Archive for the healthcare Category

Glenn Beck’s ER Experience: Much Ado About A Total Lack of Perspective

Posted in healthcare, politics on January 19, 2008 by theseep
So we’ve all been subjected to CNN’s poorly informed pundit’s “harrowing” ER experience. From what I can gather, he had a thrombosed hemorrhoid, waited for 40 minutes to be brought back to a room and around 2 hours for pain medications. He sobbed when recounting the event and how unfair it was that he, Glenn Beck, had to wait for medical care. Somehow, this has become a national news sensation and is being touted as an example of how horrible our medical system is. To top it all off, Beck’s hemorrhoids are now ridiculously being likened to the Edith Rodriguez tragedy, who actually died in a L.A. ER waiting room after waiting for hours to be seen.
I’m an ER doctor and although I do agree that our health care system is in trouble and is riddled with problems, Glenn Beck’s rectal pain does not showcase any of them.

As far as his 40 minute wait time goes, certainly he was in pain and this should be treated as expediently as possible, but I’m sorry to inform the general public that a 40 minute wait is really short! Although our hospitals only have a 15-30 minute wait, most hospitals routinely have 2 hour or longer wait times, sometimes 12 or more hours for less acute issues! It is unfortunate that he had to wait 2 hours for pain medications, but I would assume that in a busy ER, there were likely much more pressing issues from other patients like heart attacks and people trying to die. There are multiple reasons for prolonged wait times in emergency departments. The most common is because of triage protocols. From all of the patients presenting to an ER, we must take the sickest patients back first – strokes, chest pain, active bleeding, respiratory compromise, sepsis (severe infections), etc, come back first. Unfortunately there are many people that present to ERs that do not actually need emergency care and these people must wait for the more acute complaints to be take care of.
Bonus rant: These are patients with coughs, colds, rashes, some chronic conditions, and a plethora of other complaints that should be treated by primary care as an outpatient rather than in an emergency department. Some come because they couldn’t get into their primary care doctor or don’t even have one, some come because they didn’t want to wait for primary care, some just want immediate gratification, and some just have noplace else to go. Regardless of the cause, primary care complaints clog up the department so poorly informed pundits screaming in peroneal agony need to wait until the other patients are cleared out. We are actually mandated by law to give a medical screening exam to any patient that presents to the ER, regardless of their complaint, be it emergent, chronic, or completely ridiculous. All this without requesting any information about ability to pay or insurance status, we must see them all. The most frequent abusers of the emergency system tend to be those on our public assistance programs, MediCal here in California. These are “heavy utilizers”, people that choose to go to the ER for even minor complaints, because they know that they can be seen quickly and they don’t have to pay a copay. Now the taxpayers get a $500 ER bill for what would have been a $75 primary care visit. Unfortunately, since there is no personal accountability built into our public health system, there is no incentive to use the system properly. In the same vein, a surprising number of patients utilizing our public health system are smokers, spending the equivalent of a low-cost heath insurance policy on a pack of cigarettes per day (~$150/month) and incurring billions of dollars collectively in smoking related healthcare costs and lost wages. These patients cost the system and the taxpayers a ridiculous amount of money and often will keep other emergency patients from being seen in a timely fashion.
The problem with our healthcare system today is not with the physicians, nurses, and other staff, we all strive to give our patients the best care we can considering the circumstances at any given time. We’re there to help, and even though we didn’t sign up to be spit on, cursed at, swung at, vomited on, sprayed with blood and other body fluids, plus have ridiculous lawsuits filed against us, we go to work anyway and try to give some help to whomever comes in, regardless or race, creed, disease state, wimpitude factor, or ability to pay. Many of you have seen Sicko, so you know that insurance companies are a big part of the problem. I think two other major contributors to our healthcare crisis are frivolous lawsuits (often from unreasonable expectation of care), and a lack of personal responsibility from a patient perspective. If insurance coverage is made non-profit, medical liability is reformed, and people have to pay the health costs of their lifestyle choices (ie: smokers pay for smoking related illness costs, obese patients contribute extra to care for cardiac disease and diabetes, etc), we’ll see a significant decrease in cost to everyone and more efficient care. Leaving healthcare up to the free market is a recipe for disaster – right now we outspend every other country in the world by far, yet our health system ranks 37th!
How’s that free market working for you?

Lead Poisoning From Your Dishes? You Betcha!

