Check out the University of Arizona College of Medicine’s well-done video and discussion (see also here) of a new approach to CPR.
Continuous Chest Compression CPR
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Category Archives: Health Care
DeVany’s Top Ten Reasons Not to Run Marathons
The Chicago Marathon was over this past weekend, which resulted in the typical dozens of hospitalizations of participants.
That reminds me to pass along health and nutrition expert Art DeVany’s top 10 reasons not to run marathons (here is a previous post on the risks of long-distance running). Art’s summary of each reason is below, but you will have to subscribe to Art’s insightful site on fitness, health, aging nuturion and exercise to read Art’s elaboration on each reason:
10. Marathon running damages the liver and gall bladder and alters biochemical markers adversely. HDL is lowered, LDL is increased, Red blood cell counts and white blood cell counts fall. The liver is damaged and gall bladder function is decreased. Testosterone decreases.
9. Marathon running causes acute and severe muscle damage. Repetitive injury causes infiltration of collagen (connective tissue) into muscle fibers.
8. Marathon running induces kidney disfunction (renal abnormalities).
7. Marathon running causes acute microthrombosis in the vascular system.
6. Marathon running elevates markers of cancer. S100beta is one of these markers. Tumor necrosis factor, TNF-alpha, is another.
5. Marathon running damages your brain. The damage resembles acute brain trauma. Marathon runners have elevated S100beta, a marker of brain damage and blood brain barrier dysfunction. There is S100beta again, a marker of cancer and of brain damage.
4. Marathons damage your heart. From Whyte, et al Med Sci Sports Exerc, 2001 May, 33 (5) 850-1, “Echocardiographic studies report cardiac dysfunction following ultra-endurance exercise in trained individuals. Ironman and half-Ironman competition resulted in reversible abnormalities in resting left ventricular diastolic and systolic function. Results suggest that myocardial damage may be, in part, responsible for cardiac dysfunction, although the mechanisms responsible for this cardiac damage remain to be fully elucidated.”
3. Endurance athletes have more spine degeneration.
The number two reason not to run marathons:
2. At least four particiants of the Boston Marathon have died of brain cancer in the past 10 years. Purely anecdotal, but consistent with the elevated S100beta counts and TKN-alpha measures. Perhaps also connected to the microthrombi of the endothelium found in marathoners.
And now ladies and gentlemen the number one reason not to run marathons:
1. The first marathon runner, Phidippides, collapsed and died at the finish of his race. [Jaworski, Curr Sports Med Rep. 1005 June; 4 (3), 137-43.]
Now there is a recommendation for a healthy activity. The original participant died in the event. But, this is not quite so unusual; many of the running and nutritional gurus of the past decade or two died rather young. Pritikin, Sheehy, Fixx, and Atkins, among many other originators of “healthy” practices died at comparatively young ages. Jack LaLanne, the only well-known guru to advocate body building, will outlive us all.
Patient expectations and Doctor ratings
Regular readers of this blog know about my opposition to the now entrenched third party payor process of even routine health care costs in the U.S. health care finance system.
Removing the consumer from controlling the complex decisions that go into paying or attempting to avoid such costs has had far-reaching consequences, not only on the cost of health care, but also on the way in which consumers view their responsibility in regard to maintaining their own health.
I was reminded of those implications recently when I came across this Pauline Chen/NY Times article on the vagaries of third party payors compensating doctors based on patient performance, and this Happy Hospitalist post on the difficulty of telling a patient who is expecting a cure regardless of the cost that the doctor really doesn’t know what’s wrong with with the patient.
These items prompted a friend of mine – first-rate hospitalist and internist – to pass along his experience on the unrealistic expectations of many patients:
Here is an insight into what the practice of medicine has evolved into.
Because hospitals and other corporate organizations are so focused on "customer satisfaction" these days (with Press-Gainey satisfaction survey scores and the like), the opinions of persons like the one the Happy Hospitalist describes get far more purchase than they have in the past.
Often times, I see drug-seeking persons like this get all the testing and all the Dilaudid they want (bad medical practice on multiple levels) because a doctor may not want to set himself up to get "dinged" on a patient survey – some places tie physician bonuses to patient satisfaction scores – some docs even get fired for bad scores.
And, unfortunately, patients like this are not a rare occurrence. I see at least one or two every week I work in the hospital.
I had a patient tell me, "Screw you" last month when I suggested that she might have a bit more money for medicines if she were to stop smoking two packs of cigarettes per day. This is after I had admitted her for treatment of accelerated hypertension and uncontrolled diabetes, found her previously undiagnosed high cholesterol, and got those all under control with medications she could get through the WalMart $4 program. There was no "thank you", and certainly no payment to me or to the hospital for our expertise.
It’s really disappointing to see how frequently the patient-physician interaction has deteriorated into something like this. I guess that other professions are subject to similar abuse, but I don’t see any other examples as severe as what I am seeing in medicine.
