nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Friday, November 14, 2008


Children who are obese, have high cholesterol may show early warning signs of heart disease, study indicates.

The New York Times (11/12, A16, Belluck) reported that a new study, presented Tuesday at the American Heart Association conference, "finds striking evidence that children who are obese or have high cholesterol show early warning signs of heart disease." The researchers "found that the thickness of artery walls of children and teenagers who are obese or have high cholesterol resembled the thickness of artery walls of an average 45-year-old."

Doc D:  Why the doom and gloom?  “Turn a frown upside down…”   This means that the average 45-year-old has the arteries of a child.  I’m feeling younger just thinking about it.

Seriously, remember the President’s Fitness Test when us older…er, more mature…folks were in grade school?  I still have my scorecard from 7th grade.  We need to bring serious fitness back into the school curriculum.  If we need some New Age justification for it, let’s called it “physical socialization.”  One day when I was still on active duty, a young airman filled out his annual physical form with the words “video games” under the question about current physical fitness activities.  When I told him we were looking for things he did that strengthened his muscles and increased his endurance, he just looked at me, uncomprehending.  Very sad for his generation, and will make the Baby Boom population’s healthcare requirements look trivial.

Research suggests listening to music may expand blood vessels, increase blood flow.

ABC World News (11/11, story 11, :20, Gibson) reported that "researchers at the American Heart Association meeting released a study showing when people listen to music that makes them happy, blood flow, a key measure of heart health, improves."

        The Los Angeles Times (11/11, Roan) Booster Shots blog adds that "ten healthy volunteers were asked to listen to music they enjoyed after avoiding the music for a minimum of two weeks before the study." Participants "were also asked to listen to music that made them feel anxious, and to audiotapes designed to promote relaxation, and to watch videos designed to induce laughter."

        Investigators "found that the diameter of the average upper arm blood vessel increased 26 percent after listening to joyful music, and listening to music that caused anxiety narrowed blood vessels by six percent," AFP (11/12) reports.

        HealthDay (11/11, Gardner) added that "blood flow also increased 19 percent during the laughter...phase and 11 percent during relaxation."


Doc D:  Does this work if I find Mettalica relaxing and Chopin anxiety-producing?  Actually there’s no correlation between episodic, temporary changes in arterial diameter and the development of cardiovascular disease.  This is one of those “findings” that, if you exercise a little commonsense thinking, you realize it’s useless.  Note that watching videos inducing laughter was not associated with changes:  I guess that means laughter doesn’t help, right?  What a waste of research funds.


Your Tax Dollars at Work rating:  Better used as kindling.


Nurses association says members are facing more aggressive patients in EDs.

The Boston Globe (11/11, Lazar) reported that with more patients and increased waiting times at emergency departments (EDs), the Massachusetts Nurses Association "says its members are fending off an increasing number of aggressive patients, as well as their frustrated family members."


Doc D:  Why include this excerpt?  Hint:  Massachusetts is the state that passed a near-universal coverage law, without considering the other three elements of healthcare reform:  quality, cost, and ACCESS. 


Supplement to previous newletter:

  1. The journal Health Affairs is the “New England Journal” of healthcare policy.  They published an analysis, prior to the election, of the incoming administration’s healthcare plan.  I tried to figure a way to attach a copy, but the journal won’t allow free distribution by subscribers.  It’s pretty technical anyway.  But I can show you an excerpt:

“The health reform plan put forth by Sen. Barack Obama (D-IL) during the 2008 presidential campaign focuses on expanding insurance coverage, providing a variety of subsidies to individuals and small businesses, and expanding eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP). It greatly increases federal regulation of private insurance, including what benefits must be offered by all insurance plans, but it does not address core economic incentives that drive health care spending. The plan does not promise universal coverage, and it does not include a mandate on everyone to purchase insurance, which was central to Sen. Hillary Clinton’s (D-NY) plan during the Democratic primary….  The following analysis reflects the authors’ concern that Senator Obama’s failure to address the perverse incentives in the U.S. health system will exacerbate the cost problem he has argued must be solved if we are to achieve anything close to universal coverage. Tax subsidies that promote first-dollar coverage have led consumers, health care providers, and suppliers to act as if any service that might yield some value, no matter how small, should be covered. Subsidized third-party payment has helped drive up health spending and, as demonstrated by the Dartmouth Atlas, sometimes has even led to poorer health outcomes. Realistic expectations about cost, value, and the outcomes that health care is likely to provide must be better understood by all parties. Senator Obama promises business as usual, albeit with greater regulation intended to impose behavioral changes from the top down. In our view, such a strategy will fail to limit spending growth, will impede useful innovation, and will require more sacrifices in the years ahead.….(main body of text)…

The savings estimates and the resulting impact on federal outlays from the Obama plan are controversial. Savings proposals include familiar ideas, many of which are embraced by both candidates: greater use of information technology (IT), improved disease management and care coordination, clinical effectiveness research, and better payment methods. Although many policymakers and experts agree that such policies would improve health system performance, there is little evidence that they can be implemented quickly or effectively and little proof that implementing the policies would yield net reductions in health spending.  The Congressional Budget Office (CBO), for example, has analyzed the likely savings from the adoption of health IT and found that “the adoption of more health IT is generally not sufficient to produce significant cost savings.” In another report, the CBO noted that “initial results from disease management programs and other efforts indicate the difficulty of reducing the use of care.” In a letter to Rep. Pete Stark (D-CA), the CBO reported that total health spending might be reduced by $6 billion over the next decade through the use of comparative effectiveness research, of which $1.3 billion would accrue as reduced federal outlays. Over that period, national health expenditures are projected to total $32.5 trillion.”--“The Obama Plan:  More Regulation, Unsustainable Spending” by Joseph Antos, Gail Wilensky, and Hanns Kuttner, [Health Affairs 27, no. 6 (2008): w462–w471 (published online 16 September 2008; 10.1377/hlthaff.27.6.w462)]

  1. Speaking of the New England Journal of Medicine, the current issue this week has a series of free articles on reforming Primary Care.  This concerns the Access part of reform.  A short quote:

U.S. primary care is in crisis. Primary care physicians must care for more and more patients, with more and more chronic conditions, in less and less time, for which they are compensated far less than subspecialists. They must absorb increasing volumes of medical information and complete more paperwork than ever, as they try to function in a poorly coordinated health care system. As a result, their ranks are thinning, with practicing physicians burning out and trainees shunning primary care fields. In a roundtable discussion …four experts in primary care and related policy…explore the crisis, as well as possible solutions for training, practice, compensation, and systemic change.”

See the articles here:  The Future of Primary Care,


Medical quote of the Day

Science, of course, is necessary; it has its justified place and each year it becomes more important to the proper practice of medicine.  But neither tests nor science can fully replace the art of medicine and that is fast disappearing, though occasionally one sees shy, frightened bits peering cautiously out at the man who is ill through the maze of millimols and hydrogen ions and tests for histoplasmosis, which mean precisely nothing.—Henry Jackson, Jr.  New England Journal of Medicine, 1956.


Doc D

Opinions are entirely my own.  Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation), PND News Briefs – Texas Edition ( © 2008, Physician's News Digest, Inc.), and AMA Morning Rounds (© U S News Custom Briefings), and other sources in the public domain.  As always, you may share this column, with appropriate attribution (above) included:  I just ask that you not forward my email address.  I don't care to argue with wacky strangers.


Posted By Doc D to NOSTRUMS --Dissecting the Medical Doc D at 11/14/2008 09:40:00 AM

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