You’re the Boss

Managing not only an illness but also the doctors and hospitals who take care of you

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May 23, 2012 | 10:23 AM | By

PSA Debate on Morning TV: American Cancer Society vs. Basketball Coach

The debate about the U.S. Preventative Services Task Force giving the PSA test a “D” rating was all over the morning talk shows today. But perhaps the most interesting debate happened during a commercial break. While this clip did not air, CBS fortunately recorded it.

Watch as Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, and former basketball coach Digger Phelps, who has had surgery for prostate cancer clearly articulate the two opposing poles of the PSA test.

Hat/Tip to HealthNewsReview for blogging the video.

Near the end, Phelps passionately argues against “watchful waiting,” saying the idea of having cancer is too frightening to postpone treatment. Brawley starts to make the case for informed consent, but doesn’t have time to finish in this clip.

But this is exactly the paradox of going ahead and doing the test. Brawley estimates a million men have been needlessly cured of their prostate cancer– a disease men are significantly more likely to die with and not from.

This is what’s behind the U.S. Preventive Services Task Force recommendation: if you can’t live with doing nothing in the face of a prostate cancer diagnosis, then don’t have the PSA test in the first place. You are more likely to be harmed by the treatment–the harms range from incontinence, impotence and death.

FILED UNDER: Policy, You're the Boss, Overtreatment, PSA Test
May 18, 2012 | 2:55 PM | By

A Heart Patient’s Quest for Full Access to His Medical Data

By Eve Harris

X-ray of Hugo Campos' ICD. (Courtesy: Hugo Campos)

X-ray of Hugo Campos' ICD. (Courtesy: Hugo Campos)

Hugo Campos was apologetic about postponing a scheduled interview with me two weeks ago. In a midday email he wrote, “Just had the biggest arrhythmia ever. I’m trying to recover from the scare. I might go into the ER. I’ll keep you posted.”

Arrhythmia is when a heart unpredictably beats in an irregular rhythm. For Campos it’s a symptom of an inherited heart condition. If the arrhythmia goes untreated his heart could stop beating, putting him at risk of sudden cardiac arrest.

For many patients, the best treatment for arrhythmia includes an implantable cardioverter defibrillator or ICD. The ICD monitors the heartbeat and can jolt the heart back into a normal rhythm if necessary. Campos got his ICD in 2007 and his device is part pacemaker, part gentler pulses of electricity. The response of the device depends on the type of arrhythmia he experiences. In either case, the day of our cancelled interview, the ICD may well have saved his life.

“You go from feeling fine to thinking you’re going to die.”

The arrhythmia episodes, or “events,” are sporadic and frustratingly unpredictable. When this event came the 46-year-old Oakland resident was working in his home office. The first thing he did — before he called 9-1-1 was tweet his followers. Then he kept tweeting. Dave deBronkart Storified Campos’ dramatic and frustrating E.R visit.

“You go from feeling fine to thinking you’re going to die,” Campos said after the crisis passed. “It’s emotionally exhausting and traumatic.” Continue reading →

FILED UNDER: You're the Boss, e-patient
May 10, 2012 | 5:07 PM | By

FDA Panel Approves First Drug to Prevent HIV Infection

The FDA panel approved Truvada, an antiretroviral drug for use by healthy people to prevent HIV infection. (Justin Sullivan: Getty Images)

The FDA panel approved Truvada, an antiretroviral drug for use by healthy people to prevent HIV infection. (Justin Sullivan: Getty Images)

From AP:

A panel of federal health advisers has endorsed the first drug shown to prevent HIV infection in healthy people, clearing the way for a potentially landmark approval in the 30-year-old effort against the virus that causes AIDS.

In a series of votes, the Food and Drug Administration advisory panel recommended approval of the daily pill Truvada for healthy people who are at high risk of contracting HIV, including gay and bisexual men and heterosexual couples with one HIV-infected person. The FDA is not required to follow the panel’s advice, though it usually does. A final decision is expected by June 15.

Drugmaker Gilead Sciences Inc., of Foster City, already markets Truvada as a treatment for people who are infected with HIV.

