Dr. Corso's med blog

2010-08-02T18:12:00.000-07:00

Important new book by author & physician, John Corso MD

2008-02-06T21:41:00.000-08:00

Dying of Embarrassment

2007-03-19T12:42:00.000-07:00

I was asked to write about some of the embarrassing medical conditions that women may conceal from their physicians, things like facial hair, body odors, etc. Having done this job for 20 year I’ve heard it all from bad breath to old tattoos.

But the one issue I definitely want to put forward, because it’s proven to be more than embarrassing, is the often-mortifying experience of urinary incontinence. Over 20 million American women (and several million men as well) silently suffer from this health issue! Many lay people are already aware of the problem of leakage after childbirth or surgical trauma to the pelvis. The woman with this problem (stress incontinence) must be careful every time she laughs, coughs or sneezes for fear of a bit of urine getting away. However, this only constitutes about one fifth of the problem. A different form (urge incontinence) affects over 15 million ladies and can cause the untimely emptying of the entire bladder!

The cause is neurological and progressive, beginning with a sense of urgency to find a bathroom and progressing to a complete inability to hold back the voiding reflex. Sleep can be terribly disrupted and depression is common. Many of these patients become withdrawn and isolated and the death rate soars from a variety of medical and social dysfunctions. And the terrible truth is this: urge incontinence is the easiest of all to treat. They say that nobody ever died of embarrassment, but they're wrong. Lonely, isolated women do so every day, it's just a long, slow process.

The problem is believed to be the loss of the inhibitory signal (part of the sympathetic autonomic nervous system) that descends automatically from the brain to the bladder, to keep it from emptying on its own. We all take this inhibition for granted even though it was something we had to develop during our potty-training years. Patients with spinal chord injuries rediscover that the bladder is happy to fill and empty on its own if it can no longer talk to the brain.

Treatment goes after both legs of the problem, the psychological/social and also the medical. Often these patients have developed neurotic habits around going to the bathroom, knowing the location of every place-to-pee in their world, or habitually going to the restroom every half hour or so to avoid getting to the point of feeling any urgency. Medication helps to restore the balance between the sympathetic and parasympathetic arms of the autonomic system and is remarkably effective in many cases. If you or someone you know is concealing a urinary incontinence problem, get to your doctor today. Surgery is seldom needed and relief may just be a simple medicine away.

Vaccination Guidelines Get It Right With HPV

2007-03-14T19:01:00.000-07:00

The CDC reported that one in four women has HPV, further supporting guidelines from major health groups calling for the widespread vaccination of 11 and 12-year-old girls.

I believe these guidelines are well thought out and target those patients where a concentrated effort at vaccination will do the most good, both for the individuals receiving treatment and for the future population of adults that these adolescent ladies will become. One often-overlooked benefit of individual vaccination is this: the greater the percentage of people immune to a viral disease, the harder it becomes for the virus to spread. It is possible to actually wipe a virus out of existence by only vaccinating “most” people.

The FDA has approved the vaccination for girls and women between the ages of 9 to 26, but it is best to vaccinate the patient before they become exposed to HPV, that is, before the onset of sexual activity. True, many women in their 20’s are not yet infected, but the risk jumps up with every new sexual partner, especially since this is a largely invisible infection in both men and women. This vaccination covers the four most common/destructive strains.

My daughter and a friend are slated to receive the first injection next week. We will be paying cash for it as it’s not covered by our insurance. No matter. We are just thrilled that this wonderful breakthrough exists. The benefit is more than worth the price.

How is Burnout affecting health care at our local doctor’s office?

2007-03-05T07:52:00.000-08:00

Burnout seems rampant throughout all of our healthcare specialties. As a general internist in a large primary care clinic, we are seeing the effects of two things: Family doctors and internist are retiring earlier than expected due to dissatisfaction with the lifestyle and work environment that now defines medical practice.

In choosing which specialty of medicine to enter, the deal was that family practice and internal medicine would offer less money but you’d get higher satisfaction from knowing your patients well and having a reasonable work day and work week. These were the fields for people who valued lifestyle and career. But that deal has been broken,

It would seem that medical practice is now owned and operated more by the insurance companies and government agencies like Medicare, who have imposed large, expensive and time-consuming bureaucracies on what was once a simple relationship between caregiver and patient.

The result is that the average medical practice, which employed 1.8 office workers per physician in 1980, now must hire between four and five employees to push paper. They must bill, re-bill, request permission for treatments and dozens of other functions that are not directly related to patient care.

So the physician must see his or her first dozen patients of the day just to cover the fixed overhead of being in business. Salary only shows up After that, through the extra patients that must be crammed in to an overfull day. This is why the average patient visit has gone from a half hour down to ten minutes in a typical office.

Burnout comes from the mountains of paperwork after the clinic closes that keeps physicians from getting home at a reasonable hour, and from the unsatisfactory experience of rushing through patient visits. Let’s face it, if the patient is rushed, the relationship becomes strained and it’s more common to have an adversarial relationship between the clinic and the office instead of a collaborative one. This gets very old, very fast.

We’re looking at a doctor shortage of unprecedented size and scope. While politicians dictate what Medicare will and won’t pay and talk about imposing a one payer bureaucracy on us doctors, they forget that this is still a marginally free country. They can’t force us to practice. They are going to drive the best and the brightest further away from the practice of medicine, at a time when the baby boomers will need doctors the most.

Baby Boomers Feel In Charge of Their Health

2007-02-24T15:56:00.000-08:00

UPI Poll: Most feel in control of health
WASHINGTON, Feb. 21 (UPI) -- Nearly all U.S. respondents to a UPI-Zogby International poll said they feel they have control over their personal health.

At first I just thought that these people must be deluded, since from my point of view, we are losing access to our health care providers. Every phone menu option or human screening we must negotiate our way past to get in touch with the physician is a new obstacle. Every minute shaved off the ever-decreasing length of the office visit lowers how well we can be heard.

