Monthly Archives: October, 2008

When Private Medical Records Become Public…

Medical personnel take doctor-patient confidentiality seriously and will not reveal a person’s medical details to the public without the individual’s consent or without a  court order. But this does not seem to be the norm when you are a US presidential nominee!  Obama, McCain, Biden and Palin have all been asked to release their medical records for public scrutiny. The American public (including doctors,too!) are demanding that the candidates bare all their past medical records.  In fact, more than 2,700 doctors in the US have petitioned that McCain release the documents to the public domain.

Obama - clean medical history enough to see him through next week?

Why? Because, ostensibly, the public want to know whether the new President (and Vice-President, who will have to step in should anything befall the nation’s chief executive) is fit enough to fulfil the voters’ mandate to run the nation. The electorate want reassurance that the nominees can fulfil the requirements of holding the highest office; so, the nominees need to sacrifice quite a bit of their privacy, as far as their medical records are concerned. The voters need to make an informed choice based on these records, say a spokeman for the petitioners. So have the 4 nominees obliged? Most of them have, except for Sarah Palin. Take a look at what has been released:

McCain - the scar on his left cheek, a remnant of the surgery for melanoma in 2000.(courtesy of NY Times)

John McCain,72 : has hypertension (currently on hydrochlorothiazide), high cholesterol(on simvastatin), allergies(Zyrtec),sleep problems (zolpidem) and takes aspirin as a blood-thinner. Of most concern, though is his past bouts of malignant melanoma,a form of skin cancer which was diagnosed as stage 2 in 2000 and carries a 66% recurrence rate.

Barack Obama,47: released the results of his medical check-ups up till Jan 2007 which were all normal. A smoker for the last 20 years but stopped last year.

Sarah Palin,44: has not released medical records so far. Has a child with Down’s syndrome.

Joseph Biden,65: has had brain surgery twice for aneurysms in an artery of the brain. Released 49 pages of his medical records to the Press recently showing he was healthy.

Read my recent entry “Obama’s Fitness To Rule” here.

Health Alert (5): New Slimming Pill Banned

The European Union(EU) drugs watchdog agency has recommended that doctors stop prescribing one of the latest anti-obesity drugs – rimonabant – which is marketed as Acomplia.

Acomplia...from hero to zero

In a press release dated 23rd October 2008 ,The European Medicines Agency(EMEA) has said the risk of serious psychiatric problems and even suicide are too high in those taking this medicine. This drug was introduced end-2006 and is widely available in most Asian countries as well as the EU. In Great Britain alone, it is estimated that 97,000 have been prescribed this drug. To its credit, the United States FDA rejected its sale in the USA.

This medication has been marketed as an adjunct to diet & exercise for the treatment of obese patients and initial reports seemed to show good results on those who have tried it. To be fair, the makers Sanofi-Aventis had warned doctors not to prescribe this drug to those on anti-depressants or those with a history of depression.

However, recent studies, even by the makers themselves, revealed double the risk of psychiatric illness in those taking it. In a clinical trial between June-August this year, there were five suicides among patients taking it.

Click here if you wish to look at more  Q&As on Acomplia.

The message here is that, sometimes, its better to go for time-tested medications than to jump for every new kid on the block.

You Are What You Eat,Period

The Heart Attack Burger...worth dying for? (actually sold in an outlet in Arizona)

The mainstream media was awash yesterday with articles proclaiming that the Western diet raises the risk of getting a heart attack. Whether it was the BBC, AFP, ABC or Reuters, they all described a study where 16,000 people in 52 countries  were studied according to what they ate and their risk of getting a heart attack.

The study categorised their dietary patterns into 3 groups:

  • The Western Diet – emphasis on salty snacks,fried foods, and to a lesser extent, meat.
  • The Oriental Diet- high on tofu and soy products, including soy sauce.
  • The Prudent Diet- rich in fruits and veggies.

It wasn’t a surprise to find out that those on the Western Diet had a 35% greater risk of getting a heart attack whereas those on the Prudent Diet had a 33% lowering of the risk. The researchers gave a neutral score for the Oriental Diet as they felt that the salt in soy sauce neutralised the protective effects of soya.

My criticism of this study is that it oversimplifies matters concerning eating habits and tends to give the impression that fruits and vegetables are the perfect solution and that all Western diet are bad.

The fact of the matter is, whether you are in Maine, Mumbai or Malaysia, you need to reduce salty, oily, fried or fatty foods,period. The style of cooking is what matters. That includes reducing the intake of fried veggies in favour of raw or lightly blanched styles. Taking fried kai-lan in oyster sauce will only serve to destroy the protective effects of the veggies. Similarly, a lean cut of grilled tenderloin is much better than pan-fried rib-eye, if taken in moderation, due to the lower fat content.

