Friday Tidbits 05-18-12

Well, finally the American Medical Association decided they did not want this hung on their neck. I am talking about the over-the-counter medications the FDA is considering. Until recently, the AMA has been silent and it appeared that they were in favor of this happening. Apparently, there has been an up swell from within the ranks causing the AMA president to take an official stand.

Recently, Peter W. Carmel, president of the AMA published an article in USA Today and then repeated it in The Health Care Blog on May 13, 2012. Better late than never is apparently the motto of the AMA. Yet even this may not be enough as more in the medical community are speaking out against the FDA actions, both officially and in the news media and written word on the internet.

The next item that may interest you is a blog also on The Health Care Blog about our poor healthcare science status. Marya Zilberberg, MD wrote the article and has her own medical blog here. Dr. Zilberberg is not afraid of telling it like it is. She pulls together several blogs sources of good information; follow her links for additional good reading.

Dr. Zilberberg is refreshing in her analysis of “fast science.” She describes some of the problems science, especially medical science faces today. According to her, fast science is the reason people will not publish a second study that backs up a study that confirms a previous study and in many cases the funding dries up once something is proven. She sees a problem with the current trend of reputations and profits being the driving force behind the studies of today. This race to the finish line is ruining science and leaving much out of medical science that affects the clinical value.

She has no immediate answers, but knows that the future of medical use for clinicians is being damaged. She wishes “fast science” would slow down and become more valuable and maybe profitable in another way so that clinicians would find more value in it.

In my blog here, I covered some of the problems about studies not being published and Tom Ross covered the topic of false or as he says it, “bullshit” studies that cannot be replicated. This is some of the “fast science” that is causing many of the problems of today.

The third topic is about unpublished studies. It takes a slightly different tact than the one in my blog link above. It does list the same website for clinicaltrials dot gov. Unpublished trials are becoming a real problem and it is small wonder that doctors are complaining about missing information that could be vital in the treatment of patients.

The last item is about HSAs (health savings accounts) and if you have one, be prepared to have it invalidated. Three separate provisions in the new healthcare law plus its regulations will reduce access the HSA plans. The current healthcare law contains restrictions on deductibles and cost sharing. The medical loss ratio will also impose new restrictions on HSA plans and some cash contributions made under the new law will mean that the plan no longer qualifies as government approved. Read about the new snags that may make your HSA plan invalid.

Diabetes Patients Benefit From Naturopathic Care

When I read this study, I knew my inbox was going to be full of emails about “see naturopathic care works.” Some were polite and just asked me to read this and a few were proclaiming their wares and few were not so pleasant in their language. If this study was not so small, and an obvious attempt to get more funding, it could have been more interesting.

The other part that I must point out is that conventional medicine was part of the study and patients continued to take their medications. There was not any control groups so that comparisons could be made. For those that still believe that their naturopathic ways cure diabetes, I think you need to reread this study and understand that the two disciplines, conventional medicine and naturopathic practices, worked together to achieve the results. The largest flaw in the study is that it was an observational study, which could distort the figures any way desired.

If there was true collaboration between conventional medicine and naturopathic medicine, I say this could become valuable when the correct types of studies are done using this method. I will continue to denounce situations as I did in this blog, when patients throw conventional medicine out because they believe there is a cure. Seeking only alternative medicine is not the answer.

The other sticking point is when patients do not list the alternative medicines and supplements because they are “natural”, and their doctor has no need to know. Many patients may not have problems with this until they need certain prescription medications that conflict with these supplements and several can cause severe health problems and even death. Some supplements may even mask certain health conditions and prevent the proper treatment.

At the same time, I will denounce doctors that are so full of themselves that they will not recognize supplements, herbal medicines, and naturopathic medicines. These doctors often belittle a patient for mentioning these, and some doctors even bully their patients to stop taking them. When this happens, patients should do themselves and their health a favor and seek out another doctor. It is sad that these doctors cut off lines of communication that affect the health of their patients.

There can be advantages when doctors of all types of medicine work together, but too often each type of medicine thinks they have the only solution. When the whole patient is treated, and not just the disease, more patients will have greater health benefits. Many doctors of all medicine types do not treat the mind-body-soul part of the patient.

