Thursday, February 6, 2020

The Evidence on Vitamin D is Clear

In August 2018 I wrote my first blog on Vitamin D and wondered how long it would take for clinical practice to change. Much more has been documented since then to move prescribers to rethink and change what they recommend.


Even with critically ill patients the benefits were not evident. The December 26, 2019 NEJM original article “Early High-Dose Vitamin Dfor Critically Ill, Vitamin D–Deficient Patients” from The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network concluded “Early administration of high-dose enteral vitamin Ddid not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D–deficient patients."

When it comes to recommending Vitamin D the willingness to change current prescribing behavior is still missingThe lag between the bench and clinical practice is not just a matter of communication; prescribers also have to be willing to change. 

Wednesday, March 27, 2019

High-fructose Corn Syrup (HFCS) and You

While the March 22, 2019  report in Science, "High-fructose corn syrup enhances intestinal tumor growth in mice," may need to be confirmed with humans, it is reasonable to expect that a similar effect will be found with people. At the very least each one of us who shops for food or beverages for ourselves and others should carefully read the ingredients that are listed on the label. And then what? When the product has HFCS...be proactive with your health and and the health of those you love and get something else.

Thursday, January 17, 2019

Saving Money in Health Care

A good way to redirect the discussion on health care costs and savings is by reading our piece on clinical trials. We need to make sure that each person gets the medicines that we know will work for them. This is how to save lives and save money in our health care system.

Tuesday, August 21, 2018

Redo Recommendations Now: Vitamin D, Fake Data, and Hype


We all need Vitamin D, a hormone, but the challenge is in how to measure levels of Vitamin D, how to determine how much a person needs, and when necessary how to supplement it. Over the years it was difficult for me to reconcile how practically everyone I knew had a Vitamin D deficiency. Since we are not all part of one cohort and we are certainly a group that is diverse in many ways it seemed very odd that we all had the same deficiency.

An answer came in two recent articles. First and most concerning was the August 17, 2018 issue of Science article,"Tide of Lies— The researcher at the center of an epic scientific fraud remains an enigma to the scientists who exposed him."(DOI: 10.1126/science.361.6403.636). This analysis detailed that much of what we know about Vitamin D was based on Dr. Sato's fabricated studies. According to the article his work was "referenced more than 1,000 times, and 23 systematic reviews or meta-analyses have included one or more of the 12 trials." Second, on August 18, 2018 A Kaiser Health News investigation for The New York Times, "Vitamin D, the Sunshine Supplement, Has Shadowy Money Behind It," revealed the effect of one person on an entire field of practice.

Both are disturbing commentary on the state of our knowledge...and our sense of responsibility to one another. How fast will clinical practice change to take this fake data and hype into account? How long will it take to change the Recommendations for Vitamin D Supplementation, the Algorithms in medical decision making and AI, and all the other information that we give and have been giving. Given this evidence how do we answer the question, "Do I stop taking my Vitamin D?"

Friday, August 3, 2018

How Can We Do Better...

This has been a year of field research that evidenced that too often efforts to create a better situation ends up compromising a person's health and well-being. Here are three cases to consider.

Heathcare-associated Infections (HAIs)
Frank entered the hospital with pneumonia but upon returning home it seemed that while in the hospital he had contracted an infection of his foot. Several weeks later the infection was much worse and Frank was taken back to the hospital to determine how much of his leg would have to be amputated. There were no plans for rehab. 

In 2011 75,000 patients with HAIs died during their hospitalizations.

Best Practice
After Rosa’s stroke she was told that in order to prevent another stroke she needed to have the blockage in her artery cleared, i.e., carotid endarterectomy (CEA). Rosa knew the risks of the procedure but went through with it. Much to her disappointment, a few months later the blockage had reappeared. One year later she still has the blockage but no stroke.

Translational research is a step in the right direction but the continued lag from the bench (research) to the bedside (clinical practice) is unacceptable. At the same time evidence based medicine (EBM) continues to be undermined by the lack of inclusion and analysis by individual characteristics as well as the tendency of clinicians and insurers to apply a rigid set of procedures that are not nuanced to the person in front of you.

Defining Comfort
Agnes was having difficulty breathing and was taken to the hospital. Her initial diagnosis was pneumonia and a UTI; then, suddenly while at the hospital she had two heart attacks. Her family was told that (1) her heart had stopped working and was severely damaged, (2) there were no treatments available, and (3) diagnostic procedures that were invasive were not possible given her age and fragility. Agnes' family was also told that she would die that night in the ICU. Agnes's family decided that given the damage to her heart that "palliative or comfort" care was the best option for her. Somehow Agnes got through the night and after two more nights in the ICU Agnes was moved to a private room. The family was told she could not go home because the levels of oxygen given were higher than allowed in a home setting.

Comfort care what does that mean? How do we know?




Tuesday, June 27, 2017

Statement on CBO Estimates of Better Care Reconciliation Act
22 million people losing health insurance is unconscionable

“The CBO estimate of 22 million people losing health insurance should be a bill stopper.  This bill was supposed to increase the number of people who have health insurance.  As it stands the legislation is unconscionable,” said Jane L. Delgado, PhD, MS, President and CEO of the National Alliance for Hispanic Health, the nation’s leading Hispanic health advocacy group.

“It’s time for legislators to go back to the drafting table.  The American people deserve bipartisan legislation that will deliver on the promise of insurance for everybody.  Congress must (1) ensure access for people with pre-existing conditions instead of enacting barriers to access that may be a death sentence; (2) roll back Medicaid cuts and allow for rates of growth that reflect the reality of an aging population; (3) ensure an orderly transition that does not disrupt care and ensures states can respond to changes in a way that reduces cost growth without compromising quality and access; and, (4) strengthen and expand the network of community health centers that have a proven capacity to deliver quality services,” emphasized Dr. Delgado.

“The one thing that everybody agrees on is that our system is not perfect, so it is time to start working in a bipartisan fashion and serve the interests of the nation.  The American people deserve better,” concluded Dr. Delgado.

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About the National Alliance for Hispanic Health (The Alliance) 
The Alliance is the nation's foremost science-based source of information and trusted advocate for the best health outcomes for all. For more information, visit: http://www.healthyamericas.org or call the Alliance's Su Familia National Hispanic Family Health Helpline at 1-866-783-2645.

Thursday, June 22, 2017

The New No Gimmick Diet— 
The Buena Salud® Guide to Losing Weight and Keeping It Off

I am thrilled by the review and recommendation by Redbook for the latest book in the Buena Salud® Series. You can order the book from Amazon in English or Spanish or through your local bookstore. Let me know what you think. The process of writing and living the book has been quite a journey.

The other books in the Buena Salud series include:
The Buena Salud® Guide for a Healthy Heart
The Buena Salud® Guide to Diabetes and Your Life
The Buena Salud® Guide to Arthritis & Your Life
The Buena Salud® Guide to Overcoming Depression and Enjoying Life