Monthly Archives: August 2009

Senator Edward Kennedy

A legend in life, a moment in death.  Such is the passing of Senator Edward Kennedy.


For many of us, this is not just the passing of a man.  It is the end of an era, and undoubtedly a new beginning.  This was the last survivor of a family that did not so much live out loud as it lived in view.  This was a family that knew unimaginable heights, yet suffered unspeakable losses.  And now the last is gone.


I don’t have personal recollections of the Senator.  Like you, I viewed him from afar.  But as I listened to the broadcasts this morning, it came to mind that he had been so many personae to so many people.  He was a champion, he was a legend, he was humane.  He was also frail, and he was human.  He achieved great things, and caused great sorrow.  But he also was offered forgiveness, found his way, and touched the lives of millions.  In a sense he was different from us while at the same time he was like so many of us.


To the health community, … Continue reading →

When The “News” Isn’t News

Once again, we have an example of when the news isn’t exactly news. 


A study reported today in the journal Cancer Research  says that treatment to prevent breast cancer recurrence with the drug tamoxifen  increases the risk of a woman developing a second, more aggressive of breast cancer in the opposite breast over 400%.


That’s the headline.  But the fact is we have basically known that since 2001, and frankly the way we treat women with breast cancer has changed considerably in between the two reports.  So the practical implications of the article aren’t new information, and the unfortunate unintended consequence is that many women with breast cancer may become unnecessarily alarmed.


Women with breast cancer are frequently put on preventive therapy to avoid a recurrence or spread of their cancer.  That treatment can include hormone-related medicines, such as tamoxifen or drugs called aromatase inhibitors, and may also include chemotherapy drugs which frequently have to be given intravenously.


We know these treatments—which may also include radiation therapy–are very effective in reducing the risk of cancer returning in the breast where it was diagnosed, as well as in the … Continue reading →

Side Effects and Selling of HPV Vaccine:What’s Up?

Two articles and an editorial in the current issue of the Journal of the American Medical Association (JAMA) about the side effects and marketing of the cervical cancer vaccine are probably going to raise questions.  They may also fuel the fires of concerns among some groups that have raised thorny political questions about the vaccine, especially as to whether or not this vaccine should be mandatory for young girls.


The primary “scientific” report in JAMA describes the results of a post-marketing surveillance program that monitors the side effects of new vaccines. 


The study, written by researchers from the Centers for Disease Control and Prevention and the Food and Drug Administration is fairly straightforward. 


In order to monitor reports of subsequent adverse reactions, the CDC and the FDA sponsor an adverse event reporting system called the US Vaccine Adverse Event Reporting System (VAERS).  Anyone can submit a report of a suspected vaccine-related adverse event to this system, even if they are not the patient, a family member, a physician or other health care professional.  Once the vaccine has been in widespread use for a sufficient period of time, those reports can be evaluated … Continue reading →

“Euthanasia” Is Taking The Debate Too Far

The debate about euthanasia has gone too far.


Someone’s intent to do a good and necessary deed has now been transformed into a hideous misrepresentation that not only affects our humanity and dignity as a nation, but goes to the heart of the physician/patient relationship and the responsibility that physicians have to provide healing and comfort as well as treatment. 


That’s our oath, and that’s what we are supposed to do.  Recognizing that imperative is not something that should be punished as an evil act.


Perhaps some background would be helpful in framing the issue:


Medicare is supposed to only pay for medically necessary and effective care.  It is not allowed to provide other services such as screening or prevention unless specifically authorized by Congress.  End of life counseling falls under the category of non-covered services, but probably gets into the payment mix as part of other billing codes which doctors use to get paid for more routine “evaluation and management” services. 


Providing explicit payment for this service will encourage appropriate and needed discussions between physicians and patients on this very important, difficult and humanitarian topic.


For years, many … Continue reading →

Repeat After Me: “Prevention Works!!!”

For once, some good news: Plain and simple, prevention works. 


“The message from our analysis of the data from the EPIC-Potsdam study is clear: adopting a few healthy behaviors can have a major impact on the risk of morbidity.  The participants with all 4 healthy lifestyle factors had a reduced risk of major chronic disease of almost 80% compared with those with none.  These results applied equally to men and women.”  So say the authors of a new research report that appears in today’s issues of the Archives of Internal Medicine.


But wait a moment.  As pointed out in an editorial in the same issue, this really isn’t news.  We’ve known this for a long time. 


So if we know so much, why can’t we do something about it?  That, my friends, is the $64,000 question.  Or perhaps that figure is really outdated.  Today, it’s the multibillion dollar question.  Just go ask the folks in Washington.


The research took a lot of effort, but is stunningly simple in its theory. 


The researchers followed over 23,000 people in Potsdam, Germany for … Continue reading →

What I Want From Health Care Reform

I suspect I am one of many who are not unhappy that Congress has finally taken their August recess.  I suspect I am also one of many who are alarmed and upset by the next act in this play, which is the rancor and near-violence we are seeing on our TV sets every day at the various town hall meetings when health care reform is the topic of discussion.


This isn’t what health care reform—or whatever you choose to call it—is supposed to be about.  This is a serious matter for our nation and for many of our fellow citizens. It deserves thoughtful and deliberate discussion.


The events of the past several days have left me distressed and concerned.  The anger, the accusations, the lack of decorum and the distortions and occasional “untruths” being promoted by all sides have left me dismayed.  It is even beginning to affect relationships among friends and families.


All of this has led me to think about what is important to me, and for my family.  What do I really want from health care reform? 


1)      I want to know that I can get Continue reading →

Cervical Cancer Vaccines: What Is The Real Story?

The headline on the press release says, “More Than Half of Texas Physicians Do Not Always Recommend HPV Vaccine to Girls.”  That sounds bad. 


The “sub headline” in the press release says, “Approximately 50 percent do not recommend the vaccine.”   That sounds really bad.


The problem is that the headline is misleading and the “sub headline” isn’t true.


When you read the actual research paper, you find out that 75-87% of the doctors are making the right recommendation most of the time. 


Given the strong social and political interest in this topic, those differences have significant implications, especially given the headline and sound bite world we live in today.  And that could influence how this paper may be used to drive public policy.


First, a bit of background:


We know that the majority of cervical cancers in the United States are caused by two types of human papilloma virus, or HPV. 


A cervical cancer vaccine was introduced in the United States in 2006 which could significantly reduce the risk of cervical cancer from these viruses.  We also know that the vaccine has not been used as … Continue reading →

Keep Prevention In Health Care Reform

A recent headline saying that prevention is under attack as part of health care reform really bothered me.


One of my core principles as a physician has been that preventing illness when possible is much better than treating illness.  I can’t even begin to imagine a revamped health system that does not shift emphasis and money to prevent disease. Billions (if not trillions) for technology and machines and pennies for prevention is unbelievable and unacceptable.


Is our health care in this country technologically outstanding? Absolutely. You can’t find anywhere in the universe that has more fancy medical machines per person that the good old US of A. Giving us good value, effective care and long, healthy lives for the amount of money we are spending?  No way.


The only solution I have to improve my odds of living longer and healthier is to do whatever I can to take care of myself, and that means incorporating prevention into my daily life.  I happen to think that prevention is also the right prescription for the country.


Prevention has always been close to my heart professionally as well.


Years ago, I started my practice … Continue reading →