Wednesday, October 14, 2009
QD: News Every Day--The disconnect of health reform
ACP Internist's daily digest of internal medicine in the news continues with the disconnect on health care reform, a larger analysis of who was hospitalized for H1N1, and more on the primary care shortage.
Health care reform
Americans want health care reform to change, but they don't want to pay for it.
Meanwhile, the Economic Policy Institute, a think tank focused low- and middle-income Americans, points out that Medicaid and the SCHIP held in check the number of children who would have gone without health between 2000 to 2008. Children without insurance dropped 1.7% between 2000 and 2008, while adults less than 65 without insurance rose 3.1%. By contrast, children with public coverage grew 8.8%, compared to a 3.5% increase for the adult population under 65.
H1N1 influenza
Health officials now say that 46% of 1,400 adults hospitalized with H1N1 influenza did not have a chronic underlying condition, according to the largest analysis to date. The study looked at adults and children hospitalized from April through August in 10 states at medical centers participating in a special disease surveillance network. Anne Schuchat, FACP, who heads the CDC's National Center for Immunization and Respiratory Diseases, said the larger analysis looked at underlying conditions not previously examined. Among adults, 26% had asthma, 10% had diabetes, 8% had some other chronic lung disease, 8% had weakened immune systems and 6% were pregnant.
Primary care shortage
A financial advisor chimes in with his analysis of why primary care doesn't pay, including input from his own internist. The doctor says, "The average income of a primary care doctor in Massachusetts is about $86,000. Why do I do it? Because I love it."
The medical home
Profiles of practices trying the patient-centered medical home include Greenhouse Internists in Mt. Airy, Pa. and the Adirondack Regional Medical Home Pilot, which also an effort to stop the loss of primary care practitioners in the region. And for a lighter note, don't miss ACP Internist's own Stacey Butterfield's report from the MGMA meeting in Denver.
In case you missed it ...
In Minnesota, the Vitality Project prompted one town to build sidewalks and bike trails; restaurants, groceries and schools to push healthier foods; and employers to give workers time to exercise. The experiment added an average 3.1 years to the longevity of about 2,300 residents who calculated their lifespans by answering 36 lifestyle questions.
Labels: diet, exercise, flu, H1N1, health care reform, health insurance, health policy, patient-centered medical home, primary care shortage, QD
posted by Ryan DuBosar at
11:53 AM
0 Comments
Wednesday, October 7, 2009
1500 calories for $5--good deal or bad?
Maybe it's an argument for the soda tax. Or further explanation of the association between poverty and obesity.
In any case, this NY Times article about the impact of posting calorie counts is fascinating. It reports on a new study which found that people actually ordered more fast food in some poor neighborhoods after calorie counts were posted. Why? From the anecdotal interviews in the article, it sounds like the customers really just don't care about calories.
Is this the fatal flaw in calorie posting? Are people overeating by ignorance or by choice? The findings raise the unfortunate possibility that the only major accomplishment of posting calorie counts could be saving yuppie dieters some math.
Labels: diet
posted by Stacey Butterfield at
9:00 AM
0 Comments
Tuesday, October 6, 2009
Is there anything the Med diet can't do?
In addition to the cardiac, weight-loss and glucose-control benefits we already knew about, now comes the news that the Mediterranean diet can reduce the risk of depression. According to a Spanish study in the latest issue of Archives of General Psychiatry, "individuals who followed the Mediterranean diet most closely had a greater than 30 percent reduction in the risk of depression than whose who had the lowest Mediterranean diet scores."
So maybe it's not just be the weather that makes southern Europeans so happy. Of course, the researchers might want to be careful in making conclusions about causation, since we have anecdotally observed a certain link between depressive symptoms and the desire to eat ice cream. But this research should fix that. Next time you have a bad day, try comforting yourself with olive oil instead!
