Signup Thing

http://www.signupgenius.com/go/letusbegin

Here's a link to the automated sign up list we're using at the UGMC. Check it out

Patchy

So on Christmas Eve We're gonna open this clinic

Down at the Union Gospel Mission on 1st street there's a little clinic that's been there about 13 years.  A mess of health care workers have volunteered to run a clinic by appointment from 9-3 tomorrow Christmas Eve.  It's pretty sweet little clinic with dental chairs and dental xrays in a couple rooms and 2 small medical exam rooms.   There's not a lot of medical supplies like injectables and lab testing supplies and stuff but we'll get supplies as we go.

Itsa free clinic and we're starting out with just seeing folks living at the mission and working/volunteering at the mission.  Plus I'm allowed to schedule my own home-visit/email patients in there too.

We'll be doing a walk in clinic for the mission folks on Christmas from 1-5 if anyone wants to stop by and bring us food :)

Email me if you want to make an appointment for tomorrow

doctorcrafts@yahoo.com

Here's their website https://www.yugm.org/ministry.asp?ministryID=16  ;  it'll get updated eventually with the more recent developments

right now it's got stuff about the med student clinic that's been running every other saturday run totally by the DO med students

there's a long story to this ,  of course

heath care workers who want to volunteer contact yugmvolunteers@gmail.com

Everyone who has wanted to donate money to me over the last 14 odd months,  please donate to the UGM and the UGMC once we get a donate button.

Cheers!

Same old song, different year

In the news today there's a flood of articles about flu shots reducing heart attacks.   I've yet to find the original study but the news indicated British researchers reviewed charts and found a 21% decrease in the rate of heart attacks in people over 40 if they got the flu shot between september and mid november and a 12% decrease if they got the shot later in the year.  

This isn't new.  Last September stories like this were published 

http://www.nydailynews.com/lifestyle/health/2009/09/22/2009-09-22_swine_flu_vaccines_are_key_for_heart_patients_as_flu_viruses_can_cause_heart_att.html

Before that there have been studies showing a 50% to 90% decrease in mortality in elderly people who received the flu shot.  

All of these studies suffer from what's called "selection bias".   People who choose to get the vaccine,  especially elderly people, are more likely to seek medical care for their chronic conditions like high blood pressure or heart disease.   Influenza doesn't account for more than 5% of deaths in the elderly and yet the shot somehow lowers mortality 50% or more?   Additionally some of these studies found the "benefits" growing the following summer after the shot and flu season were long gone.   

The theory that reducing the stress of the viral infection,  influenza, will prevent heart attacks makes sense to me but it is equally reasonable that the myriad other viral infections that replace it (in the minority of vaccination recipients who do benefit) will stress the system just as much if not more.   Influenza unlike a few other respiratory viruses isn't known to directly infect the heart muscle for example.  

It's flu season and the stories touting benefits to vaccination are coming out of the woodwork again.  

http://www2.cochrane.org/podcasts/review_summaries/mp3/special_flu.mp3

Here's a good summary of what we know about influenza from vaccinations to antiviral drugs.

This one specifically talks about the misleading results on mortality

http://www.cochrane.org/podcasts/issues-1-3-january-march-2010/two-updated-reviews-influenza-vaccines

gotta hit play on that one

So when you hear the flu shot prevents heart attacks say "that's selection bias bubba".  

Blame Manichanh

My PA friend sent me this article from one of them PA magazines
http://www.jaapa.com/pneumococcal-disease-swinging-away-at-a-dangerous-killer/article/177825/?DCMP=EMC-JAAPA_Perspectives

It got me all riled up and my comment ended up being a pretty good overview of several vaccines so I gotta save it here.   You can stop reading now if you're not ready to spend like an hour thinking about this mess.



Are you serious?   How about instead of reading CDC reports and recommendations and parroting them to PAs,  we look at the actual clinical trials and quantify the benefits and risk of the vaccines you covered?  


PCV-7:  The 2 prelicensure trials show a decrease in IPD which becomes less pronounced over the short 3 year span of the studies.  There is a marked serotype replacement phenomenon that continues to be studied to this day.   PCV-7 was just mentioned in a JAMA article which reported a RCT showing serotype replacement with 19A nearly twice as often compared to unvaccinated controls.   Additionally there is zero mortality benefit demonstrated in any PCV7 clinical trial and the pneumonia benefits don't reach statistical significance unless the trial was outside of the US where attack rates are much higher.  
PCV7 isn't even recommended at this point with the new PCV13 taking its place.  There were no clinical trials used in the approval of PCV13 except for immunology studies which showed borderline responses for 3 of the 13 serotypes by the by.  


