Why You Shouldn’t Take A Stroller On An Escalator

Therea??s an epidemic at our malls: parents taking their small children up and down escalators in strollers of all sorts of sizes and shapes. I ended up behind one such parent yesterday and found strollers heading up and down all afternoon. Some were small, some large. Some had bags dangling off of them, others not. Sometimes parents had both hands on the handles, other times they were balancing the stroller and a drink or cell phone.

Some escalators have signage to indicate a??no strollersa?? but this mall didna??t have any visible. But, do we need signage for common sense? Given what I witnessed, perhaps we do!! Plus, the statistics reveal a story of danger for young children that most parents dona??t realize with escalators, on foot or in a stroller.

Before I share with you the statistics, check out this YouTube Video to see one scenario that could have occurred:

Or, this one:

Scary, huh?

Coupled with these images, we have compelling data to support how dangerous escalators are to young kids if we dona??t use them with more common sense.

A 2006 study from Pediatrics looked at escalator injuries from 1990-2002 and concluded that there were a a??disproportionate amount of escalator related injuries in children who were younger that 5 years of age.a??

51% of the injuries were falls, 36.5% of the injuries were entrapment in this age group (such as a hand being caught in the side). 6% of injuries in this age group were from a stroller, usually from falling out of the stroller.

In the under 5 age group, the hand was the most common body part injured and entrapped due to escalator accidents. Of all the injuries seen, lacerations, some severe enough to cause amputation and avulsion, were the the injury most common in the under 5 age group.

Ita??s time we all start using transportation devices the way they were designed and stop playing Russian Roulette with our childrena??s safety. So, next time you are at the mall, give your self the extra time and use the elevator if you have a child in a stroller. Just think about the future ER visit youa??ll be saving.

                       

Teens Can Give College An Overnight Trial Run

If your teen is seriously considering a college, I now highly recommend setting up an overnight visit with the admissions department. Here is our experience: while on this college visit my daughter spent the night as a guest with two sophomores at the college we are visiting. We thought it would be a great way to get a feel for what it is like to live on campus in this little town and really get a feel for whether or not she “fits in.”

Upon arrival, we read and signed the paper about the rules, she was given her itinerary, meal tickets, appointment with a faculty member in the department she was interested in, and information about the class she was going to visit the following morning. The two young women who were hosting her introduced themselves and off she went - not a glance back - into the next grand adventure. The admission director smiled at me knowing I was holding back the tears - excited for her and knowing my life would never be the same. That evening my younger daughter, her friend and I saw a movie, had dinner and my younger daughter congratulated me when I did not text her older sister to say goodnight.

We picked my eldest up the following afternoon and her first words were “I love x university!” deep sigh - it had gone well! Her hostess hugged her goodbye and as we sat enjoying coffee at the bistro on campus she told us all about the apartment-style living, the great food service, the Hawaii club she visited the international relations class with only 20 people, the professor she had spoken with, the opportunity for a year abroad, how everyone had welcomed and talked with her, loved the school, the emails she had received about fun jobs to do on campus, the introduction to the theater director, and how much she felt like she belonged!

She said she never would have known about the clubs, food and rooms without having spent the night, and believes everyone should “try out life on any campus they’re seriously considering.” There you have it - words from the expert.

Photo credit: borman818

                       
                       

This post, Teens Can Give College An Overnight Trial Run, was originally published on
                        Healthine.com by Nancy Brown Ph.D..

What Can Diet And Exercise Actually Help Do?

First, an article in the New York??Times talks about whether exercise can actually help you lose weight. Short answer: Probably not, but it may help you keep the pounds off. Click here to read the article.

Second, Ia??ve done a podcast about my post on whether diet can be used??to control??blood pressure long term. Each week Razib Khan, Kevin Zelnio and I discuss an article wea??ve covered on one of our blogs, and it was my turn. Click here to listen to the podcast online, or??click??here??if youa??d like to subscribe to the podcast. You can also visit iTunes and search??on a??ResearchBlogCast.a??

                       

Breast Cancer Prevention: Komen And KFC?

I must say I was surprised (astounded) when I first saw the KFC commercial touting their Buckets for the Cure.??It’s a partnership between KFC and Susan G. Komen for the Cure.??KFC donated 50 cents for each bucket purchased.

