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FDA Defines "Gluten-Free"

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More and more of my patients are asking me and telling me that they are following a "gluten free" diet. What many people do not realize is that this is more than a fad diet of the moment. This is the recommended diet of people with the clinical diagnosis of Celiac Disease.

What I did not know is that the term "Gluten-Free" really has not been defined officially, and manufacturers can call about anything they want "gluten free" to take advantage of the popular health craze. 

Earlier this month the US FDA (Food and Drug Administration), defined "Gluten-Free" as the following:

  • Food that does not contain any ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
  • Food that does not contain an ingredient derived from these grains and that has not been processed to remove gluten
  • Food that does not contain any ingredient derived from these grains and that has been processed to remove, gluten, if it results in the food containing 20 or more parts per million gluten

I gotta be honest. I read that three times, and I still don't know what it means. This is what government double speak is like. How do I really know if the food is "gluten-free" or not? How would you instruct people and patients on this?

The fad diet thing for "gluten-free" will fade in a few months until the next popular diet comes along. I guess I'm kind of reassured that there is at least some definition to "gluten-free" and that my patients with a true diagnosis of celiac disease can have some faith that this label will be a proper one for them.

 

Hope Disqualifies Olympian

Apparently, hope is a performance enhancing drug that disqualifies athletes. Victoria Arlen (pictured above) is a US athlete who is the defending gold medal champion for the 100m freestyle at the 2012 Paralympic Games. 

This week, Victoria was disqualified because the International Paralymic Committee has questions whether her disability is "permanent." Seven years ago, she woke up from a coma and could not move her legs. She is paralyzed from the waist down and is also wheelchair bound.

After she won four medals and set a world record last year, there was a review of her medical records. It was deemed that there was still "hope" that her disability is not permanent - and this drew the ban from this year's competition. 

Doesn't every athlete (whether it be olympian or paralympian) have hope to recover from illness, injury, and disability? Plain and simple, she was unfairly penalized for being too good. Before he went nuts, Oscar Pistorius was questioned whether technology (meaning his bionic legs) was an unfair advantage during his paralympic dominance.

What kind of precedent does Victoria's disqualification send through the paralympic world? Don't disabled athletes have enough of a challenge? Will these athletes now be discouraged from participating at the highest levels when they have to compete against other athletes and the International Paralympic Committee? This ruling is definitely not in the spirit of The Olympic Games.

Is There A Physician #IDcrisis

There will be a twitter chat at 2pm Eastern Time on Friday, August 16, using the hashtag #IDcrisis and twitter account @BermanInstitute. This is from Johns Hopkins and they have taken up the idea of social media professionalism with physicians. Of course, this is not a new concept, but I find it interesting how academic medicine is approaching it. For background information on the chat, check out this link.

There have been some guidelines released, particularly from the ACP & FSMB, stating that "maintaining separate personal and professional identities in web postings may help to avoid blurring boundaries in interactions with patients and colleagues."

My social media colleague Dr. Katz posted the above tweet and I agree with him. People have told me for a long time to have separate twitter accounts for my personal stuff and professional stuff. How do I respond?

I tell people I'm a proud Family Doc in small town America. Personal and professional identities are constantly clashing whether it be at the hospital, at my office, at the grocery store, at the gas station - everywhere. Dealing with your personal and professional life is a daily reality, especially for a small town physician. 

I don't separate my personal from my professional comments in real life. Why should I do that in my online life? And, to be honest, I don't have the time to manage more than one twitter account and more than one facebook account. If people don't like it, then they are more than welcome to unfollow me or defriend me. What you see is what you get whether in real life or on the internet. 

So, I won't be able to participate in the #IDcrisis chat on Friday, basically because I will be seeing patients in my office. But, I'll be monitoring the chat and I will be interested in what those academic docs from Johns Hopkins and other places will have to say about this "crisis" they are talking about. If for anything else, I encourage medical students and other trainees to pay attention to the chat as it will be valuable information as you try to figure out professionalism in a social media world... 

2014: The Year Of The Family Physician

Thanks again to my guest Ronald L Fong, MD, MPH from the University of California Davis talking about his idea of "2014 will be the Year of The Family Physician" and why people like Time Magazine should recognize The Family Physician as the 2014 Person of the Year.

Did you know that on May 28 of this year, the city of Sacramento, California signed a resolution designating 2014 at the Year Of The Family Physician. In addition, to help with marketing the idea, they have a great twitter account and bumper stickers for people.

