Can bloggers and talking heads please shut up about New York City and now Universal Studios banning trans fats?

You’d think these entities were banning butter and fat outright. Trust me, there’s plenty of lard to go around, people. Plenty of people will still have the right to clog their arteries, lower their HDL, and raise their LDL. They’ll just have to work a little harder at it.

Trans fats, you will be not be missed. No one will notice the difference. Muffins and cookies have existed for much longer than trans fats. I think we’ll survive.

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From the Snarky-Comment-Slash-Breaking-Medical-Studies Department:

My governor broke his femur . I was going to recommend that he go back on the anabolic steroids, as they help bone mass (corticosteroids hurt bone mass and cause osteoporosis), but then I saw that stomach acid reducers (proton pump inhibitors like Nexium, Protonix, and Omeprazole) can cause decreased calcium absorption . Maybe the poor guy just has bad heartburn. And that I can empathize with.

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Matthew Holt writes that the last year (or at least 6 months) of Gerald Ford’s life was a poor use of resources , and an example of what’s wrong with the health care system today. He thinks the money could have been better spent providing prenatal care to an uninsured woman.

So consider Ford’s last few months of life. He was admitted to hospital last January for pneumonia. Then spent much of July in hospital in Vail; then went to the Mayo Clinic for not one but two angioplasties in August. Then went back into hospital in California in October, and now has died in December. All that time he was obviously going to die within a year or so, and all that time he was at least 92 years old.

My guess is that over the last 12 months of his life well in excess of $100,000 was spent on his health care. And that money probably extended his life by three months at most.

Do we often perform “heroic measures” on people who might not want it, or don’t receive any quality of life benefit from it? Absolutely. Now maybe Holt has an in with the Ford family, or was following his health very closely, but there’s no way for me to know that he was “obviously going to die within a year or so.” Yes, he was 93, yes, he had had several hospital admissions. These are not Good Signs. But still–ask any doctor: internist, geriatrician, palliative care specialist–and they’ll all tell you we’re shitty at predicting when someone’s going to die . Because there’s definitely 93 year-olds out there that get a pneumonia, get really sick, but then recover and end up living 10 more years.

I’m all in favor of having people have these discussions with their family members–living wills, durable powers of attorney–but how can we tell if Ford was gonna kick it until 103?

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Just got back from a whirlwind tour of Budapest and Prague, and while the Europeans (and still most US cities) don’t have the whole “no smoking in bars or restaurants” thing down, they beat us on cigarette warnings. I love how blatant they are:

Here’s some warnings from other countries.

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Wow. December already. That being that, the NYT has put out its 2006 Year in Ideas , and that being that, many are health or medical related. So heeeeere we go:

• The Tongue Sucker : Instead of an oropharyngeal airway which might be awkward for a bystander to insert, the tongue sucker just sucks onto the tip of the tongue to pull it out of the way (oh yeah: people can choke on their tongue). Why didn’t I think of that?
• Straw That Saves Lives : The LifeStraw has 7 filters to make potable drinking water. Only costs $3 to make. Filters 99.99% of bacteria and protozoans from the water, apparently. Not too shabby.
• Human-Chimp Hybrids : Some MIT and Harvard researchers (what do they know, anyway) have come up with a hypothesis about why our X chromosome seems to have branched off from our chimp ancestors later than the rest of our DNA: our human-ish ancestors were still having hot monkey sex with… chimps. The males (XY) would be infertile, but the XX females could go on reproducing. From the article: “the two populations interbred on repeated occasions over hundreds of thousands, if not millions, of years, producing hybrids of protohumans and protochimps.” Redefining the word “natural.” Ugh.
• The E-Coli Wipe : A handi-wipe that changes colors when it detects E. coli in the environment, by having the wipe embedded with antibodies. Yes, EHEC is that really nasty E. Coli (O:157 H:7) that hospitalizes people and causes general badness, but unless the wipe is going to detect only pathogenic (disease-causing) E. coli, people are going to be in for a nasty surprise. Where’s the E. Coli from? Uh, well, poop. Most E. coli is acutally our friendly colon resident that helps us digest food and make vitamins we need. People will be seeing false-positives of E.coli everywhere, as there is poop everywhere, on every surface . Like those black lights for inspecting hotel bed sheets, you kind of know it’s there, but would prefer not to be reminded of the fact.
• Bike Helmets Put You At Risk : A cyclist puts a sensor on his bike, and then bikes with and without a helmet. With the helmet, cars come 3.4 inches closer to him than without the helmet. Maybe similar to the seat-belt dilemna: less fatal accidents, but more accidents overall . But seriously. Still wear a helmet. Especially your children. *Please*.
• The Beer Gut Flask : A rubber balloon that hugs your waist and holds all the alcohol you want. Welcome, The Beer Belly . No longer pay those ridiculous arena prices for the beer you crave. Side effects: you look like you have a gut. If you see someone you like at a game, he/she will see said gut. And if you try to point it out or take it off, he/she will just think you’re lame. Because you are.
• Tushology : There is now an equation for the perfect ass. You could do the math, or you could just use your eyes, and your brain does the math for you. I prefer the latter.
• The Visage Problem : Holy crap, possibly 2 out of every 100 people have some degree of face blindness; could this be the reason some of my colleagues are just so totally clueless? Also: it’s known that people are less able to distinguish people from other races–no idea if this was factored in.
• Walk-In Health Care : The instant doctor, now available at your local big-box retailer. Terrible idea? Policy-wise yes, but probably practical for those without health insurance or with shitty insurance. And much cheaper than the ER. It seems like we have primary care and emergency care, but not much in the way of urgent care, which these clinics are probably filling. Probably also caters to the American ideal of not wanting to wait. (I would love to see the rates of antibiotics prescribed for these clinics: if you’re forking over cash, I am incredibly, incredibly confident that docs are going to be more likely to prescribe antibiotics–especially if a patient knows a follow-up visit will cost them another 40 bucks to come ask for a prescription.) But hell, I’d take 99 bucks for a suture-job than what my ER will probably charge you. (Then again, if you’re uninsured and go to an ER, you can always just use a fake name and address and never pay the bill anyway.)
• The Wheelchair Car : Now some people in wheelchairs can enter their own car and pop into the driver’s seat. Wouldn’t require pedals, as it’s controlled by joystick. But mostly a commuter and get-the-groceries car: goes 25 mph. Sounds like at least a promising prototype design.