This, after the recent addition to KFCa??s menu of the Double Down Sandwich!??It’s my opinion that KFC doesn’t have anyonea??s health as their goal.

I want to encourage anyone who wants to support Susan G. Komen for the Cure or other breast cancer groups to simply bypass KFC and donate directly to the group.??

Benefits of donating directly include:

• You get the tax write off, not KFC.??


• You might avoid a heart bypass procedure by eating healthier at home or elsewhere.

Ia??m not the only one who feels this way.??Check out the article by Jennifer LaRue Huget??in the Washington Post, which states:

A 10-piece bucket of KFC fried chicken (including the sides) costs about $20. If you’re really interested in supporting Komen for the Cure’s efforts, why not just mail them a check directly?

                       

How An Empowered Patient Finds A New Doctor

What if the average patient (person) knew what healthcare insiders, providers and expert patients know?

Take the process of looking for a new personal physician. Conventional wisdom tells people that when looking for a new physician they need to consider things like specialty, board certification, years in practice, and geographic proximity. Online services like Health Grades allow you to see and compare the satisfaction scores for prospective physician candidates.

But industry insiders know different.??Consider those patient satisfaction scores for physicians. In reality, a??one can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show,a?? according to a 1991 lecture by Avedis Donabedian, M.D.:

a??Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.a??

Given the constant drumbeat about the lack of care coordination and medical errors, it would seem that some people (patients) are beginning to reach the breaking point alluded to by Dr. Donabedian. The empowered among us are starting to compare physicians (and the hospitals that employ them) to a higher standard –??a higher standard that reflects the nature and quality of the medical services physicians actually provide. Empowered patients today are a??being taught to be less patient, more critical, and more assertive.a??

In Donbediana??s own words, a??patients are justifieda?|in suspecting that the practitioner who has been cursory, inattentive, uninformative, or even rude has not marshaled the full potential of technical skills on their behalf. a??

So how might an empowered healthcare consumer go about finding a new??doctor these days? For starters, herea??s a list of evidence-based questions I would be inclined to ask:

• How would you describe your communication style?


• How do you inform patients of lab test results?


• How long after you get your lab results before I can expect to be notified?


• What percent of your adult patients have had their recommended preventive screenings?


• What percent of your patients are non-compliant with respect to taking their medications or otherwise following treatment recommendations?


• If I need to hospitalized, who would my doctor be??? You or some hospitalist?


• What safeguards do you have in place to prevent communication hand-off errors should I be hospitalized or seen in the ER?


• How do you feel about my bringing a friend or spouse to my visit?


• Do you encourage patients to ask you about health information they have found on the Internet?


• For patients needing additional information, do you have a list of recommend websites you can give me?


• Will I get a written post visit report summarizing what occurred at each office visit, including medication and self care instructions?

So if you are a self-satisfied hospital administrator patting yourself on the back because of your high patient satisfaction scores (with your physician-owned practices) watch out.??There are hospitals and physicians across town that a??geta?? what empowered health consumers want, and one day soon they are probably going to eat your lunch.

REFERENCE: Donabedian, A., “Quality assurance in health care: consumersa?? role.” The Lichfield Lecture. Quality in Health Care 1992;1:247-251.

                       

Is Sunburn More Likely On The Beach Or In The Mountains?

While vacationing in Idaho and Montana last week (blissfully off the grid), I experienced something beautiful: altitude. At 6,260 feet Stanley, Idaho is a mile higher than my home in San Diego. The skies there were a brilliant blue. There was daylight well after 10PM.??The mornings were a chilly 35 degrees. And I got sunburned.

How can this be? Montana is over 1,000 miles north of San Diego. Shouldna??t the sun be stronger down here?

Several things determine the suna??s intensity. The closer to the equator you are, the more intense the suna??s rays. But also, the higher up you are, the more intense the suna??s rays. Your ultraviolet (UV) exposure increases by 10 percent??for every 3,280 feet in altitude; at 6,000 to 8,000 feet in elevation, youa??re exposed to 25 percent??more ultraviolet radiation than at sea level.

Also, snow (which fell during our mid-June trip) is an efficient??reflector of sunlight. When skiing or hiking in snow, 80 to 90 percent??of UV light is reflected at you, dramatically increasing your sun exposure. Grass in comparison reflects only about 3 percent??of sunlight.

