Carolina Wellness (AtroGene Wellness Blog)

WellnessOne - New Medical Director

2012-01-03T20:53:00.000-05:00

Importance of HDL-Cholesterol in Cardiovascular health

2012-01-01T12:19:00.002-05:00

HDL vs Cardiovascular Events: Thoughts on current medical literature & news as it pertains to optimizing our health.

by Alvin B. Lin, MD, PLLC - December 19, 2011

Provided by My 2 Cents

Big Pharma has struggled of late to demonstrate the availability & safety of a product that can raise HDL & prevent cardiovascular events. Initial efforts to raise HDL via cholesterylester transferase protein (CETP) inhibitors have not been very successful, eg torcetrapib in 2006. More recently, witness the debacles that were fenofibrate and niacin.

So why the push to raise HDL? Well, we've gotten pretty good a lowering LDL w/statins. But more importantly, for any given LDL, cardiovascular events still occur, demonstrating residual risk. From a different perspective, the higher the HDL, the lower the risk of events.

For instance, in a prospective cohort study published last week in the Annals of Internal Medicine, the authors followed for 11yrs 26,861 healthy women participating in the Women's Health Study and concluded that HDL is inversely related to cardiovascular events, even in those with low LDL. And just how much HDL does one need to appreciate benefit? More than 61.6mg/dL even in women w/median LDL <89mg/dL!

So if we don't have any drugs in our armamenterium, what do we do? Fall back upon our old standby and exercise!

===============================================
After 17 years in Northern California, I headed south where I graduated with a Bachelor of Science in Biology from the University of California, Riverside, in 1984 and promptly entered the private sector. A glutton for punishment, I returned for post-baccalaureate studies in Computer Science in 1987 after which I earned my Doctor of Medicine in 1991 from the Bowman Gray School of Medicine at Wake Forest University. Love called & romance blossomed, so I returned to the San Francisco Bay Area where I completed my Family Medicine residency at Merrithew Memorial Hospital at the University of California, Davis School of Medicine in 1994.

After 3 years wandering around the country as a locum tenens physician and collecting a dozen state licenses along the way, I was feeling rather masochistic once more. So I applied for subspecialty training, completing my Fellowship in Geriatrics at the Brody School of Medicine at East Carolina University in 1998. I joined the faculty as an Assistant Clinical Professor in the Department of Family Medicine and was appointed Director of the Ambulatory Geriatric Center in Greenville, NC. In 2003, I was recruited by Cenegenics Medical Institute to build it into the ubiquitous presence it is today in your airline inflight magazines. After 7 years as an employed physician, I left to return to my family medicine & geriatric roots by developing a small private practice which this website represents.

I have served as a Clinical Assistant Professor in the Department of Family and Community Medicine at the University of Nevada, School of Medicine since 2004 and recently became an Adjunct Assistant Professor of Family Medicine & Geriatrics at the Touro University Nevada College of Medicine. Along the way, I have written many articles, given many presentations, and made myself available to both patients and colleagues. I plan to continue more of the same (but without the middle-man!). For more information, go to http://www.alvinblin.com/ and http://www.linkedin.com/in/alvinblin.

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Weight Loss at Wellness One w/ hCG Diet Program and more

2012-01-01T09:36:00.000-05:00

With mounting obesity epidemiological statistics, it is as important as ever for those that are overweight, obese or suffer from metabolic syndrome (obese, elevated lipids, hypertension and pre-diabetes) to seek a "reduction" in body fat. There are now easy steps in which to achieve quick reductions and establish lifestyle changes for good health. Dr. Saleeby is associated with Wellness One of Myrtle Beach, SC as their new medical director. Wellness One is a health and beauty medical spa that offers the proven hCG diet program and other protocols for weight management.

Watch the video below for more on the hCG Diet Program and contact information for Wellness One and Dr. Saleeby.

Call for an appointment today: (843) 444-WELL (9355)

As a feature of being an active patient of Dr. Saleeby and WellnessOne, you will be ability to gain access to Xymogen pharmaceutical-grade (physician-only dispensed) supplements.

Additionally, you are granted access to other health provider exclusive supplement lines with a 5% discount (Pure Encapsulations, Perque & Designs for Health DFH) via Emerson Ecologics. Both web sites give you access to high quality, pharm-grade, well engineered lines of dietary supplements. Many of the products the general public cannot purchase or order without access through a healthcare professional, so they are not available over-the-counter. To set up a free account to order is simple; follow the steps on this page:

For discounts (5% and more) on your supplements access code: yms333

Emerson Ecologics is an online distributor of many high quality and exclusive products and I recommend shopping for great deals on this site. You are sure to find any supplement you are looking for on this site. As an active patient of mine you have special access with additional discounts. The account comes with a 5% discount to you on ALL products over and above the discounted prices. You must have my access code to qualify for these discounts and access to some physician exclusive products. You can learn more about what is available by visiting: www.emersonecologics.com. Again as one of our patients you receive an additional 5% discount on your orders. Use Dr. Saleeby’s zip code 29512 and the access code: yms333 or take the shortcut link below (cut and paste into your browser if you get an error message):

https://www.emersonecologics.com/CustomOrder.aspx?RefID=00171325

XYMOGEN

Physician exclusive product access:

1) Visit this link: https://store.xymogen.com/PatientSignup.aspx this is a secure web portal to Xymogen.com.

2) Next click on the button that states: No, my doctor has provided me with a code to create a new account.

3) Enter for Code #: staywell (all lower case and no spaces)

4) Enter for Practitioners Last Name: saleeby (lower case)

5) Click on and this will allow you access to set up your own secure account in which you can order Xymogen products on your own. They are drop shipped directly to you. I am not involved in that process. The fact that it is online means you have access 24/7.

If you have questions regarding supplements, what may be the best products for you,

or how and when to take them, Dr. Saleeby is available via email to help answer questions: jpsaleeby@aol.com

Excessive cancer screening in the elderly

2011-12-28T10:43:00.000-05:00

Excessive cancer screening in the elderly

Based on the National Health Interview Survey, researchers at the University of Connecticut have reported that patients ≥75 years of age continue to undergo cancer screening in spite of unproven benefit. Specifically, 57%, 62%, 53%, and 56% of patients 75-79 years of age have colorectal, breast, cervical, and prostate screening, respectively. More than 50% of patients > 75 years of age undergo cancer screening based on physician recommendations.

http://www.medicalnewstoday.com/articles/239052.php (MNT)

------------------

From MNT blog:

U.S. Preventive Services Task Force guidelines recommend against routinecancer screening, especially for breast, cervical, colorectal and prostate cancer, but adults 75 and older are still receiving regular cancer screenings. The report published in the December 12/26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, is a part of the journal's Less is More series, the aim is to educate healthcare professionals and patients alike in cuttings costs, but having a better service at the same time.

The authors write as background information in the article :

"In the United States, the number of adults 65 years or older, currently estimated at 36.8 million, is expected to double by the year 2030. Providing high-quality care to this growing population while attempting to contain costs will pose a significant challenge ...

While a great deal is known about cancer screening behaviors and trends in young and middle-aged adults, less is known about screening behaviors in older adults from different racial backgrounds."

Keith M. Bellizzi, Ph.D., M.P.H., of the University of Connecticut, Storrs, and colleagues analyzed data from the National Health Interview Survey, an annual in-person nationwide survey used to track health trends in U.S. citizens, to estimate the prevalence of cancer screening among older, racially diverse adults. The study population included 49,575 individuals, 1,697 of whom were 75 to 79 years of age and 2,376 were 80 years of age and older.

Percentages of those reporting cancer screenings are as follows :

62 percent Women age 75 to 79 - A mammogram within the past two years.
50 percent of women age 80 and older - A mammogram within the past two years.
53 percent of women ages 75 to 79 - A Papanicolaou screen (also known as a pap smear or pap test) for cervical cancer within the past three years.
38 percent of women ages 80 and older - A pap smear within the past three years.
57 percent highest of men and women 75 to 79 - Screenings for colorectal cancer.
57 percent of Men 75-79 - Prostate cancer screening.
42 percent of Men 80 and older - Prostate cancer screening.
40 percent of Men 50-74 and older - Prostate cancer screening

Analysis showed large differences in breast, colorectal and prostate cancer screening among older adults, but the authors found that these differences were accounted for by low education.

Individuals without a high school diploma were significantly less likely to be screened for breast, cervical and prostate cancer, compared with adults older than 75 years with a college degree. Adults older than 75 years were also significantly more likely to be screened for breast, colorectal, and prostate cancer if a physician recommended the test.

The authors concluded :

"A high percentage of older adults continue to be screened in the face of ambiguity of recommendations for this group ... Prevalence results from this study can serve as a benchmark for progress as we move the science of cancer screening in older, diverse adults forward."

In additional commentary, Louise C. Walter, M.D., of the University of California, San Francisco and San Francisco Veterans Affairs Medical Center, writes that :

"There are no quality measures that address appropriate target rates for cancer screening in persons older than 75 years ...

While at extremes in older age the likelihood of surviving long enough to benefit from potential detection and treatment of asymptomatic cancer becomes quite small and the likelihood of harm becomes quite large irrespective of other factors, Bellizzi et al were not able to calculate screening rates in subgroups older than 85 years owing to the small number participating in the survey ...

Still, the data by Bellizzi et al raise the issue of whether quality measures should address the overuse of cancer screening."

Dr. Walter concludes :

"While it is useful to determine screening rates among persons in whom screening will likely result in net benefit or net harm, between these two groups is a large number of older persons in whom screening offers small or uncertain net benefit ...

For these persons, the decision about whether the potential benefits of screening outweigh the risks is a value judgment that requires informed decision-making ...

While arguments persists about what is the 'right' rate of cancer screening in older persons, it seems clear that the rate of informed decision-making should approach 100 percent."

Written by Rupert Shepherd
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Rupert Shepherd B.Sc. "Cancer Screening In Older Patients Very Common." Medical News Today. MediLexicon, Intl., 13 Dec. 2011. Web.
28 Dec. 2011.

APA

Rupert Shepherd B.Sc. (2011, December 13). "Cancer Screening In Older Patients Very Common." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/articles/239052.php.

Colorectal Cancer Screening

2011-12-09T08:33:00.000-05:00

Expert Insights (Quest Diagnostics Patient Information)

A Two-pronged Strategy for Combating Colorectal Cancer

Thursday, March 31st
By: John L. Marshall, MD
Category: Oncology

Colorectal cancer a disease that is preventable, treatable and beatable, and for which early detection is of paramount importance.

Last year, colorectal cancer (CRC) caused an estimated 51,370 deaths in the U.S1.

Most of those deaths could have been prevented.

“When colorectal cancer is detected early and treated, the 5-year relative survival rate is 90%,” notes Dr. John Marshall. “This drops to around 70% for patients diagnosed with regional disease and 12% for those diagnosed with end stage disease2.”

CRC is the third most common cancer in the U.S., but the second leading cause of cancer related deaths3. Dr. Marshall sees two keys to promoting survival from CRC: more widespread screening and more targeted therapy.

A glaring need for more widespread screening

“Colon cancer is one of those diseases where early detection clearly matters,” Dr. Marshall says. “Yet screening rates are terrible. Only 50% of Americans over 50 years of age receive any kind of screening for CRC. That compares with a screening rate for breast cancer of around 70%4. And it’s tragic because regular screening could prevent as many as 60% of CRC deaths.5”

Why are screening rates so low? "Partly because the tests for CRC are difficult for patients to undergo," says Dr. Marshall of colonoscopies and sigmoidoscopies. "Fecal tests help a little, but it's no fun to collect stool. People would rather have a needle stuck in their arm. Better screening techniques and early detection are critical. The field has been moving slowly, which is why recent developments, such as a DNA blood test, are important." This new blood test option, methylated Septin 9, is now available to aid CRC detection for the more than 52 million individuals over 50 years of age, who do not follow guidelines and remain untested.

Genetic profiling for more targeted therapy

In addition to advances in promoting more widespread screening, Dr. Marshall sees promise in targeted testing once CRC is diagnosed. “We give everybody the same treatment up front and just hope that it will help. But we don't know who will benefit.” he says, “We need to get smarter about who gets which drug. We should know which patients are at risk and who needs adjuvant chemotherapy. With stage 2 and 3 patients, for example, deciding who needs adjuvant therapy is critical.”

Dr. Marshall points to genetic profiling as a major step toward evaluating the risks and determining which treatments patients should receive. “Genetic testing is making its way into clinical practice and having an impact on therapy,” he says. “People are getting away from the microscope and looking at certain gene or protein expressions to understand which treatment to select.”

The promise of more effective treatment

Dr. Marshall is optimistic that advances in genetic profiling will lead to more effective therapies. “The only way we’re going to get more effective medicine is through this concept of molecular profiling and targeted drug development.”

"The hope is that this will lead to additional breakthroughs – not necessarily for everyone with colon cancer, but for subsets of patients with specific kinds of colon cancer. I expect we will start to see these efforts come to fruition over the next three to five years."

Testing using the ColoVantage (CRC) screening test can be found at http://www.estatlabs.com/ under cancer markers/cancer screening testing.

References

National Cancer Institute, U.S. National Institutes of Health

www.cancer.gov/cancertopics/types/colon-and-rectal

National Cancer Institute, U.S. National Institutes of Health

http://seer.cancer.gov/statfacts/html/colorect.html#survival

American Cancer Society, Cancer Facts & Figures 2010

American Cancer Society, Breast Cancer Facts & Figures 2010

http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf

National Health Interview Survey Public Use Data File 2000, 2003, 2005,and 2008.

