For those of you who will be here and are interested in the intersection of Cyber and medicine, the University of Arizona College of Medicine-Phoenix and the Atlantic Council are hosting the CyberMed Summit on Thursday, June 8 and Friday, June 9, 2017 at the University of Arizona in Phoenix. This first-of-its-kind simulated clinical cyber crisis exercise and discussion summit will feature notable voices in clinical medicine, security research, medical device manufacturing, and public policy. For more information see http://cybermedsummit.com and to RSVP, contact Anni Piiparinen of the Atlantic Council at apiiparinen@atlanticcouncil.org or 202-292-5164.
In addition to the readings on Doctor's Don't Listen, another reading from last Wednesday was on The Patient's Playbook. Here is a short (2 min) video from the CEO, Leslie Michelson.
Here is a quote from the article (linked):
Getting a scary diagnosis can be emotionally overwhelming. While it’s not always easy, the best approach is to summon the courage to ask tough questions, do more research on your condition, and get additional expert opinions. It’s essential to do this before before agreeing to powerful therapies or surgeries, as diagnostic error isn’t just inconvenient and frustrating: When you are misdiagnosed, you run the risk of receiving unnecessary and potentially harmful treatments.
Here are 8 essential questions to ask your doctor about a diagnosis. You should supplement them with questions that are relevant to your specific circumstances.
I understand that you believe I have this disease, but how confident are you in the diagnosis?
Is there anything else could this be?
Are there more tests that can be done to confirm this diagnosis?
Was the lab test sample good/the imaging clear? Would it make sense to get a second read?
Have you read all my medical records to get the full picture of my symptoms? Would it help if I went over them with you?
You say I have an abnormal blood test/a lab abnormality and that we can treat it with medication. But is it possible that this is indicative of a bigger problem? Are there other tests we should be doing to rule out serious diseases?
Before we move forward with treatment, are you confident we’ve explored all my options?
I appreciate what you’re saying, and it sounds very serious. I’d like to get copies of my lab reports/imaging/medical records in order to get a second opinion.
Here is a link to the book, Patient's Playbook. You can read more about this. After the 8 essential questions, I clicked on Toss Your Diet Books! Good Health Comes Down to 5 Simple Steps. There is a PBS video on "In Defense of Food" by investigative journalist Michael Pollan There's even a documentary about it (trailers shown below on this page - scroll down).
I saw this last year (Oct. 2016), and maybe you did, too. The language is explicit, and views of addicts and what they do to get their drugs. But it's relevant to our earlier conversation. He interjects his strange humor as he gets to the main points, which are important, especially Purdue's marketing of OxyContin.
Here is a series of articles related to our topic this week. Rather than add it to our readings, I thought we could comment here. Click on the author and Gazette-Mail link for access to the three articles. I'll post some thoughts below. But you can do the same.
Mr. Eyre (pronounced AIR), 51, won the award for a series of articles about the opioid abuse epidemic in West Virginia. Mr. Eyre, the paper’s statehouse reporter, began his multipart series with these words: “Follow the pills and you’ll find the overdose deaths.” It took Mr. Eyre years to acquire the documents most important to his reporting, and he did it “in the face of powerful opposition,” according to the Pulitzer citation. A lawyer defending a drug wholesale company said that it was vital to protect crucial court records “from the intrusive journalistic nose of the Gazette-Mail.”
From the first article, it's about collusion of the nation's largest drug wholesalers flooding notorious “pill mill” pharmacies in West Virginia's smallest towns and poorest counties with hundreds of thousands of painkillers, according to court records the companies had sought to keep secret for more than a year. Moreover,
West Virginia has the highest drug overdose death rate in the nation, and the deaths are climbing. Oxycodone and hydrocodone are the most widely abused prescription painkillers, and contribute to more overdose deaths in the state than any other drug. West Virginia spends more than $430 million a year on problems caused by prescription drug abuse, according to the state's lawsuit.
The series uncovered how small towns of 392 people were devastated from opioid overdoses. Look at the data, read the series, and comment.
It begins by noting that the 10,000 daily steps, incorporated as a goal into many activity monitors today, has not been scientifically validated as a way to lessen disease risk. So how much exercise might be needed in order to avoid heart disease has remained very much in question?
In a new study, which was published this month in The International Journal of Obesity, researchers at the University of Warwick in England and other institutions decided to examine postal workers in Glasgow, Scotland.
The Glaswegian mail carriers generally cover their routes on foot, not by driving, and spend many hours each day walking, the scientists knew. But the mail service’s office workers, like office workers almost everywhere, remain seated at their desks during the bulk of the workday. [So for the same group of employees, there are those who walk a lot and those who sit a lot. -sw] This sharp contrast between the extent to which the workers move or sit during the day could provide new insights into the links between activity and health, the scientists felt.
The researchers began by recruiting 111 of the postal-service workers, both men and women, and most between the ages of 40 and 60. None had a personal history of heart disease, although some had close relatives with the condition. They then measured volunteers’ body mass indexes, waist sizes, blood sugar levels and cholesterol profiles, each of which, if above normal, increases the chances of cardiac disease.
The variations turned out to be considerable. Some of the office workers sat for more than 15 hours each day between work and home, while most of the mail carriers barely sat at all during working hours. But the greatest benefits came from the most exaggerated amounts of activity. Those mail carriers who walked for more than three hours a day, covering at least 15,000 steps, which is about seven miles, generally had normal body mass indexes, waistlines and metabolic profiles. Together, these factors meant that they had, effectively, no heightened risk for cardiac disease.
The implications for what this means and how to get people to walk 4 miles an hour (and steps to achieve that) are discussed in the article.
How likely is it that people who think 10,000 steps are hard to do will increase it, when they learn it's not enough? More importantly, why did the industry think 10,000 steps was a good goal? Did one company start it and the rest followed?
In a couple of weeks, we will discuss alternative ways to treat patients. As I was following e-patient Dave's website, I found this graphic, called the Taxonomy of Burden (click on it to get a better view, and download it, share it. It's “Creative Commons Share-Alike with Attribution” – anyone is welcome to reuse it, as long as the credit is carried with it), Then I read further...
Dave learned about the graphic you see here, which was published last year as part of a paper in the journal BMC Medicine.
I love it. At the very center is one item: the word “burden.” Coming out from it are three dots:
Healthcare tasks: the things you’re told to do.
Consequences of healthcare tasks imposed on patients. (See above!)
Factors that worsen the burden of treatment: communication problems, getting to and from the doctor’s office, etc etc.
Then, extending from each, are additional realities: under Tasks are paperwork, understanding the illness, follow-up, rearranging life etc etc; under Consequences are impact on work, financial impact, etc etc; under Factors that worsen are the many many things that just plain get in the way of doing the right thing.
Why do I love this graphic? That whole thing could be printed out as an outline list, many pages long, but that has no “all at once” impact: you browse a list item by item, but this visualizes it all at once, making you realize: “Holy crap! Look at all this!”
I felt the same way. It's worth looking at it in some detail. It provides a sobering view of all the reasons why healthcare is so darn complex. But you knew that!
The diagram is from this article in BMC Medicine: bit.ly/TaxonomyOfBurden, by Viet-Thi Tran , Caroline Barnes, Victor Montori, Bruno Falissard and Philippe Ravaud.
Check out Dave's Resources link. The Communities link is especially interesting, but so is his blog. As you can see, I enjoyed reading it. Thought you might find it useful, too. 😊
Here is the info on the talk by Dr. Victoria Sweet, author of God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine. She is talking right after our class, and with a dessert reception. It's at the Marriott University Park at Main Gate, so it's pretty close by. (The link above is to her website).
