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, February 9, 2010
Vitamins in a Nutshell
This post by Davis Liu, MD, originally appeared at Better Health.
Some patients love their vitamins, spending hundreds to thousands of dollars annually. At times, they will even forgo proven medical therapy. As more Americans go without health insurance coverage while others face higher office visits and copays, increasing numbers of patients are seeking alternative, natural therapies instead of medical care. Are vitamins really the scientific breakthrough and secret that doctors refuse to recommend, or are they simply marketing hype? As any medical school student will tell you, the correct answer to any question is: it depends.
For certain groups, pregnant women, patients with macular degeneration and vegetarians, vitamins and minerals may be recommended as research finds them helpful. Prenatal vitamins have more folic acid, which has been found to decrease the risk of neural tube defects in the fetus. Vegetarians may need to supplement their diet with vitamin B12, iron, and vitamin D, which are absent in their food choices.
Patients with a history of gastric bypass should be on a multivitamin that contains iron and vitamin B12. The surgery, which is used to cause weight loss in morbidly obese patients, can bypass part of the digestive tract responsible for absorbing these nutrients.
Women of all ages should take calcium and vitamin D to improve bone density to decrease their future risk of osteoporosis. This means at least 1,000 mg of calcium daily and vitamin D 800 to 1,000 international units (IU) per day. Women over 50 should be taking 1,500 mg of calcium/day. A common misconception is that a multivitamin has enough calcium. It doesn't! A typical multivitamin has about 45 mg of calcium (a glass of milk is about 300 mg).
Aside from these individuals, the result of us with a balanced diet should get the right amount of vitamins and minerals. You don't need the large mega-dose vitamin packs found at your local warehouse store or nutritional shop. Not only are they expensive, but also unproven.
If you still feel like you can't get through life without taking vitamins, then at least be aware of the following:
Limit the amount of fat soluable vitamins that you ingest, specifically vitamins A, D, E and K. Unlike water soluable vitamins, of which excess amounts are excreted by the kidneys, fat soluable vitamins can build up levels in the body.
For vitamin A, toxic levels begin after ingesting more than 50,000 IU daily. Upper limit of tolerable intake (what is considered the upper limit of normal but still safe) is 10,000 IU. Recommended daily allowance is 3,000 IU.
For vitamin D, the upper limit is 2,000 IU. The current daily allowance is 600 IU. A new recommendation is expected in May 2010 by the Food and Nutrition Board. Vitamin D is obtained by the skin via sunlight exposure. With people indoors more often than generations ago and possibly the increased use of sunscreen, doctors are seeing more cases of vitamin D deficiency. Your doctor may prescribe a weekly dosage of 50,000 IU weekly for three months to replace. Low levels of vitamin D can cause muscle pains, so if a constant problem, ask your doctor to check your levels. (Cod liver oil, incidentally, is rich in vitamin D and is probably why growing up in Canada I had a lot of it during the winter. Ick.)
For vitamin E, the recommended dosage is 22.4 IU with the upper limit of tolerable intake no more than 1,500 IU. Some research suggested that there was increased mortality for those individuals taking more than 400 IU per day. Because of its antioxidant properties, researchers thought taking more was better. It wasn't.
For vitamin K, found in green leafy vegetables, it is the only fat soluable vitamin where there is no defined upper limit for toxicity. Overdose of vitamin K is rare.
Am I against vitamins? Of course not. For some patients, in fact, they are recommended. What I am against is, however, having individuals spend their hard-earned money for therapies that aren't proven. Note that the FDA, under current legislation since 1994, has no oversight over nutritional supplements.
This is why all vitamin package inserts have the following statement:
* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Want to live well? A better insurance policy than vitamins is to not smoke, perform regular physical activity, take in five servings of fruits and vegetables, and possibly drinking alcohol in moderation (as a doctor I can't recommend that, but if you drink already, it might be ok). Researchers found individuals who did all four behaviors added 14 years to their lives. Why don't more of us these activities? They all take some effort. Swallowing vitamins are quicker and easier.
If I still haven't convinced you not to take unnecessary vitamins, then at least check with your doctor before stopping your medical therapies or adding supplements that can interfere with your treatment.
Finally, please avoid colon or total body cleanses. Sounds natural and healthy, but again aren't required. A product found at a large nutritional chain's special "anti-oxidant" formulation basically consists of fruits, vegetables and fiber. You can do that yourself for a lot less, and it probably tastes better too.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: alternative medicine, drug interactions, vitamins, women's health
posted by the Better Health network at
9:00 AM
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Tuesday, February 24, 2009
Crying wolf: Bypassing EHR drug warnings
WhiteCoats blogs that a recent Archives of Internal Medicine study about the tendency for most doctors to override electronic health record warnings of potential drug interactions, "shows how forcing clinicians to jump through more and more micromanagement and regulatory hoops in order to practice medicine won't necessarily have the intended effect."
The study, which analyzed 233, 537 medication safety alerts generated by 2,872 clinicians in three states in 2006, found that a majority of clinicians bypassed most high-severity DDI and allergy alerts. Researchers concluded that the current warning system falls short of providing meaningful patient protection.
But WhiteCoats counters that since there hasn't been a flood of adverse outcomes reported, maybe the warnings are overblown. Alerts lose power when too many turn out to be theoretical dangers that don't apply to actual individual patients. What do others think? Are electronic reminders of DDIs helpful or just more annoying pop-ups?
Labels: drug interactions, electronic medical records
posted by Janet Colwell at
10:49 AM
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