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Many doctors and other medical professionals routinely make recordings of procedures or details of the methods used in caring for patients. A medical transcriptionist must listen to these recordings and put them in readable form. This makes it easy to find patient information when necessary.

By Dr. Wes

With the preponderance of optimistic takes on physicians participating (some even suggesting we have an obligation to participate) in various forms of social media through blogging, Twitter-ing, and Facebook-ing, perhaps one of us should take a moment to acknowledge that there are some downsides to this practice for doctors and nurses. Increasingly, I have been thinking a lot about this topic and how to explain it without sounding like "Debbie Downer."

As my perspective has matured in the blog-o-sphere, I have had several insights that have tempered my unabashed enthusiasm for social media. Perhaps it would be helpful to share those to keep the discussion real for doctors considering a dive into this space.

Blogging, unlike diamonds, really is forever

Even if you try to delete a single published post or an entire blog, it’s tough to delete all the references to the work that have been reprinted, reformatted or placed in an archived cache online. Further, the anatomy of a single tweet exposes us to the reality of the Internet: much more is contained in any post or tweet besides its content — like time, computer type, location. Just as important: you are writing in pen (make that an indelible marker!), not pencil, when your publish a thought on a social media platform. While this might be a good thing for many, the potential to take prose out of context (sarcastic or not) could have significant legal ramifications for those involved in the care of patients. In my 6+ years of writing, I often think about this and wonder if the benefits I have garnered by sharing my insights could be rendered mute by a single legal reference to this blog.

You never hear the bullet that hits you

Way back in October, 2007, Allen Roberts, MD (an ER doctor of Gruntdoc fame) sent me an application that he had received for obtaining "board certification" in cardiology from an unknown entity calling itself the "American Academy of Cardiology." All he had to do was complete the form, send in $300, and send the money to receive a "board certificate" in cardiology. Allen asked me in his e-mail: "Want to do anything with this?"

Well of course I did! I was the citizen journalist who could end this practice, right?

I researched the organization, the name of the individual, Googled the website and its possible sponsor, and quickly realized this was a money-making scam.

So I wrote a post — a very satirical post — but still couldn’t conclusively identify the individual responsible for the scam. Remarkably, the first anonymous commenter on my blog post identified this individual by name. Other comments followed with links to other not-so-great untoward activities by this individual. In the interest of full disclosure, I permitted those comments to be published. I felt I did my job and laid the topic to rest.

In June, 2008, while seeing patients in clinic, my front desk clerk handed me a large envelope containing a subpoena and cover letter insisting I appear the following day for questioning at a local lawyer’s office. Further, the cover letter insisted I remove the blog post I published on this board certification matter as well as the picture of the fraternity paddle I had emblazoned with the words "American Board of Cardiology." Without going into all of the details, as you can see, the post and picture still stands. But not before my lawyer made three trips to court and I accrued almost $14,000 in legal fees.

Did I win?

I suppose for patients and gullible doctors who might be scammed into purchasing these fake board certifications, I did. But when I consider the costs of the legal haggling coupled with the months of worry for myself and my family, I’m really not so sure. I still wonder why I continued blogging. Perhaps it was to show my "strength." Perhaps because I didn’t like to "lose" the right to stand up for what I believed. Whatever it was, I quickly grew up as a physician blogger. I pause every time I’m about to post. From that lesson it became abundantly clear to me: blogging, no matter how careful I tried to be, was clearly not a legally risk-free endeavor.

I also grew to appreciate the power of social media for my patients and colleagues. On occasion, when discussing sensitive subjects, the truth can hurt those exposed. But people who decide to attack bloggers who tell the truth risk being even more exposed themselves (this phenomenon has been dubbed "The Streisand Effect.") That’s because most bloggers do their homework and are careful to obtain background documents or refer to clinical references to support their commentary. Most of all, good bloggers consider their words carefully and know when NOT to publish as well. So if you’re going to do this social media thing seriously, realize it does have risks that you might not suspect to be associated with it. In this regard, it is good to review information offered by the Electronic Frontier Foundation. They have many helpful legal resources for bloggers there, new or old.

