Dr. Buttery's Public Health BLOG

In the New York Times's (7/29, F6) Well column, Tara Parker-Pope writes that a "growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks." This "relationship is the cornerstone of the medical system -- nobody can be helped if doctors and patients aren't getting along. But, increasingly, research and anecdotal reports suggest that many patients don't trust doctors." According to data from a Johns Hopkins study published this year in the journal Medicine, approximately "one in four patients feel that their physicians sometimes expose them to unnecessary risk." Sandeep Jauhar, M.D., director of the heart failure program at Long Island Jewish Medical Center, noted that one reason for patients' frustration is the fact that everything is so rushed these days, and "[n]obody is talking to the patients." Comment: This should not surprise anyone with the current emphasis on carrying out procedures and avoiding “wasting“ time talking to patients. This is specialism at its worst and is partly the result of rushed legislation that will not wait to evaluate any activity, and partly the result of inappropriate evaluation by the LCME which evaluates medical school curricula, and the ACGME which evaluates graduate programs. Neither has any focus on public awareness, only on technical proficiency..

Posted by at 10:48 AM | Permalink | Comments (0)

The AP reports that "Google, Inc., Microsoft Corp., and a hodgepodge of healthcare providers and insurers have agreed on ground rules for protecting the privacy of the sensitive information" contained in personal health records (PHRs). The companies are "hoping to persuade more people to store their medical records online," by "reassuring patients that they can enjoy the convenience of keeping their medical histories in online filing cabinets, without worrying that will open a door for outsiders to peruse the data without their knowledge." Comment: It is unfortunate that so many physicians are Luddites, using every excuse they can dredge up to avoid using technology to improve practice outcome, prevent medication errors, and limit E.R. access to patient records. No other developed nation is as far behind the use of PHR as tHe U.S. We should not have to wait for Google and Microsoft to manage patient records for us.

Posted by at 9:46 AM | Permalink | Comments (0)

A move in the right direction ot reduce complexity of vaccine schedule. The UPI (6/24) reports that the "Food and Drug Administration has licensed a vaccine against five childhood ailments in a single dose." Sanofi Pasteur's Pentacel vaccine, the "first five-in-one pediatric combination vaccine," is "approved for use in infants and children six weeks through four years of age." The vaccine provides protection "against invasive disease due to Haemophilus influenza type b, diphtheria, tetanus, pertussis, and poliomyelitis."
Presently, "children in the United States receive up to 23 injections by the time they're 18 months old, as recommended by the Centers for Disease Control and Prevention," HealthDay (6/23) noted in its Health Highlights section. The use of Pentacel could reduce that number of shots by as many as seven

Posted by at 10:05 AM | Permalink | Comments (0)

For those of us who had corneal tranplants years ago and have to use contact lenses , the new artificial corneas that will be available this year may be a solution, but it may be best to wait 2-3 years until there is more experience with their use. For those of us whose eye doctors have difficulty with obtaining the best fit for prescriptions a new automated system appears to be a significant option as it is introduced into the doctor's offices.

Posted by at 10:33 AM | Permalink | Comments (0)

The news media are having their usual feeding frenzy about the latest report on foodborne disease outbreaks outlined this week by the CDC. Washing fresh fruits and vegetables can reduce the risk of food poisoning, but only irradiation kills almost all disease-causing bacteria according to a study presented at the American Chemical Society's annual meeting in New Orleans. The researchewrs noted "washing with plain water did not reduce bacteria levels in spinach or lettuce. Chemical treatment did not significantly reduce E. coli in spinach leaves, and was less than 90 percent effective when it came to removing E. coli from lettuce." But, irradiation "reduced the level of E. coli by 99.99 percent in lettuce, and by 99.9 percent in spinach." The researchers also noted that "salmonella died more easily when exposed to radiation, while E. coli was a little bit more resistant."
If we can just get the public away from the 'Jane Fonda" syndrome about radiation being bad, we might make more progress in food safety. Suing food producers will not improve food safety.

Posted by at 10:53 AM | Permalink | Comments (0)

Just because the media annouce a new drug, don't assume you should rush out to your doctor and ask for it. A careful patient should only ask about a new drug if the present one, or a less expensivce one, is not doinig the job. Most new drigs do nothing except expand income for drug companies. Very few new drugs make any significant difference to the outcome of most chronic diseases. This is the case with Vytorin and Zetia.

Posted by at 11:01 AM | Permalink | Comments (1)

Researchers at Purdue University have developed a new technology that can simultaneously screen thousands of samples of food or water for several dangerous food-borne pathogens in one to two hours. With the repeated recalls of tainted produce and the inablity of local communities to provide sufficient funds to inspect food service places adequately, and usually only after an outbreak shows the deficiency, this is a technology that needs rapid translation from the laboratory to the field.

Posted by at 10:02 AM | Permalink | Comments (0)

Today, only 9 percent to 12 percent of physicians in the United States have access to full-fledged electronic medical records. Among advanced nations, the use of medical information technology here ranks among the “worst of the worst,” Crounse said. The United Kingdom spends 10 times as much as the United States on health IT, said Bradford Hesse, chief of the Health Communication and Informatics Research Branch at the National Cancer Institute.
“We have clearly failed to keep our population healthy,” said Bosworth of Google, who noted that tracking the advance of obesity and diabetes in the United States has been “like watching an alien virus spread across the country.”