But then I realized that personal health has very little to do with the doctor, especially these days when information is available to all us baby boomers at the touch of a mouse. Two important trends in which patients are starting to take greater control of their health and well-being came immediately to mind:

Lay people are becoming more educated:
It is now possible to extract accurate information from the web and media about what tests, treatments and behaviors will truly extend life and promote well-being – and, conversely, to identify the hype and nonsense.

Consumers are willing to spend more on their health:
More and more of us baby boomers are taking advantage of new medical practice models that afford a return to the more intimate relationship between patients and physicians as well as enrolling in medical wellness programs such as HealthWise. This demonstrates a growing willingness to go beyond the restrictive menu of one’s health care benefits and invest a little cash in one’s own health.

A final thought. People “largely feel in control of their health.” But are they? In my professional experience, many such people die way before their time. They thought they were obeying “Nature’s Rules” for healthy living and so neglected to search for, or adequately deal with dangerous medical conditions they didn't know they had – conditions we now have the medical technology to find and cure.

The skyrocketing costs of health care

2007-02-16T22:42:00.000-08:00

I was recently asked about why the costs of healthcare are skyrocketing and what consumers, employers and healthcare providers are doing to adapt to the situation.

Here’s a countdown of three big areas of increased cost: (a more detailed discussion of each, which you may wish to use, is provided at the end of this email.)

#3 on my short list, but often first in the news and in the complaints I hear from patients and consumers is the high cost of pharmaceutical medications. The percentage of health care spending devoted to expensive new drugs certainly has risen from about 8% fifteen years ago to about 16% today. HOWEVER, this is actually a huge value because the number and cost of hospital stays, surgeries and doctor visits that result directly from the diseases these new drugs treat has fallen proportionately – and the patients are healthier. Our extraordinary new pharmaceuticals actually represent one of the best values in medical care today. The advancement in technology mirror the pace of computer progress: exponential. So is the cost, not the least of which is caused by increased demands from the FDA to prove safety and efficacy – hundreds of millions of dollars per new drug.

#2 Second is the fact that consumers now demand that all matters of health and wellness be covered by their insurance – everything from cancer treatment (a good place for insurance) to the purchase of Viagra, birth control and even therapeutic massage (more a lifestyle choice in many cases.) This is a financial disaster, because as insurance companies compete to expand the services they cover to meet their customer’s expectations, they must raise rates for everybody. No one had their insurance pay for medication twenty years ago, and mammograms were not covered either. No health plan would have the nerve to deny a mammogrom today! Imagine in the automotive world if you could make your car insurance pay for oil changes, stereo/iPod upgrades or a new paint job for your SUV whenever you felt like it. The skyrocketing cost of car-care benefits force many a motorist to drive uninsured.

#1 Last is the insurance industry itself. All we need to do is step back and take a look at enormity of this profitable bureaucracy. When I started practice twenty years ago there were, on average, 1.8 employees per physician. Now that number is between 4 and 5 and is matched or exceeded by an equal and opposite contingent of paper pusher in the offices of the insurance companies and government health plans like Medicare. I must hire a person to bill their person who sends it back for more information before clearing a bill for payment. The volume of families whose lives are supported health care dollars is simply enormous, and growing every day as new laws such as HIPPA (the federal patient privacy act) spawns whole industries that healthcare providers must pay to make sure they are in compliance with these unforgiving laws. (and we thought OSHA was tough!) We’ve helped buoy up unemployment but have darn near sunk the health industry.

What have doctor and patients and employers done in response to skyrocketing costs? For the most part, employers have been forced to scale back by:

* Denying benefits for part time employees and limiting new hiring to only part time status.
* Removing family members from employee’s existing plans.
* Increasing the portion of the health premium that employees must pay themselves.
* Switching to lower-cost health plans which are more restrictive about who a patient can see or what medications they will pay for.

A promising trend in large companies like Jeld Wend and Les Schwab Tires is to take health care in-house. My experience is a much more efficient and cost effective system, since the for-profit middle man is cut out. We can get things done faster and better.

As a physician, I personally sought to cope by starting Oregon’s first retainer-based medical practice, also called "concierge" or "boutique" practices. They are often misunderstood as being for rich people only, and nothing could be further from the truth; many of my patients, even with low incomes have actually saved money in such a model.

Avoid second hand smoke, but do it for the right reason!

2007-02-13T22:35:00.000-08:00

I was recently asked about the danger of lung cancer from second hand smoke since Television spots about such tragedy are now getting a lot of airplay. I think avoiding second hand smoke is great but I prefer a bit more accuracy. There are close to 170,000 lung cancer deaths each year in the US but only about 3000 cancer deaths can be attributed to second hand smoke. And there are a whole lot more nonsmokers than smokers, millions and millions of us. So if lung cancer was the only danger from passive exposure, it would be a relatively rare occurrence.

However, tobacco smoke, whether first or second hand, has now been convincingly demonstrated to be highly toxic to heart health, resulting in added heart attack risk, about 80% as much in second hand exposure as in the actual smoker.

The toxic effects of tobacco smoke on the coronary arteries is almost immediate. This is in contrast to other cardiac risks such as chronically elevated blood pressure or high levels of the “bad cholesterol,” which increase heart attack risk gradually over time. Certain compounds in tobacco smoke represent an acute “assault” on the delicate inner lining of the coronary arteries, the endothelium. These effects can be measured within 30 minutes of smoke exposure.

Although I don’t know of any specific data regarding the timing of second-hand smoke exposure and an actual heart attack, it is well known that when a smoker dies of a heart attack, it is commonly during or within minutes of smoking a cigarette.

Fight to avoid second hand smoke! But do so because of real king of death in America – heart disease.

Migraine headaches - are there foods to avoid?