Author contributing to Expert Insights:

John L. Marshall, MD

Professor of Medicine

Chief, Division of Hematology-Oncology

Director, Clinical Research

Lombardi Comprehensive Cancer Center

Georgetown University

Washington, DC

Water-borne Pathogens: Risks in flooding disasters

2011-11-12T13:22:00.000-05:00

Click on this link

White Colored Fruits & Vegetables vs Stroke Risk

2011-09-20T09:31:00.000-04:00

White Colored Fruits & Vegetables vs Stroke Risk: Thoughts on current medical literature & news as it pertains to optimizing our health.

by Alvin B. Lin, MD, PLLC - September 19, 2011

Provided by My 2 Cents

Diet, schmiet. We know what healthy food is, just as we know what unhealthy food is. It's more a matter of acting upon what we know. So is it any surprise when the only diets that have survived the test of peer-reviewed publication (as opposed to Internet & TV show advertorials) include a varied number of fruits & vegetables in them, eg Mediterranean diet. Specifically, one way to teach our kids to eat is the consume the colors of the rainbow each day in terms of fruits & vegetables (not Skittles and M&M's). Of course, that raises the question of which fruit or vegetable is more important. For instance, the darker ones theoretically have more antioxidants.

However, in a nice twist, a study was published early online last week (prior to release in print in November) concluding that high consumption of white-fleshed fruits & vegetables is associated with lower stroke risk, all other things being equal. Just what are these white-fleshed fruits & vegetables? Apples & pears, apple juice & sauce, bananas, cauliflower, chicory, cucumber, mushroom, garlic, leek & onion.

In the prospective, population-based cohort study, the authors followed for 10 years 20,069 men & women average 41-42yo w/o known baseline cardiovascular disease. Consumption of green, orange/yellow & red/purple fruits & vegetables was not associated with stroke risk while each 25g/d increase in white-fleshed fruit & vegetable consumption lowered stroke risk by 9%. Given that the participants consumed 118g/d of white-fleshed fruits & vegetables, this calculates out to a 42% reduction. When comparing those in the upper quartile of consumption (>171g/d) to those in the lowest quartile (<78g/d), the authors noted a 52% lower risk of stroke.

I found it particularly gratifying to know that the average participant also consumed 62g of green, 87g of orange/yellow, and 57g of red/purple fruits & vegetables daily in addition to their 118g/d of white-fleshed fruits & vegetables. Still, when all is said & done, I'm a lumper & not a splitter. Rather than have you each just one color, I'm still going to recommend eating the colors of the rainbow each day. By the way, don't forget to optimize your blood pressure, cholesterol & sugar in order to best lower your stroke risk!

===============================================

After 17 years in Northern California, I headed south where I graduated with a Bachelor of Science in Biology from the University of California, Riverside, in 1984 and promptly entered the private sector. A glutton for punishment, I returned for post-baccalaureate studies in Computer Science in 1987 after which I earned my Doctor of Medicine in 1991 from the Bowman Gray School of Medicine at Wake Forest University. Love called & romance blossomed, so I returned to the San Francisco Bay Area where I completed my Family Medicine residency at Merrithew Memorial Hospital at the University of California, Davis School of Medicine in 1994.

After 3 years wandering around the country as a locum tenens physician and collecting a dozen state licenses along the way, I was feeling rather masochistic once more. So I applied for subspecialty training, completing my Fellowship in Geriatrics at the Brody School of Medicine at East Carolina University in 1998. I joined the faculty as an Assistant Clinical Professor in the Department of Family Medicine and was appointed Director of the Ambulatory Geriatric Center in Greenville, NC. In 2003, I was recruited by Cenegenics Medical Institute to build it into the ubiquitous presence it is today in your airline inflight magazines. After 7 years as an employed physician, I left to return to my family medicine & geriatric roots by developing a small private practice which this website represents.

I have served as a Clinical Assistant Professor in the Department of Family and Community Medicine at the University of Nevada, School of Medicine since 2004 and recently became an Adjunct Assistant Professor of Family Medicine & Geriatrics at the Touro University Nevada College of Medicine. Along the way, I have written many articles, given many presentations, and made myself available to both patients and colleagues. I plan to continue more of the same (but without the middle-man!). For more information, go tohttp://www.alvinblin.com/ and http://www.linkedin.com/in/alvinblin.

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

RECOMMEND THIS ARTICLE

You must be logged in
to recommend articles

Average (0 votes)

» Recommended Articles

Comments Add Your Comments

JP Saleeby, MD (SC)	on 20 Sep 2011 at 9:29 am

Your comment is awaiting moderation.
Thanks for a nutritionally minded blog entry. JP Saleeby, MD www.saleeby.net

ER Docs Frustrated.

2011-08-20T04:03:00.001-04:00

ER Docs Frustrated, Burned Out by Repeat Patients: Survey

Use of ER for routine, non-emergency care is a national problem, researchers find

Posted: June 10, 2011

By Alan Mozes
HealthDay Reporter

FRIDAY, June 10 (HealthDay News) -- Americans who routinely turn to hospital emergency departments for non-urgent primary care are a big source of frustration and stress for the doctors who run those facilities, a new national survey reveals.

Roughly 90 percent of ER doctors polled said that the frequent draining of emergency resources and staff to manage chronic medical and social issues is a problem and a challenge.

"What we found is that emergency department doctors recognize that this is a problem and are asking for help," said study author Jennifer Peltzer-Jones, a clinical psychologist and registered nurse in the department of emergency medicine at Henry Ford Hospital, in Detroit. In some cases, patients are coming back 20, 30 or 40 times a year, she added.

"Most, 97 percent, of physicians stated that they have frequent users," she said. "So, this is a national problem."

While more than two-thirds said that hospital administrators need to implement programs to manage the problem, fewer than one-third said their hospitals had actually done so.

The result: a drop in empathy for frequent-use patients, coupled with a rise in physician burnout.

The researchers, who defined frequent ER users as those seeking emergency room care 10 or more times a year, presented their findings recently at a meeting of the Society for Academic Emergency Medicine.

A lack of medical insurance is not always the prime motivation for seeking care in an ER setting, the researchers found. Frequent users, they said, often struggle with a chronic medical condition while lacking easy access to a primary care doctor or specialist. In some cases, homelessness and lack of transportation resources play a role. Substance abuse and psychiatric illness were also cited.

Between July and October 2010, the researchers polled 1,000 members of the American College of Emergency Physicians, and 500 hospital physician residents, staff members and formeremployees. More than a quarter (representing ER staff in all states except for Alaska) responded.

Eighty-two percent said they felt some degree of burnout as a result of trying to cope with the inappropriate frequent use of their ER.

Aspects of burnout included feeling emotionally exhausted, treating patients with an increasingly depersonalized eye, and/or a plummeting sense of personal accomplishment on the job.

Being an "experienced" ER physician did not appear to protect physicians from the threat of burnout, the survey indicated.

Nearly six in 10 ER doctors said they felt less empathy for frequent ER users than for those seeking appropriate urgent care. About three-quarters said they bore a bias against such frequent users.

The survey did not address how lack of empathy might affect quality of care, Peltzer-Jones noted.

"If we don't want our health-care providers to burn out, I think hospitals really have a responsibility to help them and provide some kind of program for these patients," she added. "Because at a minimum, it is having an effect on staff."

Dr. Marshall Morgan, chief of emergency medicine at Ronald Reagan UCLA Medical Center in Los Angeles, said he was not surprised by the poll results.

"Frequent use patients tend to have problems that can't be managed well in an emergency department," he said. "Some lack insurance, and so they have problems that need to be addressed but can't set themselves up with a continuity doctor because they can't afford it. Others have chronic pain problems and come in looking for relief, and often have developed a dependence on pain medication, particularly narcotics. And this makes ER doctors particularly crazy and frustrated. Which is understandable."

"Managing these patients better can not only make your staff happier, but it can also pay off in the long run," Morgan said. "Because they take up a lot of staff time, and are a huge cost to a hospital that will often not get reimbursed. But I don't know of very many places that have done an effective job at coping with the problem."

Because the research was presented in a meeting, the findings should be considered preliminary until published in a peer-reviewed journal.

Global Trigger Tool identifies Hospitals Adverse Events in a better way

2011-06-24T00:23:00.000-04:00

According to a new study in the Health Aff Journal, the GTT was able to identify more adverse events in hospitals (by ten fold) over those previously reported by voluntary measures. GTT proves a better reporting system.

---

‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured' Health Aff., April 2011, vol. 30 no. 4; 581-589

¹David C. Classen (dclassen@csc.com) is an associate professor of medicine at the University of Utah, in Salt Lake City.
²Roger Resar is a senior fellow at the Institute for Healthcare Improvement, in Cambridge, Massachusetts.
³Frances Griffin is a faculty member at the Institute for Healthcare Improvement.
⁴Frank Federico is an executive director at the Institute for Healthcare Improvement.
⁵Terri Frankel is a director at the Institute for Healthcare Improvement.
⁶Nancy Kimmel is director of quality and safety at the Missouri Baptist Medical Center, in St. Louis.
⁷John C. Whittington is a senior fellow at the Institute for Healthcare Improvement.
⁸Allan Frankel is an associate professor at Brigham and Women’s Hospital, in Boston, Massachusetts.
⁹Andrew Seger is an assistant professor at Brigham and Women’s Hospital.
¹⁰Brent C. James is chief quality officer at Intermountain Healthcare, in Salt Lake City, Utah.

Abstract

Identification and measurement of adverse medical events is central to patient safety, forming a foundation for accountability, prioritizing problems to work on, generating ideas for safer care, and testing which interventions work. We compared three methods to detect adverse events in hospitalized patients, using the same patient sample set from three leading hospitals. We found that the adverse event detection methods commonly used to track patient safety in the United States today—voluntary reporting and the Agency for Healthcare Research and Quality’s Patient Safety Indicators—fared very poorly compared to other methods and missed 90 percent of the adverse events. The Institute for Healthcare Improvement’s Global Trigger Tool found at least ten times more confirmed, serious events than these other methods. Overall, adverse events occurred in one-third of hospital admissions. Reliance on voluntary reporting and the Patient Safety Indicators could produce misleading conclusions about the current safety of care in the US health care system and misdirect efforts to improve patient safety.

Improving patient safety continues to be a priority for both policy makers and health care providers in the United States. As a result, during the ten years since the publication of the Institute of Medicine’s landmark report, To Err Is Human: Building a Safer Health System, there have been numerous initiatives to improve the safety of patient care in the United States.¹ ^–⁴

Several studies have reported on the often resource-intensive interventions intended to improve the safety and reliability of care in the highly fragmented US health care system.² ^–⁴ Many studies have attempted to evaluate the safety of US health care overall. Some emphasize great progress, and others highlight how much more work is to be done. A recent study of hospitals in North Carolina showed a high rate of adverse events that has not changed over time, despite notable efforts in the state to improve the safety of inpatient care.⁵ ^–⁷

A key challenge has been agreeing on a yardstick for measuring the safety of care in hospitals.⁸ Some studies have relied on the rate of adverse events based on voluntarily reported sentinel events (any unanticipated event in a health care setting resulting in serious injury or death, not related to a natural course of the patient’s illness) at the national or state level. Many health care organizations have also used their own internally reported sentinel events to measure the safety of their system.⁹

This focus on sentinel events has been encouraged by the adoption of reporting patient safety “never events” (events that should not have happened; for example, deaths from blood transfusions) in several states. The Joint Commission’s Sentinel Event Policy of 1996 and the Patient Safety and Quality Improvement Act of 2005 encourage further development of such voluntary reporting systems.¹⁰ However, an Institute of Medicine–sponsored review noted that voluntary reporting systems miss many significant adverse events, and it called for the development of other methods for measuring patient safety.¹¹

Some—including the Institute for Healthcare Improvement in its 100,000 Lives and 5 Million Lives Campaigns—have used overall and risk-adjusted hospital mortality rates, which take into account the severity of medical conditions, as global measures of patient safety.¹² Many health care organizations have also adopted a mandatory review of the records of all patient deaths as part of this approach to measuring safety.¹¹ However, mortality rates are crude measures of safety that focus on the most extreme events and are not suitable for evaluating the overall effect of multifaceted patient safety programs or the effect of specific interventions.

Accordingly, other measures of patient safety—such as the Agency for Healthcare Research and Quality’s Patient Safety Indicators or the Utah/Missouri Adverse Event Classification (a superset of Patient Safety Indicators)—have been developed with ease of use and automated mining of administrative and financial databases in mind. Both of these measures rely on an automated review of discharge codes to detect adverse events.¹³ ^–¹⁵ The Utah/Missouri approach is more comprehensive because it uses many more diagnostic codes. Organizations, states, and the Centers for Medicare and Medicaid Services have used these measures to compare or benchmark hospitals’ performance for patient safety.

Some studies have suggested that these automated measures of patient safety are neither sensitive nor specific enough to correctly identify adverse events.¹⁶ This concern has prompted the search for more direct approaches to measuring adverse events. Such approaches generally rely on more exhaustive physician or nurse reviews of a patient’s complete medical record or chart. This was the approach used in the Harvard Medical Practice Study of adverse events in hospital patients.¹⁷ However, it is extremely labor-intensive, which limits its use.