Water, especially when still, also reflects sunlight. Still lakes, including the beautiful Yellowstone Lake pictured above, can reflect up to 100 percent of UV light (hence the term mirrored lake), doubling your UV exposure.

So although you might feel hot lying on the beach in June in Southern California, you might be more vulnerable to sunburn on a chilly hike in Yellowstone after a June snowstorm — which is exactly what happened to me.

Photo: Madsit (Stanley, ID)

                       

In Front Of The Mirror Of Middle Age

“It was the best of times, it was the worst of timesa?|”

An intermission, the curtain has closed on youth, but the next act awaits.

Caring for hiccups of the heart, like atrial fibrillation for example, often throws me in front of the mirror, of middle age that is, and sadly the reflections show imperfections. Since I am middle aged myself, there are my own experiences. But everyday at work, on my job site, I see the effects of these same middle-age experiences on the atrium of my patients. The results are often profound. So must be the pressures.

I read??a passage in the wee hours of the quiet morning, in the dark, with a flickering book light. It grabbed me. It is from Elisabeth Strout’s Pulitzer Prize-winning, Olive Kitteridge.

Olive is an older women, her husband (Henry) of many years has suffered a stroke and now lives unknowingly of himself or others, in a nursing home. Her only son has moved away with a women who soon after leaves him. She is alone in her cold New England town and she ponders this thought:

“There was beauty to the autumn air, and the sweaty young bodies that had mud on their legs, strong young men who would throw themselves forward to have the ball smack against their foreheads, the cheering when a goal was scored, the goalie sinking to his knees. There were daysa??she could remember thisa??when Henry would hold her hand as they walked home, middle-aged people, in their prime. Had they known at these moments to be quietly joyful? Most likely not. People mostly did not know enough when they were living life that they were living it. But she had the memory now, of something healthy and pure. Maybe it was the purest she had, those moments on the soccer field, because she had other memories that were not pure.”

Life moves so fast. The 100-year-old Dr. Bing likened life to a rapidly flowing river.

It seems just yesterday I stood in line at the coaches office waiting to dial the rotary phone to call Mom or Gramps for a ride home.

Here’s to enjoying the ride while on it.

JMM

h/t to Dr Wes, for the Dr. Bing video, and to Staci, who suggested Olive Kitteridge, along with many other good suggestions.

                       

National Prescription Drug Take-Back Day: Over 34,000 Sites Join In

The Drug Enforcement Administration (DEA)??coordinat[ed] a??National Prescription Drug Take-Back Daya?? this [past] Saturday [September 25th], encouraging people to turn in their unused prescription drugs. The agency hopes the event will help decrease rates of crime and addiction linked to prescription drug abuse, the New York Times reports.

From the DEA press release:

This initiative addresses a vital public safety and public health issue. Many Americans are not aware that medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are increasing at alarming rates, as are the number of accidental poisonings and overdoses due to these drugs. Studies show that a majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet. In addition, many Americans do not know how to properly dispose of their unused medicine, often flushing them down the toilet or throwing them away a?? both potential safety and health hazards.

                       

Friends And Searching For Health Information Online

Turning to friends for online information is the hot topic within the Web world, and in Mondaya??s New York Times Technology and Business section, Jenna Wortham writes about how a??Search Takes a Social Turn.a??

Online sites are taking notice of what people like.??Web companies are trying to make searching online for information more useful by tapping into the inner thoughts of what people like:

After a decade when search engines ruled supreme a?? tapping billions of Web pages to answer every conceivable query a?? many people now prefer getting their online information the old-fashioned way: by yakking across the fence.

Turning to friends is the new rage in the Web world, extending far beyond established social networking sites and setting off a rush among Web companies looking for ways to help people capitalize on the wisdom of their social circles a?? and to make some money in the process.

Listening and communicating

Listening and communicating with our friends can prove to be invaluable at times, and often they are our springboards for sharing our latest woes or trumpeting our successes.??Whatever the case, friends are ruling the social networking world and frankly their opinion matters. Friends can be invaluable, and the geniuses behind new technology companies are taking notice and creating online sites focused on what friends are sharing with friends.

