Tuesday, September 30, 2008
An herbal remedy called “horny goat weed” has been studied by Dr. Mario Dell’Agli and his team at the University of Milan. The herb has long held a reputation in China as a natural aphrodisiac and now it looks like it could be a promising alternative to Viagra for impotent men. Dr. Dell’Agli calls it a “natural Viagra” because the compound targets the phosphodiesterase molecule (PDE-5) and it blocked the erection-inhibiting enzyme as well as Viagra.
Drugs like Viagra or Cialis or Levitra work by increasing blood flow to the genitals. The Italian researchers studied a number of plants and found that “horny goat weed” produces a compound called icariin, which blocks the enzyme and allows for increased blood flow to the penis. Also known as Epimedium or Yin Yang Huo, horny goat weed holds an important place in traditional Chinese medicine.
Erectile dysfunction affects an estimated 18 million men in the United States alone. The prescription drugs now available are effective, but can have side effects such as visual disturbance and facial flushing. They cannot be taken with certain heart medications. The researchers report that the modified chemical, icarrin, found in “horny goat weed” may be just as potent without the unwanted side effects.
It will take years of study and comparative trials to determine if this “natural Viagra” is as safe or as effective as the pharmaceutical version. Further tests in animals and humans are needed before it can be safely recommended. There have been reports of tachyarrhythmia and hypomania in men who took the herbal compound.
Experts from Johns Hopkins University School of Medicine are calling for health warning labels on "energy drinks" due to their high caffeine content that may pose a risk to adolescents and young adults. A single serving of some of these drinks can contain more than 500 mg of caffeine, an amount equal to 14 cans of Coca Cola.
Because the amount of caffeine is often not labeled, there is variability between the drinks and people don't know what to expect. In a 2007 survey of 496 college students, 51% reported consuming at least 1 energy drink during the past month. Of these energy-drink users, 29% reported "weekly jolt-and-crash" episodes and 19% reported heart palpitations from consuming these beverages.
It is common for young folks to combine energy drinks and alcohol and it is a common recreational practice. Bars stock "Red Bull" and other energy drinks and young adults pay for "Table Service" where they secure a party table at a club, stocked with champagne, vodka, other spirits and energy drinks. The caffeine from the energy drink not only potentiates the alcohol effects, but the drinker can consume more over a period of time.
We are giving weird messages to our kids when they can buy an energy drink called "Blow" which is sold in vials and the energy drink "Cocaine" that mimics illicit drugs. The cocaine website shows Christina Aguilera singing the national anthem (patriotic cocaine?) and it encourages kids to "Rock the Vote". Very mainstream and grown-up.
I don't know if warning labels are the right answer. At the very least parents should know what is out there and be educating kids at an early age about health and making right choices.
Sunday, September 28, 2008
Medical device maker Medtronic settled a whistleblower lawsuit in 2006 by agreeing to pay $40 million while admitting no wrongdoing. In that complaint, Medtronic allegedly gave surgeons incentives to use its products, including entertainment at strip clubs and paying for lap dances.
That suit claimed that Medtronic, one of the largest medical device makers in the USA, made payments of $50 million in just four years to physicians doing implant surgery. One surgeon in Wisconsin was paid$400,000 for 8 days of "consulting" work. A surgeon in Virginia was compensated with nearly $700,000 in fees for nine months of work in 2005.
Now the same whistleblowers have filed against 100 spine physicians and the suit claims they received unwarranted Medicare money and kickbacks from Medtronic to use their devices. Plaintiffs and former employees, Jacqueline Kay Poteet and Bobbie Vaden, accused more than 130 orthopedic spine surgeons, neurosurgeons, medical practices and distributors of taking kickbacks from Medtronic for using their products, promoting off-label use of FDA-approved medical devices and filing Medicare claims in violation of the False Claims Act, among other things.
The whistleblower is Ami P. Kelley, a former senior legal counsel for the company’s Memphis, Tenn. based spinal products division. The lawsuit describes boondoggles like the “Alaska Think Tank,” a five-day-all expense paid trip to Alaska where doctors were supposed to present case studies to each other. Instead, there were no prepared presentations and the physicians drank and partied together. Medtronic paid for another trip to the Ritz-Carlton in Cancun, Mexico for physicians and their families. Participants were offered free golf, tours of Mayan ruins and parasailing. Similar education events were held in New Orleans and the education was described as being “light on content” but heavy on Mardi Gras drinking, partying and beads.
