360 Commercials

By Emily P. Walker

There I stood in the 105-degree heat, sweat rivulets ricocheting down my body, trying to stand perfectly still on one foot so as to win the approval of the incredibly taut, nearly naked gray-haired man standing on a platform in the front of the room. At the end of the 90-minute sweat session that was my first experience with Bikram yoga, I felt mentally, physically, and liquid-ly drained.

I’m home in Michigan for a week staying with my parents, and didn’t want to deviate too much from my workout routine. My cousin recommended a Bikram yoga class, telling me that it could burn up to 1,000 calories during a 90-minute session. I figured that could help counteract the eggnog, brie cheese, and peanut brittle I’ve been eating, so I went to check it out.

Bikram yoga, which was created by Bikram Choudhury in the 1970s in a series of 26 postures performed for 90 minutes in a room heated to 105 degrees. The idea behind the heat is that it increases flexibility, and the added bonus of sweating profusely is that it supposedly flushes toxins out of the body.

When I first walked into the super-heated studio, referred to by Bikram devotees as the "torture chamber," I was overcome by the heat and the musky smell of all the sweaty bodies that have come before me. The poses were nothing particularly new, but what was new was sloshing around in a pool of my sweat and exercising while willing myself not to faint.

One incredibly long, slippery, and mentally challenging (as in willing myself to not simply push open the door 10 feet away and drink in the cool parking lot air) workout later, I left feeling pretty good.

Later, I wondered: Was that actually a good workout? Or would sitting in a sauna for two hours accomplish the same thing?

I looked at some online message boards on how many calories are actually burned during Bikram, and one commenter pointed out that the hardest workout she could think of — 90 minutes of a military-style drill complete with sit-ups and jumping jacks, squats, and lunges — would only burn about 750 calories, so there is no way that holding your body in mildly uncomfortable positions in a hot room for an hour-and-a-half could compare, calorie-wise. 

But burning calories isn’t the whole point to working out and I don’t
necessarily do yoga for calorie-burning or even muscle-building
purposes.

During my online searching, I also learned that Bikram has also been in the news as of late for a bit of controversy: Bikram Choudhury is currently suing the creator of a Bikram offshoot called "Yoga to the People" for stealing the supposedly copyrighted Bikram poses and the order in which they’re performed. Yoga to the People is very similar to traditional Bikram, but instead of
costing close to $20 a class, it’s either donation-based or under $10,
and is usually billed as just "hot yoga."

While the creator of Yoga to the People did shell out the $7,000 required to train under Choudhury to become a cerified Bikram instructor, he never agreed with Choudhury’s idea that Bikram-style yoga should only be performed in sanctioned spaces and that it had to be expensive.
 
At issue is whether yoga poses and the order in which they’re performed are something that can be protected by copyright. Choudhury says yes, and those who support Yoga to the People say, no, yoga poses have been around for centuries, and should be free to whomever wants to practice yoga.

Bloomberg recently reported that a regulator in the U.S. Copyright Office said that yoga poses are exercises and not choreography and shouldn’t be copyrighted. However, the U.S. Copyright Office has apparently awarded copyrights to yoga poses and their sequences in the past, according to the article.

I’ll give Bikram another chance before I head back to D.C. I like a new
fitness challenge and will keep an open mind while I decide whether the
thousands of people who swear by it are on to something, or whether it’s
just a money-making venture built on hype and whole lot of hot air.

By Gary Schwitzer

Chocolate,
seaweed, omega-3, antioxidants, laser toenail fungus treatments, enzyme
deficiencies, snoring, anti-aging, cure for cancer, seasonal affective
disorder, itching, vaginal dryness, miracle diets, zits, ta-tas, head
lice, “uber” nutrients…..
Flashback to the snake oil salesmen of yesteryear?

No. These are just some of the things promoted in news
releases saved by just this one little blogger in the course of a year. 
Some of the biggest names in American health care join in the barrage.
Recently we wrote about what was missing in a Cleveland Clinic “News Tip” email message.

That same day a reader also brought to our attention the following Tweet from the Harvard School of Public Health.