Metformin – Is This First Line Medicine Safe?

This is the substance of an article published in the April issue of Diabetes Care. The title they use is “Diabetes Prevention With Metformin Is Safe, Well-Tolerated.” In essence this is correct, but only when other vital information is added which is absent from the details of this study. A pharmacist friend very kindly pointed this out to me in an email.

She stated, “Metformin can for many (but not all) individuals cause a Vitamin B12 deficiency. Unless they consume foods high in Vitamin B12, most people will end up having this deficiency in long-term Metformin use.” Even my own endocrinologist suggested adding a Vitamin B12 supplement to my regimen while on Metformin. I am thankful I listened to her. I was not Vitamin B12 deficient, but I was at the low point in the recommended range.

Based on my experience, I would suggest anyone taking Metformin (glucophage) talk with their doctor about having the Vitamin B12 test done to establish a baseline and a discussion about adding Vitamin B12 at some point. I repeat, this should include anyone taking or adding metformin to their medication regimen. This is one area that I now feel strongly enough about to repeatedly urge people taking metformin to have the vitamin B12 test done. 

A little background into the symptoms of vitamin B12 deficiency shows they are the classic fatigue and anemia. Most doctors will not do this test, “because the 'Standard of Care' is to ONLY do Vitamin B12 Testing if a patient has a condition called Macrocytic Anemia- where red blood cells become large and shows up as a high number on the MCV Blood Test that is part of a Complete Blood Count. This is somewhat arbitrary and stops many tests that could prevent severe vitamin B12 deficiency.

This article from WebMD dated June 8, 2009 is the article my pharmacist friend suggested that I read. Yes, it is a very convincing argument for being screened for vitamin B12 deficiency. In the study, 40 percent of type 2 diabetes patients using metformin had vitamin B12 deficiency or were in the low-normal range for vitamin B12. Of 77 percent of metformin users with vitamin B12 deficiency also had peripheral neuropathy. This is a common nerve damage complication associated with type 2 diabetes.

Peripheral neuropathy is a major complication of diabetes, as such, the researchers suggest that people using metformin be screened for vitamin B12 deficiency or supplemented with vitamin B12. They further stated that anyone already diagnosed with peripheral neuropathy that uses metformin should be screened for vitamin B12 deficiency.

Vitamin Deficiency Anemia

Since Allen ended up on the deficient side for Vitamin B12, we have been doing a lot of research about the signs, symptoms, and causes. We have found quite a bit of information. First, from the Mayo Clinic is their article on vitamin deficiency anemia, which covers the tests Allen was fortunate that the doctor did do. He was at the low point on folate, very low on vitamin B-12, and low normal range for vitamin C.

The doctor did tell him to add a daily men’s supplement to his regimen and make sure that he added a vitamin C to his regimen. The doctor told him that the prescription levels of vitamin D and vitamin B12 would be for a month only and then he should purchase the supplements in any store and set the lower limit at the level he ordered until the completion of the next tests. Allen commented that this was good to know and that he was surprised that the doctor was concerned about his supplements. Both Tim and I said that was a good thing and that he would probably continue to test for these until his body maintained them in the recommended range.

We did discuss this and three of our members said they were going to ask their doctor to run the same tests. We also pulled up several listings of what foods were high in the vitamins and some minerals. Allen now has his license back and feeling much more active. He did decide to use insulin after we presented him with several articles and did a lot of discussion. He did ask if he might be able to drop back to oral medications and we all agreed that could be a goal if he wanted it, but that may not be what he needs for the long term.

After we covered many of the myths about insulin, even Ben admitted that his blood glucose management was so much better; he doubted he would consider going back to oral medications. Ben also has decided to change doctors so that he could be tested for vitamin shortages. We all have been reading about vitamin B12 and several things we could do. Vitamin B12 deficiency is a risk for neuropathy, and several other health problems.

