Medicine For People!

January 2010

New Year's Revelations

Happy New Year! We're always interested in your health, but this year Medicine for People will not inveigle you to get more exercise, stay away from sugar and fat, and quit smoking. You already know you should do that. Instead, we are offering five fresh insights into health. These stretch from the political to the practical to the spiritual. Here are our five New Year's Revelations.

Healthcare Reform - Not Always What It Seems

The pharmaceutical and health insurance industries have been popular scapegoats for our nation's health care woes. Through the years, I've taken the unpopular stance of defending these industries in newsletter articles; see, for example, our August 2006 newsletter. To my amazement, the National Public Radio series, This American Life, ran a superb summary of the difficulty assigning blame. The first segment covers physicians who milk the system. Before you become too incensed, the second section focuses on patients who drive costs higher despite honest and capable physicians. Next, an insurance company executive describes his losing battle to hold down expenses (and premiums) in the San Francisco Bay Area. Finally, you'll learn of some surprising rays of hope arising from the current healthcare debate.

Comparison Shopping - A Better Doctor at a Better Price

Last week I noticed a lemon-sized hernia in a man consulting me for another reason. When I inquired, he said he knew what it was and that it could be repaired. But he worked as a laborer, had no insurance and few resources, and was resigned to living with it.

Some years ago a Dr Kugel near Olympia limited his practice to hernia and, due to his skill, he attracted patients from all over the state. By streamlining his office to care for just this one illness, he achieved great advances in cost-effectiveness, and offered the procedure in his office surgery suite at about $2500. Total. No other charges. Those of my patients who sought his care found him communicative and competent. Unfortunately, Dr Kugel has retired, leaving no one to take over his practice. The only advice I could give was to sit down at the telephone, find some clinics that could and would quote a price (many won't), then compare. Free-standing surgical clinics and major medical centers are more likely to know what their global price would be, the former because all the work is billed out of one location, the latter because they have more overseas patients who will not come without a set price. The last time I had to do this for a member of my own family, the Mayo Clinic surpassed all others in listening to my question, pausing a few moments, then giving me the most attractive price.

As a careful shopper, you'll want to check out how other patients rate the clinic's physician at ratemds.com or drscore.com, and be sure of their credentials at the Washington State Department of Health's Health Systems Quality Assurance Online Search. In the case of surgery, you can check out the hospital at the Medicare Hospital Quality Compare. Don't forget, word of mouth is still one of the best sources for finding a doctor. Ask a trusted friend with some experience or expertise.

As for my hernia patient, while we found some offers to take care of him at reduced cost, no one in this immediate area would quote a price.

Sometimes Patients Know Better than Doctors

In a recent New York Times article physicians complained that more and more women at high risk for breast cancer are refusing to take the drug tamoxifen to prevent the disease. Doctors know that taking the drug may prevent breast cancer in some patients. So why are women refusing?

Putting the numbers from the article into a table, we see that:

If 1000 women at high risk for breast cancer take tamoxifen for five years
Good things that happenBad things that happen
9avoid breast cancer21develop endometrial cancer
13avoid a fracture21develop a blood clot
31develop a cataract
12experience sexual problems
120develop menopausal symptoms
21Good outcomes205Bad outcomes

Seeing these numbers, most women decide the side effects are worse than the benefits. You can't help wondering why docs are pushing their patients to take tamoxifen and why the Times journalist calls women's decision not to take the drug "a phenomenon known as omission bias." How can anyone question the woman who turns down such an offer?

Our New Years Revelation: don't count on the medical authorities to make your decision for you. Pay attention, and do what is best for yourself.

Target Your Worry

Worried about N1H1? Flesh eating bacteria? An airplane crash? These threats are not worth your worry-time - better to face one of your biggest risks, the man or woman in the mirror. Our nation's health trouble-shooter, the Centers for Disease Control in Atlanta, lists the leading causes of death.1

CauseNumber of deathsPercent of all deaths
tobacco435,00018%
poor diet and physical inactivity400,00017%
alcohol consumption85,0004%
microbial agents75,0003%
toxic agents55,0002.3%
motor vehicle crashes43,0001.8%
incidents involving firearms29,0001%
sexual behaviors20,0000.8%
illicit use of drugs17,0000.7%

A Get-Well Secret - "The Helper's High"

Can generosity make you well? A recent article in the New York Times gives compelling evidence that it can. People with chronic pain, the elderly, even those with multiple sclerosis fare better when they are helping others. People who give and help others are more pain-free, have fewer disabilities and even live longer. One study showed that elderly people who volunteered were 44 percent less likely to die during the study period. Apparently altruism lowers the levels of stress hormones whereas self-absorption makes them worse. You may be helping yourself when you lend a helping hand.

