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You Are What You Eat

I, like most people, do not have the world’s best eating habits. I think in part that is because it is very hard to make food for one person. There are plenty of cookbooks for two people but not nearly enough for one. In addition, it is hard to make something and realize that you are going to spend all week eating the same food. And of course, with all this you also have to determine what is healthy enough to eat. Relying on food nutrition labels will only give you a so-so understanding of what you are consuming.

Nutrition Labels

I think that most people can probably agree that our current nutrition labels are less than helpful. Portion sizes on these tend to not reflect the way most people consume. Who really eats only 3 Oreos in a sitting? And not only are the portions misleading, but nutrition labels often contain a lot of confusing, scientific terms and leave you wondering what you are truly consuming, how good it is for you, and how much you should actually be consuming (possibly none). Earlier this year, the FDA proposed a new nutrition label that, in theory, is more in line with American eating habits.

Nutrition Label

However, nutrition labels still hide a lot of information about food. According to Dr. David Kessler, the commissioner of the FDA, “although the numbers can look good, the product may not be real food and have no nutritional value.” But, at the very least the revisions require companies to list out the different types of sugar and provides a more accurate portion sized based on America’s eating habits.

One key challenge is that the measurements used are often hard to reconcile. You might be shocked to learn that a 20 ounce coke has 16 teaspoons of sugar. Eating pancakes for breakfast involves less sugar than that. In addition, since ingredients are listed separately it is hard to determine what is naturally in the product versus what was added during the processing of your food.

Juices are one of the worst offenders because most claim to be 100% juice but for many filtered water is listed as the main ingredient. Can something be 100% juice if you first ingredient is water?

Don’t Leave it All to the Label

For all of us who wish to know what we are consuming and how healthy the item is there is now a great resource. Environmental Working Group built a Food Score database. The site contains information on more than 80,000 items sold in groceries stores. The site offers details of ingredients, nutritional information, and how processed the food items are.

Food Score Database

The site assigns food products a score from 1 to 10, with 1 being the best. The score is based on how nutritious it is, how many ingredients are in it, and an estimated how processed it is. The rating also includes information about whether the food product is organic, how the animals were raised, whether antibiotics were used, and if the food was exposed to dangerous environmental factors like pesticides. The site also tells you if it gluten-free, whether it potentially contains genetically modified ingredients, and how it stacks up to the competition. While the site isn’t perfect, it’s a great place to look if you want to better understand what you’re eating.

The Food Score database has also done broad analysis of trends found in different foods. They found that 60% of the products on the database contain added sugar. Shockingly, 90% of granola bars contain added sugar while 100% of stuffing mixes contain added sugar. And processed meats such as bologna and salami also contain added sugar.

Eating Right is Hard, But Worth it

Eating well is hard. The best choice is obviously to cook your own meals with foods that you have meticulously researched. Unfortunately, it is often hard to find the motivation and time to do so. But the new nutrition labels are a start, and for those who want to look deeper sites like the Food Database make it easier for us to make healthy choices. While finding and choosing the healthy option is sometimes inconvenient, it’s a smart choice.

Advances in Medicine: Beginning to Now

Test TubesThe spread of Ebola has been a prominent feature in the news over the past couple of months. While the disease is getting closer and closer to being contained, it has taken a serious toll on Western Africa. One key reason for this is the fact that local doctors did not have easy access to gloves, which could have helped stop the spread significantly. As of right now, at least 36 health workers in Liberia have died because they had nothing to clean their hands with when the moved on to the next patient. With all of our medical advances, we have forgotten that other countries have not necessarily caught up. But it wasn’t that long ago that America was under siege by disease. We’ve had the fortune of producing some of medicine’s greatest early innovators.

The Revolutionary War Against Disease

In 1721, Reverend Cotton Mather and Dr. Zabdiel Boylston introduced the first documented inoculation in Boston during the smallpox epidemic.  The vaccination was rather straightforward; patients were cut and a little “pox” was put into the cut. People could still die but the odds were better than if you had no protection. They found that after being vaccinated, people were sick for a couple of days but recovered more readily then if they had caught the disease.

During the American Revolution, George Washington had his troops inoculated which helped many of them survive and go on to win the American Revolution. George Washington found that when he inoculated his troops, only 1 in 50 died of the smallpox. Soldiers weren’t the only ones being inoculated; Abigail Adams inoculated her entire family. Without this medical technique, it is highly likely that we would have lost many more soldiers and might have lost to the Redcoats.

Vaccination has come a long way since the 1700s. It’s become widely accepted and much more efficient. In fact, it has led to the elimination of some diseases, including smallpox.

