Friday, October 26, 2012

The island where people forget to die

From the New York Times Magazine, on an island in Greece where people regularly live into their 90s and 100s without heart diseases or dementia:
The researchers followed subjects for an average of six years, measuring their diets, physical activity and how much they napped. They found that occasional napping was associated with a 12 percent reduction in the risk of coronary heart disease, but that regular napping — at least three days weekly — was associated with a 37 percent reduction. She also pointed out a preliminary study of Ikarian men between 65 and 100 that included the fact that 80 percent of them claimed to have sex regularly, and a quarter of that self-reported group said they were doing so with “good duration” and “achievement.”
Also seemingly important: a Mediterranean plant-based diet and a social lifestyle.

Added to my lexicon: Supply-sensitive care

Fascinating sentences from John Wennberg's Tracking Medicine: A Researcher's Quest to Understand Health Care:
Supply-sensitive care is not about a specific treatment per se; rather, it is about the frequency with which everyday medical care is used in treating patients with acute and chronic illnesses. Here I am talking about physician visits; referrals for a consultation, home health care, and imaging exams; and admissions to hospitals, intensive care units (ICUs), and skilled nursing homes... 
This category, which accounts for roughly 60% of Medicare spending, may be difficult to grasp because it runs counter to the widespread belief that medical interventions are driven by explicit medical theories and scientific evidence. Most of us, including most doctors, believe that a physician makes decisions such as when to schedule a patient with diabetes for a follow-up visit, for example, or when to hospitalize a patient with chronic heart failure, or when to call in an infectious disease specialist for a patient with a fever, on the basis of medical science, augmented by some combination of experience and wisdom. As it turns out, medical science is virtually silent on such matters.  
There is another factor that influences such decisions. As Figure 1.3 illustrates and the book will demonstrate, physician decisions regarding supply-sensitive care are strongly influenced by the capacity of the local medical market—the per capita numbers of primary care physicians, medical specialists, and hospital or ICU beds, for example. (In the jargon of economics, the market is in disequilibrium—supply pushes demand or utilization.) This may seem deeply counterintuitive, and the effect of supply on professional behavior by and large goes unrecognized by physicians, who are unaware of the effect that capacity has on their decisions. But in the absence of a constraining professional consensus on best practices, and under the cultural assumption that more care is better care, available resources are used up to the point of their exhaustion.
Only on chapter 2, but this book has been full of eye-opening arguments and data so far.  

Thursday, October 25, 2012

More on Prop 37

The LA Times reports that most scientists don't believe that genetically modified crops have negative health effects:
Genetically engineered crops have been extensively studied. Hundreds of papers in academic journals have scrutinized data on the health and environmental impacts of the plants. So have several in-depth analyses by independent panels convened by the National Academy of Sciences.
The reports have broadly concluded that genetically modified plants are not only safe but in many respects friendlier to the environment than nonengineered crops grown via conventional farming methods.
For instance, a review this year of 24 long-term or multigenerational studies found that genetically modified corn, soy, potato, rice and wheat had no ill effects on the rats, cows, mice, quails, chickens, pigs and sheep that ate them. Growth, development, blood, tissue structure, urine chemistry and organ and body weights were normal, according to the report in Food and Chemical Toxicology.
Meanwhile, the positive effects include fewer pesticides, more targeted insect control, fewer toxic chemicals, and less soil erosion.  

Wednesday, October 24, 2012

Wellness tips

Laugh more; it is a form of exercise:
And in Dr. Dunbar’s experiments, pain thresholds did go up after people watched the funny videos, but not after they viewed the factual documentaries.
The only difference between the two experiences was that in one, people laughed, a physical reaction that the scientists quantified with audio monitors. They could hear their volunteers belly-laughing. Their abdominal muscles were contracting. Their endorphin levels were increasing in response, and both their pain thresholds and their general sense of amiable enjoyment were on the rise.
 And humans are social creatures, so remember to exercise (or laugh) in groups:
Laughter is an intensely infectious activity. In this study, people laughed more readily and lustily when they watched the comic videos as a group than when they watched them individually, and their pain thresholds, concomitantly, rose higher after group viewing.
Something similar may happen when people exercise together, Dr. Dunbar says. In an experiment from 2009, he and his colleagues studied a group of elite Oxford rowers, asking them to work out either on isolated rowing machines, separated from one another in a gym, or on a machine that simulated full, synchronized crew rowing. In that case, the rowers were exerting themselves in synchrony, as a united group.
After they exercised together, the rowers’ pain thresholds — and presumably their endorphin levels — were significantly higher than they had been at the start, but also higher than when they rowed alone.

Hospitals must stay the course on EMRs

NYT has an article about the ups and downs of electronic health records, in which it publicizes many complaints about the transitions:
Dr. Brailer encouraged the beginnings of the switch from paper charts to computers. But in an interview last month, he said: “The current information tools are still difficult to set up. They are hard to use. They fit only parts of what doctors do, and not the rest.”
Long before computers, many hospitals and doctors charged for services in ways that maximized insurance payments. Now critics say electronic records make fraudulent billing all too easy, and suspected abuses are under investigation by the Office of the Inspector General at the Department of Health and Human Services. 
Based on error rates in other industries, the report estimates that if and when electronic health records are fully adopted, they could be linked to at least 60,000 adverse events a year.
This is important information, and it's vital that these problems be addressed, but I don't think it presents an argument for slowing down implementation.  It doesn't make sense to continue with paper charts forever simply because the transition to EMRs will be messy.  The potential gains from this transition are too big, and hospitals are already several years behind the curve on health IT.