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"Where have you been?", I hear you cry.  Well, to be brief, I've had nothing much to write about that I believed would  pique your interest.

That was until I read about the danger to your health that neckties have recently been proven to be.

Indeed, in spite of all the dangers known to lurk in every nook and cranny there was one nook, or cranny, that has been overlooked. Until now that is. That is men's necks.  Er, their neckties.

As reported in the WSJ, Thursday, November 19, 2009, page 1, and in many prestigious medical journals, the necktie may be doing us in.

Not that most men's necks should  not be tied, some tightly if you ask me, it is now proven the ties themselves, not men who wear them necessarily, can be a hazard to your health.

To properly understand what I have to say about this you'll need to know the meaning of the word: 'fomites', a word you may not have used recently, but is common in medical parlance.

Fomites are not people that foment things, rather they are things that foment disease.

To be clear, the definition of 'fomites' is:

any agent, as clothing or bedding, that is capable of absorbing and transmitting the infecting organism of a disease.

Which brings me back to neckties.

We are all, hopefully,  now familiar with the necessity of proper and frequent hand washing to mitigate the spread of infections such as swine fu. The reason, of course is that infectious organisms, such as the swine flu virus, find haven upon us and can be transmitted from 'hand to mouth' as it were.

Indeed avoiding people, and places, in general is a good idea for lots of reasons, avoiding infection being one of them.

Now it is has been determined that the common tie, bow or straight, can be a major source of infection and as such has been banned outright from many hospitals and other places where health care is delivered.

Now, to make it official, and to assure the populace (us) that they are on the forefront of health policy and protecting the public, the ancient, in more ways than one,  American Medical Association considered this past June Resolution 720, which advocates a new dress code for doctors.

That's right folks, forget pesky cancer and nuisance heart disease, the AMA is busy, not saying 'Yes to the Dress', but, 'No to the Bow' (tie).  That's the long and short of it.

Ties, it seems are never, never, ever, washed by their owners. They are fondled by patients, sneezed upon, stuck in bad places, and, as I said, never washed. Nor changed very often either.

To some older doctors the problem is a 'knotty' one of sorts, they believing the issue is created by younger doctors who prefer a more casual style of dress, sans tie.

In 2006 the British Medical Association took a hard line banning physicians from wearing 'functionless' clothing, including neckties, because of the risk of spreading infection.  Indeed ties have been found to cause infections including forms of pneumonia and a serious infection of the bowel caused by a dangerous bug called Clostridium difficle.

To that end, the neck end that is, a company called SafeSmart, Inc has been selling ties "treated with a stain-resistant coating that the company says thwarts microbes.

 Perhaps once the official dress code is established, the AMA will be able to focus on more pressing issues.

PRACTICE HEALTH DEFENSE: Keep your children's, and your, hands off of the doctor's tie, or anyone else's for that matter.

The current Swine Flu pandemic is real, real important, and possibly for some, real confusing.

First, here is a little reminder of past influenza pandemics:

SERIOUS STUFF, HUH?

Here are some flu-facts that may help reduce flu conFLUsion.

First think of one influenza virus as a randomly arranged Rubik's Cube. Imagine trying to remember the color pattern.  This is what your body's immune system does in order to recognize that one virus when you are exposed to it.

Now imagine that there are multiple different flu viruses each with a different color arrangement and having to recognize each of them. Your body does that too.

The regular influenza vaccine contains the color arrangements of several virus coats. The idea is that the vaccine mix has the colors of the most likely viruses floating around and coming this way this flu season.

There is one novel color pattern that is a particular problem, the Swine Flu pattern and this pattern is not in the regular influenza vaccine mix.  Hence, the need for the separate 'Swine Flu' vaccine. This Swine Flu virus is also called the 'Novel H1N1' or 2009 H1N1 virus.

The unique coat of the virus means that your body is unlikely to completely recognize it when exposed and, therefore, you may become infected by the virus.

THE REGULAR FLU VIRUS- kills about 36,000 people each year and hospitalizes more than 200,000. Of those hospitalized 20,000 are under 5 years of age and over 90% of deaths are in people over 65.

THE SWINE FLU VIRUS- causes a greater burden in people younger than 25, including newborns exposed in the womb. There are few cases reported in people over 64, in contrast to the regular flu.

Worrisome is that pregnancy and other high-risk disorders such as asthma, diabetes, disorders like cancer that can impair the immune system, heart disease, kidney disease and others increase the risk of serious infections no matter your age.