Trust and better recommendations

We trust our friends, and one company taking notice of the friendsa?? trust factor and creating its content based on smart recommendations is a New York City start-up company, Hunch.

a??Hunch, a start-up based in New York, wants to go beyond cataloging the places and products for which your friends have already expressed affection. With some complex software, it tries to use that information to predict what other things you might like, even if nobody you know has ever offered an opinion on those things before,a?? writes Wortham.?? a??The service pulls in data about articles, topics and people that you and your friends have a??likeda?? on Facebook or follow on Twittera?|a??

Friendsa?? offer valuable information

While we value our friendsa?? opinions for the latest recommendations in movies, restaurants, hotels, TV shows, electronics and more, I was curious to find out if they are talking about health.

Health category

I dug a little deeper into Hunch and indeed, the health category is covered.??Sparingly, but people are talking about health.

From a??Ways to De-stress,a?? to a??Healthy Eating Habits,a?? to a??Exercises for Losing Weight,a?? and from Blood Pressure Monitors,a?? and a??Diabetes Monitoring Devices,a????to a??Cancer Specialist Hospitals,a?? to a??OTC Allergy Remedies,a?? and a??Yoga DVDs ,a?? to name a few; friends on are sharing their opinions, and Hunch has tapped into that.

The long-term goal is for Hunch is for a??a user to be able to come to Hunch looking for a smart recommendation on just about any topic, and after answering a handful of questions, get as good a recommendation as if she had interviewed a group of knowledgeable people or done hours of careful research online,a?? stated on the companya??s website.??a??Eventually, when Hunch gets good enough, we hope users will trust its recommendations without having to turn to lots of external time-consuming sources of information.a??

Friends are offering good recommendations to De-stress.??Take a vacation, read a good book and listen to music are the first three suggestions that round out the 49 recommendations.??Additionally, a??prosa?? and a??consa?? in some instances are mentioned and by clicking a??Learn morea?? you can find where the recommendation originates from.

Number 23 is from Andrew Weil, M.D. and offers the recommendation for a??Breathing exercisesa?? and thata??s a great tip to De-stress.

Be cautious

Caution comes when you get to number 49.??a??Take a Lorazepam,a?? that is the recommendation to De-stress.??While there is a a??cona?? listed that states, a??Cons: This is a powerful anti-anxiety pill that should not be taken unless a person has clinically diagnosed anxiety. There are very serious side effects including withdrawal once stopped,a?? it makes sense for you to be in charge of your health and research a little further.

Along the same line is a??OTC Allergy Remedies.a????While your friends may be taking something to help their allergies, it doesna??t mean ita??s right for you.

Finding out from friends about the best movies, restaurants and travel is extremely helpful.??Finding health information can be very useful as well, however you should always check with your healthcare provider before diving into uncharted territories.

Friendly reminder

Our friendsa?? opinions are important to us, but ita??s also helpful to go to more than one source when searching for health information.??There are excellent health sites and blogs online that offer extremely useful and accurate information.??Always take the extra step when it comes to your health to find out whata??s right for you.??Be in charge and be an empowered health consumer.

Turning to friends

Clamoring with our friends about the latest gadgets, the hottest fashions, the best movies, favorite places to visit and health topics have captured the attention of technology companies, so remember your suggestions can impact many, many people in the social world.??What you like is impacting the way companies are creating technology.??Simply, your opinion matters.

Your turn

How important do you think your suggestions and recommendations are to your friends?

[Image - iStockphoto]

                       

Movie Popcorn Is Shockingly Fattening

After a holiday weekend of movie-going and eating that popcorn that smells so good in the theater,  it was a shock to read the report from the Center for Science in the Public Interest that shows just how bad theater popcorn is.  The researchers studied medium size popcorn from three large movie chains;  Regal Entertainment Group,  AMC and Cinemark.

The analysis showed that a Regal medium popcorn contains 1,200 calories and 60 grams of saturated fat.  AMC popcorn was a “smaller” medium and contained 590 calories and 33 grams of saturated fat.  This was before adding the butter topping.  Cinemark wasn’t much better at 760 calories but it only had 3 grams of saturated fat.

Kudos to Cinemark  for popping their corn in canola oil with less saturated fat.  The other chains use heart unhealthy coconut oil, which is about 90% saturated fat.  Lard is 40% saturated!

The study showed that a $12 medium popcorn and soda combination at a Regal movie would be the equivalent of three McDonald’s Quarter Pounders with 12 pats of butter.