While not technically a news release, that is, in essence, what such a Tweet is. But whatever you call it, it’s wrong. It links to a story about an observational study,
which can’t establish cause and effect.  So “appears to reduce” hedges
but is still wrong.  Following the link, the Harvard news piece says
more definitively that women “reduced their risk for cancer.”  Wrong,
wrong, wrong.  The words matter, as we remind readers and journalists with our primer on this topic.  Using active verbs with causal language describe the results of observational studies is inappropriate.
So that’s just one example each from the venerable Cleveland Clinic and Harvard School of Public Health.
Here are some of the rest of the health care news releases I saved over the course of 2011:

• Laser Technique for Widespread Toenail Problem – “Winter is here,
  the snow has begun to fall, and many people will book a warm Caribbean
  getaway this month. Toes that have been hidden in warm winter boots for
  months will once again be revealed. “Many women realize toenail problems
  in January and February when they are prepping for beach vacations with
  a pre-trip pedicure. After the December ‘holiday-red’ polish comes off
  they are horrified to find that their toenails are yellow, discolored,
  and thickened.”

• Go cocoa loco because “chocolate is delicious, packed with healthy antioxidants”

• Take the Enzyme Deficiency Test because “ our modern cooked diet … destroys the natural enzymes found in raw foods that aid in digestion.”

• “First major breakthrough in Omega-3 science in 40 years” – “Omega-3 supplement that is up to 50 times more absorbable than fish oils.”

• “THE NEW SCIENCE OF COCOA THERAPY – Based on the Kuna Indians’ Remarkable Cardio Health ” – peddling pure organic cocoa supplements

• A doctor who is “performing life-saving procedures that only a handful of doctors across the country are even capable of” – extracts tumors using a CO2 laser scalpel.

• “77% of Americans will be snoring this Valentines Day” – Dentists
  help loved ones cope thanks to private company’s airway diagnostic
  technology

• “6 out of every 100 people in the US experience Seasonal Affective
  Disorder” – and here’s a wrist watch that delivers frequencies that help
  wearers relax, feel less stressed, focus more clearly and sleep better

• (separate news release, same product) ”Arthritis affects people in
  all age groups including nearly 300,000 children and in total, over 45
  million Americans” – the watch delivers “natural frequency technology”
  in which the body is exposed to frequencies in the individual’s
  biofield, regulating the body’s energy and informing the body to relax,
  in result alleviating many arthritis symptoms including persistent joint
  pain, inflammation, fatigue and lack of energy.”

• “the anti-aging and healing science” of “the first and only source of balanced, stabilized signaling molecules outside the body”

• “world’s first multidisciplinary program designed solely to understand and treat itch” opens.

• pediatric dentist has developed a breakthrough beverage that will
  have parents reconsidering what they put in their baby’s bottles and
  toddler’s sippy cups

• “Help rejuvenate your mom with a day at the spa, indulge her with
  chocolates and flowers, help her relax and slow down from her fast-paced
  world full of deadlines, commitments and obligations. And help her be more comfortable with A Long Lasting Vaginal Moisturizer.”

• Women’s Health Magazine special issue “Talking About Your Ta-tas” (a term I know is despised by many breast cancer advocates)

• “New breakthrough in prostate tumor treatment” – “There are only two
  doctors in the US that perform this procedure and (our doctor) has done
  the most.” (Gee: the most out of two!)

• “first doctor in the US to use the new minimally invasive technology to treat small spider veins and varicose veins”

• “miracle diet can cause uterine fibroids to disappear”

• “In the battle of the bulge, seaweed may be the secret ingredient you have been missing.” (I know I have!)

• Bikini Boot Camp

• Please consider (Dr. X) as a resource for any cosmetic, health or
  humanitarian stories.  “If you haven’t heard of him, that’s because he’s
  not in it for the fame.”  (Then why did he hire a PR firm?)

• “It’s estimated that about 80 million men and women in the U.S.
  suffer from thinning or receding hair” – (our product) “is a natural
  hair loss solution” that “combines all known methods for treating hair
  loss, resulting in thicker and fuller hair."

