Week of March 3 - In Case You Missed It...TOMF Medical News Roundup
March 7, 2014
In Case You Missed It...
March 7, 2014
Just Walk
Pima County Medical Society will host a physician led walk along the Rillito tomorrow at 8:00 a.m. Please arrive at least 15 minutes prior to the walk start. Use the parking lot on the east side of Swan, just south of the bridge. The group meets at the ramada by the water fountain.
The walk is open to anyone and the course is generally flat. Wear comfortable shoes. You may bring a cane or walking stick, and a bottle of water. Be sure to dress for the temperatures. For questions call Dennis Carey at 795-7985.
Just Walk - a walk with a doc - is a program founded in 2005 by David Sabgir MD, a board-certified cardiologist in Columbus, Ohio. It has spread to 40 sites throughout the country. Just Walk is a non-profit organization dedicated to encouraging healthy physical activities for people of all ages and fitness levels.
Sierra Vista Hospital Construction Starts
Concrete is pouring this week into the foundation of the new 175,000 square foot Sierra Vista Regional Health Center, the Sierra Vista Herald reported today. Construction will be finished early next year but interior work and furnishing will take some time before patients can be seen.
Hospital Execs Answer Tucson Chamber on ACA
Today's Inside Tucson Business contains an editorial by TMC CEO Judy Rich, Carondelet CEO Jim Beckman and UA Health Network CEO Mike Waldrum MD answering last month's blasting of the Affordable Care Act by Tucson Chamber CEO Mike Varney.
It is a cordial reply, and promotes discussion rather than shutting it down, and gives reasons why the ACA is important locally. Worth a quick read.
Trial Balloon or Policy Triumph
We never know when a bill gets a hearing in the Arizona House of Representatives if the idea is floated to see where darts come from or a genuine Republican Caucus policy consensus. Nor do we know when a bill passes from the Arizona House if deals have been reached with the Senate and all the legalities have been worked out.
Take HB 2367.
It passed the Arizona House yesterday 35-22 and limits Arizonans to five total years on AHCCCS. There are exceptions to this time limit, that came in a flurry of friendly amendments, but this is a major change for a Medicaid program.
The problem. The Feds set eligibility, and right now there are no time limits, only income levels. Today's Arizona Daily Star says the Feds would have to grant a waiver and there has been no signal such a waiver is in the offing.
So is this a major policy proposal? Could be. Ideas from the states become federal policy all the time. It also could be that this is an election year and conservative bona fides can be held up in primary and general campaigns.
Give Me A Little Sugar...No Thanks
Sugar not only makes us fat, is linked to fatty livers and high blood pressure, it may also be killing us, says a new study summarized in USA Weekend.
For example, those of us who consume a sugary drink seven days a week have a 29 percent higher chance of death from heart disease than those who consume one a week.
On average US adults get 15 percent of daily calories from added sugar. That equals about 300 calories. The American Heart Association recommends 150 calories for men and 100 calories for women from added sugars.
Added sugars will be part of the new food labeling law. Remember, natural sugars from fruits and veggies do not count against your sugar total.
Watchful Waiting for Prostate Gets Shock
Surgical side effects from prostate operations are too numerous to list here so the byword for these slow growing tumors has been, "Let's keep out eye on it." The benefits seem to outweigh the risks of surgery.
Until Wednesday's New England Journal of Medicine came out.
In an 18-year study of 700 men diagnosed with prostate cancer, half underwent surgery and half followed watchful waiting protocols.
Not only did the watchful waiting group die more often from all causes (247/348 v. 200/347) but more in the watchful waiting group died from prostate cancer than those who had surgery (99/348 v. 67/347).
In Case You Missed It...
March 6, 2014
Sherwin B. Nuland MD, 1930-2014
Surgeon, teacher and award-winning author Sherwin Nuland MD died March 3, ending a remarkable career and silencing an astute voice for medicine.
Dr. Nuland loved his profession and was one of the few who could express that love in a manner people understood. Never afraid, however, to examine some of the pitfalls and fallacies of medicine he was nonetheless its champion because he felt the seeds of redemption were in every fiber of its questing and questioning outlook.