Continue reading →

FILED UNDER: Policy, You're the Boss
May 10, 2012 | 2:00 PM | By

Mommy Wars, Redux: Let’s Hope Not

It’s the Time magazine cover that’s gone viral. A Los Angeles mother breast-feeds her 3-year-old.

Time’s Facebook page is already logging pro, con and grossed out comments.

These articles about attachment parenting have come in waves ever since Dr. Bill Sears wrote the book on the topic he named himself more than a decade ago.

The arguments — yea and nay — are the same now as they were then. But, geez that picture and provocative headline make you want to read the article, don’t they?

Alas the article is behind a paywall, but you can watch a 4 minute interview with the reporter talking about what she learned here:

Learn More:
KQED’s Forum will be discussing attachment parenting Friday, May 11 at 9am. Listen at kqed.org, click “listen live.”

FILED UNDER: You're the Boss, Breast-Feeding, Parenting
May 1, 2012 | 3:29 PM | By

New Mammogram Research for Women in Their 40s

(Photo: U.S. Navy)

(Photo: U.S. Navy)

It’s hard to believe that a one in a hundred risk of something bad happening would generate so much heated debate, but that’s where we’re at when it comes to the question of mammograms for women in their 40s. Since breast cancer is a disease which risk increases with age, the clear cut off point for mammography has been age 50. Mammography will find cancer in women in their 40s, but will carry a much higher risk of false positives.

Specifically, a 40-year-old woman has a 1.5 percent chance of developing breast cancer at some point during her 40s. The 1-in-8 chance repeated so frequently is over a lifetime — up to age 80.

While mammography is the best tool we have in detecting breast cancer, it’s not a perfect test. Mammograms will pick up abnormalities that are not breast cancer. The problem is that doctors can’t say definitively these abnormalities are benign without further testing. Sometimes that means having an additional mammogram, sometimes women must then have a biopsy. In the meantime, many of these women are worrying. Continue reading →

FILED UNDER: Policy, You're the Boss, Breast Cancer, Mammograms
May 1, 2012 | 1:38 PM | By

New Facebook Status: Organ Donor

Facebook is turning its social media power to the problem of organ donation. Last year, 7,000 people died on a waiting list for a new kidney, liver, heart or other organ.

Today Facebook announced that it is making “organ donation status” an option members can add to their profiles.

The New York Times cited experts in the field of organ donation saying this move by Facebook could potentially have a profound effect:

They say people declaring on Facebook that they are organ donors could spur others to sign up at motor vehicle departments or online registries. But these experts say Facebook could create an informal alternative to such registries that could, even though it carries less legal weight, lead to more organ donations.

That is because a disclosure on Facebook could provide the evidence of consent that family members need when deciding whether to donate the organs of a loved one, said Dr. Andrew M. Cameron, the surgical director of liver transplantation at Johns Hopkins Hospital.

“This is going to be an historic day in transplant,” said Dr. Cameron, adding that people who die for want of an organ do so mostly because there are not enough organ donors, not because of any shortcomings in medical technology. “The math will radically change, and we may well eliminate the problem.”

If you’re one of the 161-million American Facebook members, here are more details:

FILED UNDER: You're the Boss, Organ Donation
April 30, 2012 | 11:35 AM | By

Perhaps Watson Can Explain the Future of Health Care

By Christian Torres, Kaiser Health News

(Courtesy: IBM)

(Courtesy: IBM)

IBM’s Watson frequently had the right answer when the supercomputer competed on Jeopardy last year. Now, the nation’s second largest health insurer is hoping it will have the right diagnosis and treatment for patients.

Representatives from IBM and Wellpoint discussed their developing partnership at a Friday event on Capitol Hill. The tech company aims to make Watson useful to the health care industry, and Wellpoint believes it can help doctors practice evidence-based medicine.

