I am constantly astonished by the ads for health care that make false and deceptive claims, but more importantly diminish, and make light of, the seriousness of illness and it's consequences upon the individual and their families.

Being ill is no joke. Often illness becomes our worst nightmare, disrupting lives and losing them as well.

Newspaper ads that make frivolous statements, outrageous claims or tempt the ill with deception have no place in our lives. Often these ads attract patients to services that, though advertised, are not actually available, attract people who are well but led by the ad to believe they are ill, or divert patients from legitimate providers.

If there ever was an area in urgent need for regulation and oversight, besides government and sausage making,  it is in the area of medical advertising and medical practice.

Don't hold your breath, however, it ain't gonna happen in any of those areas.

The Health and Fitness section of a local rag seems to be a popular playground for ad wars around these parts.

"TELL IT LIKE IT AIN'T"

One regional cardiology group advertises "Complete Cardiovascular Care". They may be the best at what they do, I wouldn't know, but do they offer 'complete' cardiovascular care?

The word 'complete', in the context of cardiology services, would usually be taken to mean 'if I have a heart problem you can find it and fix it'.  No?

 A dictionary look-up reveals that 'complete' means:

That's what I thought.  OK, assume you go to this group with a complaint of chest pain and they diagnose you having a heart attack, right then, right there. Can they put in a stent and open up your arteries?  Not according to their office manager when I called to ask. They would need to refer you out of their practice to an interventional cardiologist, which none of them are.

A problem?  Might be if your were expecting the advertised 'complete care', and if time was of the essence, as it often is in that pesky heart attack thingy.

What I object to is the bold statement of 'complete care' when, in fact, the care is partial care. Truth in advertising would demand they say 'here is what we do: check your blood pressure, etc...' and 'here is what we don't do: put in stents and save your life...'. Such  truth in advertising is risky as it might divert patients elsewhere.

What boils my blood is the insincerity, the deception, and the lack of ethics that combine to diminish the seriousness of what doctors do and what patients expect and deserve.

"THE 'SCARE-EM AND THEY WILL COME', or GUESS WHO'S COMING TO DINNER"

'RENOWNED CARDIAC SURGEON FEATURED DURING FREE DINNER....", so the next ad goes.

Ok, here's the idea. Surgeon to hospital marketing department: 'I have the scalpels, but I need more patients, can you help?'

The surgeon's claim to fame (and fortune) is fixing mitral (heart) valves.

Here's marketing's plan.  Let's take a common condition that almost every patient has been told they have like a heart murmur (usually of no medical significance), and tell'em it could be from a floppy mitral valve (also usually of no surgical significance) ,and let's make it sound scary over a free dinner. And tell 'em we can fix it surgically. Don't include in the ad what's for dinner because some folks might not like chkn.

Oh, don't forget to say in the ad that the surgeon's "success rate last year was 100% compared to the National average of just over 50%"!

What's this?  Nationally the success rate is only 50%?  What do we have in this nation, child surgeons, incompetent surgeons, can't the Mayo and Cleveland Clinic find surgeons as good as the one in the ad?

Or, is this just a darn risky procedure and half the time the procedure goes wrong? Or what really?

The 'what really' is that to take a common condition that generally requires no surgery, advertise it to death, skim off a few souls for surgery, and claim 100% success rate is, well, really everything bad.

The surgeon and hospital running the ad should recognize, and state, the seriousness of any surgery,  particularly valvular heart surgery.

The ad should say BOLDLY: not every one with a heart murmur has a medical problem or needs surgery, not every murmur is caused by the mitral valve,  not everyone with mitral valve issues need surgery, first check with your doctor and ask if you have a surgical mitral valve problem,  no doctor has a 100% 'success rate' and explain what that '100% success rate" figure really means. (For example did the surgeon operate on just one person last year? Does 'success' mean the procedure went well, but the patient died?) And state what is for dinner, some people are allergic.

I'd be wary of any 100% success claim, but suture self.

SIGN LANGUAGE

 Today I passed a large electronic sign in front of an annex of a large hospital. The sign flashed and scrolled in blue neon the following message: "Only dual source 128 slice CT in Florida".  This type of CT may be the state-of-the art and that may be a good thing, or not, but it is a bold statement and one designed to attract patients and bolster  image.  Kudos for the marketing department.  WOW, right here in lil ol Sarasota, the only CT of its  kind in the whole state of  Florida.

