Category Archives: health trends

Ballooning Healthcare Costs

The prices of things are going up again (they call it inflation), but probably in no other area of industry is the inflation rate going up relentlessly year after year in the region of 10-15%. Take a look here:

healthcare-chart

The way things are going, this cartoon may not be that funny at all:

healthcare-nowadays4

Here’s my tips on how you can cut your healthcare costs (short of not receiving any!):

https://doctor2008.wordpress.com/cutting-your-healthcare-costs/

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Taking Better Care Of Your Heart..

 

game-changerThis being the end of another year, I thought it might be worthwhile to focus on the top game-changers in 2012, as far as the treatment of heart diseases are concerned. As a cardiologist, the rate of new advances in this field is bewildering and unless one were to update regularly, it is all too easy to fall behind..

 

The Polypill the concept of a pill containing more than a single medication was first introduced in polypill2003, but the idea of adding several medications into one pill for people with multiple conditions have gained appeal in recent years. This year, it was shown at the American Heart Association meeting (the UMPIRE study) that a fixed-dose polypill that included aspirin, a statin (anti-cholesterol medication) and two blood pressure drugs, all rolled into one, were more efficient and improved compliance among people when compared to them taking 4 or more pills a day.

 

The Good Cholesterol – this year, more evidence were presented (the AIM-HIGH study)to say that increasing the good cholesterol (HDL-cholesterol) does not necessarily protect one better from a heart attack. However, it remains important to reduce the bad cholesterol (LDL-cholesterol) to reduce the risk for a heart attack.

 

Bypass vs BlowJob –if you’re diabetic and have multiple blockages in your heart arteries, then you’re better off going for a heart bypass surgery than subjecting yourself to multiple angioplasties.(the FREEDOM trial)

 

Bless the Generics –For years, clopidogrel (Plavix) , a blood-thinner pill used to prevent heart attacks and stroke among others, remained the second-most popular pill in the world..but at a premium: its high cost. Now, with the expiry of the patent, it is available at a quarter of its original cost.

A box of Plavix

A box of Plavix (Photo credit: Wikipedia)

Replacing a Heart Valve Without Open-Heart Surgery – replacing a diseased aortic valve in the heart via a tube inserted into the femoral artery (in much the same way as an angiogram) using an FDA-approved device offers hope for those who cannot undergo an open-heart surgery for various reasons. Transcatheter Aortic Valve Replacement (TAVR) is now an approved treatment.

tavr

TAVR – replacing the aortic valve without open-heart surgery

 

New Side-Effects of Statins – many on these cholesterol-lowering drugs are familiar with the possible side-effects of muscle damage and impotence, but the FDA has issued a warning that it can increase both blood glucose and blood HBA1C levels (read: cause or worsen diabetes).

 

New Blood Thinners –for years, people have depended on warfarin although it is notorious for being difficult to give the correct dosage continually and requiring frequent blood tests. New blood-thinners like dabigatran and rivaroxaban are more efficient and do not need regular blood tests.

 

 

 

 

Rare Earths – And Why the iPad is Made in China

Have you wondered what the iPad is made out of?  Beneath the sleek streamlined device, apart from the aluminium and glass, there are several reasons why the iPad has to be made in China. These include:

  • cheap labor – minimum wage in China is about a tenth that of the US
  • lax environmental regulations – when you consider that producing a  1.44-pound iPad results in over 285 times its own weight in greenhouse gas emissions, its no wonder China lies 116th of 132 countries in Yale’s Environmental Performance Index rankings.
  • the need for significant amounts of rare earth elements.

Oxides of rare earth elements. Clockwise from top center: praseodymium, cerium, lanthanum, neodymium, samarium, and gadolinium.

So what are rare earths? The term is a misnomer as they are not rare and they are not a kind of dirt. Rare because they are found widely dispersed on this planet but not in sufficient amounts at any one place. They comprise of 17 minerals found in the periodic table of elements that are important in the manufacture of a wide range of high-technology products, including flat-screens, smartphones and the iPad.

The crunch is that China virtually produces commercially almost all the  rare earth supply on this planet. Although Apple have not officially confirmed what kind of rare earths are used, many believe, for instance, that here may be lanthanum in the iPad’s lithium-ion polymer battery, as well as “a range of rare earths to produce the different colours” in the display. The magnets along the side of the iPad and in its cover are possibly a neodymium alloy.

The reason many countries, including the US and Australia, have not embarked on rare earth refining is largely environmental and anti-green, where toxic by-products are released into the environment, including hazardous radioactive substances which can pose a danger to health for surrounding residents, if inadequate safety measures are not in place.

A case in point is the Lynas refinery plant, the world’s largest, in Kuantan, Malaysia. Here, rare earth is imported by ship from Fremantle, Australia for refining and then re-exported to Australia. Permanent disposal of the roughly 20,000 tons a year of low-level radioactive waste that will be produced has been a big issue although the International Atomic Energy Commission has reportedly approved the safety of the plant. The progress toward opening the plant has been hampered by street demonstrations over radiation concerns, regulatory challenges and the withdrawal of a major equipment supplier worried about the safety of the refinery.

Environmental and health safety concerns have sparked street demos at the Lynas plant in Kuantan, Malaysia

Meanwhile, the price of rare earths has multiplied 30x in 2011, although it has since softened, largely because of the impending Lynas plant, which can meet 20% of the world’s needs.

Additional Reading

Rare Earths – the New York Times

Rare Earth Plant in Malaysia Ready To Go – Yahoo.

 

Rising Trends In Healthcare

The cost of healthcare delivery continues to rise unabated due to many factors, estimated to be at least 10% year-on-year. Some of the reasons are pretty obvious, such as newer medications where extensive research has been undertaken and new technology.

Costs aside, one can forsee that, in the near future, some trends in the way healthcare is provided, are emerging.

Your health records..all on a tablet

Take a look, for instance, at electronic health records – storing a patient’s medical history, medications, lab work and recent tests in the computer so that there is record sharing to improve safety and for convenience for patients. Throw away the thick patient folders and time-wasting in deciphering doctors’ handwriting!

Relaying your vital signs to a doctor in his office

Telehealth has also made great inroads, especially in rural or remote areas. Telecommunications technology (read ‘internet’) is used to provide and support in-home health care for those not easily reached.

Aspects of the medical home concept

Quite a new concept is that of the medical home, not a name for a building but more of a concept of medical care, where a primary care provider, like a GP,takes the lead on coordinating all aspects of a patient’s care, be it surgical wound dressings, flu shots, blood tests or emotional health. This avoids duplication of medications when a patient is seeing multiple doctors for various ailments.

Integrative medicine — The combining of conventional Western medicine with alternative treatments like acupuncture,homeopathic medicine have already entrenched themselves into some societies When conventional medicine doesn’t bring relief, more people are trying acupuncture, botanical remedies, dietary supplements or stress reduction techniques for help, thus addressing the patient as a whole person, not a person suffering from just one disease.

Of all recent trends I’ve noticed, the one that has the greatest potential, to my mind, is individualised medicine – the tailoring of treatment for a disease to each patient’s specific needs based on that patient’s gene profiling. After all, it does make sense – one pill does not fit all – that individual variations make it necessary to tailor doses and type of medications to one’s genetic makeup. By identifying the genetic makeup of an individual, doctors and reduce or increase doses of a particular medicine to give maximum effect minus the side-effects. In some leading medical centres, like Mayo Clinic, there are even Centres for Individualized Medicine. See here.

 

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