Articles on General
Wednesday, January 23rd, 2013
Government agencies have become obsessed with requirements for universally accessible medical records. They will enforce this requirement by law within the next two years. I shudder to think what this will do to individual privacy. Already I have seen the shadow of the computer come between the individual and the physician, interfering with communication as the physician fiddles with screens while ostensibly listening to the patient. Eye to eye contact is becoming a thing of the past. I deplore this, since it detracts immensely from the physician-patient relationship.
Recently I requested a patient’s records, and was sent an E-mail containing 300 pages of notes, largely illegible and mostly irrelevant. It took me half an hour to obtain a few bits of useful information that could have been expressed in one paragraph.
Saturday, August 25th, 2012
A patient goes to a doctor’s office with the belief that the doctor knows something, or has the ability to do something, that will help the patient. It is the doctor’s obligation to have knowledge, or have access to knowledge, relevant to the patient’s situation, or the training to perform a procedure to evaluate or treat the patient.
It is therefore important for the doctor to be educated in what he purports to know, to offer recommendations based on a satisfactory knowledge base. It is also important that the basis of a physician’s recommendation is the well-being of the patient, not the physician’s self-interest.
These conditions are by no means straightforward. Many types of approaches are available for most conditions, while other conditions have few proven therapies. Still, patients will always look for answers, for some kind of help, because it is not in man’s make-up to sit and do nothing in the face of adversity.
The doctor must keep in mind that a given treatment may not help the patient, or may cause complications and make the patient worse, or that the real diagnosis lies elsewhere. The age, physical and mental status of the patient must also be considered in choosing a therapy. Cardiac bypass surgery may be a proper choice for a 50 year-old, hard-driving businessman, but excessively dangerous for an 85 year-old woman with severe arthritis and emphysema. Determining the best therapy may more involve the art than the science of medicine.
Sunday, July 22nd, 2012
Whether it is alternative or allopathic (conventional), bad medicine is just bad medicine. We have patients who take no prescription or over-the-counter medication at any time. We see others who are taking 10-12 medications at once, who are interested in getting off as many of them as possible. They know that prescription drugs can be and often are toxic, and they experience those adverse effects. Certainly we deplore situations where patients enter the hospital with chest pain and are discharged with eight new medications, with no detailed advice on beneficial life-style changes, and told not to eat vegetables because they are on Coumadin.
There are times, however, that prescription drugs are useful and even life-saving. There are times when surgery can save a life, as in the evacuation of a subdural hematoma, and times when it is massively destructive, as in prefrontal lobotomy for psychiatric disorders.
I have seen physical therapy employed when the cause of pain was obvious but undiagnosed malignancy, herbs employed for critical aortic stenosis that needed surgery, congestive heart failure treated with acupuncture. The list goes on, and indeed every practitioner in every field of medicine has failed at some point to make the right diagnosis, or has offered the wrong therapy, or failed to offer the right therapy. Conventional practitioners are for the most part untrained in alternative therapies, and often demean them, while alternative practitioners have limited training in conventional diagnosis and treatment. (more…)
Tuesday, March 27th, 2012
An editorial in JAMA, Jan 4, 2012, deplores the persistent promotion of outmoded medical practices, in the guise of being valid. (Reversals of Established Medical Practices, pp37-38)
Modern medicine presents itself as being “evidence-based,” meaning that its tests and therapies are proven by research to be valid. Unfortunately for patients, that is patently not the case. Many standards of care have never been tested in trials, or worse, have been tested and shown to be wanting in efficacy. In a recent evaluation of 35 trials of established medical practices, 46% reported results consistent with the current practice, but an additional 46% offered results contradicting current practice, and another 8% were inconclusive. In other words, more than half of the practices were lacking or had dubious validity.
Among the invalid therapies are vertebroplasty for spinal fractures, demonstrated in two studies to lack effectiveness, but nevertheless now utilized as much or more than before the studies were published. Another invalidated procedure is the use of coronary artery stents in the treatment of stable angina. Stents provide no advantage in survival, although they do reduce exertional chest pain, but so do medications, and with much less risk.
Saturday, February 4th, 2012
The New England Journal of Medicine, the most prestigious and influential medical research publication in this country, enters its 200th year. During that time, its staff and contributors have witnessed vast changes in medical knowledge and practice. These include the acceptance of the germ theory of disease, the discovery of antibiotics, the use of hygiene in surgery, vaccination, discovery of the causes and effective treatments for heart disease, and the debunking of flawed therapies like bloodletting and forced sterilization.