Labels: depression, diet
posted by Stacey Butterfield at
1:01 PM
0 Comments
Tuesday, September 1, 2009
Mediterranean diet trumps low-fat diet for diabetes management
Researchers compared the effects of a Mediterranean-style diet versus a typical low-fat diet for diabetes management in one of the longest-term randomized trials of its kind to assess their effectiveness, durability and safety on the need for diabetes medications in overweight patients with newly-diagnosed type 2 diabetes.
Researchers randomly assigned 215 patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years. Nutritionists and dietitians counseled both groups in monthly sessions for the first year and bimonthly sessions for the next three years. Patients on the low-carbohydrate Mediterranean diet avoided medication, lost more weight, and decreased some coronary risk factors. Results were reported in Annals of Internal Medicine.
After four years, 44% of patients in the Mediterranean-style diet group required antihyperglycemic drug therapy compared to 70% in the low-fat diet group. Patients in the Mediterranean diet group also experienced greater weight loss and an improvement in some coronary risk factors.
View Video
Labels: Diabetes, diet, obesity, weight loss
posted by Ryan DuBosar at
7:00 AM
0 Comments
Friday, August 14, 2009
This guy is cool.
If you've ever sat in front of the TV wishing that every other commercial didn't reinforce your desire to stuff yourself with junk food, you might appreciate the efforts of Dr. Jason Newsom. According to USA Today, the Florida physician had a digital sign outside his office with messages like "French fries=Thunder thighs" and "America Dies on Dunkin'".
Not so surprisingly, that second one got him in trouble. The doughnut dealers protested and Dr. Newsom had to find himself a new job. You have to appreciate his attempt to fight the messaging imbalance between consumption of crap and healthy living. But if you want to follow his example, it may be safer to avoid targeting specific brand names. Try it "Coming to America"-style: "Eating at McDowell's will increase your jowls."
Labels: diet
posted by Stacey Butterfield at
11:37 AM
0 Comments
Tuesday, June 23, 2009
The doughnut hole will need a new name
Yesterday, pharmaceutical companies agreed to shrink the Medicare doughnut hole by offering a 50% discount on meds purchased while a patient in the hole. The full price of the medicines will continue to count toward getting back out the other side. Given this development, the gap in coverage is going to need a new name to convey its smaller size--maybe the icing in the eclair or the Oreo filling?
More seriously, the most interesting thing about this change is how it benefits everyone involved. The advantages to patients are obvious. But the seemingly altruistic move by big pharma will probably benefit their bottom line, too, according to an analyst interviewed by the New York Times.
"'Because of the discounts,' he said, 'Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them.'"
It makes you wonder why they didn't do it sooner. Was this strategy reserved until it would have the biggest possible PR impact as a contribution to health reform?
And if the talk of doughnuts and Oreos has made you desperately crave some junk food, my apologies. The NYT also has an interesting article about this psychological torment.
Labels: diet, drug companies, health care reform
posted by Stacey Butterfield at
2:30 PM
0 Comments
Wednesday, May 20, 2009
Another reason to skip the soda: Potassium depletion
Supporters of the recent Senate Finance Committee proposal to tax sugary drinks may want to arm themselves with the findings of a new study on soda drinking. The study, published online May 13 by the International Journal of Clinical Practice, presents some alarming case studies of cola-induced hypokalaemia brought on by chronic consumption of up to 10 liters per day of sugar-sweetened cola.
The study's findings suggest that "potassium deletion should be added to the long list of soft drink-related health problems," (obesity, type 2 diabetes, dental decay and metabolic syndromes, to name a few), said a related editorial. To illustrate, the editorialist relates a case from his own files in which a 51-year-old man with COPD, hypertension and idiopathic gastroparesis developed persistent hypokalaemia, generalized weakness and loose stools. After running through a number of possible causes, the doctor hit upon the problem when the patient arrived in his office with a two-liter bottle of Pepsi in tow; upon further questioning, the patient estimated his total daily consumption at 4 liters. He agreed to keep his intake to two liters, and saw his potassium gradually rise back into the normal range.
