How Americans get information on health and cancer

New results from a federally funded survey are out that describe trends in sources Americans use for finding health information. The survey revealed that we trusted our health care practitioners more in 2005 than in 2003, but the internet somewhat less between those two years. That, of course, is before this blog was born (August, 2006), so the internet trend may yet reverse ;-) .

Republican health care positions

For the record, and posted without comment, here's a link to a Kaiser Family Foundation summary of a presentation on health care by Republican presidential candidates, sponsored by the Lance Armstrong Foundation.

Tough talk on improving health care in California prisons

Today's NYTimes has a story about Robert Sillen, the court-appointed federal receiver chosen to overhaul health services in California prisons as the result of a class-action lawsuit. Sillen does not mince words with legislators in Sacramento and has no patience, for example, for political rhetoric about keeping felons off the street that elected officials must adopt.

He also dismisses the idea of setting goals and monitoring progress in health care improvement.

The Prison Law Office filed a complaint in federal court in June saying that Mr. Sillen’s plans have “no concrete details of how any of the goals or objectives are to be accomplished, no real timelines and no metrics.”

In an interview in his office in San Jose, Mr. Sillen dismissed the group’s assertions. “When people ask me how long and how much,” he said, “I have a stock answer: Long. Much.”

This, of course, is a mistake. I'll give him the benefit of the doubt and say he's just being contrary for the benefit of the media, but I'd be happy to help him with such a project.

The Receivership website is here.

More on (lack of) regulation of lead in toys

Much more, from Slate.com.

The plot thickens.

Catching up on the health blogosphere

Maybe all of you keep up better than I do with the health care sector of the blogosphere and this is a useless exercise, but here's the thing: sometime during my 6-week hiatus from blogging, my feed reader went dead, and I had stopped looking at it anyway. Today, though, I fixed it, and found a bunch of good stuff that seemed worth sharing. Here are some highlights (most of them, in fact, current).

At the Health Affairs Blog, a UK doctor writes about the ups and downs of pay-for-performance in the National Health System.

I didn't know, but I had wondered, what role the U.S. government might be playing in keeping China manufacturer-friendly; the Pump Handle blog today points to a McClatchy newspaper article alleging that the Bush administration has fought inspection rules that might have prevented recent lead poisonings from toys made in China. I found the article itself a little skimpy on facts, but I imagine - hope? - it's just the beginning of investigation on this issue.

This sounds like something I should be writing more about: the idea that a virus causes obesity, and the viral spread of the idea in the news. Read Knight Science Journalism Tracker's take on news coverage here.

Here's an obesity story I liked better, from Nature Newsblog, about how chimps practice dietary self-control; it's good to remember that, in the end, we are all apes. (Yes, even you, unless you happen to be that rare gerbil or komodo dragon who reads blogs.)

Thanks also to the KSJ Tracker for this cool science story (not about health, but I couldn't resist) about a juvenile sooty shearwater - a wide-ranging seabird, photo above - in New Zealand that had picked up a tiny tracking device implanted in a salmon in the Pacific Northwest of the U.S.

White Coat Notes, from the Boston Globe, reports that Harvard researcher and patient safety guru Lucian Leape approves of the new Medicare non-reimbursement rules, because, in Leape's words,

We’ve got a lot of solutions out there and the thing that is so frustrating is they haven’t been implemented.

Finally, Gary Schwitzer wrote about the increasing infomercialization of health segments on local TV news station. Scary.

Just trying to figure out...

why this blog has a whole raft of hits today emanating from my interview with Nick Genes last December, when I hosted Grand Rounds.

So if you're coming from there, did someone else recently link to that interview?

Not paranoid, just wondering.

National Quality Forum request for public comments

Just passing along a request for comments...

August 20, 2007 Update

Public Comments Requested for Three NQF Reports. NQF is pleased to announce that the following three draft reports are available for public comment. Comments must be received by Friday, September 7, 2007, 6:00 pm, EDT. NQF is now using a program that facilitates electronic submission of comments.

