Saturday, February 5, 2022

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.













Wednesday, December 16, 2020

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


Saturday, August 1, 2020

COVID-19 Vaccine Trials Need to Be Based on Good Science

It is 2020 and we still have to remind the health care decision makers that data need to be collected, analyzed, and reported by race, ethnicity, and gender. The reason behind this push to have meaningful inclusion of diverse population is that it is good science; and, to not do so may have dangerous consequences. This is especially true for clinical trials as they are meant to provide information that is useful about anyone who will use it or take it. Here is our OpEd piece on COVID-19 vaccine clinical trials that appeared in The Hill.

Buena Salud® Guide on Understanding Depression and Enjoying Life

As COVID-19 began to change our way of life I knew that this would be a hard time for most people and that many people would need support. I wrote the first edition in 2011 and because of how the science has advanced and how our expectations have changed what started as an update ended up being 90% new plus 92 endnotes. 

Life has changed and what is needed is a combination of science, clinical insights, and the lessons learned from many others. There is much that we can do on our own to make our lives better and when we cannot do it alone...there are many options for treatment.

The book is available at Amazon and at your local bookstores. 
Here is the link for English edition and for the Spanish edition

Wednesday, July 8, 2020

COVID-19 Requires Hospital to Rethink The Patient Experience

Keeping patients and health care workers safe is more than cleaning surfaces and having people tested for COVID-19 four days before they come from a procedure. It also means thinking about exposure, viral load, and ventilation. The time a patient spends in a hospital or health care facilities must be minimized for the health of the patient and all those who work in a health care setting. Procedures need to be recalibrated in real time to take into account the changing realities of COVID-19. It is not about having to wait; it is about the extra time spent possibly being exposed or exposing others.

For example, it is unconscionable that Georgetown University Hospital asks patients to check-in 2 hours before they are taken in to start the prep-op for a procedure. Good management practices would find it unacceptable that the process should take 2 hours. In the case that I witnessed the process actually took less than 20 minutes but the patient had to be there 2 hours before and then ended up waiting an additional hour because the other procedures were delayed. Of course there is paperwork that needs to be done, but much of that can be, and is often accomplished by phone or online.

I contacted the hospital by email about my concerns. The “Patient Advocate” responded in a way that made clear that they were an advocate for the hospital. I eventually called Dr. Michael Sachtleben, President, MedStar Georgetown University Hospital and Dr. Lisa Boyle, Vice President of Medical Affairs kindly returned the call. I emphasized that especially now, under the current circumstances, 2 hours should be unacceptable to all. For certain what is required is timely action and not the process of a committee to agree that 2 hours is too long. The goal must be to reduce time spent in the hospital as much as possible. No excuses. Following pre-COVID-19 standard operating procedures is dangerous to some and fatal to others.

I will see if there is any change as I will be taking my patient back for a repeat procedure. 


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.