2007-01-10T22:40:00.000-08:00

I often have patients who suffer from migraine headaches because it is an extremely common problem. But the majority of this vast population has finally caught on to the extremely effective, almost miraculous, medications that can save the day more often than not.

Unfortunately there are exceptions, patients on whom the newer meds do not work, and these headache sufferers are the ones we now see in medical practice most often. Since the quick and easy treatments don’t work, they focus on what things might trigger a headache, in the hope that avoiding as many of them as possible will spare them lost and painful days. And the question of which foods to avoid is often first in line. Here’s what I tell my patients about food triggers for migraine:

1) They represent one of many triggers and can be somewhat unpredictable as well as dependent on other factors at the time. For example, a prime trigger for women is the immediate pre-menstrual state of "falling estrogen levels." Should an offending food be introduced at this time, it may be more likely to trigger a headache (the final straw if you will) than at other times of the month. Besides premenstrual status, some of the other common triggers include peri-menopause status, hunger, lack of sleep, genetic tendency, stress and especially chronic use of pain medications such as ibuprofen, acetaminophen, and aspirin.

2) Foods most commonly associated with triggering headache include wine, chocolate, nuts, cheese, citrus, MSG (monosodium glutamate – the “Chinese Restaurant Syndrome”), aspartame/Nutrasweet® - my personal nemesis – and caffeine withdrawal. Others food triggers are known but less common and tend to be more specific to isolated individuals. I have one or two patients who only get headache with yeast exposure, for instance.

3) Almost all headaches, including those thought to be “tension” or “sinus” headache have now been convincingly proven to be migraine in origin. The term “migraine” refers to the etiology of the headache, not the severity, as so many people think. Interestingly, like so many medical conditions, migraine was originally defined by the most severe and dramatic cases – picture the patient in a dark quite room, cold wet towel over light-sensitive eyes, nauseous and miserable. But most true migraines are much more mild, yet caused by the same triggers and treated effectively with the same treatments.

Real Vs Junk Science

2006-12-06T10:27:00.000-08:00

This is a copy of the email response I gave to a friend who asked me to review the “science” behind a supplement made of volcanic rock:

“I listened to the on-line "scientific discussion" of the product. I get asked to participate in teleseminar discussions of this sort a lot and no longer waste my time. I'll tell you what I tell most of my patients and friends who ask my scientific/medical opinion of such a product.

Let me just say first, that I don't want to offend anyone, especially, you. But you have directly asked for my opinion so I'll share it with you. In looking at what I wrote below, I find that I am going on a bit - but I hope you'll take it in the spirit of a friend who happens to understand the science part of health.

I am a scientist; I understand the math, the statistics and the methods that are meaningful for establishing scientific evidence and I also recognize those things that aren't. I only dwell on this because I want you to realize that understanding the science of a health study is very complicated and most people who don't do this kind of thing for a living don't have a clue. It's not about brains, but it is a specialized area of knowledge. It's easy for people in companies like this to sound scientific to the average, intelligent person, but to still be talking nonsense. And that's what they’re talking.

I find this company/product to be typical of the industry, that is, advertising and selling a substance as a "toxin remover" and claiming scientific evidence to back the claim. But they can't have it both ways. It's OK to claim some mystical power for your product and sell it to "believers," claim that individuals who take it say they feel better, etc OR you can claim that real science backs your claims. But they try to do both.

There is real science, and there is sham-science and theirs, unfortunately, is the latter - it's nonsense. They quote three studies in goats or sheep (ruminants) where all the animals got a supplement, 50% their brand, 50% brand "X" and their goats had "better nutritional status" at the end of the study proving that they not only remove toxins but are "nutrition enhancers." No placebo control. No genetic homogeneity in the animal (a MUST in animal studies with small numbers) and no prospective endpoints defined before the study begins. I could just as easily say that their study only showed that brand “X” was a “nutrition detractor.”

This is a typical snake oil show for those who do not understand real health studies. My book talks a bit about the difference between retrospective and prospective studies (their's doesn't qualify as either!) and how carefully each study must be constructed and carried out to be able to actually make a claim at the end. And claims from real studies NEVER generalize with stupid words like "toxins" or "nutrition enhancers." Real science is about details. What toxin are you referring to, sir? What nutrition marker(s) are you quoting and why? Where are the hundreds of references that establish the validity of the toxins and nutritional measurements you use? Real studies are difficult to set up, to justify, to carry out, to get reviewed by the experts and to get published in reputable journals.

To draw an (admittedly obnoxious) analogy, I would ask you: Would you rather get on the maiden voyage of a plane built by scientists who carefully and accurately calculated things like the true tensile and ductile strength of the metal used to build the wings, the maximum shear tolerance the wings can handle in a sharp turn, the real atmospheric turbulence data about how our skies actually behave, the thrust range of the engines, the results of hundreds of wind tunnel simulations and every other one of the millions of real details that allow an airliner to fly successfully 99.92% of the time?

Or would you get on a brand new, untested plane, beautifully painted, (as it's being rolled off a cliff and into the sky for its maiden voyage) which was designed by an enlightened artist who used his intuition and sense of style and who claims to have divinely solved the problem of how to "avoid problem zones of sky - sky daemons" and to "flow with nature's beautiful healthy lines of force" by using a special ancient icon taken from a Mayan pyramid which has protected people for centuries! and so can be counted upon to gently transport you in health and happiness?

There's a reason the planes made using real science fly, and why you won't see many functional flying machines of the latter kind. But many of us who look at the so-called science behind a health supplement choose not to use the same rigor and criticism we might bring to bare if we were deciding to put our child onto one of the two contraptions described above. The rules of science are the same - the stakes are just so much smaller when it comes to "eating washed volcanic ash" which the FDA has noted isn't absorbed into the body and doesn't seem harmful. So we let our belief system decide what we swallow and try to delude ourselves that there is science behind our choice.