The editorial also cites the intriguing case of a 44-year-old ostrich farmer who returned from a kangaroo-hunting trip in the Australian outback with profound muscle weakness and respiratory distress that required intubation and mechanical ventilation. It turned out that his serum potassium level plummeted when he upped his Coca-Cola intake to 10 liters (from his usual 4 liters daily) to combat his thirst on the hunt (From the study, "Coca Cola and kangaroos," Lancet, 2004; 364: 1190).
The editorial warns against relegating these cases as "outliers," citing some rather unsettling statistics. Worldwide consumption of soft drinks was almost 83 liters per person in 2007, with the U.S. level even higher at an estimated 212 liters per person. While healthy adults often can tolerate low potassium levels, not so for patients with heart problems, the editorial points out, and even moderate chronic cola consumption has been associated with chronic kidney disease.
The statistics should be a wake-up call for internists, especially considering the steady rise of obesity and type 2 diabetes. Most people know that sugary drinks are unhealthy, but public health initiatives have focused largely on children and teens. However, the editorialist urges, internists need to start asking their adult patients about soft drink consumption, along with questions about alcohol, cigarette and drug use.
Labels: chronic diseases, diet, obesity
posted by Janet Colwell at
9:51 AM
0 Comments
Thursday, May 14, 2009
A light breakfast
Regular readers of this blog know that our conference coverage usually serves as an opportunity not only to pick up clinical knowledge, but also to conduct some zoological observations of physicians in their natural habitat.
Along these lines, I'm pleased to report that attendees at the Society of General Internal Medicine's annual meeting practice the healthy eating that they preach. At this morning's buffet, piles of muffins and danishes sat untouched while people formed a LINE at the fruit table!
Those docs were probably glad of their restraint when keynote speaker Robert H. Brook, MD, took the stage. As a solution to the obesity epidemic, he advocated decreasing the availability of the food supply. For example, for his office at RAND, Dr. Brook has pushed for the elimination of all food outside the cafeteria and replacing buffets with calorie-limited servings.
He had similarly harsh prescriptions for practitioners of general internal medicine--think procedures and meds instead of snack food. More on that in my next post.
Labels: diet, SGIM meeting
posted by Stacey Butterfield at
1:35 PM
0 Comments
Friday, March 13, 2009
Finally, a practical use for Twittering
One of our constant questions at ACP Internist is: What is Twitter really useful for? Everyone has a feed but no one is really saying anything. Just as we'd given up on a practical purpose for it, (surgery aside) we found two bread-and-butter applications for internal medicine: smoking cessation and weight loss.
Qwitter helps users track how many cigarettes they smoke, keep a journal, view progress over time and share info with supporters.
Next, you can Tweet what you Eat, using Twitter to set up a diary, track consumption, enter calories and find our how many are in the food you eat.
Personally, I think Twittering would help reduce smoking or eating just because it's something else to do with your hands. If you try these, or let patients try them, let us know how you fare.
Labels: diet, smoking cessation, social networking, weight loss
posted by Ryan DuBosar at
8:30 AM
2 Comments
Friday, February 27, 2009
Wanna lose weight? Eat less!
The big diet study in this week's NEJM seemed like a good target for news of the obvious, but since the mainstream media is giving it tons of positive attention ("The secret to weight loss," screamed cable news), we'll play along.
In short, researchers assigned 800-some patients to three different diets with varying proportions of fat, protein and carbohydrates. They found that a) patients weren't very good at sticking to the instructions so they ended up eating more similarly than intended and b) people lost weight at the start of diets but then started gaining it back within two years.
So, the good news is that successful weight loss is not complicated (any kind of diet works as long as it's lower in calories), but the bad news is that it's really hard. As an accompanying editorial said, "even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic."
Need some humor after that depressing news? Check out the "Clinical Directions" comments that accompany the study on the Journal's website. Readers offered a number of interesting weight-loss techniques, including eating like a caveman, following the advice of Muhammed, and carrying a tape measure everywhere.
