Personal Health: The "Small Steps" Program
Last month we presented the problems in getting the states to do their fair share -- as they had promised -- to reduce smoking among youngsters and oldsters. The states are dragging their feet and their pocketbooks. But now comes an appeal-to-youth "good cause" area that seems to be working at a better pace, hopefully around the country.
For close to two years the federal government, health advocacy organizations and private companies have joined forces in an effort to at least start to turn around American youth's propensity to eat too much and to eat too much of the wrong thing…while too-often trying to imitate their parent's "couch potato" lack of energy. The campaign is broad-based, but the major target has been teenagers, simply because they are still in a formative stage…and if carefully and gently prodded, are old enough to accept some reasonable lifestyle changes.
McCann-Erickson, one of America's top advertising agencies, has given freely of its time and talent in an effort to instill the idea of "proper eating" in the minds of both kids and their parents. Hopefully convincing the younger group in particular (directly or through their parents) that it pays to eat wisely and stay healthy, rather than to automatically reach for high-fat burgers-and-fries. This effort is still in its formative stage, but McCann seems to be taking its cue from the moderate approach used in the "don't drink and drive", "buckle up", quit-smoking and screen-for-cancer campaigns, each of which has slowly achieved a measurable level of success.
Small steps. You don't get them all, but you do make a dent!
The developers of the program say that means stop shouting at your target audience, never have a spokesperson in a white coat lecturing them with facts and figures, but rather start approaching them with emotional benefits they care about and can understand.
On Madison Avenue that is called "sell the sizzle" and that's what this eat-right, lose-weight, exercise-more campaign to kids and young adults has been trying to do. Step-by-step, because everyone realizes this is an ingrained, long-term problem that is tough to beat. It's being promoted mostly though TV, but is heavily supported by reality shows, info-websites, download-able computer games…and even instant messaging.
The Nickelodeon Channel and MTV are two of the prime supporters of much of this ancillary material. The approach is based on softly presenting proven facts to people who still think their health is invincible and that they just may "live forever". Fact is telling younger people they may be leaving themselves open to possible cancer, diabetes, heart disease or a dozen other nasty illnesses some day just doesn't work. But what seems to work some of the time is to instead concentrate on regularly telling and proving it is really important to take the first steps right now. To repeat again and again and again the joys of being able to skate faster, stay healthier or jump higher -- now and in the future -- are there for the taking. If you start now! And, whenever possible, show them that McDonald's and its compatriots are not at the center of the food chain!
Media outlets have donated more than $150 million worth of ad time or space to getting this message across to youngsters and young adults in just-starting-to-form families. More than 100 million people have seen the ads. More than a million people have logged onto Small Steps' website. It will take years to discover whether the same relatively-soft-sell targeted approach that at least made a dent in teen smoking will turn them on to solidly-good food in reasonable portions. Everyone and every company involved seems to think it will. America is apparently betting a generation's chance to stay healthier and live better -- while taking a bite out of the country's huge $115 billion healthcare costs -- on the hope this is the right approach!
Personal Health: NAACP Campaign Supports Rx Drug
BiDil is a new medication for heart failure; the first approved by the FDA that includes a race-specific label: "For African-Americans only." For some yet-unknown reason, in trials BiDil had little effect on patients of other races, but showed excellent results when tested exclusively on Black patients. In fact, when taken along with other medications, BiDil reduced cardio deaths among Blacks about 43% and lowered their hospital admission by 40%.
America's oldest civil rights organization has now joined the makers of BiDil in the company's $1.5 million education program designed to spread the word about America's first ethnically-driven drug, which just happens to be designed to combat the leading cause of death in this group. The participation is a first for the almost century-old NAACP, whose efforts until now have mainly been targeted towards gaining equal civil rights and educational opportunities for its members.
This is apparently the first drug that is based at least in part on race-independent gene variants.
Dr. Lucille Perez, the NAACP's National Health Director said that the organization's departure in approach is a logical move because healthcare is such an important factor facing everyone today. According to recent reports, African-Americans are stricken with more incidences of high blood pressure, diabetes and kidney disease than most other ethnic groups. So it is only natural to include such a healthcare-awareness in messages to both their members and the community at large.
The program will run for approximately three years and will also include broad-based and general healthcare information.
BiDil's program has been praised by the Association of Black Cardiologists and the National Medical Association, while other groups are bothered by the race-targeting of the drug and the NAACP's support of a specific product. The organization replies it is an important breakthrough and is therefore incumbent on them to make members aware of this potential healthcare and life-saving opportunity.
They also point out to the nay-sayers that this is a medical breakthrough…since it now seems likely that someday many new drugs will be developed that will prove more beneficial to one racial group than another.
Rx 2005: Final Report
New drugs were a relative rarity in 2005 despite much talk and great promises. The FDA reports that only 20 new drugs were approved, as against 36 the year before. In fact, only once in the past ten years has the number of approved new drugs been smaller.