* National Voluntary Consensus Standards for Ambulatory Care: Cycle 3
* National Voluntary Consensus Standards for Ambulatory Care: Measuring Healthcare Disparities
* National Voluntary Consensus Standards for End Stage Renal Disease Care

Questions about the NQF and/or this email can be directed to info@qualityforum.org or 202.783.1300.

Preventing motor vehicle injuries in primary care

The US Preventive Services Task Force has just issued its findings on counseling for seat belt use and on drinking and driving in the primary care setting. The Task Force basically identified critical research gaps for both: they concluded that there is insufficient evidence to assess whether physicians' counseling of patients on seat belt use or drunk driving adds to existing public health efforts such as legislation.

Such evidence gaps are, unfortunately, common amongst evidence-based primary care recommendations.

Anyone at NIH or CDC want to fund a study?

More bloggers weigh in on Medicare nonreimbursement

The Physician Executive blog and Medpundit ("You Broke It, You Bought It") have posted their thoughts on the new Medicare rules stipulating that treatment of certain preventable adverse events and health care-associated infections will not be reimbursed. It's worth reading the comments on each, also those at Paul Levy's blog.

Mike Leavitt starts a blog

US Department of Health and Human Services Secretary Mike Leavitt has a blog. Sounds like he's writing it himself, but will have help managing the comments, and therein lies, I imagine, the challenge. Cheerfully posting HHS news updates is one thing, confronting the masses head-on and transparently in this format will be quite another.

Preventing medical errors: an official incentive

Medicare now says that it won't reimburse hospitals for hospital-associated infections, or the sequelae of serious adverse events, according to an article in today's New York Times. About 100,000 deaths per year are estimated to occur from hospital-acquired infections alone, and treating such infections is estimated to cost billions of dollars. The idea behind the new rules is that such events are preventable, and that non-reimbursement will further compel hospitals to take steps to ensure that they don't occur.

Hospital organization representatives interviewed in the article question the extent to which adverse events and infections are, in fact, preventable. (Paul Levy, CEO of Beth Israel Deaconess Hospital and blogger, believes that infections are preventable, and has written at length - e.g., here - about his hospital's goal of zero infections.) Hospitals also worry that they'll be have to spend more of their own money on tests of infection upon admission so that they can demonstrate that certain infections are community-acquired. It'd be an interesting economic analysis (that I'm not qualified to make) to see whether diligently working toward zero infections, in a climate of nonreimbursement for infections, pays off as well as investing dollars to try and prove that infections are not hospital-acquired, though the latter could provide interesting data if studied rigorously.

More details on this initiative soon.

More on aging in For Better or For Worse

Today's For Better or For Worse comic strip (go to August 16, 2007, in the archive if it's not visible when you look) addresses the issue of polypharmacy: the grandfather, who is working to recover from aphasia caused by a stroke, is apparently depressed, and when his daughter suggests upping his meds, his wife replies that he's already taking too many.

Tough one. It'll be interesting to see how the strip, which takes place in Canada, resolves this issue. Will they bring in a consulting pharmacist to review all Grandpa's meds? Will they find a way, given that he can't talk, to engage him in psychotherapy (e.g., instant messaging)? Or will he be miraculously and glibly cured - maybe even of the aphasia - from an insight experienced, say, in the presence of one of his grandkids or great grandkids?

In any case, the thread is a refreshing break from the saccharine and highly annoying romance of Anthony and Lizard Breath (see, for example, August 11 in the archive).

Grand Rounds

Please check out medical blogging's Grand Rounds hosted this week at Med Journal Watch.

It's been much too long since I submitted anything to Grand Rounds; I really need to get with the program.

Kids brainwashed by advertising

This article in today's NYTimes describes how kids prefer foods that come in McDonald's packaging to the same foods in plain wrappings. Apparently the official McDonald's response is to add healthier foods - with the proper appealing packaging - to their lineup, rather than cop to the brainwashing.

