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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Monday, November 5, 2007

THE MEDICAL NEWS FRONT

Poll finds most Americans favor birth control in public schools.

In continuing coverage from previous briefings, the AP (11/3) reported, "People decisively favor letting their public schools provide birth control to students," according to an AP-Ipsos poll. "The survey was conducted in late October after a school board in Portland, Maine, voted to let a middle school health center provide students with full contraceptive services." Investigators found that "67 percent [of respondents] support giving contraceptives to students." Among these, "37 percent...would limit it to those whose parents have consented, and 30 percent [would provide birth control] to all who ask." In addition, "62 percent said they believe providing birth control reduces the number of teenage pregnancies." Notably, "[m]inorities, older and lower-earning people were likeliest to prefer requiring parental consent, while those favoring no restriction tended to be younger and from cities or suburbs." Those "who wanted schools to provide no birth control at all were likelier to be white and higher-income earners." The AP pointed out that "nearly half of teens aged 15 to 19 report having had sex at least once, and almost 750,000 of them a year become pregnant."

Doc D: I try to stay away from politically charged issues in medicine, but I’m dubious about the validity of this poll (they’re all this way). There’s too little information on how the questions were asked, which is the most critical element determining the answer you get. (1) If the question was just a generic one about giving contraceptive to “students”, then there’s too little discrimination for people to define their answer: middle school students? High school? College? (2) Also, ask yourself, if 37 percent want parental consent and 30% don’t, what do the other third want…”I don’t know?” “I’m not sure?” “I don’t care?” Way too big a group not to comment on. (3) “62 percent…believe…reduces the number of teenage pregnancies” ? In most studies the pregnancy rate is off by the extent of how available abortions are: these figures are less likely to get included as pregnancies. For instance, California has a lower teen birth rate than Texas. Tx uses abstinence, Ca uses contraceptives. Does this mean that contraceptives reduce pregnancies? Maybe not: in Ca it’s very easy to get a teenage abortion, in Tx it’s not. (4) finally, “half of teens 15 to 19” had sex at least once, implies that this is another reason to use contraceptives. Did I miss something here? This discussion started with a school board authorizing contraceptives for “middle” school. It’s been a long time, but aren’t the 15-19 year olds in “high” school? I’ll stop here, but I have about twenty other questions…all unanswered.

All of this is not to say for sure that the poll and people’s beliefs are not correct. But, one thing is certainly true…it’s pitiful reporting.

North Carolina project to improve care for heart attack patients shows promise. The AP (11/5, Marchione) reports that the "nation's most ambitious statewide project to redo how serious heart attacks are handled" is taking place in North Carolina, according to findings presented at the American Heart Association meeting. The program includes "55 small hospitals [which] agreed to send appropriate patients to 10 larger ones for angioplasty, even though it meant giving up thousands of dollars of revenue." When researchers "compared the care of more than 2,000 patients before and after the project," they found that more patients received angioplasty, "and the portion of eligible patients not receiving artery-opening procedures dropped." They also found that "[m]ore patients got care at top-tier heart hospitals, and more quickly than similar patients did before the project began. Helicopter transfers rose, and more paramedics diagnosed heart attacks from EKGs done in ambulances." In addition, the "average time it took a small hospital to evaluate and refer patients to a larger one dropped from two hours to 71 minutes."

Doc D: A couple of other studies you might like to know about. I’m sorry if I’m fuzzy on the details but I can find the references if need be.

  1. At one time not so long ago, heart attack patients in one country (I think it was Scotland, but I’m not sure) were sent home without hospitalization if they had no complicating findings. The data showed that survival rates between using that approach and using a Coronary Care Unit in those circumstances were about the same. Hunh?
  2. I can’t remember the exact dates, but, say the 70’s. Researchers in Rhode Island did a study of survival of everyone brought to the ER who had arrested outside the hospital and were resuscitated in, or before arriving at, the ER. All patients so defined were then admitted to Intensive Care. They also wanted to know what it cost to save a life in this way. They accumulated some ~350 cases over a period of time and looked at how many were still alive 30 days after the event. First the cost: on average somewhere between 50 and 100 thousand dollars. The survival at 30 days? Zero. (Yes, none survived.)

Caveat: these are ambiguously related to results about angioplasty. The point is a general one only. When I hear about results that show “improved care” I always ask myself “against what standard?” It’s great to get treated by the best, with the best, and quickly. The assumption is that if you get that, then you’re in great shape…but that’s not the end result we want: we want RECOVERY.

As with most of these emails, which I enjoy writing, the message is to criticize what you’re told. Every information source is biased and advocating something (even me). I’m thinking of putting together a list of Medical Myths, like…(1) All doctors are rich (avg income is 132K, hasn’t change in 10 years), (2) all drug companies are rich (a few are, but more go out of business), (3) universal healthcare will solve the healthcare cost crisis (anybody who thinks the govt does anything cheaper, hasn’t been paying attention—and guess where they get their money?), etc….

Opinions are my own…and that of few others, unfortunately.

Cheers,

D

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