Minneapolis medical device industry attorney Mark Duval says, “this is a sour grapes lawsuit by two qui tam relators who apparently didn’t get any money when the government settled the first case against Medtronic for $40 million. So they are taking another bite at the apple and sticking it to Medtronic by going after their physician customers.”
In its web site response, Medtronic said employees follow the company’s ethical standards in all arrangements with physicians, including consulting and service agreements and appropriate travel and entertainment.
The former Medtronic employees, who brought the lawsuit, allege that the amount of the “consulting fee” paid by Medtronic to each physician is directly related to the gross purchase of spinal implants made by each physician. They also claim that the devise “INFUSE” (a bone graft), was used for off-label (not FDA approved) use at least 75% of the time. While not illegal for the physician, the FDA does prohibit companies from marketing off-label use of drugs or devices. Medtronic spinal division revenue is over $2 billion annually.
This is one of the first lawsuits that target this many physicians. Devise industry attorney Duval says, “This is a wake up call to the medical community that they have to take compliance seriously. Physicians and their medical societies and clinics and institutions will demand more scrutiny over relationships and will, in some cases, not allow physician/industry collaborations.”
The shake up is just beginning.
Saturday, September 27, 2008
The cost of health insurance continues to rise and premiums far exceed the rate of wage increases and inflation in the United States. Insurance premiums are going up ten times faster than people’s incomes and the average dollar amount employees must pay per year for family health coverage increased by 30% from 2001-2005.
Federal employees premiums will climb an additional 13% next year for enrollees in the Blue Cross and Blue Shield Plans. The Office of Personnel Management (OPM) negotiates on behalf of the nations largest group of employees, more than eight million federal health workers, retirees and dependents. Despite this bargaining clout, they were unable to keep cost increases at a reasonable rate. On average, enrollees with family coverage will pay about 30% of the plan’s total cost with the government picking up the remaining 70%.
Blue Cross and Blue Shield, which covers the bulk of Federal employees, blames the cost increases on drug costs and the fact that few patients have switched to cheaper generic medications. In 2009, the government wide service benefit plan will waive the first four copays for members who use mail order generic drugs in an attempt to reward the switch. Members will continue to save 5% on copays for generic drugs they buy at pharmacies.
Other reasons cited for the soaring cost of insurance was “higher utilization of health care services, technology and medical inflation”, according to Jena Estes, vice president of federal employment programs for Blue Cross Blue Shield. Colleen Kelly, president of the National Treasury Employees Union, said, “It’s very discouraging to see average increases of this magnitude…particularly given the bargaining power OPM should be able to exercise as manager of the nations largest group plan.”
Nancy Kichack, OPM’s associate director for strategic human resources policy, reported that the increasing premium costs reflect the rising costs of health care, though she stressed that Federal premium increases are less than increases for most major health care programs in the private sector.
Since the government sector is covered by our taxes and the private sector is covered by our wages, the American people are paying either way. There is no relief for the American people when health costs spiral upward and the bargaining advantage of that insurance giant, “The Blues”, has far exceeded the power of the government to negotiate lower rates for its employees.
Friday, September 26, 2008
Little Mackenzie Argaet from Australia was born with biliary atresia and underwent life-saving liver transplant earlier this year. But the transplanted liver was too big for her two year old body and was compressing vital blood vessels. Her surgeon, Dr. Albert Shun, was using a sponge to keep the vessels open but he couldn't close her up and he needed a solution and he needed it now! This quick thinking surgeon called his wife and said "Run to the store and get me a package of ping pong balls."
Using inovation and creativity, her surgeon placed a sterilized ping pong ball in her liver as a way to keep the liver off the arteries. The light, tough ping pong ball remains in place, doesn't deteriorate and the liver just grows around it without causing an infection.
What you see in the radiograph are the staples along the bottom, a nasogastric (or oxygen) tube in the middle and a round (think ping pong ball) in the right side with a drain tube coming from the area.
For $2, Dr. Shun solved a problem and saved a life. He has used the ping pong ball in other surgeries since this one was such a success. Amazing!
UC Irvine (UCI) Medical Center is being placed under the oversight of the State Department of Public Health because federal inspectors found that doctors were filling out medical records in advance and even putting patient's outcomes in the record before the procedures were done.
