Kim’s public health blog

The New York Times reports, “There is a crisis in medicine today, and it will not be fixed by any candidate’s proposal to provide health insurance for the 45 million Americans now without it. In fact, an increase in insured Americans could make it worse.” This “crisis is a diminishing supply of primary-care physicians, the doctors on the firing line — family physicians, internists, pediatricians, gerontologists, and others — who practice the art and the science of medicine, and who seek to put patients at least on a par with their pocketbooks.” These physicians “spend far more time talking to patients and helping them avert health crises, or cope with ailments that are chronic and incurable than they spend performing tests and procedures.” In addition, they “ask pertinent questions about health and also about life circumstances,” and they “listen carefully to how patients answer.” But, many primary-care physicians “are burdened with paperwork and hours spent negotiating treatment options with insurers. And the payments they receive for services have not increased as the costs of running a modern medical practice have risen.”
Comment: Finally a major newspaper has seen through the fallacy of the suggested fixes for the health care system. Just pumping more money in without changing the infrastructure will only make matters worse. Not only are PC Physicians burdened by the insurance bureaucracy but they are woefully underrepresented among medical school graduates. The AMA makes much ado about the health care system but will not pressure medical schools to enhance training in primary care, nor Congress to enhance support for primary care because it is a captive of hospital based specialists..

ScienceDaily (Sep. 25, 2008) — American children are approximately three times more likely to be prescribed psychotropic medication than children in Europe. A new study claims that the differences may be accounted for by regulatory practices and cultural beliefs about the role of medication in emotional and behavioral problems. A team of researchers from the USA, Germany and the Netherlands who investigated prescription levels in the three countries said, “Antidepressant and stimulant prevalence were three or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5 to 2.2 times greater”. One of the study authors concluded that, “Direct to consumer drug advertising, which is common in the US, is also likely to account for some of the differences. The increased use of medication in the US also reflects the individualist and activist therapeutic mentality of US medical culture”.

New research published in the Sept. 24 issue of JAMA reinforces importance of Black Americans getting screened. Black Americans have a higher occurrence of colon polyps, according to a new study. This is a significant finding considering the incidence of colon cancer among black men has increased and remained unchanged among black women during the last 20 years.
“These data show that Blacks who receive screening are more likely to have serious polyps, compared to Whites, and are therefore likely to benefit from more intensive screening. Black men and women age 50 years and older should be strongly encouraged to receive colon cancer screening,” said Lieberman, who also is co-director of the OHSU Digestive Health Center at the Center for Health & Healing and a member of the OHSU Cancer Institute. According to the researchers, colorectal cancer prevalence and death are higher among black patients. Death rates for black men and women are 38 percent to 43 percent higher than for white men and women, and incidence rates are 15.5 percent to 23 percent higher in black individuals.

CT colonography (CTC), known as virtual colonoscopy, is as accurate at screening for colorectal cancers and pre-cancerous polyps as conventional colonoscopy, the current screening standard, according to the National CT Colonography Trial, a nationwide multicenter study that included the San Francisco VA Medical Center (SFVAMC). “This is a landmark study,” says study co-author Dr. Judy Yee, chief of radiology at SFVAMC and professor and vice-chair of radiology at the University of California, San Francisco. “It demonstrates that CTC is a practical alternative to other, more invasive methods of colon cancer screening. The hope is that these results will encourage more health care payers to cover screening CT colonography.” The study appears in the September 18, 2008 issue of the New England Journal of Medicine.

UCSD — In an effort to curb the rising rates of HIV and sexually transmitted infections (STIs) along the Mexico-US border, a binational team of researchers led by the University of California, San Diego School of Medicine have shown that brief but personalized behavioral counseling significantly reduced rates and improved condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico. The researchers observed a 40 percent decline in the combined rate of new STIs (including HIV, syphilis, gonorrhea and Chlamydia) in the group of female sex workers who received the 30-minute one-on-one counseling intervention.

SEATTLE A team of researchers led by Fred Hutchinson Cancer Research Center reports online toda: y in the Journal of Clinical Oncology the validation of a potential “HIV-test” equivalent for the early detection of lung cancer. The test, which relies on immune-system signals, much like an HIV test, can detect the presence of lung cancer a year prior to diagnosis, long before symptoms appear. “This kind of immune response won’t necessarily kill the tumor, but it can act as a canary in a coal mine, signaling lung cancer at an early stage, before actual symptoms emerge,” said Hanash, head of the Molecular Diagnostic Program in the Public Health Sciences Division at the Hutchinson Center. “It is an important step toward developing a biomarker-based blood test for the early detection of lung cancer.”

The AP reports that last year, nearly “100,000 tests for breast cancer gene mutations were done,” and as more women undergo the test, parents may now be facing “a tough question: Should we test the kids?” A number of “medical experts advise against such testing before age 25, saying that little can be done to prevent or screen for breast or ovarian cancer until then, so the knowledge would only cause needless worry.” But various studies and interviews “show that many people who have BRCA gene mutations — and even more of their offspring — disagree.” Still, “research…shows there can be benefits to at least talking about testing and inherited cancer risks with teens.” This inherited risk could be lowered by taking “anti-estrogen drugs or having [one's] breasts or ovaries removed,” but “these drastic measures are not advised for very young women.” In fact, “mammograms are not advised till age 25.” In light of these facts, some medical groups “say that when the risk of childhood cancer is low and nothing can be done to lower it, children should not be given gene tests.”

ScienceDaily— There may be no such thing as a ’safe’ tan based on ultraviolet (UV) radiation, according to a series of papers published in the October issue of Pigment Cell & Melanoma Research, the official journal of The International Federation of Pigment Cell Societies (IFPCS) and the Society for Melanoma Research. The authors of the three review papers – leading researchers in the fields of cell biology, dermatology and epidemiology – have examined the effects on skin of UV radiation, including that from indoor tanning beds. As well as highlighting the need for greater research into this area, they have called for the use of such beds by under-18s to be banned, along with any publicity that claims that tanning beds are safe.

A number of studies have shown associations between individual lifestyle factors, such as smoking and diet, and risk of chronic diseases, including cardiovascular diseases, type 2 diabetes and various cancers. Few studies, however, have looked at the bottom line — how a combination of lifestyle factors might influence mortality. A new, large-scale study from researchers at the Harvard School of Public Health (HSPH) shows that women who followed a combination of healthy lifestyle factors — not smoking, maintaining a healthy weight, regular physical activity and a healthy diet — had a dramatically lower risk of dying from all causes during the two-and-a-half decades of the study. Furthermore, their risk reduction surpassed that from following any single healthy factor alone. It is the largest and longest-running study to directly estimate the impact of a combination of lifestyle factors on mortality. The study appears in advance online on Wednesday, September 17, 2008 in The British Medical Journal.

The AP reports, “Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain,” according to government officials who aim “to get both patients and their doctors to recognize the emergency in time.” Acting Surgeon General Steven Galson, M.D., who announced the new campaign on Monday, said, “I don’t think most people understand that this is a serious medical problem, or what can be done to prevent it.” Dr. Galson “issued a ‘call to action’ for better education of both consumers and doctors, plus more research.” The AP notes, “At issue are clots with cumbersome names: A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE.” Some physicians, however, are also “ill-informed” when it comes to DVT awareness. Research suggests 33 percent “of patients who need protective blood thinners when they enter the hospital for major surgery don’t get them.”