More worrisome still was the fact that most of the new drugs were for rare diseases that therefore helped few-in-number patients. In the face of all this, the pharmaceutical companies reported that they had spent $38 billion on research in 2005, a new yearly high.
The development process, with its many checks-and-balances, was blamed by some and stirred the FDA to announce that it was yet-again seeking new ways to speed up the process. This in the face of high-visibility objections by some members of congress and consumer-advocates for even more testing before FDA final approvals are granted. The apparent Vioxx debacle is much-mentioned by these groups.
In general, the industry is upbeat, though, with many scientists claiming there are a relatively-large number of new drugs currently in early stage-development… and that many of these are sure to make it to market in the immediate years ahead.
Diabetes Reaching Epidemic Proportion
The Centers for Disease Control and Prevention now estimates that one child in three born in the United States five years ago is expected to become diabetic in their lifetime. The number of diabetics has grown by 80% in just the past decade. And that this number is accelerating.
The CDC also estimates that 21 million Americans have high blood sugar levels and are therefore diabetic, but don't realize it because the outward signs are not showing…yet. The CDC also estimates 41 million others are prediabetic, with blood sugar levels steadily increasing. Most people with early signs of the disease are not taking necessary action by more-carefully choosing what they eat.
Bringing all that a bit closer to home…it is estimated that more than 10% of New York City's population already has diabetes, which has more than doubled in the city in the last decade. The CDC calls it an epidemic.
Adherents say that one of the major causes of this explosion is that health-services have concentrated on higher-profile or communicable diseases such as cancer, TB and heart disease. But the truth seems to be coming to the surface…and that truth is finally making "wake up America" type headlines. The American Diabetes Association claims that diabetes-related medical bills, disability and time lost on the job totals currently cost about $150 billion a year. In 2002, estimate for all expenses like this and time lost due to all types cancers was not much more: $171 million.
First step in the battle seems to be a change of names. Until 1997, Type-1 diabetes (basically an immune system problem) was called Juvenile Diabetes and Type-2 (caused by obesity and inactivity) was called Adult Onset Diabetes. But so many children now have Type-2 -- which currently makes up somewhere between 90 and 95% of all cases -- that those nametags are now rarely used.
The high-profile, regular monitoring and insulin shots are only part of the problem. Diabetics are up to four times as likely to experience a heart attack or stroke and up to three times more likely to die of complications from pneumonia or the flu. Perhaps most horrible of all, approximately 50% of so-called "lower limb" amputations are diabetes-related; mainly caused by peripheral neuropathy, vascular disease and infection.
First steps for most people is monitoring blood sugar levels of course, eating less and exercising more…all of which is too-often ignored until things really get serious! Even though the CDC has projected that the life expectancy of a ten-year-old diagnosed with Type-2 diabetes is nineteen years shorter than that of a non-afflicted child.
Billion Dollar Investment
An amazing perspective of how rapidly the medical/hospital world is expanding…the 140-year-old University Hospitals Health System (Cleveland) recently announced a five-year, $1 Billion expansion-of-facilities; the plan includes $100 million targeted to "technological enhancements" including system-wide EHR.
First planned step is a 200-bed hospital dedicated to every aspect of cancer care. Concurrently, a 40,000 square foot outpatient medical center will be constructed nearby. Its ER is planning a major overhaul in order to accommodate the current load of more than 70,000 adult and pediatric patients. A separate hi-tech children's hospital is also a part of the plan. Of special interest…a 2010-era centralized medical records depository is planned to serve all buildings and elements in this giant complex. It will include patient demographics and history, medication usage, medical progress reports and lab data. The system will have a built-in monitor that prevents duplication of meds…as well as testing protocol to check allergies and drug interactions. The need for pens and pencils will apparently be minimal!
State-of-the-Art IT
"Malware" is a word you won't find in the dictionary; it's often used as an insider's description of computer viruses that aim to maim a system or destroy essential data. So a whole anti-virus industry of extensive security vendors has arisen to seal off their client's software against the possible damage "malware" can cause.
Most of these damage-doers are currently specifically-targeted at Microsoft's Internet Explorer…simply because its anti-virus properties are a known quantity bundled into its system. All this may change soon and that change seems to be led by Apple, which just-recently began to bundle its Safari browser into the Mac OS; others are ready to follow.
Medicinal Tobacco
In an era when the word "tobacco" has constantly been associated with "bad", a molecular biologist has forecast some surprising "good" in tobacco. Professor Henry Daniell of the University of Central Florida claims he has developed a method that enables one acre of genetically-engineered tobacco plants to produce -- in the event of a terrorist attack -- enough anthrax vaccine to inoculate every man, woman and child in the United States. Quickly, safely and even inexpensively!
