Finally--- New Guidelines on Vitamin D Suggest Against What Many Have Been Told

"Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline" [Link] is free and available. Please note that these guidelines are consistent with what many have been saying for years (see my blog on 8/21/18 and 2/6/20)...the routine screening for Vitamin D in healthy adults, the target levels for 25(OH)D and the need for taking Vitamin D supplements were not based on sound science. These new guidelines will save people from unnecessary testing and reduce the out-of-pocket costs for people. Some highlights:

General Recommendations: Suggest against routine screening for 25(OH)D levels in healthy adults, adults with dark complexion, and adults with obesity. Suggest daily, lower-dose vitamin D for those aged 50 years and older who have indications for vitamin D supplementation or treatment, rather than intermittent, higher-dose vitamin D.

Thresholds for Vitamin D: The panel did not establish specific 25(OH)D thresholds for disease prevention due to the lack of supporting clinical trial evidence. Previous target levels for 25(OH)D, such as 30 ng/mL (75 nmol/L), are no longer endorsed.

Nonpregnant Adults (<50 years): Suggest against empiric vitamin D supplementation above the Dietary Reference Intakes (DRI) established by the Institute of Medicine (IOM). Suggest against routine 25(OH)D testing in this population.

Adults (50-74 years): Suggest against routine vitamin D supplementation above the DRI.Suggest against routine 25(OH)D testing in this population.

 

What women want...information and no commercials

By listening to women and working with a fabulous group of experts we found that Latinas and their health care providers want information on how to be as healthy as possible that (1) does not have any commercial interest driving the message and (2) inspires and reinforces healthy behaviors. As a result we developed a three day seminar that includes the different systems in our bodies and how they interact, risk factors you can control, seeking well-being, importance of reading food and product labels, and much more.  Over 640 community health workers and community leaders have completed the three day seminar.  

We also recognize the limited time many of us have so we distilled the information to a two hour webinar that is self-paced. We released it today to celebrate International Women's Day. It is available in English Link and Spanish Link.

Let me know what you think.

Harmful Health Outcomes (HHO)— Are All About You

To have world class science and the best health outcomes means moving forward in bold ways that will improve the lives of scientists, health care providers, and people. 

For more details read "To advance science we need to address 'otherness' " in Nature Human Behaviour published on 2/2/24. You can access the free online version here or for a free ePrint please click on this link.

Dear Patient---I Only Have Some of Your Health Record.

Most patients believe that once they grant permission that a health care provider has access to their full health history. In fact, what is shared is limited in many ways. Jack Lewin and I had our Commentary on Interoperability and the need for the full patient record published in StatNews.  

Some medical records are very lengthy and go back decades. Is all that information really necessary? It depends on the situation. One reader from Norway shared their story.

"This is interesting, since I recently witnessed how lack of available medical records may change a planned surgical procedure just minutes before an operation.

Norway has less inhabitants than Manhattan, but the principle of making medical records available to all medical health providers, is universal. Over here, Southern Norway has a system whereby all MDs and all hospitals may access any patient medical record, - if (note!) the patient has been treated in southern Norway. If a patient has had an operation in Northern Norway, a health provider in Southern Norway will not learn about this, unless the patient mentions it. And the same goes the other way around, - south vs. north. To my surprise this system has remained for the last 10 years, without health authorities doing anything about it.

On December 4 I was going to have a hernia operation in Bergen, - on the southwest coast of Norway. The hospital has a section specializing in hernia repair with 3 surgeons performing only this kind of operation. They have extensive experience with laparoscopy (lap), and as I met my surgeon on the morning of the operation, she told me that the lap method was their standard procedure, unless the patients' condition dictated otherwise. I then told her that I had been operated for intestinal loop (blockage) back in 1970 in Bodø (Northern Norway), and she was surprised. She had not read anything about that in my medical record, and I showed her the remaining sutures. That made her change her mind regarding her planned way of repairing my hernia just minutes before the operation as the 1970 operation had actually accessed both the stomach lining and cut a muscle. So she decided to make an open repair."

What do you think about the need for access to the full patient record? If AI is seen as the solution how can we expect AI to guide clinical decision making if the data on the patient are at best incomplete. 

We have a long way to go...and we need to get there soon.

View "Real or Synthetic" and Share the Wait2Click Challenge

Over the past year The Healthy Americas Foundation worked with The Carter Center and the creators of the comic strip "Baldo" to develop "Real or Synthetic?"  These materials explain how information people receive is meant to engage them quickly. These resources are available in English and Spanish. 

The challenge is not to click, especially when something quickly grabs your attention. Here are specific cues to look for. 

1. When you have a strong and immediate emotional response to the content or an image. False information often relies on strong emotional appeals, to get people to believe it and share it. A story or claiming vista is often specifically designed to make you angry, scared, or overly excited. Moreover, it is increasingly easy to create images that are not real and increasingly difficult to detect when they are not real. 

2. The sender asks for personal information or money. They may not ask the first time they contact you, but do so after a series of interactions when they have earned your confidence. 

3. The sender claims to have been referred by someone you know. Contact the person, preferably by phone, and check.

4. Promises a quick solution to a problem.

5. If it sounds too good to be true, it usually is not true. There are many fact-checking websites and organizations that verify the accuracy of claims and news stories. Websites like Snopes.com, FactCheck.org, and Politifact.com can help you determine if a piece of information is true. For Spanish go to https://factchequeado.com

Most important of all invest 30 minutes of time and watch the free webinar wait2click.org

New England Journal of Medicine and my article, "Beyond Diversity— Time for New Models of Health." It is all about leadership.

Although I had collected data for my dissertation in the US, Colombia, and Brazil, my committee told me not to use the word culture as culture was not a relevant variable. That was over 40 years ago. Fast forward to the summer of 2021 when I submitted an article to JAMA. One of the comments in the rejection was, "The section on cultural themes does not make sense."

It was not the first time I heard that comment so I submitted my article to New England Journal of Medicine (NEJM). The thoughtful editors had specific questions and very helpful, insightful suggestions. They accepted my article for publication and here is the link to the online version, "Beyond Diversity— Time for New Models of Health." The print version is in the New England Journal of Medicine, Volume 386:6, February 10, 2022, Pgs 503-505.

But this is not about my article, it is about how an institution and its leadership leads. NEJM is an example of leading through words and actions.  The closing sentence of NEJM's October 7, 2021 editorial "Striving for Diversity in Research Studies" clearly stated, "From this perspective, diversity in research isn't simply a matter of social justice. It's a critical part of learning how to improve the health of every person." NEJM's actions were to outline new requirements for future submissions for publication that included a supplementary table on the representativeness of study participants. Words and actions. 

I am hopeful that my article will be widely read and stimulate healthy discussions. Consultant driven solutions, e.g., an organizational theory of change, setting up DEI committees, or appointing a Chief Diversity Officer, may create activities but are rarely the solution for meaningful outcomes.

Change happens through leadership and that starts with each one of us.

More on Sadness, Depression, and COVID

 Just want to share my two recent articles on depression that were published in The Hill.

Sadness is not Depression

Holidays and Stress