I stopped in the facility and picked up some literature. There was no one to speak to, but, their Newsletter said: "the  first in the state of Florida'. Hmmm, not the only one, just the first?

I called the facility to ask if their scanner WAS the only one in Florida and the person 'in the know' there said: 'well, not really, the message is a little out of date, we need to get that fixed'.

 Why is this important? It is important because what healthare providers say to you on billboards, and in ads,  should be honest, and if it is not honest there, there is a good chance what they say to you in the privacy of an exam room may not be as well.

DOCTORS ARE NOT SUPERHEROES AND TO SUGGEST THEY ARE IS SUPERWRONG.

Being sick, I mean just sick or really sick, is serious stuff.  I don't like the headline in one full-page, color hospital ad that their doctors "actually are superheroes, defy odds, and increase survival rates." Just like Superman does? Are they also faster than a speeding bullet?

Consider your horror when things go bad in the emergency room, cath lab, or operating room when you realize the ad saying their doctors are 'superheroes and defy odds', was just baloney from the PR department.

How about this ad instead. Say our doctors are overworked, believe they are underpaid, have no control over their professional lives, are generally an unhappy lot, and, most often, are too busy to talk to you or call your family. Oh, mention that most medical errors occur in hospitals and represent the fourth cause of death from all causes in the U.S.  Superheroes or just plain folk?

There is much more to say and no time.

PRACTICE HEALTH DEFENSE:

Be wary of ads bearing claims.

Find a doctor who will call you back.

Be wary of doctors paired with free dinners.

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.

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

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 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.

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?

'He seems to have the 'fidgets', she tells the doctor. 'It seems to get worse at night and his sleep is not normal either', she says. 'He also complains of 'worms' in his legs, particularly after dinner.'

'Worms in his legs' exclaims the pediatrician, 'Wow, what an imagination you son has', he says.

'Well, when a eight year-old can't sit still it's probably Hyperactivity Syndrome', the pediatrician said.  'Let's try some Ritalin'.

'But, what about his sleep issues and the 'worms' in his legs?', his mother asked.  'Let's see what the Ritalin does', the pediatrician responds, ignoring the mother's pertinent questions.

The above scenario is a classic case of a doctor not listening to the patient and not forming a differential diagnosis-a list of ALL possible causes of the complaints. 

Nothing good will happen when these two serious errors occur together.

In my experience, nothing substitutes for a mother's sense of whether her child is ill and what is wrong with her child. Mother's, and fathers,  must be forceful in making their child's doctor listen to all of the complaints and demand a list of all possible causes for the complaint so each can be ruled out.

Hyperactivity syndromes, as in ADD and ADHD, the kind so often treated with Ritalin, are by no means the only cause of 'kids who can't sit still'.

There is growing understanding that Restless Legs Syndrome (RLS), an unfortunately inadequately descriptive name for an important chemical disorder of the brain, is responsible for many of the complaints of restlessness, fidgets, agitation, sleep disorders of all types, pain in the extremities, and much more.

Unfortunately, the knowledge obtained from studies that point to RLS in children is not yet being uniformly applied in the pediatrician's office.

RLS is diagnosed by meeting all of the following four criteria.  Note, in children, sometimes all four are not present:

1. An involuntary urge to move, could be one or more limbs or the whole body.

2. Sensations, often in the limbs that are described as 'creepy crawlers, worms, electricity, cramping, pain, and more.

3. The above complaints, or signs, generally begin towards evening, and may progress through the entire night disrupting the child's sleep.

4. The above complaints, or signs, diminish or go away with activity, such as getting out of bed and walking.

RLS is a serious disorder in that it can disrupt a normal life preventing sitting in school, sitting on an airplane, sitting to to take the SATs, or sitting in a movie theater or concert.  Not to mention the distortion of normal sleep patterns and the resultant effect during the day of the nighttime sleeplessness.

Mothers, fathers, grandparents of all ages, if there are issues similar to what I described above consider the diagnosis RLS and other disorders.

RLS is now known to be related to a number of factors.  There is a definite genetic predisposition and many children with RLS have parents with RLS.

At times RLS is related to iron deficiency in the brain. One point here, a 'normal' level of iron in the blood does NOT mean the level of iron in the brain is normal.  Doctor prescribed iron supplementation may help.

There are good, effective meds for RLS.