A whistle blower complaint preceded an investigation and a 30-page inspection report that listed problems dating back at least three years. They included substandard equipment checks, inadequate record keeping and falsified records by doctors. Anesthesiologists were found to fill out operative reports a day before the surgery was even done.
The Department of Anesthesiology had problems dating back to 2003 when half of the 26 professors signed a letter alleging that "the direction of the department has been radically altered to achieve financial goals at the expense of academic goals." Many of the doctors resigned over the next few years.
After a lengthy search, UCI hired Dr. Zeev Kain, executive vice chairman of anesthesiology at Yale, as chairman of the renamed department of anesthesiology and perioperative care. He began on March 1 and hired six new faculty members and installed a new electronic monitoring system that eliminates the opportunity to fill out records in advance.
Kain said he was brought in to "clean things up" and all staff members have now signed a zero tolerance policy for falsifying records. (amazing that it should even need to be addressed in a signed policy)
It would seem that something is seriously wrong at UCI. They have been involved in a number of large scandals over the last 13 years. They had to shut down their transplant program when Medicare funding was withdrawn after 32 people died awaiting livers in 2004-05. Their doctors turned down organs that were successfully transplanted elsewhere.
They came under fire when the director of the University's Willed Body Program sold parts of cadavers and did unauthorized autopsies.
In 1995 the fertility doctors were accused of stealing patient's eggs and embryos and implanting them in other patients without permission. That program was also shut down.
One of the leaders in the Cardiology Department was found to have no California license and no cardiology credentials. He resigned.
Usually, repeated high-profile scandals such as these indicate serious problems with ethical culture and it starts at the top. There seem to be endemic management problems and too many examples of poor ethical decision making. I am certain there are hundreds of dedicated, well intentioned clinicians at UCI who provide excellent patient care. But I would challenge the Board and Medical Executive Committee to do a thorough house-cleaning and shine the light on management to start a culture change of ethical and open behavior.
Wednesday, September 24, 2008
We are experiencing a glorious Indian Summer in Northern California, but Autumn is in the air and I can see some leaves starting to turn golden. When the weather changes, I know viral illnesses such as influenza and colds are also lurking and are just around the corner.
The most common reason for school and work absenteeism is a viral "cold". We call them "upper respiratory infections" and there are over a hundred different cold viruses. Influenza is also a virus and is passed from person to person in much the same way as a cold...via hands, touch, surfaces and droplets in the air from sneezing. Eighty percent of infectious illnesses are passed by touch.
One of the cheapest and most effective sanitizers for cleaning surfaces is bleach. Master chefs know this secret and use bleach to clean their cooking surfaces. Just mix a solution of 1 part bleach with 2 parts water in a spray bottle and you are ready to kill the cold virus and other bacteria.
Parents: Most teachers have to buy their own school cleaning supplies. Give your kid's teacher a spray bottle with the bleach solution and a roll of paper towels and and she can wipe down surfaces at school. Hand sanitizers in every classroom are also helpful. Better yet, form a parents cleaning work team and volunteer to periodically help clean the classroom. Visit "Clorax Classroom" for more tips.
Protect yourself by washing your hands several times throughout the day. Keep a hand sanitizer at your desk at work and use it frequently. Use that bleach solution to wipe door knobs, light fixtures and any surface that has multiple people touching it.
A little bit of prevention may go a long way in allowing all of us to avoid the misery of a cold. Wash away!
Sunday, September 21, 2008
Kudos go out to the British Association of Aesthetic Plastic Surgeons (BAAPS) for speaking out against "unrealistic anatomically impossible" breasts that are being used in advertisements to seduce female patients. The Association, which represents about a third of cosmetic surgeons in the UK, launched its own advertising campaign against parts of the trade because of the ads some clinics had posted showing a woman with a body that was digitally enhanced.
Breast augmentation continues to be one of the fastest growing segments of cosmetic surgery. I've heard reports of young girls receiving breast implants as "sweet sixteen" birthday presents and high-school graduation presents from their parents. That is obscene and entirely too young to be making major decisions about serious and permanent body enhancement. TV and other ads are targeted at young, impressionable women and can make them think these types of artificial bodies are the norm. When they look in the mirror, they see the variations of natural bodies, and believe they need to change. The fact that breast augmentation is now quick and relatively safe is also a lure. Hollywood stars and models are seen with normal bodies one day and enhanced breasts the next.