• a new method of detecting breast cancer as early as at ‘stage 0′ through breath

• “the ultimate skin tightening serum” – for the amazing price of $79.42 – a savings of $40.58 !!!

• “vitamin K2 – an ‘uber’ nutrient” – “So how many cardiologists know
  this? NONE. Bunch of over-paid, probably well-meaning folks who have no
  idea of the etiology of all the inappropriate calcium in arteries.”

• Pimples 101: How to Pop, Treat & Conceal a Blemish – ending with a plug for “Skin Balancing Super Antioxidant Mattifying Concentrate Serum w/ Retinol“

• “There’s more to Halloween than Trick or Treating. When Children
  share masks and costumes, Head Lice infestations can increase!” – ending
  in a plug for an FDA “cleared louse buster device”

• “Cure for Cancer, It’s Closer Than You Think” – news release
  promoting the work of a major medical center’s radiation oncologist.

I’ll end this piece the way I ended last year’s year-ending post, “Year-end review of health care PR puffery sent to journalists.”

This is not all fun and games. In my 2009 report on “The State of Health Journalism in the US,” I wrote:

“The challenging nature of the news environment today threatens to make it more difficult for health
journalists to maintain the wall that once existed between the
editorial and advertising sides of the business, and perhaps less able
to see through or deflect the influence of public relations
professionals. For journalism, and for the audience it serves, this may
be the most troubling trend today. … The danger is that with the
increasing constraints in many newsrooms, the PR folks may be winning
more often — getting their messages through to news audiences in a less
filtered or unfiltered way. They’re helping to provide content to fill
the shrinking news hole — content that the shrinking news staff can’t
provide. In an interview for this report, one East Coast newspaper
reporter said that ‘My big fight was with the way PR people were
basically able to steer news …The health team was relying more and more
on public relations to provide the story, and sources for the story, and
they had too much control over the story. When you let someone else who
has an agenda — to make a hospital look as good as it can — [control
the story], it gets in the way of finding that truth.’ ”

And it’s not fun and games when we’ve found more than 100 stories in
the past 5.5 years that have relied solely or largely on news releases
in “reporting” on healthcare news.

By Todd Neale

The U.S. Environmental Protection Agency (EPA) recently issued new rules regarding pollution for coal- and oil-fired power plants that are largely similar to the rules proposed in March to meet a court-ordered deadline stemming from the striking down of a rule proposed during the Bush Administration.

The rules represent the first national standards for emissions of mercury, arsenic, acid gas, nickel, selenium, and cyanide. They would require all power plants to install pollution-control technology, something more than half of all plants in the U.S. have already done.

According to the EPA, the new standards could have widespread health benefits, including prevention of up to 11,000 premature deaths and 4,700 heart attacks each year, in addition to prevention of 130,000 cases of childhood asthma symptoms and about 6,300 fewer cases of acute bronchitis among children annually.

Various professional organizations, including the American Academy of Pediatrics (AAP), have endorsed the rules.

"Air pollution is costly — not only in terms of jobs, healthcare, and education — but also in human suffering and quality of life," AAP president Robert Block, MD, said in a statement. "Preventing air pollution is an investment that will pay off by avoiding birth defects and disabilities among our children and families."

The cost of implementing the rules — estimated to be about $10 billion a year — would be more than offset by the health and economic benefits, according to the EPA.

But industry representatives disagree. In a Q+A, Scott Segal, director of the Electric Reliability Coordinating Council, which lobbied against the new standards, said the rules would undermine job creation and would not yield health and economic benefits outweighing the investment.

"The rule suffers from statistical errors, inaccurate technological assumptions, and inadequate economic and reliability analysis," Segal said. "Given that the rule is one of the most expensive air rules ever, the American public deserves better."

By Iltifat Husain

By Chris Kaiser

That was the title of a recent commentary in Circulation Research by Christoph J. Binder, MD, PhD, and Joseph L. Witztum, MD, from the University of California, San Diego (Circ Res 2011;109:1103-04).