Germ Theory: Louis Pasteur, Robert Koch, and Joseph Lister

Between 1860 and 1864 Louis Pasteur studied nutrient broth (agar which is poured into a petri dish to solidify) and found that if the container that held it was sealed, nothing strange grew in the broth. However, if it was not sealed, living organisms would grow in the broth. Through this observation, he concluded that what affected the broth came from the outside. This disproved the theory of spontaneous generation and contributed to the idea that outside factors (in the air) could contribute to spoiling of food and the spread of diseases.

Pasteur also developed the concept of pasteurization to slow the spoiling of food and drinks. Pasteurization is heating liquids (or foods) to high temperatures and then quickly cooling it down before bottling it therefore allowing the liquid to remain fresher for a longer period of time. As a result of pasteurization you can buy milk and orange juice, among many other liquids. It also cuts down on the number of deadly pathogens that can be found in food and drinks. Another important figure in the development of germ theory was Robert Koch.

Robert Koch, a Germany physician, who founded modern bacteriology and finding the specific causes of tuberculosis, cholera, and anthrax. He contributed to germ theory by establishing four criteria to establish that a disease is created by a particular organism. He created a way to identify and study a disease by isolating the diseased organism, studying it, and then introducing it to a healthy organism to see what would happen.

The most important contribution came from Joseph Lister, a British surgeon. Between 1883 and 1897 he began the practice of sterilizing surgical instruments and making sure the dressing of the wound had been sterilized. He also introduced the concept of having surgeons wash their hands BEFORE and AFTER surgery in addition to wearing clean sterilized gloves!

Unfortunately, the major tenets of germ theory were not established before the American Civil War. Because of our poor understanding of sanitation practices, many additional lives were lost. We did not as a country clean surgical instruments before moving on to the next patient in the Civil War. A lot of men would have been saved if we had done this. The United States has access to some of the best health tools and facilities; most of which we take for granted. We take for granted the fact that hospitals are clean and sterile. A lot of countries and people wish they had the facilities we do.

What Can I Do

Reading about the spread of Ebola, you remember how simple things have made a huge difference. As a child I spent hours watching MASH; Glovesthey always yelled for gloves or alcohol to kill the germs. As a child, I did not appreciated what a relatively new concept sterilization was and how many lives it saved.

But if you do not have these tools, then what do you do? We take for granted some of the major medical breakthroughs that allow us to live longer. So do yourself a favor, wash your hands and maybe donate a box of gloves to Africa, it might save a couple of lives. Because sometimes it is the little things that have a big impact.

E-Cigarettes and Youth: Curbing Consumption (Part 2)

This year marks the 50th anniversary of the Surgeon General’s Reporting on Smoking and Health where the dangers of cigarette smoke wereCigarettes first revealed to the public. But despite 50 years of warning ads, anti-smoking campaigns and an ever-deepening understanding of the dangers of tobacco, smoking is still considered cool. Smoking kills about 480,000 people a year and is considered the single largest cause of preventable death in the United States. Earlier this week, I discussed whether or not e-cigarettes would curb or increase smoking. The data does not exist to answer this yet, but there is a more important question in the short term – Will e-cigarettes lead to an increase of youth smokers as a result of it looking cool, coming in fun flavors, and appearing to not have as many health risks?

E-Cigarettes and Youth

A survey from the Center for Disease Control and Prevention in 2012 found that about 10% of high school students had tried e-cigarettes; up from 5% in 2011. In addition, 7% of those who had tried e-cigarettes said they had never smoked a traditional cigarette.

Introducing children to smoking isn’t the only way e-cigarettes are hurting children. In 2013, there were 1,351 poison cases linked to e-liquid (the stuff in e-cigarettes). The number is expected to double in 2014. A fair number of these cases involved children – in Minnesota, over 1/3 of the cases in 2013 involved children 2 and under. E-liquid in its concentrated form is more dangerous than tobacco because it is consumed more quickly (like if you consumed mouthwash).

More concerning is the growing evidence that suggests e-cigarettes are targeting youth. A report that surveyed 8 major producers of e-cigarettes, including Altria and Green Smoke, found that major producers of e-cigarettes give away free samples at youth-oriented events and run radio and television advertisement during youth programing. Six of the eight said they had sponsored music and sporting event, and all eight companies said they had given away free samples. The survey also found that in 2012 and 2013 a total of 348 events featured sponsorship and/or free giveaway of e-cigarettes.

E-Cigarettes and Youth: A Study

Stanton A. Glantz, a professor of medicine at the University of California in San Francisco, conducted a study investigating middle school and high school student use of e-cigarettes. The study used federal survey data for 17,000 students in 2011 and about 22,000 students in 2012. Its results indicated that students who used e-cigarettes were more likely to smoke real cigarettes and less likely to quit smoking than those who did not. However, there was one notable problem with the study – the same students were not studied both years. Still, this information is concerning and suggests that e-cigarettes may do more harm than good, especially for the younger generations.