I never thought I'd see a professional organization of cosmetic surgeons come out against breast augmentation in this way, so hats off the the Brits on this one.
Saturday, September 20, 2008
Thursday, September 18, 2008
Senator Charles Grassley (R-Iowa) is investigating the University of Chicago Medical Center about the hospital's efforts to steer patients with non-urgent complaints away from the emergency room to local clinics. He is requesting financial records, board minutes, and other information related to hiring, job promotions, business contracting and care for the poor.
Michelle Obama, wife of presidential candidate, Barack Obama, is currently on leave from her position as the V.P. of community and external relations at the Hospital and she was a key person in the initiative to utilize community clinics.
I have news for Senator Grassley. Emergency departments across the country are in big trouble from over crowding and they are filled with patients who are using the hospital for primary care and non-emergent health issues. The New York State Health Commissioner has said that overcrowded emergency rooms are a sign of a health-care crisis for which there are few rapid, inexpensive or simple solutions.
Emergency department (ED) use has increased 23 percent between 1992 and 2002, while the number of hospital EDs shrunk by 15 percent over the same time. Today, many cities are reporting dramatic rises in ED wait times and ambulance diversions, as insured and uninsured patients are increasingly relying on emergency rooms to seek treatment.
Hospitals all across the country are looking at innovative ways for patients to receive the most appropriate and cost effective treatment. Non-urgent matters SHOULD be treated in community clinics, not the ED.
So, Senator Grassley, do your homework before you open an investigation. The Senate is not your own political playground. You are there to solve problems, not create them.
Wednesday, September 17, 2008
A new study reported in the American Journal of Clinical Nutrition says eating pistachio nuts decreased total cholesterol and LDL (bad) cholesterol compared with a control diet that had no nuts.
One of the control groups was fed a step 1 (low fat) diet without pistachios. Two other groups were fed the same diet with low doses of pistachios (32-63 gms/day) and high doses of pistachio nuts (63-126 gms/day). The pistachios were low salt and were fed as snacks and incorporated into recipes.
There was a significant lowering of total and LDL cholesterol in the pistachio diet groups and it was dose related with the higher pistachio intake having a greater effect. The authors concluded that the magnitude of reduction in LDL cholesterol for the high-dose pistachio eaters was equivalent to that of statins and would result in a 9-12% reduction in heart disease risk.
It should be noted that the study group was small (10 women and 18 men) and the study was sponsored by a grant from the California Pistachio Commission along with the NIH and other funders.
I wonder if eating pistachio ice-cream will have the same beneficial effect?
(Addendum: I just looked up the calories in 1 cup of pistachio nuts - 685 yikes!)
Tuesday, September 16, 2008
Sunday, September 14, 2008
Thursday, September 11, 2008
With only 2% Medical Students planning careers in General Internal Medicine, we are in for a huge medical crisis. The USA will have 200,000 fewer doctors overall than it needs by 2020, yet the number of older Americans is expected to nearly double.
The reasons are clear and medical students are walking away from Primary Care specialties in droves.
- High medical school debt (average >$150K)
- Lowest income of all specialties
- Highest hassles and horrible paper work of all specialties
- High cost of running an office (supplies, phones, billing, space needed, employees needed)
- Grueling crush of patients with no relief (no lunch, no break, no time for research or thinking about complex medical problems)
- High level of responsibility for "everything"
- Grueling call schedule
- Lack of respect from other physicians. Often dumped upon... "Call your primary"
- Requirements for best practice prevention and screening without systems to help manage it.
- Inability to combat low reimbursement and claims denials.
As Internists and Family Medicine doctors retire or wind down, there is no one to take their place.
Forget what you hear about Universal Care. If you can't find a doctor, it doesn't matter what your insurance is. With 2% of Medical Students choosing primary care, the Emergency Departments and high priced specialists will thrive and continuity of care will be a thing of the past.
Tuesday, September 9, 2008
I have a patient who is absolutely phobic about getting a colonoscopy for colon cancer screening. She has a family history of colon cancer so the fear may be about what is "found" or it may just be the anxiety of going through the test. No amount of cajoling on my part or her husbands part has been successful for getting her tested. I've even offered valium to get her through it but she just won't take that next step!
I feel so strongly about this because colon cancer is one disease that is truly preventable if found early.
