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

Saturday, May 13, 2017

Considering Arthroscopic Surgery for Your Degenerative Knee Disease?

According to the most recent recommendations published in BMJ it seems that your answer should be,"No." The exceptions are young patients with sports-related injuries, patients with major trauma, and those with a true locked knee. This is a huge concern as according to the article 25% of people 50+ years old have degenerative knee disease. 

While a health care provider may be an expert on this procedure and may have been doing it for years...the time has come to rethink when to do it or have it done. The evidence is that in most cases arthroscopic surgery for degenerative knee disease does not produce the desired outcome.

There will be more research to come...in the meantime the challenge is to develop new interventions which are truly helpful. 

Friday, February 17, 2017

Back Pain

The data indicate that most people with back pain that lasts less than 12 weeks get better regardless of the treatment. Some people get better even without treatment. Taking all this into consideration as well as all the available evidence, the American College of Physicians recently published new guidelines for the treatment of back pain. This was the first revision since 2007 and what is recommended is a departure from past practice. 

There are surprises in the new guidelines, e.g., for acute back pain the recommendations include superficial heat, massage, and acupuncture. There are also very specific guidelines as to the medicines a person should take. Take a look at the recommendations and share them with a friend. 

The science behind wellness is growing. To make the best decisions for our health and the health of those we care for, we each need to know the latest science based information. 

Monday, August 15, 2016

Another Limit of the Electronic Health Record

Do most people take the time to review their medical record? Of course not. In my case, what was supposed to be a tool to improve care missed the mark.

For 35 years I had the same internist. As he changed practices I went with him. Whether he was a preferred provider or not it was reassuring to know that he had my whole health history at his fingertips. He could flip through the decades of my health history and see the changes in my life. It was wonderful to feel the security inherent in the vision of continuity of care.

All that came to an abrupt stop when this past year my internist retired. I was all prepared to find a new internist when I realized it would be helpful to have a copy of my medical record. Imagine my surprise when I discovered that 31 years of my medical history were gone.  What had happened?

It seems that when my internist changed his practice to being part of MedStar my paper records did not go with him. MedStar was on an electronic system and the health record they had was only for the last four years he had been with them.  All previous paper records were not with MedStar. When I asked what happened to 31 years of my health record the MedStar person referred me to my internist’s former practice.

It seemed that while Medstar was willing to take the patients that came with the physician the paper health records of the patient were not welcome.
The situation became more problematic as I reviewed my electronic record.    There were diagnoses for conditions I never had and prescriptions that were never given.

My suggestion to everyone? Carefully review your medical record and keep a copy of it for yourself. The life you end up saving may be your own.