The Food and Drug Administration has announced that they will propose new rules for the tobacco and smoking industry, which will give them authority over not only cigarettes, but also e-cigarettes, pipe tobacco, and cigars. The new regulations ban the sale of e-cigarettes, cigars, and pipe tobacco to minors (anyone under 18). To ensure that the age limit is followed, people will have to show a photo ID. This means e-cigarettes will now join sharpies, white out, Nyquil, and mouth wash, all of which you must be 18 or older to purchase. In addition, the new rules would require producers of cigars and e-cigarettes to register with the F.D.A. and to provide the agency with a detail accounting of the product’s ingredients. Manufacturers would also be subject to F.D.A. inspections.

The new regulations do not ban any of the flavors of e-cigarettes or restrict the marketing of the product. But because these regulations move e-cigarettes under the smoking category, manufacturers will no longer be able to issue free samples and e-cigarettes will require a warning label about the addictiveness of nicotine. These rules will also crack down on vending machines selling e-cigarettes and ban internet sales.

The regulations are expected to take about a year to go into effect. However, lobbying groups will likely fight against the regulations and potentially delay or prevent the passage of these regulations.

Will this Regulation Protect Children?

As somebody who grew up in an age where in theory smoking ads did not explicitly target children, I still knew who the Marlboro Man was and could recognize Joel Camel. While these measures will stop children and youths from being directly targeted, the FDA can only do so much. I do not smoke but I know that smoking is still considered cool and even with data about the risk and years of regulation, that hasn’t changed and it isn’t likely to change now. Before we throw our support behind or against e-cigarettes it would benefit us to learn more about them and the side effects.

E-Cigarettes: A Solution for Smokers or a Bunch of Hot Air? (Part 1)

CigaretteOver the past couple of months I have seen more and more electronic cigarettes (e-cigarettes). For a non-smoker, I was curious about the health ramifications and how the FDA and other organizations treat e-cigarettes. Let’s be real, everyone knows smoking is bad for you, it kills about 480,000 people a year and is considered the single largest cause of preventable death in the United States. More Americans have died from smoking than all the wars America has fought. But despite all this, people smoke anyway. So why are people switching from cigarettes to e-cigarettes and are they better, worse or the same for you?

Electronic Cigarette

Electronic cigarettes, also known as personal vaporizers (PV) or electronic nicotine delivery systems (ENDS), are a battery powered device that produces a vapor instead of smoke. Some e-cigarettes contain a mixture of nicotine and flavorings, while others do not have nicotine. For those with nicotine, it is in a liquid that is heated to form a vapor (instead of smoke). In theory, e-cigarette allows the consumer to get nicotine and the sensation of bringing a cigarette to one’s mouth without the harmful substances like tar found in traditional cigarettes.

Originally e-cigarettes were disposable and looked like cigarettes. However, more and more of them are reusable gadgets that can be refilled with the liquid. The question is whether or not these will lead to the end of cigarettes or an increase in smoking?

Can E-Cigarettes End Smoking?

There are a couple of arguments and studies that suggest that e-cigarettes will potentially decrease the number of smokers. A team led by Riccardo Polosa in Italy studied 40 hardcore smokers. The study gave e-cigarettes to all participants. After six months, more than 50% of the participants had cut their regular consumption of traditional cigarettes by at least 50%. And almost 25% of the 40 people had stopped using regular cigarettes.

Another study from New Zealand found that after 6 months, about 7% of people given e-cigarettes had quit smoking, making it more effective than nicotine patches. In addition, Robert West, the director of tobacco studies at University College London, in response to an increase in people quitting, said, “It is impossible to know whether e-cigarettes drove the changes but we can certainly say they are not undermining quitting.”

Dr. Michael Siegel, a public health researcher at Boston University, argues that e-cigarettes could be the end of smoking in the United States. And Dr. Neal L. Benowitz, a professor of medicine at the University of California in San Francisco, says that, “nicotine may have some adverse health effects, but they are relatively minor”. Some people argue that nicotine is a lot like a caffeine addiction.

Or Will E-Cigarettes Make the Problem Worse?

Stanton A. Glantz, professor of medicine at the University of California, San Francisco, predicts that “the modern gadgetry will be a glittering gateway to the deadly, old-fashioned habit for children, and that adult smokers will stay hooked longer now that they can get a nicotine fix at their desks.” In addition, he argues that there is little evidence that people are switching from regular cigarettes to e-cigarettes, and if anything they allow people the opportunity to get a, “dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.” He also worries that smoking looks cool again. He’s got the fact that Julia Louis-Dreyfus and Leonardo DiCaprio used e-cigarettes at the Golden Globe Awards to back him up on that one.