Do you want soda with your popcorn?  A 54 ounce large soda at Regal has 33 teaspoons of sugar and 500 empty calories.

Taking the family to a movie should be a treat.  Giant portions of heart unhealthy food are making us fat.  See the movie, skip the snacks.

Great movie tip: “Precious”.  See it for the academy award performances and the amazing, heartrending story.

                       

Standing Up To Bullies: A Father Shows His Son How It’s Done

Brad asked how I think I influenced his development as a child. I think I taught him about leadership, perseverance, patience, problem solving, pattern recognition, innovative thinking, and compassion for others. The irony is I believe he taught me more than I taught him.

Mutual trust and respect must go hand and hand with the love for a child. Kids are people too. They have the same emotional responses to perceived events as we do as adults.

One of many incidents of mutual respect comes to mind. Brad was 11 years old in the 6th grade.

My accountant, at that time, was an avid stamp collector. I thought learning about the sub culture of stamp collecting would be a terrific intellectual experience for both of us. My accountant took us to several stamp shows and taught us how to value stamps. We started collecting. We accumulated a nice stamp collection. The collection had great potential to increase in value. We both learned a lot and grew together in the stamp collecting business.

Brad was very proud of his stamp collection. One night at dinner, Brad asked if he could bring a couple of sleeves of stamps to his 6th grade to explain the joys of stamp collecting. I said a??sure.a??

At dinner the next evening he told us someone had stolen his stamps. He left them in his school desk pocket during recess. They were gone when he got back to his desk. He explained that he was certain he knew who stole the stamps.

I asked him how he knew who stole the stamps. He told me about a wise guy kid who was always intimidating his classmates. This kid bullied other kids and constantly took things from them.

I remember a kid like that in my 6th grade class. He was always hitting us up for pennies.

I asked Brad what he wanted to do. He said he wanted to figure out how to get his stamps back. He had already spoken to the teacher. She said she would talk to the boy.

I thought that was a great first step. I said I would call the teacher in the morning. I spoke to the teacher. It was obvious to me she did not want to get involved.

I then asked to speak to the Principal. When I explained the situation to the Principal, she volunteered to speak to the teacher. She then set up a meeting with both boys and their fathers.

I cancelled my scheduled patients from 10.30 am to 2pm on the day of the meeting and came to the school. Brad told me he was more convinced than ever that the boy took the stamps. Other kids told him he had taken things from them but they did not have the courage to complain.

The meeting started at 11 a.m. There were two fathers, two boys and the Principal present. After I explained the situation the boya??s father became indignant. I said,a?? hold it.a?? We have evidence that your son has been a bully to other kids in the class. He has intimidated them and taken things from them. He is the most likely person in the class to have taken Brada??s stamps.

The father wanted the proof. I told him we would be happy to produce the proof. The pressure on the boy was too much. He admitted taking the stamps. He promised to return them in the morning. The boya??s father was enraged and embarrassed. There would be no attempt by the father to understand the boya??s behavior.

Both the father and son apologized to us. Brad and I accepted the apology. I could just feel how proud Brad was of me. I expressed how proud I was of him for sticking up for his rights.

This bonding experience is one of many. It lasts to this very day. The proof of this bonding between us can be seen in Brada??s introductory blog to this series.

Our goal is to explore why our relationship works and help others if we can improve their relationship with their kids.

                       

Potassium And Exercise: Sports Drink Or Orange Juice?

As I stutter through recovery from LungMutiny2010, I’m paying more attention to my diet. So as I try to go out for my 10-minute walk everyday, I still drink some sports drink — usually Gatorade made from the massive vat of powder you can buy at Costco.

We tend to get plenty of sodium in our diet — far too much in the U.S. actually — but I always worry about potassium when I’m sweating (Disclaimer: I am not an exercise physiologist or a cardiovascular or nephrology physician.)

I always thought that the widely-sold sports drinks were the best sources of potassium outside of eating bananas or some dried fruits. I was surprised to learn that an 8-ounce serving of orange juice contains 18-fold more potassium than an 8-ounce serving of Gatorade?? (450 mg vs. 25 mg). Who knew?

I suspect this is a good thing when exercising, but perhaps a concern for hypertensive patients who must monitor their potassium levels.