Gag Orders

Increasingly, doctors find that they no longer serve just their patients, but because more and more of them are becoming employees, they must serve their employers, too. Because of this new role, there exists a potential for conflicts for doctors between the needs of their patient and the needs of their employer. Although rare, an unhappy doctor could upset the careful balance between care delivery and business policies. Therefore, administrators are careful to protect their corporate policies and procedures. The make sure to place the onus of responsibility for participating in social media squarely on the participant’s shoulders. Health care institutions commonly place doctors under restrictive social media policies that ban them from talking about business practices, contracts in place with vendors, and the like.

Can doctors still participate in social media in that setting? Of course! But commentary will be necessarily geared toward the sanitized and polite (some call this "professionalism"). And while I still meet doctors hungry for honest discussions about thorny issues that affect them directly, I have to be very careful what I include on this blog. Each of us must respect the fact that being too forthright could cost us our jobs. In some ways for patients, this is too bad, since honest discussions are potentially "filtered."

While doctors are partially muzzled online by these policies, patients are becoming increasingly vocal. As such, it will be the patients, perhaps in subliminal collaboration with their doctors, that will drive our health care system to improve. Social media is becoming a very effective way for patients to voice their concerns to others, and health care systems of tomorrow are launching their own social media campaigns to counter the potential for those patient concerns to be amplified many times over by others. And for this reason, maybe some of these downsides of social media for doctors will be outweighed by social media’s benefits to our patients. Better yet: social media-savvy doctors might become the best voice of reason to address new patient concerns that arise.

Time

For doctors, this is the Granddaddy downside of them all. Culling news stories or scientific articles, reflecting on your own personal experiences, placing pen (or fingertips) to paper (or computer), spell-checking (it happens sometimes) and processing feedback are prerequisites for a good physician or nurse blog. Even doctors NOT participating actively on social media are increasingly interrupted by the push of information to their smart phones, be it in the mall or in hospital hall. Surely, I’m not sure the last time I didn’t run into someone checking their cellphone. Trendy journalists, ever eager to slam our profession, coin new terms for this phenomenon: distracted doctoring. (Never mind that the journalist has Tweetdeck open on his own computer as he writes his prose and receives his newsfeeds while driving). * sigh *

But we should acknowledge the seductive nature of social media. It is rewarding to post something online that people can positively acknowledge. There is also an element of mystery and intrigue: who’s reading and commenting? Where do they come from? Do they like what I have to say or are they critical? Sadly, bloggers can find out fairly easily. They just set up a little Sitemeter account and they gain the ability to see where and when readers come from. So the statistics are checked again and again — linkbacks explored — and time is frittered away. Bloggers wanting to grow their readership rationalize this "checking" as necessary. After all, it’s all about generating "traffic," "stickiness," and "re-visits." Get enough of these and you can make a dollar from Google Adsense each day or promote your blog to advertisers through its page views.

Sometimes, these time constraints can catch up to doctor bloggers. You simply can’t write about everything that interests you on short order. Even if doctors understand this potential pitfall and limit their participation in social media to time only at home, the time required to participate can still intrude on one’s personal or family life. After all, each of us are limited to only 24 hours in a day. To counter this, doctors should plan blog-breaks, sabbaticals, or even shutting things down temporarily or permanently. These breaks should not be seen as a sign of weakness (despite what happens to your Klout score or Technorati ranking) on the physician blogger’s part, but rather, healthy insight into blogging’s toll on life’s other important priorities. For the reader of doctor blogs used to seeing instantaneous feedback from other non-medical social media sites, if a doctor doesn’t respond to every comment within minutes, publish a post every day or even every week, then at least they’ll understand where doctors are coming from.

This is not to say that doctors don’t get things from participating in social media ourselves — we do. We learn from our patients. We learn from our colleagues. We develop a network where we bounce ideas off each other. We gain useful information quickly that we can apply to real-world problems. Beyond this, writing a blog can be therapy, a sounding board, or an information font. We can use social media in creative ways: for reference organization, to make considerable income, or maybe do it just because we like to write.