According to David B. Abrams, executive director at Schroeder National Institute for Tobacco Research and Policy Studies at the Legacy Foundation, e-cigarettes, “need a little help to eclipse cigarettes, which are still the most satisfying and deadly product ever made.” But researchers worry that because e-cigarettes are so easy to acquire (they are sold on the internet) and come in appealing flavors (mango and watermelon) they will be attractive to both non-smokers and youth.

Risk of E-Cigarettes

Data has not truly caught up with e-cigarettes yet, since they have only been out on the market for about 7 years. However, studies analyzing their potential health effects are underway. Earlier this year a laboratory study reported that, “the nicotine-laced vapor generated by an electronic cigarette promoted the development of cancer in certain types of human cells much in the same way that tobacco smoke does.”   This data is based on preliminary findings – the study used specially treated human lung cells, not people. The researchers modified human lung cells to have genetic mutations that are correlated with an increased risk of cancer. They grew some of the cells in a liquid exposed for 4 hours to the vapor produced by e-cigarettes and grew other cells in a medium exposed to tobacco smoke. Both sets of cells exhibited changes that are normally associated with cancer. The team will be gathering more data before submitting their findings to a medical journal.

So What Does This Mean For Me?

Right now, people can smoke an e-cigarette anywhere (even right in front of you). The reality is that there is not enough data to support claims that e-cigarettes discourage or encourage smoking. There is also currently no data to support that e-cigarettes are less dangerous than traditional cigarettes or that they can cause cancer. There is simply not a lot that is known about them. The question of whether they are dangerous or safe will likely remain a hot issue while we wait for more solid evidence about the effects of e-cigarettes. It will be interesting to see where this technology goes and what will be the long term ramifications, if any, of e-cigarettes.

But What If There Isn’t A Generic Drug?

Stuck in the medicine aisle, wracked with indecision about which cold medication to buy? Although we complain about having too many Medicineoptions we have when choosing OTC medicine, having options is really a great thing. Tylenol might work for one person while Advil is better for another. And, of course, generic options keep costs down. But some pharmaceutical companies actively work to prevent options from being made available, to the detriment of the consumer.

Case Study: Asthma Medication

Ever wonder why your asthma inhaler looks different from time to time but yet the medicine is the same? Asthma medication is one of the best examples of pharmaceutical companies preventing generic drugs from entering the market. These companies are allowed to patent the inhaler model, so even though the medication in the inhaler hasn’t changed in roughly twenty years, the patent remains because they changed the inhaler shape. This successfully prevents generic inhalers from being introduced in the market. Pulmicort uses this technique setting the retail cost of their inhalers at $175. For reference, consider that in Britain patients receive the same medicine for free and the pharmacist only pays $20 for it.

But this patent trolling is limited to only brand name drug companies prevent competition right? Unfortunately, it looks like a Teva, a generic drug manufacturer, is using this same technique.

Teva Pharmaceutical and Copaxone

Teva Pharmaceutical is the world’s largest maker of generic drugs. They have been publically critical of brand name companies that try to block a generic drug from being produced. However, when it comes to Copaxone, a brand name drug that Teva Pharmaceutical manufactures, they sing a different tune.

Teva Pharmaceutical produces Copaxone, a drug used to reduce the frequency of multiple sclerosis (MS) attacks. Last year the drug had global sales of $4.3 billion, with $3.2 billion coming from the United States. Copaxone has been available for 17 years and is considered one of the best-selling treatments for MS. Over the last decade, MS drugs have almost quadrupled in price, raising the list price for Copaxone to $60,000 a year. According to Dr. John R. Corboy, co-director of the Rocky Mountain Multiple Sclerosis Center at the University of Colorado “the price would go up 10, 20, 30 percent at a time.” Luckily for patients, the patent for Copaxone is set to expire in late May. But Teva is fighting to prevent a generic drug from driving down prices.

In an attempt to protect the patent, Teva Pharmaceutical opened a lawsuit and in late March the U.S. Supreme Court agreed to hear the case. Teva has submitted multiple petitions to the Food and Drug Administration arguing that since Copaxone has such a complex makeup it is almost impossible to create a generic drug that is the same as the original.

In addition to pursuing a case in the court system, Teva Pharmaceutical has tried to find other methods to prevent losing their competitive edge. Currently, patients who use Copaxone must inject themselves every day with the drug, which of course is inconvenient for patients. Teva has created a more concentrated form of Copaxone that patients only need to inject three times a week. Although this is easier for patients, the new form of Copaxone is registered under a different patent, meaning the generic option is still years away. Unfortunately for patients, once they switch to new version of Copaxone, returning to the old one to purchase the cheaper generic option will be difficult.

