Dr. Buttery's Public Health BLOG

A quote from a discussion at a meeting reported in the BMJ today �CMS is clearly the big kahuna, paying out over $300 billion for health care last year. CMS is managing a "care improvement program", a huge randomized trial of 20,000 Medicare enrollees, each of whom is in some sort of disease management program. It’s called Medical Health Support. Too soon for results. “Medicare patients with five or more chronic conditions see an average of 14 different physicians and get 57 different prescriptions a year.�
What kind of quality can this approach possibly provide? No wonder our system costs so much and performs so badly!

Posted by at 7:49 PM | Permalink | Comments (0)

Today tthe MMWR released the Recommendations of the Preconception Work Group. All health directors and public health nurses will want to read and keep this set of recommendations.

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An amusing story with a moral in today's London Telegraph
The argument runs that, for those who are either unable to stop eating or lack the ability to gauge when they are full, a drug that curbs appetite with negligible side effects could be a godsend. Very few diets actually work and those that have true merit in the long term cannot deliver the sort of results that most of us want in the short term. Resorting to tricks to help you or, worse still, to do it for you does nothing in the long run and I can almost guarantee that you will regain the weight. And more.
Yet $millions are made from the continuous spate of ads on TV. Our nanny goverment, which seems to want to ban everything does nothin about the 'diet' pills.

Posted by at 9:50 AM | Permalink | Comments (0)

Ethyl Mercury, used in dental amalgams does not cause mental retardation or other mental illnesses. This new study in JAMA this week clearly demonstrates lack of effect. The thoughtful accompanying editorial points out that more than one study may be needed to settle the issue is worth resding.. When we consider the millions of dollars spent to refute activist fears about dangers of current vaccines, the use of thiomerasol , the use of cell phones, dangers of power lines, or the use of breast implants, we should beware of diversion of funds that could have been spent to improve the health of miliions, that has been wasted on studies to prove that 'nothing' happened or will happen, and also the costs of law suits and inappropriate awards. How many potentially useful vaccines and medications will not be developed because of our willingness to listen to every activist voice, even when there is no biological plausibility for their concern?.

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In the April 15 Lancet an editorial focuses on the US AIDS/HIV prevention package, PEPFAR, provided through the WHO. PEPFAR hopes to secure US$15 billion in funding between 2004 and 2008. 15 countries that are especially badly affected by HIV will receive $9 billion between them: 12 countries from Africa, plus Guyana, Haiti, and Vietnam. PEPFAR will also spend $5 billion on ongoing bilateral programmes in 105 other countries and will donate $1 billion to the Global Fund to fight AIDS, TB and Malaria.
The cornerstone of PEPFAR's prevention strategy is the ABC approach—Abstain, Be faithful, use Condoms—with a strong emphasis on A and B, over C, in most settings.
Because of ambiguity on what is high risk and who can use a condom in this package the editorial, correctly in my opinion, suggest a reversal to CAB. US morality should not be used to bludgeon other countries, that Condoms are still the best protection in most parts of the world.

Posted by at 10:22 AM | Permalink | Comments (1)

In a strongly worded review published in the recent edition of The Journal of the American Medical Association (JAMA), the head of the Johns Hopkins Diabetes Center urges physicians and patients to better use the blood-testing tools at hand to manage the disease and prevent most of its dire impact on the heart, kidneys, nerves and vision. An estimated 14.6 million people in the United States have been given a diagnosis of diabetes, most of them with so-called type 2 or adult onset.
Both self-monitoring of blood glucose (SMBG) and more precise physician testing of hemoglobin A1c (HbA1c) can help diabetics take proper control of their blood sugar levels and successfully manage their disease.

Posted by at 11:32 AM | Permalink | Comments (2)

In a recent blog I revisited Ivan Illich's essay on the dangers of the medical profession to the health of the population. From the BMJ news this week is an interesting report: Disease awareness campaigns turn healthy people into patients. We need to be careful. the the medical marketplace can detract from the public health message.
The conference on disease mongering, held in Newcastle, Australia, was timed to coincide with a theme issue of the journal PLoS Medicine, published by the US Public Library of Science (PLoS).
April's issue of PloS (US Public Library of Science) Medicine carries 11 peer reviewed articles on disease mongering, which is defined by this month's guest editors as "the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments."

Posted by at 10:59 AM | Permalink | Comments (0)

Another useful dietary update from the Mayo Clinic
If you enjoy shellfish but are reluctant to eat it because of worries about cholesterol, take heart. Blue mussels, broiled scallops or a fine Maine lobster are actually heart-healthy protein sources. Most shellfish are not only low in cholesterol, but they can also be rich sources of heart-healthy fats.
The April issue of Mayo Clinic Health Letter explains that the commonly held view was likely driven by the fact that the nutritional profile of shellfish includes chemical compounds called sterols. Although cholesterol is just one among many sterols, less sophisticated testing methods used in the past grouped all sterols under cholesterol. So, the cholesterol levels for shellfish generally looked high. Now, laboratory tests can differentiate cholesterol from non-cholesterol sterols.

Posted by at 1:43 PM | Permalink | Comments (0)

A simple 3-second office screening test may enable pediatricians to identify amblyopia, or vision loss in one eye, in children as young as two, report ophthalmologists at Children's Hospital Boston in the April Archives of Ophthalmology. Amblyopia, also known as "lazy eye," affects 3 to 5 percent of all children and is the leading cause of vision loss in childhood. Because preschoolers cannot reliably communicate or read eye charts, amblyopia often goes undetected at the time when it is most correctable.
The new screening instrument, known as the Pediatric Vision Scanner, is designed to be easy for pediatricians and pediatric nurses to use. It looks like a hand-held camera and displays a visual target: a blinking light inside a bull's eye. As the child looks at this target, the device scans the eyes' retinas with a low-power laser to take a series of five readings of the eyes' alignment and ability of both eyes to focus on the target simultaneously.
This has potential for child screening by public health departments.

Posted by at 1:38 PM | Permalink | Comments (0)

This article from the CDC journal on Chronic Diseases researches health related information on the Web. The most important features of the Internet that would encourage its use for health information were ease of finding and using the information and clarity of the information provided. Internet use differed by sex and age and was strongly associated with income and education. The article concludes that public health professionals have a unique opportunity to use the Internet as a tool to complement and supplement the health information that the public receives from health care professionals. How many local health departments increase their visibility and credibility by providing user friendly links to important sources of health information on their web pages? Does yours?

Posted by at 11:39 AM | Permalink | Comments (0)

For many advocates of a change to our "health" system the British NHS has been the commonly chosen poltical model. Those interested in changing our system should reveiw the current problems within the British NHS, as it appears to the health professionals. it is probably discussed best in the BMJ this week but should be followed. I can only wonder how much of the problem is the failure of long range planning, based on changes in disease from acute to chronic, with the fastest growing segment of the population being that over 85 yeasr of age. It is worth reading Ivan Yllich's book "Medical Nemesis", again.

Posted by at 11:53 AM | Permalink | Comments (0)

In today's BMJ [BMJ 2006;332:808 (8 April)] in an editorial noting women NOW live longer than men across the globe, credit is given to William Farr of the UK, for first discussing Health Inequalities in the 1850s. If you read todays' publication's one would think this phenomenon had only been a topic of interest for the last 10-20 years.

Posted by at 11:46 AM | Permalink | Comments (0)