A good resource for RLS information is the RLS Foundation website: www.rls.org

PRACTICE HEALTH DEFENSE- Know about RLS.

Their gullilbility to the hype of advertising causes them to swallow unknown, in many cases unpure, substances for vague or uneccessary reasons and the benefits thereof unproven.

What many people do not realize are the dangers inherent in taking supplements and herbal remedies.

We, as a society, are supposed to be going green, you know eating organic, pure things, not something slapped together in Bob's basement.

When the FDA, in 1990 something, made the ruling that allowed herbals and supplements to be classified as food products, rather than the chemical drugs they are, the flood-gates of of 'herbalism'  and 'supplementalism' were opened and there was no going back.

There is not enough time to go over all of the reasons to be cautious, but, Ill try.

From http://altmedicine.about.com/library/weekly/aa022501a.htm

Top Herbs in the United States.

*Note the column 'Reason People Take', SHOULD NOT BE CONFUSED WITH 'Condition Treated" as this statement is forbidden by law. In fact, all herbal remedies and supplements must carry the disclaimer: 'These statements have not been evaluated by the FDA. This product is not intended to treat, cure, or mitigate any diasease.'

Top Supplements in the United States

Herbal Remedies and Supplements causing dangerous interactions with prescription medications, along with pill purity, dose consistency and control are among the biggest worries.

Bottom line is that, to my knowledge, there is no federal or state agency that monitors or regulates these substances as regards purity, safety, quality, active or inactive ingredients. And there are no standards for these.

OK. For people on anticoagulants like Aspirin, Coumadin, Warfarin, Plavix, the following are SOME agents that may cause SERIOUS BLEEDING PROBLEMS. Check with your doctor.

Bilberry, Forskolin, Ginko Biloba

Chamomile (German), Dong Quai, Licorice

Cat's Claw, Feverfew, Garlic, Ginger

Here are some additional problems that have been reported with supplements:

Black Cohash-nausea, dizziness

Echnicea-avoid if have autoimmune disease, hayfever, or allergies to flowers

Ginseng-avoid if uncontrolled high blood pressure, diabetes, insomnia, canDECREASE EFFECT OF ANTICOAGULANTS

Kava Kava-can be toxic to the liver, kidney, avoid with alcohol, antidepressants, ifParkinsons disease. Has been removed from the market in several countries.

A few words about Kava Kava, other supplements or enhancers and smoothies. There are chains and franchises, some maybe coming to your neighborhood soon, that promote the extrordinary healthy and tasty benefits of smoothies and other products made with Kava Kava and other supplements in formulations and concoctions loaded with possibly unknown and, as I mentioned above, possibly dangerous substances, yet touted as healthful.

Ask yourself, why am I drinking, eating or swallowing these things?

If you don't have a real good answer, best stay out of harm's way, and don't do it.

I've seen many serious and uneccessary problems in patients who from a misguided effort to stay healthy or treat an illness resorted to swallowing the unknown.

PRACTICE HEALTH DEFENSE:

When it comes to herbal remedies and supplements, think twice, check with your doctor, or unless there are compelling reasons to swallow blindfolded, just avoid them.

There will be no supplement to this posting!

A 59 year-old female presents to the emergency department acutely ill and functionally incapacitated. Her chief complaint is several days of severe nausea, persistent visual changes she describes as if seeing 'heat radiating off of a hot car', dizziness, a generalized and severe sensitivity to sound, light, and odors, and mild background headache. Her examination is normal, including a CT of the head.

The patient has a thirteen year history of visual disturbances- 'like seeing zig-zag lines', at times associated with headache-mild to severe. Over time the visual disturbances and associated headache progressed in frequency and duration, until at the time of her admission to the emergency department these occurred daily.

The patient was diagnosed with chronic migraine that transformed into 'status migraine' (severe, persistent migraine symptoms lasting more than three days duration) that resulted in her admission.

She was treated and discharged in good condition.

Migraine is a term commonly used by patients and doctors alike to describe headache of a certain type.

Therein lies a major dilemma because 'migraine', the disorder,  can be the correct diagnosis for symptoms not involving headache at all, and the complaint of headache can often be a result of causes arising outside of the head.

The distinctions are important to understand if you want to get the right diagnosis and the right treatment.

