You’re the Boss

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

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March 19, 2013 | 11:56 AM | By

Mammograms: Which Women? How Often?

(Photo: U.S. Navy)

(Photo: U.S. Navy)

As everybody knows by now, how frequently a woman should have a mammogram is a topic of hot debate in the U.S. In particular, women in their 40s have been troubled by recommendations almost four years ago from the U.S. Preventive Services Task Force that mammograms are not routinely recommended for them. Instead, the decision is an “individual one” that a woman can make, presumably in conversation with her doctor.

Now, a new study has a tailored recommendation. For women in their 40s with “extremely dense breasts,” annual screening will reduce their risk of being diagnosed with advanced stage breast cancer.

“There is this sub-group that is higher risk and has more aggressive tumors,” said lead researcher Karla Kerlikowske, an epidemiologist and biostatistician at UCSF. “Annual mammography is probably better for that group.”

To date, most recommendations have relied on one risk factor: age. A woman’s risk of breast cancer increases as she gets older. But there are other risk factors, too, like breast density. About 12 to 15 percent of women in their 40s have “extremely dense breasts.” Radiologists categorize breast density on a scale of 1 to 4, and a score of 4 is “extremely dense.”

Continue reading →

FILED UNDER: Tests & Treatments, You're the Boss, Breast Cancer, Mammograms, Mammography, Science
March 11, 2013 | 8:34 AM | By

The Doctor Will See You Now — Virtually

A demonstration of CareSimple's virtual house call.

A demonstration of CareSimple’s virtual house call.

Remember the really old days of house calls? A kindly doctor with a black bag would come to your house and treat your (often minor) complaint?

Frankly, I don’t remember those days either. But I have heard of the house call, and now Carena, a Seattle-based company, is expanding into California with a 21st century house call — a virtual house call.

It works like this: like everything these days, you first create an account. When you need care, you log on and request a visit. Within 30 minutes, Carena says, a doctor or nurse practitioner will contact you by phone or email (your choice). If it’s email, you will get a link to a secure “virtual exam room.” (The man in the photo above is Dr. Ben Green, in a virtual exam room.)

From there you are diagnosed. If you need a prescription, CareSimple says its doctors are licensed in California and can phone in a prescription to your pharmacy. The service is $25/month with a $5 per visit fee. Or you can pay for a single visit, without the membership. That’s $85.

Continue reading →

FILED UNDER: You're the Boss, Primary Care, Virtual House Call
March 8, 2013 | 2:26 PM | By

Wounded Veterans Find Comfort, Hope in Cooking Class

By Mina Kim

Chef Lars Kronmark teaches veterans how to remove the skin of a fish; part of a four-day "boot camp" at Napa's Culinary Institute of America where injured veterans and their spouses learn healthy cooking tips. (Mina Kim/KQED)

Chef Lars Kronmark teaches veterans how to remove the skin of a fish; part of a four-day “boot camp” at Napa’s Culinary Institute of America where injured veterans and their spouses learn healthy cooking tips. (Mina Kim/KQED)

In a stainless-steel teaching kitchen deep within the old stone walls of the elite Culinary Institute of America in Napa Valley, acclaimed chef Lars Kronmark pulls a piece of fat from the cavity of a raw, whole chicken.

“A big chunk of fat like that, it doesn’t really hurt to leave it in there,” Kronmark said. “But in the end of the day, that’s still going to be too much fat.”

It looks like a standard cooking class. But this is an unusual class for an unusual group of students. It’s a healthy cooking “boot camp” designed for wounded veterans of the Iraq and Afghanistan wars with a goal of helping veterans connect with each other and learn to eat healthier.

Six military veterans and their spouses dressed in white chef’s coats and hats watch Kronmark closely. His healthy cooking techniques are welcome tips to the group of 12, including veteran James McQuoid, who lives with post-traumatic stress disorder.

“I’m of the larger variety,” McQuoid said. “A couple years ago, I didn’t care about my health. I was very reclusive and what not, but through therapy and stuff I’ve come to realize — I’ve got a younger child — I want to be around a bit longer, and I’m really not helping myself at all.”

A healthy dinner is served at Napa's Culinary Institute of America healthy-cooking boot camp for injured veterans. (Mina Kim/KQED)

A healthy dinner is served at Napa’s Culinary Institute of America healthy-cooking boot camp for injured veterans. (Mina Kim/KQED)

Federal officials estimate more than 70 percent of the veterans receiving care in the VA are overweight or obese. McQuoid’s doctor recommended he get more omega-3 fatty acids by eating fish instead of fatty meats.

“But I didn’t know how to cook fish,” McQuoid said. “After being here though, I can cook fish!”