The two commentators were impressed by Wang et. al.’s research showing the
involvement of immunoglobulin E (IgE), which plays an important role in
allergic reactions, in promoting atherogenesis (J Clin Invest
2011;121:3564-3577).

IgE, in relation to allergic reactions, activates mast cells by binding
to IgE’s high-affinity receptor FcER1. In addition to allergic
responses, mast cells participate in other inflammatory diseases,
including atherosclerosis, Wang and colleagues wrote.

For their study, Wang et. al. analyzed serum IgE levels in two separate
Chinese populations and found them elevated in patients with myocardial
infarction and unstable angina.

Those with acute MIs had the highest levels of IgE, followed by those
with unstable angina, and then those with stable angina. In other words,
the circulating levels of IgE correlated with plaque instability, Wang
and colleagues wrote.

In addition, the investigators found IgE and FcER1 in human atherosclerotic lesions, mostly localized in macrophage-rich areas.

Prior studies had found that people with common allergic diseases such
as asthma and allergic rhinitis were more prone to develop
atherosclerosis (Arch Intern Med 2005;165:2521-6), suggesting a link.

But such detailed association of IgE with atherosclerosis had not been seen before, Wang et. al. said.

And what it means is not entirely clear, Binder and Witztum wrote in their commentary.

Nevertheless, "the evidence continues to accumulate supporting an
important role for immunological mechanisms in all phases of
atherosclerosis," the commentators said.

There is a host of "combinatorial groupings" involving IgE and other
receptors that contribute to the "pro-atherogenic activity of IgE in
humans," including macrophage activation and apoptosis, Binder and
Witztum said.

But they focused on the fact that elevated IgE levels typically reflect allergic-type immune responses.

"It would be of great interest to know whether the increased IgE levels
were polyclonal or reflected any disease-specific antigens, such as
those to oxidation-specific epitopes characterized for IgG and IgM
isotypes in humans and murine models of atherosclerosis." 

A problem with the current study is that the levels of IgE were low
overall. Also, it is unclear whether the IgE levels were a cause or
product of the heart disease.

However, the evidence of IgE in atherosclerotic lesions and in serum
from patients with unstable plaque "support the notion that such ‘minor’
immunoglobulin molecules may participate in the activation not only of
mast cells, but also other blood-borne inflammatory cells … during the
pathogenesis of human atherosclerosis," Wang and colleagues concluded.

By Celebrity Diagnosis

Pictured left is Aerosmith front man and American Idol judge Steven Tyler whose accident, while on tour in Paraguay, once again demonstrated that the bathroom is the most dangerous room in the house. Mr. Tyler is one of Barbara Walters‘ 10 Most Fascinating People of the Year and has also been featured in our series on Ailments of the Aging Rock Star.

In addition to covering common diseases affecting uncommon people, our reporting on celebrity health and lifestyle topics in 2011 included a number of unusual conditions and practices including Angelman Syndrome, breast milk ice cream, buttocks augmentation, Dukan Diet, entomophagy, Maroteaux-Lamy Syndrome, misophonia, music therapy, nude psychotherapy, pica & pregnancy cravings, "pinkwashing," psychopathy, "spider medicine" and tanorexia.

Listed below are our Top 27 Teachable Moments* in celebrity health, selected from 300 stories published this year.

By Gary Schwitzer

It’s only one little data point, but I find it very interesting.
A column on Forbes.com
explains how Matthew Herper, who covers science and medicine for them,
is posting less often, but with longer articles, and online traffic is
responding positively.  Excerpt:

Take a look at his numbers in the chart.
Matt started out posting quite a bit (the green line), but reduced his
output as he discovered the long-form rhythm worked best for the topic,
his audience and his traffic numbers. “I think it’s partly because, in
medicine, a lot of the challenge isn’t just pointing out what is
important, but also why,” Matt says. “For a piece to be really valuable,
you may need to take the reader into another world.” As you can see,
his audience is trending up even as his output dramatically slows down.
It would be fascinating if more news organizations would share some
of their data like this.  I  have often felt that there hasn’t been a
true, fair test of readers’ wants and needs when it comes to health care
news stories.  While this Forbes info is short-term, about only one
writer’s work, from only one news organization, and with a selection
bias among its readers, I still find the trend line hopeful and
important.