In today’s egalitarian society, its certainly not heartening to note that heart attacks are no longer an affliction of only the rich, perhaps a reflection of improper eating habits irrespective of social status. Heart disease is a problem that needs to be addressed by all strata of society – and this begins with you being what you eat.

A Titanic Task To Sail Into The Sunset..

RMS Titanic carried 2200 people when it left Southampton

The last remaining survivor of the Titanic came to grips with the reality of the cost of living in a nursing home when she had to auction off her personal mementos from the ill-fated liner to keep up with the payments.

Millvina Dean- the last of the survivors

When the mega-liner sank in April 14, 1912 in the bitterly cold Atlantic after hitting an iceberg, 96 year old Millvina Dean was only 2 months old then when she was placed in a sack and carried to safety, together with 705 other survivors. In all, 1,517 passengers and crew  perished in the disaster.

The wreck was only located in 1985, 3600 metres below sea-level

Among the items that were to be auctioned were rare prints of the Titanic and letters from the Titanic Relief Fund offering her mother one pound, seven shillings and sixpence a week in compensation.

But the star item in the

auction is the salvaged wicker suitcase that fetched USD18,650. The total proceeds of the sale netted USD 54,000. At USD1,500 per week for the nursing home, this does not seem enough to see her sail into the sunset quite comfortably.

Although Britain has a socialised (‘free’) health care system, private providers offer more comprehensive services for a fee. In the case of nursing homes, state-run facilities are available and cost much less than private ones but they are more spartan and offer fewer amenities, such as shared rooms and no private TVs.

In today’s egalitarian society, one cannot blame the only remaining survivor of the Titanic to live her remaining years in as comfortable manner as possible. But will all of us be able to afford to do the same, given the increased life-span of today’s adults that will deplete most of our retirement savings in no time at all?

Postscript: Millvina Dean died 31 May 2009, thus ending an era. See here for details.

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‘Staying Alive’ – to stay alive

Heard of the Bee Gees hit “Staying Alive”? When the pop group launched their disco classic in 1977,  little did they realise that it would be the theme for thousands of medics to hum along as they performed the life-saving procedure known as CPR (cardio-pulmonary resuscitation). How come?  Well, the pulsating rhythm of the song is at 103 beats per minute, which is close to the recommended 100 beats/min that the medics need to do in terms of the speed of chest compressions.

First, view this to appreciate the rhythm and the nostalgia of the disco hey-days:

Now, take a look at how its done, courtesy of CNN, by clicking the red button:

Vodpod videos no longer available.

I would strongly recommend every lay-person learn basic CPR as the next time somebody has a cardiac arrest (it can happen anytime!), CPR can triple the survival rate.

For those who have already learnt, do note that the recent recommendations that were introduced a few years back now suggest 30 chest compressions followed by 2 breaths.

Or, for those who don’t like the Bee Gees and prefer rock, I would suggest this alternative “Another One Bites The Dust” by the Queen, although the title isn’t too appropriate!

Once a Doctor, Always One

Its often been said, quite rightly too, that being a doctor is a calling. Just like when one enters priesthood, one’s thoughts and actions become entrenched around the profession, 24 by 7.

So, it wasn’t surprising to read in the Chicago Tribune that a former doctor who is serving time in prison in Waterloo, Iowa on methamphetamine charges has had his sentence reduced after he helped save the life of a fellow inmate.

Officials say 51-year-old Dr Mark Louviere was walking past a soccer game in the yard at the Newton Correctional Facility in August when one of the participants collapsed. Louviere reportedly helped medical staff perform CPR which eventually saved the victim. Corrections officials say acts of heroism, such as saving a life, can reduce an inmate’s prison time.

Officials then awarded Louviere 30 days off his remaining sentence.

Here’s the catch: he will be released 30 days earlier from a 45-year term. It just shows that being a doctor is not necessarily always a really rewarding one.

When the Stock Markets Collapse, so do People..

Last week’s tsunami on the financial markets is bound to have far-reaching implications on the financial health of many  corporations and governments , but its the health of the individual which will be  of utmost concern.

I wrote earlier about the importance of prevention (see here), so it really is heartening to see that crisis management is really being practised by the Hong Kong health authorities.

The Social Welfare Department (SWD)  in Hong Kong will inject additional funding of HK$1.2 million into the CEASE Crisis Centre and the Family Crisis Support Centre to strengthen support services for people with emotional and family problems arising from personal financial crisis amid the recent global financial turmoil. The hotlines will be manned by registered social workers around the clock. See here.

Said a spokesman,   “In addition, social workers will provide face-to-face counselling and organise support groups to help individuals and families with emotional or family problems arising from personal financial crisis by strengthening their skills in coping with stress and working out positive ways to manage their problems.  Where necessary, social workers will also refer cases to appropriate welfare services for follow-up.”

