Dr. Buttery's Public Health BLOG

The Robert Wood Johnson Foundation has just released a landmark report and founded the Commission to Build a Healthier America. The report and commission spell out the reason for studying disparities in health status and state that much ill health has little to do with medical care and everything to do with the social support system provided within communities. The commission will study health disparities within the U.S and recommend actions to change support systems to improve everyone's health. Tables within the current report show how far the U.S. has is fallen behind the other developed countries in caring for its citizens during the last 40 years. Part of the problem is clearly the focus on technology and research while loosing sight of social needs.

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Racial and ethnic minorities often receive lower quality health care compared to whites, even after controlling for socioeconomic status, education, access and other factors, according to the report from lead author Wally R. Smith, M.D., professor of medicine and medical director of the Center on Health Disparities at Virginia Commonwealth University. Smith and eight other experts who authored the report originally were brought together by the Society of General Internal Medicine to develop recommendations for training in internal medicine. But their completed report is aimed at all medical students, resident trainees and physicians.

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From today's BMJ an editorial[BMJ 2007;334 (16 June),] tells us that the US has the lowest percentage of primary care physicians, the highest percentage of population uninsured for primary care, and the lowest mean number of primary care visits per person per year. This will not be solved by training more doctors who will gravitate to the best paid specialties, but by changing the training to focus on primary care, along with medical school debt relief and practice support.

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PBS will broadcast a series of four programs on Remaking American Medicine in October which focus not only on hospital errors. but on nosocomial infections and chronic diseases. The first pressentation will be on October 5 at 10 pm.

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The weeks NEJM contains an article on direct marketing of Genetic Testing. It is worth reading by all. One problem is consumers whose science background is insufficient to know what the test might mean. There is the problem of false postives when scared consumers demand testing en-masse. There is the problem of false negative tests for those who need intervention but the test tells them there is no problem. There is no counseling available with online testing. This will further divide those with insurance/money to buy the test from those without It perpetuates trhe problems of advertising by the pharmaceutical and medical technology industry. It relies on the paranoia perpetuated by the 'media'..

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02/02/2006 - A handheld sensor could help food companies quickly detect within 10 minutes whether their
products are laden with Escherichia coli or listeria -- before they are shipped out of the plant. Industry news shows that there is an Increasing regulatory emphasis on food safety in plants and the cost of recalls has spurred food companies to seek faster ways of detecting pathogens.

Raj Mutharasan, an engineer at Drexel University in Philadelphia, Pennsylvania, has developed what he says is a cheap, quick and simple detector that just about anyone can use.

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An editorial in this week's Lancet states that despite warnings from the IOM in 2002 (Future of PH in the 21st Century), the Federal Government has failed to provide necessary infrastructure support for the Public Health System in the U.S. The editorial discusses the weakness of links within the public health system, and lack of response coordination among the local. state and federal public health agencies. There is no formal cordination and response, just plans on paper without force of law. The editorial suiggests that rather than placing public health response within Homeland Security it should be within HHS. Further, the editorial states that "assessment criteria to test states' compliance with national obligations have been criticised as meaningless and impossible to measure"

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University College London Hospital NHS Foundation Trust (UCLH) today announced the UK's first successful implementation of IDX ® Carecast™ – a landmark step in implementing electronic patient records (EPR), opening up the prospect of a virtually paperless hospital and a revolution in patient care,
Over coming months Carecast will gradually replace traditional paper records with information being stored online and immediately accessible throughout the Trust's 8 hospitals. UCLH is the first European hospital to use the IDX Carecast system, one of the most sophisticated anywhere in the world. It is earmarked for use throughout the NHS in London as part of the NHS's radical modernisation of its IT system. Carecast will provide immediate benefits for patients across the UCLH hospitals, but particularly in the Accident & Emergency and Maternity departments.
Lost notes and delayed test results will be a thing of the past. Patients will no longer have to repeat their case histories every time they have an appointment and the electronic patient record will help in the fight against hospital acquired infection by allowing much better tracking of where patients have been.

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A fascinating report in today's Telegraph.
Homeopathy has been proved more successful and cost-effective than conventional medicine in the first comparison of the two approaches.
Researchers in Germany recruited more than 400 adults and children with long-term health problems ranging from sinusitis to insomnia and depression. Half were treated using conventional therapy; the other half were treated homeopathically. After six months, the condition of the patients treated homeopathically had improved significantly more, and more quickly,
Too bad the refernce was not provided!

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Special Issue of Newsweek June 20 2005, - The Future of Medicine
New treatments, new science, new technologies - and what it all means for you and your family. Order now.
Highlights: The Future of Medicine
• The Future of Medicine
• Cancer Treatments with Fewer Side Effects
• Inflammation: The Root of All Illness?
• The Best Methods to Beat Diabetes
• Radiology: A New Alternative to Surgery

The possibilities are endlessly seductive. But technological progress is not a complete recipe for better health, and there is real danger in equating newer with better. America has built the world's highest-tech medical system, yet the nation ranks 46th in life expectancy (behind Japan, Singapore, Canada and virtually all of Europe and Scandinavia). And 41 countries, including Cuba, have achieved lower rates of infant mortality. "Without systemwide health-care reform," says Dr. Henry E. Simmons of the non-partisan National Coalition on Health Care, "we're missing massive opportunities to create a healthier population."

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