War Against McDonalds

The Physicians Committee for Responsible Medicine, a nonprofit advocacy group with a mission of promoting preventive medicine and conducting clinical research, released a controversial advertisement two days ago.  This ad shows a man on a gurney with his death grip (pun intended) on a fast food hamburger.  The end shows the McDonald's logo (the largest fast food chain and producer of high-fat, high-sodium, & high-cholesterol meals) with "I Was Loving It."

You can watch the ad by clicking here and can view the NYTimes story by clicking here.

What are your reactions?  Mine?  Finally someone is educating the television-viewing public about potential dangers and consequences of eating unhealthy.

UnMoral Minds

Wow, not even peer-reviewed journal articles are safe from false information.  Apparently a Harvard researcher, Marc Hauser, may have provided false, made-up data (at least for the control condition of the study) for a 2002 article published in the journal Cognition.  Although extremely rare something like this would happen, it's worth taking note of.  Sad to say, but this man will likely be looking for a new career. Ironically, he published a book called Moral Minds. It looks like someone teaching others about right and wrong has a few things to learn.

Read the story here.  And because I know you're interested (obviously I was), here is the man behind the story and his photo is at right.

Will You Develop Alzheimer's Disease? Do a Spinal Tap and You May Find Out.

I had to share this extremely interesting study.  It is one of the many findings found from the Alzheimer's Disease Neuroimaging Initiative (ADNI), of which I worked a research coordinator for at the University of Kansas Medical Center site.  One of the large $60 million study's goals was to look for biomarkers for Alzheimer's Disease.  Previously, the only definitive confirmation of an Alzheimer's Disease diagnosis was autopsy, whereupon one could see plaques and tangles in the brain.  


Published on Tuesday in the Archives of Neurology, was an article using results from ADNI to predict who with memory loss would go on to develop Alzheimer's Disease.  The authors were 100% accurate in using spinal fluid to make this prediction.  The article is titled, "Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People."  


Also interesting was the fact that the authors found this Alzheimer's Disease "signature" biomarker (presence of beta-amyloid plaques and tau tangles) in 36% of people who were cognitively "normal," or healthy people with no signs of memory loss.  Would you want to find out if you were going to develop Alzheimer's Disease or not?  It might be possible very soon.  


A cure though?  Not yet possible.  The current treatments for Alzheimer's Disease only treat symptoms, not the underlying disease.  This means the current medications will ease some of the disease's side effects, but the plaques and tangles will continue to build up in your brain and the disease will progress.  


Click here to read a NYTimes news article written about this same study.  

Real Men Go To The Doctor

Recent research shows than men are 24% less likely to visit a doctor than women are.  And they are more likely to be hospitalized for health conditions that could have been prevented.  

Thus, the Agency for Healthcare Research and Quality (AHRQ--where I am currently employed) released their public service advertising campaign yesterday to promote men's preventive health.  The timing coincides with Men's Health Week, which, for 2010, is June 14th through 20th.  Laura Landro covered the story in an excellent video for the Wall Street Journal (WSJ), which you can watch here.

Please encourage your friends and family to visit the doctor.  Simple preventive tests can detect diseases early, when treatment is easier and your health outcomes will be better.  Here is a list of preventive medical tests men should have completed. Immunizations and screening tests for body mass index, cholesterol, blood pressure, depression, sexually transmitted diseases, and colerectal cancer are just a few of the preventive tests that should be done. 

There are a number of campaign materials here, including television, radio, and print.  I highly suggest checking them out--they are effective, well-crafted, and really interesting!  I've included a couple of the print materials and an outdoor banner as the images for this story.

Attention Nonsmokers: Your Mental Health

According to a recent study published in the Archives of General Psychiatry, second-hand smoke could potentially be causing mental illness.  Yep, we know how bad smoke and second-hand smoke are for our physical health, including cancer risks, but it may also affect our mental health.  The risk of mental distress is higher among exposed nonsmokers than exposed smokers, 1.5 times higher for psychological distress and 3 times higher for psychological hospitalizations. Mental illness was defined as psychological distress, mainly meaning symptoms of depression and anxiety, and was measured with the General Health Questionnaire.  The authors additionally found the risk of psychiatric hospital admissions was higher for people exposed to second-hand smoke.  This study provides more reason to encourage your loved ones, coworkers, friends, and the public to quit the lethal habit.

Happy Birthday! Peel an Orange

A number of nurseries in the UK are trying something new for kids--no more birthday cake, or any sweets for that matter.  The elimination of the the age-old tradition of birthday cake is removed from children's diets as part of a program called the "Pre-school Nutrition Project," which is basically a program geared toward encouraging healthy eating.  It was set up by the Knowsley Borough Council and Chester University.  


I love this.  Stick a candle in an apple and I'm happy.  


But don't worry, birthday cakes and sweets are still allowed on the kids' birthdays--they just can't be eaten on-site.  The sweets will get sent home with parents, who can them decide on their own whether to allow their kids to indulge or not.  


Is this taking it too far?  Or is this a great idea to combat our overwhelmingly growing obesity problem and teach children healthy eating habits?  

Curative+Palliative=New Hospice?

Prior to health reform, Medicare (federal program for 65+ and disabled) only covered palliative (non-curative) care for individuals on Hospice care.  Hospice is both a type of care and a philosophy for terminally ill patients, focused on management and alleviation of pain symptoms and spending the end of one's life with friends and family in a manner of dignity and peace.  The focus is on quality of life, rather than lengthening duration of life, or providing cures, and occurs on one's home or a hospice facility.   