Just wondering, will they accept long-distance calls? There should be quite a queue from Wall Street.

McCain vs Obama on Healthcare

Considering that the President of the United States in the last 20 years has been either a Bush or a Clinton, at least one thing is certain -no more Bush or Clinton. A new man will be at the helm, to be decided this November 4th, which is less than a month away. Some of the biggest issues that may well decide who will win and become the 44th President include :  the state of the economy, Iraq, fuel prices, illegal immigration and healthcare.

Obama and McCain - Who Will Be Still Smiling on Nov 5th?

The lattermost issue (healthcare) is one of the most contentious.  And It is not difficult to see why: when one considers that 46 million Americans are still not insured, the waiting lists are getting longer, increase in healthcare costs rising in the double digits annually and the tightening of insurance benefits via increasing premiums and copayments (the percentage of the hospital bill that the patient has to pay out of his own pocket).

How did healthcare in the US get into such an unhealthy state? For one, there was never a formal scheme or program by government to implement access to healthcare for everyone. Fragmented attempts by both government (Medicare and Medicaid) and the private sector( private health insurance existing for profit) has left many out of the loop. Added to this has been the unbridled  medicolegal litigation costs and medical inflation.

So how to the two Presidential candidates plan to improve access to healthcare? Simply put, McCain the Republican wants government to increase private insurance coverage so that everyone can buy insurance with the help of a tax rebate obtained largely by moving the rebates from employers to employees. Now, everyone can buy! is the hope of McCain supporters.

Obama the Democrat, on the other hand, is pushing for government to provide healthcare for everybody by expanding the role of the existing Medicare into a compulsory public insurance scheme.

Both candidates’ proposals has got its pros and cons and many other countries have tried the proposed models earlier and encountered their  fair share of problems. Essentially, its a case of private vs public insurance.

Other countries will be watching too because, whatever direction the US takes, it will have a definite impact on the healthcare world. As they say, when America sneezes, the world catches a cold…

Worry About the Health of the Economy..and about the Economy on Your Health

Now that the world’s economy is in recession, it is logical to assume that this will lead to ill-health, or isn’t it?

True, the rate of stress-related illnesses and suicides tend to go on the rise. In Japan recently, the government noted that the rate of suicides increase whenever there is economic depression -about 90 people do it daily, one of the highest suicide rates in the developed world. In the US, a poll by the American Psychological Association (APA) showed that 3 out of 4 Americans are under extreme stress with money woes. The loss of one’s home, shattered dreams, feelings of hopelessness, anxiety and anger can lead to depression and unhealthy lifestyles.

The effects  of recession go beyond individuals to companies – distressed banks like Lehman’s and Bear Sterns also give rise to distressed employees, who, apart from being given unpleasant tasks to execute foreclosures, now find that they are themselves foreclosed!  Why, even healthcare institutions are worried sick because, with recession, potential patients will tend to postpone non-urgent operations; healthcare subsidies are likely to be cut; and hospitals are likely to find increased account receivables.

How does this stress affect health? In many ways:-  fatigue, headache, irritable stomachs, knotted muscles, poor appetite and sleep, teeth-grinding and low sex-drive. There is a tendency to take it out on food, smoke and drink too much, as well as being a full-time couch potato.

But within this picture of murky gloom, there is some light. A study “Are Recessions Good For Health?” showed that, contrary to expectations, recession did cause improved health and lesser deaths! These are the people who, having found more free time after having lost their jobs, undertook productive activities to manage stress. APA mentioned such stress-releasing activities as listening to music; reading ; exercising or walking ; spending time with family and friends and praying .

And if you get stressed reading this post, may  I suggest listening to some relaxing Baroque music!  🙂

For Those Studying Medicine..(4)

The superior doctor prevents sickness;
The mediocre doctor attends to impending sickness;
The inferior doctor treats actual sickness;

-Old Chinese Proverb

Comments: This saying exemplifies the holistic concept of Chinese traditional medicine, whereas Western medicine focuses mainly on curative treatment. If there’s an infection, the Western-trained doctor would focus on antibiotics to knock off the bug, but Chinese medicine would attribute it to imbalance of forces in the person and focus on their general wellbeing and rectifying the imbalance. There is a greater emphasis on prevention; as seen by the omnipresent barefoot doctors promoted by Mao Tse-Tung in the 1960s.

Medical students should not forget that preventative medicine is the backbone of their role as doctors and not over-emphasize curative treatment. The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease, so said Thomas Edison.

Management staff can learn from this too : it is important to pre-empt any problems from arising; by looking out for warning signals, rather than allow untoward events to eventually happen.

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