It should be noted that the new Copaxone is cheaper than the older version. The new concentrated version is $4,641 a month compared to the older version which was $5,060. However, it is highly possible that a generic would be priced much lower than $4,641 a month.

A Generic Copaxone Alternative

Momenta Pharmaceuticals, and Natco Pharma have both submitted a generic version of the older Copaxone to the F.D.A. Both of these groups claim that their drug is just as viable and are confident that the F.D.A. will approve their drug; unless of course Teva gains the ability to expand its patent. Insurances companies want the generic drug to enter the market as well, as it will significantly drop their costs. Excellus BlueCross BlueShield in upstate New York is fighting back against Teva Pharmaceutical’s attempt to switch patients from the daily dose to the concentrated version. They are requiring that the switch be medically necessary and not just for convenience. They are hoping to outlast Teva so that they can switch their patients to a cheaper generic version.

What’s Best for the Patient?

GavelIt sounds like Teva Pharmaceutical losing their case is the best option – this means generic drugs will be introduced into the market reducing the cost for patients. But there’s another problem – the U.S. Supreme Court case Mutual Pharmaceutical Co v. Bartlett and in PLIVA Inc. v. Mensing ruled that a patient did not have the right to sue a generic drug company for any side effects that might occur, but are not listed on the label. If a patient suffers unlisted side effects from a brand name drug, they can successfully sue. If the generic drug is really as dangerous as Teva Pharmaceutical claims, than how many patients will experience severe side effects and be left with NO options simply because their insurance company forced them to take a generic drug?

Stand Up, Move, Trust Me: You Will Live Longer

ExerciseA while ago, I wrote a blog about the dangers of cutting school recess because it made it harder for kids to focus in class. A couple of studies found that exercising helps children remember and retain information better. However these benefits aren’t limited to children – exercise is good for adults as well. Not only will exercising help adults focus (like it does with children and students) but it can help you live longer even if your other risk factors are high.

Framingham Heart Study

The Framingham Heart Study, which began in 1948, tracked 5,200 adults living in Framingham and monitored their health and lifestyle. The study found that high blood pressure, cholesterol levels, obesity, age, gender, and smoking all influenced whether a person would develop a cardiovascular disease. This information was compiled to create the Framingham Risk score, which calculates the chance of an individual having a heart attack within the next 10 years. Low numbers are better than higher numbers. A women who has 9 points or less on the scale has less than a 1% chance, while for men it is 4 points. However, the Framingham score excluded one key factor: physical activity.

New Study: How Much Does Exercise Help?

Because most old studied did not factor in the effect of exercise, a new study was conducted to determine the relationship between exercise and an individual’s risk of cardiac disease. Researchers at Curtin University in Perth, Australia used data from 6,662 Australian men and women over the past 15 years. These volunteers (ages to 30 to 55 at the study’s beginning) submitted to cholesterol and blood pressure testing, waist circumference measurements, and a questionnaire about exercise. The questionnaire asked how many minutes they exercised, and whether the exercised had been easy or hard.

The researchers used these numbers to determine each volunteer’s Framingham Risk Score at the time of the initial study. They divided the group into three categories based on the frequency and intensity of the exercise. The highest category included people who had high Framingham score, the middle group had medium Framingham scores, and the last group had low Framingham scores. They then checked the names of the volunteers against the national death registry in Australia which list somebody’s cause of death, if known. In the intervening 15 years, 211 of the men and women had died of heart disease. Most of those who had died had high Framingham Risk Scores and had large waistlines. But in addition, those in the lowest category (those with low Framingham scores) had about twice the risk of dying from heart disease compare to those in the middle category. In addition, the lowest category was 6 more times likely to die than those in the highest category

Exercise did not help as much as a healthy cholesterol, blood pressure, and weight did, but still helped reduce people’s risk of dying from heart disease. The study found that, “someone with a high Framingham score who exercised had less risk of dying than someone with a similar score who did not.” The study found that those who walked often and at a respectable pace were more likely to be alive 15 years later than those who did little to no physical activity.

I Know Exercising is Good, But (Insert Excuse here)

Everyone knows exercise is good for you, but few people act on this knowledge. Finding time and motivation to exercise is hard. I suggest Excusefinding a friend that helps motivate you to exercise. I personally work out with a co-worker of mine during my lunch break. Also buying a dog helps you exercise as walking the dog is good for the dog and for you.

If you do not have a co-worker or cannot get a pet, I suggest trying to join a class. If you only have a couple of minutes, doing a few squats is one of the most effective exercises you can do in a short period of time.