Is there anyone with more practical knowledge about potassium and physiology willing to weigh in? Is a dilute, no-pulp orange juice (maybe 1:1 with water) a good adjunct to a sports drink when carrying multiple bottles of beverages on a bike ride or trail run?

                       

Baby Boomers And Skin Cancer

Baby boomers may have a new reputation. According to new cancer research, they are??five times more likely to be diagnosed with malignant melanoma — the type of skin cancer that kills the most people.

The incidence rates of melanoma have risen from 7 cases per 100,000 people in the 1970’s to 36 cases per 100,000 today. The rising rate corresponds to the increase in tanning during the 1970’s, when baby boomers were young adults.

Parents and grandparents of teens should be checked by dermatologists as part of their preventive healthcare. I can only hope that teens today will be responsible for the stopping of this increase as they’ve grown up with the message that sunscreen is important and should be a daily part of their lives.

Photo credit: tata_aka_T

                       
                       

This post, Baby Boomers And Skin Cancer, was originally published on
                        Healthine.com by Nancy Brown Ph.D..

The Diaphragm Is Back, And It’s Latex-Free

After a prolonged hiatus, during which diaphragms became as scarce as Elaine’s treasured sponges, the Ortho All Flex diaphragm is back, and it’s now latex-free.

The over one-year (at least in my area) shortage happened as the manufacturer transitioned from the old latex to new silicone diaphragms, and suppliers everywhere began backordering this important barrier contraceptive.

I called Ortho today, and was informed that the new diaphragms have been available for a few months now. I checked with my local pharmacy, and they advised me they could get a size 75 within 24 hours. At online pharmacies, diaphragms sell for $40 to $50. You’ll need to restock spermacidal gel at a price of about $15 a tube (good for 30 or so uses).

Milex also makes non-latex diaphragms (arcing spring and wide seal), but these diaphragms must be ordered by your doctor from Cooper Surgical, as opposed to you filling the prescription at the pharmacy. I’ve been purchasing these diaphragms for my patients for the past year, and will continue to use them for patients whose anatomy calls for the added secure fit of the wide seal or arcing spring.

These days, it seems I rarely prescribe the diaphragm — most women seem to prefer other methods. In my younger years, the diaphragm was a very popular method. It’s a good option if you don’t want to or can’t take hormones. Efficacy ranges from 84 to 94%, but in motivated couples who use it properly (Mr TBTAM and I were in that group for years), the diaphragm can be extremely effective. It only works if you use it properly every time you have intercourse, so if that’s not you then look elsewhere for your birth control.

Don’t use the diaphragm unless you know your??partner is HIV negative, since the method requires the use of spermacides, which can increase HIV transmission from an infected partner. Although most women use it without problems, users of the diaphragm have a slight increase in vaginal infections and urinary tract infections.

For more information and to see if the diaphragm is right for you, visit Planned Parenthood’s “Diaphragm” webpage.

                       

Using Rap To Teach CPR

Earlier this week we facetiously found??out how sex??is being??used to teach CPR. Now the American Heart Association is turning to rap to teach CPR basics in its Be The Beat campaign:

                       

Unnecessary Tests And Treatments: Responsible Reporting Can Help

Just when Ia??ve lost hope that mainstream media will stop perpetuating the myth the more medicine equals better care, the Associated Press came up with this excellent piece. The article states, rightly, that a??anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary,a?? and that, a??it may lead to dangerous side effects.a??

Regular readers of this blog should be familiar with those concepts. I wrote recently that patients often reject evidence-based medicine. One reason is that there??aren’t enough clinical guidelines available for patients to make an informed decision.

That leads to unnecessary tests, which can range from birth a?? with an escalating C-section rate, for instance a?? to death, with the copious amounts of dollars funneled into end-of-life care. And thata??s ignoring the billions of dollars spent on unnecessary antibiotics, unproven cancer screening, and imaging scans.

Responsible reporting like this can help sway some patients to be more critical of their physiciana??s recommendations. And when a doctor discusses the pros and cons of ordering a test, patients may be more receptive to the fact that more tests will not necessarily improve their health.

Ita??s also encouraging that medical journals, like the Annals of Internal Medicine and Archives of Internal Medicine, are planning a series emphasizing a??high-value, cost-conscious care.a?? But to reach patients, mainstream media needs to pick up the baton and run with it. More articles like the AP piece would be a great start.