The Take-Home

So after all of this, what do I really think about social media for doctors now?

I feel social media’s benefits for doctors are probably net neutral: not awesome, not horrible.

It is what it is.

In our increasingly connected medical world, social media will be an asset for some, a liability for others. Where it settles out will be a personal choice. Social media doesn’t make us a better doctor, it just makes us a better public doctor that likes to write and type. It is not more than that. Doctors who have no typing skills can still have exceptional doctoring skills, but they’ll probably never participate in social media and that’s okay.

But there is one thing I know after all of this: whatever our new electronic medical world will become in the years ahead, social media use by our doctors of tomorrow sure isn’t likely to go away.

-Wes

Laptops are necessary in todays world. With so many electronic devices, like smart phones, tablets, desktop computers, etc. A laptop is definitely a device that needs to be insured. Laptops, have the availability, and sleekness of a smart phone. But, with the storage capabilities of a desktop computer. Because it has so much power to hold all of this memory and information.

By Gary Schwitzer

Not to be missed:  last week’s BMJ published an analysis by a team at
Dartmouth Medical School led by Steven Woloshin and Lisa Schwartz – “Influence of medical journal press releases on the quality of associated newspaper coverage.”
This is an important contribution to our understanding of the food
chain of the dissemination of research news to the American public: 
medical journals feed journalists, who feed the American public what they
get out of journals – sometimes driven largely by what’s in journal
news releases.  If the information at the source is complete and high quality, the flow of information from journalists to the public is more
likely to be complete and high quality as well.  But this analysis also
suggests that “low quality press releases might make (associated
newspaper stories) worse.”
Excerpts:

Higher quality press releases issued by
medical journals were associated with higher quality reporting in
subsequent newspaper stories. In fact, the influence of press releases
on subsequent newspaper stories was generally stronger than that of
journal abstracts. Fundamental information such as absolute risks,
harms, and limitations was more likely to be reported in newspaper
stories when this information appeared in a medical journal press
release than when it was missing from the press release or if no press
release was issued. Furthermore, our data suggest that poor quality
press releases were worse than no press release being issued:
fundamental information was less likely to be reported in newspaper
stories when it was missing from the press release than where no press
release was issued at all (although the findings were generally not
statistically significant).

…

Reporting on medical research
is challenging: newspapers need to reach readers who vary widely in, for
example, statistical literacy and reading levels. But these issues are
not unique to medical news. Journalists constantly report quantitative
information. Imagine the sports section without scores, player
statistics, or team standing tables; or political polls without numbers.
Although further work is needed to improve public understanding of
medical research, a first step is to ensure that people have access to
the fundamental information—basic study facts, quantified results,
important study limitations—information they need to understand the
findings and to decide whether to believe them. Our results suggest that
press releases of high quality increase the chance that readers will
receive this information.

High quality abstracts might
improve newspaper coverage. But our observations suggest that well
written press releases issued by medical journals could do even more to
improve the communication of medical news to the public. Our observation
that press releases have more influence than journal abstracts on
reporting is unsurprising. Abstracts are dense, technical, and written
mainly for a professional audience. Press releases are written in a
non-technical narrative format that explicitly targets journalists, many
of whom have limited scientific training.

High quality press releases are
a simple way for medical journals to increase the chance of newspapers
receiving key information. We hope our observations encourage medical
journals to issue high quality press releases. Press officers could use a
checklist to remind them to include the basic facts, numbers, and
cautions. A more ambitious approach would be to develop a standardised
press release that would help journalists find key information, perhaps
by including structured tables quantifying benefits and harms. Some
small journals, however, simply lack the necessary staff to produce high
quality press releases, emphasising the need for editors to ensure that
the relevant information is easily accessible in the journal abstract.

Our study shows that there is
substantial room for improving press releases. Medical journals should
use press releases not simply to make medical news — but also to make news
reporting better.