Posted in ethical consumerism, healthcare, sustainability on December 26, 2007 by theseep
 Once again, our runaway train to industrialization and mass-production has turned up more ways that we’re poisoning ourselves. Over the last month or so, a flurry of concern has arisen across Utah after a 16 month old girl was found to have lead poisoning. After extensive testing of their home, it was found that the plates that the mother was eating from contained lead, which was then passed to the child through breast milk. Wow. The original story aired on KUTV from Salt Lake, and their local on-air watchdog, “Get Gephardt“, did some further investigation. The television station was able to get viewers to bring in over 1,500 plates for lead testing and found that more than 30% contained toxic levels of lead (pdf link for the full report and list of manufacturers). It seems that glazings commonly have lead and many plates with colorful paintings or patterns often have higher levels as well. The lead in the glazing and paints leeches out into your food, especially when heating them in microwaves. Although some of these plates were made in China, many were made in Europe, or here in the good old US of A. And it wasn’t just cheapo Walmart brands either, expensive names such as Spode were full of the stuff.

Lead is extraordinarily toxic to the developing nervous systems of young children and can cause permanent developmental delays and retardation. This is just another example of how industrialized production of goods from improperly tested materials can be harmful. We’re finding more and more toxic substances in everyday items, from toys, to food containers, to foods, and more. Imagine how many things we haven’t figured out are harming us at low levels or have an additive effect with others?
If you can, get your dishes tested. If you can’t, consider performing a “tox audit” of your home – we’re transitioning to metal water bottles and glass food containers from petrol-based plastics with phalates, Bisphenol-A, and other toxins (here’s a good quick article on plastics).
As far as the lead-tainted dishes in question go, there have been no recalls, although the HomeTrends/Gibson dishes in question were pulled from WalMart’s shelves. Utah legislators are going to bat and trying to get a law passed to require manufacturers to label products with lead. Nice start, hopefully that will help you choose when you buy new dishes in 5-10 years.

Not-so-shocking Study Shows Childhood Obesity Significantly Increases Risk for Heart Attack

Posted in ethical consumerism, healthcare, sustainability on December 17, 2007 by theseep

In a recent New England Journal of Medicine article, Danish researchers showed significant correlations between childhood obesity and coronary artery disease as adults. Looking at 276,835 children born between 1930 and 1976, a linear correlation was found with increasing BMI (Body Mass Index) directly related to increasing risk of having a heart attack. The example used was that a 13 year old boy who is 11kg (24.2 lbs) overweight will have a 33% higher likelihood of having a coronary event than a similar boy of average weight.

NIH statistics show that 17% 0f American children are obese, triple the number since 1980!

Smoking and obesity have become two of the major causes of morbidity and mortality in our country, both of which are preventable. Obesity is a multifactorial issue that stems primarily from the obvious – poor diet and lack of exercise. Granted, the “American diet” is horrendous overall, with plastic-wrapped, preserved offerings of fried this and that, breaded and cheese-filled whatevers, and heaping portions of processed carbohydrates. One of the problems is that these foods are being marketed to children. Sales and demographics experts run numbers to see how they can most effectively sell horrendously unhealthy foods to more and more children (don’t you feel guilty, you heartless bastards?). Cartoons and plastic gifts are used to entice kids to throw fits until they get the Happy Meal or package of sweets that they saw on TV. Also, there is a trend in the media to say that “It’s OK to be yourself (aka obese).” Yes, it is good to be comfortable with yourself as a person, but it is not OK to be morbidly obese! From a pure healthcare standpoint, once you are more than 10-20 lbs overweight, you should start looking at ways to lose some poundage, not find ways to justify your excess weight in the eyes of society. It’s not insensitive or rude, it’s your health. We have gotten so bad, that last year a physician in New Hampshire actually lost his license because one of his patients was offended that he told her that she was overweight and needed to lose weight for her health. She complained to the board and when he refused to go to sensitivity training, they took his license! This to me is absolutely ridiculous. It’s like an alcoholic suing you because you told them to stop drinking!

It comes down to parents, however, to provide their children with a healthy diet and teach them lifelong lessons of nutrition and regular exercise. To do your child the most good, feed them locally grown, organic foods when possible, avoid prepackaged foods as much as you can, and avoid fast foods entirely. Minimal or no sodas/sport drinks/etc, water down your juices, and no bottled water (that’s more of an environmental concern, though). Once the kids are out of the house, it’s tough to encourage these things, so do it while you have their full attention. Also, don’t forget the exercise! Limit TV/computer/video game time significantly. Go cycling or play ball with your kids, take them surfing or hiking instead of letting them vegetate in front of the television. Don’t buy your child Guitar Hero, buy them an actual guitar! Fiddling with 4 buttons on a plastic guitar teaches them nothing except that it’s OK to sit around on the couch and do nothing to better yourself in any way. Your son won’t thank you for all the dates he DIDN’T get because you encouraged him to be an awesome “Guitar Hero.” He may, on the other hand, thank you for guitar lessons after the plethora of dates he did get from his swoon-worthy real-life guitar melodies.  Oh, and virtual dates don’t count.

Baker JL et al. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007 Dec 6; 357:2329.

