Monthly Archives: August, 2010

Abortions: Cry For Argentina

This South American country is considered one of the most liberal in Latin America, what with a female President and  legalised same-sex marriage in a predominantly Roman Catholic country.

Cristina Fernandez de Kirchner - Argentina's second female President, lawyer, mother of two, who replaced her husband as President

The largest Spanish-speaking country, it is renowned for its beef, wines and football. But, on the darker side, according to the Human Rights Watch, women and girls suffer needlessly in Argentina because of negligent and abusive reproductive health care. Argentina has the highest abortion rate in the world – a shocking 40%, double the average for any othe Latin American country.

Because abortion is banned (not surprising in this Roman Catholic country), illegal abortions are widespread. Legal abortions are allowed only if the mother’s health is medically at risk or when it is the result of rape, but even then there are several bureaucratic obstacles. As such, unsafe abortions form the leading cause of maternal mortality in Argentina.

The irony of it is that  the Argentine President was a strong advocate of human rights when she came into power – and yet, enforcement of womens’ reproductive rights have fallen to an all-time low. Well, the women are not taking it sitting down – female activists are now campaigning for legalised abortion and this looks imminent, after the legalisation of same-sex marriage.

Female activists press for social justice - the banner reads "Ensure legal & free abortion"

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Fasting and the Olympics

2012 Summer Olympics

Image via Wikipedia

The news that the 2012 London Olympics is going to be held entirely during the Muslim fasting month of Ramadhan has begged the question: does fasting affect sports performance?

In July 2012, it is estimated that more than 11,000 athletes will compete, of which about a quarter of whom will be Muslims who will be expected to undertake a dawn-to-dusk complete abstinence of all food and water.

In the 2012 Olympic long-distance races, contestants from East Africa,mainly Muslims, will compete during the fasting period.

Lets take a look at how fasting may affect sports performance. Broadly, it does so in the following ways:

1. Energy restriction – while it is generally held that the total calories will drop in a day, the food intake is very cultural and depends also on whether the diet is balanced. So it is possible to ingest more calories than one would normally do when not fasting with consequent weight gain. Experts are divided whether there is any curb on energy at all.

2.Hydration – dehydration of more than 2% of body weight will impair aerobic exercise performance, despite the attempt by the body to conserve water, as seen by one’s highly concentrated urine when fasting and the fact that one tends to sweat less when exercising.

3.Body temperature is governed by circadian rhythm of one’s body and explains why body temperature, muscular strength and reflexes become optimum in the late afternoon, at the peak of the circadian rhythm. When fasting, the alteration of sleep (sleep deprivation)and altered eating habits affect the circadian rhythm. This may cause a reduction in exercise performance.

4.Training load – while it is generally believed that fasting will affect training, largely by a perception of easy tiredness, professional coaches have established that, if diet, sleep, a balanced diet and hydration are maintained, athletes can undergo the same physical training load as those who are non-fasting.

Most authorities accept that athletes who maintain their energy intake and  prefasting hydration status and who get adequate sleep can maintain their training load during fasting without suffering any substantial impairment in performance. Of course, if the fasting is on religious grounds, this is a personal matter for the athlete to decide as to whether, in the first place, he should fast at all and defer the fasting period till after the race.

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Medical Errors Can Cost Quite A Bit!

A recent study on medical errors committed in the US in 2008 showed that it cost $19.5 million, the loss of more than 2,500 potentially preventable deaths and more than 10 million lost days of work. The study, published in July 2010, put in stark perspective the tremendous cost that errors made by medical personnel can entail, despite attempts by health-related agencies to work towards zero-tolerance in the last decade or so.

Let me clarify that medical errors are best defined as a preventable adverse event of medical care that is the result of improper medical management, ie an error of commission, rather than the progression of medical illness due to lack of care, ie an error of omission.

Medical Errors also Affect Doctors...read how it Affected One (http://www.nytimes.com/2009/07/09/health/09chen.html?_r=1)

Definitions aside, the cost of such errors are sometimes not measurable, such as pain & suffering and malpractice costs.