Headache, particularly severe or persistent headache, is a common reason people visit the doctor.  If you go to the doctor with the complaint of headache there is a very good chance you doctor will shut down his (when I say 'his' I mean 'her, as well) thinking cap and only consider things in and around the head that can create head pain. Many causes of the complaint 'headache', however, arise from outside of the head, including depression, hypertension, and many others.

Good doctors make what is called in the 'doc biz' a differential diagnosis', something I've mentioned before in my postings.  In the case of headache the differential diagnosis would be a list of all possible causes of headache which list is then used to derive the actual cause (diagnosis) of your headache. That's what good doctors would do.

But, what if you complained of generally not feeling well, fatigue, weakness, visual changes including light sensitivity, blind-spots,or blurred vision, increased sensitivity to sounds and odors, irritability, abdominal pain, nausea, and more, but no headache. Would your doctor consider the diagnosis of migraine? He should, and now so should you.

All of these symptoms can be the result of what is called 'migraine', just not 'migraine headache'.  People who experience these symptoms, with or without the classic signs of migraine headache are called migraineurs ( mig'-gra-nurs or my'-grain-urs).

You see, migraine is a chemical disorder of the brain that can affect all parts of the body.

There have been some recent and amazing, and not so amazing, but important, discoveries about migraine that you should know about.

Here are some.

Migraine is now considered a chronic disorder with episodic, or periodic, attacks of headache or facial pain with or without any of the other symptoms I mentioned above..

Migraine can also be the correct diagnosis in patients with the generalized complaints I mentioned above, but with no headache.

Migraine is now considered a progressive disorder where the spells come more frequently and the symptoms more severe.

Migraine can have destructive effects on peoples lives, including disruption of work, careers, relationships, and more. This feature of migraine needs to be stressed because most doctors, and patients do not recognize the progressive, erosive effects that migraine can bring over time and which needs to be understood for proper treatment.

There are specific medications called 'triptans' that treat the chemical cause of migraine and the symptoms that you take just when you think you are about to get or just getting a migraine spell, not afterwards. This is called 'early intervention'.  Recently, the FDA approved the combination of sumitptan (Imitrex)and naproxen (like Aleve) for this purpose.

Here is a list of some 'triptans:

• Axert
• Frova
• Imitrex
• Maxalt
• Relpax
• Treximet
• Zomig

Keep in mind these are not pain medicines, which are generally to be avoided in treating headache.  Also, any one of the 'triptans' may work well and have no side effects, while the others will not work or bother you. Experimenting is the key to success.

There are many, many, medicines that can prevent migraines from occurring. These you take every day to prevent the migraine from occurring in the first place. These include;

• Calcium Channel Blockers such as Verapamil
• Beta Blockers such as Inderal
• SSRI drugs such as Paxil, and the like
• Tricyclic drugs such as Pamelor, and the like.
• Anti-Seizure drugs such as Topimax

You may need one or more of these to prevent your migraines.  They, like all drugs have potential benefits and risks that have to be weighed against each other in your individual case.

PRACTICE HEALTH DEFENSE:

Know what migraine is.

Know that only about half of patients with migraine are correctly diagnosed.

If you think you may have migraine suggest the diagnosis to your doctor or see a neurologist with an interest in headache.

If you have headaches, or migraines, DO NOT SEE A 'PAIN DOCTOR'. Pain doctors generally treat pain with pain medicines no matter the cause of your pain. You always need a diagnosis and a treatment specific to that diagnosis, not medicines to mask the symptoms. Pain doctors can be of help in certain specific circumstances when the diagnosis is clear and treatment options are gone, but, they are few.

Taking pain medicines on a regular basis can CAUSE headache and should be avoided.  These include the OTC drugs such as Tylenol, Advil, Aleve, and others.

Be wary of self-treating headache.  There are many causes of headache, some of which may be life threatening. 

If you are not getting good results from your primary-care doctor see a neurologist with a special interest in headache.

Over time I have become increasingly aware of deficiencies in the reporting of medical results to patients that reflect a 'sickness' of the reporting process itself.

Obtaining the best diagnostic tests and medical opinions in the world will be of little use to you if the results are not communicated to you completely, honestly, and in terms you can understand.

Unfortunately, this failure, or deficiency, of appropriate reporting can result in your being the victim of a missed, or delayed, diagnosis, such as cancer, and, therefore,  being denied the opportunity to receive prompt and appropriate care.