As summed up by one of the researchers,

“We often hear that parents are the ones responsible for their kids’ nutrition,” Dr. Robinson said, “but in reality there are these other factors, created by a tremendous amount of advertising effort, that undermine parents’ ability to make healthy choices.”

Evidence is the main issue for supplements

Interesting perspective on prioritization of research on dietary supplements, from Mark Moyad, Director of Preventive and Alternative Medicine at the University of Michigan. Thanks to The C.A.M. Report blog for pointing this out.

Raw milk: "Russian roulette" is right

My usual morning newspaper routine includes reading the health sections on Tuesdays, and the food sections on Wednesdays. I gather the raw milk people have been plastering news outlets with press releases recently, because Sally Squires' Lean Plate Club column yesterday in the Washington Post health section was pretty direct about the risks of drinking raw milk, and the Times reported on it in today's Food section (see below).

Squires' column reports a number of recent cases of milk-borne bacterial illness in humans (there are a number of pathogenic bacteria specific to milk), and gives good data on the extent of the problem: raw milk from a quarter of the farms tested had disease-causing bacteria in it. Particularly telling regarding public understanding is Squires' online chat yesterday, where a number of people wrote in to say, basically, that they drank raw milk all the time growing up and never got sick. As I always say, though, the plural of anecdote is not data. People, did you read Squires' column?

Today, the New York Times reports in the food section on raw milk, and the struggle over whether it should be legal or not. Writer Joe Drape interviews a number of raw milk fineshmeckers, some of whom even feed it to their kids, who have apparently fallen for the improved healthfulness arguments cited in Squires' article. More enzymes? Sorry, they're destroyed as soon as they hit the stomach. Maybe it tastes better but, as the Center for Science in the Public Interest points out in the Times article, universal pasteurization led (early in the 20th century) to a precipitous drop in the proportion of food-borne illness caused by milk. Otherwise, the Times does not offer any data on risks, just perceptions.

I think many people are more likely to fall back on their own experience than to pay attention to hard numbers. Some consumers, those who are more likely to prefer small, organic farmers over large industrial farms, for example, (and I sympathize, but for other reasons) may prefer to take their chances with "natural." They might believe the hokum spouted by the Sally Fallon, who is trying to promote consumption of the who says that non-industrial dairy-produced milk has its own antimicrobial properties. Is that so? Well, until you submit your magic milk for bacterial testing along with everyone else, I'm not touching it. In this case, I'll side with the National Dairy Council official quoted by Squires, who said that that drinking raw milk is "like playing Russian roulette" - it's hard to argue with that.

Update from Health News Review

Gary Schwitzer, who runs a site called Health News Review that systematically reviews the quality of health news, has posted highlights from the site over at the World Health Care Blog. Gary points out a number of disappointing stories in recent national health news.

I, for one, am grateful that Gary has continued to mind so ably the quality-of-health-news store while I've been off investigating new directions (nothing terribly exciting to report as a result, I'm afraid) and noticing what it's like not to blog regularly (was harder to stay away than I expected).

Where are the standards?

I was surprised this morning to find that the Washington Post had published this piece. It's about a biochemist who is promoting manuka honey from New Zealand as a wound-healing agent, and it also does a pretty good job of promoting manuka itself.

But the article presents almost no evidence that manuka works. Instead, it interviews other honey experts, who lament the slowness of the medical community in accepting alternative treatments. The writer does, to his credit, quote researchers in the field who acknowledge that more research is necessary - including in vivo studies. One small, unpublished study is described: it's not clear whether it was s randomized, and though 7 of 10 wounds colonized with MRSA were no longer colonized at the end of the study, no comparison result is offered.

Apparently the FDA has approved manuka as a wound dressing, but what does that mean? that they don't think it will kill you? and if so, how do they even know that? Are the standards different for wound dressings from, say, anti-cholesterol drugs?

Why so much fuss about something that hasn't even reached the level of credible research? The article has that alternative-medicine air of "let's take back medicine from evil Pharma, and go back to natural remedies used for thousands of years" - even if there's really no good evidence that those natural remedies were actually effective or safe.