So there you have my take on this product from what I've seen so far. There is no science at all. Whenever a sales person talks about "toxins" but cannot name the exact molecule(s) and the exact effects of the so-called toxicity, they are either liars or they're ignorant.

Many of my friends believe in such products - and I have no trouble at all with that or with them, because if someone believes they will be healthier, they will be. I don't want to threaten them in any way with my opinions (I don't care what others choose to believe) and I don't claim these products aren't at all good. I claim that SCIENCE has not said anything about them one way or the other. That's all. So my opinion as a scientist is unnecessary. There is no science - just hype - in the claims they make.

When salespeople choose to lie and distort the facts about real science as it pertains to their product, I must view them as dishonest profiteers. That's what I found on the web site of this company and dozens of others like it. I believe history will look back on the supplement craze and the multilevel marketing that drives it with an unkind eye. Hope you're not sorry you asked, but I'll always answer honestly to a friend."

2006-12-02T21:49:00.000-08:00

Welcome to my medical blog. Here you can share the politically incorrect thoughts of a practicing physician on the subjects of health care, preventive medicine, our news media, alternative medicine and more. Below is the beginning of my new book for a sneak preview. Please feel free to leave your comments or contact me by visiting myweb site at www.stupidreasonspeopledie.com

Exerpt from:
STUPID REASONS PEOPLE DIE
An Ingenious Plot For Defusing Deadly Diseases

"There are only a few stupid reasons people die -
they just happen to kill a whole lot of people"

Chapter 1
Rumors, Tumors and Baby Boomers

Ed was having a very good night. It may have been a freezing Michigan evening in the dead of winter, but Ed was glowing. He had just bowled a perfect 300 for the benefit of his team, the third perfect game of his life.

He had been bowling for decades, but these three scores were all hallmarks of the past two years, as was his induction into the Kalamazoo Bowling Hall of Fame. Life was great. Ed was at his peak.

Ten more pins went their separate ways as he nailed another strike on the fourth frame of the next game. Returning to his chair, he suddenly knew something was terribly wrong. Then, nothing.

Friends and family watched their Kalamazoo hero clutch his chest and collapse. A tiny blood clot had suddenly formed in Ed’s heart. His life simply stopped.

John Ritter’s darling daughter was celebrating her 5th birthday, just a few days prior to her dad’s 55th. Her famous father was busy, preparing to tape the latest episode of his hit television series, 8 Simple Rules for Dating My Teenage Daughter.

While working on the set, he began to feel ill. Things quickly went from bad to worse and Mr. Ritter was rushed to St. Joseph’s, the same Burbank hospital where he was born. Several hours later, as a team of surgeons struggled to repair his torn aorta, he died on the operating table.
The sudden tear that ended John Ritter’s life was reportedly due to a heart defect, an undetected problem Mr. Ritter may have had since birth.

Ed’s story made the national news because in the midst of personal glory he dropped dead. John received even greater coverage because he was well known to most Americans.

Every day, the lives of average, healthy-looking folks come to an abrupt end, sending shock waves of misery through the lives of their loved ones. Their stories may lack the tragic irony or celebrity status to make them newsworthy, but for every John Ritter, there are a thousand John Does.

As I write this, the first baby boomers are just hitting 60, and the average life span in America is up to 78 years. And that’s great, since life expectancy was only 40 years just a century ago.
Yet it’s a harsh statistical fact that in every group, somebody has to fall below the average. This means that for all the spry characters who make it to their 80s and 90s, an equivalent number of unlucky souls die long before Medicare ever kicks in.

We’ve all seen it. A father dies suddenly of a massive heart attack. A mother wastes away from cancer. End of story. No more holidays, soccer games, or school plays to share with the family. Someone else must walk their daughters down the aisle. Show up to your next high school reunion, and you’re sure to hear about a few more.

Here’s the tragedy: Many of these people die in the prime of life from common medical conditions we already know how to find and fix.

How could this happen? In most cases, it happens because no one looked for or treated the problem the right way, in the right place, at the right time.

Devastated friends and relatives, watching a loved one die, can’t help asking if something could have prevented this life from ending so soon. Whether the patient is suffocating from congestive heart failure or battling a cancer consuming their body, the answer is often a heart-breaking "yes." It’s terrible to realize that someone you loved might still have been with you.

Every year, tens of thousands of people "slip through the cracks" and pay the ultimate price. And it’s not that we don’t care! Both the health-conscious and the "worried well" in America spend billions of dollars on products that promise to keep them healthy or ensure a long life.

No-Fat! * All-Natural! * Lite-Lite-Lite!

If a fraction of this energy and money was applied to truly effective screening, prevention, and treatment, death could be postponed for tens of thousands of men and women.

There are countless "stay healthy" books to guide you through myriad dietary and lifestyle changes, herbal and vitamin cures, and other instant miracles to ensure your health and longevity. This is not one of them.

Even the books with good advice on healthy living don’t seem to inspire and sustain meaningful changes. They just leave most readers feeling guilty. Often, it seems impossible for busy people with too many demands and not enough time to redesign their lifestyle.

Not that cutting back on junk food or taking time to exercise are bad ideas; they’re not. But here’s the irony. Even if you pull it off – exercise every day, eat only salad, fish and tofu, take vitamins, meditate, and grow your own organic vegetables, you will only increase your chances of avoiding a preventable early death by a tiny percentage.

In fact, if every citizen in this country ran five miles a day and never again ate cholesterol-laden food, there would still be millions of people like Ed, dying for stupid reasons, dying because of heart attacks, strokes, cancers, and other diseases that could have been detected and stopped.
This book is about real results. And real results for living longer don’t come from good intentions and superhuman discipline. They come from being smart about identifying and treating the things most likely to kill you.