TESTING FOR FLU: There was a very sad story reported in the paper of a 10 month old baby who reportedly died of the Swine Flu, though allegedly tested for it in the doctor's office and the test 'reported to be negative'.  The child it was reported was NOT treated with Tamiflu, an effective treatment for Swine Flu. The baby, it was reported, was found to be infected with Swine Flu at autopsy.

What hapened? Possibly the test was an office-based test for Swine Flu, often called the Rapid Flu Test.  It is often insensitive to the presence of flu and should NOT be relied upon to defer treatment if the test is 'Negative', meaning 'no flu'. If there is any hint clinically of Swine Flu in the face of a negative Rapid Flu Test there better be a better reason not to start treatment.

The best test is the so-called PCR test.  You don't need to know what that stands for, BUT, if you get an office-based 'Rapid' Flu Test and it says 'No-you don't have it' and no treatment is started DEMAND that the PCR test be sent out.

THE SWINE FLU VACCINE

If I could be made immune to every disease I would do it. I would like to be immune to Swine Flu and the new vaccine is likely to confer some degree of immunity. Those at high risk should certainly consider it. My reading tells me that the risks of complications from the Swine Flu vaccine are comparable to those of the Regular Flu vaccine, which are usually nil. The past, however, doesn't predict the future so discuss the vaccine with your doctor, but don't just blow-off the possible importance of the vaccine to you if you are in one of the high risk categories I mentioned above.

If you think you need it, call your doctor now and get in line.

PREVENTION:

Consider vaccination.

Go to the Moon or Mars.

Stay clear of crowds and people with flu-like illnesses.

Wash your hands with soap and water and use Purel-like sanitizers OFTEN. Particularly after touching any public doorknob, terlet, etc or any other person.

Avoid touching your eyes, nose, and mouth.

If you think you may have flu seek medical attention promptly.

If you are a caretaker for someone with influenza and you are not immunized or at high risk ask your doctor to consider prescribing Tamiflu for you before you catch the flu to reduce your chances of becoming infected.

FINALLY: If you are ill with a flu-like illness, stay home until you are better and let me know if we had any plans to get together.

MORE INFO: Go to the CDC site at www.cdc.gov.h1n1/qa.htm

 I just received this announcement and thought those who subscribe to my website would be interested.

The link below should take you to the 233 page document.

Note that the proposal, and it is only a proposal, does NOT include the so-called Public Option.

Enjoy.

Senate Finance Committee releases health system reform proposal
U.S. Senate Finance Committee Chair Max Baucus (D-Mont.) released a health system reform proposal this morning that will be considered by his committee next week. "America's Healthy Future Act of 2009" (PDF) is a comprehensive proposal that includes insurance market regulations, income-related subsidies for purchasing coverage and other reforms. Notably, the proposal does not include a public plan option; rather, it creates authority for the formation of a Consumer Owned and Oriented Plan, or CO-OP. Also, as anticipated and reported previously, the proposal differs significantly from the U.S. House of Representatives health system reform bill in that it would not repeal the sustainable growth rate (SGR) formula used to calculate Medicare physician payment updates. Instead, the Senate Finance Committee proposal replaces the scheduled 21 percent cut in 2010 with a 0.5 percent Medicare physician payment update. The package includes several other proposals of concern to physicians as well.

I have been 'asleep at the mouse', again, but only as regards these postings.

I have been very busy developing a website that helps patients and their doctors, manage diabetes on-line.

I have been busy, as well, writing a book called 'Exam Room Confidential' , a novel full of mystery and intrigue and exposing the pettiness and politics that surround the everyday practice of medicine. Advanced, pre-publication, orders are now being accepted.

And now to the point of today's posting given by the above title.

I have collected too many medically-related advertisements with claims that are either misleading, deceptive, incomplete, or patently false.

Many ads mislead, or omit, the credentials or qualifications of the person or organization offering the services. Some of these, as in the case of cardiologists, suggest the doctor is qualified in all categories of cardiac care when indeed their skills are limited or restricted to specific areas.

Some healthcare providers, and facilities, have 'catchy' names intentionally suggesting they are more than they are as when the word 'Institute" is attached to a one-doctor office or a facility that offers only routine, hum-drum services. Where I come from, 'Institute' implies a center of higher learning where scholars conduct state-of-the art research, and house educators, scientists, laboratories, and the like. Why the need to create false images?