By Gary Schwitzer

The first is from one of our HealthNewsReview.org medical editors, Richard M. Hoffman, M.D., M.P.H.,
Professor of Medicine at the University of New Mexico School of
Medicine and Staff Physician at the New Mexico Veterans Affairs Health
Care System.  Hoffman spoke at the conference on “Improving the
Communication of the Benefits and Harms of Treatment Strategies.” He
writes these after-thoughts:

“I just returned from attending an NIH
State-of-the-Science conference on active surveillance (AS).  AS is a
strategy for monitoring men with low-risk prostate cancers using PSA
tests, digital rectal examinations, and prostate biopsies in order to
avoid or delay undergoing active treatment with surgery or radiation. 
The rationale for AS is that many men with low-risk cancers are unlikely
to ever suffer any clinical problems.  Therefore, aggressively treating
these men, which can adversely affect urinary, sexual, and bowel
function, is unnecessary.  However, identifying patients who are truly
low-risk is challenging.  In contrast to the often unwelcome approach of
watchful waiting, which provides only palliative treatment for
symptomatic cancer progression, active surveillance allows men with
low-risk cancers to initially avoid treatment and still be able to
subsequently undergo attempted curative therapy if there are signs of
cancer progression or they change their mind.

Active surveillance is being evaluated in
an ongoing randomized trial in the United Kingdom, but data from
observational studies and randomized comparisons of surgery with
watchful waiting suggest that AS can be a safe and effective strategy. 
The NIH convened a panel to evaluate the evidence.  Their final draft
report, issued on December 7, is a thoughtful document that generally
supports AS with the caveats that more research is needed to identify
optimal patient selection criteria, monitoring strategies, and triggers
for active treatment while also measuring the benefits and harms of
active surveillance that matter most to patients.

This rigorous scrutiny of an innovative treatment strategy is laudable.  Ironically,
I’m not aware of any similarly stringent review being conducted — or
expected – when urologists began performing robot-assisted laparoscopic
prostatectomy or radiation oncologists began offering CyberKnife and
proton-beam radiotherapy — expensive technologies which offered uncertain
additional benefits and harms compared to standard treatments. 
Meanwhile, a conservative strategy designed to minimize the harms of
unnecessary treatment receives a cautious endorsement.

If our society is committed to improving patient-centered health outcomes and controlling health care costs, we cannot afford this double standard. 
We must address the unbridled dissemination of new technologies.  Such a
daunting effort may require regulatory changes for introducing new
technologies, reconsidering how care is reimbursed, creating
expectations for documenting clinical effectiveness, and providing
counter detailing for the public and patients — who all too often are
seduced by the marketing hype that innovation and high-technology equals
effective, safe, and necessary care.”
The second perspective comes from journalist Laura Newman, who wrote, “Let’s Not Call it ‘Prostate Cancer.’ ” Excerpts:

“The Panel said that terminology matters
and that men who have PSA screening results that read 10 ngs or less
with a Gleason Score of 6 or less should no longer be told that they
have “cancer.” “The word “cancer” sets off an emotional response,” said
Barry A. Kogan, MD, part of the Consensus Development Panel, and chair
of urology, Albany Medical Center, Albany, NY, during the briefing.
According to the Panel’s preliminary report, more than 100,000 men fit
within the thresholds above, and are candidates for active monitoring.

If active surveillance gained visibility
and credibility, it would be a sea change in practice. The Panel declined
to say what term should replace “cancer,” instead leaving it to expert
pathologists and urologists  to sort out the science and meaningful
language….

Some doctors are simply too entrenched in
treatment for a variety of reasons so that active surveillance is
anathema. Further, many physicians claim that they have active
surveillance protocols, but the exact thresholds beyond which they would
advise treatment and whether they are based in science or opinion are
not easy for patients to pinpoint. For example, many doctors may be
uncomfortable with cutpoints as high as 10 ng PSA and Gleason Score of 6
less for “cancer.”