Unfortunately there’s a little craze going on in the diet industry and that craze is centered on HCG diet drops. What this means is that there are 100′s of different HCG products available to choose from and that can make it almost impossible to find drops that actually work. When searching for the best HCG drops it’s important that you find ones that do the job because this is going to make all the difference in whether you succeed or fail in your diet efforts. These are the most important factors that I take into account when ranking HCG drops:

Shopping for a life insurance policy? The great thing about the internet today is that you can compare policies at a glance at a single source. To shop and compare life insurance policies, visit the website above and see how much you can save. There’s also a grat little needs calculator that with just a few simple questions can help you determine the amount of coverage that’s right for you.

Have you heard about the Ab Circle or seen it on TV? It’s certainly a novel approach to abdominal exercise and losing weight, incorporating a movement that is certainly much more unique when compared to the countless number of exercise machines which basically amount to nothing more than assisted crunches.

One thing that’s critical to remember is that weight loss works best when exercise is combined with proper diet. You can work as hard as you want to burn the fat off through exercise, but cleaning up your diet is a must if you want faster and better results.

If you’re interested in finding out more about the “Kidney Disease Solution,” visit the website above to learn more. You’ll also learn about some of the symptoms and possible causes of kidney disease, which is great since the first step of treatment is diagnosing and attempting to understand your issue. The “solution” is heavy on diet and lifestyle, which is certainly known to have impacts on many chronic health conditions, but of course please do remember to always consult your physician in order to work out a game plan with them, having your health records and history at their disposal.

Well, we’re one month into the new year. How’s your weight loss goals coming along? For many, they find that they simply cannot do it on their own and that they need a real, vetted gameplan to get themselves on track and losing the kind of weight that they dream of.

To be at your best, you need a system that incorporates both diet and exercise components. At the end of the day, it’s calories in vs. calories out, so diet (calories in) and exercise (calories out) together will always yield the best results.

Looking for tips to spice up your love life? You’re certainly not alone, and there’s nothing wrong with that. Any relationship requires work, and it really shows that you love and care for your partner when you try to find ways to make things a little interesting and bring the spark back into your romantic lives.

Hiring the right lawyer does make all the difference when it comes to the rest of your life. Make sure that you have a lawyer that has theDUI experience and the court room experience to give you the best results possible.

In a nutshell, Google has an army of humans that guide their algorithm changes by examining the “quality” of websites. Those quality signals eventually become encapsulated into the mathematical algorithm and then roll out into the entire Google index. Your website goes up-or-down based upon your “quality footprint.” The possibility even exists that your site could go up or down as a result of a manual review, outside of an actual algorithm change.

This data comes from pipes.yahoo.com but the Pipe does not exist or has been deleted.

This is an amazing tool for anyone that promotes Amazon products. A video walk-thru inside my account, how it works, and how to use it.

By SHADOWFAX

I have been working as an ER doctor for over a decade, and in that time I have come to recognize that there are certain complaints, and certain patients who bear these complaints, that are very challenging to take care of.

I’m trying to be diplomatic here. What I really mean is that there are certain presentations that just make you cringe, drain the life force out of you, and make you wish you’d listened to mother and gone into investment banking instead. Among these, perhaps most prominently, is that of the patient with cyclic vomiting syndrome.

The diagnosis of cyclic vomiting syndrome, or CVS, is something which is only in recent years applied to adult patients. Previously, it was only described in the pediatric population. It has generally been defined as a disease in which patients will have intermittent severe and prolonged episodes of intractable vomiting separated by asymptomatic intervals, over a period of years, for which no other adequate medical explanation can be found, and for which other causes have been ruled out.

That is not seem to exist much in the way of good literature about this disease entity, which is surprising, because it is something that I see in the emergency department fairly regularly, and something with which nearly all emergency providers are quite familiar. These patients are familiar to us in part because we see them again and again, and in part because they are memorable because they are so challenging to take care of.

Some things about the cyclic vomiting patient that pose particular challenges:

Coexisting with the vomiting is often a fairly severe complaint of abdominal pain, for which no clear diagnosis can be established, requiring in some cases high doses of intravenous narcotics. CVS patients are interesting in that sometimes the only agent that will stop the vomiting is hydromorphone. (For the nonmedical readers, it is worth noting that hydromorphone has no anti-vomiting properties, and in fact causes many people to vomit.)

