Little Black Bag

Why are Medical Bills so Confusing?

2008-02-20T00:00:00-06:00

I think this New York Times article does a nice job of showing how insurance companies use an "illogical" system to pay for healthcare services. Of course, as long as it is saving them money and they can continue to turn a nice quarterly profit, why should they change?

Health Plans Put Onus on Insured

Flu Epidemic in the Making for 2008?

2008-02-11T00:00:00-06:00

Well, it's official. The CDC released surveillance results last week of the 2008 Flu season which suggests that we are heading for an epidemic this year.

The 08 Flu season has gotten off to a slow start but in the last couple of weeks has fired back with a vengeance.
The problem seems to be that this years vaccine is not a good match for 2 of the 3 circulating strains of Flu. Therefore, offering less protection from the illness.
The good news (so far) is that the number of deaths and hospitalizations related to the flu has been low.

Be on the look out and remember to WASH YOUR HANDS(a lot!)

CDC-2007-2008 Influenza Season Week 5, ending February 2, 2008

Universal Healthcare in San Francisco

2008-01-29T00:00:00-06:00

For anyone interested in San Francisco's efforts to promote intracity Universal Healthcare, this is the best article I have seen to date explaining the process.

Golden Gate to Health Care for All? San Francisco's New Universal-Access Program

Mitchell H. Katz, M.D.
Certainly a aggressive and "brave" program. I actually applaud their efforts. However, fear what it will mean for the cities economic health. It will be interesting to see how this plays out over the next few years. I'm also interested to know what will happen the first time the program is sued for malpractice.
Good luck San Francisco.

Why Is Paying Attention, So Hard To Do?

2008-01-22T00:00:00-06:00

This is a really fun experiment showing how often we don't pay attention to our environment.

One of the comments on the page suggested that the men be replaced with women. now that would be very interesting....

Change Blindness Video

Zetia Goes Down in Flames

2008-01-14T00:00:00-06:00

A few years back, Zetia came on the market and was going "help reduce cholesterol" for patients who were not at goal despite high doses of Statin therapy. In a brilliant marketing move, the drug companies combined Zetia with Zocor to produce Vytorin, and they put lots and lots of commercials on TV.
Im all for combination drugs. It's always better to take fewer pills but this one is turning out to be a bust.

I was a resident when Zetia came on the market and I remember a teacher who made the comment to me,"sure it lowers cholesterol... but will that actually translate into decreased heart disease?" That always stuck with me and I was determined to avoid the drug until I saw real proof that it improved heart disease. Well, now i'm very happy I was suspicious.

It turns out that Zetia not only did not improve heart disease, it may have actually made atherosclerosis worse. Another unfortunate blow for Merck.

Cholesterol Drug Has No Benefit in Trial

And then of course... will we ever learn? Doomed to repeat history? only time will tell for new drugs.

Genzyme Wins Cholesterol Drug Deal

Just a Little Nostalgia...

2008-01-08T00:00:00-06:00

If you have never heard this before, or it has been awhile. I encourage you to listen again.

Advice isn't worth much. But Mr Baz Luhrmann is right about it being nostalgic.
his song still makes me feel good about human spirit and the common goals we all share.

RepRap 3D Printer

2008-01-08T00:00:00-06:00

I have been following the RepRap technology and the idea of 3D printing for the past year or so and I think this is one of those wonderful feats of engineering that will soon change how we live.
This group of engineers is working on a machine that will essentially replicate and will be able to build fully working 3D objects.
Star Trek style replicators.

It is complicated to understand the implications of this but I think this lecture does a pretty good job.

I love Science. Engineers are awesome and I'm always impressed by what they do.

Adrian Bowyer RepRap Lecture

The best part of it all. They are giving the information away. The Website even tells you how you can cheaply build your own replicator. RepRap

Would You Accept Only $4000 for the Top of Your Head?

2007-12-31T00:00:00-06:00

Wow...
This would be an entirely different story if it was in the United States. A tragic situation however, I really wish the story eluded more to why the man needed surgery.
Was his skull cap diseased anyway?
lots of questions... no real answers, but...

I think this article shows quite nicely the difference in social expectations in the US health care system vs that found in a more socialized system.

$4,000 for a skull cap?

Robot to Help Doctors Talk to Patients

2007-12-31T00:00:00-06:00

Would you like to have a robot help you talk to your doctor? In Japan they actually have invented such a thing. The Japanese Muu Socia robot.

I really hope it never comes to this for me and my patients. :)

But who knows... Maybe the government will decide to mandate all Docs carry one of these little critters in ordered to be paid by Medicare.
You know... to improve healthcare quality.

Looking For A Little Support?