Other ads suggest, or blatantly state flat-out, that what they offer can change the course of a disease, when there is no proof whatsoever that they can. The case below regarding Parkinson's disease is a prime example. To offer false hope to patients and families of this disease is cruel. But, who is watching over these ads? No one.

Sadly, the area of 'truth in advertising' in medicine extends to the monetary incentivized recommendations for treatments or procedures by doctors themselves who know what they offer will only help their bank accounts.

How is a patient to know?

Sadly, in most cases patient's are the least able to determine the facts as to whether a treatment, either advertised in the newspaper or offered face-to-face by their doctor is appropriate, necessary, and the least risky and most beneficial of all possible treatments for their condition.

Most doctors know, and most patients do not, that many disorders get better without any intervention and that thoughtful waiting is the best choice.

SOME EXAMPLES WHERE the 'AD CZAR' is needed: (President Obama, are you reading this?)

In the July 28, 2009 issue of the Health & Fitness section of the Sarasota Herald Tribune, on page 8E was a half-page ad from Sunshine Therapy Associates with the headline:

"A New Therapy for Parkinson's disease"

The ad went on to say that that their program, called 'LSVT BIG', as regards the course of Parkinson's disease, can:

"..delay progression..." (of Parkinson's disease)

Their headline claim is misleading in that it could be interpreted that they possess the knowledge and competence to administer a new treatment for Parkinson's that will alter the severity or course of the disease itself, not just symptoms or signs of it.

In fact, as the ad states beneath the headline, what they offer is a program of physical therapy.

Though physical therapy of any kind may or may not be beneficial in this disease and if recommended by a physician could be tried, my concern here is that the headline suggests a lot more than what is offered.

Their second claim, that their therapy can ' delay progression' of Parkinson's Disease is false as the physical therapy administered by this group has not been shown in independent, controlled, double-blinded scientific studies to delay progression of Parkinson's Disease in humans.

I personally spoke with the company that sells LSVT BIG Parkinson's disease physical therapy packages to end users such as your neighborhood physical therapist or Chiropractor and I was impressed by their professionalism and response to my concern. They communicated with the above mentioned local group and the group was eager to correct any misunderstandings and will place an ad clarifying what they can do and can do not do as regards Parkinson's Disease.

LSVT BIG is sold nationally so ads such as the one mentioned above may appear in many newspapers across the country.

Physical therapy is just one modality of treatment for Parkinson's disease and should be part of an overall program of care prescribed and supervised by a specialist in Parkinson's disease.

"MY SON, HE'S A CARDIOLOGIST." "YEAH, WHAT KIND?"

What kind, indeed? Many people have cardiologists, but are all cardiologists created equally? The answer is 'No'.

You would think any Board Certified cardiologist could take care of your heart attack by snaking in a catheter and expand your narrowed artery or put in a few stents if needed. Taint so.

In fact, Cardiologists come in different flavors, and if you're looking for chocolate and you get plain vanilla, you may be disappointed, particularly if you are in the middle of a heart attack and your cardiologist tells you 'well, I don't put in stents, I need to refer you to a cardiologist who does.

Now, here is where the truth in advertising comes in.

A cardiologist who only diagnoses heart artery disorders (the kinds that causes heart attack) by testing methods that DO NOT include cardiac catheterization and treats cardiac conditions ONLY MEDICALLY (does not do angioplasty or places stents) is called a "non-invasive" cardiologist.

A cardiologist who diagnoses heart artery disorders (the kinds that causes heart attack) by methods that does include cardiac catheterization and treats cardiac conditions ONLY MEDICALLY(does not do angioplasty or places stents)is called an "invasive-non-interventional" cardiologist.

A cardiologist who does all of the above AND is trained to diagnose and treat heart artery disorders by performing angioplasty and placing stents to open heart arteries is called an interventional cardiologist.

There is nothing at all wrong with being a non-invasive or invasive-non-interventional cardiologist and not an interventional cardiologist, but shouldn't you know up-front what your cardiologist can and cannot do when selecting one?

Many people develop heart rhythm disorders such as atrial fibrillation or ventricular tachycardia. Very often these people wind up in the hands of cardiologists not specifically trained in heart rhythm disorders. That may be a big mistake.

These sub-specialized cardiologists are called 'cardiac electrophysiologists' and should be considered when rhythm disorders are an issue.

If you open the Yellow Pages and look under 'Cardiologists' it is unlikely you will be able to tell cardiologists apart in terms of their skills and training. Why is that?