Posted by at 9:39 AM | Permalink | Comments (0)

A fascinating story in today's BMJ from Dr. James Goldacre in the U.K. is about the failure of the media to pick up on well documented improvements on the social behaviour of children as rhe result of training parents. This is just as much a problem in the US as in the UK, yet we keep looking for a magic pill, while the media and the mental health public interest groups ignore the role of parents.

Posted by at 11:59 AM | Permalink | Comments (0)

Knowing whether the meningitis is viral or bacterial is imperative to early effective treatment. But distinguishing between the two types of infection is difficult because of similar symptoms. Patients with viral meningitis usually recover within two weeks without any medical intervention. Bacterial meningitis, however, can lead to brain damage, hearing loss and even death if not treated properly The U.S. Food and Drug Administration (FDA) cleared for marketing a test that uses molecular biology to quickly detect the presence of viral meningitis.

Posted by at 2:34 PM | Permalink | Comments (0)

This article from the Mayo Clinic is a good primer on the confusion about Stem Cells, particularly with the latest newspaper story about who said what to whom when, and was a recent paper in Science fraud or just poor composition.

Posted by at 10:36 AM | Permalink | Comments (0)

From Cornell University: Each year, tuberculosis kills nearly two million people while an estimated nine million develop the disease, including 450,000 new cases of multidrug-resistant TB, including people recently diagnosed with particularly lethal new resistant strains. today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test — developed more than a century ago — manages to detect TB in only about half of the cases.

Posted by at 11:15 AM | Permalink | Comments (1)

The Robert Wood Johnson Foundation (RWJF) has launched Common Ground: Transforming Public Health Information Systems. It hopes to:
Persuade public health agencies to integrate informatics principles and sound development methodologies to improve the delivery of public health services.
Examine existing public health service business processes—and define requirements for the information systems used to support these processes.
Help agencies develop new information system requirements that are more effective and that streamline the delivery of essential public health services.
Minimize duplicative efforts by identifying common business processes and information system requirements that are applicable across the pubic health field.
Encourage stakeholders at the local, state, and federal levels to endorse, adopt, and implement redesigned business processes and information system requirements that support public health preparedness and chronic disease prevention and control.

Posted by at 12:17 PM | Permalink | Comments (0)

See today's BMJ for an article by Don Combs from EVMS (BMJ 2006;333:1308-1311 (23 December)) on how new technology may transform medical care. It is only a short step to think about how these technologies may also change the face of population health.

Posted by at 11:35 AM | Permalink | Comments (0)

A study from researchers at the University of Michigan Health System and the Veterans Affairs Ann Arbor Healthcare System suggests that a program focusing on increasing step length and speed is more effective at improving mobility and balance than tai chi. This is the first comparison of two balance training programs in which each type of program has been proven to reduce falls, notes lead author Joseph O. Nnodim, M.D., Ph.D., clinical instructor in the Division of Geriatric Medicine at the U-M Health System and a research scientist at the VA Ann Arbor GRECC.

Posted by at 10:00 AM | Permalink | Comments (0)

IN an article in the LA Times today reporters Brink & Solovitch examine the evidence for taking vitamins and find it lacking. "Essentially, if you don't take multivitamins, there's no reason to start," says Dr. J. Michael McGinnis, senior scholar at the Institute of Medicine and chair of the NIH state-of-the-science panel on the role of multivitamins. "If you do, there's no evidence to stop." Also says Dr. Charles Halsted, editor of the American Journal of Clinical Nutrition: "You're deluding yourself if you think you're preventing a heart attack or cancer with a multivitamin. It's a waste of money if you're perfectly healthy and have a proper diet." Yet we waste millions of dollsrs on these worthless nostrums.

Posted by at 11:30 AM | Permalink | Comments (1)

From Purdue University today: researchers are developing two inexpensive technologies that may be able to prevent future food-borne illness, such as the recent outbreak of E. coli in contaminated spinach.
Together, these technologies rapidly detect and eradicate food-borne pathogens.
The first method uses a laser to detect and identify many types of bacteria, and is about three times faster and one-tenth as expensive as current technology.
"A second innovation uses chlorine dioxide gas to kill pathogens on produce, fresh fruits and vegetables. This would be a large step up from current technologies, which mainly involve washing and scrubbing, and cannot completely rid a product of a pathogen like E. coli," said Richard Linton, a professor of food science.

Posted by at 1:00 PM | Permalink | Comments (2291)

From the Massachussetts General Hospital today: "We are investing tens of billions of dollars in health information technology [IT] nationally, yet the medical profession has been very slow to adopt these tools for clinical care," says Richard Grant, MD, MPH, of the MGH Division of General Medicine, the paper's lead author. "We were shocked at the very low rate of basic IT use, particularly among solo-practice and non-academic physicians. I'm sure that the vast majority of them personally use e-mail and the Internet, but most do not have effective ways to integrate these tools into clinical practice."
Not only in clinical practice, but in many health departments. All of us should think about how much better our use of prevention practice would be with better data systems linking clinical practices to local health departments.

Posted by at 12:54 PM | Permalink | Comments (1)

Women age 65 years or older constitute half of new breast cancer patients each year, and the number of older women with breast cancer is forecast to double by 2030 as the baby boomers age. Yet despite their increasingly large numbers, older women who develop breast cancer often fail to receive the same care as offered to younger women according to Jeanne Mandelblatt, M.D., of Georgetown University’s Lombardi Comprehensive Cancer Center. she calls on doctors treating breast cancer in older women to look beyond the year in which a woman was born and to take into account her overall health, frailty and ability to tolerate various cancer treatment.

Posted by at 11:26 AM | Permalink | Comments (0)