Sunday, July 26, 2015

Warning! Cell Phones Can Kill You!

In medicine and beyond, folks just want stuff to be true.  Sometimes, we believe stuff that is unproven, but might be true.  We doctors recommend such treatments to patients every day.  On other occasions, a benefit of a drug or food item is extrapolated way beyond the data.  For example, if Nexium is known to be effective against stomach ulcers, then why not use it for patients with stomach aches who are ulcer-free?  There’s not a gastroenterologist on the planet that hasn’t engaged in this therapeutic mission creep.  More interestingly, folks often persist in beliefs that have been disproven.  The notion, for example, that certain vaccinations can cause autism has been thoroughly debunked by rigorous scientific study, yet there remain diehards who defy the science. 

Curiously, many unproven or disproven practices have gained a fair measure of street cred in the Court of Political Correctness.  Keeping a gluten-free diet today is downright chic.  Colonic cleansing is the bomb.  Kale is king. 

If we want to generate some heat in the green crowd, just mention the word ‘radiation’.  Ingesting irradiated food, for example, is believed to be tantamount to swallowing strychnine.  No persuasive evidence necessary.  Faith will suffice.   Nuclear reactors are regarded as atomic bombs in waiting, as if burning coal or hydraulic fracturing (fracking) are as clean and pure as the first snowfall.  The sun’s radiation, which assaults us daily is somehow not demonized, nor are cosmic rays, high energy radiation which bombards our atmosphere and can reach down to earth itself.

Cell Phone-Free Zone!

The City of Berkeley, the epicenter of New Age Goofiness, has just passed an ordinance that requires retailers to warn customers about the medical risks of devices that emit radiation, such as cell phones.
Here’s an excerpt from the caveat.

If you carry or use your phone in a pants or shirt pocket or tucked into a bra when the phone is on and connected to a wireless network, you may exceed the federal guidelines for exposure to radio frequency radiation.  This potential risk is greater for children...

Luckily, I'm mostly in the clear.  I am not a child and do not don female underwear.  I secrete the phone into the left inside pocket of the sport jackets I wear each day to work.  The phone, therefore, rests above my heart.  Perhaps, the gentle radiation from my beloved iPhone is conferring a cardiac benefit on me?  While it's just conjecture, perhaps, if my heart gets tempted to beat out of step, that my iPhone's rays keep my rhythm sure and steady.  

If I were the cell phone companies, here's how I would fight back.  Forget about litigation or trashing the fiends who fear all radiation, foreign and domestic.  I would sell my theory of cardiac protection to the American Heart Association. For a proper donation, they might consider cell phones to be 'Heart Healthy'.  

If your adversary argues without facts, then shouldn't you?



Sunday, July 19, 2015

Should Physicians Profile Our Patients?

Profiling in this country is highly discouraged and is illegal in many circumstances.  Anti-profilers decry this technique which, they argue, unfairly targets innocent individuals violating their rights.  Our beloved Transportation Security Administration, or TSA, is charged not to use profiling as a screening tool.  Personally, I object to this prohibtion.  While an individual’s rights are important, it must be weighed against the rights of the community.  Our cherished rights to free speech and assembly are not absolute.

I have flown on El Al airlines, whose personnel actively profile in an effort to keep its passengers safe.  Anyone who has been a passenger on this airline will likely agree with me that he has never felt safer on an airplane.  I have a right not be blown up, and if profiling further minimizes this risk, then call me a fan.
Last year, my mother, who appears as threatening as a school librarian, was patted down twice when she traveled to visit me in Cleveland.  I’m sure that the patter-downers were following the rules and regs, but this doesn’t seem to be a well targeted effort. 

A Non-controversial Profile

I’m familiar with the argument against law enforcement using profiling to reduce crime and protect public safety.  I understand that this can lead to abusive practices by overzealous police officers.  But I wonder if, as El Al believes, this can be a legitimate tool in law enforcement’s armementarium.  I’m open to the debate here.

I’m a physician and I certainly profile my patients.  I don’t have a single template for treating abdominal pain in all  patients.   For example, if I see a recent immigrant from China with stomach issues, a part of the world where gastric cancer is relatively common, this may affect the speed and intensity of my evaluation.   If an American born patient comes to my office with the same complaint, my response might differ.   If breast cancer is more common in Ashkenazi Jewish women, shouldn’t we factor this in when we are advising them on risk reduction?  Certain populations have different health risks.  Physicians are always trying to separate out patients who might warrant special attention. 

