Friday, February 26, 2010
How Much Does Technology Improve Health?
This post by Jonathan LaPook, ACP Member, originally appeared at Better Health.
Last week's CDC report, Health, United States, 2009 confirms that Americans are increasingly turning to medications, scans, and procedures to improve their health. Exercising, eating right and weight loss: not so much.
Watch Dr. LaPook online
Don't get me wrong. I love technology as much as the next guy--maybe more. I'm writing this on a laptop while jetting from California to New York. My iPhone, Blackberry, and Kindle are all within 10 feet of me. But my inner Luddite is starting to stir.
Here are the good news and bad news about three major findings of the CDC report:
1) The use of imaging studies like CT and MRI scans has tripled in the past 10 years.
The good news
These tests can be truly lifesaving. They can diagnose conditions like appendicitis and cancer much earlier than in the past.
The bad news
They're expensive and carry risks. The annual price tag for all these scans is about $100 billion and about 35% to 40% are estimated to be unnecessary. Experts are concerned that radiation exposure from tests like CT scans might increase the risk of cancer. And false positives often lead to further testing.
2) The percentage of Americans taking at least one prescription drug increased from 38% in 1988-1994 to 47% in 2003-2006. Those taking three or more drugs increased from 11% to 21%.
The good news
Medications clearly help control many medical problems, for example, hypertension, high cholesterol and diabetes.
The bad news
The more pills you take, including vitamins, minerals, and herbs, the greater the risk of an adverse interaction. Just three months ago, the FDA warned that commonly-used medications such as Prilosec and Nexium can make the anti-clotting drug Plavix less effective.
And medications can give patients a false sense of security. No matter how much Lipitor you take, you're not safe from heart disease if you eat a lousy diet, never exercise, and are obese.
3) Procedures such as angioplasty (opening up a blocked artery supplying the heart) and joint replacements are skyrocketing.
The good news
Used wisely, procedures are a tremendous boon. Emergency angioplasty performed during a heart attack saves lives. Knee and hip replacements can keep people active who otherwise would become immobile.
The bad news
About 30 percent of elective procedures are unnecessary, according to experts like Dr. Elliott Fisher, director of population health and policy at the Dartmouth Institute for Health Policy and Clinical Practice. Dr. Fisher advises, "If I were a patient, I'd ask two questions: help me understand the risks and benefits of these procedures, and by the way doctor, do you have a financial interest in ordering this test?"
To try to put the CDC report in perspective, I spoke to Dr. Linda Fried, Dean of the Mailman School of Public Health at Columbia University. She explained that despite advances in many areas over the past decade, we are falling way short in providing adequate healthcare to Americans. A big reason: We lack a public health system that emphasizes prevention.
She told me, "In our fast paced society, which goes for silver bullets, quick fixes, high return on investment on quarterly reports, prevention is not part of that scenario because prevention's for all of our lives, for our whole lives. And if we're successful in prevention, we don't see anything different and that is a mindset change which we need to learn to live with." She added, "Eighty percent of health is created through prevention and public health. Three percent of our (health care) dollars go into that. We need to find a better balance."
This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: clopidogrel, Diabetes, diet, drug interactions, exercise, health policy, obesity
posted by the Better Health network at
1:00 PM
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Tuesday, March 31, 2009
ACC '09: A vote of confidence for clopidogrel
For the 40-50% of patients with atrial fibrillation and high stroke risk who can't take warfarin, adding clopidogrel (Plavix) to their aspirin regimens might be a good bet, a new study finds. 7,554 aspirin-taking patients given clopidogrel vs. placebo in an RCT had 11% fewer vascular events, with the bulk of the difference comprising strokes (28% reduction in stroke).
Here's the catch: adding clopidogrel increased the risk of major hemorrhage by 58%, taking it from 1.3% to 2% a year. Put another way, if you had 1,000 patients on clopidogrel + aspirin for three years, you'd prevent 28 strokes and six heart attacks, but at a cost of 20 major bleeds, three of which would be fatal, said Stuart Connolly, MD, of McMaster University, at a press conference at ACC '09.
By comparison, warfarin reduces stroke risk by 38%, but increases major hemorrhage by 70%.
"We will need to work through with patients the risk and benefits," Dr. Connolly said. While warfarin is still the treatment of choice, "I think you will see clopidogrel become an alternative therapy," eventually, he added. The study is now online via NEJM.
Labels: acc '09, atrial fibrillation, clopidogrel, plavix
posted by Jessica Berthold at
11:07 AM
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