Below is a lengthy, but interesting, description of these categories, including their salaries which are now likely much higher:

"Training and Education for Cardiologists: Again, cardiologists start by training as internists, including 4 years of medical school, plus three years of residency training. After completing the internal medicine residency, a prospective cardiologist may enter one of many different types of cardiology fellowships. Cardiology fellowships are 2-3 years depending on the type of fellowship.

Non-Invasive Cardiologist: A non-invasive cardiologist primarily runs an office-based practice, seeing patients to prevent and manage potential heart problems. The average non-invasive cardiologist sees about 25-30 patients per day in the office. Non-invasive cardiologists do not do procedures; they mainly perform diagnostic tests to identify heart problems. If the problem is treatable with diet or medication, the physician will prescribe the appropriate drug therapy or dietary regimen. However, if the heart problem requires any type of surgical procedure, the non-invasive cardiologist will then refer the patient to another physician. Non-invasive cardiologists perform tests such as ECHO’s, stress tests, and EKG’s (electrocardiograms). Another more recent development for non-invasive cardiologists, which has been a lucrative advancement for them, is nuclear cardiology. Nuclear cardiology involves a high-tech special “nuclear camera” which is used to take images of the heart after the patient is injected with radioactive dye. These nuclear images are much more effective than other tests for diagnosing a number of heart issues.

Compensation for Non-Invasive Cardiologists: Approximately $400,000 per year, according to the MGMA.

Invasive, Non-Interventional Cardiologists: Invasive cardiologists do all the things non-invasive cardiologists can do, plus a bit more. Invasive cardiologists are trained in a diagnostic procedure called cardiac catheterization, which is used to find blockages of the arteries. Therefore, the non-invasive cardiologist’s time is split between office visits and time in the “cath lab” doing these catheterizations. If a blockage is found, and an additional procedure is needed, a non-interventional cardiologist can't intervene to fix the problem. Therefore, the non-interventional cardiologist would refer the patient to an interventional cardiologist for the angioplasty or whatever procedure is needed.

Compenation for Invasive, Non-interventional Cardiologists: The average invasive, non-interventional cardiologist earns about $454,000, according to the MGMA.

Interventional Cardiologists: This type of cardiology requires additional fellowship training, of 1-2 years in addition to the 3-year cardiology fellowship. The interventional cardiologist is able to perform more advanced procedures than the invasive and non-invasive cardiologist. Interventional cardiologists will spend most of their time in a hospital performing procedures such as balloon angioplasty to open blocked arteries, or placing tiny mesh stents into narrowing arteries. Most interventional cardiologists also spend some time weekly in an office, following up with patients after procedures, or consulting with them prior to the procedures. Interventional cardiologists typically complete hundreds of procedures per year, including up to 300 catheterizations and up to 100 angioplasties.

Interventional Cardiologist Compensation: Averages about $545,000 per year, according to the MGMA.

Electrophysiologists (EP): Yet another option for cardiologists is to complete an additional 1 to 2-year fellowship in electrophysiology, which is the study of the bio-electrical impulses of the heart which control the pace of one’s heartbeat. When the electrical impulses are not functioning properly, this can cause a heart arrhythmia which can be fatal if left untreated. Not long ago, the only remedy to correct irregular heartbeats was to insert a pacemaker. Now, although that is part of what EP’s do, there are also a variety of other surgical procedures such as ablation which essentially disables the part of the heart which is malfunctioning, and drug therapy to manage complex arrhythmias.

Electrophysiologists compensation: EP's earn about $480,000 annually, according to the MGMA.

PRACTICE HEALTH DEFENSE:

Read ads carefully and if they make claims that don't pass the 'smell test', move on.

Ads that claim cures or alter disease states should be viewed with skepticism.

When offered treatments where the benefits do not clearly outweigh the risks, get other opinions.

If you have a cardiologist, or about to select one, ask whether they are of the non-invasive, invasive / non-interventional , or interventional type.

If you have a cardiac rhythm disorder consider seeking out a cardiac electrophysiologist.

Tomorrow is July 4, 2009.

In the United States, Independence Day, commonly known as the Fourth of July, is a federal holiday commemorating the adoption of the Declaration of Independence on July 4, 1776, declaring independence from the Kingdom of Great Britain.

It is, according to the philosopher I trust the most, the day we also celebrate obesity in America. It is a day we can OFFICIALLY AND MUST gorge upon all the hot dogs, hamburgers and everything else we can stuff into our mouths and not only feel good about it, but patriotic as well.

That said, let us reflect for a moment on how far we have come, technically speaking, from the year 1776, when modern communication then meant signals from horseback rather than from an iPod.