To learn more, read on.

The MEDICAL-RESULTS REPORTING DEFICIENCY SYNDROME

An Unrecognized Disorder of the Healthcare Delivery Process

WHAT IF DYING FROM CANCER ISN'T ALWAYS NECESSARY?

“The truth? You can’t handle the truth”

So said Jack Nicholson in A Few Good Men, 1992.

Well, patients can handle their medical truths, but, there is evidence that doctors can't, or won't provide them.

DIAGNOSTIC ERROR

The March 11, 2009 issue of the Journal of the American Medical Association published an article titled: Diagnostic Errors-The Next Frontier for Patient Safety (JAMA, March 11, 2009-Vol 301, No. 10, 1060-1062).

According to the article “Diagnostic error can be defined as a diagnosis that is missed, wrong, or delayed, as detected by some subsequent definitive test or finding.”

Not all diagnostic error results in harm. Diagnostic error that results in harm can be defined as harm that results from the delay or failure to treat a condition actually present when the diagnosis given to the patient was wrong or unknown or from treatment provided for a condition not actually present.

EXTENT OF DIAGNOSTIC ERROR

According to the article, about one of every twenty causes of death (5%) determined at autopsy differs from the cause of death written by the primary care provider on the death certificate and represents a lethal diagnostic error for which a correct diagnosis coupled with treatment could have averted the death.

Each year in the U.S., an estimated 40,000, to 80,000, hospital deaths result from misdiagnosis.

Why so many? Bad doctors, or could it be poorly informed patients?

MEDICAL INFORMATION and MEDICAL RESULTS

The culture of medical practice has traditionally been that of a secret society. Keeping the skills and knowledge of medicine within the society of physicians, specifically, to the sons of physicians, dates back to Hippocrates and is written into the Hippocratic Oath.

Unfortunately, that tradition has mutated into trends that keep patient’s medical records, reports, and medical truths away from patients, and today represents a malignant feature of healthcare delivery.

The reader might reply indeed the opposite is true given the current efforts towards providing patients access to their electronic medical records. However noble these efforts are, they are few in number and often offer limited, or no, access to the detailed reports of radiologists, pathologists, and the letters of consultation of specialists. Even if they did these are written by physicians for physicians and offer little in the way of interpretation or personalization. Most important is that these records are often inadequate themselves, or complex, at times with important content hidden in fine-print.

The usual standard of medical practice, in this regard, I call ‘don’t ask-don’t tell’ meaning that ‘if patients don’t ask the right question, doctors generally feel under no obligation to tell the right answer’. Tell not-Sue not.

The prime sign of this approach is the reluctance of doctors to release to patients copies of the originals of documents and to invest the time to share the knowledge contained in them.

It is a well known fact that physically obtaining copies of one’s medical records or medical reports is made arduous, if not, impossible, by the medical establishment. And, the notion of being obligated to explain those records or reports in detail to the patient in patient-understandable terms just doesn’t happen in the normal practice of medicine. As a result, complex and revealing medical information contained in medical results are rarely reported to patients in terms they can understand.

It is not uncommon for detailed and complex results to be summed up to a patient by the words ‘everything is normal’ spoken over the phone by a doctor’s secretary.

However, these reports often contain life-saving or life-threatening information created by the most sophisticated and complex means by the most advanced machines and expert physicians, yet often get trivialized to a simple phone call or card in the mail.

The results of tests and the opinions of specialists form the content of reports that are, I believe, primarily for the immediate benefit, knowledge, and ownership, of the patient, and secondarily, the ordering physician. I doubt many doctors would agree as current medical practice doesn’t practice this philosophy.

Collectively, the various ways in which medical results reporting fails the patient I call The MEDICAL-RESULTS REPORTING DEFICIENCY SYNDROME.

SOME EXAMPLES

BREAST CANCER and MAMMOGRAPHY-WHAT DOES ‘APPEAR TO BE NORMAL’ MEAN?

Breast cancer is the most frequently occurring cancer in women and the second leading cause of death, yet the recommended screening procedure, digital mammography, will miss, at least, 4% to 8% of cancers present. That equates to missing 1 in every 12 to 25 cancers present at the time of the test. Most women, are never told this although the fact appears on the report their doctors receive.