This requirement for narcotic medication supports a perception that the patient is drug-addicted or drug-seeking, itself reinforced by the fact that patients tend to come back to the emergency room several times in quick succession for recurrent vomiting. (For this reason, some have referred to CVS as an "abdominal migraine.")

All of this makes management difficult in the setting where there is fairly little in the way of evidence-based guidelines, or even much in the way of expert recommendations or academic agreement on the definition of the syndrome. My observation, over the years, is that while Zofran and Reglan and Compazine can in some cases be helpful, in most cases they are not. I have however, had very good success with the use of benzodiazepines such as lorazepam or midazolam.

Benzodiazepines seem to work in two ways: they are well known to have anti-emetic properties, but they are also quite sedating, and the patient does need to be awake to vomit. Interestingly, while use of normal vomiting medications seems to drive patient requests for narcotic medications, when I use the benzodiazepines, I almost never have to co-administer a narcotic.

Since I have made these observations and implemented them in my personal standard treatment protocol, I found that CVS patients are much easier to care for, both in the sense that they’re less emotionally draining for me and in the sense that they get better quicker and go home feeling better. It’s not clear to me whether this treatment protocol results in fewer bounce-back presentations to the emergency room, but I would be very interested to find out if that is the case. (Interestingly, the use of hydromorphone seems to increase the likelihood of bounce-back presentations.)

I’m a little curious whether propofol could be used to manage the vomiting of CVS, since it is also known to have anti-emetic properties, but given the demise of poor Mr. Jackson, I suspect such off-label uses of that medication are not going to be encouraged.

One thing which I’ve recently become aware of, in part through our good Aussie friends at Life in the Fast Lane and in part from a journal club that I recently attended, is that there seems to be a fairly strong association with marijuana use and CVS. In fact, there has been proposed a disease entity called cannabinoid hyperemesis syndrome which may possibly represent the same clinical syndrome of CVS, or at least a significant overlap.

This is particularly interesting because marijuana is in fact generally perceived to have antiemetic properties. Leon Gussow, a toxicologist who blogs at The Poison Review, has a nice write up over at Emergency Medicine News, where he speculates:

Because cannabinoids are lipophilic and have long half-lives, they may accumulate with chronic heavy use to the point where they start to exert a paradoxical effect. This may be related to their well-described ability to delay gastric emptying and decrease gastrointestinal motility.

However, I would temper that against the observation that in CVS patients, gastric motility and gastric emptying is often increased.

Since I have become aware of this association between marijuana use and CVS type presentations it has been my “good fortune” to care for nearly a dozen patients in the emergency department who self-reported diagnosis of CVS. Curiously, of these patients about 10 admitted active marijuana use, and the two who denied it had positive urine screenings for marijuana.

This does not exactly make a case series, but is certainly another interesting observation. Of course, since the prevalence of marijuana use in our Emergency Department seems to approach 100% sometimes, this also may not be a statistically significant association! Each of these patients was counseled about the possible causal relationship and advised to stop smoking the devil weed. Lord knows whether they will or not, but maybe it will actually do something to reduce their ER visit frequency.

I’d be interested to hear your observations on this matter, whether other ER folks have noticed the same thing.

By Gary Schwitzer

Kudos to reporter Kirsten Stewart of the Salt Lake Tribune
for showing how to avoid local boosterism – so often seen when the local
health care industry makes an announcement or holds a ribbon-cutting
ceremony.  In her story, “Utah doctors tout high-tech cancer treatment,” she helps readers think critically.
You should read the full story, but here are some excerpts:

An independent group of radiation
oncologists affiliated with hospitals throughout Utah is hyping the
arrival of “the world’s most advanced radiation therapy.”

Residents of Davis, Washington — and now
Salt Lake — counties have ready access to Accuray Inc.’s TomoTherapy
Hi-Art Treatment System, says a news announcement by physicians at Gamma
West Cancer Services. The technology, showcased in full-page newspaper
ads and at a Friday open house at St. Mark’s Hospital, takes 360-degree
CT scans of patients, allowing radiologists to better spot tumors,
pinpoint therapy and minimize damage to healthy tissue.