It’s not difficult to avoid the most common killers if you accept that reducing your chances of dying young is worth a little effort and money. That is what this book will help you do. Minimal scare tactics, no false promises, and no reasons to feel guilty.

When people die prematurely, it’s rarely because they’re lazy, simple-minded, or have a death wish. It’s because they’re misled. But while it may not be their fault, they are part of the problem. If you are an average, forty-plus American, you’re most likely focusing your efforts to be healthy on the wrong things. Most of us plow headlong into harm’s way because of some basic things we fail to do and because of one thing we should never have allowed in the first place. I will bet that:

- You are not getting the all the right tests to see if you have a life-threatening medical time bomb waiting to go off.

- You are not taking the medicine, supplements, or other treatments that can defuse that bomb.

- You are not separating useful health information from the hype, partial facts, and plain nonsense you get from the news media.

- But you are allowing accountants, bureaucrats, policy makers, and politicians to make major healthcare decisions for you, perhaps unknowingly.

Medical issues fascinate many of us and affect the health of all of us. They also make juicy headlines, whether it’s Mad Cow prime rib, the dangers of Phen-Fen, or the latest Avian Flu scare. Yet this simple fact never makes the daily news:

Your number one, greatest risk of dying is from a
disease that can be prevented or successfully treated.

Apparently, this crucial message isn’t considered newsworthy.

Of course, there are a million ways to die. A meteorite could fall from the sky and end my life in an instant. An inoperable brain tumor could kill me in a few months, or I might just get onto the wrong plane at the wrong time. I hope to avoid all three, but I don’t worry about them. These possibilities and thousands like them are unavoidable, incurable, or random tragedies.

Most of the time, however, death is a dreary, predictable intruder. It comes in the guise of some health condition that can be detected and arrested before it claims its victim. Yet, it slips in easily and frequently, picking off friends and family because we aren’t paying attention!

If there were hundreds of complicated things we need to do to avoid such disaster, there might be an excuse for not taking action. But, here’s the frustration: There are only a few stupid reasons people die; they just happen to kill a whole lot of people.

Bad things do happen and everyone dies. Freak accidents, toxic shock, pancreatic cancer, unexpected asthma, Lou Gehrig’s disease, all tragic causes of death – but for unavoidable reasons. What makes dying stupid is when it could have been avoided.

Academy Award winner George C. Scott, best known for his famous portrayal of General George Patton, died in 1999 of a ruptured aortic aneurysm. This is a defect that can be easily detected and repaired before it takes a life. An ultrasound machine screens for an enlarged area of the aorta with almost 100 percent accuracy.

I don’t know the details, but I doubt Mr. Scott’s perfectly competent physicians thought to look for an aneurysm as part of his plan of care. After all, have you and your physician ever discussed screening for an aneurysm? It’s painless, harmless, and dirt cheap. There are a lot of aneurysms out there. Some are time bombs, and most can be defused. But if your physician is not aware of your risk or options, where does that leave you? I’d say that leaves you in the driver’s seat; it is, after all, your life.

I’m not suggesting you obsess about your health – just the opposite. I want you to address it effectively once or twice a year and move on, secure in the knowledge that you are not slipping through the ever-expanding cracks in America’s healthcare system.

The best that modern medicine has for keeping you alive and healthy is almost certainly not on the menu of your health benefits. I want you to know what’s available and how to get it. Here, you will find practical information that is not complicated or time-consuming to put into action with the help of your physician.

I will focus on the big-ticket killers, the few diseases that are most likely to cut your life short. They have become too mundane to make the late night news, too ordinary to get the attention they deserve. This is not about scaring you. It’s about empowering you.

Our life expectancy is 30 years longer than our great-grandparent’s. We live in a country with the world’s most advanced medical knowledge and technology. When they fall ill, people from all over the world flock to the United States to obtain the most effective treatments available. Something, then, is terribly wrong when millions are dying from preventable diseases when, in fact, their prevention is a straightforward and manageable process.

Why are we failing? It’s not from a lack of desire, effort, or access to powerful medical tools, but from our human tendency to ignore "potential" problems plus our individual and collective investment in misinformed, wasted efforts.

Subtle traps lurk in human nature that lead both doctors and patients to bad choices. Decisions, made with the best of intentions and for all the right reasons, can and do kill. These medical "wrong turns" often stem from outdated belief systems, misleading information from the media, or from our amazing, but terribly flawed, healthcare system. In other words: Bogus Beliefs, Bad Data and a Broken Bureaucracy.

Bogus Beliefs.

History is constantly rubbing our nose in the facts. When a long-held belief is completely disproved, convincing the public to change its collective mindset is a huge undertaking and usually requires a fall guy. Take poor Galileo. He was imprisoned for arguing that the sun, not the Earth, is the center of our solar system.

We all have a hard time letting go of what we’ve accepted to be true. We cling to the beliefs we acquired as children, even when faced with undeniable proof that they are false.
Usually, being wrong is no big deal. One can believe the earth is flat and go right on living. Being wrong about science and our health, on the other hand, can be fatal.

Madame Curie’s pioneering work with radioactive elements like radium led to her fame and the honor of a Nobel Prize. It also caused the leukemia that killed her. Today, we recognize that radiation is nothing to play with. We do learn. We don’t expose our kids to lead paint or second-hand smoke. We buckle our seat belts and, when necessary, get flu shots. We know how to run away from danger.Unfortunately, we don’t move so fast to eliminate threats of a different kind. I’m talking about our failure to quickly implement life-saving discoveries. When a new way to prolong life or prevent disease is discovered, it is often either rejected or treated apathetically for years before its benefits become widely accepted.

