April 6, 2012

A Few Tidbits from Medical Blogs

Many topics come across my computer screen and many times, I just read and forget about them. However, lately they have become more interesting and a few are worth blogging about.

The first short article really got my attention. Having diabetes and having much information shoved at me in a “one-size-fits-all” mantra by the ADA, AADE, and many other medical professions, this article makes me very happy. John Goodman titles his blog “Why One-Size-Fits-All-Medicine Doesn’t Work.”

The second short article is about healthcare acronyms. I actually laughed about the dilemma that doctors have with some acronyms. Just this short article was interesting by itself, but the reference link at the end is really what I want to emphasize. Do not be in a hurry to skim over it as it is a 51-page PDF file, and loaded with information. I have not yet read it all, but I will be later as there is a lot to digest, includes some very handy graphs, and charts.

The third blog is about generic insulins. Don't get excited. Apparently this will not be likely to happen under current FDA regulations. Too many hoops to jump through and Big Pharma is working hard to keep this from happening. Still, it does add to the problems people with diabetes will continue to face and the budget will not get relief soon.

The fourth and final item for this blog is about adding nurse practitioners to a doctor's office. In some states this is already working where there are not enough doctors to meet the demand. Still, this may have drawbacks unless the mindset of doctors is changed, states legislate this as a possibility, and nursing education is upgraded in some states.

April 5, 2012

Researchers Do Make Up Desired Results

Every once in a while studies like this come along that makes a person wonder about all studies. The disclosure in this blog on John Goodman's Health Care Blog is very interesting. The blog title is “When Data Don’t Cooperate, Make Up the Answer You Want” and the researchers did just that.

I will let you read the blog and comments and follow the link to the abstract and full text to get the full picture. I have to wonder what other studies I have been reading about fat, sodium, sugar, and statins, have fabricated results. We all know that some researchers have agendas, but the question is how far are they willing to go and completely ruin their reputation. Or do they not care?

This is just another clue about our medical researchers and their behavior. In looking back over some studies I have not blogged about, I realize how easy this may be accomplished with observational studies. Often you can tell when there is an agenda, but sometimes they do hide the agenda and make you think they actually can conclude what they “discovered.” This is not what we need to retain confidence in our medical research, or nutrition research.

April 4, 2012

What Are Friends For When Diabetes Is in the Mix?

In the group of us that meet to discuss diabetes, most of us are (6 of 8) on insulin. The latest addition to our group asked why we were testing so often. We had answered many of his questions before, but this time we knew he was fishing for a different answer. I asked Allen about the purpose behind the question this time. He stated that two in his group were only testing infrequently and generally just before they were to have their A1c test.

We knew that they are allowed two test strips per day, and asked if he knew if they were using them all within a few days. He said he was not sure what was happening. I ask Allen how many were eligible for Veterans benefits and he stated all of them. We found out that only Allen was actually receiving VA medical benefits. The rest were a question mark and he was not sure why they were not receiving benefits. I knew what Allen and I were going to be doing. I told Allen to find out where they had their DD 214 forms and we would accompany them to the local VA office.

In the process, we contacted Sue to help her brother. Sue said she was sure her brother was already on the VA roles, but that she would check and find out what was happening. I asked her to let us know as soon as she could. The next day, she called me and said he was, but for two years had not submitted a means test and he was denied benefits. She also stated something that would interest all of us. Her brother was slowly losing his eyesight and his last A1c had been above 9.0. Sue would not say exactly what it was, but the cause of her brother’s depression was now known. Sue was sure that we were on the right track in getting him reestablished with the VA.

I asked if she would help and she asked what she could do. I explained what should be needed and gave her the telephone number of the VA office where she could check what may be needed to get her brother back under VA benefits. She then asked if anyone would be able to help with her brother and I said I would talk to Allen and he would talk to the other two who had assisted him. She said that would be okay and appreciated if they would contact her.