If you are trying to reduce a certain disease that is largely restricted to one segment of the population, doesn’t it make sense to target this segment rather than everyone?

I realize that health and law enforcement may not be analogous.  I also realize that profiling in law enforcement is a very sensitive issues, particularly for minorities who have been victimized by this technique.   But, if we abandon the procedure entirely, are we forfeiting a tool that could keep us all safer? 

El Al has a different view.  Here, in America, TSA is trying to detect evil stuff. El Al is trying to detect evil people.  Which makes more sense?


Sunday, July 12, 2015

When to Call the Doctor After Hours

Patients are entitled to receive medical advice 24 hours a day.   If you call your doctor at 3 a.m., you will reach a physician who will advise you.   Of course, it may not be your own personal physician as this individual cannot be expected to be available 365 days a year until he retires.  Physicians partner with colleagues who share on-call responsibility for evenings, holidays and weekends.   For example, my gastroenterology group has 3 physicians who take turns during the off ours to be available for our patients.

Here are some tips for patients who are seeking advice after hours from the on-call physician.

When possible, call your doctor before sundown.

I advise against calling the doctor after hours for a question that only your own physician can answer, unless an emergent situation is suspected.   For example, the on-call physician will not know what the next step will be if next week’s colonoscopy is negative.

If you call after hours for advice on a medical issue that has been present for weeks or months, then don’t expect a magic bullet response.   When my partner’s patient calls me after hours because he has had 2 months of nausea, it’s unlikely that I can solve this on the phone with a patient I don’t know, when my partner hasn’t figured it out after  a month of office visits and diagnostic testing. 

Have mercy on us!  Reserve after hour phone calls for truly urgent matters.  Realize we may have been awakened multiple times throughout the night with hospital phone calls, or even made a midnight run to the emergency room.  Sunday morning is not when your doctor will welcome a conversation on flatulence. 
Be reasonable.  If you call thinking that your college student who is home for winter break needs some Nexium to calm his overheated stomach,  don’t expect a prescription if your kid is not our patient.

It’s best to direct your inquiries during daylight hours to the physician who knows you best.  Of course, emergencies can occur at any time.   If you develop a medical urgency, or you are uncertain if the issue can wait until the office is open, then please call us.   We never want you delay contacting us about urgent condition, which might delay your treatment.   If the medical matter ends up being non-emergent - no foul.  You guys aren’t doctors.  What’s routine to us may understandably be concerning to you.

Let’s see what you’ve learned. Which of the following hypothetical scenarios merit a late night call to the doctor?
  • My hemorrhoid doesn’t feel right.  I know it’s 2 a.m., but I thought I should call  now when it will be easy to reach a doctor.
  • I had 4 episodes of rectal bleeding since dinner and I’m feeling a little dizzy.   I think it will pass.  If I call the doctor he might make me go to the hospital and miss the family BBQ party tomorrow.
  • Wow!  This Wellness Festival is awesome!  I know it’s Sunday, but I’m going to call my doctor now to ask which probiotic-fortified kale chips to buy.
If you enjoyed this post, call me.  Day or night.




Sunday, July 5, 2015

No Confederate Flag This Fourth of July

It’s the birthday of the nation, the Fourth of July.  John Adams proclaimed in a letter to his dearest wife Abigail that this day “will be celebrated by succeeding Generations, as the great anniversary Festival…with Pomp and Parade, with Shews, Games, Sports, Guns, Bells, Bonfires and Illuminations from one End of this Continent to the other from this Time forward forever more.”

Years later, in an amazing twist of historical fate, John Adams and Thomas Jefferson would each ascend to heaven on the very same Fourth of July.

'Illuminations'

These days, many of our historical figures and symbols are under review, judged in the context of current mores and sensibilities, always a process to be undertaken with care.  The Confederate flag is being banished from government property, as it should be.  During an earlier part of my life, I was sensitive to the argument that this flag properly honored the heritage of Confederate forefathers.  A little wiser now, I now realize that my ‘sensitive’ southern viewpoint was wholly insensitive.  The offense that this symbol has for most of us clearly outweighs competing arguments to brandish the flag on public lands.  If you want to display this image to honor the gallantry and heroism of your ancestors, your home is still your castle and you may adorn it as you wish.   Or, put on a T-shirt, get a tattoo or apply a bumper sticker. 