Regardless of what you pick it should be something you like to help ensure you stick to it. And exercise can not only help you live longer and lose weight; it will help you focus more at work. When in the office, stand up, walk around and move a little bit; it will at least allow you to rest your eyes from staring at a computer screen all day. And hey, you might meet somebody new.

Skipping Sleep is NOT a Solution

SleepAmericans often complained about lack of sleep. While the United States may not be the worst offender when it comes to trading sleep for work, we definitely work long hours to our own detriment. As job pressures rise, especially in the current economic situation, many people feel they cannot say no when asked to put in extra work. Roughly 41 million people in the United States get six or fewer hours of sleep a night. Research shows that people should be averaging 7 to 8 hours a sleep a night.

In an earlier blog, I talked about the health ramifications of not getting enough sleep. Consistently being deprived of sleep makes you as impaired as when you are drunk. In addition, the University Of Pittsburgh School Of Medicine and a Japanese study that found a correlation between sleep deprivation and health. This included an increase of risk of cancer, cardiovascular diseases, and strokes, among many others. But there are even more potential costs tied up in too few z’s.

Sleep Helps Fight Depression

Recently on the Freakonomics podcast, Stephen D. Levitt and Stephen J. Dubner discussed the fact that there are more suicides a year in the United States than homicides. In 2009, there were 36,500 suicides and 16,500 homicides. The reasons that people commit suicide are very complicated but one of the main assumed reasons is depression.

Depression affects approximately 18 million Americans every year. More than half of all Americans who have depression also suffer from insomnia. For years, doctors have considered poor sleep to be a side effect of depression. However, a pilot study at Stanford in 2008 found evidence that insomnia can precede depression and in fact the relationship is bidirectional. In addition, several studies suggest that developing insomnia doubles a person chances of becoming depressed.

After the pilot study, the National Institute of Mental Health financed additional studies, one of which took place at Ryerson University in Toronto. The team at Ryerson found that curing insomnia in people with depression could double their chance of a full recovery. The study used an insomnia treatment that focused on talk therapy instead of drugs. The study found that 87% of patients who resolved their insomnia in four biweekly talk therapy sessions saw their depression symptoms disband after eight weeks of treatment. This was true for patients regardless of whether they were using an antidepressant drug or were part of the placebo group.

This study relied on a therapy called cognitive behavior therapy for insomnia (CBT-I). The therapist advises people to stick to a regular wake up time, get out of bed during waking periods, avoid reading, eating, or watching TV in bed, and to not nap during the day. It is designed to help people who feel they have to do something in order to get to sleep. Admittedly, the study was small with only 66 patients, but the results are promising.

It’s worth noting that not only will curing insomnia help people fight depression, it is also significantly cheaper for patients than anti-depression drugs. This means it may be a more cost-effective way to help the U.S. decrease its suicide rate. But there may be even more benefits from a better night’s sleep, that have to do with your risk of developing Alzheimer’s disease.

Sleep Can Help Me NOT get Alzheimer’s?!

A new study from Maiken Nedergaard, a neurosurgeon at the University of Rochester, found that when mice are asleep the cleanup system of the brain – which flushes out toxic waste produced by cells – goes into overdrive. Not only does that part of the brain function faster, but the cells even shrink in size to make it easier to clean out the system. One of the products that the brain gets rid of during this time is beta-amyloid proteins, which can clump and form the plaques found in Alzheimer’s patients. Rats deprived of sleep die within a week.

Nedergaard found that the glymphatic system drains waste from the brain. It does this by, “circulating cerebrospinal fluid throughout the brain tissue and flushing any resulting waste into the bloodstream, which then carries it to the liver for detoxification.” To study the effects of sleep they tagged the fluid with a fluorescent dye. During sleep the fluid increased the space between cells by 60% which allows the flow and speed to increase. However, when the mouse was awake, flow in the glymphatic system was limited. The study also found that harmful beta-amyloid protein can be purged from a sleeping brain twice as fast.

Nedergaard is working on an MRI diagnostic test for the glymphatic system and hopes that it might be possible to create a drug that could force the brain to clean out the system. While still is still a few years away, there are some ways you can improve your sleep in the short term.

Can I Track My Sleep?

Tracking your sleep will allow you to know how much sleep you are actually getting and how well you are sleeping. There are currently many apps and tools that you can use to track your sleep. Although they are not always the most reliable they are still pretty decent in determining approximately how much sleep you are or are not getting. Currently Fitbit, Sleepbot, Sleep Cycle, Jawbone UP, Aura sleep system, Beddit, SleepRate, and Basis track how well people are sleeping. They work in various different ways, some of them worn on the wrist, some are placed under the bed sheet, and some use cognitive behavior therapy. Even though none of these devices are perfect it would still be beneficial to get a more accurate reading of how much sleep you are getting. You might not be getting as much as you think.