It was not without concern that they also witnessed the inevitable move toward specialization that accompanied the expansion of knowledge. The Journal commented in 1924: “Are we not losing sight of that fundamental thread of truth that gives us a perspective of the real value of our work; that enables us to consider our patient as an individual and not a pathological unit of a human body or a representative of an age group?” (more…)
Saturday, January 7th, 2012
1. Doctors spending more time with patients
The average office visit for established patients in most practices runs 7-15 minutes, and 30 minutes for new patients. That is barely enough time to get right down to business, do a cursory exam and write a prescription, with no opportunity to learn about the patient’s lifestyle, family difficulties and other stresses. Physicians may be scheduled to see 30-40 patients a day. Being in such a rush stresses the doctor, leads to wrong diagnoses and wrong therapies. It also leads to more drug prescribing and more tests, as the quickest way to dispose of a patient is to write a prescription or order a test. Discussion invariably suffers from neglect.
Our regular office visits last 30 minutes, and new patients receive one hour. Sometimes it is during the last five minutes that patients come out with what is really troubling them. Certainly we arrange enough time to make patients comfortable, to find out about them and their families, and to create a relationship. It is this relationship that fosters healing, an opportunity for the doctor to assert an intention to improve the patient’s well-being.
Electronic medical records have further aggravated the situation, as physicians sit in front of their computers, typing away, scarcely looking at the person in front of them.
The issues we deal with are often sensitive, difficult for patients to express. They deserve, at least, the doctor’s full attention, with eyes on the patient and not on the clock.
2. Better research on nutritional therapies
The quality of nutritional research leaves a lot to be desired. The conclusion reached is often that a nutrient has no effect on a particular outcome. Doses employed in the studies are often low, lower than we employ in our practice, and frequently not obtained from the same source for all patients. The source of the vitamin should be constant, the dose should be substantial, and blood levels should be measured.
Regarding vitamin C, it has been demonstrated that the anti-cancer effect requires a high dose, only achieved through intravenous administration. Also, the effect of folic acid in preventing fetal malformations increases as the dose is raised.
With conventional drug studies, it is established that 80 mg of Lipitor is far more effective than 20 mg in preventing cardiac events. This approach, of using higher doses and comparing them with lower doses, should be employed in nutrient research. There is the further benefit that nutrients are generally safe in high doses. (more…)
Thursday, September 23rd, 2010
Cranberry juice could offer protection from serious ‘staph infections’ like toxic shock syndrome and MRSA, according to researchers at Worcester Polytechnic Institute.
The researchers, led by Dr Terri Camesano, professor of chemical engineering at Worcester Polytechnic Institute (WPI), reported the surprise finding of the study – that that a cranberry juice cocktail blocked a strain of Staphylococcus aureus (S. aureus) from beginning the process of infection.
“Most of our work with cranberry juice has been with E. coli and urinary tract infections, but we included Staphylococcus aureus in this study because it is a very serious health threat,” Prof Camesano said. “This is early data, but the results are surprising.”
Cranberry has long been linked with protection from UTIs, with previous studies showing mixed reviews for the benefits of cranberry juice.
In a systematic review of the evidence the Cochrane collaboration reported: “There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs.”
However, last year the European Food Safety Authority (EFSA) issued a negative opinion to global cranberry leader Ocean Spray for an article 14 health claim relating consumption of cranberry and urinary tract infection (UTI) in women.
E. coli is accountable for around 80 percent of urinary tract infections (UTIs), whilst S. aureus can cause a range of “staph infections”, ranging from minor skin rashes to serious infections like toxic shock syndrome.
Antibiotic resistant strains of S. aureus like Methicillin-resistant Staphylococcus aureus (MRSA) are a growing problem – in the USA deaths from MRSA more than doubled between 199 and 2005.
Infection occurs when bacteria manage to adhere to a host cell and form a biofilm, this thin film creates an environment where the bacteria can multiply and thrive.
Read the rest of this article here.
Monday, August 23rd, 2010
Oh, to be the Bildens. Their three kids go to bed at a decent hour — around 9 — and sleep through the night. No little ones tiptoeing out of the bedroom for a third glass of water or fifth bathroom trip.
“The embarrassing part is, I go to sleep shortly after them. I raise the white flag and crawl into bed. I get up early, by 5,” says Kristin Bilden of Durham, N.C., whose three children range in age from 6 to 13.
Healthy parent sleep habits like Bilden’s just might be one of the keys to why her kids are well rested, while technology may be kids’ biggest sleep robber, says Nancy Collop, president-elect of the American Academy of Sleep Medicine (AASM).
“Cellphones, Facebook, iPods and video games are keeping kids up later at night. And the literature is suggesting it’s getting worse, not better,” Collop says.
Friday, April 9th, 2010
Recently, EWG President Ken Cook met with CNN Chief Medical Correspondent Dr. Sanjay Gupta in Mossville, Louisiana, where they talked about the impacts of toxic chemicals on human health.
You can watch this interview on Sanjay Gupta MD this Saturday or when it re-airs Sunday (April 10th and 11th) at 7:30am ET.
We hope you can tune in to hear this interesting conversation.