Less trans fat dunkin donuts

For some reason, those words should not be used close together. However, according to the Associated Press, this company will announce today that they will be eliminating most trans fat from their menu.

Now, I totally understand why this is happening. There is a lot of business and social pressure out there to do this. A lot of their competitors out there have already done this, or will be doing this. But.....

Is there nothing else sacred than a trans fat dunkin donut? Sure, the taste will be pretty much the same. Sure, there is an obesity problem in this country and in some places around the world. But, c'mon! And, forget going to krispy creme....

Dunkin' is ahead of Krispy Kreme Doughnuts Inc., which has yet to roll out a zero gram trans fat doughnut but hopes to do so. Brian Little, a spokesman for the North Carolina-based chain, said, "We continue to work aggressively with outside supply partners, and our goal is to get to zero trans fatty acids while maintaining great Krispy Kreme taste."

Oh well. What am I going to do now? Maybe I'll try to unlock my iPhone - that sounds like fun. Sorry I was away so long away from my blog. I'll try harder to be here this week.

Busy week

Sorry I haven't been around this week. It was just a busy week at work. I'll try to catch up on blogging this weekend. Thanks to everyone who sent me an e-mail checking up on me. Other than being very tired, I'm doing ok. More soon....

Medicare threatening hospitals

Thanks to MSSP Nexus Blog for pointing out this story. In today's New York Times, there is a story describing a significant policy change directed at hospitals. Of course, this will save Medicare millions of dollars, but what are the unintended consequences of this policy?

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products. The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

Now, don't get me wrong. I definitely agree with the intent of this idea. There are definitely some hospital infections that could be prevented, and it's been well documented the impact of medical errors during a hospital stay. I understand why patient advocate groups are happy with this policy decision.

With regard to preventing falls, does that mean that hospitals will have to utilize bed restraints more - because in the middle of the night, sometimes patients are confused and don't know that they're trying to get out of bed. Restraints are already a no-no according to some regulatory agencies.

When it comes to preventing infection, I see more unnecessary testing being done to prove that an infection was obtained before hospitalization. What will be the cost of this? In addition, I see even more increased use of antibiotics, which will further increase the resistance of organisms - and complicating the treatment of infections in the future.

So, while the government's intent is noble, I'm afraid of what the unintended consequences will be. If the government wants people to be accountable, they should start cleaning up their own house first. Of course, we know that will never happen...

Government program for medical marijuana

Are you a supporter of medical marijuana? Do you support the legalization of marijuana? Well, this story is for you. The governor of the great state of New Mexico is proposing a government program to pay for those who need marijuana for medicinal purposes. (Associated Press)

On Friday, [New Mexico Governor Bill] Richardson directed the [New Mexico Department of Health] to plan for full implementation of the program, such as preparing the regulations that will permanently govern how it operates.

Under the law, the department is to issue the rules by October, including for licensing marijuana producers and developing a system to distribute the drug to qualified patients.

The new state law allows the use of marijuana for pain or other symptoms of debilitating illnesses such as cancer, glaucoma, epilepsy, multiple sclerosis, HIV-AIDS and certain spinal cord injuries.

New Mexico is the 12th state to legalize marijuana for certain medical uses, but it's the only one calling for state-licensed production and distribution of the drug.

Supporters of this policy should be cheering, right? Well, there is a little itty-bitty hangup in federal law stating that the distribution and use of marijuana is illegal -- DUH! So, this may become a state government vs federal government media circus.

New Mexico, and any other state considering taxpayer sponsored medical marijuana, has to be very careful if they actually decide to implement this. (My personal feeling is that this is political posturing, and will never happen since the NM governor is running for US president.)

Canada made this same move. And, instead of people being happy, they eventually became upset because of the perceived low quality marijuana that was being given out. Check out the news report below or click here.

Too much depression?