                       

Nutritional Supplements: Do They Really Help Prevent Disease?

(Guest post submitted by MD Anderson Cancer Center)

Aisles in grocery stores and pharmacies are stacked with vitamins, minerals, herbs or other plants that you take in pill, capsule, tablet or liquid form. And, many of us buy these supplements and take them regularly, hoping to lower our chances of getting cancer and other diseases.

But do supplements really work wonders? Should you take them to help prevent cancer? Our experts say beware.

a??Dona??t be fooled by the label on the bottle,a?? says Sally Scroggs, health education manager at MD Andersona??s Cancer Prevention Center. a??Researchers are still unsure about whether or not supplements actually prevent cancer.a?? Some studies have suggested that supplements may actually increase cancer risk by tilting the balance of nutrients in the body.

Results from the Womena??s Health Study and The Physiciansa?? Health Study II found that vitamins E and C do not prevent cancer. The Selenium and Vitamin E Cancer Prevention Trial showed similar results, suggesting these supplements didna??t help prevent prostate cancer.

a??If you eat lots of vegetables, fruits, whole grains and beans, you should get the nutrients, including fiber, vitamins and minerals, your body needs to lower your chances of getting diseases like cancer,a?? Scroggs says. a??Taking a pill cana??t replace a healthy diet.a??

Not sure which foods get the job done??? See our list of recommended foods packed with cancer-fighting nutrients.

Supplements may benefit some

More research is needed to truly understand the relationship between supplements and cancer risk, according to the American Institute for Cancer Research.

Still, there are some situations when taking a supplement might do your body good. This is especially true for men and women who are not getting enough nutrients because of food allergies, genetics or chronic illnesses.

Here are a few examples of when supplements may be right for you:

• Women who are pregnant or breastfeeding


• People at risk for vitamin D deficiency


• People at risk for osteoporosis


• People at risk for B-12 deficiency


• People age 50 or older


• Vegans who consume no animal foods

Get professional advice

Thinking about taking supplements?

Speak with your doctor or a registered dietitian first. He or she can decide which pills you really need and what dose you should take. Keep in mind that there is no vitamin or supplement thata??s good for everyone.

A registered dietitian also can tell you what to look for on supplement labels. This is important because some supplement labels can be confusing or misleading. Many companies claim their pills can cure cancer when, in fact, they dona??t, according to a recent Congressional study.

a??Remember, supplements are just that a?? supplements,a?? Scroggs says. a??Even if your doctor recommends them, your top priority should be getting the nutrients you need from the food you eat.a??

Do your research and talk to your doctor before you add supplements to your diet

This article originally appeared on MD Anderson Cancer Centera??s Focused on Health e-newsletter. To read the full newsletter, click here. To subscribe to future issues, click here.

REFERENCES:

American Institute of Cancer Research

Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Journal of American Medical Association. 2009 Jan 7; 301(1):39-51.

Herbal Dietary Supplements: Examples of Deceptive or Questionable Marketing Practices and Potentially Dangerous Advice. U.S. Government Accountability Office. 26 May 2010.

Downloaded at http://www.gao.gov, 13 September 2010.

Physiciansa?? Health Study II: Vitamin E, Ascorbic Acid, Beta Carotene, and/or Multivitamins in Preventing Cancer and Cardiovascular Disease in Older Healthy Male Doctors

Vitamin E in the primary prevention of cardiovascular disease and cancer: the Womena??s Health Study. Journal of American Medical Association. 2005 Jul 6, 294 (1): 56-65.

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We would love to hear from you.?? Do you take vitamin and supplements??? Do you eat fresh fruits and vegetables??? How do you maintain a healthy diet?

[Image:?? Provided by MD Anderson Cancer Center]

                       

Diabetes Criminals And Diabetes Police

At TCOYD??[Taking Control Of Your Diabetes], one of the sessions I attended was about Diabetes Police (Healthcare Providers) and Diabetes Criminals (People With Diabetes).??And I was a little taken aback by the title of the session, but we used it to our advantage when we walked into the session a few minutes after it had already started.

“Okay, we see a few late stragglers in here.??It’s not like they had to be on time or anything,” Dr. Edelman quipped from the front of the room, giving us a smirk. ??