With health reform becoming law, Medicaid (state-federal program for the poor) must now provide both palliative care and curative care for children with terminal health conditions.  Additionally, Medicare is instructed to start approximately 15 demonstration projects around the US (rural/urban mix) to test this palliative and curative combination.  Basically, the demonstration projects will be 3-year programs allowing individuals to receive all currently covered Medicare services while simultaneously receiving hospice care.  If the demonstration projects show benefits (defined as the impact on patient care and quality of life) without increasing costs, this could become a new policy for Medicare.  It is listed as Section 3140 of the Patient Protection and Affordable Care Act (PPACA) (and its reconciled Healthcare and Education Reconciliation Act) and is called the Medicare Hospice Concurrent Care Demonstration Program.  


What do you think the outcome will be?  Will this combination of therapies work?  Will costs increase?  Does the addition of curative therapies confuse the point of hospice care (to end life peacefully and with dignity)? Will this make the end of life easier or more difficult for families? 

Robots & Quality Health Care

In yesterday's Wall Street Journal, John Carreyou talks about da Vinci (the robot, not the artist).  The da Vinci is a robot used to perform minimally invasive surgeries.  The machine costs between $1.4 million and $2.2 million and is manufactured by Intuitive Surgical.  It's operated by surgeons with joystick controls with the purpose of providing better visibility and greater flexibility and ease in surgeries.  

Tha da Vinci then is argued to be good for patients because leads to: less blood loss, smaller scars, and less infection.  Additionally, one study found da Vinci surgeries to cut hospital stays, thus reducing hospital costs by a third.  Sounds great, but what are the potential problems?


For one, if unexperienced doctors are performing these procedures, there could be harmful outcomes for patients.     


The da Vinci has been marketed as a technological advantage for small hospitals to be competitive with other hospitals.  One such hospital, Wentworth-Douglas Hospital, in Dover, New Hampshire, has been using the da Vinci for years.   The hospital has performed about 300 surgeries in 4 years.  As a comparison, individual robotic surgery experts, like Dr. David Samadi at Mt. Sinai, average 400-600 per year.  Now, Wentworth-Douglas hospital is under investigation for quality concerns with the robotic surgeries.  There have been some complications in surgeries, but the hospital also notes their da Vinci complication rates are below some recently published rates.


There isn't current data to compare the rates of complications across hospitals, comparing high-volume (high number of procedures in a year) to low-volume.  However, there is data on number of procedures and offsetting cots.  One recent study in the Journal of Urology said that doctors need to perform over 500 per year to offset costs of traditional surgery.


So how can we ensure that we can allow for technological innovation while ensuring consistently high quality medical care delivered to patients and keeping costs down?  If it takes continuous experience (i.e. high volume hospitals, specifically the physicians in the hospitals, performing the procedures frequently) to ensure top-notch quality, how do we ensure access to top quality to less-resourced areas?  Can we ensure equality in quality geographically?

The Skinny on Childhood Obesity

Yesterday, Michelle Obama led the White House Childhood Obesity Summit.  The meeting was a follow-up to her (much-needed) Let's Move Campaign she announced in February.  We all know childhood obesity is a problem and the first lady is getting some national discussions started on how to combat this public health epidemic within the next generation.  Both Health and Human Services (HHS) Secretary Kathleen Sebelius and Surgeon General Regina Benjamin have also stated their plans to help Americans stop the obesity epidemic.

One of the leading health policy journals, Health Affairs, released their special March 2010 issue (Vol 29, No 3), with the theme: Child Obesity: The Way Forward. In this issue, there are a number of great articles discussing implications of childhood obesity and potential next steps to combat it.


Regarding costs, John Cawley's article on "The Economics of Childhood Obesity," mentioned two interventions shown to be not just effective, but cost-effective in youth.  One is the Coordinated Approach to Child Health (CATCH) and the other is Planet Health (cost-effective for females).  He argues that we need to use policies and incentives to promote cost-effective interventions and to find other cost-effective measures to stop this problem costing us $14.1 billion in outpatient care and $237.6 billion in inpatient care each year (direct costs).  


So, what can we do and what's being done? Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC) was the lead author on an action agenda, "Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity," in the Health Affairs issue.  Recommendations include: food and beverage taxes, zoning policies, banning ads, counterads, increasing exposure to healthy foods, increasing physical activity, and decreasing sedentary behavior.  However, the food and beverage taxes would likely need to be pretty high as a study released last week in Health Affairs revealed soda taxes at 4% have no effect on consumption.  However, if the tax revenues are used to fund cost-effective interventions for childhood obesity, there is still potential benefit in these increased taxes, also noted by the authors.    The authors also called to duty: federal, state, and local governments, parents, the food industry, and businesses to act.


Additionally, issue and policy briefs were released in Washington DC.  The Senate Health, Education, Labor and Pensions (HELP) Committee started a series of hearings on child obesity and how to address the epidemic, with the first in the series being the Health Affairs hearing on March 2.  A number of stakeholders convened to begin discussions on what can be done, the built environment, and food policy. You can view the Health Affairs Issue Briefing here.  Aside:  One of the speakers was Debbie Chang, Vice President of Policy & Prevention for Nemours.  I consulted with Dr. Cynthia Minkovitz and the Johns Hopkins Women & Child Health Policy Center (WCHPC) on a policy scan last year regarding current policies practiced by youth-serving organizations to promote healthy eating and physical activity.  It's exciting to be a part of positive change for our nation.


What are your thoughts on the best way to fight childhood obesity?  What is the largest barrier to stopping the epidemic?

Health Affairs, 29, no. 3 (2010): 357-363

The theme issue for Health Affairs was supported by the Robert Wood Johnson Foundation.
Photo of Michelle Obama courtesy of Evan Vucci/Associated Press.