He discovered the Yale library's medical section early in his career and published several ground-breaking histories based on his findings there as well as the best-selling Doctors in 1988. The general public became aware of him through New Yorker articles and his book How We Die, which won the National Book Award for nonfiction in 1994 and was a Pulitzer Prize finalist.
In 2001, Dr. Nuland recounted his bout with severe depression in the 1970s and how electro-shock therapy saved his career and life.
Nuland taught medicine, medical history and bioethics at the Yale School of Medicine and was on the Hastings Center Board of Governors, 2006-2012.
His voice will be missed.
Make End of Life Wishes Known
As we note the passing of Dr. Nuland, we also observe a new study of nearly 8,000 Americans (published in the January 2014 issue of the American Journal of Preventive Medicine) only 26.3 percent have any sort of advanced directive.
While most of us think advanced directives are living wills they don't have to be. In fact many experts in the end-of-life field advise against relying on living wills and their standardized language. Instead they recommend:
1) Naming a surrogate decision maker (medical power of attorney)
2) discussing how you feel about possible issues that might come up
Failing that, put your thoughts down on paper, date it, and let someone know where those thoughts are in case of emergency.
In Case You Missed It...
March 5, 2014
Home Births Are Up, But Remain Small Part of Birth Equation
There was a brief report last night that home birth numbers in the US had almost doubled this century leaving one to wonder if OB/GYNs and maternity wards are a thing of the past.
Thank goodness for the Centers for Disease Control and the Internet. It does not take long to find answers.
Out of hospital births dropped to 1 percent in 1969, and hovered there for the rest of the 20th century. In 2012 that percentage of home births had climbed to a whopping 1.36 of all US births. The actual number is roughly 35,000 births and 16,000 births at freestanding birth centers can be added in.
The vast majority of moms who give birth at home are well-to-do white women followed by women living in remote parts of the US (Alaska, Montana, Idaho).
Get Covered
Many people, whether they are intimidated by the red tape or worried about cost, who lack health insurance tell local navigators they'll risk fines and see how things work out during the coming year rather than obtain insurance by March 31.
Navigators pose a different strategy: get covered and see how things work out.
For the 83% of insured Americans this is understood. Insurance protects your family and eases the drain on the system from forced "free" care. But for those who have never had the opportunity to be insured these are new ideas, and a recent poll shows they have an unfavorable view of the Affordable Care Act and are unaware of the subsidies that help underwrite the coverage.
Hospice Care Still Short and Getting Shorter
The National Hospice and Palliative Care Organization (NHPCO) recently looked at hospice stays and found that while numbers of patients getting hospice care is roughly the same, the service stay -- already short -- got shorter.
NHPCO said "The unique interdisciplinary team of hospice is equipped to aid patients through the last months of life." Instead, the median length of hospice service was 18.7 days in 2012, down from 21.2 days in 2009. About 35.5 percent of all hospice patients spent fewer than seven days in hospice.
In Case You Missed It...
March 4, 2014
Cindy Wool Memorial Lecture Coming in April
Cindy Wool, a native Tucsonan and wife of Steve Wool MD, died far too young and Dr. Wool decided to honor her energy, caring and enthusiasm with an annual lecture about humanity and medicine.
This year Dr. Jerome Groopman and Dr. Pamela Hartzband will speak April 2 at the Marriott University Park. Cocktails begin at 5, dinner and the seminar begin at 5:30. Tickets are $50. You have until March 21 to reserve a seat by calling 577-9393 x118.
Dr. Groopman writes for the New Yorker and is a bestselling author and oncologist. Dr. Hartzband is an endocrinologist and Harvard educator. Both have been patients recently and will discuss cutting through confusion to make medical decisions.
Neither a Borrower Nor a Lender Be When it Comes to Painkillers
According to the Centers for Disease Control overdose deaths from prescription painkillers tripled to 16,000 deaths, passing the combined overdose deaths from heroin and cocaine (8,000).
Where are people getting these meds?
Fifteen percent purchased them dealers. Twenty-five percent doctor shop, and get prescriptions from many doctors. The rest get them from friends and neighbors.
Look at UAMC Trauma Center Online
If you missed the documentary about Tucson's only Level One trauma center last week, the entire show is on now online. Click here to view.
It is a good look at the teamwork required and examines rural care as well as educational work and speaks about the economics behind providing a public good we all take for granted. The running time is just under one hour.