More Insights Into The Cost of Smoking + bonus rant

Posted in conservation, ethical consumerism, healthcare, politics, sustainability on November 21, 2007 by theseep

Also, see “Some Insights Into The Costs of Smoking.”

Besides the fact that smoking causes more deaths per year than AIDS, homicide, suicide, heroin, cocaine, alcohol, auto accidents, and fire deaths combined, this video shows the amount of tar inhaled into your lungs smoking a pack a day for 20 days 7.2 grams, the volume of about 2 charcoal briquettes.

Imagine the tar/dust from 2-3 briquettes coating your lungs every month for years. Imagine that every pack causes irreversible hardening of all of the arteries of your body, promoting the formation of fibrinous plaques that rupture, sending cascades of clot-activating protein into the small arteries of your heart and brain, causing early heart attacks and stroke. Imagine the inflammation from your immune system trying desperately to remove the tar and inactivate cancer-causing free radicals. Oxygen-exchanging alveoli are broken down, intima is thickened, and smooth muscles spasm, causing COPD and emphysema, which becomes progressively irreversible. While you are breaking down your own lungs, causing your cancer, and contributing to your future stroke and heart attack, the second-hand smoke does the same thing to your friends, your family, and your children.

The average healthcare costs of a smoker are 40% higher than the average person and an additional 40,000-60,000 cardiac deaths per year are due to exposure to environmental tobacco. According to the CDC, smoking accounts for about 87% percent of lung cancer deaths and 30% of all cancer deaths. How is this legal? How do we allow the tobacco corporations to cater and market to the poorest subsection of our population, those who work the hardest and utilize the most tax-funded healthcare dollars? By not holding the companies accountable, we are actually subsidizing the profits of tobacco companies. By not holding the smoker responsible for their lifestyle choices, we allow them to draw far more than their share of healthcare funding, thereby subsidising their tobacco habits as well.

Here’s my proposal, and I realize that this is just rough math leaving out many variables. If there are 44.5 million smokers in America with healthcare costs directly attributable to smoking topping 50 147 billion heathcare dollars per year, with 30 billion packs of cigarettes sold in the U.S. every year, that works out to about $3.08 $6.50 per pack of cigarettes. We simply add this $6.50 as a tax to each pack of cigarettes that will go directly to pay for the projected heathcare costs that smoking that individual pack will incur. Of course, for our healthcare and public assistance programs to work, many more things need to be done, like making healthcare as an industry not-for-profit (single-payer could work as well, but this is easier), initiating tort reform with penalties for frivolous lawsuits (both of the aforementioned mean campaign reform and eliminating lobbyist favors/contributions/bribery), and instituting personal accountability for lifestyle choices. Let’s get some people in Washington that have the integrity and moral fortitude to question and challenge the status quo. Let’s start doing the right things for the right reasons and hold both corporations and individuals accountable for the true costs of their actions, socially and environmentally.

Anyone up for it? Dennis Kucinich? Barack? Stewart and Colbert?

via Gizmodo

The Beginning of the Next Evolution of Humankind Through Technology

Posted in healthcare on November 15, 2007 by theseep

  Humanity has stopped evolving. To be more precise, we have stopped progressing forward in a traditional  evolutionary sense and thanks to medical technology and cultural constructs, we are actually de-evolving in certain ways. The unfortunate but simple truth is that Darwinism has been defeated by modern science. No longer do the strongest and most intelligent survive, we now keep alive the weak and ill and due to both technology and social constructs less desirable genes and traits are passed along more and more. Don’t get me wrong, I’m not saying that we shouldn’t be doing these things, I am simply pointing out how technology has altered natural environmental pressures and we should expect to eventually see physiologic and physical changes in humanity as a result. Besides altering natural evolution, we are also developing our own version of evolution through technology. We have seen a melding of humankind and machine for years in Sci-Fi books, movies, and television shows and are there more and more evidence that this could represent the future direction of the human race. We have already made significant progress in cyborg technology – prosthetic limbs, cochlear implants, eye implants, exoskeletons (and here), and other advancements. One of my favorite tech blogs, Engadget, has had a recent few posts that show some of the newer developments – targeted muscle reinnervation for prosthetic limbs to allow better control, and a brain implant that should allow a patient to speak again through a computer. Both DARPA (Defense Advanced Research Research Project) and Segway inventor, Dean Kamen have developed prosthetic arm prototypes that are revolutionary with incredible dexterity thus far unsurpassed function for a robotic limb. The next 100 years will certainly be interesting for humanity – climate change, peak oil, superbugs, technoevolution, and who knows what else?