“I’m sorry we’re late.??But what do you expect???We’re the criminals, man!”??I shot back at him.??And the crew of us “criminals” took up the last few rows, our smartphones at the ready to Tweet out the best of the session.??(We were the total nerd row.

The charismatic team of Dr. Bill Polansky and Dr. Steve Edelman were running this session, and it was packed with both PWDs [people with diabetes], caregivers, and medical professionals.??Bill and Steve took to the white board, asking first for complaints that PWDs have about healthcare providers.

The list that was compiled ran the familiar gamut:

• HC providers are always late.


• They dona??t work together (one doc may recommend a treatment that contradicts a specialist’s recommendation for another condition you may be living with).


• Docs set unreasonable goals.


• Patients are blamed for blood sugar numbers (the whole “good numbers/bad numbers” discussion).


• Patients want positive feedback, too, not just the negative stuff.??(Stacey brought up a good example of her most recent A1C being the lowest she’s ever achieved, and her doctor said, “Nice job!!”??It feels good to get patted on the back when you deserve it.)


• Docs say that they dona??t have enough time to answer all the questions.


• Audience member:??a??[My blood sugar numbers were] creeping up for a long time, but a??all of a sudden I was diabetic.a???? Where was the preventative measure to bring them down?a??


• One patient summed up the “seven minutes we get” sentiment with this statement:??a??Ita??s so hard to believe hea??s paying attention because his hand is always on the doorknob.a??

But it wasn’t all patients ranting about healthcare professionals.??The HCPros had their time to voice their frustrations, too:

• Insurance companies actually grade us on the number of diabetes patients that make it a??to goal” — regardless of the advancements that patients make, even if they dona??t hit a??goal.a??


• One doc asked:??”Why cana??t patients ‘get to the point’ and bring the most diabetes-related issues to the table???I want to help, but I can’t help with every issue they have.”


• Hearing the statement a??You dona??t know what ita??s like to have diabetes.a????Hard to make improvements suggestions because they arena??t taken seriously. (a??I am an RN and my son thinks I cana??t prick his finger, but his girlfriend can prick his finger.a??)


• a??I ran out of my meds.a????Patients need to remember to renew/order/take their medication.


• When patients dona??t update their medication list.??a??You know what Ia??m on.a??


• When patients dona??t know their own A1Cs


• a??You never told me I was borderline diabetic.a????Frequently, patients arena??t very honest about what theya??re eating.??(Bill:?? a??So theya??re also liars?a??)??Going on another medication costs too much, they dona??t want a second med, etc.??(Bill:?? Jokingly points to the word a??idiotsa?? on the sign.)


• Patients make up numbers on their logbooks, but the downloaded blood sugars form their meters tell a different story.

It was a good natured discussion, but some important points were raised by both sides.??It’s not just the PWDs who are grappling with the healthcare system — doctors and nurses and CDEs are tackling issues, too. “We’re graded on how many patients we have that make that goal [the A1C target set by the American Diabetes Association], even if the patient has made tremendous advancements towards good health.”

(This issue resonated for me, because I’ve always struggled for an A1C under 7%.??That pre-pregnancy goal took me a long time to achieve, and I conceived my child at an A1C of 7%.?? It dropped immediately and stayed very low and steady throughout my pregnancy, but for me, a goal of 6% pre-pregnancy was near impossible for me to hit without harrowing lows.?? My doctor and I had to take the blanket recommendations into account, of course, but we also had to tailor goals to my individual diabetes needs.)

I want this tattooed on my face.

The most refreshing moment of the session was near the end, when Bill took the microphone and offered this story as almost an aside. ??

a??I realized Ia??ve told patients to keep 3 days of food records, but Ia??ve never done it, myself.??So I tried it.??And I lied.?? I lied on my food record, to myself.??I was like: a??I ate one Oreo.a????But I ate a whole sleeve of cookies.a??

The doctor-patient relationship is just like any other — filled with dissenting opinions, moments of high triumph, and personal emotions.??Living with diabetes, our disease requires our detailed attention every moment of every day.??My hope is that healthcare professionals left this session understanding that their patients are more than their A1Cs, and that patients walked away knowing that healthcare pros are people, too.??And that there’s a way we can meet in the middle and improve our diabetes health.