I asked Ashutosh Tewari, MD, Director of
the Robotic Cancer Institute, Cornell University Medical Center, N.Y., to
clarify his position on active surveillance. He has gone on record at
urology meetings as supporting active surveillance and has invited
leading researchers who back it to speak with residents. He emailed me
back: “Active surveillance is the right treatment and we do it here all
the time.” Later, he called me to tell me that he has “hundreds of men
on active surveillance.”  Tewari is a leading robotic prostatectomy
physician internationally. Robotics is an extremely
lucrative field. Many people might wonder whether people invested in
robotics could be totally objective. One physician who asked not to be
named, remarked: “There is too much money to be made to really push it
[active surveillance].”

Perhaps one day, volume of
procedures will not be so inextricably linked to physician income.
Health care reform with incentives for value and good outcomes would be a
start.”
The bold emphasis in each person’s comments was mine, pointing out
how a physician and a journalist came to the same topic of expensive
technologies and questions of evidence and outcomes.

By Michael Smith

People are bigger these days.

I was thinking about that this week in the context of concussions. Fans of the Pittsburgh Penguins hockey team know what I’m talking about — their star player, Sydney Crosby, is back on the sidelines with yet another brain bruise. And so are a roster of other professional hockey players. (And the malaise extends to football as well, if I recall correctly.)

Up here in the land that hockey created, this has been the cause of endless hand-wringing. Not to mention finger-pointing, blame-shifting, and all of the other side effects of a tense situation.

But to me the issue is simple. The players are too big. Or the ice surface on which they play is too small.

Currently, during a National Hockey League game, there are 16 huge men (and I speak as a 185-pound, six-foot shrimp)  moving about at high speed with knives on their feet and clubs in their hands. (OK, the goalies don’t move much and the four officials try to keep out of the way, but still … they’re out there.)

Even if physical contact were not an integral part of the professional game, you’d get injuries.

The addition of contact, driven by the need for marginal players to play extra hard to justify their seats on the team bus, is guaranteed to lead to serious injuries and — as we have seen this year and last — a lot of concussions.

Much as I’d like to see the game go back to normal-size players (say 185 pounds or so, maybe six feet) it ain’t gonna happen.

So that leaves the other side of the equation. Make the ice surface bigger, so the relationship between the players and the amount of room they have is closer to what it was in the middle part of the last century. That wouldn’t eliminate major injuries, but it would make them rarer.

After all, you can’t lay a headshot on a player you can’t catch.

If you’re interested in reading reviews for the ever popular No No hair removal product, check out the website linked above for more information. Did you know that more than 2 million units of No No have been sold worldwide? What started as a simple “as seen on tv” infomercial product has gained mainstream popularity and endorsements as a painless method of hair removal. No No also reduces the re-growth of hair after each use, which is a great benefit when compared to waxing or shaving.

Interested in business networking in the Ottawa area? Visit the website above to learn more about a special networking event taking place on January 26th. According to the website above, betwen 8-9 out of 10 successful salespersons get their business through networking.

There’s arguably no greater advantage than being well connected. Many sales take place through referrals, as we often value the opinions of our friends and acquaintances more so than an advertisement or mailer.

By Kevin, M.D.

Doctors often have trouble saying "no" to patients.

And that will only get more difficult as more physicians will be judged on patient satisfaction.  Some may not want to risk the ire of their patients, thus lowering satisfaction scores.

Pediatrician Rahul Parikh says this is a reason why doctors need to be better negotiators.

"’Patient-centered care’ or ‘shared decision-making’ are euphemisms for negotiation," he writes.  "And perhaps, like other professionals, we in medicine ought to focus more on negotiation tactics."

Business principles such as negotiation need to be better incorporated into physician training, so that every patient encounter can end in the proverbial win-win situation.

***

More doctors are turning to retainer medicine to fight burnout. 

Is that a crime?