Femtosecond Lasers May Save Us From Superbugs

Posted in healthcare on November 14, 2007 by theseep

 On November 1st, the Institute of Physics published an article describing the use of specialized femtosecond laser pulses to destroy viruses and bacteria while leaving human cells unscathed. Using a process called Impulsive Stimulated Raman Scattering (ISRS), lethal vibrations are produced in the protein coat of microbes similar to an opera singer shattering a glass with her voice. Supposedly by modulating wavelengths and frequency, human cells are not damaged by the laser. If this research comes to fruition and can be developed further, we may have our next wave of high-tech “antibiotic” treatment. Since we’re currently manufacturing “superbugs” through overuse of antibiotics, we’re going to have more and more difficulty finding chemical cures for these wee beasties and this type of therapy just might save our skins. This is truly a groundbreaking news and could revolutionize the way we treat infections – imagine getting a 30 minute laser treatment for pneumonia instead of being admitted to the hospital on 10 days of antibiotics!

Via Engadget

Rivera Family Sues After NYC MRSA Death, Why Superbugs Will Take Over

Posted in conservation, ethical consumerism, healthcare, politics, sustainability on October 30, 2007 by theseep

Nobody will argue that the death of 12 year old Omar Rivera was not a tragedy, but why does his name need to be dishonored by suing the hospital and NYC Health and Hospital Corp?  This is not a one-sided argument, however.  This is the type of high-profile case that vilifies everyone, from the parents, to the hospital that treated the child, to the media, to our entire healthcare and judicial systems.  Firstly, this case is already causing a panic in the population because of how it has been handled by the media. This MRSA, or methicillin-resistant Staph Aureus, was first isolated in 1953 and has been a constant battle in hospitals, showing up in the sickest, most stressed and immunocompromised patients.  Along with VRE (vancomycin-resistant enterococcus), healthcare workers have constantly put themselves at risk to treat these “superbugs” that are nothing more than the natural response of bacteria to our use (and often overuse) of antibiotics.  All organisms have the ability to adapt to environmental pressures, and since the advent of antibiotics, humanity has pressured bacteria to evolve in order to survive our chemical assault.  The unfortunate part is, that through irresponsible use of antibiotics, we have hastened this evolution and continue to encourage microbial resistance.  As an ER doctor, since moving from Massachusetts to California just 4 years ago, we have gone from treating skin infections, known as “cellulitis”, usually caused by Staph and/or Strep bacteria (which live on all of our skin and you can’t get rid of, no matter how much antibacterial soap you use), with penicillin or a 1st generation cephalosporin like cephalexin (Keflex), to using entirely different classes or multiple antibiotics due to resistance.  Currently in California, greater than 50% of skin infections are due to MRSA, which is now classified as “community acquired”, since we no longer see it exclusively in very ill or immunocompromised patients.  Because this is such a new phenomenon, I still see primary care doctors and others placing patients on the “old” antibiotics for these newer “superbugs”. It sounds like young Mr. Rivera was placed on amoxicillin for his cellulitis, which just a few years ago, would have been fine.  This issue is so new, however, that studies are just coming out that document these new changes in resistance patterns and the proper antibiotic treatment is still under development.

So what can we do? We as citizens need to question any and all antibiotic use.  Stop demanding antibiotics from your doctors.  Stop using antimicrobial soaps and sanitizers (see this previous rant)- we evolved to live commensualistically with bacteria on our skin, you cannot and should not sterilize yourself.  In today’s high-volume, low-reimbursement healthcare system, it is easier for a doctor to prescribe antibiotics for a viral cold than to explain to a demanding, rude, uninformed patient, that antibiotics are only for bacterial infections like pneumonia, cellulitis, and urinary tract infections and do not treat viruses.  People expect a “magic bullet”, that by going to the doctor there will be come miracle cure for every ailment and sniffle.  Unfortunately this is not the case, but these expectations, along with the corporatization of healthcare, demanding “customer satisfaction” over good medical practice, is indirectly leading to the type of irresponsible antibiotic use that is causing these “superbugs” in the first place.  We as physicians need to take the time to discuss the proper use of antibiotics with our patients and give them only what they need, not what they think they need.

I could continue to rant about how our current legal system and our “sue-happy” nation is one of the major factors contributing to the impending downfall of our healthcare system, and how the Rivera family is disgracing the memory of their child by trying to leverage $25 million dollars from their son’s death, but I will leave it at this:  Everything we do has an impact, from every bit of fuel we burn contributing to global warming, to each mass produced bit of clothing we buy contributing to the oppression of those workers and dispersing toxins into the environment, to every dose of antibiotic we take contributing to antimicrobial resistance.  Most of our problems on a macroscopic scale are being caused by our individual actions on a microscopic scale.  If we each educate ourselves and begin making the right decisions, we will see a slowing of these phenomena, which represent nothing more than the equal and opposite reaction of our personal and collective actions.