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(And Where He’s Right.)

So Google Vice President Adam Bosworth posted a bunch on the Official Google Blog about his ideas for fixing health care information sharing , after the unfortunate death of his mother, after her cancer symptoms were missed for 9 months.

He talks about Google Co-Op , which lets users define high-quality websites–in this case, doctors can mark certain sites as providing accurate health information, so that patients could feel comfortable that a site is providing reliable information. This is really important–first, there’s a lot of bad or incomplete data out there on the web about medications, side effects, diseases, treatments, etc–and I’m always educating patients about things that are incorrect (or that they’re mis-read or mis-interpreted) from the web. Second, it’s important for providers to have access to accurate information, too–you might be frightened by how often providers Google a drug to find out the right dosage.

An even more interesting idea is his concept of the “Health URL”–essentially, one central website where patients could store and access all their health information, and could then give doctors access to said website to review their records. In theory, this is amazing. Right now, one hospital can’t get lab results from a hospital across the street electronically. We can’t view x-rays, read medical reports, even the most basic of things you can do with pretty much any other part of society now.

He’s gonna run into some major issues–namely HIPAA, that heart-in-the-right-place-but-implemented-so-incredibly-awfully law that is supposed to protect your privacy, but actually doesn’t, and impedes patient care.

And then there’s t his post about “Google Scrapbook” , which could turn into the “Health URL.”

Now for the problems:

This is great for sick people and people with chronic disease. It’d be great to have this information, to know their history, see what tests have already been done, view previous scans, etc. And while more and more of medicine is chronic disease management, does Bosworth think patients are actually going to be actively involved in this? Those with cancer and other terrible, possibly-fatal illnesses or unclear diagnoses will certainly be interested. But getting the folks with diabetes to get involved? Much harder. It’s the classic issue with human nature–we’re much more likely to invest in things that provide relief or help for the present, but we’re not as good with short-term pain, long-term gain. (Often we have enough trouble just getting patients to take their meds, let alone maintain some sort of “health URL.”)

Will people trust Google with their data? Having a computer read one’s emails and supply ads is one thing–but will people be sure that people will be okay with knowing they’ve had an STD, or take Viagra, or have had an abortion, or on anti-retroviral drugs?

Finally, in a talk Bosworth made about his mother’s care, he writes:

Once she was diagnosed, it was extraordinarily hard to determine with whom she had the best
chance of recovery or remission. While in the end we found an amazing team, it was much harder
and scarier for her than was necessary. And recently, as she was dying, there was no way for her
physicians, nurses, health aids and hospice workers to collaborate online to ensure that they knew
what is happening with her, that the right medicines are being delivered and dispensed, and that
she was as happy as she could be. My mother couldn’t possibly keep up with all of this, and
neither could I. So, for lack of an easy way to find the right specialist and for lack of
comprehensive medical information about her that could have been shared between her doctors
and caregivers, she ended up being sicker than she should have been and dying sooner than she
should have.

We already have specialists that can often help with these issues. They’re great communicators, and work with different parts of the medical field to coordinate care: they’re called internists, or even more specialized, palliative-care physicians. But here’s the problem: we’re running short on internists, and we train very few palliative care docs every year. And why is that? Money and happiness with the jobs, plain and simple .

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