Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

CVS Stops Selling Tobacco

Doctors are tough critics — as well they should be. Today the news that CVS Caremark pharmacies will no longer sell tobacco brought about quite a bit of rapid online dialogue. Even President Obama chimed-in with praise, a response that some in the business world say is worth billions for CVS. Having a good reputation, particularly when you’re in the business of delivering health care and lending health advice, seems essential. In my mind we should praise and celebrate what today brings — leadership for making it harder to get addicted to tobacco products we know seriously harm health.

But not all doctors may think a move to ban the sale of tobacco in a health care environment is enough. Dr Sunny Chan, a family doctor in Canada, asked the tough question about our health care providers (HCP) working environment:

Meanwhile, Texas pediatrician Dr Bryan Vartabedian wrote a blog post this morning asking CVS to take a bigger step  by banning sales of unhealthy sugar-sweetened beverages (that we know are associated with obesity) and junk food. He wrote,

You can’t make money peddling savory snacks while at once setting the pace for a healthy lifestyle.  And condemning one vice works for the press release, but not as a brand offering health solutions.

When focusing singularly on CVS’ decision to stop selling tobacco products, it’s easy to say the choice is a phenomenal one. Not promoting (or profiting) from the sale of carcinogens is always in the best interest of our communities and our long-term health. I return to what Centers For Disease Control’s Director, Dr Thomas Friedman, recently wrote in JAMA , “Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people.” Read full post »

Reducing Poverty And Improving Health

Yesterday marked the 50th anniversary of Lyndon B Johnson’s 1964 State of the Union address where he made a proclamation to commit to end poverty in our rich nation. Nationally, there has been a huge and beautiful focus on the anniversary. Despite the political divisions and tense partisan discussions on how to proceed in poverty reduction, I heard many reports on the radio, read newspaper coverage, and saw chatter all day on social channels about where we stand. I was floored by the statistics. I’d not, unfortunately, ever before spent time thinking about Johnson’s proclamation and the line in the sand created by his words.

After his proclamation, the country went to work creating Medicare, Medicaid, Head Start (promoting school readiness through social, nutritional, developmental support for children from birth to age 5), food stamp programs, and Job Corps. Since 1965, Head Start alone has served more than 30 million children and set precedent for contemporary thinking on early education and consortiums today like Thrive by Five. Much of the media coverage yesterday focused on the profound progress we’ve made helping Americans quit or reduce cigarette smoking with the Surgeon General’s first Report on Smoking and Health. Still, nearly 1 in 5 Americans (18%) smoke in a country that has proven cigarettes to be the #1 leading cause of preventable death. Dr Thomas Frieden wrote in JAMA yesterday, “Tobacco is, quite simply, in a league of its own in terms of the sheer numbers and varieties of ways it kills and maims people.” Read full post »

My Adorable Activity Tracker. I’m Streaking!

First Day With My Shine

Self-tracking, life-logging, activity-tracking, “the quantified-self (QS) movement” as the smarty-pants say, or as some have asked, “What’s with the weird watch?” Well, I’m hooked. I don’t go anywhere these days without my device. My activity tracker had me at hello.

Over the summer I started wearing the Shine. I’d been waiting for it–it had a significantly delayed shipping date–which only heightened my desire. I’ve worn it every day (except one) since. The world really is different to me now. Before you start to criticize and marginalize my proclamations, know that I waited nearly 1/2 a year to write about this to ensure it wasn’t just a fad.

How My Activity Tracker Is Changing Me:

First things first: I realized how sedentary some of my days are. Especially when I’m writing or working intensely; knowing this has changed how I think about walking. Secondly, I’m really much happier knowing how much movement I have during a day rather than guessing about it. Even when I’ve hardly moved a few paces, I’m thankful for the insight. I mean, some days we pig out, some days we aren’t as hungry and eat salad, some days we run miles. Other days we work and write and sit far too long. My activity tracker helps me understand the patterns and think about new ways to live differently. The boys always want to know how much we’ve moved. This tracker has power around here. If there’s any New Year’s “resolution” that may be worth committing to–it may simply be to check in on how you’re moving. Find a tool to give you observable data. Behavior change perhaps will follow.

To be clear, it isn’t the device I’m attached to that is changing my life, it’s the new experiences I’ve having because of it. New insight from my Shine changes my mood, the way I map out my day, and has undoubtably made me more self-aware. I’m thankful for my consultant.

Reality is, many of us are tracking our lives and our movement without realizing it. Before you write we trackers off, read on.

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Simplifying Health Care

StrikeWe all want simple solutions to living a healthy life.

It feels like I was born at just the right time for my work in health care. I completed my medical training just as social tools were percolating out to the masses. Motherhood and my practice of pediatrics auspiciously coincided with the bounty of information that technology has distributed, offered up, and shared unlike ever before.