In response to the need for a more practical and less labor-intensive approach to assessing patient safety, the Institute for Healthcare Improvement developed the Global Trigger Tool.¹⁸ This new method has been increasingly used by hospitals in the United States and the United Kingdom (such as Ninewells Hospital near Dundee, Scotland, as described in the article by Carol Haraden and Jason Leitch, also in this issue).¹⁹ The tool has also been used by quality improvement organizations, and by regulators such as the Department of Health and Human Services (HHS) Office of Inspector General, which has used it in a study to estimate the incidence of adverse events in hospitalized Medicare patients.²⁰

This study by the HHS Office of Inspector General has led to recommendations that the Centers for Medicare and Medicaid Services develop new detection methods for adverse events in hospitalized Medicare beneficiaries. The study has also informed ongoing work to evaluate and update national patient safety measures at the National Quality Forum, a nonprofit organization that seeks to build consensus around national performance measures for quality and disseminate them.

The Global Trigger Tool uses specific methods for reviewing medical charts. Closed patient charts are reviewed by two or three employees—usually nurses and pharmacists, who are trained to review the charts in a systematic manner by looking at discharge codes, discharge summaries, medications, lab results, operation records, nursing notes, physician progress notes, and other notes or comments to determine whether there is a “trigger” in the chart. A trigger could be a notation indicating, for example, a medication stop order, an abnormal lab result, or use of an antidote medication. Any notation of a trigger leads to further investigation into whether an adverse event occurred and how severe the event was. A physician ultimately has to examine and sign off on this chart review.²¹

In our study we evaluated the ability of these three methods (the hospital’s voluntary reporting system, the Agency for Healthcare Research and Quality’s Patient Safety Indicators, and the Institute for Healthcare Improvement’s Global Trigger Tool) to detect the incidence of adverse events among inpatients in three leading hospitals that have invested heavily in advanced patient safety programs, initiatives, and research projects. We also compared the performance of these methods for measuring patient safety among the three hospitals. This article reports our findings.

Agoraphobia Help Available

2011-06-16T10:42:00.000-04:00

Agoraphobia: Help and Hope for the Agoraphobic and Shut-In patient.

Yusuf Saleeby, MD

The advent of telehealth, the use of modern telecommunication advances to direct health care delivery, has helped those who are shut in, unable to leave their homes, access to health care.

The condition known as Agoraphobia, the fear or anxiety of being in public, leaving the house, being among strangers (even in your house), complicates the health care for those who suffer and live with this disorder. Fact is that Agoraphobics get sick too. Acute illness like urinary tract infections, ear aches, headaches occur. Chronic conditions such as diabetes, hypertension, anemia also occur with regularity as in the non-agoraphobic population. But lack of medical intervention due to the inability to contact a physician, make an office visit will cause these conditions to be ignored, ill-diagnosed or go untreated. With the advent of Telehealth, shut ins and agoraphobics are able to get the health care they need in a timely, affordable manner. They no longer have to ignore or put off contact with a medical doctor or psychologist for assistance with any condition that arises which is able to be diagnosed and treated via phone or video conference.

Eventual kiosks which house hardware (and software) that can make in-house diagnosis easy and practical are under development. Instruments that can be applied by the patient in their home, will allow doctors to monitor and evaluate vital signs, visualize body parts and even evaluate internal organs.

Agoraphobia Definition (Taken from the Mayo Clinic Web site):

Agoraphobia is a type of anxiety disorder in which you avoid situations that you're afraid might cause you to panic. You might avoid being alone, leaving your home or any situation where you could feel trapped, embarrassed or helpless if you do panic.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. The fears can be so overwhelming that you may be essentially trapped in your own home.

Agoraphobia treatment can be tough because it usually means confronting your fears. But with medications and psychotherapy, you can escape the trap of agoraphobia and live a more enjoyable life.

Agoraphobia is a type of phobia. A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place. Commonly feared places and situations are elevators, sporting events, bridges, public transportation, shopping malls, airplanes, crowds or lines of people.

Typical agoraphobia symptoms include:

· Fear of being alone in any situation
· Fear of being in crowded places
· Fear of losing control in a public place
· Fear of being in places where it may be hard to leave, such as an elevator or train
· Inability to leave your house for long periods (housebound)
· Sense of helplessness
· Overdependence on others
· A sense that your body is unreal

In addition, you may also have signs and symptoms similar to a panic attack, including:

· Lightheadedness
· Trouble breathing
· Dizziness
· Excessive sweating
· Rapid heart rate
· Flushing
· Nausea
· Upset stomach or diarrhea
· Chest pain
· Feeling a loss of control
· Trouble swallowing

Symptoms: Agoraphobia usually starts in your late teens or early 20s, but younger children and older adults also can develop agoraphobia. Women are diagnosed with agoraphobia more often than are men.

Possible agoraphobia risk factors include:

· Having panic disorder
· Experiencing stressful life events, including sexual or physical abuse during childhood
· Having a tendency to be nervous or anxious
· Having an alcohol or substance abuse disorder
· Being female

Treatments: Agoraphobia treatment usually includes both medication and psychotherapy. It may take some time, but treatments can help you get better.

Medications
Antidepressant and anti-anxiety medications are often used to treat agoraphobia and panic symptoms. You may have to try several different medications before you find one that works best for you.

Your doctor is likely to prescribe one or both of the following:

· A selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac, Prozac Weekly, Sarafem).

· Another type of antidepressant, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.

· An anti-anxiety medication. Also called benzodiazepines, these drugs can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. Your doctor will weigh this risk against the potential benefit of this class of drugs. Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include alprazolam (Xanax) and clonazepam (Klonopin).

Both starting and ending a course of antidepressants can cause side effects that seem just like a panic attack. For this reason, your doctor likely will gradually increase your dose at the beginning of your treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication — often over the course of a year or more after your agoraphobia symptoms are controlled. [AtroGene Telehealth physicians are able to prescribe SSRIs, SNSRIs, Benzos, & TCAs]

Psychotherapy
Several types of psychotherapy or counseling can help agoraphobia. One common therapy that's used is cognitive behavioral therapy.

Cognitive behavioral therapy has two parts. The cognitive part involves learning more about agoraphobia and panic attacks and how to control them. You learn what factors may trigger a panic attack or panic-like symptoms and what makes them worse. You also learn how to cope with these symptoms, such as using breathing and relaxation techniques.

The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely face the places and situations that cause fear and anxiety. A therapist may join you on outings to help you stay safe and comfortable, such as trips to the mall or driving your car. The more you go to feared places and realize you're okay, the more your anxiety will lessen.

If you have trouble leaving your home, you may wonder how you can possibly go to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer to see you first in your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through email. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed. [AtroGene Telehealth has on staff psychologist that can help with psychotherapy via phone]

Source: www.mayoclinic.com/health/agoraphobia

In conclusion, for the shut in or Agoraphobic, there is hope, the preverbial light at the end of the tunnel in respect to basic health care, resolution to acute minor illness. That hope is realized within the realm of Telemedicine. For more information visit www.AtroGene.com

===

Yusuf M. Saleeby, MD is Southeastern Regional Medical Director for AtroGene Telehealth and the DAT lab resource eStatLabs.com . Dr. Saleeby may be reached at ymsaleeby@gmail.com

Also found at:
http://www.wellsphere.com/mental-health-article/agoraphobia-hope-and-help-for-the-agoraphobic-and-shut-in/1452248

Save our Antibiotics

2011-06-13T08:22:00.000-04:00

Antibiotic Stewardship

Yusuf M. Saleeby, MD

To open up, I want to make it perfectly clear the intentions of this article by stating a few facts. These are facts back up by loads of peer-reviewed publications. These facts are likewise rational and logical.

Fact: Antibiotics save lives.
Fact: Antibiotics reduce morbidity and mortality in severe and life threatening infections.
Fact: Antibiotics have in the past 20-years been overprescribed.
Fact: Antibiotics are necessary in the practice of good medicine and new guidelines need to be followed in light of present day resistance.

It is both intuitive and evidence based that appropriate use of antibiotics in modern medicine have saved thousands of lives. Prior to the discovery of the antibiotics (antimicrobials) infection was a leading cause of death in humans. Today, many life threatening illnesses such as pneumonia, sepsis, flesh-eating bacterial infections (necrotizing fasciitis), or meningitis are so dangerous, that delay in antibiotic therapy can cost a life.

For those pseudo-healthcare practitioners that are blinded by sheer bias and hatred toward contemporary western medicine (and suffer brain squeeze because their craniums are so far up their rectums), spouting the foolish notions that "you don't need antibiotics" or "antibiotics are never good for you", be warned. Those reading this article that are experiencing a grave illness due to a microbe should be aware that those advocating the cockamamie notion that all things antibiotic are evil, should run as fast and far away from those practitioners. Furthermore, they can and should be held culpable for the death of a patient should they intentionally delay people from getting life saving antibiotic therapy. Intuitive practitioners, some chiropractors and those who favor wave eagle feathers and crystals over folks in an attempt to cure a complex septic patient should put their unsubstantiated opinions and bias' aside and refer their patients to a medical doctor for definitive care. No need to stain you hands with blood over an idiotic notion unfounded by any empirical evidence. Enough ranting about unfounded prejudice against antibiotics amongst healers.

While there is no question about the helpfulness of antibiotics, it is also true that since their inception they have been abuse and over prescribed. Now we realize the ills of haphazard and unbridled use as we see resistant organisms appear more often and on the rise.

According to Dr. J. G Bartlett in a Medscape CME published in November of 2010 entitled "Addressing the Rising Tide of Antimicrobial Resistance" he spells out the rise of the top six microbes that are defying our current regiment of antibiotic therapy. They are Enterobacter, Staph. aureus, Klebsiella, Acinetobacter, Pseudomonas aeruginosa andEnterococcus. In the US methicillin-resistant Staphylococcus aureus (MRSA) is on the rise with some 94,360 cases a year and 18,650 deaths reported by Kelevens et. al., in JAMA in 2007. Those are some fierce numbers for a bacterium that only 10 years ago was only seen in hospital ICUs and nursing homes. Now greater than 60% of cultures of abscesses in my local region culture positive for MRSA. The whole penicillin class of drugs (Amoxil, Keflex, etc.) is useless against MRSA. Clostridium difficile infections are another example with diagnosed cases on the rise and antibiotic resistance mounting as well. Death by C. difficile infection has taken an exponentially rise since 1999.

Furthering the crisis of antimicrobial resistance and of great concern is that in the last ten-years the development of new antibiotics and antibiotic classes has all but dried up. A 2004 report by the Infectious Disease Society of America (IDSA) stated that there is “antibiotic discovery stagnation” were we are witnessing bad bugs with no new drugs to fight them. An example of how slow we are to develop new antimicrobials is seen in a study published in 2009 in theClinical Infectious Disease journal by Dr. H.W. Boucher reporting that between 1983 and 1887 sixteen new antibiotics were developed. From 1993 - 97 ten antibiotics were developed and this dropped to only five from 2003 - 07 and from 2008 projected until 2012 only one new antibiotic coming to market. From the 1930's through the 1970's there were eleven new classes of antimicrobials developed by pharmaceutical companies, with only four classes in the 1950, and during the 2000's only two new classes were developed. The 1980s and 1990's saw a dry spell, with no new antibiotic-class development. These are scary numbers considering the rapid rise in microbial resistant organisms just in the past decade.

So while antibiotic use is necessary and critical in the very ill, judicious use is necessary to save our "big guns" for those really bad infections. Most pharangitis infections are viral and despite this fact many GPs would prescribe antibiotics just to appease an anxious patient, and not treat the real root cause. This practice has to stop. No one will argue about utilizing a broad spectrum aggressive antibiotic regiment in a septic patient, but we need to look at the evidence of stopping drugs when cultures are negative and using effective shorter courses. Evidence is mounting that a three day course of antibiotics for community acquired pneumonia (CAP) is as effective as a seven- or ten-day course. On the other side of the continuum, those that don't advocate the use of antibiotics at all will harm the really sick. We must reach a happy medium.

Yusuf M. Saleeby, MD is an emergency room physician who practices integrative medicine in solo practice. His weltanschauung is practical, pragmatic, slightly pendantic and shying away from granola. For information on his patient advocacy site visit: RedBanyan.blogspot.com

Serum NTx a better tool for managing Osteoporosis!

2011-06-05T10:33:00.000-04:00

GREAT article by Dr. Singer.

eStatLabs is offering serum NTx at a greatly discounted price... $95. Well under the usual prices for out of pocket / non-insurance covered costs.

N-Telopeptide (NTx/ Serum)

$95.00

Add To Cart

Really get to the point of better biomarker testing for osteoporosis.. why wait 2-years for a DEXA scan to reveal that you were NOT on optimum therapy. Come on Docs, lets get with the 21st Century of practicing medicine. A call out to all practicing physicians to get with the program!

NTx: A New Tool to Track and Treat Osteoporosis

Technology Spotlight

Michael S. Singer, MD, PhD

Contributing Editor

Harvard Medical School

Over 10 million Americans suffer from osteoporosis, which involves a chronic loss of bone density and disruption of bony microstructure. An important source of morbidity and mortality, osteoporosis leads annually to 40,000 deaths and 1.5 million fractures, typically of the spine, hip, or forearm. Many patients remain asymptomatic until they sustain a fracture, which underscores the need for early detection, risk stratification, and prevention. Today, an assay for NTx (cross-linked N-telopeptides of type I collagen) provides a revolutionary and valuable tool for these purposes.