I’ve always thought that the best approach is to do what’s right for the patient, even if it is not necessarily what the patient wants. In this current climate, this has at times put me at odds with hospital administration.
What do you think Walt [my late father] would do if faced with this deterioration of patient-physician interaction?
I think my father’s reaction would be the following:
1. When you remove from the patient the responsibility to pay – or at least contributing to pay — for their health care, patients tend not only to become more irresponsible regarding how they spend money for their health care, but also less interested in understanding how to avoid those costs.
2. Doctors share a big part of the blame for the foregoing problem because they encouraged (and previously got rich by) over-billing of third party payors who insulated the consumer from the cost of health care. Now those chickens are coming home to roost.
I continue to believe that the solution to these problems is not by adding complexity to the health care finance system. Rather, take away insulation of routine health care costs and require consumers to pay those costs, allow insurers to provide true insurance for catastrophic illness or injury and use government as a reinsurer of true health insurance and an insurer of last resort for folks who cannot afford health care or private insurance. Allow such a system to develop over a generation or two and we might bring some semblance of consumer education and price stability through market forces back to the health care finance system.
But I’m not counting on it.
Stifling Competition
Special business interests commonly use governmental power to stifle competition. Nevertheless, you really couldn’t make this example up (H/T Jeff Miron):
The folks who deliver beer and other beverages to liquor stores have joined the fight against legalizing marijuana in California.
On Sept. 7, the California Beer & Beverage Distributors gave $10,000 to a committee opposing Proposition 19, the measure that would change state law to legalize pot and allow it to be taxed and regulated. [. . .]
“Unless the beer distributors in California have suddenly developed a philosophical opposition to the use of intoxicating substances, the motivation behind this contribution is clear,” Steve Fox, director of government relations for the Marijuana Policy Project, said in statement.
“Plain and simple, the alcohol industry is trying to kill the competition. Their mission is to drive people to drink.”
Amazingly, the alcoholic beverage distributors don’t realize that one of the unintended consequences of the misguided drug prohibition policy is that illegal drugs are often much less expensive than legal alcoholic beverages.
What disaster is worse?
On one hand, the vested interests in America’s unending War on Drugs continue to rationalize the enormous cost of drug prohibition by suggesting that the alternative is worse:
Every past administrator of the 37-year-old Drug Enforcement Administration is calling on the Justice Department to sue California if its voters decide to legalize marijuana in November.
Peter Bensinger, who ran the D.E.A. from January 1976 to July 1981, said legalizing the recreational use of pot, even in one state, would be a “disaster,” leading to increased addiction, traffic accidents and trouble in the workplace.
Meanwhile, the WSJ’s Mary Anastasia O’Grady writes about the wages of the War on Drugs just across the Texas border near El Paso:
Ju√°rez is dying. Since the beginning of this year, more than 2,200 people in the city have been murdered. Since 2008, the toll is almost 6,500. On a per capita basis this would be equivalent to some 26,000 murders in New York City. Drug warriors play down these numbers by claiming that some 85% of the dead were themselves involved in trafficking. But that claim is dubious since in many of the murders-more than 90% of cases this year-there hasn’t even been an arrest. And what about the hundreds of innocents, the other 15% of the victims, that the government admits were not criminals? [. . .]
In the 40 years since Richard Nixon declared war on drug suppliers abroad-because American consumers had consistently demonstrated that they had no interest in curtailing demand-illicit drug use in rich countries has remained fairly constant. Only preferences have shifted.
A report released in June by the United Nations Office on Drugs and Crime found that “drug use has stabilized in the developed world.” Cocaine use in the U.S. has dropped in recent decades, but there is “growing abuse of amphetamine-type stimulants and prescription drugs around the world.” The report also said that “cannabis is still the world’s drug of choice.” In other words, billions of dollars in warring has left us about where we started, except, according to the report, that the indoor cultivation of cannabis is now a major source of funding for criminal gangs.
As I’ve noted many times, America’s War on Drugs is lost and it is long past time that we require our leaders to acknowledge that and end it.
Even if legalization would increase drug abuse and addition (not clear, but certainly possible), at least such a policy would allow the abusers to harm themselves rather than impose substantial risk of harm on innocent citizens.
The War on Drugs is dangerously close to becoming a war on us.
Answering the Obesity Paradox
On one hand, drinking even diet soft drinks causes higher risk of heart disease?:
A new US study has found that drinking more than one soft drink a day, whether regular or diet, may be linked to an increased risk of developing heart disease, via an increase in metabolic syndrome, a group of characteristics like excess girth, high blood pressure, and other factors that increase the chances of getting diabetes and cardiovascular problems.