2007-12-31T00:00:00-06:00

I recently found this Site and Thought I would share....

it is a site dedicated to putting like minded people together to form specific support groups. Great idea.
If your looking to talk to someone about a special problem, then give them a try.

dailystrength.org

YouTube for Your Health

2007-12-31T00:00:00-06:00

Finally today....

Just wanted to share one more site I recently found.

icyou.com

Some interesting videos on many different health topics.
Good stuff, but as always, remember that the information is not "validated" and is not guaranteed to be factual.
Watch, Enjoy, and be suspicious. :)

Need Help Understanding Healthcare Coverage?

2007-12-31T00:00:00-06:00

Getting even basic health insurance coverage has become quite cumbersome.

I will be honest... I'm a health care professional and I hardly understand the whole mess.

I can only hope that this sight can help some people understand the system and their options.
Another Argument for a single payer system?

Foundation for Health Coverage Education

Doctor's Dont Do Well in Trust, A New Gallop Poll

2007-12-19T00:00:00-06:00

Let me first start by saying that I often dismiss Gallop polls. I believe they are usually performed via telephone and therefore biased purely due to limited number of people that will actually sit and participate in these surveys. To be honest, I worry about the credibility of someone that is not "to busy" in life to participate in these surveys.

Regardless, Gallop polls are flung around in the media constantly as verbal fodder, and whether I like it or not they do have an affect on the viewing public.

This poll released yesterday (as flawed as it may be) certainly points toward a problem.

Pharmacists Continue To Rank High In Gallup Poll, USA

Not that I believe teachers, nurses, and pharmacist do not deserve their ranking, I do! But that physicians did so poorly. The professionals that should be the most connected and personal adviser someone has, comes in 5th. Well, maybe I should be happy the profession is "in the top tier" but somehow I feel disappointed.
I'm sure I could postulate for hours about why we physicians have fallen from public grace in recent years but honestly it is of little consequence. The entire health care system is broke and Doctors as the health care leaders must take responsibility.
Responsibility to get back in touch with our patients.
Responsibility to remove insurance and corporations influences on our relationships.
Responsibility to be accountable to our patients and to earn their trust again.

i don't know... just what I think.

Beware of YouTube & Wikipedia

2007-12-06T00:00:00-06:00

I should not act surprised to hear that people are beginning to look to YouTube and Wikipedia as "reliable" sources of information, but honestly, I'm shocked and even disgusted by it.
I even hear that college students are even using references to Wikipedia for college papers and research. This is terrifying.

This recent Canadian report suggest that YouTube videos (related to vaccinations) are filled with faults and these misinformed videos are viewed MORE often than educated videos.

YouTube as a Source of Information on Immunization: A Content Analysis

The Internet is a wonderful thing and I FULLY support online research. However, we must view all information as suspicious and consider it's source. Wikipedia, YouTube, and other openly populated informational sights can be a good starting point of information, but they should not be considered factual without further study.
What makes Wiki and YouTube great, is also it's downfall.

Remember: Knowledge determined by the majority does NOT make it true.

I think Galileo & Copernicus would agree with that.

Presidential Canidates and Special Interest Money

2007-12-05T00:00:00-06:00

Interesting little website that shows the Presidential hopefuls and how much money they have accepted from Special Interest groups.

Everyone should see this and understand what influences their choice for president.

http://www.opensecrets.org/pres08/select.asp?Ind=K02

Better to be Fat and Fit....

2007-12-05T00:00:00-06:00

I for some time now have been telling my patients, "it's better to be Fat and Fit then to be Thin but a couch potato."

I'm constantly trying to educate patients to exercise for the sake of being fit and feeling better, not just to lose weight. Sure, weight lose is a natural byproduct of exercise and healthy eating but that should not be the driving force.

With recent studies suggesting that people with a little extra weight actually having lower all cause death rates

(Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity-JAMA)

and

This study supporting that being fit is more important than actual body weight

(Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults)

I think we may be seeing a shift in American healthcare away from the "Loss weight at all cost" mentality. Constant fad diets and schemes to "melt" away fat abound in our image conscience society. But do they improve our mental or physical health. I just somehow doubt it.

We are physical creatures and before long, hopefully, we will understand the importance of movement and exercise and not worry so much about the extra weight.

Medical Identification Theft

2007-11-29T00:00:00-06:00

It has been recently brought to my attention that there is a new form of Identification theft.
Medical ID Theft

As I understand it, bad people out there are stealing Health Insurance and personal information and then using it to get "free" health care. It doesn't surprise me as health care has become so expensive that it is now a major commodity that's worth stealing.

What is even scarier about this is it can affect your health. If persons claiming to be you seek health care from a physician or hospital their diagnosis and medical records will be linked to you. It could affect your insurance coverage as well as possibly link medical conditions or allergies to you that you do not have.