Here are some facts:
- Colon cancer is the 2nd leading cause of death from cancer
- Fewer than half of all men and women are up to date on their colon screenings
- The majority of colon cancer is diagnosed in people over 50
- Colorectal cancer often occurs with no symptoms
- Most colorectal cancer can be cured if diagnosed at an early stage
- Regular colonoscopy can prevent colorectal cancer all together
- You can reduce the risk of colon cancer by maintaining ideal body weight, eating less fatty foods and increasing dietary fiber
- Researchers are trying to find biomarkers in blood or stool samples to simplify detection
Sunday, September 7, 2008
Can you believe it? A prominent dentist with homes in Pennsylvania and the Jersey Shore has been accused of "unlawfully discharging a pollutant and unlawful disposal of regulated medical waste." Lets say it in plain English...he dumped a bag of 300 used needles, 180 used cotton swabs and other materials from his medical office. He admitted to tossing the material from his boat a few miles offshore and, Surprise! The debris washed up on shore, closing down the beaches of Avalon, a resort town about 25 miles South of Atlantic City, throughout the Labor Day weekend.
I just don't get it. We have had years of "Earth First", "Earth Day", "Save the Earth", "Save the Ocean" and you would have to be in a coma not to know that dumping is illegal and immoral.
Thomas McFarland needs more than a fine for this ignorant and willful offense. He should get jail time and be forced to watch Jacque Cousteau documentaries and "Finding Nemo" over and over until he cries.
Saturday, September 6, 2008
A federal judge issued a preliminary injunction against Tyson Foods last April and ordered them to withdraw advertisements claiming their chickens "are raised without antibiotics that impact antibiotic resistance in humans." Tyson said it would appeal that decision.
Tyson Foods now states it will "voluntarily' withdraw its labels for chickens raised without antibiotics because of what it called "uncertainty and controversy over product labeling regulations."
Tyson says its claims "raised without antibiotics" is true, even though they inject eggs with antibiotics and used antibiotic molecules in the chicken feed. Inspectors found they used Gentamycin, an antibiotic commonly used in humans, to inject eggs before they hatch.
Talk about deception! If I want antibiotic free poultry (AND I DO!), I want to know that the advertising really means ANTIBIOTIC FREE.
Friday, September 5, 2008
Postpartum depression is more common than we thought and it is often missed by doctors and even families in the chaos and changes brought about by a new baby in the house. Postpartum depression can last for months and goes beyond the hormone fluxes that most new mothers experience with changing moods and fatigue. Postpartum depression is a serious disorder that requires identification and treatment.
A new study published in Pediatrics shows a simple questionnaire is a useful screening tool for postpartum depression. The sensitivity of the questionnaire was 95% and the beauty of it is how simple it is to administer by the doctor or nurse.
Women are asked to respond to these statements:
- I have blamed myself unnecessarily when things went wrong
- I have felt scared or panicky for no very good reason
- I have been anxious or worried for no good reason
(I've read some articles that postpartum depression can affect dads too, but this study only dealt with mothers. It's been my experience that when mom is happy...everyone is happy)
With the Democratic and Republican "Rah Rah" conventions over, it is time for Americans to do the hard work of really looking at the issues to decide the next president. It would be so refreshing if we actually voted based on policy and effectiveness...rather than hero status, race, sex, TV ads or sound bites.
I don't understand voters who zero in on a single issue and vote because of the candidate's stand on that issue. Whether it is gay marriage, guns, the war in Iraq, creationism, abortion, tax cuts, or Health Care, there are too many important factors that affect us all to choose because of one belief.
But speaking of Health Care...I found a bipartisan website that can help us all do our homework on a very complicated subject. Check out HealthDecision '08 to see Obama and McCain's health proposal summary side by side with both the advantages and the challenges.
It is a complicated subject and simplistic measures are a LIE. I see flaws with both proposals but will continue to make sense of them and report in EverythingHealth. Get informed...read, learn, vote.
A new study shows polybrominated diphenylethers (PBDEs), flame retardant chemicals found in most household products, accumulate in children's blood and tissue at rates three times higher than their mothers in the same household..... to find out more go to EmaxHealth, where I have written a report about PBDEs and why we should care.
image from myaspiebrain Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient...
Hey, I'm easing back into the blog world after a fun trip to NYC. If you are a Doctor or ever thought you'd enjoy the world of Med...
I love learning something new in medicine and this was a new one for me...black spot poison ivy. Poison ivy (also known as rhus dermatitis...