http://tinyurl.com/ybnc3xp  


http://www.ncbi.nlm.nih.gov/pubmed/17456820


http://www.news-medical.net/news/20100224/FDA-approves-Wyeth-Pharmaceuticals-Prevnar-13-pneumococcal-disease-vaccine.aspx


http://jama.ama-assn.org/cgi/content/abstract/304/10/1099?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=pneumococcal&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT




Routine influenza vaccination was summarized so well by Cochrane that I've nothing to add:
http://www2.cochrane.org/reviews/en/ab004876.html (in the eldery)


http://www2.cochrane.org/reviews/en/ab005187.html (health care workers)


http://www2.cochrane.org/reviews/en/ab000364.html ( patients with asthma)


http://www.digitaljournal.com/article/288946 (swine flu and routine influenza vaccination) 


Why would you recommend routine influenza vaccine?  Is it because the CDC recommends it?  That is NOT evidenced based medicine.  It's expert opinion based medicine.  


As for adult vaccination with PPV23:   The results are underwhelming 


http://www2.cochrane.org/reviews/en/ab000422.html


I do like the baseball analogy.   PAs are like the designated hitter in the majors.  They're paid less but reap huge rewards for the team.  I agree it's time for the PAs to "step up to the plate" but only metaphorically speaking.   It is time for PAs to join their brothers and sisters watching the GAME from the stands.  It is they who pay your salary and it is they who you are duty bound to advocate for.   Stop playing the GAME and start examining the men behind the curtain.  

Good News, Cancer Rates and Health Care Costs Decreasing

http://www.kaiserhealthnews.org/Daily-Reports/2010/August/30/Medical-Imaging.aspx

AUG 30, 2010

"Part of the explosion in medical imaging over the past two decades may be attributable to overuse, and steps need to be taken to cut back," according to a study in the journal Radiology, MedPage Today/ABC News reports.

"Initiatives include rewriting the fee-for-service system, curbing physician self-referral practices, and creating appropriateness criteria for imaging, according to William R. Hendee of the Medical College of Wisconsin in Milwaukee and colleagues. … Imaging services and their costs have grown at about twice the rate of other technologies in healthcare including lab procedures and pharmaceuticals, Hendee and colleagues wrote." Overuse of imaging "also exposes the public to unnecessary radiation." The authors "called for a national effort to develop evidence-based appropriateness criteria for imaging, so that physicians can make greater use of practice guidelines in requesting and conducting imaging studies" (Fiore, 8/29).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

http://www.kaiserhealthnews.org/Stories/2010/August/23/imaging-tests-health-risks-sidebar.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn%2Ffulltext+%28All+Kaiser+Health+News+%28Full+Text%29%29

Several recent studies show the risk of cancer associated with CT scans appears to be greater than previously believed.

Related Content

Health Law Changes Rules For Docs With In-House Imaging Machines

A study published last year in the Archives of Internal Medicine projected that 29,000 future cancers will be directly attributable to the 57 million CT scans performed in the United States in 2007.

Another study last year by the National Council on Radiation Protection and Measurements found medical imaging was responsible for about half the total radiation exposure to the typical U.S. resident, up from just 20 percent in the 1980s. The council was chartered by Congress to recommend ways to limit radiation exposure.

A 2007 study published in The New England Journal of Medicine estimated that 0.4 percent of all cancers in the country may be attributable to the radiation from CT studies. By adjusting this estimate for current CT use, this estimate might now be as high as 2 percent.

"By definition, an unnecessary exam that uses radiation, such as a CT scan, is an unnecessary exposure to radiation and, in self-referring facilities, perhaps an inordinately high radiation dose since many of them are not properly accredited," said John Patti, chairman of the American College of Radiology’s board of chancellors.

-------------------


To have something in the journal Radiology that calls for evidence-based guidelines for when to order a CT.......  Leaves me speechless.

This combined with the decreases in screening mammograms will decrease cancer rates noticeably and cut a major source of revenue for hospitals and specialists.   Health care expenditures are going to decrease because of this.   That's not good news for the larger institutions' bottom line.  

So let's summarize:

Less cancer + less expensive health care =  financial hardship for radiologists,  oncologists and hospitals

That's a recipe for disaster,  having the incentives between patients and institutions clash so completely.


Let's see if I find a copy of the journal articles themselves.

Happy Birthday to Me

So way back on May 8th I got this cake in the mail.   My artist friend from Bellingham makes treats and sends them through the mail.  

 



She actually designed her own little business around it on flickr.  











She also takes incredible pictures which end up in the northwest newspapers.





So if you want custom made confectioneries just let Juline know.




http://www.flickr.com/photos/julescakewalk



And her pictures are here http://www.flickr.com/photos/julineb/


But most importantly,   those of you with flickr accounts (and you automatically have one if you have aYahoo mail account)  please favorite this picture of the cake and/or comment on it.


http://www.flickr.com/photos/julineb/4580632440/in/set-72157622526233311/




It's for a good cause.