Experts agree image-guided radiation
therapy is fast becoming the standard of care, especially for
hard-to-reach tumors. But it isn’t new technology, nor is it new to the
Salt Lake area. And whether the TomoTherapy brand is “a step above”
other systems, as described by Gamma West’s founder and chief medical
officer, John K. Hayes, is open for debate.

…

The trick for patients, of course, is
finding which treatments, if any, are right for them — a decision
complicated by the soaring cost of cancer care in America.

From 1990 to 2008, spending on cancer
grew to $90 billion from $27 billion, according to a 2009 study in the
Journal of the American Medical Association. Authors tied the increase
to new drugs, robotic surgeries, radiation techniques and an aging
population.

The rise of high-tech medicine has
coincided with a decrease in death rates from cancer. But scientists
differ on whether it’s directly responsible for prolonging lives.

“We are very medicalized in this country.
We think that every predicament in life is a medical predicament and
there’s some miraculous solution,” said Nortin Hadler, an immunologist
and microbiologist at the University of North Carolina, Chapel Hill and
author of Rethinking Aging and Worried Sick.

But about 80 percent of our increase in
longevity is tied to our socioeconomic status — “something about the way
we live together, whether that’s job security or education levels,”
Hadler said.

Biomedical advances, on the other hand,
are responsible for about 20 percent, which Hadler says he’s proud of.
But he rails against the overtreatment of patients by an industry that
he says has “lost its moral compass.”

…

The question on every patient’s mind
should be, will this treatment work? “I don’t care if they have the
latest proton thing out of science fiction or if my insurance company
will cover it or how well they market it. I care how much it will help
my patient who is ill.”
Hype.
Medicalization.
Costs.
Informed patient decision-making.
She fit a lot into this story and deserves a shout-out for the effort.

By Gary Schwitzer

The BMJ reports:

“More than one in ten (13%) UK-based
scientists or doctors have witnessed colleagues intentionally altering
or fabricating data during their research or for the purposes of
publication, while 6% say they are aware of possible research misconduct
at their institution that has not been properly investigated, reveals a
BMJ survey published today which attracted over 2,700 responses.

…Dr Fiona Godlee, BMJ Editor in Chief,
said: “While our survey can’t provide a true estimate of how much
research misconduct there is in the UK, it does show that there is a
substantial number of cases and that UK institutions are failing to
investigate adequately, if at all. The BMJ has been told of junior
academics being advised to keep concerns to themselves to protect their
careers, being bullied into not publishing their findings, or having
their contracts terminated when they spoke out.”
A summary of the report has been posted online, downloadable as a pdf file.
Meantime, Reuters reports:

“A University of Connecticut researcher
(Dipak K. Das, who directed the university’s Cardiovascular Research
Center) who studied the link between aging and a substance found in red
wine has committed more than 100 acts of data fabrication and
falsification, the university said on Wednesday, throwing much of his
work into doubt.

…Although many scientists have been
skeptical of various claims made about resveratrol, it has garnered
significant commercial interest. British drugmaker GlaxoSmithKline
bought Sirtris, a company that worked on the compound, in 2008 for $720
million but later discontinued work on one version of a drug that mimics
its activity because of disappointing results.

A Las Vegas resveratrol maker called
Longevinex has promoted Das’ research, and he appears in a lengthy video
touting the nutrient as the next aspirin.

Das also shared a 2002 patent on the use
of another compound in grape skins called proanthocyanidin to prevent
and treat heart conditions.

Other scientists have taken notice of
Das’ work, citing 30 of his papers more than 100 times each, according
to Thomson Scientific’s Web of Knowledge. Last year, he won an award
from the International Association of Cardiologists.”

By Kevin, M.D.

Should healthcare providers hug their patients?

That’s a question that neuropsychologist Dominic Carone asks in this provocative guest post:

When a patient tries to initiate a hug, my response is to simply say in a nice and respectful way that I am not allowed to hug patients because it crosses a boundary line. Then I offer my hand for a handshake. This can admittedly result in some slight embarrassment on both sides, but it is better to be safe than sorry.