Consider this: In the 1840s, 30 years before Louie Pasteur developed his "germ theory" of disease, 20 percent of new mothers in the hospitals of Vienna, Austria died a few days after giving birth. The cause, "childbed fever," was three times more common in hospital deliveries than in women giving birth at home with midwives. Yet Vienna physician, Ignaz Semmelweis, had clearly demonstrated an astounding drop in the maternal death rate of hospital deliveries, down to less than 1 percent of mothers, simply by requiring one thing of his staff: that they wash their hands with water and a bit of chlorine.

Hand washing brought the safety of giving birth to an unprecedented level, possibly the lowest maternal death rate that human childbirth had yet seen. Dr. Semmelweis pleaded with the other doctors and students to do the same, especially after coming from their autopsy class, before delivering babies.

Yet his message was ignored and often disdained by his colleagues. After all, they "knew" disease came from an imbalance of the body’s four humours, not dirty hands. In frustration, Dr. Semmelweis resigned and moved to another maternity clinic. There, he showed the same benefits from hand washing, an admittedly inconvenient practice at the time, but again faced ridicule and scorn. Even after his death, he was the object of derision in his field.

Doing things "the way they were always done" cost the lives of countless new mothers even when the facts about infection were undeniable. Decades passed before hand washing became the standard of care in medicine. Clearly, our natural resistance to change can cost society dearly.

So can language. This essential tool is a double-edged sword. Humans are unique in how we use language to communicate, understand our world, organize, categorize, and share experiences.
But in the process, we attach emotion to words in ways that attract or repel us. We back away from suggestions of pain or fear. We race toward what we interpret as pleasure, comfort, and security. These categorizations help keep us from harm. Would anyone you know touch the pretty blue flame on a stove more than once?

Unfortunately, the emotions we attach to words do not always serve us well. Many people associate medicine with poison, chemical, or something artificial. They may also believe any food or remedy labeled "All Natural" is good for their health. The fact is, natural has very little to do with better health, and sometimes a chemical isn’t half bad.

"Drug" is another emotionally charged label. What is a drug, anyway? Is a woman on estrogen therapy taking a drug or a natural substance that replaces what she’s lost? Music alters one’s mental state. Does that make it a drug? What makes a drug "good" or "bad"? We will explore these issues and examine widespread prejudices and misconceptions, exposing how our views become distorted, with serious consequences for our health and well-being.

Bad Data

Information that seems to make sense influences our opinions and decisions but may be only partly accurate or incomplete. The military knows all too well that almost, but not totally accurate information is usually much more dangerous than no information.

Every day, we are at the mercy of an avalanche of external and internal messages. The information we act upon, often inaccurate, comes from the outside world – the media, the government, advertisers, the Internet, friends and family. Errors also originate from within the fascinating workings of our own human minds.

Most of us, while intelligent and educated, operate from an incomplete understanding of how medical knowledge actually becomes known. This is different from just being wrong. It amounts to taking accurate information, processing it through our individual mental and emotional software to come up with skewed interpretations and incorrect conclusions.

Health information is uniquely susceptible to distortion by this usually reliable process. The way we naturally think and the way most medical information is organized DO NOT MATCH. Medical facts exist mostly in statistical form and only have meaning when they are interpreted and applied in this form. It’s all about probabilities.

For example, statistically, a popular blood pressure medicine may carry a risk of serious kidney damage. An alarmed patient, hearing this report on the evening news, tosses his bottle of the drug into the garbage. What he is missing is that the risk only applies to patients with a specific medical condition, something his doctor knows he does not have. For most people, the kidney risk does not exist at all, while taking the medicine can mean a substantially longer life. Heard the right story – got the wrong message. On the other hand, the newest life-saving miracle cholesterol drug might be worthless for certain patients, offer no benefit at all, and put them at needless risk for side-effects.

Anyone can learn what statistical information on a subject means for them, but it doesn’t come naturally. Our minds decipher information in terms of cause and effect, filtering everything new through our past experiences. Our emotionally colored "this-means-that" way of interpreting the world serves us well in many cases, but it is a huge disadvantage when trying to apply scientific findings to our individual situation.

Let’s face it, if everyone made choices independent of emotions like greed, fear, or lust, and became instinctively good at probability and statistics, every casino in the world would close overnight. Don’t hold your breath.

The news media and advertising industry, fully aware of how we respond to new information, give us brief, intriguing, and oversimplified sound bytes to get the results they’re looking for: high ratings or big sales. Even if you’re blessed (or cursed) with a statistical mind, you must go beyond the hype and the partial, condensed reporting to get the facts that affect you personally.
This wouldn’t be a big deal if the worst that happened were unnecessary purchases due to slick advertising. But when it comes to your health, reacting to misleading information is dangerous.
Fortunately, we can train our minds to use the best available information in the most useful way. It involves asking a few simple questions whenever you hear an alarming news report about a medication or other health issue.

Let’s say the news of the day is, "Woman dies after taking an anti-depressant." Before flushing away an effective medication or lining up for the class-action lawsuit, an alarmed viewer, taking the same medication, might ask:

- Is there evidence her death was directly caused by the drug, or were other medical conditions or emotional problems the cause?

- How many similar patients might commit suicide because they are not on this medication?

- What are the risks to me of stopping this medicine, especially if I do it abruptly?

The answers to simple questions like these help clear away the confusion for patients who hear something scary about medication or a medical procedure.

A heartfelt warning: Never stop taking a prescribed medication because of something you hear or read until you talk to your doctor.

Broken Bureaucracy

Again, people who can afford it come from all over the world to take advantage of our country’s medical services – and for good reason! Medical miracles are performed more often in the U.S. than anywhere else. Yet our healthcare system is also the party most responsible for the failure to prevent unnecessary death. It’s a safety net with gaping holes.

Despite criticisms I offer in this book, I wouldn’t trade the quality and content of medical care in the United States for any other in the world. But why does our healthcare system fail to stop diseases that are, in fact, stoppable?

