA if he or she answers yes to 5 or more of the 8 questions. This information has value beyond the benefits to anesthesia care. After being diagnosed with OSA, the patient can be referred to an internist or sleep physician to receive proper long-term treatment after the operation. Being a person with OSA myself, I know how important this is and I would not go back to my problems before sleep apnea treatment.

Having surgery done without knowledge of sleep apnea and in a hospital without an ICU may mean that you will not survive the operation. In the study, surgeons were not able to identify 90% of the patients with severe OSA. Anesthesiologists did not diagnose 53% of these patients. About one third of the patients with sleep study-identified OSA had only one or no cardinal symptoms of OSA. This indicates that these asymptomatic, "silent" patients are not going to be identified purely by history obtained by the physician.

One group of patients that is concerning to the anesthesiologist is surgical patients with undiagnosed OSA. Anesthesiologists also worry that such patients will be at higher recovery risk, especially when discharged home on opioids for pain. These patients may also have a higher incidence of difficult intubation, postoperative complications including delirium, increased admissions to the intensive care unit, and longer hospital stays.

If a patient is known to suffer from sleep apnea, then the anesthesiologist can be extra careful in properly managing opioids for pain relief and weighing other factors such as the risk for postoperative respiratory depression. This also opens the door for other combinations of analgesics or regional anesthesia to be considered. These patients warrant extra and longer monitoring in the recovery room. Initiation of continuous positive airway pressure (CPAP) perioperatively is also likely to be useful. A patient with undiagnosed OSA presenting for surgery would not receive such care if the diagnosis were unknown.

09 September 2013

Connected Health – Generates Quality Care

This is a take-off of a blog posted recently by Nancy Finn on her site. I read her blog with interest as it was so much different from another article also posted recently on Medscape. Nancy's blog indicates an extremely large dollar savings while the Medscape article reports no savings.

Now before I go further, the UK study was a once monthly telephone conference as a 1-on-1 health coaching session. Nancy covers a broader range of telemedicine. She brings in the internet, telecommunications, video technology, smart phones, robotics, digital sensors and scanners. This is all used to provide patients in remote, medically underserved areas, or those who are homebound, immediate quality care. This makes it easy to understand why the UK study was unsuccessful.

Enough about the UK study, Nancy's blog gives hope. Considering the range of services she is talking about, there is hope that her projected savings is possible and even if not met, large dollar savings should still exist. What I enjoy about Nancy's blog is the fact that her ideas are not limited by technology, but embraces technology to care for patients. From using an interface to hook up patients with appropriate healthcare specialists, speech therapy, and mental health counseling when and where it is needed. Also of interest is the assisting of patients with chronic diseases to manage there care remotely.

Nancy states, “The Center for Connected Health and Partners Home Care did a pilot where over 500 heart failure patients were monitored remotely. Home health nurses collected vital signs, including heart rate, blood pressure and weight, using simple devices in the patient’s home. The information was sent daily to a nurse, who could identify early warning signs, notify the patient’s primary care physician, and intervene to avert a potential health crisis. The program resulted in reduced hospital visits and improved quality of health care for the patients.”

This is the first I have read about a “smart” pill bottle being used to detect when a patient at home did not take their scheduled medication. The pill bottle would send a signal to an ambient orb in the patient's home to remind them to take that medication. I can see that this could reduce the chances of a medical crises and even an emergency room visit. This could alone save big dollars.

Using technology could make the workload for doctors' decrease and provide better care for patients. Now I will need to be alert to see if state medical boards will fight to prevent these technologies from happening and if doctors will welcome these technologies or try to say that it is robbing them of revenue when the Affordable Care Act becomes a reality. There are many areas in the US that could benefit from modern technology.