Human bone is continually remodeled by osteoblasts, which build bone matrix, and osteoclasts, which resorb it. It is helpful to think of osteoporosis as a dynamic imbalance of resorption over formation. The condition is often due to hormone levels, for example in postmenopausal women. Systemic diseases and medications such as corticosteroids represent other causes. A number of treatments are available to inhibit bone resorption and restore the equilibrium between osteoblast and osteoclast activity. These include bisphosphonates, hormone replacement therapy (HRT), estrogen replacement therapy (ERT), calcitonin, estrogen receptor modulators, and recombinant parathyroid hormone (PTH). Some of these medications have significant side effects, and therapy depends on the severity of osteoporosis, symptoms, risk of fractures, side effects, and response to prior therapy. Patients differ considerably in these respects. It is particularly important to monitor response to therapy since approximately 20% patients do not improve with the initial treatment.

A traditional method of monitoring patients is a radiographic scan of bone mineral density (BMD). This provides a static measure of cumulative bone loss, which varies on a relatively slow timescale. For example, once a patient commences therapy, a repeat bone scan is not indicated or expected to show improvement for 1-2 years. The exam requires an appointment, special equipment, and a skilled technician.

On the other hand, NTx provides a dynamic measure of the rate of bone resorption. Type I collagen, which makes up 90% of the organic matrix of bone, consists of numerous cross-linked protein strands. The cross-links make the structure unique (and especially durable) compared to other proteins. A small, cross-linked portion of collagen’s amino terminus, NTx is a stable and specific breakdown product of bony collagen. An elevated NTx level therefore correlates with diminishing bone density over time. The dynamic nature of NTx levels makes it possible to monitor patients on a much more rapid timescale. Levels can be measured in either urine or serum.

A CLIA-waived, point-of-care urine test for NTx (Osteomark) is available from Ostex International. This rapid, disposable, noninvasive test yields results in five minutes and is convenient for offices as well as laboratories. The test uses a monoclonal antibody and ELISA method with readout by spectrometry. Urine NTx levels are normalized with respect to urine creatinine.

The NTx assay has been validated for prediction of osteoporosis as well as response to therapy. While the definition of osteoporosis still depends on cumulative demineralization measured by densitometry, NTx assesses the rate of bone matrix loss. This is useful to identify patients most at risk for osteoporosis. Particularly in the menopausal period, this is useful to quantify the indications for hormone replacement therapy in view of any side effects or concerns about endometrial or breast cancer. Women with elevated baseline levels of urine NTx (approximately twice the reference value) who do not use HRT have vastly elevated risk of bone loss within one year. Likewise, lower baseline NTx values indicate lower risk.

Once a patient initiates therapy, NTx measurements can be repeated as soon as three months later. NTx responses, which are both rapid and dose-dependent, have been documented for a variety of treatments such as HRT and bisphosphonates. A reduction of 30% or more in NTx levels is considered a favorable response. This information not only aids the clinician but also promotes patient adherence. If treatment is stopped, NTx levels tend to return slowly to the pre-treatment baseline, which makes NTx a useful monitor for poor adherence. Still other uses for the NTx assay are likely to appear in the future. Already, elevated NTx has been show to predict poor outcomes (and the need for intensified therapy) in patients with bone metastases. All of these applications hold promise in the effort to predict and prevent millions of fractures and other consequences of osteoporosis.

source: http://www.medcompare.com/spotlight.asp?spotlightid=181

For more on s-NTx test: http://www.osteomark.com/pdf/OSTEX%20SERUM%20ENG%208X11.PDF

Posting from RedBanyan

2011-06-03T11:46:00.000-04:00

Jack Kevorkian Dead: Assisted Suicide Advocate Dies At Age 83

COREY WILLIAMS 06/ 3/11 10:08 AM ET

**Editors notes: No matter your opinion on Assisted Suicide, humans were never designed to LIVE FOREVER, despite what some patients and their family want or desire. Too many times physicians are faced with expectations that are not rational or logical and the terminally sick and dying patient has to endure much suffering to extend "life" beyond what biologically and ethically should be allowed. While I don't believe in the proactive approach of assisting one end their life, as it does violate the Hippocratic Oath in principle, I do advocate the halting of any medical intervention that prolongs the inevitable, painful, unnecessary extension of a terminally ill patient's life. With rising health care costs, it is in our future to ration care by following a more pragmatic and pedantic protocol with those that are near end of life or who cannot contribute to society in any meaningful way. -RedBanyan

DETROIT — Jack Kevorkian, the retired pathologist who captured the world's attention as he helped dozens of ailing people commit suicide, igniting intense debate and ending up in prison for murder, has died in a Detroit area hospital after a short illness. He was 83.

Kevorkian, who said he helped some 130 people end their lives from 1990 to 1999, died about 2:30 a.m. at William Beaumont Hospital in Royal Oak, close friend and prominent attorney Mayer Morganroth said. He had been hospitalized since last month with pneumonia and kidney problems.

An official cause of death had not been determined, but Morganroth said it likely will be pulmonary thrombosis.

"I had seen him earlier and he was conscious," said Morganroth, who added that the two spoke about Kevorkian's pending release from the hospital and planned start of rehabilitation. "Then I left and he took a turn for the worst and I went back."

Nurses at the hospital played recordings of classical music by composer Johann Sebastian Bach for Kevorkian before he died, Morganroth said.

Kevorkian was freed in June 2007 after serving eight years of a 10- to 25-year sentence for second-degree murder. His lawyers had said he suffered from hepatitis C, diabetes and other problems, and he had promised in affidavits that he would not assist in a suicide if he was released.

In 2008, he ran for Congress as an independent, receiving just 2.7 percent of the vote in the suburban Detroit district. He said his experience showed the party system was "corrupt" and "has to be completely overhauled from the bottom up."

His life story became the subject of the 2010 HBO movie, "You Don't Know Jack," which earned actor Al Pacino Emmy and Golden Globe Awards for his portrayal of Kevorkian. Pacino paid tribute to Kevorkian during his Emmy acceptance speech and recognized the world-famous former doctor, who sat smiling in the audience.

Pacino said during the speech that it was a pleasure to "try to portray someone as brilliant and interesting and unique" as Kevorkian and a "pleasure to know him."

Kevorkian himself said he liked the movie and enjoyed the attention it generated, but told The Associated Press that he doubted it would inspire much action by a new generation of assisted-suicide advocates.

"You'll hear people say, `Well, it's in the news again, it's time for discussing this further.' No it isn't. It's been discussed to death," he said. "There's nothing new to say about it. It's a legitimate ethical medical practice as it was in ancient Rome and Greece."

Eleven years earlier, he was sentenced in the 1998 death of a Lou Gehrig's disease patient – a videotaped death shown to a national television audience as Kevorkian challenged prosecutors to charge him.

"The issue's got to be raised to the level where it is finally decided," he said on the broadcast by CBS' "60 Minutes."

Nicknamed "Dr. Death" because of his fascination with death, Kevorkian catapulted into public consciousness in 1990 when he used his homemade "suicide machine" in his rusted Volkswagen van to inject lethal drugs into an Alzheimer's patient who sought his help in dying.

For nearly a decade, he escaped authorities' efforts to stop him. His first four trials, all on assisted suicide charges, resulted in three acquittals and one mistrial.

Murder charges in earlier cases were thrown out because Michigan at the time had no law against assisted suicide; the Legislature wrote one in response to Kevorkian. He also was stripped of his medical license.

People who died with his help suffered from cancer, Lou Gehrig's disease, multiple sclerosis, paralysis. They died in their homes, an office, a Detroit island park, a remote cabin, the back of Kevorkian's van.

Kevorkian likened himself to Martin Luther King and Gandhi and called prosecutors Nazis, his critics religious fanatics. He burned state orders against him, showed up at court in costume, called doctors who didn't support him "hypocritic oafs" and challenged authorities to stop him or make his actions legal.

"Somebody has to do something for suffering humanity," Kevorkian once said. "I put myself in my patients' place. This is something I would want."

Devotees filled courtrooms wearing "I Back Jack" buttons. But critics questioned his publicity-grabbing methods, aided by his flamboyant attorney Geoffrey Fieger until the two parted ways before his 1999 trial.

"I think Kevorkian played an enormous role in bringing the physician-assisted suicide debate to the forefront," Susan Wolf, a professor of law and medicine at University of Minnesota Law School, said in 2000.

"It sometimes takes a very outrageous individual to put an issue on the public agenda," she said, and the debate he engendered "in a way cleared public space for more reasonable voices to come in."

Even so, few states have approved physician-assisted suicide. Laws went into effect in Oregon in 1997 and Washington state in 2009, and a 2009 Montana Supreme Court ruling effectively legalized the practice in that state.

In a rare televised interview from prison in 2005, Kevorkian told MSNBC he regretted "a little" the actions that put him there.

"It was disappointing because what I did turned out to be in vain. ... And my only regret was not having done it through the legal system, through legislation, possibly," he said

Kevorkian's ultimate goal was to establish "obitoriums" where people would go to die. Doctors there could harvest organs and perform medical experiments during the suicide process. Such experiments would be "entirely ethical spinoffs" of suicide, he wrote in his 1991 book "Prescription: Medicide – The Goodness of Planned Death."

His road to prison began in September 1998, when he videotaped himself injecting Thomas Youk, a 52-year-old Lou Gehrig's disease patient, with lethal drugs. He gave the tape to "60 Minutes."

Two months later, a national television audience watched Youk die and heard Kevorkian say of authorities: "I've got to force them to act." Prosecutors quickly responded with a first-degree murder charge.

Kevorkian acted as his own attorney for most of the trial. He told the court his actions were "a medical service for an agonized human being."

In his closing argument, Kevorkian told jurors that some acts "by sheer common sense are not crimes."

"Just look at me," he said. "Honestly now, do you see a criminal? Do you see a murderer?"

The U.S. Supreme Court twice turned back appeals from Kevorkian, in 2002, when he argued that his prosecution was unconstitutional, and in 2004, when he claimed he had ineffective representation.

In an interview at the time Kevorkian was released from prison, Youk's brother Terrence said his brother received "a medical service that was requested and, from my point of view, compassionately provided by Jack. It should not be a crime."

But Tina Allerellie became a fierce critic after her 34-year-old sister, Karen Shoffstall, turned to Kevorkian in 1997. She said in 2007 that Shoffstall, who suffered from multiple sclerosis, was struggling with depression and fear but could have lived for years longer.

"(Kevorkian's) intent, I believe, has always been to gain notoriety," Allerellie said.

Born in 1928, in the Detroit suburb of Pontiac, Kevorkian graduated from the University of Michigan's medical school in 1952 and became a pathologist.

Kevorkian said he first became interested in euthanasia during his internship year when he watched a middle-aged woman die of cancer. She was so emaciated, her sagging, discolored skin "covered her bones like a cheap, wrinkled frock," Kevorkian wrote.

After building a suicide device in 1989 from parts he found in flea markets, he sought his first assisted-suicide candidate by placing advertisements in local newspapers. Newspaper and TV interviews brought more attention.

On June 4, 1990, he drove his van to a secluded park north of Detroit. After Janet Adkins, 54, of Portland, Ore., met him there, he inserted a needle into her arm and, when she was ready, she flipped the switch that released a lethal flow of drugs.

He later switched from his device to canisters of carbon monoxide, again insisting patients took the final step by removing a clamp that released the flow of deadly gas to the face mask.

Kevorkian's fame – or notoriety – made him fodder for late-night comedians' monologues and sitcoms. His name became cultural shorthand for jokes about hastening the end of life.

Even admirers couldn't resist. Adam Mazer, the Emmy-winning writer for "You Don't Know Jack," got off one of the best lines of the 2010 Emmy telecast.

"I'm grateful you're my friend," Mazer said, looking out at Kevorkian. "I'm even more grateful you're not my physician."

When asked in 2010 how his own epitaph should read, Kevorkian said it should reflect what he believes to be his "real virtue.

"I am quite honest. I have trouble lying. I don't like people who lie."

[ he was blessed with a quick death, something I am sure he would have wanted ]

source: http://www.huffingtonpost.com/2011/06/03/

Thursday, June 2, 2011

Colchicine: An Example of Big Pharma Exploitation

Yusuf M. Saleeby, MD

RedBanyan.org (President, Patient Advocacy Group)

After attending a “medication update” CME course in Charleston, SC in May, it was brought to my attention that a drug that has been around and used to treat gout before I was even born, dispensed as a generic for decades was somehow off the generic list. Formally “FDA approved” for the treatment of gout recently, the pharmaceutical company that pushed this process through the FDA with two small (and short lived studies) was granted seven years of patent protection. This drove the cost of a single dose of Colchicine from $0.09 to over $4.85 per pill. I was outraged to say the least.

Colchicine is an anti-gout drug, derived from the seeds from the Colchicum autumnale plant, also known as "meadow saffron.” Traditionally, it has been used in a number of ways for over 200 years to treat gouty arthritis flare ups, as an acute agent dosed in rapid succession to reduce the gouty arthritis attacks or as a twice a day drug to prevent gouty attacks. Currently it has FDA approval for the treatment of gout and a very rare genetic inborn condition called familial Mediterranean fever (FMF). Both these indications and approvals are only a couple of years old, granted by the FDA and as a consequence the drug company was bestowed patent protection. Colchicine also sees use as an anti-inflammatory agent for long-term treatment of Behçet's disease, another rather rare disorder. Coincidentally, the combination of Colchicine and probenicid to treat gout as a combination medication was FDA approved decades ago and is still approved. Colchicines as a standalone drug was never FDA approved until recently despite it pervasive use to treat gout worldwide.