Of course there are some instances when it’s appropriate to hug a patient, and everyone may not agree with Dr. Carone’s blanket approach.  But it is a sobering commentary on our society that some providers have taken such a drastic black-and-white stance.

***

Edwin Leap talks about the controversial issue of board certification exams.

He notes that, as we gear medicine toward more evidence-based practice, there is little data showing that board certification improves patient care:

More irony: medical practice is supposed to be evidence-based. So where’s the data that board certification makes a difference in patient outcomes? Maybe it does, maybe it doesn’t. But even if it does, we’ll need to break it down to see if ongoing certification matters, if repeat testing matters, who sponsored the study. etc. Our certifying bodies should be eager to see independent evaluations of the question. Or would that be a problem?

There are doctors who take the cynical view that board exams are a revenue-generating activity for our professional societies, which may be true.  But I think the public identifies certification with competence.  In lieu of any other standard, that’s worth considering before we do away with exams completely.

By Gary Schwitzer

In more than 7 years of blogging about health care messages affecting
the public dialogue, I don’t think I’ve ever written before about radio
call-in programs.  But this one hit pretty close to home.
Nothing makes me more upset than people fear-mongering and lying about health care to suit their own interests.
I don’t listen to radio call-in shows, so maybe some of you who do can tell me how prevalent this is.
My 89-year old mother e-mailed me recently, forwarding a well-traveled e-thread that read like this:

• Be sure to listen to this.  Chilling and scary!

• Behind closed doors in Washington there are some very evil forces at
  work the depth of which we have no idea. Please listen to this chilling
  report.

• Read this report on how 70-year-olds will be treated IF they have any neurosurgical medication or surgery problems.

Because I know she’s worried about my 91-year old Dad’s health and
his imminent need for medical attention for some problems he’s been
having, I listened to the audio clip she sent.  After all, it was the
first audio clip she’s ever sent me.  I didn’t know that she knew how to
send these.  But then again, she didn’t load the audio clip.  She was
merely forwarding an already well-traveled senior circuit call-in show
excerpt from the Mark Levin radio program.  Levin’s website labels him
as:

“one of the top new authors in the
conservative political arena….a frequent guest and substitute host on
The Sean Hannity Show, and has also been an advisor to Limbaugh, who
frequently refers to him on the air with the nickname “F. Lee Levin.” He
is perhaps more well-known for his nickname, “The Great One,” coined by
his friend Hannity. Mark Levin is one of America’s preeminent
conservative commentators and constitutional lawyers.”
The “chilling and scary” part of the show came when a caller, “Jeff
from Chicago,” said he was a brain surgeon who just returned from
Washington.

“… where we were reading over what the
Obama health care plan would be for advanced neurosurgery for patients
over 70 which we all found quite disturbing … Basically what the document
stated was that if you’re over 70 and you come into an emergency room
and you’re on government-supported health care, that you get comfort
care.”

The host said, “Wait a minute.  What document? And what’s the source for this?”

Brain surgeon “Jeff” stammered:  “This is uh… the….uh….Obama’s new health care plan for advanced neurosurgical care.”

Host:  “And who issued this? HHS?”

Brain surgeon “Jeff”:  “Yes….and
basically for patients over 70 years of age, advanced neurosurgical care
was generally not indicated.”

Host:  “Is this published somewhere?”

Caller:  “Not yet.  Not yet.”

Host:  “So this was discussed just with your community, the neurosurgeons.”

Brain surgeon “Jeff”: “Exactly … the AANS
and the CNS …. the American Association of Neurosurgeons and the Congress
of Neurosurgeons.”