Given the above figures, one can imagine that medical errors can be somewhat frequent. Indeed, the  Annals of Surgery reported that 9% of surgeons in the US admitted they had made a “major medical error” in the preceding three months.

So how do you avoid mistakes when going for  surgery ?

Some pointers include looking for a hospital with a good safety record as well as those possessing a recognised accreditation standard (such hospitals voluntarily undergo screening by a recognised review body, such as the JCI, in order to provide services of a certain minimum quality).

Find out from your doctor where he sends his relative to. What’s good enough for a doctor is usually a stamp of approval. Why, even nurses in the hospital may provide the right doctor if one cares to ask.

Look for a doctor who’s busy. Sure, it means long waiting times, but this might be worth it in the long run.

Finally, some health department websites do provide statistics on how many specific operations are done in a year and what the complication rates are. This way one can opt for the best hospitals for a particular procedure.

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The Many Faces of Viagra

Going through a very recent Drug Alert in my mail-box, I noted that the FDA in the US had issued a directive to a drug company to recall all its products designed to help erectile dysfunction aka ED aka sexual impotence.

ED - a major health issue with a major source of profits

This was because they all were purported to contain sulfoaildenafil . This substance was not declared on the label and is structurally similar to sildenafil, the chemical name for that famous blue pill, Viagra. In fact, both drugs carry a similar profile of side-effects – the major concern being it works in a similar fashion to drugs used in treating heart patients, and so can cause an over-reaction of these drugs which can lead to collapsing and even death in those heart patients.

Because the patent rights of Viagra are exclusive to Pfizer, many so-called performance-enhancing products and herbal remedies that profess to produce ‘stiff nights’ are believed to contain the alternative sulfoaildenafil as this product is non-patented and available from thousands of importers.

So its a great big market out there with countless such remedies. The marketing department of the drug company subject to the recall (here) must have worked overtime to come up with such names as:


Stiff Nights, Size Matters,Erex, Mojo, Hard Drive, Eyeful, Straight Up,  Monster Excyte, WOW,  Verect, Prolatis Libidinal, OMG, OMG45.

The last one above (OMG45) ,by the way, is not, as you might imagine, make it last 45 min…its for those aged 45 and over! 🙂

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Model’s Breastfeeding Boo-boo

Supermodel Gisele Bundchen, has many things to be thankful about. Touted to be one of the world’s highest paid model, this Brazilian now lives in California with her football star husband.

After giving birth in December, she extolled the virtues of breast-feeding. Nothing wrong with that…except she insisted that it should be law that all mothers breastfeed for six months. This created an uproar, more so when it was discovered that she herself breast-fed for only 6 weeks (presumably the call of the catwalk became irresistible).

While women usually love taking parenting advice from role models & supermodels, it is understood this sentiment may have offended the millions around the world who cannot breastfeed for medical reasons.

“I think breastfeeding really helped [me keep my figure],” the 30-year-old added, further adding insult to injury to those who did not breastfeed. Because of the criticisms, Gisele finally backed down with an apology in her  blog.

What a shame. As she rightly put it, why feed your baby with milk belonging to another species? Its well-known that mother’s milk provides all the nutrients babies need; it protects against illness and infection, aids physical and mental development, and promotes a loving bond between mother and baby. That advantage extends to mothers as well – they have a lower risk of pre-menopausal breast cancer and tend to lose the weight they gained in pregnancy faster.

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The World’s Best Hospitals – How To Be One

There are a lot of hospitals who claim to be among the world’s best – but has anyone ever listed what it takes to be one?