As expected, many who are now decrying the flag are doing so for political and economic reasons.   I don’t think that Amazon or WalMart have suddenly experienced a moral revelation as they scour their shelves to remove Confederate merchandise from their inventory.  Similarly, presidential candidates who weeks ago would finger-wag that these issues were ‘better left to individual states’, are now racing up the flagpoles themselves to be the first to tear down the flag.  Sounds like an electoral epiphany. 

My worry is that this will initiate an avalanche of a politically correct cleansing of our historical icons and symbols.   What should the standard be for us to publicly honor our historical and modern figures?  If the standard should be moral purity, then we will be spending the next decade carting away statues, demolishing monuments and changing the names of schools and streets throughout the country.  Who could make the cut?   We can’t even agree on if a female portrait should appear on the ten or twenty dollar bill, let alone who should be selected. 

It’s not easy to define a hero.  Name half a dozen Americans whom you think are our nation’s best, and I guarantee that there will be folks who see it through a different lens.  Same is true for the revered legends in American history.  Should we admire Robert E. Lee for his deep sense of honor, while he took up arms against his government?  Should we honor Henry Ford, who changed the world, but was a viscous anti-Semite?  Should honor Harry Truman as one of the most popular presidents in modern times, even though he dropped two atomic bombs on Japan within 3 days of each other?  

This nation emerged from a crucible in which virtue and vice cohabited.  We cannot expect that those who created and sustained the nation would be perfect.  Indeed, the preamble to the Constitution begins with the phrase ‘in order to form a more perfect union, acknowledging that we can never achieve the ideal state, but must strive toward it. 

Those men were also not perfect.  Thomas Jefferson, who penned the immortal phrase ‘all men are created equal’ into the Declaration of Independence, was a slave holder and a miscegenist.  George Washington owned hundreds of slaves.   Should the Jefferson Memorial be converted into a Museum of Tolerance?  Should our nation’s capital be given a new name?  If we sanitize every corner of the public square, what will we be left with?





Sunday, June 28, 2015

Is Gastric Bypass the Right Choice?

Bariatric surgery, including gastric bypass surgery, has become a popular remedy for obesity in this country.  Hospitals have weighed in on this issue and are marketing this service directly to the public who are ever willing customers of this slenderizing surgery.  I have many patients who have undergone the procedure and the results have been variable.   It’s too dismissive for me to refer to gastrointestinal bypass (GIB) as a ‘procedure’ as it is major surgery with major potential complications.  There are several types of bariatric surgery available today, but GIB is the standard surgery performed.

It profoundly reroutes the guts and changes every day of your life.  This is not like undergoing a heart bypass surgery when after a period of recovery you resume your normal life.  After GIB, there is no normal life afterwards.  Your life is irrevocably altered.  Meals are such a significant and personal part of our lives.  Think of all of life’s celebrations and you will recognize that food is a part of them.

Scale from Ancient Egypt

I point out these strong caveats to remind folks that the decision to proceed with GIB is not a casual one.  It requires careful deliberation and an understanding of the lifelong changes that one is committing to.  In addition, this operation is no quick-fix cure.  A patient who is a food addict, for example, will regain the lost weight after surgery, a sad and predictable outcome.  This is why high quality bariatric programs screen patients very carefully psychologically.   If a program accepts nearly all applicants, then one must wonder about the quality of the institution.

Personally, I feel that bariatric programs pull the trigger too quickly and that the public is too willing to serve as targets.  These surgeries, which should be regarded as last resort rescues are increasingly offered as front line therapies.  Eligible patients are rightfully told that GIB weight loss can melt away diabetes, sleep apnea and hypertension.

Before consenting or seeking GIB, have all other methods of weight loss been exhausted?  Has the individual received intensive dietary and nutritional counseling from weight loss professionals?  Has there been an adequate system of coaching and accountability?   Quitting a diet or two after a few weeks does not constitute exhausting all efforts.  I think that the existence and marketing of bariatric programs has influenced patients to leapfrog over conventional weight loss programs directly to the operating table.

I absolutely believe there is an important role for bariatric surgeries.  I am less sure that we are performing these surgeries only when they are the most appropriate option.  It's weighty issue for sure.  Feel free to weigh in yourself.
 

Sunday, June 21, 2015

Deflategate – Tom Brady Makes the Wrong Call

The Deflategate investigation has concluded that it was more probable than not that Tom Brady had general awareness of the mysterious shrinking footballs.  Now the fun started.  Although the investigator, Ted Wells, is highly regarded for his probity and objectivity, he was attacked by Brady supporters for what they argue were his tendentious findings.  As is so true today in our political world, when allegations are true and damaging, attack the messenger. 