Labels: diet
posted by Stacey Butterfield at
8:00 AM
0 Comments
Friday, December 19, 2008
What's the big deal?
I'm mystified by the attention and press coverage that a new study in JAMA about dietary options for type 2 diabetics has attracted. The Canadian nutrition research found a very small difference in A1c levels resulting from two different diets (a .5% drop in patients who ate low-glycemic-index vs. a .18% decrease in those who ate a high-fiber diet). The results were less than overwhelming, but if these dietary changes are easy, maybe they're worth suggesting, right?
Good luck. The primary distinctions between the two diets are so miniscule that an obsessive-compulsive dieting teenager would have trouble keeping track, let alone your average overweight type 2 patient. To quote from the study, the first group was encouraged to eat "low-glycemic index breads (including pumpernickel, rye pita, and quinoa and flaxseed) and breakfast cereals (including Red River Cereal [hot cereal made of bulgur and flax], large flake oatmeal, oat bran, and Bran Buds [ready-to-eat cereal made of wheat bran and psyllium fiber])" while the other group ate "whole grain breads; whole grain breakfast cereals."
And what do both these dietary plans have in common? Carbs!
There are some potential significant differences hidden in the details of the diets (the low GI list included nuts, while the high-fiber people ate potatoes). Might that have been responsible for the differential in A1cs? We'll never know, because the effects were buried under the details of the cereal aisle.
It's a pet peeve of mine how little attention the relationship between carbs and blood sugar gets in diabetes care recommendations. It's one thing to suggest that obese patients cut the fat, but having people obsess over bread varieties instead of just eating their sandwiches open-faced? Frustrating.
posted by Stacey Butterfield at
12:54 PM
0 Comments
Friday, October 31, 2008
Don't let Halloween go to waist
With obesity and in particular childhood obesity in the news so much, parents are finding ways to cut back on Halloween candy excesses, including exchanging candy for money or toys.
It takes about 3,500 calories to produce a pound of weight gain. Exercising off 3,500 calories produces a pound of weight loss. But how much candy makes up 3,500 calories?
Kid's Health, the well-respected, ad-free resource, offers an easy and kid-enticing game to calculate how much candy makes up a day's worth of calories, which they estimated at 2,000 for kids ages 8-12. Eight big candy bars is all it takes to get a day's worth of calories. By the same measure, 13 would produce an extra pound of weight. Keep that in mind when checking over the Halloween loot.
Labels: diet, obesity, weight loss
posted by Ryan DuBosar at
6:00 AM
0 Comments
Friday, October 10, 2008
Is honey the new red wine?
We've already heard (and re-heard) that red wine, olive oil, omega 3-rich fish and dark chocolate have healthful properties. Now it looks like honey is primed to have its place in the sun.
Cochrane Researchers have found that honey reduced the healing time of patients suffering from mild to moderate burn wounds. They reviewed 19 studies and found honey worked better on the burns than some gauze and film dressings. It also kills the bacteria that cause chronic sinusitis, another new study found.
Last year, a study found that a single dose of buckwheat honey resolved symptoms of upper respiratory tract infections in kids, while honey-flavored cough medicine didn't.
Of course, unlike the other foods, researchers here are focusing on honey's healing properties, rather than its potential preventive benefits. Either way, looks like we might want to start paying attention to that declining bee population...
posted by Jessica Berthold at
11:55 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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Previous Posts
- QD: News Every Day--Santa's take on H1N1 influenza...
- Rethink pink: breast cancer screening evidence met...
- QD: News Every Day--Santa's take on H1N1 influenza...
- QD: News Every Day--when evidence and politics col...
- Ghostwriting haunts Congress' hallowed halls
- QD: News Every Day--payment fix inches forward (fo...
- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.
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EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
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A roundup of health policy news drawn from a database of hundreds of Web sites.
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Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
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The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
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The Public Library of Science's open access materials include a blog.
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