Because our healthcare system reflects our human nature: we react to a disaster after it happens far better than we anticipate and act upon an impending crisis. Experts and government officials knew a major hurricane in New Orleans was likely and would be devastating. Yet the necessary preventive measures were not taken. We are now paying the price for a predictable catastrophe in terms of lost, uprooted families, destroyed property, the long-term impact on a unique culture, and billions of taxpayer dollars. New Orleans will never be the same.

That directly parallels our healthcare system. It is absolutely clear what can be done to save tens of thousands of lives every year. We just don’t do it.

Consider our major killers: heart disease, stroke, and cancer. We don’t practice the very best medicine, the "state of the art," when it comes to preventing these diseases or screening to find them in time to disarm them. Instead, physicians are encouraged to practice what’s called the "standard of care," a level of care based on information that is typically five to ten years out of date. Medical science moves extremely fast, and this creates an enormous gap in quality between providing the status quo and providing the best available care in preventing disease.

Most patients and many doctors are not aware the gap exists. Why? Many factors influence how physicians practice, but high on the list of barriers is this: patients and physicians have bought into a system where the insurance industry dictates what physicians "can" and "can’t" do. Control has been turned over to entities that have a glaring conflict of interest.

They are measured first and foremost by their profits or, for government-funded programs, by how well they manage money. They are not measured by the success of their policies in preserving health and life. They choose the care they will "cover" based on how little it costs to provide what is considered "standard." Insurers rigorously resist paying for new tests, procedures, and treatments for as long as possible, even if they are a major improvement over current standards. The widespread use of medical advancements can be stalled for decades – yes, decades – based on the industry’s arbitrary claim that they are still "experimental."

I’m not suggesting there is a conspiracy against patients by the medical community or insurance industry. They are victims as well, victims of a healthcare system that has taken on a life of its own that limits and disables the content and scope of our preventive medical care.

Remember the response when Dr. Semmelweis demonstrated to his colleagues that clean hands save lives? Thousands more women died needlessly, because no one wanted to change the standard of care. How can patients advocate for their own healthcare if physicians are pressured to maintain, or voluntarily cling to, the status quo?

Intellectual inertia is part of human nature, but the world of medicine carries the consequences to a new level. Combined with the financial interests of government and insurance agencies and with our own passivity as patients, we have created a "perfect storm" for failure.

Now, back to you, the individual. As long as you rely on someone else to ensure you get the care you think you deserve and to pay the entire bill on your behalf, you will wind up with the least that modern medicine is willing to offer. Not because healthcare providers don’t want you to have the best, but because our healthcare system can barely afford your annual check-up.

If you want the best modern medicine has to give, it’s going to take a little time and money – yours. It will also require you to have some fresh insights and solid facts to enable you to be your own best advocate. Ready to start? ... continued in the next chapter. Read more at www.stupidreasonspeopledie.com

2006-12-01T22:22:00.000-08:00

Followup to the Winter 2006 Newsletter

HEARTSCAN
(A long hard look at your heart)

In the mid 1970’s, researchers wanted to take advantage of what was then an exciting new technology, the Computerized Axial Tomography Scanner later christened the CAT Scan, to capture images of living heart muscle in order to better study it. The problem was that conventional Scanners had many moving parts including an X-ray gun that had to rotate around the patient while taking each scan. This required several seconds to take one image. The heart, however, is not very cooperative about holding still to have its picture taken. So to speed things up they developed a way to quickly generate the needed x-rays without physically rotating an X-ray gun around the patient. They did so by replacing the familiar doughnut shaped apparatus that surrounds the patient in a normal CAT scanner with a large tungsten metal ring. Then, exposing this ring to a high-energy beam of electrons, the tungsten gives off the needed x-rays to create the picture. The electron beam is similar to that created in every TV picture tube only on a much larger scale. It is focused and quickly swept around the ring, using electromagnets in much the same way a single electron beam is rapidly swept across our television screens to cover the whole surface many times each second.

The rest of the machine is pretty much the same as a conventional CAT Scanner, but this change in how X-rays are created and handled results in a very fast machine that can take a complex CAT scan image in 1/100 of a second! This is ample time to get a clear picture of the heart if the timing is right. Timing is achieved by simply taking the picture between heartbeats, using simple EKG electrodes placed on the patient's arms and legs to tell the machine when to take the picture.

Once this wonderful machine was actually built, researchers noticed that certain hearts had a calcium buildup in the coronary arteries and that other hearts did not. At the time, our understanding of how heart attacks occurred was so flawed that the potential value of this observation was mostly ignored, except by a few very tough individuals who have withstood the skepticism and sometimes ridicule of their colleagues to pursue the possibility of using this information.

As our understanding of heart disease has progressed, it has become clear that the more calcium a person has in their heart vessels, the more plaque they have. Even though most plaque does not contain much calcium (only about 20% of plaques do) and the plaques that rupture may indeed be the ones without much calcium, the percentage of total plaque that contains calcium remains fairly constant, so if a person’s calcium plaque-load doubles, so does his total plaque load. Also, if a person has no calcium seen in his arteries, research has proven that his total plaque load is so small that he’s exceedingly unlikely to have a heart attack.

This technology has been tested on over 60,000 individuals over more than two decades to study how well it can predict the “future” of these people. And the last few years have seen many publications based on the information from this decade of observation and study. The good news is that the technology works. The ability of the ultra high-speed CAT scan, called a HeartScan, to quantify the amount of coronary plaque correlates with an accurate prediction of the likelihood of a heart attack or sudden death.

I have personally known about this technology for about twelve years, yet I did not start using it until 1999. The reasons I avoided this technology were two-fold. First, the ability to take a picture of a problem did not in any way suggest that the information would predict either safety or danger in terms of a patient's risk for a heart attack. I was concerned that a “clean” picture could give a false sense of confidence to some people and steer them away from life-saving treatments of known risk factors. I had already met people who had chosen to stop taking cholesterol-lowering medication because of a low HeartScan score. Second, a high score (lot's of artery disease) was not going to change how I treated that patient. I was already treating all the risk factors I knew how to treat in each patient, and I felt that a picture showing lots of heart disease would add nothing but anxiety to the situation.