Colcrys® is now the new brand name and patent protected form of colchicine, it is the only legal form able to be purchased in America. The drug company has effectively sued all other manufacturers to halt production and dispensing of generic colchicines. Since 1810 doctors have prescribed colchicines for gout as an effective treatment, dosing it hourly until effective, but this caused severe gastrointestinal upset and toxicity. The recent pharmaceutical industry supported studies showed effectiveness in a two dose regiment that was easier on the GI tract. Additionally, the studies helped warn about potential severe drug reactions. Certain common inhibitors (drugs) of CYP3A4 and/or P-gp, including grapefruit juice, may increase the risk of colchicine toxicity, namely two calcium channel blocker drugs used in the treatment of hypertension. The new dosing regimen is one 0.6 mg dose twice daily. Worth mentioning, colchicines will be the first FDA-approved drug for the treatment of a rare condition called familial Mediterranean fever (FMF), which is an inherited inflammatory disorder. Because this disorder is so rare, drug companies are given protection with extended patent rights for devoting resources to developing a rather non-profitable drug. These types of drugs are called “orphan drugs”. The studies (AGREE trial was one) that were done were not extensive, utilized a small number of subject (184 patients), could not have cost the supporting drug company much money to fund, and was halted early due to data showing effectiveness of treatment. The data of the AGREE trial was reported in the Journal of Arthritis & Rheumatism in April 2010.

The FDA has been pushing for approval of unapproved drugs on the market. Incentives have been offered to drug companies who produce evidence based studies to lend credence for their use in the American market. The FDA wants all medications to be scientifically tested for adherence to modern standards of safety, efficacy, quality and labeling. While the program is noble in theory, the burden of this particular outcome is upon the end user, the patient who now has to pay 40 times the original cost of the medication.

Let’s look for a moment at the company that took on the low risk gamble of funding a study to appease the FDA and obtain “FDA approval” for the treatment of gout officially and in so doing obtain patent protection for not just three, but 7 years (as this patent extension covers its use as an orphan drug for FMF). United Research Laboratories (URL) was established by Albert Roberts a chemist educated at the University of Pittsburgh. In the early days the company manufactured ACTH to treat arthritis and sold this directly to physicians. The company built a successful distribution business after these humble beginnings. Once manufacturers started bypassing distributors, Mr. Roberts established the Mutual Pharmaceutical Company, in 1984, to develop and manufacture generic products. In 1988 Mr. Robert’s son, Richard Roberts, then a MD, PhD from Harvard joined the company as COO. The younger Roberts lead the company to great profits. In 1997 after venture capital groups Elliott Associates and Momar Corporation purchase majority shares of the company, Dr. Roberts was retained with minor shares as the company’s President, CEO and Chairman of the Board. This heralded a change from manufacturing generic drugs with limited profitability to pursuing development of brand-name medications, launching the company into exponential profit making. By the year 2001, URL Pharma (formerly known as Pharmaceutical Holdings Corp and spawned from URL) had net sales exceeding $100 Million. They manufactured 35 products and had 14 abbreviated New Drug Applications (ANDAs) with FDA approval pending. The company leadership realized by 2004 that the profitability of generic pharmaceuticals would deteriorate as other markets such as Asia gained greater market share with FDA approved drugs, so they took an ambitious path to transform the company away from generics into the realm of branded drugs. The graph below depicts the transition from generic to brand-name manufacturing and distributing. URL Pharma also established AR Scientific, Inc., a company that markets four branded drugs, Fibricor®, Qualaquin®, Bactrim^TMand of course Colcrys®.

Another example of a “generic drug” turned “branded” is Quinine Sulfate. This drug dates back to the time of the American Civil War. Generic for almost 200 years, the company in 2006 was able to brand this product gaining FDA-approval (the only company to do so) thus getting brand name protection and orphan drug exclusivity for the treatment of malaria. The patent runs out in 2012. According to the company web site, they foresee continued protection and exclusivity past the expiration date.

In 2007, URL Pharma had recorded annual sales of $483 Million, with more than 250 ANDAs approved and more proprietary products underway. With recent developments in drug delivery systems with NanoBurst, MultiBurst and Z-Burst technologies, the company is expected to earn even greater profits in the near future.

With the 2009 approval of Fibricor® (fenofibric acid) a cholesterol lowering drug similar to Tricor® or Trilipix®, their web site boasts great savings when compared with these other two drugs (http://www.fibricor.com/patient-landing.htm). In actuality, the Fibricor® price is around $6/pill versus the now generic Fenofibrate drugs costing only less than a dollar through some outlets. The Internet site www.pharmacychecker.com is a place that compares drug prices and details this drug price disparity.

I am all for profitability and positive growth in industry, as an unabashed supporter of the free-market economy system, however, I am not a big fan of what may certainly be construed as unbridled greed to the point of causing untoward effects on the end user/ consumer. Just recently a woman I treated in the Emergency Room with a history of gout, suffering an acute flare up of her arthritic condition, was one of many who are faced with no choices when it comes to suffering this painful malady. Her drug cost for her colchicines (generic) which she had been on for decades skyrocketed from 20 cents per day (approximately $6 per month) to roughly $10 per day ($300 per month), which she could not afford. The folks paying the price? Well this lady suffers with physical pain in her joints. The tax payer suffer the burden of rising public health costs with the rise of prescriptive drug costs, covering the uninsured or under-insured patient visiting the emergency departments or primary care practices seeking relief. And of course the small rural hospitals slammed with a rising tide of non-emergent visits choking their emergency rooms and hindering their ability to stay afloat financially. Those are the victims of this FDA approved branding protection.

I am sure Dr. Roberts and the URL Pharma leadership have been heralded by the company and share holders as “heroes” and are more than likely iconic figures within the corporation, I am sure they are languishing in the profits and productivity of their company and basking in the glory of discovering and taking advantage of that governmental loophole that brought them such profits. The question remains; is what this company has done with Colcrys®, Fibricor® and Qualaquin® ethical? Should such great profits be made on the backs of the unfortunate? The company would argue that nothing illegal was done. And they are probably right, but ethically, that is another story. Should human suffering come under the guise and protection of the federal government by some unintended legal loophole? It must be determined by the general public and their perception and suffering at the hands of Big Pharma, the FDA and the Federal government, to speak out and ask for justice.

Source: URL Pharma web site.

An announcement in Feb. 2011 on the URL Pharma web site announces a co-pay assistance program for Colcrys users who have health insurance. Obvious bad public opinion and advocacy groups may have impacted the company’s reputation and they went on “damage control mode” to come up with this program. Nonetheless, their profits despite these assistance initiative programs will not suffer negatively.

From URL Pharma web site:

2/9/2011

URL PHARMA ENHANCES CO-PAY ASSISTANCE PROGRAM FOR COLCRYS®

Monthly Co-Pay Reduced to $15 for Most Patients with Health Insurance

PHILADELPHIA, PA, February 11, 2011 – URL Pharma today announced that it has enhanced the Colcrys® (colchicine, USP) Co-Pay Assistance Program, an initiative designed to help patients save money on their health insurance co-payment for Colcrys. The enhanced program is available to patients immediately.

Colcrys is the only single-ingredient colchicine product approved by the FDA, and is indicated for the prevention and treatment of gout flares and for the treatment of Familial Mediterranean Fever (FMF).

The enhanced Co-Pay Assistance Program now enables most patients with health insurance to obtain Colcrys for $15 per month with a reusable coupon. Previously, the co-pay limit was $25 per month. Although the launch of the enhanced program is scheduled for March, patients do not have to wait until then to realize the new benefits. Effective immediately, URL Pharma will honor the currently-available $25 coupons at the new $15 co-pay amount.

The enhanced program has several other newly-added features:

· Patients will now be able to save a maximum of $75 on their Colcrys prescriptions, up from $65 under the previous program

· Patients may use co-pay coupons 12 times per calendar year

· The program runs through January 31, 2012

“We are committed to making Colcrys accessible to everyone who can benefit from it,” said Richard H. Roberts, M.D., Ph.D., President and CEO, URL Pharma. “In response to feedback from patients and healthcare providers, we enhanced our Co-Pay Program to facilitate access to Colcrys.”

The Colcrys Co-Pay Assistance Program works as follows:

· Patients may obtain a co-pay coupon directly from their doctor’s office or by downloading it atwww.colcrys.com and present it to their pharmacist when filling a Colcrys prescription

· Alternatively, patients may have their COLCRYS prescriptions filled at any of more than 32,000 pharmacies nationwide that participate in the evoucherRx™ program from Relay Health. Patients may visithttp://evoucherrx.relayhealth.com/storelookup for a listing of pharmacies participating in the evoucherRx program.

Patients can learn more about the Colcrys Co-Pay Assistance Program by calling 1-800-657-7613 from 8:00 am to 8:00 pm Eastern Time, Monday through Friday.

The Colcrys Co-Pay Assistance Program is valid only for patients with primary health plan coverage. Patients are not eligible if prescriptions are paid for in part or in full by any state or federally funded program including, but not limited to, Medicare, Medicaid, Medigap, VA, DOD, or TriCare, or where prohibited by law. The coupon is also not valid for cash-paying patients or rejected claims, and is void in the state of Massachusetts and where prohibited by law.

For patients who are uninsured or have Medicare Part D, URL Pharma offers Colcrys free of charge or at reduced cost to those who qualify through the company’s Patient Assistance Program. Patients may visitwww.needymeds.org or call 1-888-811-8423 from 8:00 am to 6:00 pm Eastern Time, Monday through Friday for more information about the Patient Assistance Program.

Yusuf Saleeby, MD is an emergency room physician and founder and president of the patient advocacy groupRedBanyan.org. He also heads a team of physicians and staff with a mission statement of bringing affordable and cost-contained health care delivery to the general public. Online telehealth services such as AtroGene.com and a DAT serviceeStatLabs.com are means by which RedBanyan offers affordability and exemplary care to those uninsured or under-insured in America.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000756/

http://www.medpagetoday.com/ProductAlert/Prescriptions/15358

http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/22600

"Colchicine for acute gout: updated information about dosing and drug interactions". National Prescribing Service. 14 May 2010.

Cocco, Giuseppe; Chu, David C.C.; Pandolfi, Stefano (2010). "Colchicine in clinical medicine. A guide for internists". European Journal of Internal Medicine 21 (6): 503.

http://www.nps.org.au/health_professionals/publications/nps_radar/2010/may_2010/brief_item_colchicine. Retrieved 5/15/11

http://www.urlpharma.com. Retrieved 6/1/11

http://www.fibricor.com. Retrieved 6/1/11

http://www.pharmacychecker.com. Retrieved 6/1/11

Terkeltaub, et. al., High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010 Apr;62(4):1060-8

MUSC Update on Prescription Drugs Conference, May 12-14^th, 2011, Charleston, SC

Colchicine: An Example of Big Pharma Exploitation

2011-06-03T00:37:00.000-04:00

Colchicine: An Example of Big Pharma Exploitation

Yusuf M. Saleeby, MD

RedBanyan.org (President, Patient Advocacy Group)

Source: URL Pharma web site.

From URL Pharma web site:

2/9/2011

URL PHARMA ENHANCES CO-PAY ASSISTANCE PROGRAM FOR COLCRYS®

· Patients will now be able to save a maximum of $75 on their Colcrys prescriptions, up from $65 under the previous program

· Patients may use co-pay coupons 12 times per calendar year

· The program runs through January 31, 2012

· Patients may obtain a co-pay coupon directly from their doctor’s office or by downloading it atwww.colcrys.com and present it to their pharmacist when filling a Colcrys prescription

Yusuf Saleeby, MD is an emergency room physician and founder and president of the patient advocacy group RedBanyan.org. He also heads a team of physicians and staff with a mission statement of bringing affordable and cost-contained health care delivery to the general public. Online telehealth services such as AtroGene.com and a DAT service eStatLabs.com are means by which RedBanyan offers affordability and exemplary care to those uninsured or under-insured in America.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000756/

http://www.medpagetoday.com/ProductAlert/Prescriptions/15358

http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/22600

"Colchicine for acute gout: updated information about dosing and drug interactions". National Prescribing Service. 14 May 2010.

Cocco, Giuseppe; Chu, David C.C.; Pandolfi, Stefano (2010). "Colchicine in clinical medicine. A guide for internists". European Journal of Internal Medicine 21 (6): 503.

http://www.nps.org.au/health_professionals/publications/nps_radar/2010/may_2010/brief_item_colchicine. Retrieved 5/15/11

http://www.urlpharma.com. Retrieved 6/1/11

http://www.fibricor.com. Retrieved 6/1/11

http://www.pharmacychecker.com. Retrieved 6/1/11

Terkeltaub, et. al., High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010 Apr;62(4):1060-8

MUSC Update on Prescription Drugs Conference, May 12-14^th, 2011, Charleston, SC

Acute Otitis Media - problem solved for much less with TeleHealth

2011-05-26T23:26:00.002-04:00

A minor acute illness that affects thousands each year and contributes to huge health care dollars being spent rather unnecessarily. $489 Million spent on Acute Otitis Media? What? None that presented to ambulatory care centers required admission. 3% visiting emergency department were admitted? What??? Malignant Otitis Media where surrounding soft tissue around the ear canal is inflamed and concerns about an aggressive spreading cellulitis are certainly red flags for considering an admission for this condition. However, one wonders if there are industry and administrative pressures to "admit" when these relatively ubiquitous and easily treated conditions report to the emergency department.