Dense breasts can be a significant risk factor for breast cancer, and it is well known that moderately, or significantly, dense breasts, a commonly reported finding on digital mammography, can obscure tumors that are present. One would think, therefore, that this finding would be routinely reported directly to the patient in order for the patient to consult her doctor and consider other imaging such as MRI.

Yet one major mammography center I know of reports the finding of dense breasts, and the associated limitations of the mammogram, ONLY to the ordering physician, and not to the patient. This is done at the same time the center sends the patient a card stating simply, in carefully constructed words, that her results “appear to be normal”!

Does not each woman have the right to know if her mammogram was sufficient to detect breast cancer and if not that there are other tests available that could find it, or, should she be left ignorant of her medical truths only to become an unfortunate statistic of inadequate reporting and a later victim of cancer?

THE ABNORMAL 'NORMAL' PATHOLOGY REPORT

A patient’s medical truths are often hidden in ‘fine print’.

Some pathology reports check -boxes marked 'Normal' or 'Abnormal' and use fine-print to make comments that can contradict the box checked. This kind of reporting is, in part, at the root of missed and delayed diagnoses.

Pathology results are transmitted from the pathologist to the ordering physician, indirectly by fax or mail, rarely personally. It is unusual for a pathologist to call a physician directly to discuss findings. I have never heard of a pathologist every discussing result directly with the patient.

A busy primary care doctor will rarely read the entirety of a pathologist’s report, or any report for that matter.

Rather doctors tend to ‘scan’ a report, looking for a ‘flag’ like ‘H’(high) or ‘L’(low), or look for a ‘checked-box’ or a line labeled ‘Impression’ or ‘Conclusion’. In many cases a quick look finds a ‘Normal’ result and the fine-print with comments stating otherwise is overlooked.

In one report I have, the pathologist reporting on a FISH TEST (for cancer), having checked the 'Normal' box, stated in the smallest font the following:

“3 positive (meaning ‘cancerous’) cells were noted which is below our cutoff for a positive result (greater than or equal to 4 positive cells). Suggest repeat if clinically indicated”.

This patient was one cell short of a diagnosis of cancer and yet assigned to the ‘Normal’ category! This statistical and impersonal method of ‘reporting’ critical medical truths and the fact that this tiny message was the pathologist’ main communication of the likelihood of cancer to the doctor is representative of the inadequacy of current methods of reporting medical results to patients and an example of the MEDICAL-RESULTS REPORTING DEFICIENCY SYNDROME.

CAN A DOCTOR'S EGO INFLUENCE REPORTING|?

In another example the pathology report from a patient who went to her GYN for a routine pelvic exam and Pap smear revealed, otherwise, unspoken truths. It was the patient’s intent, in part, of course, to learn if she had any evidence of pelvic cancer. Her expectation was, that the Pap smear would inform her of the presence of cervical cancer.

The GYN examined her and performed a Pap smear and sent the specimen to the pathologist. Shortly thereafter, the patient was called by the doctor’s nurse and told the doctor said:

“the Pap smear was ‘inconclusive’, but, based on the examination you can wait another year for a repeat”.

A close look at the pathologist’s report, which of course the patient never saw until she was advised to obtain a copy, revealed the following:

DIAGNOSIS: UNSATISFACTORY FOR EVALUATION

1. Specimen adequacy: “…unsatisfactory for evaluation.

2. Reason for test: “Screening for malignant neoplasm of the cervix”

Instead of being told, honestly, that the Pap smear was inadequate to determine cervical cancer, and why, and that the test needed to be repeated, she was deceptively told the test was ‘inconclusive’, which it was not, It was unsatisfactory for evaluation. The purpose of the test: “Screening for malignant neoplasm of the cervix” went unanswered.

Did the primary care doctor violate a basic trust between patient and doctor. The patient had the rightful expectation that the Pap smear would be done correctly and the results would indicate whether she had evidence of cervical cancer. Was the doctor too embarassed to report the facts?

Most importantly, this example gives additional credence to the notion that the current method of reporting of medical results is itself sick and a contributor to the delayed and missed diagnosis of cancer. Did the pathologist have an obligation to notify the patient?

HOW DOCTORS WORK

Here is how doctor offices typically work. Reports come in by mail, fax, or office-based printer. An assistant attaches the report to the front cover of the patient’s chart, usually by paper clip. It should be noted that not infrequently the report is attached to the wrong chart.