This is just a reminder to be careful and protect your personal information. Your Insurance cards and benefits records (which you receive in the mail) could all be used to gain access to your Insurance coverage.

Thanks to the fine people at "The Prescriber's Letter" for creating a nice patient informational sheet on this topic.

Medical Identification Theft Info Sheet from The Prescriber's Letter

Raising Smart Kids?

2007-11-29T00:00:00-06:00

This Article from Scientific America is one of the best summaries I have seen about how to encourage children and not blindly "praise" them.

We have for years been so worried about our children's self-esteem that we have forgotten to teach our children to constantly strive for better. As Ernest Hemmingway put it,
"Contentment is the foe of heresy." i.e.- Those who are content will never question anything.

The Secret to Raising Smart Kids
Hint: Don't tell your kids that they are. More than three decades of research shows that a focus on effort—not on intelligence or ability—is key to success in school and in life

Funny Cartoon but Scarily True

2007-11-21T00:00:00-06:00

Ran across this amusing cartoon. It is a scary truth that seems more and more prevalent. I for one am trying to educate my patients about this pitfall. Medicines are wonderful but maybe we use them as a crutch to often? or... Maybe all the commercials we see on TV are really true.... you decide.

Want Your New Mom to Lose that Pregnancy Weight?

2007-11-21T00:00:00-06:00

More reason to support new moms. This is a significant study. fairly well done (although it doesn't address all the variables.) Mom's that don't get enough sleep are 3 times more likely to hold on to the pregnancy weight at one year. Ok dad's, time to strap on those boots and do more 1am baby feedings:)

Sleep Helps New Moms Fit into Their Old Jeans

by Allison Aubrey

America Gives to School Children

2007-11-15T00:00:00-06:00

Im a big believer in giving to education and children (the only way that has ever improved poverty.) This website is great.

Donors Choose

Teachers apply for a school project, you get to choose a project and help fund it. Then the teacher will perform the project & you get feedback about how the project went. And of course... it's tax deductible.

If your looking for a way to give back to this world. This may be a nice and rewarding way to do it.

Return of the Bubonic Plague!?!?

2007-11-10T00:00:00-06:00

Every so often an unfortunate story like this shows up.
A young person (usually out west) contracts a strange disease and becomes very ill or worse dies. The diagnosis is made and it is the PLAGUE!!!! (RUN FOR YOUR LIVES!!!)
The media immediately picks up on the story and before you know, it's Plague hysteria everywhere. Well I would like to calm some fears.
This story recently occurred. An unfortunate 37 year old biologist from the Grand Canyon recently contracted and died from pulmonary (or lung) plague a few days after performing an autopsy on a mountain lion from the region. This is tragic and my thoughts go out to the young man's family and friends, but this is a rare and a freak event.
Plague is caused by a bacteria that is found in many animal populations. During the 1400s, crowded inner city populations in Europe and horrible public sanitation the bacteria was rapidly passed from rats to people by flea bites. Because they had no antibiotics the illness killed nearly 25% of the worlds population at the time. The Bubonic (or Black) Plague.
It often killed by blood infections and lead to large black lymph nodes or Bubos (thus the name.) Rarely the bacteria can go airborne and cause a severe and almost always fatal pneumonia (which seems to have happened in our unfortunate biologist in Arizona.)
But the fact is that Yersinia pestis (the dubious bacteria) is sensitive to simple penicillin.
It is treatable (most of the time.)

So please.... it is an interesting and historical illness but NOT something for people to get worked up about. If you want to worry... worry about cervical cancer, diabetes, and malaria. Those diseases cause much more death and illness and we can do something about it.

Plague Suspected In Death Of Man In Arizona

Can Green Tea Save Someone from Severe Sepsis

2007-11-10T00:00:00-06:00

Over the last few years new light has been shed on the condition known as sepsis. Sepsis is the term used when someone dies from an overwhelming blood infection. It is extremely common and seen often in the hospital. We previously thought that it was related to toxins produced by the infecting organisms. But new evidence suggest that it is actually caused by an immune response from the body against the invaders. Like an autoimmune disease. Sepsis is hallmarked by blood pressure and cardiac collapse.
This interesting study suggest that a compound in green tea may actually reduce the risk of Sepsis occurring in infected people. This is exciting because to date we have little to nothing to truly treat sepsis.
This is only a study on mice so much more study is needed but I'm encouraged by this.

Green Tea Proves Powerful Medicine Against Sepsis

Keeping Holidays Simple for Grandma

2007-11-10T00:00:00-06:00

This is some great advice. We often want to do so much for our elderly yet... most of the time. SIMPLE is Better.

Six Creative Holiday Ideas For Your Senior Family Member

Journal of Neglected Diseases

2007-11-08T00:00:00-06:00

Finally a little respect for all the infamous but neglected diseases of the world!