At the end of our interview, Dr. Ron acknowledges that this is a "pie in the sky" idea, but why not be an Advocate for Family Medicine with this idea in mind. He's hesitant to direct people what to do, but I think that this is a great opportunity to talk to our patients and to our communities about why Family Medicine and Primary Care are essential to fix our broken health care system. 

At the end of the episode, I shared a short segment from Show Number One of my podcast way back to August 30, 2007. Yes, this is the six year anniversary of the podcast. But, don't worry, I am not quitting or taking any more social media breaks for this anniversary. It was fun to edit together this first show to share with all of you. 

You can listen to the show in the players above. You can also download the episode here and listen anytime. You can listen anytime to episodes on demand on iTunes or on RSS. I also encourage you to check out my accounts on twitter, facebook, an linked-in. Enjoy!

Podcast Preview Episode 313

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 "2014 will be The Year Of The Family Physician," says Ronald L Fong, MD, MPH who is the Director of the Family Medicine Residency Network at the University of California Davis. He has written a series of essays at the Family Medicine Revolution website.

To have a galvanizing effort, we need to take to the streets of cyberspace and educate the editors ofTime that the family physician is the right choice for Person of Year in 2014.
Go forth, take a stand and stand out.  Arise and lift those who are in need.  Do it for your patients, neighbors and for the future.  I believe it is our moment to shine as family physicians.  Do not let it pass you by.  Write your legacy from the inkwell of sweat.  Our voices should be hoarse from staying on message and our fingers calloused from typing and texting.

Hope you can join me for the live podcast today at Noon Eastern Time (9am Pacific Time) for the Mike Sevilla Radio Program Episode 313. If you're on a mobile device (like smartphone or tablet), you can click this link to listen live. Don't worry if you cannot catch live, you'll have the opportunity to download and listen to the show later. Hope you can join us later! 

 

Sanjay Gupta Inhales

Dr. Sanjay Gupta made a "shocking" announcement this week leading up to his CNN special this weekend. He wrote an essay called, "Why I Changed My Mind On Weed." Four years ago, he wrote an article for Time Magazine entitled, "Why I Would Vote No On Pot."

What's different now? He smoked marijuana (really). He looked at the medical research, especially for chronic pain and cancer patients. And, he declared that all of us have been "systematically misled" on marijuana. Really? Have we been?

Media analysis of this announcement includes articles entitled, "Sanjay Gupta Rejects Everything Sanjay Gupta Once Said About Marijuana," and "Is CNN's Sanjay Gupta Right About Weed." The Atlantic Wire article does a nice job of tracing his evolving position over the past few years. 

It is not news that a physician supports medical marijuana. I also agree with some of the research on THC use for cancer and chronic pain patients. However, if you read his essay carefully, he says nothing about recreational use of marijuana.

What will be news is the "anytime, anywhere, any condition" marijuana supporters will use this announcement to advance their recreational marijuana position. Will Dr. Gupta go along with this, too? Wait a few years. He may change his mind again for a future CNN special...

The President & Choosing Wisely

Are the physicians for former President George W Bush - are they Choosing Wisely? The debate for unnecessary testing and treatment was sparked again this week with the announcement of the former President receiving a cardiac stent procedure following a routine physical.

The Choosing Wisely campaign is an effort to decrease unnecessary testing and treatment which is driving up the cost of health care in the United States. In a previous post, I wrote about five reasons why I think this campaign will not succeed.

Some have said that the only way a cardiac stent was placed (possibly) was because of cardiac/heart testing during the routine physical. Should routine heart testing be done in patients without symptoms? Choosing Wisely says no...

  • Do not order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms (American Academy of Family Physicians)
  • Don't perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients (American College of Cardiology)
  • Don't perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (there wasn't even a heart attack here, yet a stent was placed)

Editorials from CBS News, to the Boston Herald, to Bloomberg,com - all these have criticized the physicians of the former President for this course of action. On the other hand, I have had many of my patients this week ask me about heart disease in a healthy 67 year old male who, just a couple of months ago, rode 100k on a bike with injured veterans.

Just like Angelina Jolie's story about cancer risk and cancer markers gave me the opportunity to talk about breast cancer with my patients, this news story has definitely given me the opportunity to talk about heart disease with my patients. The cost debate will continue, but the care debate with patients is always a good one to have...

 

Ariel Castro: Mind Of A Monster

Last week, Ariel Castro was sentenced to life without parole plus 1000 years in prison. Cleveland is about an hour from where I live, and there have been a lot of people following this story, including me, for the past few months.

I was in my car, driving around, last week right before the sentencing when I heard the above statement from Castro. I just could not believe it. It was fascinating and scary at the same time. 