Another example of an industry run amuck with over-the-top defensive practice costing hundreds of health care dollars diverted unnecessarily away from where it should be spent. AOE is such as simple and straightforward diagnosis to make, an average clinician can make the diagnosis with 96% certainty with just a good history alone. No need for fancy tests or examination, having the patient "tell" you it hurts to depress the tragus or yank of the helix of the ear is "proof enough" to make a diagnosis with a recent history of "water in the ear", swimming, and wearing ear plugs in humid environments. Another near perfect example of how telemedicine can drastically reduce the health care cost of a simple condition. No need to spend more than $55 on a diagnosis and treatment. No real cause to spend $200 or more for this condition to be assessed.

Swimmer's Ear Triggered 2.4 Million Treatment Visits

By: ALICIA AULT, Family Practice News Digital Network

05/19/11

Swimmer’s ear caused an estimated 2.4 million trips to physician offices and emergency departments in 2007 and cost nearly $500 million to treat, the Centers for Disease Control and Prevention reported May 19.

The condition, also known as acute otitis externa (AOE), is easy to prevent, however – a fact the CDC is highlighting in advance of the nation’s swimming pools opening around Memorial Day weekend.

"Most people think of swimmer’s ear as a mild condition that quickly goes away, but this common infection is responsible for millions of illnesses and substantial medical costs each year," Dr. Michael Beach, associate director for healthy water at the CDC, said in a statement. "By taking simple steps before and after swimming or coming in contact with water, people can greatly reduce their risk of this painful infection," he said.

A study in the agency’s Morbidity and Mortality Weekly Report is the first to look at the national costs associated with swimmer’s ear, a common condition in which pathogens proliferate in a moist environment in the ear canal (MMWR 2011;60:605-9).

The condition occurs most often in people who are exposed frequently to water, through bathing or swimming, and also in residents of warm and humid climates. Swimmer’s ear is characterized by pain, tenderness, redness, and swelling of the external ear canal. Most cases can be treated easily with topical antimicrobials, according to a statement from the CDC.

Not surprisingly, the study showed that AOE cases peak during the summer months. A total of 44% of cases occurred during June, July, and August, noted Dr. Emily W. Piercefield of the CDC’s Division of Applied Sciences, and her colleagues.

The data showed that children aged 5-9 years accounted for the highest frequency of physician visits for AOE, at 18.6 visits/1,000 people. Children aged 10-14 years accounted for 15.8/1,000. Interestingly, adults age 20 years and older accounted for 53% of AOE-related physician visits.

Southerners had the highest frequency of visits, at 9.1/1,000. AOE cases were least frequent in the West, at 4.3/1,000. There was no difference in frequency between urban and rural residents.

The study authors obtained incidence estimates by using the CDC’s National Ambulatory Medical Care Survey for 2003-2007 and the 2007 Nationwide Emergency Department Sample. Costs were estimated through use of a commercial insurance database.

The estimated annual tally for direct health-care costs was $489 million. The average cost per case was $200 for those patients who did not require hospitalization. None of the ambulatory care patients required admission, but almost 3% of those who visited an emergency department for swimmer’s ear were hospitalized.

Health care providers spent an estimated 597,761 hours annually treating swimmer’s ear in the ambulatory-care setting, according to the study authors.

Among the prevention measures suggested by the CDC:

• Use ear plugs or bathing caps to reduce exposure of the ears to water.

• Dry the ears after swimming.

• Keep foreign objects – which could break the skin and create an avenue for infection – out of the ear.

The agency also cautioned against removing ear wax, which protects from infection. And it recommended that pool and water park operators maintain proper pH and chlorine levels to retard growth of Pseudomonas aeruginosa and Staphylococcus species, which are responsible for AOE infections.

The CDC has two websites for more information on swimmer’s ear and healthy swimming. [editor's note: A reasonable and cost effective means for evaluation and treatment is via telemedicine, a premier group experienced in telehealth is AtroGene Telehealth Consultations]

Benefits of Glucophage (Metformin)

2011-05-24T09:00:00.000-04:00

Metformin: Glucose Control & Weight Loss

by Yusuf M. Saleeby, MD

For more than forty years the drug named Metformin (Glucophage® manufactured by Merck, but now available generic as the patent has expired) has been used to treat Type II diabetics with great success. Unlike other medications used to lower blood glucose levels, Metformin will not cause hypoglycemia because it acts quite differently than other classes of diabetic medication.

Observing the nearly 4 decades of Metformin use in overweight diabetics with cardiovascular disease, hypertension and dyslipidemia brought to light the amazing transformation this drug has on this group of patients with this insidious and life-shortening disease. Metformin happens to be one of the only drugs used to treat type II diabetes that has an impact on reduction of death by heart attach and stroke. While other agents raise the insulin levels, Metformin's mechanism of action work to make endogenous insulin levels more effective on a cellular and molecular level by up-regulating insulin receptors. What is more, the ideal anti-diabetic drug for type II should exhibit enhanced cellular sensitivity to insulin (reducing insulin resistance and glucose intolerance), inhibit excessive intestinal absorption of sugars, reduce excessive liver production of glucose (gluconeogenesis), promote weight loss and correct lipid abnormalities. Many unfortunately raise insulin levels, a condition undesirable as type II DM has elevated insulin levels along with elevated glucose levels.

With the CDC’s predictions that one of every three children born after 2000 will develop type II diabetes, this is certainly a topic of paramount importance. Metformin answers the call today as probably the most important DM II drug on the market.

Take these well documented positive finding for glucose reduction, reduction in insulin resistance and metabolic syndrome, and apply them to the non-diabetic patient. Several studies have done just that, and a growing number of forward thinking physicians are prescribing this drug as a part of their regiments for patients over 40, with risk factors for diabetes, obesity and syndrome X (metabolic syndrome). It remains an FDA off-label use, but that is not unusual for drug prescribing today. A good physician who is a patient advocate cannot wait around necessarily for the FDA to approve drugs for certain uses. The FDA process is unbelievably slow, full of bureaucratic red tape and riddled with political interventions by Big Pharma and other interest groups.

Three placebo-controlled trials using Metformin in non-diabetics reported a reduction in fasting insulin and c-peptide levels, normalization of serum glucose and harmful low-density cholesterol (LDL-C) and apo B levels. One of the three even reported lowering of blood pressure and fasting triglyceride levels. It is shown time and again that Metformin is able to assist patients with weight loss. Now with new biomarkers and gene making efforts, it can be determined if a patient has the “right gene” that will allow for most effective use of this drug. A blood test called AccuType Metformin (offered by Quest Diagnostics and available online without a prescription on eStatLabs) can determine if Metformin is beneficial and effective for you.

Metformin has other uses too. It has been used to treat women with polycystic ovary disease (Stein - Leventhal syndrome) and infertility or menstrual irregularities. There are also studies published in the medical literature showing Metformin's activity against cancer and enhancement of cellular immunity. Metformin has been found to suppress growth of some tumors and enhance the activity of anti-cancer drugs. In one such study it reduced the incidence of chemically induced cancer in laboratory rats.

As with all medication there are some patients who should not take this drug and there are some side effects one should be aware. For example, people suffering from sever liver and/or kidney disease should not take this medication. Those with a history of alcohol abuse should avoid this because of an associated lactic acidosis when the two are taken together. Additionally, people who are to take an Iodine-based intravenous contrast agent for special radiological examinations need to stop the medication a couple of days prior and not resume use for up to 3 days following that type of exam. There is an associated risk of kidney damage when Metformin being taken when IV-iodine based dyes are used. One common side effect is diarrhea, especially at the onset of use, loose stools are common and dose dependent, but with time that goes away.

Finally, continuous use of Metformin will predispose a person to vitamin B12 malabsorption. So people taking Metformin for prolonged lengths of time need to supplement with vitamin B12. By and large this is a very safe drug and the benefits attained from its use outweigh the relatively small number of untoward effects.

The multiple positive effects of this single drug (for its ability to reduce development of diabetes, cardiovascular problems, endocrine disorder, nephropathies, retinopathies, decreased immune function and cancer, as well as weight loss) make it a top disease preventing & longevity medication. There are special doses recommended for the use of this medication for prevention purposes and it is best prescribed by physicians with this as their focus of practice. It is a regular recommendation in my practice as a “supplement” medication for continued good health and with a simple blood test, it can be determine effective in each patient on an individual basis.

===

Dr. Yusuf Saleeby is a physician with prevention and nutritional interventions as a focus. He performs telemedicine consultations with the AtroGene Telehealth group. For more visit www.atrogene.com

References on file.

Emerson Ecologics for hundreds of supplements discounted

2011-05-15T13:41:00.000-04:00

Ask for special access code for additional 5% discounts

email Dr. Saleeby (jpsaleeby@aol.com)

How do patients judge their doctors?

2011-05-08T13:00:00.000-04:00

Answer: The single most important criterion by which patients judge a physician is the way they interact with them.

Discussion: The practice of medicine is much more than a black bag of clever tests and diagnoses; it includes the art of human interaction. Effective communication helps to establish patient trust. Try The practice of medicine is much more than a black bag of clever tests and diagnoses; it includes the art of human interaction. Effective communication helps to establish patient trust. Try to establish what the patient’s expectations of the patient/physician encounter are. Physician communication is the most effective strategy in decreasing the possibility of malpractice claims!

[in my 20-year career I have not had any patient ask me what school name is on my diploma, or where I did my residency, few will go online to sites that "score" doctors, most if not all judge us by what we say and how we talk to them]

-Schumacher Group CME

2011-05-06T08:44:00.003-04:00

Emerson Ecologics Link

2011-05-05T09:55:00.002-04:00

Atrogene & Dr. Saleeby patients can get discounts on Emerson Ecologics Web site for hundreds of supplements by going to the following link. Use access code: you must be an active patient... please go to estatlabs.com or atrogene.com to purchase membership ($25 for 2 years)

Click here to buy products.

Medical Tourism - Will the Far East overshadow US medicine?

2011-05-01T14:43:00.000-04:00

Thai embrace of medical tourism divides professionals

Despite the benefits of generating income, critics say Thailand's plans to become an international leader in medical tourism could adversely affect health treatment for the poor.

A Thai therapist treats a client at a medical spa in Bangkok. Photograph: Saeed Khan/AFP/Getty Images

Medical tourism has been described as one of the fastest growing businesses in the world, and by 2012 it is predicted to be worth $100bn annually. India, Singapore and Thailand can offer high quality medical procedures with English-speaking doctors at a fraction of the cost incurred in the west. However, despite its benefits in generating income, one prominent Thai economist, Ammar Siamwala, has described the intention to create an international medical hub inThailand as an "evil plan" that will adversely affect health treatment for the poor.

More than 1.6 million foreigners are treated in Thai hospitals annually, with an estimated 500,000 travelling specifically for medical treatment. These are phenomenal figures given the nascent state of the medical tourist industry only a few years ago.

The former Thai prime minister Thaksin Shinawatra initially proposed making Thailand an international leader in medical tourism in 2003 through aggressively marketing the country as a medical hub and curbing restrictions on foreign doctors practising there.

Proponents for this policy argue that it will provide huge financial benefits for Thailand. Indeed, the foreign medical services sector is already expected to make 100bn baht ($3.3bn) by 2015. The government also states that it will create more medical expertise and greater accessibility to new medical equipment. Additionally, it could help reverse the "brain drain" away from western countries by attracting highly qualified Thai doctors living abroad back to Thailand.

However, Ammar has described the medical-hub plan as "the worst policy that the government could ever think of". The salary for doctors is about 8-10 times more in a private clinic than in a state hospital, so Ammar warns that private expansion will result in even greater wage inflation in the state sector. "The ministry has already increased their salaries again and again [but it's] never enough. How can they compete with the private sector?"

Dr Amphon Jindawattana, secretary general of the National Health Commission of Thailand (NHC) agrees, saying: "The medical-hub policy is the accelerator causing the brain drain of doctors, super specialists and other medical workers to private hospitals." Thailand already has a shortage of doctors compared with other countries in the region, and health reforms to expand provision to the low paid have put a greater burden on the public health system.

However, in 2005 the government only managed to train 1,300 doctors, and saw nearly 700 doctors resign in the same period – many to work in the expanding private sector.

The Rural Doctors Society is also scathing in its criticism of foreign medical expansion. Bangkok already has eight times as many doctors per capita as the worst served rural regions, and the RDS points out that concentrating resources in the large cities will simply worsen these discrepancies.

There are also concerns over the growing divergence between state and private health provision. Some of the big private hospitals now resemble five-star hotels. Doormen will guide you to a gleaming marble foyer before elevator attendants take you to your waiting room. These "hotel-spitals", designed specifically for the needs of foreign patients, mean that the Thai middle classes are increasingly unable to afford private healthcare provision at these centres.

Erik Cohen, an emeritus professor in the faculty of social sciences at the Hebrew University of Jerusalem, predicts that the big private Thai hospitals will inevitably expand to become greater regional providers of services, and that western governments and insurance companies will increasingly look to outsource patients to reduce costs and waiting lists. Indeed, one academic projection estimates that by 2015 foreign patients will require resources equivalent to between 23%-34% of the total number of doctors currently working in the private sector.