But things have changed. Recent studies have put to rest concerns I had about people with no visible heart disease dying from "invisible" plaque. They don't. Of course this is an over-simplification but the ability of the scan to predict people who would not have heart attacks in the near future has been very reassuring. As for high HeartScan scores, they now greatly affect how I treat my patients. We are in a time of explosive discovery about the details of heart disease and stroke. The presence of diseased coronary arteries in an otherwise healthy appearing adult is to me like a smoking gun that must lead to a manhunt for the cause(s). Dozens of new risk factors and their respective treatments have entered the game and we can not only do more for each patient, but we can direct our treatments much more specifically once we know who is and who isn't forming large amounts of coronary plaque.

The HeartScan is a very easy test, requiring five to ten minutes. There are no needles involved or any specific preparations. It doesn't even require disrobing. The person lies on the CAT scan table and four electrodes are connected to his or her limbs so that the machine can take its pictures in-between heartbeats. The study is over and done with in a matter of moments. The results are often available immediately and sometimes discussed with the patient by the technician at the study center. The results are then sent to the patient’s physician and can be used along with other information to make very meaningful recommendations for the prevention of cardiac disease.

This information wouldn’t be so important if we didn’t have so many safe, easy and effective ways to reverse this hardening of the arteries. But we do. So it behooves all of us in our middle years to get our heads out of the sand and find out where we stand with the nation’s #1 killer and then, if necessary, take steps to thwart that killer. Every year doctors learn about new risk factors that can be measured in a person's blood or by their history that can suggest an increased risk for heart attack. On the other hand, it remains unknown for each new risk factor whether intervention to alter it has any long-term effects for the individual. Also, it becomes impossible to keep up with all the testing that can be done on an individual in order to find a hidden risk factor lurking in their body.

Since new risk factors are being discovered so frequently and our ability to effectively manage them is uncertain at the present time, it makes a great deal of sense to actually look at a person’s heart and see if they are developing plaque and, if indeed they are, to then heighten our search for reversible causes. On the other hand if a person has some numbers that may be disturbing such as an elevated cholesterol or more obscurely, an elevated fibrinogen level or C-reactive protein, two of the new and poorly understood risk factors, a negative heart scan can help us to put the person's mind at ease and allow us to simply follow that person without exposing them to needless restrictions, medications, etc.

At the time of this writing, the worst scan result (highest plaque score) of any of my patients is of a personal friend, a 66 year old man who has normal cholesterol, blood pressure, blood sugar, and who has never smoked. His exercise treadmill test with special imaging is completely normal. His scan is shown in part above. The white areas represent calcified coronary artery disease. Without this scan, nobody would have ever suspected that his hardening of the arteries was in the red-alert range. We went on to look for less mainstream risk factors and found two severe problems that can explain the disease and can now be corrected.

He and I will continue to follow his heart disease over the coming years to be sure our treatments are working and to stay abreast of newly discovered risk factors that may be involved in his problem. Without this scanner, I would not know on whom I should be focusing such intense attention. The information it provides is truly life-saving, yet despite the fact that it’s been around for 20 years and the studies have proven that it works, it will still take doctors and patients another decade to fully realize that it is no longer “new” or “experimental”. Currently “unofficial” recommendations are to scan all men over the age of 40 and all woman over the age of 50 if they have at least one other risk factor. I personally encourage my patients to get scanned whether they have any other risk factors or not.

The HeartScan is not available in every city in the United States. One company that makes them is GE Imatron and it hosts a web site (http://www.geimatron.com) with current locations and more information. I live in Oregon and at the time of this writing there is only one scanner in my state. Prior to its arrival dozens of my patients made the trip to neighboring California or Nevada to have the test and they were all very glad they did. Whether they experienced relief from a negative test or had to face the fact that their arteries needed help, they are grateful to know either way since problems can now be treated.

HeartScan costs about $450.00 and it is not a test that is usually paid for by most insurance companies at this time (much the way mammograms, pap smears and PSA tests for prostate cancers weren’t paid for in years past). While we wait for this test to be considered “the standard of care” in the insurance industry, while doctors remain ignorant of the few simple facts I’ve presented here and while patients steadfastly refuse to invest $450.00 of their money into their own health for the irrational reasons discussed in earlier chapters, thousands more people will die needlessly as a result, moms and dads, husbands and wives who could have been identified, treated and saved if they had made the small effort to get this scan. Don’t be one of them.

What about the more established practice of identifying indirect risk factors for heart disease such as high cholesterol, high blood pressure, diabetes, smoking, family history, etc? How do we integrate all these things into avoiding heart disease? HeartScan does not replace, but rather augments conventional screening for cardiac risk factors. It helps us to identify people, like my friend who would be missed by conventional screening of blood work, family history, blood pressure, etc. It helps determine for which patients we need to “dig deeper” to identify the cause of the silent, hidden heart disease it finds. It also helps point out which patients with known risk factors we need to treat with the most aggressive therapies and which we can try to treat without medications.

We clearly need to stay on top of conventional and newly emerging risk factors to make good choices for health and survival. Let’s start in the next chapter with my favorite, Serum Cholesterol. Since I personally have a very high cholesterol whenever its left untreated, I take a great deal of pleasure in the fact that modern medication now gives me a cholesterol lower than 95% of men my age and that I have coronary arteries devoid of dangerous cholesterol plaque. Having worried about my "genetically" high cholesterol for years, I can’t help but now feel a bit like the kid who finally turned and confronted a longstanding bully knocking him flat out of my life once and for all.