Host:  “So Sarah Palin was right, we’re going to have these death panels aren’t we?”
The audio of that portion of the program has now been posted on YouTube.
So I went to the AANS website and here’s what I found:

Washington, DC – On November 22, 2011, an individual claiming to be a “brain surgeon” made several statements referencing neurosurgical care on a Mark Levin radio show segment. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) reviewed this segment and found that it contained several factual inaccuracies which we wish to clarify. The AANS and CNS are unaware of any federal government document directing that advanced neurosurgery for patients over 70 years of age will not be indicated and only supportive care treatment will be provided. Furthermore, in conducting our own due diligence, the caller who identified himself as a brain surgeon is not actually a neurosurgeon, nor was there any session at the recent Congress of Neurological Surgeons’ scientific meeting in Washington, DC at which a purported government
document calling for the rationing of neurosurgical care was discussed.
…We have requested numerous times that this podcast be removed from
Mark Levin’s website as it portrays inaccurate information which could
potentially be harmful to the patients that we serve.
My mother is afraid and confused. She is an example of the harm
described in the AANS statement.  She was probably afraid to tell my Dad
what she had learned in this viral email thread with the viral audio
clip resurrecting the malignant death panel myth.
Whoever “Jeff” was, I hope he and his radio host – “The Great One” –
somehow someday get a glimpse of the harm their fear-mongering can
cause. I’m not talking about the power trip that show biz provides from
the safety of a studio taking calls on a cell phone spouting unverified
information from unvetted sources.  I’m talking about the real world
with real old people like my mother who believe this crap and get
confused and upset and hurt in the process.
But, as with the original wildly false “death panel” claims, this story grew legs.  I found pages and pages – dozens and dozens of search results from websites that passed along this hoax.   Great for the ratings, right, “Great One”?

Meditation is quickly growing acceptance in Western culture and medicine, and frankly, it’s about time. This popular practice has been used for centuries to calm the mind and increase focus, creativity, reduce stress, and has a host of benefits for anyone.

Of course, the challenge is in learning the meditation process. For beginners, it can seem a near-impossible task to actually quiet your mind. In fact, this issue can make a supposedly soothing practice frustrating, defeating its entire purpose. This is why many have turned to the Internet and to experts in order to learn meditation techniques, so that they may easily slip into a meditative state and reap the many benefits of proper meditation.

Diverticulosis can be a pretty tough diagnosis. Given the fact that it is a disorder of the large intestine, diet can absolutely have an effect on your symptoms and treatment. If you’re interested in learning about a diet for diverticulosis, visit the website above to find out more.

Also, be sure to check with your physician before you begin any diet. Their input can be invaluable, both in regard to your diverticulosis and any other chronic or acute conditions you may face.

What is the Law of Attraction? Put simply, it is the idea that thoughts determine actions … that is, positive thoughts “attract” positive outcomes and vice versa. There’s certainly no shortage of books on the Law of Attraction (also known as LOA). For information on LOA books, check out the link above.

By Todd Neale

The other day, I found an email in my inbox carrying the subject line, "Text Neck on the Rise with Increased Use of Smartphones and Tablets." Let’s see what that’s about, I thought.

As informed by a public relations representative, "text neck results from frequent texting or looking down at your mobile device for extended periods of time, and chiropractors say it is on the rise and is quickly becoming a global epidemic." The overuse injury supposedly can cause tightness across the shoulders, headaches, neck soreness, and even permanent arthritic damage.

Of course, the email went on to sell me on a commercial product that would be perfect for treating such a condition, but I decided to see whether this was actually a problem observed outside of company marketing departments.

Apparently, the term "text neck" has been getting some play in recent months, and was purportedly coined by Dean Fishman, DC, a Florida chiropractor. The term has found its way onto the American Chiropractic Association’s Get TechnoHealthy! website, just under an article about "BlackBerry thumb."

The list of tips to avoid text neck seem to make sense:

• Sit up straight with your chest out and your shoulders back.
• Hold the device in front of your eyes so you don’t have to look down.
• Rather than hunching over, tuck your chin into your chest to look down.
• Invest in an external keyboard if you use your device for lengthy typing.
• Rest your forearms on a pillow while texting to minimize neck tension.
• Avoid using devices in bright sunlight, because straining to see the screen could exacerbate the problem.

The best way to avoid text neck is to limit use of the device, the website said, although I think most people (myself included) would find that difficult. But I’m still somewhat skeptical about how big of a problem this actually is and whether clinicians are dealing with complaints of "text neck" on a regular basis.