A couple of days later, Sue contacted me and said she had the information needed to get her brother reinstated for VA benefits. She stated Allen was to accompany her to the VA office after she, her brother, and Allen had been to the attorney's office. Sue said that her middle brother (also with type 2 diabetes) was in the process of moving back and would help in the future. They were going to the Attorney's office to have a general power of attorney executed for her and her middle brother and a medical power of attorney for them also with Allen on the medical power for times when the other family members were unavailable.

I expressed my support for what was being done and hoped that everyone in that group would soon be able to have VA benefits and this should lessen the hardship they were feeling. Sue said that she was also going to work with the other group to encourage regular and more testing. She did state that her eldest brother was now on insulin and they both would be sitting in when possible with our group since so many were on insulin. I said that would be great as there is a lot to be learned.

The experiences of the last couple of weeks have been good for all of us and we have all learned from the depression and testing problems. We have been doing a volume of research to know what we need to discuss and answer questions about for Sue and her eldest brother. We are all waiting to meet her second brother.

Allen did say that the VA applications have been filed for everyone now and it is just a waiting game.

Please understand that the names are not their real names and done only to make reference easier to follow. This is the agreement with my fellow members of the group and I will abide by their wishes.

April 3, 2012

Another Reason for Not Diagnosing Based on A1c

Ever since the American Diabetes Association made the recommendation of using the A1c for diagnosing diabetes and prediabetes, more studies are showing this to be a questionable decision. One study that I had found in the past is no longer available as when I click on the link the message I get is “page not found.” Apparently, there were some reasons for the study to have been pulled.

The A1c has been proven ineffective for use on people undergoing dialysis. This is not done for diagnosis, but should cast some serious doubts on the reliability of the A1c test for all tests. There is still a lot of discussion that for non-whites, the test is not an accurate reflection as it is for white Anglo-Saxons. Some are openly stating that the A1c test needs to be standardized for each ethnic group.

This makes sense as each ethnic group can be very different and react to medications differently. My own wife reacts very differently to medications that do not create problems for me.

Now we learn that another study proclaiming that the A1c cannot be used for diagnosis on people with iron-deficiency anemia. This study does come out of India, but highlights a very real problem in populations that are iron-deficient. Iron-deficiency increases erythrocyte survival. This elevates HbA1c concentrations at a glycemic level disproportionately.

This in turn gives a diagnosis of prediabetes or diabetes when in fact neither may be the case or prediabetes may be the correct diagnosis. The study clearly points out the problems for nutritionally compromised populations, in other words, more than half of the world's population.

April 2, 2012

Most Adverse Events in Hospitals Go Unreported

I am not sure how to react to this report. Yes, I believe the study and I am surprised it is not more of a horror story. Having experienced a few incidents first hand which I doubt were reported, anything is possible. Some hospitals are indeed better than others are, but I believe this comes from the top down. If the head of the hospital is conscientious and concerned, generally he will employ physicians and nursing staff that are concerned. Anyone can hire a bad apple, but it is the hospital administrator that sets the tone. In some cases, it is the hospital board of directors that establishes the standards.

The study reports that about 86 percent of patient mishaps in hospitals go unreported and are not entered into any incident database. Whether better reporting will improve the quality of care or patient safety remains to be seen. A big surprise in a way is that 62 percent of adverse and “temporary harm” events that were not reported were believed not reportable by hospital staff.

The Office of Inspector General (OIG) in the US Department of Health and Human Services (HHS) recommends that the Centers for Medicare and Medicaid Services (CMS) collaborate with the federal Agency for Healthcare Research and Quality and develop a master list of potentially reportable events. Then hospitals and other healthcare providers could use this list to eliminate any confusion. Presently, the three organizations that accredit hospitals - the Joint Commission, the American Osteopathic Association, and Det Norske Veritas Healthcare — do not have standardized lists of reportable patient incidents.

I seriously wonder if there will be any changes made, as you have to think that hospitals will continue on the present path. If nothing more than to minimize lawsuits, they will resist reporting adverse events. With hospitals now employing many doctors, they will continue to be profit motivated to a fault and to avoid legal problems. Nurses will continue to be dismissed when they do their job and counsel patients to the detriment of potential profits.

You may read the study here and the situation about the nurse here.