I can search and learn about health wherever I am –  at the park or in the walls of my own clinic or home. For me, using my phone, Twitter, my blog, apps, Facebook, activity tracker, and patient online communities to provide health care, consume it, and engage in it is my new reality. It turns out, amidst all the clutter and stress of health care reform and our reduced time with our own doctors I can see clearly that intuitive ways of learning about science wed with thoughtful technology will let us care, cure, and prevent illness and injury like never before.

A survey published today finds that more that 3/4 of moms search online for symptoms. The majority of mothers in the US also look up information regarding their child’s development online, read about a medicine, or track their pregnancy with online tools. I’ve done, or do, all of those things. Don’t you?

I’ve just started a new job in the hospital overseeing a group in Digital Health. Our goal is to rapidly improve the way we serve children and their family’s unique needs in the hospital, clinical setting, and community. I want to help facilitate elegant communication between parents, patients, families, and their clinicians & surgeons when they are outside the hospital or clinic. Reason is: it seems to me that the luxury of our time is the one-to-many communication we have in our pockets. Over 60% of all American adults have a smartphone in their pocket and  crowd-sourcing happens at virtual water coolers (ie Facebook) every day. Over 40% of Americans log onto Facebook everyday to listen, lurk, snoop, learn, and vet ideas. Read full post »

Arriving Early: World Prematurity Day

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I think about the essay Welcome to Holland by Emily Perl Kingsley a lot. Her explanation of what it’s like to raise a child with a disability helps approximate (for me) the unexpected realities that ensue for families who encounter significant pediatric health challenges. Although her essay is not about prematurity and it’s not new, when I sat down to write about World Prematurity Day I couldn’t help but think back to her words and her metaphor. What’s marvelous, of course, is that her essay is built of love so all of us have a chance to understand it.

Sunday, World Prematurity Day, is a day to think cautiously, bravely, and empathetically about the opportunity to improve the lives of children born prematurely, all around the world. When a child arrives early there are obviously significant health challenges not only to survival but to a long life thereafter, sometimes with significant disability. Parents all over world suffer and learn to thrive with and after prematurity every single day. In fact,

Prematurity is the leading cause of death in newborns. Although some risk factors are known for preterm birth, we don’t know very much about the cause.

None of us will really ever know what it’s like to survive and thrive in someone else’s experience. So we share stories, quotes, photos, and moments as best we can to help others understand. As I’ve met and been invited to help care for parents, families and children who are born prematurely, one thing is certain — it’s a journey. It starts often with surprise and evolves individually. The essay by Kingsley is clearly about the journey, not about the diagnosis of prematurity at the time of birth.

Here’s what a colleague and friend, Kim, shared with me about her experience with her twin daughters who were born over three months early: Read full post »

Remarkable Facts About Young Brains

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I’m thinking about the high stakes of parenting. Thing is, the more I learn about early child brain development, the more I’m astounded by the opportunity and simultaneous great responsibility it is to care for and nurture young children during their first few years. The reality is: the brain is rapidly evolving as children grow– the connections between brain cells shift and change based on experiences children have. I mean, the brain really just learns how to think as our children age, especially as infants and toddlers.

I’m at the national American Academy of Pediatrics meeting this weekend in Orlando. I’ll be sharing ideas and things I’m learning on Twitter and my Mama Doc Facebook so please follow along if you’re interested. Yet in the immediate I wanted to share a couple things I heard this afternoon about early brain development that can easily change how we think about our children’s lives now.

The first speaker I was lucky enough to hear is Dr Pat Levitt an expert on early brain development from University of Southern California. He shared some fantastic science. Here are 4 quotes from his talk and 5 ideas for what we can do to incorporate science into everyday life while raising children: Read full post »

A Cab Ride In Canada

It was sunny when I landed in Toronto on Tuesday evening so I felt a bit lifted as I sat down into one of the most pleasant cab rides I can remember. The driver was 69 he said, and his claim to good health was avoiding alcohol, shunning cigarettes, and waking up each and every morning to exercise. “Just 30 minutes a day,” he said, “Changed everything in my life.” I held my tongue as he kept talking. The coincidence with the first meeting I’d have while in Toronto was startling. As Dr. Mike Evans and I talked over coffee the following morning, the serendipity of the unified voice in Canada was an unexpected delight. A patient and doctor sharing the same similar thought—one from experience, one from expertise: 30 minutes a day could change your life. If you haven’t seen the video, please watch 23 ½ hours now.

The cab driver was one of 10 children to his mother and father born in the Philippines (5 boys, 5 girls – how’s that for biology playing out) who has lived in Canada for 11 years. All of his siblings were living now in Canada or the US and he’d asked why I’d arrived in Toronto. I’d arrived to, “Share some ideas on using social tools to transform health care,” I said. Maybe it was our deeply political and nearly anthropologic conversation that charmed me. Maybe it was the story I re-read just prior to taking off in Seattle detailing the generous cab drive a man offered a dying woman. Yet Tuesday night in the cab I realized instantly, like I usually do, that although I was there to share my thoughts with a number of people, I would learn potentially much more from Canadians than I would impart. It really is so good to get out of Dodge and see how other people do things.