The four-day boot camp is a program of the Wounded Warrior Project, a nonprofit that serves injured veterans transitioning to civilian life. The camp’s days begin with lectures on subjects like the physiology of taste and end with vets and their partners preparing dishes for dinner. Today’s menu includes roast chicken with lemon and rosemary, Baja fish tacos, and pork loin cooked in a pomegranate glaze. Continue reading →

FILED UNDER: You're the Boss, Mental Health, Veterans
March 1, 2013 | 11:38 AM | By

Can Facebook ‘Likes’ Tell You Something About Hospital Quality?

By Kelley Weiss, CHCF Center for Health Reporting

Clicking that thumbs-up “like” button on Facebook is moving beyond cute baby photos and hip new restaurants in town. Now hospitals are joining the mix.

A recent article published in the American Journal of Medical Quality says positive endorsements on Facebook could actually mean something about hospital quality.

Researchers looked at two measures: 30-day mortality rates and patient satisfaction.

Hospitals with higher patient death rates got fewer “likes.”
The study found that hospitals with higher patient death rates got fewer “likes.” It also found that people who “like” a hospital on Facebook are more likely to recommend it.

Dr. Ashish Jha,  a professor of health policy at the Harvard School of Public Health, says these findings make sense. But he cautions that the study of how accurately social media trends reflect hospital quality is in the early days. Continue reading →

FILED UNDER: You're the Boss, Hospital Quality, Patient Satisfaction
February 28, 2013 | 11:49 AM | By

Study: Sugar — Independent of Obesity — Causes Diabetes

SugarBowl_Judy_FlickrFor years, doctors have debated sugar’s role in causing diabetes. The prevailing medical opinion has been that eating more sugar means eating more calories, and it’s the resulting weight gain that leads to diabetes. But a major new study shows a direct link between sugar and diabetes — a link that’s independent of a person’s weight.

KQED’s Stephanie Martin interviewed one of the study’s authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video “Sugar: The Bitter Truth” has more than three million views on YouTube.

“This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s.”

Lustig told Martin that the study was very carefully done — researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.

In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. “Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.” Continue reading →

FILED UNDER: Policy, You're the Boss, Children's Health, Sugar, Type 2 Diabetes
February 26, 2013 | 5:13 PM | By

Video: Anti-Tobacco Advocate Debi Austin, Appeared in ‘Voicebox’ Commercial, Dies at 62

I remembered the commercial instantly:

Debi Austin appeared in the ad in 1996. In a raspy voice, she described starting smoking at age 13. Then declaring, “They say nicotine isn’t addictive,” she took a drag from her cigarette through a stoma, a hole in her throat which permitted her to breathe. “How can they say that?” she concluded.

For years, she worked to keep kids from smoking. She died last week after fighting various cancers for more than 20 years.

From a release from the California Department of Public Health:

“We are saddened by Debi’s death. She exemplified the real toll tobacco takes on a person’s body,” said CDPH Director and State Public Health Officer Dr. Ron Chapman. “Debi was a pioneer in the fight against tobacco and showed tremendous courage by sharing her story to educate Californians on the dangers of smoking. She was an inspiration for Californians to quit smoking and also influenced countless others not to start. We trust she will continue to touch those that hear her story, particularly teens and young adults. She will be greatly missed.”

Tobacco Free California says this about Austin on its website (where you can also watch a video about her):

Debi Austin started smoking at the age of 13. She continued to smoke through a stoma in her throat even after being diagnosed with cancer and having her larynx removed at the age of 42. But, Debi fought back. She starred in an iconic television ad for the California Tobacco Control Program, quit smoking and has made anti-tobacco education not only her mission in life, but her passion.

FILED UNDER: Policy, You're the Boss, Cigarettes, Tobacco
February 15, 2013 | 10:43 AM | By

Rethinking Unprotected Sex for HIV-Positive Men

By Mina Kim

Deon Brimmer, 32, is HIV positive and expecting a daughter. He’s being treated by a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)

Deon, 32, is HIV positive and expecting a daughter. He’s being treated at a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)

The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.

Now, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies — the conventional way. The program run by San Francisco General Hospital, called PRO Men, teaches men about a range of reproductive options, from adoption to in vitro fertilization — where an egg is fertilized in a lab dish — to carefully timed intercourse.

“I would say as an HIV provider community, we have really failed these men,” says UCSF professor Deborah Cohan, who runs the hospital’s Bay Area Perinatal AIDS Center or BAPAC. “We really have not created programs to help them realize those goals and do so safely.”

