Kim’s public health blog

Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians. The wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn’t increase soon, according to a new study. The U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years. Comment: Note that there is probably no shortage of specialists. To emphasize the problem the Wall St. Journal today reported that that medical professionals who “really want to do well, [should] become a nurse anesthetist.” They “typically receive an undergraduate nursing degree, have experience working as registered nurses, and complete two to three years of post-graduate training.” By one estimate, “nurse anesthetists recruited” over the past year “through the staffing firm Merritt Hawkins & Associates landed salaries that averaged $185,000.” The nurses’ salaries exceeded the salaries of “family-practice docs hired through the firm, who averaged $172,000, and internists, who averaged $176,000.” If we want access to health care we need to change the rewards system to encourage primary care practice.

In a wonderful article published in JAMA today, [Ezekiel J. Emanuel; Victor R. Fuchs:JAMA. 2008;299(23):2789-2791] Victor Fuchs describes the overselling of medical services to the public and excess desire for new technology by both health care professionals and the public. Also how rewards and punishment in the system has affected the Health Care system driving up its costs. This article should be read by everyone, both health care professionals, students and the public.

Which is more important; rights or social responsiblity? Pennsylvania motorcyclists suffered large increases in head injury deaths and hospitalizations in the two years following the repeal of its motorcycle helmet law, according to a University of Pittsburgh study. Even after accounting for increases in motorcycle registrations that occurred during this period, study authors noted a 32 percent increase in head injury deaths and a 42 percent increase in head injury-related hospitalizations, raising concerns about motorcyclists’ safety and the impact of this trend on health care costs. “Our study shows that since the repeal of Pennsylvania’s motorcycle helmet law, helmet use has gone down, while head injuries from motorcycle crashes have gone up, even after increased motorcycle registration,” said Kristen Mertz, M.D., M.P.H., study lead author and assistant professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health.

California Public Health regulators have just taken to task 13 firms advertising genetic analysis to the public. The state Department of Public Health sent the cease-and-desist letters last week following an investigation spurred by consumer complaints about the tests’ accuracy and cost, a department spokeswoman said Monday. The New York State Department of Health issued similar notices to nearly two dozen testing companies in April. The FDA has not issued notices at all. I have recommended avoiding any genetic testing offered outside teaching hospitals, because of the poor underlying science, and the likelihood of false positive tests; also the inability of the medical profession to know what to do with the results of such tests. They are innapropriate at best and dangerous otherwise.

The New York Times (6/14, A10, Cave) reported that “for Floridians, prescription drugs are increasingly a far more lethal habit” than use of illicit drugs. According to “[a]n analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission,…the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined.” The Commission’s “report analyzed 168,900 deaths statewide. Cocaine, heroin, and all methamphetamines caused 989 deaths, it found, while legal opioids — strong painkillers in brand-name drugs like Vicodin (acetaminophen and hydrocodone) and OxyContin (oxycodone) — caused 2,328.” The Florida “report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years, and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy (3,4 methylenedioxymethamphetamine), and inhalants.” Comment This is only the tip of the iceberg because so few deaths are followed by autopsies.

In a study presented at the Annual meeting of the Endocrine Society, Roshney Jacob-Issac, M.D., of George Washington University Hospital, and colleagues, “used 2,690 male diabetic veterans in VA [Veterans Administration] hospitals, most of whom were overweight or obese based on their body mass index (BMI).” Participants “were categorized as having low, moderate, or high fitness level, depending on their performance on a standard treadmill exercise tolerance test.” The authors “found that the higher the man’s level of fitness, the lower his risk of dying during the study period.” Dr. Jacob-Issac concluded that people with diabetes “should improve their fitness level or exercise capacity to at least a moderate level, by being physically active.” Comment: I wonder how often we have to repeat research establishing the value of physical fitness in preventing disease and delaying development of disabily.

From the New York Times today is a story about government action that would be howled down in the US. where we are more interested in ‘right’ than ‘responsibility.”  Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population. To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets.   Compare this to the US/State efforts to curb obesity (particularly in children) which is mainly health education, which rarely works without back up penalties.

Each year about 1700 cases of malaria occur in the United Kingdom, 1300 in the United States, and 3000 in France.  Less than half of travellers who acquire malaria have taken advice before travelling. Using intervention strategies for travelers visiting friends and relatives—such as increasing awareness in the community, dispelling myths about immunity or subsidizing antimalarials—could considerably reduce imported malaria. From the BMJ [BMJ 2008;336:1362-6]  

In this week’s British Medical Journal, Professor Winkler of London Metropolitan Unversity complains about lack of enforcement of the EU laws prohibiting all forms of misselling, including false health claims on foods and other products. However, this impressive sounding legislation will have little effect on the real world unless it is enforced proactively and comprehensively. It would be welcome to have such legislation in this country with the deluge of false claims about so many products.

June 11, 2008 | Ann Arbor, Mich. – Strong bones, a healthy immune system, protection against some types of cancer: Recent studies suggest there’s yet another item for the expanding list of Vitamin D benefits. Comment: Now the media circus for another Vitamin. We went through this with Vitamin C twenty years ago. After a couple of years we will find that what we knew, we still know, and that it will still remain an essential vitamin, but not the cure all now being toted. Of course the vitamin manufacturers will have a field day!.Full Details