Professor Daniell has spent twenty years researching medical therapies derived from genetically-engineered plants. He claims tobacco is ideal for these projects because it is plentiful, fast-growing and -- most importantly -- has little chance to slipping unnoticed into the food chain.
Far out as this may seem, a lot of people are now apparently paying attention. A jointly funded NIH-Dept. of Agriculture trial injected laboratory mice with the vaccine, then "attacked" them with anthrax levels fifteen times what could be expected in a worst-case terrorist attack. The mice survived. The results were published in the Journal of the American Society for Microbiology.
Proposed next step is human testing to evaluate the vaccine's actual effectiveness, though no one has explained how this trial could be safely conducted.
Professor Daniell's team reportedly is working on the development of similar tobacco-grown treatments for plague, cholera, type 1 diabetes and hepatitis C. They forecast that several such vaccines will reach the market in three to five years.
Free PDAs to MDs
Independence Blue Cross of Pennsylvania -- which covers the southeastern part of the state and some southern sections of New Jersey -- is the latest Blue to initiate a pilot program that offers hand-held personal digital assistants to doctors. The without-cost offer is designed to replace often hard-to-read, hand-written prescriptions with "e-Prescribing" technology . The offer includes the software, wireless network hardware and training in the use of the unit. Blue Cross of Delaware, Massachusetts, North Carolina and Maryland have previously taken similar action.
Basic use of the handheld is to enable doctors to fill and refill prescriptions electronically. In addition, the doctors will also be able to use the unit to access a patient's drug history, get the patient's insurer's list of preferred drugs, check allergies and possible interactions with the patient's other medications and even co-pay information.
The Pennsylvania "e-Prescribing" pilot is part of the year- old Pennsylvania Health Initiative, which includes over 40 health-related organizations. Eventual goal of the plan is to build a statewide electronic network that will hook into a planned national net…which in turn will enable the fed-planned switch from paper to e-health records to happen within the next decade.
Medical Minutia
Silver was one of the first anti-bacterials even though the ancient users weren't quite sure of its specific abilities.
Records show that healers in the time of Egypt, Greece and Rome applied silver to fight infections. Romans apparently also invented silver plaster-like casts to help wounds close more rapidly. Last-known major breakthrough in the medical use of silver was in 1884, when physicians learned that a few drops of silver nitrate in the eyes of babies born to women with VD often eliminated their then high rates of blindness.
Reports are that -- in the face of bacteria increasing resistance to antibiotics -- a number of researchers are seeking to "reinvent" some of silver's curative powers.
Bypassing Bariatric Surgery
Flush from there apparent successful partial face transplant, the French seem poised to reach out in an entirely different direction….developing a relatively quick and easy temporary non-surgical replacement for the gastric bypass surgery that has been getting so much attention. The idea is simple; the procedure, though, is yet to be proved and approved.
An "intragastric balloon" is inserted down the patient's throat with the aide of a standard endoscope. Once in place in the stomach, the balloon is inflated to the size of a small grapefruit. The patient then can't eat as much simply because his or her stomach simply can no longer process large amounts of food. The balloon is projected to safely remain in place for up to eight months, when a reverse procedure removes it from a supposedly much-slimmer patient.
The procedure is said to take about fifteen minutes under a local sedative. There are several possible side effects, including the warning that the balloon just might perforate the stomach; the latter hasn't happened in any trials to date, but remains an unpleasant possibility.
In the United States, stomach-stapling bariatric surgery is firmly established as the procedure of last-choice, while the so-called "adjustable stomach band" is gaining adherents in Europe and Australia.
Seems best to say this procedure is innovative and therefore interesting to discuss, but not quite there yet.
Changing the Look of Lives
Sometimes plastic surgeons have an image problem, and that is not meant as a pun. First thought is that they make people better looking with a nip and a tuck here and there. Second thought is that they repair the features of accident patients. But there are all-too-few words about what they do to help the lives of the world's poorest and often terribly afflicted.
That is the low-key charitable works done by the Face to Face Mission Project (spearheaded by the American Academy of Facial and Plastic Reconstructive Surgery) that brings the best hands and skills in the western world to people -- most often children -- with facial birth or accident defects. Cleft palates, deformed ears or eyes, twisted faces. Often orphans, seldom adoptable in their homeland because of these deformities.
Since 1992 teams of highly-trained plastic surgeons have journeyed to Russia, China, Vietnam, the Philippines, Croatia and Belize to correct damaged faces and to teach local physicians how to start to learn to perform equal miracles. The often-famous and normally well-paid doctors that perform the reconstructions and instruct the local doctors on how to follow up the procedures are all volunteers, most of them devote a portion of each year to this charitable work.
And it is harder work than most are normally accustomed to because the facilities are usually inadequate and their local assistants relatively untrained.