No, says internist Robert Centor:

Talk with physicians considering the switch to retainer medicine.  Talk with practicing physicians and understand their frustrations.  Learn from a bottom-up movement.  Perhaps through an understanding of why physicians and patients find this movement attractive we can all understand how we must restructure our health care system.  Our current payment system is badly broken; we should look for ideas for a new payment system from every successful experiment.

Doctors should not be blamed, or vilified, for turning to a retainer practice.  Instead, blame the system that forced them down that path.

By Liz O’Brien

It was a mild autumn in southeastern New York state. The geraniums in a sheltered spot on the front porch bloomed wildly with glorious pink flowers until just last week, when the first hard frost cut them down.

By Gary Schwitzer

Veteran science journalist Boyce Rensberger wrote under that headline on the Knight Science Journalism Tracker:

“A search for ‘breast cancer’ in Google
News yielded the following stories published in the past few days,
listed here by their headlines:

–Mammograms cut risk of breast cancer death by half

–Study faults partial radiation for breast cancer

–Diabetes, obesity after 60 may up breast cancer risk

–Study supports mammograms for women in their 40s

–Pfizer jury awards $72 million after finding Prempro caused breast cancer

–Breast cancer planner helps in treatment and recovery

–Federal Breast Density Inform solution sought (informing women about their breast density which can mask tumors)

–Family history not a factor in rates of invasive disease, nodal development

You get the idea.  All kinds of claims
and counterclaims are pretty much always flying. Some stories were
okay. Almost none gave significant background or context. A few medical
writers were gulled into parroting thin claims as conclusive findings.”

By Kevin, M.D.

Don’t expect doctors to be perfect.

Because, as many physicians can attest to, they’re not.

In a guest post, patient advocate Dave deBronkart says this is a serious mistake that many make:

Participatory patients and physicians alike should accept that medicine is uncertain. Jerome Groopman MD’s excellent How Doctors Think even says 10-15% of all diagnoses turn out to be wrong, on autopsy. Fittingly, his epilogue is written to the (engaged) patient – how to discuss things anew with your doctor when the treatment isn’t working.

Science keeps pushing toward certainty, and disease doesn’t wait. Perhaps if we acknowledged the difficulty of diagnosis, and if more physicians were allowed and willing in our culture to express doubt, patient questions would be welcome and we could work more collaboratively.

Wise words that need to be heeded by more patients.

***

Delta Air Lines is showing an ad on their airplanes that questions the need to get the flu vaccine.

And, according to pediatrician Natasha Burgert, that’s the reason why she’s not flying the airline.

An ad, produced by the National Vaccine Information Center (NVIC), is currently being shown to passengers on Delta flights through the month of November. The ad encourages viewers to get “information” about influenza, and the flu vaccine, from the NVIC website.

This is a deceiving double-cross. The NVIC is a well-known anti-vaccine organization.

Some may argue whether Delta Air Lines should care whether they are hurting public health.  While I agree with Dr. Burgert’s take, rather than trying to silence the opposition, perhaps physician groups need to mount a counter-campaign of their own.

Permalink

They use repetition in a way that makes you feel like you’re always progressing. (Because you are.) They also manage to avoid monotony by giving you enough time to remember and apply a response before they give you the answer to a particular question.

I use my mixer for a lot of different tasks in the kitchen, so it was important that I found a mixer that was strong enough to cope with larger jobs, like huge batches of pizza dough, as well as powerful enough to mix the tougher food items properly, like a big meatloaf batch. I also make a lot of my own bread and homemade pasta, so the ability to mix and knead bread dough or pasta dough was also important.

What’s more, there’s a convenient bumper around the base of the head to help protect your furniture. I’m not always as gentle as I’d like to be when vacuuming, so knowing my furniture and skirting boards around the edges of the room won’t get scuffed or scratched while I’m cleaning is reassuring.

You can also use the Quick-Draw Telescope Reach Wand that gives you an instant extra reach for cleaning stairs, drapes, curtains, upholstery and even those awkward ceiling cobwebs. The wand expands up to 15.4 feet, so you have plenty of reach to get into those really tricky areas with ease.