But on the other hand, even though overweight people are at higher risk of heart attacks, patients with heart failure have lower mortality rates if they are obese:
[T]he “obesity paradox” among patients with heart failure. The paradox refers to the repeated finding that while overweight people are more prone to heart failure, patients with heart failure have lower mortality rates if they are obese. The reason for this paradox is far from clear, though Dr. Lavie suggested that one explanation could be that once people become ill, having more bodily “reserve” could be to their advantage.
My sense is that the obesity paradox is more the result of overweight people having more muscle mass. It’s not the excess fat that helps them recover from heart failure. It’s the muscle mass and strength.
As Art DeVany has been saying for years: “Muscle is medicine. Strength carries us effortlessly through life.” As we age, our workout routines should be tailored toward maintaining or increasing strength.
Health care finance myths die hard
In the face of undeniable proof that the concierge medical practice model, particularly when combined with the use of Health Saving Accounts, is an innovative market force that is addressing finance problems for a substantial portion of the health care market, this New York Times grudgingly acknowledges that concierge medicine may be a viable way to control health care costs at least for a substantial portion of health care consumers.
But on the other hand, the Times doesn’t want you to forget that HSA’s don’t work for everybody:
Critics have been less enthusiastic about H.S.A.’s, worrying that high-deductible plans work only for young, relatively healthy people who do not spend a lot on health care anyway. When sick people are faced with paying high out-of-pocket costs for medical bills, they simply go without the care they need, experts note.
As Arnold Kling has observed, why does the Times think that that we cannot possibly afford health care if we have to pay for it individually, but we can afford it if we pay for it collectively?
Training camp — A football tradition that needs to die
Last week, this post noted the growing financial implications of injury risk in the National Football League and the utter lunacy of exposing high-priced player assets to such injury risk during the NFL’s grueling pre-season practices and games.
This week, William Rhoden of the NY Times notices the same thing:
The N.F.L. perpetrates two annual frauds: one against the American public, the other against players who give body and blood to make the league a multibillion-dollar enterprise.
The first fraud is preseason football, those empty, glamorized scrimmages that teams force on season-ticket holders as parts of the regular-season package.
The second, more dangerous fraud is training camp, which exposes veteran players to unnecessary risk and perpetuates the myth that football is more complicated than it really is.
Despite the fact that every NFL player engages in year-around training, the tradition of a long and largely useless training camp still survives at the highest level of American football. Thankfully, at least some in NFL management are starting to notice:
“I don’t know if the body has enough time to recuperate because you’re seeing so many soft-tissue injuries,” Jerry Reese, the Giants’ general manager, said. “There’s more opportunity for injury because there’s so much more time on the field. Then you have training camp and you go double during training camp. And you see all across the league there are a bunch of injuries.” [. . .]
“It’s a balancing act; I’m not sure how well we’re balancing it right now.” [. . .]
Giants linebacker Keith Bulluck said it did not make sense for players to beat one another up in camp “and then when we have to go play a team, we don’t have the player that we need.”
Bulluck recalled that in his rookie season, in 2000, most teams held two-a-day practices with lots of contact. “It was physical, very physical, when I came in,” he said.
Over the years, many teams have evolved toward more classroom work. [. . .]
Referring to Giants camp, he added: “Not too many two-a-days here, either. I guess the coaches are beginning to understand that it’s more about the season. Beating the guys up in August doesn’t help in September, October, November and December.”
This much is certain: training camp is an idea that has outlived its usefulness.
There are few athletic endeavors more boring than football practice. Hammering players for a month and a half before a brutal 4+ month season makes no sense at all.
Teams should complete their hardest workouts a couple of months before the beginning of the season and then tailor pre-season work-outs toward maximizing strength, speed and health while emphasizing scheme understanding.
As Rhoden’s article notes, teams are slowly moving that way. But, then again, despite serious training camp attrition already, did you know that Texans Coach Gary Kubiak announced earlier this week that he intended to expose his starters to high injury risk for three quarters in this week’s practice game against the Cowboys?
So it goes.
Hospitalist v. Cardiologist
The primary care doctors are having a nice chuckle over this one.
The irrelevance of drug prohibition
Check out this interesting letter to the editor of the Wall Street Journal yesterday from Robert Sharpe of Common Sense for Drug Policy:
What’s interesting about the drop in violence associated with crack cocaine is the irrelevance of drug enforcement. During the peak of the 1980s crack epidemic, New York City applied the zero-tolerance approach. Meanwhile, Washington, D.C. Mayor Marion Barry was actively smoking crack and the nation’s capital had the highest per capita murder rate in the country.
Despite very different leadership and law enforcement, crack use declined in both cities simultaneously. This parallel decline occurred when the younger generation saw firsthand what crack was doing to their older peers and decided for themselves that crack was bad news. Adding to what is already the highest incarceration rate in the world is not the answer to America’s drug problem. Diverting resources away from prisons into cost-effective, substance-abuse treatment would save both tax dollars and lives.