If you look on the right side bar of this page you will see under my blogroll a blog that I titled “Interesting Doctor’s Blog.” Dr. Toni Brayer has outdone herself in a blog she posted 2/3/10 entitled “Beleagred Health Care Providers.” I liked it so much that I’m posting it here in its entirety. Enjoy! bjmdjd
I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen. One insurer even told him (the owner of the business) to just “make the sessions shorter and don’t give as much care.” As if that is how it works…”You get little money..so just do a little”.

Clearly the insurance intermediaries, who never actually see a patient or deliver any care, haven’t got a clue how this whole health thing works. They are happy with mediocre doctors that cut time and care. Those doctors (and physical therapists) run mills, but the insurance companies are happy with them. Quality and quantity of time are not rewarded, and in fact are punished in the health care environment we have.

He asked me if Primary care had any problems like that. I felt like screaming “Aren’t you reading my blog?”. Or more to the point…why doesn’t the entire population know that access to a primary care physician will become as rare as swimming with dolphins. It will depend upon how much money you have to buy concierge/retainer medicine. Where you live will play a role. If your community has a large multispecialty clinic like Kaiser or Sutter Palo Alto Medical Group, you may have access.

Doctors in training are flooding away from general Internal Medicine, Pediatrics and Family Medicine in droves. Only 2% of medical students plan to go into primary care. It used to be over 50%. A recent Jim Lerher report discussed the reasons. We’ve been talking, talking, talking about it for years but things have only gotten worse, not better.

The whole premise of health care reform ensures that everyone has access to good quality care. Every nation that provides good, quality access has a strong primary care base that is the foundation. Primary care is valued by the government, the payers, the population and even by the physicians.

We have it all backward. It is time to revamp the system from the bottom up. Frankly I don’t care if we get one more multimillion dollar robot to assist in a rare surgical procedure or one more new ” next generation” imaging scanner until we can rationalize how we pay for care.

We have not yet begun the hard work to bring costs under control because there are too many pigs at the trough. One of my favorite teachers (you know who you are, Ed) said “you can’t clear the swamp until you get the pigs out of the way”.

We have a lot of pigs to move aside so more people can get to the water.

Blue Cross Blue Shield · health and wellbeing · Healthcare Reform · primary care doctor shortage

Well, it’s in the news again. Are those frequently ordered CT scans safe or dangerous? Do the larger doses of radiation that you get with a CT scan make you more likely to get cancer during your lifetime? The answer? Who knows?

There has been much concern by many over the last 3 or 4 years as to whether patients are more likely to get cancer during their lifetimes due to the increase in the number of CT scans that are being performed. There is also concern over the amount of radiation that you actually receive during the scan. In December the National Cancer Institute published a new study that predicted 29,000 extra cases of cancer would occur from the 72 million CT scans that were performed in 2007 alone. They said that as many as 15,000 of these cases could be fatal.

Depending on where you get your CT scan there can be a wide variation in the amount of radiation that you receive. Many times more radiation is used than is needed to get a good scan. The two best ways to decrease this radiation worry is to make sure that the lowest amount of radiation that is necessary is used for each scan and that the total number of scans ordered and performed is decreased.

A different study was performed at four hospitals in San Francisco. The amount of radiation used for the 11 most commonly performed CT scans on 1,100 patients was recorded. The amount of radiation varied greatly in scans on the same body part from hospital to hospital and often even in the same hospital from patient to patient. There was found to be a 13 fold difference between the highest and lowest dose of radiation in a given scan.

Even though the detail is greatly enhanced in CT scans compared to other radiological procedures, many feel that too many scans are being ordered. The amount of increase is climbing every year. Go to the emergency room (or your doctor) with a headache and the chance that you will get a CT scan of the head is pretty good. In fact many patients and parents will be mad if they don’t get one. Many feel that defensive medicine also affects the amount of scans ordered by doctors. Take that headache patient above. What if no CT scan is ordered and later the patient is found to have a brain tumor? Look out…the lawyers are on the way! No matter how unlikely a brain tumor might have been in that patient. 

Yesterday the Food and Drug Administration ordered that new CT scanners come equipped with safeguards that will prevent the risk of getting too much radiation. They are studying how to address this problem in scanners that are already in use. While this will help the problem of possibly standardizing radiation doses and preventing overdoses it still doesn’t address the problem of patients getting too many scans.

In order to get some idea of how much radiation a patient actually receives when they get a CT scan consider these numbers. Note that the dose that you see below with each type of CT scan is the amount that you SHOULD get assuming that you are not receiving an increased amount as mentioned above.