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Simply Not Factual

No-SymbolSimply not factual. That’s really all that needs to be said in response to Michael Edwards’ opinion piece entitled “Vaccine Side Effects and Why You Shouldn’t Vaccinate” published in Organic Lifestyle Magazine last week. This is clearly a non-peer reviewed, non-fact-checked online publication that Mr Edwards edits and owns. Fortunately, the magazine is reported to get about the same amount of traffic as my blog so it’s not exactly the Washington Post…

That being said, Edwards’ piece is so egregious I’m unable to hold my breath. Although I’m no watchdog, the dangerous writing demands physician attention partly because it’s been published amidst a noteworthy week in the world of vaccine misinformation:

  1. A segment aired last week by a local TV station in Las Vegas claimed doctors debating a need for vaccines. The TV station reported false information and misrepresented a chiropractor as a “holistic physician.” There was a noted uproar online, especially when original comments from physicians were, at first, taken down. Here’s more from news watchdog Gary Schwitzer, “Back To School Anti Vaccination Woo.”
  2. Mr. Edwards published false information claiming families shouldn’t vaccinate. More below.
  3. Jenny McCarthy’s credibility erodes further as it’s announced she is now advertising e-cigarettes. A pediatric colleague wrote a blog post entitled, “Jenny McCarthy continues tireless crusade to kill us all.”

Back to the piece in “Organic Lifestyle” though. What is so dangerous is not just Mr. Edwards’ misinformation but the way his article appears to the eye. Mr. Edwards published his vaccine opinion in a structure that misleads a reader to believe it’s based in fact. There are sections with headers, subtitles with supposed historical reference, and a list of resources at the end. All the while Mr Edwards warps truth and paints a picture of a fictitious world—one where those diseases now eradicated (small pox) or nearly so (polio) thanks to vaccines, aren’t.

Small pox has been eradicated by worldwide vaccination and thanks to vaccines married with a remarkable commitment from the Gates Foundation, polio is nearly gone too. Read full post »

Enter The Smart Diaper

Screen Shot 2013-07-09 at 10.09.35 PMToday I learned about “smart diapers,” disposable diapers that have QR code indicators with colored sensors ready to detect not only wetness but risk of infection, dehydration, or kidney disease. Only a matter of time, I suppose, that infants’ clothing educates us about their health since it’s been just weeks since TweetPee, the diaper unveiled in Brazil that tweets parents when wet, was unleashed. By report, the smart diapers unveiled today will ring up at the register only 30% higher than a typical diaper. These highly capable diapers may therefore become mainstream whether we like it or not. Worried about your baby’s weird smelling pee and/or worried your infant is getting dehydrated during a bad illness? Just throw on a smart diaper for some insight. Not such a bad idea for a worried parent with a punky baby at 2am.

Formal self-tracking is thunderously augmenting human life as our experience with our bodies and health adapts to available technology. Mobile health apps (think Baby Tracker or Map My Run), self-trackers (think Fit Bit or Up), and devices (think smartphone camera) are continually providing us with new ways to assess and improve our self-awareness. Many Americans (infants to adults) self-track, or are being tracked, without knowing it. Susannah Fox, a researcher studying the intersection of technology and health care, introduced me to informal self-tracking last year when she mentioned the utility of “skinny jeans.” Each pair of skinny jeans out there in closets around America showcases the perfect tracking device for weight balance. We know just where we are when we try them on…

I saw a friend last week who showed me her son’s daycare app–throughout her workday she has constant access to his “feed”–how many ounces of milk he drank, his last dirty diaper, and live, uploaded photos of him on the play mat. These 2013 babies will grow up with a distinct digital timeline. A wealth of data to evaluate and mine, indeed. Yet while the genius of great tracking devices is ease of use and insignificant work for data transfer, the beauty of a smart diaper is that it may potentially alleviate parental concern in minutes.

Some quantified-self devices are clearly amazing. But I have just one hesitation on this one.

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CT Scans And Cancer Risk

T8--approx CT scan” Yesterday’s news,” my husband said when I shared a study published, well, yesterday. Yet what we do with yesterday’s information is of course the news today. A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990’s and early 2000’s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the study came with warnings for radiologists, pediatricians, and parents.  I have tips for parents and doctors included below.

CT scans use radiation and radiation exposure is linked to cancer.

That being said, CT scans also save lives and we’re learning to use them more judiciously. Since 2007, rates of CT scans in children are declining. Don’t let these risks and media reports today cause you refuse or forego diagnostic CT scans your children need. We just have to be strong advocates and smarter about how we use CT scans. Read full post »