Physicists from prestigious universities brought us back to high school science class with theories suggesting how the squishy pigskins could have been the result of natural phenomena.  I think the science was a little squishy here.   It was, however, sentimental for me to relive the tender memories from high school physics about the exciting relationships between pressure and volume.  There’s nothing like a discussion of the ideal gas law to liven up a dull evening. 

Would Sir Isaac Newton have given Brady a pass?

Brady has now suffered a deflation in his income with a 4 game suspension and the Patriots will endure a deflation in the number of their permitted draft picks over the next 2 years.  
So, Brady and his minions pushed back hard.  The 'Pats' can teach us all about integrity and fair play, as they did in 2007 when they were caught videotaping an opposing coach’s signals.  I think that he was aware.  His statements both prior to and subsequent to Wells’ report were tentative and calculated, not consistent with what one would expect from a man who was wrongly charged.  Moreover, his refusal to turn over his text messages and emails are not the actions of an innocent man.  Of course, he has the right to refuse to share them, and we have the right to draw conclusions based on this decision.  This is not a trial where he is entitled to a presumption of innocence.

Here’s what I would have advised Tom Brady to say before the microphones.

I love the game of football.  I have fallen short and did not live up to my own standards.  While I never asked directly for anyone to manipulate the game balls, I can understand how the equipment staff thought they were serving me and the team.  I accept responsibility for this and I accept the judgement of the recent investigation.  I will devote the rest of my career and my life to earning the trust of my colleagues and the public.  Football and the fans deserve no less.

In my view, this contrition would have shown us his humanity.  Since every one of us is a flawed creature, we would be inclined to be forgiving of a fellow human being who has missed the mark.  This would have been such a refreshing event to witness since accepting personal responsibility is a rare event these days.  He could have inspired us and returned to the game a bigger man.  Instead, he has become yet another example of responsibility deflection.  He fumbled.

If Brady couldn’t bring himself to utter a mea culpa because it is the right thing to do, then he should at least have done so because it is a smart play.  No one doubts Brady’s ability to call the right play in the huddle.  He should have ditched his advisors and called an audible. 


The lesson here is universal.  When we err or truly transgress, what do we do?  Do we lateral the ball or do we take the hit we deserve?

Sunday, June 14, 2015

Does Nexium and other Heartburn Medicines Cause Osteoporosis?

Every week, I am asked by patients if their heartburn medicine causes osteoporosis.  The most effective heartburn medicines are called proton pump inhibitors, or PPIs.  If you watch more than an hour of TV per week, then you have seen ads for some of them.   Nexium, Prilosec and Protonix are 3 examples of these medicines.

Many of them are now available over-the-counter at reduced dosages. 

Patients today are incredibly informed, and sometimes misinformed, about their medical conditions and their treatments.  Most of their information is from the internet, and it’s easy for patients to become unwittingly trapped in the world wide web.

The information dangling in cyberspace is entirely unregulated.  Information can be made to appear authoritative and objective when it actually is a paid advertisement.  Many blogs may appear to function to inform the public, when their true purpose is to serve the corporation that sponsors it.  If you are learning about probiotics, for example, consider the credibility of the site if you are encouraged to purchase certain products.  Caveat emptor.

Nexium - Bad for Bones?

I personally do not believe that Nexium can break bones, although I have read the same articles in the lay press that arouse my patients’ concerns.  I understand that a headline such as, Nexium Linked to Hip Fractures, will make my Nexium users so nervous that they might get wobbly and slip and chip a hip.

However, there is no convincing medical evidence that an individual user of Nexium or similar medicines has any significant risk of sustaining a fracture.  The belief that they can cause or accelerate osteoporosis is derived from large, pooled medical studies that are not truly capable of concluding cause and effect, a critical point often omitted from your hometown gazettes.

However, no patient should be on Nexium, or any medication, unless certain requirements have been satisfied.  Here’s what runs through my mind when I am recommending a medication for a patient.
  • The drug is absolutely necessary.
  • I am prescribing the lowest dose of the drug necessary for the medical task.
  • There is no safer alternative medication or other treatment available.
Of course, cost may be an issue depending upon the patient’s insurance coverage.  However, the patient’s financial status should not taint the physician’s recommendations.   The patient, however, can indicate that the doctor’s first choice is not possible, and he may choose a more affordable, but less effective option. 

If you want a second opinion on any of this, try the internet.   That’s where I go when I need reliable medical information.

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