Face to Face teams have operated on over 600 children and offered local consultations related to more than 1,000 children. They also helped many of these facially-reconstructed orphan children find homes with families that will now accept them. Most importantly, they have taken the time and care to instruct local doctors in the western methods of reconstructive surgery that is rarely available in their native lands. Also they remain available for consults by phone or e-mail to the third-world doctors they taught best-as-they-could during their volunteer stays.
Transcription Tips
Blood access is permanent or temporary. Temporary access is via a plastic-type tube (catheter) inserted in a large vein. Three common sites are the subclavian (between neck and collarbone), internal jugular(neck) and femoral veins (groin). There are three common types of permanent access: 1) Arteriovenous (AV) graft, which connects artery to vein under the skin with synthetic material (PTFE, polytetraflouroethylene); common brand names are Gortex and Impra. 2) Arteriovenous (AV) fistula, direct connection between artery and vein with no synethetic material. 3) Tunneled catheter, a rubber-like tube placed under the skin, usually at the neck or chest area, into a large vein, used when a vein is too weak or damaged for graft or fistula creation. This is often referred to as a PermCath, the brand/registered name (Note: perma-cath, perm-a-catheter are NOT correct forms).
Auditing the News
The FDA has ruled the tiny and sometimes-controversial RFIDs (radio frequency identification chips), designed to separate a real prescription drug from a counterfeit making its way through the distribution chain, must be made part of a manufacturer's label by next year. Pfizer announced that its Viagra -- one of the world's most-counterfeited drugs -- now has its own system up and running.
Pharmacies seem to like the idea…but not the need to purchase large quantities of expensive RFID readers. Meanwhile WalMart has mandated that all its drug suppliers must have those chips in place ASAP.
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Less is more. Walgreen reports that its pharmacies on average realize approximately $5.00 more gross profit per generic drug prescription than for a brand name. One reason for this apparent discrepancy is that insurers promote lower-cost generics by offering pharmacies financial incentives for promoting them.
Doctors often don't know exactly when a generic comes to market and some chains apparently make it a point to call the prescribing doctor to see if it is okay to switch.
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According to the Agency for Healthcare Research and Quality, unhealthy behaviors are responsible for 40% of the premature deaths in the United States. Seventeen primary care groups have been given grants of $125,000 each (funded by the RWJohnson Foundation) to -- over a several year period --- test both mundane and innovative ways to reduce this percentage.
Programs will prod patients to become more physically active, stop smoking, eat a bit less and follow a much more balanced diet, moderate their alcohol intake...and follow any other approaches the medical groups can individually develop.
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Dog-lovers, they may have done it again! A small California clinic claims it has trained five dogs to detect lung cancer in the breath of patients. And done it with 99% accuracy. Reviewers have found no flaws in the testing methods or record-keeping, but remain skeptical because the results are so "far off the charts". The next step will be to analyze breath samples with a gas chromatograph to learn exactly which mixes of breath chemicals lead the dogs to make their "choices".
A National Science Foundation grant has been applied for so that more-extensive tests be performed.
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The FDA also ruled that products containing whole or milled barley grain can now claim the ability to reduce risk of heart disease. And make that claim right on their packages! Breads and cereals are the big winners. The FDA ruling mandates that 0.75 grams of soluble fiber must be contained in every serving. Beer is apparently not on the recommended list of foods.
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Harbinger of things to come. HCA recently announced that it is spending $7 million on the test-development of a new "picture archive communications system" in seven of its twelve Kansas City-area hospitals. This will enable radiological images to be stored electronically and viewed on computer screens. Supplying better readings and less file-fumbling when most-recent vs. several year old comparisons are required.
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And from Dallas, word of the self-service check-in at doctors' offices. Patients at Baylor Healthcare Systems and a large pediatric-immunology office just swipe their driver's license or credit card to register at the receptionists' desks. It makes that registration simpler and more consumer-friendly according to the designers of what is called "eClipboard"…while freeing-up office personnel for other tasks.
Baylor estimates that the system will be operational in all of its twelve hospitals by January, 2008.
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According to a study reported in The Lancet, the relationship between belly and hip size is a better indicator of heart attack/health risk than the current favored Body Mass Index.
The researches claimed that the BMI is a "very weak predictor" of the risk of heart attack because even slim people whose waists are wider than their hips may carry their excess fat in the abdomen, which is dangerously close to the heart stomach, kidneys and liver.
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Awaiting FDA approval, Acomplia, a new type of weight-loss drug that reportedly works by blocking "appetite receptors" in the brain. Patients on the drug in a year-long study lost fourteen pounds more than those on a placebo.
To top it all off, the drug seems to raise "good" HDL cholesterol, improve blood pressure and blood sugar and lower triglycerides. Possible side effects - which are apparently holding up approval -- are depression, nausea and anxiety.
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