One possible solution for Thailand will be to exploit the upcoming liberalisation of doctor movement between south-east Asian nations and import doctors from other countries in the region. However, this will have an adverse affect on countries such as Vietnam, Laos and Cambodia – and Thailand may soon become responsible for causing a regional brain drain of its own.

The explosive growth in medical tourism will have a significant impact on the healthcare systems of countries like Thailand. However, more important than either private sector lobbying or the benefits for medical tourists are the health needs of the local populace. Strong safeguards, such as a significant medical services tax and greater investment in medical training, need to be in place to ensure that they too benefit from the globalisation of healthcare and the medical tourism revolution.

source: http://www.guardian.co.uk/global-development/poverty-matters/2011/apr/26/thailand-medical-tourism-divides-professionals

Federal Agencies to Require Physician Education on Opioids

2011-04-21T14:00:00.002-04:00

Federal Agencies to Require Physician Education on Opioids

By: FRANCES CORREA, Internal Medicine News Digital Network

04/19/11

WASHINGTON – Physicians may require training on how to prescribe extended-release opioid prescription drugs in order to obtain or renew their registration with the Drug Enforcement Agency, according to new policies announced April 19 by the White House Office of National Drug Control Policy and the Food and Drug Administration.

The FDA announced that it will require the 16 prescription drug manufacturers that sell long-acting or extended-release opioids to provide educational materials for physicians and patients regarding the risks of opioid drug use.

The FDA’s Risk Evaluation and Mitigation Strategy (REMS) program would require prescribers to learn how to identify appropriate patients, how to monitor patients and how to counsel them on safe use of opioids, and the risks and benefits of opioid therapy. Prescribers would also be trained on how to recognize opioid abuse and addiction.

"We feel the prescribers are really critical in managing this," said Dr. Janet Woodcock, director of FDA’s Center for Drug Evaluation and Research, in a press briefing. She acknowledged, however, that there could be a burden for both drug makers and physicians. "This is in some ways the most far-reaching REMS program the FDA has instituted," she said.

Dr. Woodcock said the program would not interfere with access to the drugs for patients with legitimate needs but defended the program’s necessity.

She cited data that the number of Americans in 2009 aged 12 and older abusing pain relievers has increased by 20% since 2002—from 29 million to 37 million. The long-acting forms are complex and present more risk than short-acting formulations, said Dr. Woodcock. There were 12,000 overdose deaths from prescription pain relievers in 2009, she said.

Prescription drugs are the second-most abused category of drugs after marijuana, according to a 2009 study on illicit drug use in teens by the University of Michigan. Drug-induced deaths are second only to motor vehicle fatalities, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.

The FDA says it has given drug manufacturers 120 days to develop educational materials for the agency to review. The aim is for the programs to be administered by organizations that conduct continuing medical education. The agency plans to have the REMS in place by early 2012, said Dr. Woodcock.

Prescriber training is essential to combat prescription drug abuse, said Dr. Howad Koh, assistant secretary for the Department of Health and Human Services, at a press briefing.

"As a physician who has spent over 30 years caring for patients, I am also very aware that we physicians and we providers have had too little opportunity for education on proper prescribing and dispensing of opioid medication," Dr. Koh said, adding that the plan provides an opportunity for early prevention instead of belated treatment.

The administration’s plan, known as Epidemic: Responding to America’s Prescription Drug Abuse Crisis, also includes state-based drug-monitoring programs, environmentally responsible at-home drug disposal, and enforcement efforts to reduce pill mills and "doctor shopping." In addition, the Office of National Drug Control Policy is requesting an increase in funding of $123 million for drug prevention and $99 million for treatment programs for fiscal year 2012.

As a part of the plan, the DEA will be working "to reduce doctor shopping, to aggressively shut down pill mills and to investigate those who abuse their responsibilities as medical professionals, violate the controlled substances act and break their pledge to the public to do no harm," said DEA administrator Michele Leonhart at the press conference.

Opioids included in the REMS plan include methadone (Dolophine); the morphine formulations MS Contin, Kadian, Avinza, Embeda, and Oramorph; oxycodone (OxyContin); hydromorphone (Exalgo); transdermal fentanyl (Duragesic); buprenorphine (Butrans);, and oxymorphone (Opana ER). Short-acting formulations are not covered but could eventually fall under this policy, said Dr. Woodcock.

Colon Cancer Screening - CC, CV, ColoVantage - many options.

2011-04-19T15:37:00.000-04:00

Colon Cancer Screening: To scope or not to scope?

By Yusuf M. Saleeby, MD

Colon cancer screening by fiberoptic colonoscopy is recommended by the vast majority of physicians and the American Cancer Society as a screening test for colorectal cancer. While colonoscopy is the “gold standard” for colon cancer screening, nearly 50% of Americans over the age of 50-years avoid the procedure and ignore the recommendation. There are some obvious and not so obvious complications and risks associated with the procedure and the notions people have with the bowel prep process and undergoing conscious sedation are not at all appealing. But many avoid the procedure due to expense, discomfort of procedure, and inability to devote the time for the relatively invasive procedure. A recent study by a British group of researchers published in the peer-reviewed medical journal Lancet calls into question the validity of conventional fiber-optic colonoscopy as a screening tool.

Colorectal cancer is the third most common cancer and the 2^nd leading cause of cancer death in the US, Canada and Europe. There are about 100,000 new colon cancer cases in the US each year and approximately 40,000 new cases of rectal cancer. Of these, there are about 50,000 deaths annually attributed to colorectal cancer. What causes colon cancer is a difficult and elusive question that has not been fully explained. However, epidemiological studies have revealed that dietary constituents are implicated in colorectal carcinogenesis. Those constituents are a diet high in fat and red meats, considered causative, and a diet low in calcium and fiber as these would be considered protective. Additionally, there are genetic factors. For example, researchers have found that certain biomarkers in both animal and human trials affect the dietary factors. Colon cancer develops by an adenoma-carcinoma sequence in the pre-cancerous or injured cell. The appearance of colonic polyps has been an end-point in some research trials, however, normal appearing mucosa can still contain very small foci of aberrant crypts (invisible to colonscopy) referred to as micro-adenomas and these will certainly lead to dysplasia. Researchers are studying these small foci and discovering what diet and chemopreventive agents work best at suppressing their growth. Omega-6 fatty acids affect lipid peroxidation of DNA and this exposure provides stimulation for precursor tumor cells. Diets low in calcium apparently inhibit apoptosis (cancer cell death) leading to higher risk as well. Calcium has also been shown to reduce the recurrence of adenomas in three recent trials. However, in one of these studies the use of fiber in the diet actually increased recurrence dramatically, counter to what we currently believed about fiber. Much study is needed to realize the impact of our diet and environment on ur genes and how that interaction produces cancer.

It has been shown through many trials that colon cancer screening, effective follow-up and treatment can reduce risk of colon cancer death by as much as 35% and risk of getting colon cancer by 20% with early detection of precancerous polyps, this according to Dr. Otis Brawley, chief medical officer of the American Cancer Society. The much used, most efficient, least expensive and practical screening test is the stool occult blood test (aka FOB or Hemoccult®). With an abnormal finding (positive for occult blood) the next step can be taken. Most American physicians would opt for a referral for colonoscopy. But there are alternatives. There are less expensive and possibly safer alternatives to the more invasive conventional colonoscopy which has been the predominant method for further screening (and now primary screening) for colon cancer.

A 2004 research study performed in England over a 4-month period reviewed the results of some 9223 colonoscopies performed in the traditional flexible colonoscopy fiber-optic method, the majority of which were conducted in teaching hospitals. To paraphrase the study, it revealed that IV sedation was used in just over 94%, cecal intubation (the ability to run the scope to the end-point which is the cecum) was only 56.9%. Reasons for failure were attributed to patient discomfort (35%), looping (30%), and poor bowel prep (19%). Normal results were reported in 42.1%. Polyps were reported in 22.5% (a pre-cancerous finding) while evidence of carcinoma was only realized in 3.8% of cases. Rectal bleeding requiring admission was reported in six patients and the overall perforation rate was one in 769 cases. Colonoscopy was also considered a factor in six deaths occurring immediately following the procedure. The conclusion of this study revealed a wide variation of sedation guidelines, the studies were often incomplete and does not achieve the targeted 90% cecal intubation rate. Serious complications were comparative with previous studies and points out that while thousands are done in America, there are inherent risks and short-comings.

The American Cancer Society is now recommending the use of Virtual Colonoscopy as an alternative to traditional fiber-optic conventional colonoscopy (CC). Virtual Colonoscopy is the use of a spiral Computed Tomograph (CT) to visualize the colon. The trade offs are a little radiation exposure in virtual, but the gain is a better study technically, with no failure to “progress to the cecum” issue, the ability to re-visit the study and finer resolution. The upside continues as it is non-invasive and thus the risk of perforation, post-operative complications, bleeding and risks of anesthesia are eliminated. Cost is another factor in favor of VC over conventional fiber-optic method. The most obvious downside is that if a malignant lesion is noticed there is no way to perform an excisional biopsy for further pathological study; one would have to sit for a conventional colonoscopy.

Virtual colonoscopy as it continues to develop, evolve and become more popular will realize a costs drop. Patients find it more comfortable, there is no need for procedural sedation, and the risk of penetrating iatrogenic complications are almost nil. Insufflations of colon with air is the only “invasiveness” and can be mildly uncomfortable, though nothing like the introduction of a scope. Another benefit is that a day off from work and limiting other activities is not necessary. By insertion of a short rectal tube, carbon dioxide is used to insufflate or expand the colon lumen for better visualization. No sedation is required, the spiral CT study only lasts 15-minutes at most and the patient can return to normal activities post study.

Specialized software is used to produce 2D and 3D reconstructions of the colon for radiological interpretation. Using VC permits assessment of colonic segments that are rendered inaccessible to CC as in the case of an obstructing lesion or patient intolerance. Additionally, the modality of CT in the performance of a VC allows detection of potentially important extra-intestinal findings (e.g. tumor in another solid organ) that would not be found by any of the other screening techniques.

In a recent clinical study involving 6,283 screening subjects, the diagnostic yield and use of resources for screening purposes compared VC to CC. The study found that VC and CC had similar rates for detecting advanced cancer, but CC had considerably greater complication. The American College of Radiology Imaging Network trial revealed that CC does have the advantage of being both a screening and therapeutic tool, but VC appears to be a good screening alternative due to its good performance in recent studies, less invasive method, and more efficient use of resources.

Colorectal cancer screening with VC has been endorsed by the three major gastrointestinal societies: the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (AGSE), and the American College of Gastroenterology (ACG).

VC is also indicated after incomplete conventional colonoscopy, as up to 13% of incomplete CC were found to have lesions 6mm and larger. VC is better than a barium-air contrasted study due to reduction in sensitivity of the contrast. Because of the nature of the CC exam, and the unwillingness of the population at large to undergo this type of exam, this may explain the reason as to why 50% of eligible adults needing the CC do not get it performed.

The one main concern with using VC is the radiation exposure. However, the use of very low dose scanning protocols that reduced radiation exposure can still maintaining image quality. Even with the use of multi-slice spiral scanners, radiation dose is kept to a minimum by reducing the mili-Amp current used. In one study researchers found that the absolute life time risk for cancer induction from a normal dose virtual colonoscopy was only 0.14% in a 50 year-old person and about 0.07% in a 70 year-old person. When you compare the 6% mortality risk from colon cancer against the much smaller cancer risk from VC radiation exposure, the benefits far outweigh the risks. Risk of perforation with current carbon dioxide pumps is about 0.005%, again far less than with standard CC procedures.

When running a cost analysis, this is what I have found to be the case: A standard doctor’s office visit for consultation, pre-procedure lasting no more than 5-minutes costs $216. Estimates for the procedure itself for specialist performing it was around $850. The estimated cost for anesthesia was somewhere between $300 and $400. Not figured into this cost was the use of the GI suite/operating room. That would have been billed separately from the hospital used. So you are going to walk away with a bill at or over $1400. That is even before any intervention that may be involved. If a biopsy is taken, then you have that additional procedure billed and then there are the costs of the cyto-pathology report. So this becomes a very expensive screening process. Often too expensive for the vast majority of Americans who don’t have the health care coverage or who are uninsured. VC typically comes in at about $1200 for the procedure and reading, but that cost will certainly drop it becomes more popular. That being said, you are paying for convenience, comfort and putting yourself at less risk for untoward outcomes. More people can be screened with the less expensive VC procedure, thus eliminating the risks associated with CC, the expense and time involved. When positive findings are found on VC they can be referred to a gastroenterologist for CC and biopsy and further workup, thus lightening the screening burden on this sub-specialist group. Virtual colonoscopy may not be covered by third-party payers for screening purposes at this time; however that is likely to change in the near future.

But for most patients seeking screening exams there are still far less invasive, less costly and less time consuming options. The keyword here is medical biomarkers. Not to be overlooked, and worth mentioning again is the most simple and effective screening method on the first tier; the stool occult blood test (FOB, Guaiac® or Hemoccult® test). This test can be performed by your doctor or at home by yourself with a simple kit. The test kit is then developed with a chemical solution to detect microscopic blood in your feces that is typically associated with a pre-cancerous or cancerous lesion. While a positive test may mean other things besides malignancy (hemorrhoids, fissures, infection, recent intake of undercooked red meat) there are other tests used to back this screening modality up. This occult blood test can be had for a few dollars.