“It is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”

With the discovery of drugs to treat the virus, Cohan said people with HIV are living long, healthy lives. And for those who want to start families, having “safe” sex, Cohan said, can mean foregoing condoms when a female partner is ovulating. Women can also take HIV drugs, which some studies show can protect against the virus. (BAPAC has helped HIV-positive women who adhere to their medications have healthy babies for years.)

“We know that if the person who is positive takes antiretrovirals and their viral load is suppressed, meaning the medication is working at killing all the HIV in the blood, that the likelihood of them passing HIV to a sexual partner is essentially zero,” Cohan said.

Continue reading →

FILED UNDER: Policy, You're the Boss, Condoms, HIV Family Planning, HIV/AIDS
February 11, 2013 | 5:11 PM | By

How Much for A Hip Replacement? Good Luck Trying to Find Out

X-ray showing a new artificial hip. No, I don't know how much the patient paid for it. (okadots/Flickr)

X-ray showing a new artificial hip. No, I don’t know how much the patient paid for it. (okadots/Flickr)

If you want to buy a new car, you can probably figure out a price range within a matter of minutes with a google search. The same is true for many other products. But in health care, forget it.

In a new study published today in JAMA Internal Medicine, researchers called more than 100 hospitals across the country. They included a range of both top-ranked centers and community hospitals and inquired about a common elective surgical procedure — a hip replacement — for a fictitious 62-year-old grandmother.

First off, only 10 percent of the non-top-ranked hospitals and 45 percent of the top-ranked hospitals were even able to provide a price. Researchers were a bit more successful when they called the hospital and physician separately.

“It is time we stop forcing people to buy health care services blindfolded.”

And just what was the price range? $11,100 on the low end to $125,000 on the high end.

“Patients seeking elective (hip replacement) may find considerable price savings through comparison shopping,” the authors write. No kidding — except that half of the institutions couldn’t even provide a price. Continue reading →

FILED UNDER: Tests & Treatments, You're the Boss, Health Care Costs, Price, Quality, Reference Pricing, Threshold Price
February 5, 2013 | 7:00 AM | By

Mammograms: Strong Evidence That Every Two Years Is Best Option For Older Women

(Photo: U.S. Navy)

(Photo: U.S. Navy)

A major new study has found that — in older women — mammograms done every two years were as effective as mammograms done annually and led to far fewer false positive results.

The study, published online Tuesday in the Journal of the National Cancer Institute, included more than 140,000 women ages 66 to 89 from across the country.

Frequency of mammograms among women in their 40s and 50s has been the subject of intense debate for more than two decades, but this older group of women has been much less studied.

The women screened annually had a dramatically higher rate of false positives.
A team led by researchers at UC San Francisco sought to answer the question: among older women, if a woman is screened for breast cancer every two years, instead of every year, will a deadly cancer be missed?

“We found that there really was no difference,” Dejana Braithwaite, assistant professor of cancer epidemiology at UCSF and part of the research team, told me. ”The women who were screened every two years were not at a greater risk. They did not have a higher probability of being diagnosed with late stage breast cancer compared to those women who were screened every year.” Continue reading →

FILED UNDER: Tests & Treatments, You're the Boss, Mammograms, Overtreatment, Unnecessary Care
January 30, 2013 | 5:01 PM | By

Sex Doesn’t Burn Weight and 4 More Popular Myths About Dieting Debunked

Woman's feet on scale.

(Justin Sullivan/Getty Images)

I don’t cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are 88 million places I found by Googling “How can I lose 10 pounds?”

But I love evidence-based medicine. So when a group of respected researchers shatter widely-held beliefs about weight loss, I’m there. In Thursday’s New England Journal of Medicine, a group of researchers does just that.

In the review, the researchers categorized as myths those “beliefs held to be true despite substantial refuting evidence.” In other words, people have been repeating these ideas for so long, everyone thinks they’re true. But they’re not.

So, here we go:

Myth #1: Small changes — eating less or exercising more — done over time will yield large weight loss.  This myth comes from the idea that a pound is equal to 3,500 calories. But the short-term studies that looked at burning 3,500 calories to lose one pound were done 50 years ago. More recent research shows that individuals will burn calories differently as they lose weight. So the 100 calories you’re burning in exercise today will affect your body differently than the 100 calories you burned, say 18 months ago, when you started these small changes. Note that it’s not to say that exercising more — or eating less — is pointless (you will see why later in this post).

Myth #2: If you lose a lot of weight really fast, you’ll just gain it back really fast; you’ll have better long-term results if you lose weight slowly. When researchers actually looked at the studies, they found “no significant difference” between the two approaches in relation to long-term weight loss. Continue reading →

FILED UNDER: You're the Boss, Evidence Based Medicine, Obesity, Weight Loss