But, have we come very far, really?

We have, you might say, when it comes to the commercial dissemination of media content-movies, music, and videos.

But, what about news you must know immediately?  In that regard I think we have stalled.

When is the last time you received an email from your perpetually snoozing FDA alerting you to a drug recall, that might, say, seriously affect your health? Don't remember?.

I don't either, but a short article by Peter Loftus placed in the top, right corner of page B4 of today's, July 3, 2009, WSJ titled: 'U.K. Issues Recall Of Various Generics' caught my eye.

According to the article the U.K has recalled a number of commonly used generic drugs manufatured in Mumbai, India by a company called Jbilant, because, to paraphrase the article, inspectors there allegedly found 'poor manufacturing methods and innacuracies  in documentation'. 

Below is one Google search result I found on the subject:

Jubilant recalls hypertension drug in UK, sees no big impact MUMBAI,INDIA July 2 (Reuters) -

Jubilant Organosys Ltd said on Thursday it has recalled an anti-hypertension drug from the U.K. market, after the firm that was contracted to make the drug failed a UK regulatory audit.

Reuters via Yahoo! Malaysia News-Jul 01 10:01 PM

I think the reference to 'no big impact' refers to Jubilant's bottom line not your 'bottom'.

HELLO!  WERE YOU NOTIFIED ABOUT THIS AND WHAT IS GOING ON?

Among the drugs referred to in the WSJ article include;

fluoxetine-generic for PROZAC, an anti-depressant

baclofen-generic for LIORESAL, treats muscle spasms and seizures

metformin-generic for GLUCOPHAGE, treats diabetes

amlodipine-generic for NORVASC, treats high blood pressure

naproxen-generic for ALEVE, anti-inflammatory

HERE IS ONE BIG MESSAGE: DO YOU KNOW IF THE GENERIC DRUG, OR BRAND FOR THAT MATTER, THAT YOU TAKE EVERY DAY CAME FROM JUBILANT OR ANY OTHER OF THE EIGHT COMPANIES FROM WHICH THE U.K. ISSUED RECALLS?

IF YOU DON'T KNOW ASK YOUR PHARMACIST AND SEE IF HE OR SHE KNOWS. 

IF YOU GET A VAGUE ANSWER, AS IN 'I DON'T KNOW', WHAT WILL YOU DO?  WHAT SHOULD YOU DO?

THE SECOND BIG MESSAGE IS JUST WHERE ARE OUR, AS IN THE GOOD OLE U.S. OF A., REGULATORS AND WHY ARE WE NOT BEING INFORMED IN AN ORDERLY AND PROMPT MANNER ABOUT DRUG RECALLS?

OH, ONE MORE THING, YOU CAN FIND THE COUNTRY OF ORIGIN ON YOUR PEACH OR PEAR, BUT CAN YOU FIND IT ON YOUR PROZAC?

 I have made many postings on generics and you can find them by typing 'generics' in the search box.

One, I will repeat, in part, below:

A 2007 law required the Food and Drug Administration (FDA) to make public what they know about drug problems. It took years of bickering from the public and private sectors to just get the law passed, and years to get the website up and running.

For too long this information has either been kept private, or made available only to 'professionals' like your doctor, and specifically kept from those who really have the need to know, you the patient.

Now, the FDA has put al of the information you need to know in one place at their website http://www.fda.gov/cder/drugsafety.htm.

I encourage you to look at it now, and regularly.

There are many links within the website to other sites of possible critical importance to you.

Keep in mind, what is published on that site is only information that comes to the FDA.

There are many other agencies and organizations that have alot to say about drug and medical device safety about which the FDA may be unaware.

One link on the website is http://www.fda.gov/opacom/7alerts.htmlrelates to drug recalls.

One would think that the FDA would notify all of us regularly when drugs or products are recalled, but that doesn't happen.

SO FAR, I THINK THE FDA HAS FAILED US ALL IN THIS REGARD.

PRACTICE HEALTH DEFENSE:

EVERY TIME YOU PICK UP YOUR PRESCRIPTION, ASK THE PHARMACIST:

1. WHAT ARE THE COUNTRIES OF ORIGIN AND MANUFACTURE FOR ALL OF THE INGREDIENTS IN MY PRESCRIPTION?

2. ARE THERE ANY RECALLS ON ANY INGREDIENTS IN MY PRESCRIPTION?

3. WHY DON'T YOU KNOW AND WHEN CAN YOU FIND OUT?