Trade Offs

There are always trade-offs and the best laid plans frequently don’t work out as hopped, but when contemplating one more chapter in your book or another episode of your favorite show, you might want to opt for a bit more sleep instead. Your brain will thank you!

Faster is Better Right?

HospitalFor years American society has functioned under the mentality that doing things quickly is the goal. If you do your work fast then it must be good and you must be smart. But faster doesn’t always mean better. We have forgotten the age old story of the Tortoise and the Hare – speed does not guarantee success. A recent study on angioplasty offers an excellent case study in this attitude.

Acute Heart Attacks

The common consensus among hospitals and doctors is that rapid treatment of an acute heart attack increases the likelihood of a patient’s survival. The preferred procedure for patient’s having a heart attack is an angioplasty, a process that uses tiny balloons and stents (wire-mesh cylinders) to open up blockages in the arteries connected to the heart. The period of time between the patient’s arrival and the inflation of the balloons is known as “door to balloon” (D2B). The standard goal is for D2B to take no more than 90 minutes. Hospitals strive to lower the number as much as possible which results in a current average time of about 67 minutes.

But a shorter D2B time may not actually improve patient mortality rates.

The D2B Time Study

A team of experts, headed by Daniel S. Menees M.D., recently published a paper called Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI in The New England Journal of Medicine (PCI is Primary Percutaneous Coronary Intervention). The study used historical data from the CathPCI Registry of the National Cardiovascular Data Registry (NCDR), which collects data from more than 1,400 hospitals across the U.S. This studied examined the correlation between in-hospital mortality and D2B time for July 2005 through June 2009; this was ideal because during this time there was a national effort to reduce Door to Balloon time.

The study consisted of 95,007 patients. The average age of the patient was 60.8 with 20% of the patients being female. Out of the 95,007 patients 61% had hypertension, 59.2% had dyslipidemia, and 43.3% were current smokers. To control for D2B time, the study excluded patients who had been transferred from other facilities, patients who were undergoing non-emergency PCI, and patients who had D2B that were longer than 3 hours.

The study found that the median door-to-balloon time decreased each year. In 2005-2006 the average time was 83 minutes but fell to 67 minutes by 2008-2009. However the mortality rate was not significantly affected. The unadjusted (before taking out variables for the NCDR model and the patients that were excluded from the study) in-hospital mortality started at 4.8% in 2005 and in 2009 it was only at 4.7%. The unadjusted mortality rate was lower for patients who had a D2B time of 90 minutes or less (3.7%) versus those who had a longer than 90 minute time period (7.3%). However, the unadjusted mortality rate for patients who had a door-to-balloon time of 90 minutes or less remained constant at around 3.7% for the time of the study. This can be seen in the chart below. As long as the D2B time is less than 90 minutes there does not seem to be any improvement.

D2B Time

Why Isn’t a Shorter D2B Time Better?

There could be multiple reasons why decreasing Door-To-Balloon time does not seem to result in a decrease in mortality. One of which is that a retrospective study cannot provide truly meaningful insight because of its observational nature. It is also possible that currently cardiology has reached its limit. There is no way to account for how long a patient might have waited before going to a hospital. And of course sometimes angioplasties are not effective and it does not matter how long it took to inflate the balloon.

However, it should be clear that a D2B time longer than 90 minutes did have an impact on mortality rate. The study only found that there is little improvement with a D2B of less than 90 minutes. So it does not seem to matter if a patient has a D2B of 54 minutes versus 89 minutes. Regardless of external factors, this study should at least have us question the mentality that speed is our focus metric. Speed is not everything and does not guarantee better care or healthier patients.

Private or Corporate: Doctors Make the Choice

There are many advantages to starting or working at a private practice in the medical profession. Running a private practice allows you to setOlder Physician your own schedule, take vacations when you want (within reason), and focus on the type of care you are most interested in. However, like with all entrepreneurial endeavors, there are certain risks involved. There is no guarantee that your practice will be successful and profitable. And success depends on more than your medical skills. Medical school doesn’t offer opportunities to learn finance, accounting, economics, and other business skills that are beneficial for running a medical practice. Although working for a hospital might not provide as much flexibility, it does potentially provide more stability. The choice ultimately comes down to what is best for you.

The Numbers

According to the American Medical Association, 60% of family doctors and pediatricians, 50% of surgeons, and 25% of surgical subspecialists work for hospitals and corporations. 64% of the jobs filled in 2013 by Merritt Hawkins, a leading physician placement firm, were with hospitals; this figure rose dramatically from 2004, when only 11% of jobs filled were for hospitals. Merritt Hawkins expects this number to rise to 75% in the next two year; anticipating that close to 75% of new medical jobs will be with corporations and not small entrepreneurs.