• Background radiation is the amount that we all get just from walking around in the world. This amount is about 100 – 300 millirem per year.
• Chest x ray = 10 millirem
• Screening mammogram = 300 millirem
• Head CT = 150 millirem
• Abdominal CT = 530 millirem
• Chest, Abdomen, and Pelvis CT = 990 millirem
• Barium enema x ray = 1500 millirem
• Neonatal abdominal CT = 2000 millirem  

So as you can see there is a fair amount of radiation used in performing CT scans. What about MRI’s? Remember that MRI scans operate using magnetism and there is no radiation involved. Do these increased radiation doses cause cancer? No one knows. Some say yes and some say no. If you need a CT scan I think it is prudent to have it done and not worry about it. But I also feel that both patients and doctors need to be more aware of the possible cumulative effects of radiation exposure and figure that into the diagnostic equation. Happy scanning!  bjmdjd

Material modifications since posting: none

CT scan · CT scan danger · CT scan radiation doses · Food and Drug Administration · increased radiation · National Cancer Institute · radiation dose

I’ve read a couple of studies recently that reminded me about something very important that I have never mentioned in this blog. Are supplements and so called “natural” medications safe? The answer? They may be and they may not be. That really helps.

The real problem is that many people feel that any medication that can be purchased without a prescription and is called a supplement or “natural” is completely safe. This is absolutely untrue!

I feel that the main problem with many supplements is that no well designed and reliable studies have been done to determine the effectiveness and possible harmful side effects and drug interactions of these medications. They are not regulated by any governing agency. Even though the Food and Drug Administration does occasionally make a mistake when evaluating prescription medications, they have absolutely no control over the manufacture or distribution of these supplement medications.

Another problem with supplements or “natural” medications is that the correct dosages are not really known and with no regulation you really don’t know how much of the medicine you are actually getting in the manufacturers formulation. Maybe it says 500 mg but is it really? Who knows?

The bottom line…be very careful with the use of supplements and “natural” medicines. Many people complain about the cost of healthcare but they gladly purchase these expensive medicines with out of pocket money when they don’t even know if they are helping or hurting them. Because of possible prescription drug interactions you should always inform your doctor of any of these medications that you are taking.

Be very careful with anything that you put in your body.  bjmdjd

Material modifications since posting: none

are supplements safe · Food and Drug Administration · health · healthcare · natural medicines · supplements · wellness

No doubt one of the worst things that can happen to a person is to lose a child. It’s terrible no matter what the cause but it’s especially bad when the loss is unexpected like with Sudden Infant Death Syndrome (SIDS). SIDS is defined as the unexplained death of an infant within a year of birth. There is often times guilt on the part of the parents because the true cause of SIDS is not known.

A new study reveals that infants who die from SIDS have an unusually low level of the chemical serotonin in the brainstem portion of their brain. This affects responses to breathing and carbon dioxide, temperature, heart rate, and blood pressure. There has long been a link between low serotonin levels and autism. It has even been speculated by some that the babies that live with these SIDS risk factors through the high risk period might be the children that develop autism in later years. It does seem in some studies that the increase in the diagnosis of autism followed a decrease in SIDS deaths.

It is hoped that this information along with other studies can help identify infants who might be a risk of dying from SIDS. It is no doubt multifactorial including the factors listed above along with sleep position and even exposure to cigarette smoke. Several risk factors are felt to be needed for SIDS to occur and the more that are present increases the likelihood of the condition occurring.  bjmdjd

Material modifications since posting: none

autism · health · healthcare · serotonin · SIDS · Sudden Infant Death Syndrome · wellness

Well…FINALLY! A United Kingdom regulatory panel has ruled that the doctor who led the study linking autism and the MMR vaccine acted “dishonestly and irresponsibly.” It started a worldwide panic among parents and led to an increase in measles due to a decrease in vaccinations. The ruling was only on the actions of the physicians involved in the study and not on the autism question.

The original study was published twelve years ago and in 2004 ten of the study’s thirteen authors rejected the findings. This week the medical journal (The Lancet) that originally published the study retracted it after finding out that the lead researcher had accepted money from lawyers suing vaccination manufacturers even before he designed the study.

Even with all of this there is still a very active movement around the world to convince parents that the vaccination – autism link is real. Celebrities such as Jenny McCarthy and her actor significant other Jim Carrey have made it their cause.

Whether or not you believe that this controversial topic is true or not there is now little doubt that the original study was a sham. There have been numerous studies since that have shown no link but many parents are convinced and it has led to a dangerous decrease in vaccination rates.  bjmdjd

Material modifications since posting: none

autism · health · healthcare · MMR vaccine · vaccination rates · wellness