Not very long ago, mental illness, particularly depression had this negative stigma. Many were embarrassed to even talk about it. It was thought of as "going crazy" or "going insane." I believe there have been many positive strides in both the recognition, diagnosis, and treatment of depression.

Now, there is a leading British psychiatrist who is saying that depression is being overdiagnosed? He just completed a 15 year study looking at 242 teachers and found that more than 75 percent of them fit the current criteria for depression. (BBC News)

Professor Gordon Parker claims the threshold for clinical depression is too low and risks treating normal emotional states as illness.

He writes in the BMJ [British Medical Journal] that almost everyone [in the study] had symptoms such as "feeling sad, blue or down in the dumps" at some point in their lives - but this was not the same as clinical depression which required treatment.

He said: "Over the last 30 years the formal definitions for defining clinical depression have expanded into the territory of normal depression, and the real risk is that the milder, more common experiences risk being pathologised."

Now, this may surprise you, but I do agree with the professor to a certain extent. Currently, the cultural norms are such that the term depression does not carry as much negative connotation as in the past. In fact, one could argue, that the current en vogue mental illness diagnosis is bipolar disorder as this is more prominent in the media these days.

I would even go as far as saying that there is a certain element of Western culture, especially American culture, which loves to avoid personal responsibility and accountability. I wasn't really speeding, I was responding to my bad day at work, and it's their fault that I was going so fast. Alcoholism is an illness, so I cannot control any of my actions, so I'm not responsible for any consequences.

Don't get me wrong, I believe it is appropriate to treat substance abuse and depression as illness. But, I also believe that some people in the culture use this as an excuse of convenience. And, that is very sad...

Need cash? Lose weight!

You're probably going to think that I'm making this up. In the northern Italy town of Varallo, Mayor Gianluca Buonanno is offering cash rewards to its citizens not only to lose weight, but to keep it off as well. (Associated Press)

"We wanted to encourage people to lose weight, and we thought that both the money and the idea of joining a group could be stimulating," Buonanno said in a telephone interview Thursday.

Participants in the week-old Varallo initiative will be given $67 when they reach their ideal weight. If they don't gain any weight back after five months, they will receive $268.

If they maintain their ideal weight for a year, they will get $670 more. So far, 30 of the townsfolk have signed up, Buonanno said.

It's an intriguing idea, but will it work? People say that money is motivating. But, to maintain your ideal weight for one year for approximately $1000? Will the combination of less weight, increased health, and cold hard cash be the secret to success?

The baby formerly known as baby

Remember in the mid 1990's when Prince was mad as his record label and changed his name to that unpronounceable symbol? What happened? It really didn't do to much for his career and everyone called him "The Artist Formerly Known As Prince" or "The Artist." Meethinks that a Chinese couple has been listening to too many Prince albums lately.

BEIJING (Reuters) - A Chinese couple tried to name their baby "@", claiming the character used in e-mail addresses echoed their love for the child, an official trying to whip the national language into line said on Thursday.

The unusual name stands out especially in Chinese, which has no alphabet and instead uses tens of thousands of multi-stroke characters to represent words.

"The whole world uses it to write e-mail, and translated into Chinese it means 'love him'," the father explained, according to the deputy chief of the State Language Commission Li Yuming.

While the "@" simple is familiar to Chinese e-mail users, they often use the English word "at" to sound it out -- which with a drawn out "T" sounds something like "ai ta", or "love him", to Mandarin speakers.

Uh, yeah. I get it. In looking at weird baby names, one doesn't have to look to far. I mean, just look at Hollywood babies. Some of them are definitely scarred for life. I also did a quick Google search of changing names to people like Peyton Manning and Jesus Christ. What is the most unique baby name you've heard of?

Beginner's guide to medblogs

As you all know, I'm addicted to my stats, and I'm always interested in who is linking to this blog. When I was browsing through my Technocrati stats, I saw a post linked to this blog which I wanted to share with you. (image credit)

The post is called "New to medical blogs? Vitum's Beginner's Guide to Reading Medical Blogs." It was a long post (at least for me) to read. But, I thought it was well done.