One good guide is the US News ranking based on set criteria, where it ranked the best 14 hospitals in the US:

List of US News’ Honor Roll Hospitals

1 Johns Hopkins Hospital, Baltimore
2 Mayo Clinic, Rochester, Minn.
3 Massachusetts General Hospital, Boston
4 Cleveland Clinic
5 Ronald Reagan UCLA Medical Center, Los Angeles
6 New York-Presbyterian University Hospital of Columbia and Cornell
7 University of California, San Francisco Medical Center
8 Barnes-Jewish Hospital/Washington University, St. Louis
9 Hospital of the University of Pennsylvania, Philadelphia
10 Duke University Medical Center, Durham, N.C.
11 Brigham and Women’s Hospital, Boston
12 University of Washington Medical Center, Seattle
13 UPMC-University of Pittsburgh Medical Center
14 University of Michigan Hospitals and Health Centers, Ann Arbor

Johns Hopkins Hospital in Baltimore,Maryland - named as the top hospital in the US for brain diseases

Larry King speaking at the Cleveland Clinic - ranked as the best in the US for heart diseases

The following eight factors were found to be common themes in explaining their success:

1. Innovation – A desire to practice in an environment that embraces evidence attracts nurses and other staff to these hospitals.

2. ‘Patient-first’ philosophy – a no-brainer really, but quite easily forgotten by hospitals who pay too much attention to the financial bottom-line. They often forget that its the patients (read ‘customers’) who are paying their salaries!

3. Collaboration – Teamwork creates better outcomes, and many of these  hospitals have embraced fostering greater collaboration between disciplines. Every discipline brings a special domain of practice, knowledge and skill to create a village of information.

4. Quality Improvement- Structured processes for clinical services allow  staff to define and sustain clinical practice standards and incorporate new findings into practice.Care processes and measures for success can be defined and measured via a balanced scorecard.

5. Quality Nursing Care – Patients come to the hospital expecting the best doctor and often, they will be given the treatment they need for their medical condition to improve. What makes the difference is the nursing. When nurses add on compasssion on top of the usual nursing skills, they give that extra edge.

6. Positive Work Environment – Nurses form a key component in any hospital, and to retain and attract them, the hospital management has to create an environment where people will want to work in. In my experience, a good pay is important but this is not the be all and end all. Other factors come into play like professional satisfaction and empowerment.

7. Continuing Education – one of the factors enhancing point 6. We are looking not at just professional education, but also at  social skills like following up on complaints.

8. Staff Engagement – When you engage people closest to the work , you  respect them.They want to know where the organization is going and what the driving value is, and you can demonstrate how their work contributes to that. That includes letting the staff know as and when new staff are brought in as part of succession planning.

In my years as a hospital manager, the above values keep on recurring time after time and quite often, many hospitals do not make it to the top quite simply because the above lessons are not assimilated.

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Nowadays, Doctors Stop Work As Soon As Their Shift is Over

Its not unknown  for doctors in EU countries to down their tools immediately when their shift-time is up, even if they were in the middle of performing a surgery! A 37 year-old English consultant related his experience here when the doctor assisting  him said he had to go as it was his ‘home time’…right in the middle of a laparotomy. Ostensibly, the main reason for this is the implementation of the European Working Time Regulations (EWTR) in August 2009, which resulted in a reduced working week of  48 hours. (btw, ‘conventional’ hospital doctors work at least 60 hours, including weekends).

Insufficient training posts and shorter training time..are today's doctors insufficiently trained?

Imagine the uproar if this were to occur in non-EU countries, where such a law would be considered primitive! I can imagine human rights activists decrying the ‘lack of professionalism among the materialistic-minded doctors’.

Doctors trained to be specialists in the  1990s will remember that their working hours were necessarily long because they were matched with training time – the more time you had, the more training you received. Nowadays, this is no longer valid and the path for training to be a consultant is now shortened considerably. The main reason given is that there was (and still is) a lack of training posts. Fair enough.

Sociologists have an alternative explanation for this type of behaviour – that the X and Y generations treasure their personal quality time more than just slogging away at work. They don’t live for work, they work to live“. Read more here.

Old-time surgeons will have difficulty understanding the work ethics of their junior counterparts unless they fully grasp the workings of the minds of the Y generationers. Already, there are fears that the new EU rules are going to produce a generation of European doctors who will be  “lazy, clock-watching junior surgeons”.

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