The actual how-to part is still being worked out, but Watson could, for example, provide a list of likely diagnoses, or a list of potential treatments, when given a list of symptoms. Physicians and patients would remain in charge of any decisions, but Watson does have “the potential to transform health care delivery,” said Elizabeth Bingham, WellPoint’s vice president of health IT strategy. Continue reading →

FILED UNDER: You're the Boss
April 25, 2012 | 2:24 PM | By

Share and Share Alike — Especially in Medical Decisions

By Eve Harris

(Caroline_1: Flickr)

(Caroline_1: Flickr)

Patients often make decisions about their medical treatment while sitting on an exam table in a thin cotton gown. But is this the best way to fully understand your options? Of course, some healthcare decisions are pretty easy. For example, if the treatment being offered is easy to use or has a long history of success with only mild side effects.

But overall, health care decisions are becoming more complex. Your doctor may offer more than one alternative. Picking among those alternatives may have as much to do with medical evidence as your own preferences. The process known as shared decision making empowers patients to collaborate with their doctors in choosing a treatment, as opposed to the doctor pointing a patient toward one choice.

“We have an ethical duty to inform our patients what their options are and get their preferences.”

It all has to do with risks and benefits. In a shared decision process doctors put more effort into explaining trade-offs, and patients must think more deeply about what matters most to them. The relationship of shared decision making to better health is still being studied, but we know that patients who are involved in making their own medical decisions often have less anxiety and recover more quickly. Continue reading →

FILED UNDER: You're the Boss, Shared Decision Making
April 24, 2012 | 3:30 PM | By

Doctors Fall Short in Helping Seniors, Poll Reveals

(Photo: Kaiser Health News)

(Photo: Kaiser Health News)

Medicare provides free screening on more than a dozen primary care tests, but a new poll shows that seniors are not receiving the benefit. The poll comes from the John A. Hartford Foundation and looked at Americans age 65 and older.

The Foundation was interested in whether seniors had received seven services that would support “healthy aging” including:

  • an annual medication review
  • falls risk assessment
  • screening for depression
Kaiser Health News reported details of the poll’s findings: Continue reading →
FILED UNDER: You're the Boss, Medicare, Primary Care
April 20, 2012 | 10:00 AM | By

Teaching Hmong Shamans Western Medicine

A Hmong shaman blesses a pregnant woman during a traditional healing ceremony.

A Hmong shaman blesses a pregnant woman so that she will have a safe birth. (Photo: Shuka Kalantari)

A Hmong shaman dressed in an ornate red and pink costume is standing in a crowded living room in Winton, a small Central Valley town near Merced. She sways back and forth rhythmically as she shakes small ceremonial bells over a young pregnant woman. The woman sits quietly, with a rope lightly tied around her stomach. Her rope connects to another rope — wrapped around the belly of a newly slaughtered pig that lays on a sheet of plastic on the living room floor. For the next two hours, the shaman chants prayers to the spirit world, offering the slaughtered pig as a sacrifice in exchange for a healthy birth. Throughout the ceremony, the shaman’s husband burns pieces of paper money as offerings to the spirits.

Afterward, the pregnant woman and her family prepare for a feast. May Yang, the shaman, explains that this ceremony is the Hmong version of prenatal care. “This ceremony was to help the mother and baby,” Yang said through a translator.

“The shaman they can see spirits, whereas the doctor use CT, x-ray, and microscope to see disease or illness.”
More specifically, to help their souls separate. Yang explained that the slaughtered pig was an offering to the spirits so that they would assist in the birthing process. It’s part of their customs. Traditionally, in Laos, the Hmong were always more likely to visit a shaman than a doctor when they were sick or needed prenatal care. So when Hmong refugees began resettling to the Central Valley after the CIA’s Secret War in Laos, they didn’t go to the doctor.

The Hmong traditionally believe that if the body is sick, the soul is sick. So to heal the body, you must first heal the soul. Additionally, many Hmong were distrustful of western practices when they first arrived to the U.S., so they refused to get treated in hospitals, unless it was a crisis. That led to the Hmong filling up emergency rooms at local hospitals — and it left doctors struggling to understand how to treat them.

Continue reading →

FILED UNDER: Place Matters, You're the Boss, hmong, Merced, Shamans