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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Thursday, July 24, 2008

Pulling my hair out...Wait, I don't have any

Heightened autism awareness may lead to wariness of vaccines, pediatricians say.

In continuing coverage from previous editions of Morning Rounds, New Jersey's Star-Ledger (7/20, O'Brien) reported, "With autism spectrum disorders now diagnosed in one out of 150 children nationally, and one in 94 in New Jersey, rare is the parent who isn't aware of autism." But, with heightened awareness "come[s] a new wariness of vaccines, which a vocal minority of autism activists blame for the jump in cases. Pediatricians report seeing more parents question, delay, or even shun altogether the traditional round of childhood immunizations." Further complicating the situation "are celebrities who either blame or suspect vaccines, such as actress Jenny McCarthy, and radio talk show host Don Imus. Doctors complain they get an unquestioning ride in the media." While the prevalence of autism "has soared in recent years, experts are unsure whether more cases are occurring, or simply more cases are being diagnosed."


Doc D: I’ve written about this before: there’s no evidence to support a link between vaccines and autism. I can’t say that there won’t ever be, but the studies we have are pretty solid. The problem is, vaccination is one of the unique interventions in an infant/toddler’s life, and there is little else that parents can look back on as a cause. However, as you all know, this is the “post hoc ergo propter hoc” fallacy. Translated it says “after this, therefore because of this”. Bertrand Russell gave a great example of this defect in how humans think: “Every morning the rooster crows and then the sun comes up. Therefore, the rooster makes the sun come up.” See here: http://en.wikipedia.org/wiki/Post_hoc_ergo_propter_hoc


Number of e-consults growing gradually in several states.

Florida's Sun-Sentinel (7/21, LaMendola) reports that "[a]fter more than four years in the mainstream in Florida and a few states, online doctor consultations are catching on, although not like many had hoped. Only a fraction of doctors offer the service, and a small number of their patients take advantage." Still, "[p]roponents of e-consults said the number has jumped since Aetna, Cigna, and other insurers began paying for them nationwide in January. They predict the practice will one day become a prime option for patients dealing with simple health issues." Insurers are beginning to offer "online physician contacts...as a way to improve patient satisfaction, ease office burdens on doctors, and save a little money." In addition, polls have shown that "patients like the idea of contacting doctors by email."


Doc D: So much of diagnosis is seeing, hearing, and touching. I expect to see the first e-consult malpractice case any day now (if it hasn’t occurred already). Then we can have an e-court case, with e-lawyers and an e-judge.


U.S. lags in quality of healthcare despite having costliest system, report indicates.

The AFP (7/17) reported, "The United States lags behind other industrialized nations in the quality of its healthcare, despite having the costliest system in the world, according to a report released on Thursday" by the Commonwealth Fund. The foundation said in the report that the "U.S. healthcare system is plagued by inefficiency, inequality, and an incoherent national policy." Utilizing a 100-point scorecard, the fund rated healthcare systems of various countries "based on 37 categories, including access to healthcare, quality of care, and efficiency." The U.S. "ranked last among 19 industrialized [nations] when it [came] to preventing premature deaths from conditions, such as heart attacks, that can be treated with timely, effective care."

The report also indicated that "U.S. healthcare has failed to improve since 2006, while access has [been] worse, and the country should expect 'a far better return' on its massive investment in health," according to the Financial Times (7/18, Timmins). "A more efficient health insurance system could save at least $50 billion a year, and 100,000 fewer people a year would die if the U.S. achieved death rates comparable to those in leading countries," the report stated.


Doc D: I think you would find it interesting, if you have the time, to read the report. If you do, note how there are many areas of improvement not mentioned in this article. Where the US compares poorly to other nations, this is specifically noted. Where we do well, no mention is made. There are some goods points made in the details, such that focused efforts could result in improvement in our healthcare, but the activists have to make their report sound like a disaster in order to be heard above the shouts of thousands of other activists for other causes. What a shame. Here is the overview: http://www.commonwealthfund.org/usr_doc/1150_WhyNottheBest_EXEC_SUMM_METHODOLOGY_ONLY.pdf?section=4039


I think you would be surprised if you looked up other data. For instance, we hear again and again about the “47 million uninsured.” I’m surprised to find this includes all the people who make enough to not need insurance, and that 20% of the 47M are people in poverty (they are eligible…why are they uninsured?). In the report they also admit that they changed the way they calculate the total, so some of the years are not strictly comparable. So… I want to fix the problem, but how big a problem is it? Another example is global warming. I’m very worried about that subject, but I can’t validate the garbage data that both sides toss around. The main model for warming said 10 years ago that we would experience a 2 degree rise by now, but the change has only been 0.2 degrees…a whole order of magnitude off. The IPCC, the UN panel that issued the analysis and call to action on global warming, used data on tree ring thickness to measure temperatures over the last several hundred years, despite the fact that those data have been shown to be unreliable (trees grow, or they don’t, due to a lot more factors than temperature), and more reliable data tell a different story. Finally, the IPCC was billed as a panel of 2000 scientists, but wasn’t…most of the minority who were scientists didn’t have degrees in climate science. Actually only about 10 climate scientists were involved in the writing. By contrast over 31,000 scientists, researchers, engineers, and physicians have signed a petition saying global warming due to human greenhouse gas production is unproven. Who’s right?


I don’t know about you, but I’m getting overwhelmed with the junk I have to sift through to find the right answer and there’s nobody you can rely on to do that work other than yourself.



Frustrated Doc D


Opinions are entirely my own. Quotations from AMA Morning Rounds (© U S News Custom Briefings)

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