Dracunculus medinensis, Tularemia , Q-fever, and even leishmaniasis will all finally get their due.

it seemed like no one would ever want to play with a Charlie in the box!

Journal of Neglected Tropical Diseases

Treatment for Hepatitis C

2007-11-08T00:00:00-06:00

A recent study has been disappointing for treating Hep C patients with persistence disease.
The standard of care in Hepatitis C treatment is peginterferon alfa-2a. For some time we have been treating new Hep C patients with interferon therapy with the goal of eradicating the virus. Unfortunately this is not always successful and now it appears that long term interferon therapy is also unsuccessful in helping prevent liver disease.

This study gave long term interferon to patients who had failed eradication therapy. The virus levels and liver enzymes all improved, however rates of progression to liver disease were the same. The reason is unclear. This is unfortunate and we should push forward for more treatment options for these patients.

Hepatitis C Treatment Reduces the Virus but Serious Liver Problems May Progress

Are Curves Coming Back?

2007-11-07T00:00:00-06:00

Well, it looks like people are finally realizing that being thin is not actually a healthy thing. go figure....
but it actually goes further than that. just maybe, the scientist have gotten it wrong too?
A recent study shows a lower death rate for people that are over weight (note: this does not mean OBESE (BMI>30.))
The reasons for this are unclear but my guess would be that a little extra energy reserves provides a survival benefit from illness. Again, it is important to note that this was a lower death rate when compared to the "ideal" body weight. Under weight and Obese people still have higher death rates. Also, this study only looked at deaths, not at morbidity (or decreased quality of life that may be caused by excess weight. It's still to premature to make a huge change in our recommendations but this may be the beginning of an upper change in the "Ideal" body weight. Check out these links:

Causes of Death Are Linked to a Person’s Weight: New York Times

Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity- JAMA

Pentagons New Death Ray, or at Least Hurt Real Bad Ray.

2007-10-31T00:00:00-06:00

This is kind of scary. The military has created a new weapon that is like a focused microwave ray. it can target groups of people of even a single person from 500 yards away. It cause intense heat and pain but is reported to not be lethal.
They are suggesting it may even be used soon in Iraq.

How can they possibly understand what the long term (or even short term) consequences of this thing? what about pregnant women?

Well, it gets points for the awe factor but I'm afraid of what will happen. will this be another "Agent Orange" or "Gulf War Syndrome?"

Non-Lethal Weapon Emits Invisible Rays of Pain

"But I dont like taking medicine"

2007-10-19T00:00:00-06:00

It has been brought to my attention once again that the American public has a poor misconception of what is medicine.
Whether it is the "natural" supplements that patients forget to mention to the doctor, or the 7 cups of coffee that the anxiety patient has each day. There is one simple truth about medicine.

It is ANYTHING you put on or into your body for a desired effect.

well, you may say... that seems silly Dr B. think about it.

We take medicine into our body to produce some specific effect.
Water? of course it's medicine. without it we die. We use water to treat people all the time in the hospital. it can even make you sick if you take to much (an adverse side effect.)

Food? almost the same as above. we eat so that we feel good and not hungry. To much and we again, can become sick.

Sun-Tan Lotion? applied to the skin to protect from the sun and prevent aging and burns.

what about the Sun? some people chose to allow the suns rays to enter their body so they can change their skin color or to feel "rejuvenated." But of course, to much and you burn and even can get cancer.

I hope readers can understand. Obviously I have taken this to an extreme, but the point is that we are surrounded by medicine. it is everywhere! And it is silly for us to believe that side effects and adverse reactions are somehow limited to the "medicines" that you buy at a pharmacy.
I encourage people to always consider everything in their lives when they have medical problems. The source of the problem may lay with the simplest and most natural thing in your house.

Remember that everything that goes on or into your body can potentially harm you. Even "natural" things. Rattlesnake poison is natural, doesn't make it good for you!

Doc, I think I got bit by a spider!

2007-10-18T00:00:00-06:00

This has been brewing for several years now but it is sadly becoming a frequent problem. Severe skin infections caused by MRSA (Methicillian Resistant Staph Aureus.)
MRSA is a Staph A. bacteria. MRSA is a form of this bacteria that has developed resistants to several classes of antibiotics. What has made this Bacteria scary in the community is it's production of potent toxens that make it an increasing cause of skin infections. These infections have been frequently misdiagnosed (often attributed to spider bites, which are very rare!) The poor Brown Recluse spider is also frequently blamed but is rarely the cause.
All should be aware and vigilant of severe (often blistering) skin infections and should seek medical attention to have them treated. Of note: the community form of MRSA is different from the Hospital aquired form of MRSA. Confusing, but the distinction is important because they are treated differently.

Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States