The advent of biomarkers has made the screening and management of many cancers less invasive in the 21^st century. There are dozens of biomarkers that already exist and many more in development with new tests coming to clinical use each year. There are biomarkers for the detection of prostate, breast, lung cancers and many more. For the purpose of this discussion we will limit ourselves to the biomarkers currently available for the potential screening and management of colorectal cancer. Chief among the markers is Carcinoembryonic Antigen (CEA), it is rather non-specific as it can detect different malignancies that arise under the diaphragm. Smokers typically have an elevated CEA for starters and this must be realized when using this test as a screening tool.

Another cancer biomarker is CA 19-9. The CA is shorthand for carbohydrate antigen. This test is also known as sialylated Lewis (a) antigen and is also a blood test like CEA, but more specific for colon cancer and pancreatic cancer. The CA 19-9 test was discovered in 1981. While elevated levels in the blood can be found in non-malignant conditions such as Mirizzi’s syndrome and diseases of the liver and bile ducts it is currently one of the key tests for pancreatic and colon cancer management. The reluctance of using these tests more widely comes from the guidelines for the American Society of Clinical Oncology and the American Cancer Society which are still discouraging the use of CA 19-9 and other cancer markers as “dedicated screening” tests. Their reasons are mostly the higher incidence of false positives. That would be a person with a positive test with no malignancy. Other reasons may be purely political, as a simple blood tests would “take away” expensive and profitable procedures from those performing flexible sigmoidoscopies and colonoscopies. The main use of CA 19-9 is with following pancreatic tumors that are being treated with chemo or surgery; by checking for increases in levels that would indicate recurrence or worsening of the disease. As with any test, there is never a 100% specificity/sensitivity. In CA 19-9 about 5% of the population does not possess the ability to produce the Lewis antigen because of a deficiency of a fucosyltransferase enzyme and thus no Lewis antigen or CA 19-9 would be produced even with large tumor burden.

There are other markers under investigation that may become more useful in the future. In 2009 researchers at the University of Cincinnati (UC) published in a genetics journal their findings about a gene called AMACR which regulates cancer development and discovered a polymorphism (mutation) related to colon cancer. Dr. Xiang Zhang, PhD who was the lead researcher of the UC study explains, "From the colon tissues, we've identified two types of genetic deletions [of the AMACR gene] that may allow us to predict whether people will have a good or bad cancer outcome," Dr. Zhang continued to say, "If a person carries one of the deletions, it may predispose him or her to a more aggressive type of colon cancer." While not developed as of yet as a screening tool, it will help physicians determine prognosis and treatment protocols for those that have colon cancer. Yet another cancer biomarker for colon cancer is CA 242. Elevated levels of CA 242 in colorectal cancer patients had similar rates of being positive as CEA and CA 19-9. The sensitivities are similar as well, and more so for recurrence and metastatic detection using CA 242.

While there is an increased demand for biomarkers of colorectal cancer (and other cancers for that matter), for early detection, risk assessment, prognosis and follow up post treatment, the perfect, gold-standard test has not yet been realized. Short comings are: too frequent false positives and false negatives as a stand-alone screening test. Other biomarkers under the microscope for consideration are APC, p53 and Ki-ras. These are still in development for use as viable clinical tests. The detecting of colon cancer in the early stages offers clinical advantages and better outcomes; therefore, the National Cancer Institute has established an Early Detection Research Network to promote more research in this field of study. The emphasis of the network is on translational research and collaboration among scientists in the field of oncology with the hopeful development of better cancer markers in the near future.

A rather new and promising colorectal biomarker is the ColoVantage® (methylated DNA from SEPT9 gene marker). ColoVantage® is the brand name of a test launched in 2010 by Quest Diagnostic Labs and as of March 2011, has gained approval by the New York Health Department as a sanctioned colorectal screening test. With its reported 70% sensitivity and 89% specificity rating, it is a good first line test for screening large numbers of people less likely to undergo colonoscopy of any type (CC or VC). The American Cancer Society is also warming up to the idea, but is slower to act as they are advocating more scrutiny. Quest Diagnostic is offering the ColoVantage at a retail cost of $355. Direct Access Testing sites such as eStatLabs offer this test direct-to-consumer for $300.

My current recommendations are with what is available to the public today a viable biomarker testing protocol. It has a two-prong approach: First, the inexpensive and readily available FOB (Hemoccult®) test. This is still the mainstay of colorectal screening and probably will be into the foreseeable future. The second recommendation is not in the realm of CC or even VC, but rather a chemical biomarker. Cheap by comparison and readily accessible with no risk of untoward affects is the ColoVantage test. It would be done in combination with the FOB to complete the evaluation. CA 19-9, CEA or the CA 242 biomarkers would be my second choice in biomarkers for initial testing. Finally, if both FOB & ColoVantage tests are positive, the algorithm would proceed to a 2^nd tier, the virtual colonoscopy or conventional fiber-optic colonoscopy.

References:

Bowles, CJ, Leicester, R., A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut 2004;53:277-283

http://www.radiology.uchicago.edu/index.php?q=physicians/virtual-colonoscopy-physicians, acquired 3/19/11

http://www.thedenverchannel.com/health/23293547/detail.html acquired 3/19/11

http://www.cnn.com/2009/HEALTH/expert.q.a/04/22/colonoscopy.age.brawley/index.html acquired 3/19/11

University of Cincinnati, Potential Colon Cancer Biomarker Revealed Through Study Of Human Tissue. ScienceDaily (2009, January 21).

Owen RW., Biomarkers in colorectal cancer. IARC Sci Publ. 2001;154:101-11.

Sudhir, S. Mukesh, V., Henson, D., Biomarkers for Early Detection of Colon Cancer, Clin Cancer Res May 2001 7; 1118

Koprowski H, Herlyn M, Steplewski Z, Sears HF. Specific antigen in serum of patients with colon carcinoma. Science 212 (4490): 53–5.

M Ugorski, A Laskowska (2002). Sialyl Lewis a: a tumor-associated carbohydrate antigen involved in adhesion and metastatic potential of cancer cells. Acta Biochimica Polonia 49 (2): 303–311.

Robertson A, Davidson B., Mirizzi syndrome complicating an anomalous biliary tract: a novel cause of a hugely elevated CA19-9. Eur. Jour. of Gastroent. & Hepa. 19 (2): 167–9.

Locker G, Hamilton S, Harris J, Jessup J, Kemeny N, Macdonald J, Somerfield M, Hayes D, Bast R., ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J. Clin. Oncol. 24 (33): 5313–27.

Spila A, Ferroni P, Comparative analysis of CA 242 and CA 19-9 serum tumor markers in colorectal cancer patients. A longitudinal evaluation. Anticancer Res. 2001 Mar-Apr; 21(2B):1263-70.

Griesenberg D, Nürnberg R, Bahlo M, Klapdor R., CEA, TPS, CA 19-9 and CA 72-4 and the fecal occult blood test in the preoperative diagnosis and follow-up after resective surgery of colorectal cancer. Anticancer Res. 1999 Jul-Aug; 19(4A):2443-50.

Carpelan-Holmström M, Louhimo J, Stenman UH, Alfthan H, Järvinen H, Haglund C.Tumour., CEA, CA 242, CA 19-9, CA 72-4 and hCGbeta in the diagnosis of recurrent colorectal cancer.

Biol. 2004 Sep-Dec; 25(5-6):228-34.

Eche N, Pichon MF, Quillien V, Gory-Delabaere G, Riedinger JM, Basuyau JP, Daver A, Buecher B, Conroy T, Dieu L, et al., Standards, options and recommendations for tumor markers in colorectal cancer], Bull Cancer. 2001 Dec; 88(12):1177-206.

American Society of Clinical Oncology 2006 Update of Recommendations for the Use of Tumor Markers in Gastrointestinal Cancer. http://www.asco.org

Published in Journal of Clinical Oncology, Vol 24, No 33, 2006: pp. 5313-5327

Quest Diagnostic Laboratory web site, Information on ColoVantage. Acquired 3/25/2011.

http://www.estatlabs.com Acquired 4/12/2011

"Surgery & Medicine during the Am. Civil War"

2011-04-06T05:05:00.000-04:00

Surgery and Medicine during the Am. Civil War

Lecture by Yusuf Saleeby, MD

Thursday April 7th, 2011 6:30PM
Horry County Library, Conway Branch
801 Main Street, Conway, SC
For more information: 843-915-7323

A collection of Dr. Saleeby’s medical antiques will be on display at the library during April.

Again: May 26th, 2011 12:00PM
Senior Circle, Bennettsville, SC

http://www.antiquusmorbus.com/Index.htm

http://www.civilwarsurgeons.org/

http://www.civilwarmed.org/

Inquire about lecture: ymsaleeby@gmail.com

QR Codes for Atrogene & eStatLabs

2011-03-27T03:42:00.000-04:00

Scan with Smartphone for toll free number:

Atrogene Site:

EstatLab Site:

Dr. Saleeby contributes to Wikipedia - Rhodiola

2011-03-25T06:18:00.000-04:00

Rhodiola

From Wikipedia, the free encyclopedia

(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)

Jump to: navigation, search

Rhodiola

Rhodiola heterodonta
Scientific classification
Kingdom:	Plantae
(unranked):	Angiosperms
(unranked):	Eudicots
(unranked):	Core eudicots
Order:	Saxifragales
Family:	Crassulaceae
Genus:	Rhodiola L.
Species
Dozens. Included under Sedum at Wikispecies.

This article is about a plant genus. For the species in this genus that is widely used in herbal medicine, see Rhodiola rosea.

Rhodiola is a genus of perennial plants in the family Crassulaceae^[1] that resemble Sedum and other members of the family. Like sedums, Rhodiola species are often called stonecrops. Some authors merge Rhodiola into Sedum.^[2]^[3]
Rhodiola species grow in high-altitude and other cold regions of the Northern Hemisphere.^[4] Den virtuella floran gives the number of species as 36,^[5] the Angiosperm Phylogeny Group gives it as 60,^[1] and the Flora of China gives it as about 90, with 55 in China and 16 endemic there.^[4] The USDA Plants database lists only 3 species in the United States and Canada.^[6]
Among the distinguishing characters of the genus are two series of stamens totaling twice the number of petals; free or nearly free petals (not joined in a tube); a stout rhizome from whose axils the flowering stems rise; and a basal rosette of leaves. This genus contains the only species of Crassulaceae that have unisexual flowers.^[4]^[7]
The Holarctic species Rhodiola rosea is used in herbal medicine. A number of species are grown as ornamentals, but growing them is difficult outside their native subarctic and alpine climates.^[8]
The name combines the Greek rhodon, meaning rose and referring to the rose-like smell of the roots, with the Latin diminutive suffix -iola.^[9]
Species include:

References

^ ^a ^b Stevens, P. F. (Version 9, June 2008 [and more or less continuously updated since].), Angiosperm Phylogeny Website., http://www.mobot.org/MOBOT/research/APweb/, retrieved 2009-07-26
^ Ivey, Robert DeWitt (2003), Flowering Plants of New Mexico (Fourth ed.), RD & V Ivey, p. 246, ISBN 0-9612170-3-0
^ "Sedum integrifolium ssp. leedyi", National Collection of Imperiled Plants, Center for Plant Conservation, 2008-01-29, http://www.centerforplantconservation.org/ASP/CPC_ViewProfile.asp?CPCNum=7501, retrieved 2009-07-26
^ ^a ^b ^c Fu, Kunjun; Ohba, Hideaki; Gilbert, Michael G., "Rhodiola", Flora of China, 8, p. 251, http://www.efloras.org/florataxon.aspx?flora_id=2&taxon_id=128370, retrieved 2009-07-26
^ "Rhodiola L.: Rosenrötter" (in Swedish), Den virtuella floran, Naturhistoriska riksmuseet, 2000-04-18 [1997], http://linnaeus.nrm.se/flora/di/crassula/rhodi/welcome.html, retrieved 2009-07-26
^ USDA, NRCS (2009), "Rhodiola", The PLANTS Database, Baton Rouge, LA 70874-4490 USA: National Plant Data Center, http://plants.usda.gov/java/nameSearch?keywordquery=Rhodiola&mode=sciname&submit.x=0&submit.y=0, retrieved 2009-07-26
^ Flora of China, 8, Crassulaceae, p. 202
^ Stephenson, Ray (1994), Sedum: Cultivated Stonecrops, Timber Press, pp. 289–290, ISBN 0-88192-238-2, http://books.google.com/?id=Jo9VgQAsMtkC&pg=PA289, retrieved 2009-07-26
^ Eggli, Url; Newton, Leonard E. (2004), Etymological Dictionary of Succulent Plant Names, Springer-Verlag, p. 203, ISBN 3-540-00489-0, http://books.google.com/?id=u2n5vusQ1DEC&pg=PA165&dq=Rhodiola+integrifolia+ornamental, retrieved 2009-07-26

Saleeby, J.P., Keefer, A., "Wonder Herbs: A guide to three adaptogens", Xlibris, 2006. Chapter devoted to R. rosea.

eStatLabs get new Favicon

2011-03-24T12:22:00.001-04:00

A Favicon? What is a Favicon... well it is like an icon.... but appears in your browser just before your URL. Sort of a spiffy thing that makes a site more professional.... Google has the "G", Blogger has the "B", Yahoo! has the "Y!" and well, eStatLabs now has the little red e-cross.

Surgery & Medicine during the Civil War Lecture in Conway, SC

2011-03-15T08:52:00.002-04:00

April 7th, 6:30PM, Horry Co. Public Library, Conway, SC... free lecture on the Surgical and Medical techniques during the American Civil War.