Trade Offs for Doctors

Employed physicians income is partly based on how much revenue for the hospital they can generate. around $200,000 in primary care, $575,000 in cardiology, and $663,000 in neurosurgery. Dr. Cathleen London, who has practiced family medicine for 13 years outside of Boston, recently took a salary job in Manhattan. Although it is a pay cut, she said she was losing business and ground in her private practice. By joining a hospital, doctors no longer have to worry about the challenges of running an independent group, like paying malpractice premiums or finding health insurance for themselves and their staff.

The tradeoff is that doctors take a pay cut to gain stability and other additional benefits, but lose the flexibility and benefits of being their own boss.

How Does this Affect Patients?

You might think it would be cheaper for a patient if the doctor is located at the hospital.   And sometimes this is true, as can be seen in the Kaiser System (California) and Intermountain Healthcare (Utah). However the increased number of providers working for hospitals may not be better for patients.

For patients, working with hospital-based providers makes it easier for patients to find different types of doctors in one location. It also has the potential to simplify communication amongst different types of doctors which could enhance the overall patient’s care. If doctors can more easily communicate with each other, then less critical details are lost in the patient shuffle. However, there are some serious disadvantages to this happening as well. Some hospitals encourage doctors to run tests and procedures that may not benefit the patient to drive revenue. As a result, some insurance companies have pushed back by only paying an all-inclusive payment for each patient regardless of how many test or procedures are performed. Patients face a narrowing choice of physician options as big conglomerates take over and combine with other hospitals and doctors.

How Can Doctors Reduce the Risks of Private Practice?

While private practices carry more risk for providers than working for a hospital, there are ways to mitigate the danger. One of the easiest ways to simplify the challenge of managing a private practice is to apply technological solutions to reduce the amount of work required of an administrator. Another way to make working for or managing a private practice easier is to hire a practice management company to oversee the business side of your practice.

MediMobile offers a complete practice management solution, from our mobile charge capture tool to our office management to our medical billing. We have helped practices, hospitals and individual providers earn more and reduce administrative busywork. If you want to learn more about our solution, request a free practice revenue consultation!


These risk are not new. Entrepreneurs in general always face the risk of unpredictability and instability; that is part of being in business for oneself. There are always tradeoffs. Whether what is best for the doctors is also what is best for the patients remains to be seen.

Medical Discovery: There is a New Body Part!

KneeAs a person who has hurt her knees, I can testify to how painful such injuries can be. Like many other people, I have avoided knee surgery for years. This was partly because I did not want to get nailed on insurance by a pre-existing medical condition, but also because most knee surgery leaves you with a huge, nasty scar. An estimated 1 million people in the world have knee surgery every year. As more and more people plays sports, sometimes playing while already injured (I personally made this mistake), the number of serious injuries has increased. Coaches (in theory) are not supposed to let you play injured, but unfortunately this does happen. However, in light of new discoveries, it turns out that it might be a good thing that I put off knee surgery.

Knee Injuries

Currently there are an estimated 150,000 injuries a year to the ACL joint, which connects the tibia and femur and stabilizes the knee. This ligament is prone to tearing if the knee moves sideways during awkward landings or abrupt shift in directions. Sudden hard stops and quick shifts in landing and movements are common in basketball, football, soccer, volleyball, and skiing.   With knee injuries growing among student athletes, we are in need of a better treatment or a way to prevent knee injuries. Unfortunately, ACL surgeries do not always fix knee injuries. A new discovery might be one of the reasons why ACL surgeries are sometimes ineffective.

New Ligament in the Knee

Dr. Steven Claes and Professor Dr. John Bellemans, both from the University of Hospital Leuven, have found a new ligament in the knee. They have been searching for four years to understand why some patients who have had their ACL repaired still experience pivotal shifts (where the joint gives way) during physical activity.

The answer to this problem actually lies in the past. In 1879, a French surgeon theorized that there might be an extra ligament in the anterior part of the knee. Dr. Claes and Bellemans confirmed this hypothesis. They found that 97% of humans have an anterolateral ligament (ALL) in addition to their ACL.

Addressing Knee Injuries

Researchers have developed a neuromuscular training which uses a series of exercises that help teach athletes how to cut, land, shift direction, and in general move in an attempt to lower the risk of knee injuries. However few schools have implemented this programs.

Although this is promising news for people with knee injuries, or for whom knee surgery was only moderately effective, there is still a long way to go to fix the problem. Helping people with knee injuries to the ALL is still a long way off. However, before you get surgery on your ACL you might want to get a second opinion and make sure it isn’t your ALL that has been injured instead.

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