It starts off with this question, "What is the Medical Blogging Community?" And, it goes on from there. This blog is not mentioned by name, but the blogger did put a link to my post about Flea in the "Medblog Gossip" section. (Thanks so much for the link)

So, if you're new to the medical blogosphere, or, even if you've been around a year (like me) or more, I encourage you to check out the link above. It's an interesting read. Who knows? You may learn something you didn't know before.

Doctors failing obese patients

Here's breaking news: Doctors are responsible for America's obesity epidemic. Did you know that? Well that's what the press in this country want you to believe. Here's the latest example. (image credit)

According to a study involving almost 10000 patients at the Mayo Clinic in Minnesota, only 20% of study subjects had their obesity formally documented. However, if this condition was documented, then patients were more likely to be given a treatment plan which included exercise and diet instructions. (Reuters)

Not surprisingly, [the principal investigator] noted, study patients who were severely obese were more likely to have a diagnosis and a treatment plan -- suggesting that doctors need to take a closer look at patients with less severe weight problems.

I have a few of problems with this. First, I never knew that I was responsible for the obesity epidemic continuing. Those of you conspiracy theory people out there probably even believe that docs are intentionally not treating obesity because it would decrease business for medicine. How ridiculous is that?

Second, this article appears to want doctors to label their patients as obese so that they can get the proper treatment. No one likes to be labeled. In fact, if I even hint at the word obesity with my patients, I know that they would leave my practice. Labeling is a big no-no - whether it's obesity, mental illness, or any other term with a negative perception.

Third, even if I give my patient a very specific treatment plan, am I responsible for them to follow it? Well, according to the concept of pay-for-performance, physician accountability is more important than patient accountability - meaning if the patient does not lose the weight, it is my fault and it will hit my pocketbook. I know you doctor haters out there don't care about this. But, I have an office full of staff and I care how much this would affect them.

So, now that I'm done rambling, this article is just part of my continuing frustration with the press in this country. Not that I care, but articles like this create a false perception. Perception is reality to some people. And, it is this false reality that makes it difficult for me to deliver adequate health care to my patients.

Antioxidants don't help heart

I'm probably going to get in trouble for saying this, but there are many homeopathy and complementary health professionals (image credit) who are scratching their heads following the latest study from the Archives of Internal Medicine. (abcnews.com)

A study released today in the Archives of Internal Medicine is the latest to put a dent in the theory that vitamins such as C, E and antioxidants such as beta carotene can reduce the risk of heart attack, stroke or other cardiovascular events.

Although previous research has come to similar conclusions, the study at hand is perhaps one of the largest to debunk the idea that these vitamins can lead to a healthier heart.

In the past, conventional wisdom (as well as some early research) stated that there was a protective effect that antioxidant vitamins had on the prevention of heart disease and stroke. In my opinion, there has been an entire alternative medicine industry built on this belief.

"Although theoretically these antioxidants would appear to be protective … these antioxidant vitamins have not lived up to their promises," says Dr. Carl Lavie, director of cardiac rehabilitation and prevention at Ochsner Medical Center.

"Studies of nutrients for disease prevention all indicate that the active ingredient in a healthful diet is a healthful diet, and not some isolated nutrient we can put in a pill," says Dr. David Katz, director of the prevention research center at Yale University.

Of course, research is ongoing. And, probably in 3-6 months, there will be another study published claiming to debunk this study. Don't get me wrong, I'm not saying that complementary medicine is bad and the type of medicine I practice is better.

I'll just be curious on the public reaction to this news. For example, when I mention any prescription drug, my patients can list all the side effects that they say on television. 

How about when I tell them, "You know, the $50 you spend every month on antioxidants may not help your heart as much as you think." Will people stop taking their antioxidant vitamins based on these study results?