Synthetic Thyroid - The Downside of Progress

For decades, the only treatment for hypothyroidism was thyroid glands from pigs or cows, removed in the packing house, dried, and made into tablets for people to swallow. The most popular brand was Armour thyroid, produced by the meat-packing company of that name. After some time, the major element of thyroid hormone, T4, was synthesized and marketed under the brand name Synthroid. Once the pharmaceutical company had convinced doctors that the synthetic product was more predictable in potency than desiccated thyroid, they captured most of the market share, as well as the support of leading endocrinologists. As it turned out, both were incorrect, as several recalls of Synthroid proved.

Many patients (including many of our patients) reported that they felt more normal on desiccated thyroid than they did on Synthroid or any of the levothyroxine generics. At the clinic, we were able to buy desiccated thyroid in bulk and sell it for about $13 for three months' supply, compared to about $17 for generic Synthroid.

Recently, however, desiccated thyroid has become impossible to find at any price. The FDA is claiming that desiccated thyroid is a new drug and requires FDA approval, a process which is both expensive and time-consuming.

What is a patient to do? If you are lucky, generic Synthroid (levothyroxine) will get you by for about $25 for three months. If that doesn't do, then it'll run you about $90 for a three month supply of bio-identical T3 to supplement it.

While you are limbering up your check-book, you might also give a call to Senators Cantwell and Murray, and Representative Norm Dicks. Healthcare insurance reform we need, but let's look, too, at where those insurance dollars are going. In case you didn't know, many dollars pay for unnecessarily expensive brand-name drugs, because Big Pharma now pays generic drug manufacturers NOT to produce inexpensive generics that compete with their cash cows.

Mammography under 50 - A Good Use of Healthcare Dollars?

On November 16, 2009, the U.S. Preventive Services Task Force (USPSTF) reported that the benefits of mammography for women aged 40 to 50 did not justify such screening. Editorials in the December 24th New England Journal of Medicine might help clarify this important issue for you. First, two cancer specialists noted that

"more than 1900 women must be screened for 10 years to prevent 1 death from breast cancer, and there are approximately 60% more false positive results and unnecessary biopsies than there would be if screening began at 50 years of age - some younger women will choose to forgo mammograms, though others will still choose to have regular screening."

After this less than stunning defense of mammography in the younger age group, they concluded, amazingly, that

"no woman in her 40s should be denied insurance coverage for screening mammography."2

Does this cancer specialist have any inkling why the nation's health care costs are so high?

In the same issue of the Journal, a medical ethicist noted that

"Screening mammography for women in their 40s is clearly effective. The problem is that the benefit is tiny and expensive. A recent cost-benefit analysis showed that adherence to the current guidelines from the American Cancer Society costs more than $680,000 per quality-adjusted life-year (QALY) gained, as compared with a proposed alternative costing only $35,000 per QALY. Statistician Donald Berry has calculated that for a woman in her 40s, a decade's worth of mammograms would increase her lifespan by an average of 5 days - and this survival advantage would be lost if she rode a bicycle for 15 hours without a helmet (or 50 hours with a helmet). The key issue here, however, is that these figures represent population averages. For the small number of women whose lives are saved, the difference is literally as large as that between life and death."3

He concludes by noting that we as a society need to admit that we have limited resources to spend on health care. We can allocate those dollars in a way that provides us the most benefit, or we can stumble along, as we do now, afraid that some will accuse of us of rationing, ignoring the actual world of budgets and finite checking accounts.

Reserve your Mercury-Free Influenza Vaccine for the 2010-2011 Season

We offer mercury-free seasonal flu vaccine. Soon we must put in our order for vaccine for this fall. We go to extra effort to obtain this mercury-free vaccine. We can't return it, and it is usable for only the current winter season. Some years we've wished we had more; one year we had to throw some away. To help us match our order with your needs, this year we are taking $10 deposits in the office to guarantee you access to the 2010-2011 version. Once we run out, we can obtain only the usual mercury-preserved vaccine.

Next year's vaccine will include the current H1N1 vaccine.

Upcoming Classes

Meditation

Dr Rienstra trained as a teacher of the Transcendental Meditation technique, and worked as the only TM teacher in the northern Olympic Peninsula for many years. No longer affiliated with the TM organization, he still practices and teaches meditation. If you are interested in joining the next class, call us at 385-5658.

Conscious Eating/Conscious Living

Twelve week support group offering a "how to really do all this" approach to weight and life management. Wednesdays 10:30am-12:30 pm. Beginning January 20, 2010. Affordable. Facilitated by Janet Goldenbogen-Self RN 360-369-8134 janett@cablespeed.com

Coming Soon

  • Time to review the current recommendations for osteoporosis.
  • Multiple Vitamins - Myth or Miracle?

Footnotes

1 Actual Causes of Death in the United States, 2000. Ali H. Mokdad, et al. JAMA. 2004;291:1238-1245

2 NEJM Dec 24, 2009 261:2499

3 NEJM Dec 24, 2009 261:2501

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.