"Most of the sex that went on in the house, practically all of it, was consensual.... There were even times when they would ask me for sex...." 

When I heard that live, I almost stopped the car. How horrific. Blaming the victims? Really? This two minute clip sent chills up my spine. I can't even imagine 10 years of this type of thinking. 

If you haven't already, check out the entire statement. I know that it's on youtube somewhere. This clip is a great insight into the mind of a monster. I know that there is a lot of guilt in that Cleveland Seymore Avenue neighborhood where that house will be torn down. Hopefully, we can all learn from this: If you see something, say something...

My Childfree Life

I was struck by the cover of this week's Time Magazine and the title "The Childfree Life." I do not really make a big deal about it publicly , but my wife and I have been married for about 15 years and we have no children, by choice.

I will not go into detail about why we made the decision. But, I am proud to say that we talked about it for a long time, and we have our reasons why we made the decision. For those of you who have children, can you articulate the reasons why - or is it because that is what society expects? Did you really make the decision together with your partner to have children? Think about it. 

Something curious about the article is that there are almost exclusively opinions from and about women. Is there that much of a "cultural imperative" (as the article says) to be a mother, while males are given a pass even if they become a "first time father at 65." That is interesting to me.

I am not complaining, but just some observations from the past few years. Yes, I have been called "selfish" by some people.  People ask me what it is like being "childless." People say it is "not natural" because society and most religions demand offspring, if for anything else, the perpetuation of the species. I understand and appreciate all those points of view. 

I am always fascinated by media reaction to stories like this. If you want to read more, just a simple search finds a number of interesting op-eds from the LA Times, HuffPo, The Week, Daily Mail, and US News & World Report.

So, I will never mention this topic again. Just thought I would talk about it once since it was sparked by this week's Time Magazine cover. As the article says, "To make this choice, you really have to be able to manage and navigate all assumptions that are going to be made about you. You have to be able to challenge the status quo." 

 

 

#AAFPNC 2013 Attendance Record: So What?

Last week was the 40th anniversary of The National Conference of Family Medicine Residents and Medical Students by the American Academy of Family Physicians. Kudos to AAFP for grouping the twitter feeds in Day One, Day Two, and Day Three. The facebook account was also active. They also did well expanding into instagram photos and videos. They even had an app for the meeting!

You'll see from the tweet above that there was record student meeting attendance this year. Three months ago, there was record attendance at the AAFP National Conference of Special Constituencies (another advocacy and leadership meeting). In addition, the Academy enjoyed membership greater than 110,000 as of Spring 2013.

All of these numbers make the Family Medicine community feel pretty good. I have two words to say to this: SO WHAT? Does it mean our work is done? Does it mean it's time to take a break? I don't think so. For me, this is just a start. If I may be so bold, I'd like to offer this free advice to my friends all over the Family Medicine community:

  • AAFP FMIG Network needs to crank it up a notch: How is the AAFP going to establish relationships and follow-up with the record 1017 student attendance to the meeting? A key difference between when I was a student and how is social media. Social media is a tremendous opportunity for the national organization to keep in touch with the grassroots medical student organizations through facebook, twitter, instagram, webinars, and other platforms. Don't lose the momentum that was started last week. Congratulations to all those newly elected national student leaders! But now, your first test in leadership is to establish relationships with your grassroots constituents and to bring the energy and excitement from The National Conference to the local medical student campuses.
  • State Chapters need to tap into resident members from meeting: State level chapters are struggling to gain and maintain new members. What a tremendous opportunity for the state chapters to try to establish and maintain relationships with their Family Medicine Resident members. Residents have distinctly different needs than students. And, I think, that state level chapters are in a position to do some outreach with potential future state leaders.
  • It's all about the Family Medicine Match: To those outside the Family Medicine community, the only statistic that matters is on Match Day 2014. Can the Family Medicine community convert record attendance at this year's leadership meetings into Match Day success? Well, we have 228 days to work our hardest to make that happen. 

I don't pretend to know it all, and I don't pretend to have all the answers. What I do know is that I've been around Family Medicine leadership and Family Medicine advocacy for a number of years. I graduated medical school when Family Medicine's numbers were better. I've also seen when match numbers slid, and I am hopeful with the numbers over the past couple of years. 

If there is one thing that I have repeated over and over and over again, it is this question: How do you convert emotion into action? Those medical students last week see that Family Medicine is the future. The community needs to step up, reach out, and cultivate this energy. Is the Family Medicine Revolution up to the task? Show me, show yourselves, and most importantly, show those students and residents....