Through the course of a day there may be twenty to thirty, or more, such charts piled-up on the doctor’s desk. There can be two or three, or more piles of charts often reaching two-feet in height.

These charts, with the days lab results, letters of consultation from specialists, pathology and radiology reports attached, are usually addressed by the doctor in between seeing patients or at the end of the day. Allowing them to accumulate is unacceptable to any doctor as they continue to appear every day and the pile only gets higher.

Therefore, doctors, typically, do not, cannot, read each report, there is simply no time to do so. Rather they hurriedly search for the ‘Conclusion’ or ‘Impression’ line, or an ‘out of range ‘flag’ such as the trusty ‘H’ or ‘L’. Very often critical information is missed. This is not necessarily the doctor’s fault. It is however, symptomatic of a flawed system of reporting medical results that incredibly bypasses the patient.

MY FIX

There is no healthcare ‘system’ to fix the problem, indeed the problem is, in part, a result of the absence of an organized system of healthcare delivery. Healthcare is a scattered, unconnected, and unorganized collection of individual practitioners, or groups, with little to no oversight.

These practitioners are loosely connected to, and somewhat governed by, professional organizations, medical societies, hospital affiliations, and insurers.

Any ‘fix’ to the impaired reporting process will have to be voluntary and achieved through a process of publicizing the dangers of the current system and the benefits gained by changing it.

The culture of medicine is deeply ingrained and practitioners are hardened to a practice style that is wedged deeply between the wish to provide quality and compassionate care, which I believe most doctors want to do, inadequate reimbursement, and the ever lurking threat of malpractice suits.

Indeed, one of the biggest obstacles to be faced in creating an environment of responsible reporting of medical results to patients will be the fear of increased liability incurred by giving patients more information then is the current practice.

The other obstacle to be faced will be the acceptance of the concept presented here that the originator of medical results is also responsible in some degree for reporting, in some fashion, results to the patient.

After much thought, and due diligence, I, hereby, propose an:

ALLIANCE for RESPONSIBLE REPORTING of MEDICAL RESULTS TO PATIENTS

whose acronym is ARRMED as in ‘ARRMED to OBTAIN THE BEST HEALTHCARE’.

I see this as a voluntary ‘alliance’ of individual practitioners, including primary care doctors, radiologists and pathologists, persuaded by their inherent desire to help their patients and encouraged by their professional organizations to voluntary agree to adopt ARRMED’s principles of responsible reporting of medical results to patients.

I see the ‘alliance’ extending to all good institutions, hospitals, and major centers willing to support and participate in ARRMED’s mission.

I see the ‘alliance’ also being grounded on educating patients about the urgent need for this change and to take shared responsibility to make it work.

A proposed set of Principles and Mission Statement:

ALLIANCE for RESPONSIBLE REPORTING of MEDICAL RESULTS TO PATIENTS^©

ARRMED to OBTAIN THE BEST HEALTHCARE^©

The Ten Principles of ARRMED are:

1. Patients are the primary beneficiaries of all medical results created for their benefit.
2. Patients have the right to receive all medical results as soon as they are created.
3. Patients have the right to receive medical results in terms they can understand.
4. Patients have the right to receive the same reports sent to their physicians.
5. Patients have the right to receive results directly from the originator of the results.
6. Patients have the right to receive their results directly from their primary care doctor.
7. Patients have the right to know if test was sufficient to answer the reason for the test.
8. Patients are partners with their providers and share responsibility obtaining results.
9. Patients must learn to become owners of their health.
10. Patients must learn to become owners of their health information.

The Mission of ARRMED is to build a community of healthcare providers who believe in these Principles and are willing to commit to their patients that they will cooperate in achieving the goal of responsible reporting of medical results. It is also the Mission of ARRMED to educate patients about the need to take responsibility for their health and healthcare, and to teach them how to become empowered patients and complementary partners in their healthcare delivery process.

CONCLUSION

The MEDICAL-RESULTS REPORTING DEFICIENCY SYNDROME is real and its effects, if they could be measured in terms of missed, or delayed, diagnosis could be significant.

It seems to me that a public awareness campaign is required. The effort would certainly have more credence were it led by a public figure known for compassion, devotion to good causes, the ability, passion, and interest to persuade the good men and women of healthcare to change and the wish to answer the question posed in the title of this article with the answer:

No, dying from cancer isn’t always necessary?

Louis Siegel, M.D.

April 28, 2009