Since the Mayo Clinic article lists the signs and symptoms of vitamin deficiency anemia, we decided to study the article with care. They list the following signs and symptoms:

• Fatigue
• Shortness of breath
• Dizziness
• Pale or yellowish skin
• Swollen tongue that may appear dark red
• Weight loss
• Diarrhea
• Numbness or tingling in your hands and feet
• Muscle weakness
• Irritability
• Unsteady movements
• Mental confusion or forgetfulness

All of us could recognize something in the list that fits us and so the discussion would continue. Everyone agreed that if their doctor would not test them for the same tests that Allen had, they would be changing doctors. Ben is back with the VA and he and Allen both have had their appointments scheduled. Allen is happy since this will help get his insulin much cheaper and they have moved his appointment up to the middle of May. Even Barry is now set up for an appointment locally after his move and his records are now here.

We discussed vitamin B12 foods that would help prevent the deficiency. Most were not aware that much of the vitamin B12 needed could be obtained from eggs, milk, cheese, yogurt, red and white meats, shellfish, and some fortified foods. This was a discussion that opened some eyes and at the same time led to a discussion of low cholesterol and low fat. Tim took over in this discussion about the importance of lower levels of carbohydrates, medium protein and fat since there was much resistance to higher cholesterol and fat.

Brenda did surprise us when she spoke up and said Tim was right and that she had been following this food regimen for several years and her tests showed that the food ratio of carbohydrates, protein, and fat of 20 percent: 30 percent, 50 percent had not caused her test results to increase and that she was actually having better test results and had lost a few pounds. She said she would provide the test information to anyone needing confirm this. She continued by saying that her sister, a nutritionist, had worked with her for the last five years and could also discuss this with anyone needing guidance.

This took a lot of the argument out of the discussion and we moved on to other causes of vitamin B12 deficiency. We pulled up the article by the Mayo Clinic and since no one has had gastric bypass surgery, Crohn's disease or celiac disease, or other problems that interfere with absorption of the vitamin B12, we moved to discussion of the intrinsic factor as vitamin B-12 deficiency is most often due to a lack of this substance.

Intrinsic factor is a protein secreted by the stomach that joins vitamin B-12 in the stomach and escorts it through the small intestine to be absorbed by your bloodstream. Without intrinsic factor, vitamin B-12 cannot be absorbed and leaves your body as waste. Lack of intrinsic factor may be due to an autoimmune reaction, in which your immune system mistakenly attacks the stomach cells that produce it. Vitamin B-12 deficiency anemia caused by a lack of intrinsic factor is called pernicious anemia.

Vitamin B12 is important not only for the production of red blood cells, but also for a healthy nervous system. Vitamin B12 deficiency can lead to neurological problems in neuropathy, mental confusion and forgetfulness. This tells us how important vitamin B12 is for healthy brain function.

Allen joked that he did not want to be the cause of all this learning, but felt that our insistence of his being tested had helped all of us and he had learned a great lesson about nutrition.

We agreed that we may have found a good article to use as our center of discussion, but that we all had learned and needed to learn more. I thanked Tim and Brenda for leading much of the discussion. Brenda said that was why she wanted to be part of this discussion as this was what she had gone through several years ago and realized we were serious about discussing it. She knew some things had changed and she wanted to learn more if possible and she had.

We also gave this article to everyone for reading. It is from WebMD and is very specific to vitamin B12 deficiency.

LCHF Diet Proving Naysayers Wrong

This could be one of the studies you want to shout “Extra, Extra, Read All About It!” It is a good thought, but for a small study with no controls, there is no way you can proclaim it worthy of shouting it from the roof tops. It is worthy of a mention and a hope that others will decide to take up the mantle and once and for all prove that saturated fat is good for us.

Ever since 1953, when a physiologist named Ancel Keys, Ph.D., stated that fat was not good for us and rigged the results of his study, slowly people are disproving this to be true and showing that saturated fat actually helps heart health. The medical establishment has carte blanche accepted Keys and still pronounces it as fact.

This is the reason studies of this type are not funded in the USA. At least Sweden has a small study we can at least point to and acknowledge. Many of us with type 2 diabetes know this is correct and can say with certainty that we believe the study, though small is correct. I am surprised that it even was published in the US.

The study is a two year dietary study at Linkoping University in Sweden and 61 participants were randomized into two groups. One group followed a low carbohydrate high fat diet and the other group a high carbohydrate low fat diet. Both groups lost approximately nine pounds. Since I am not able to find a conversion table for the blood glucose levels, I will have to assume they are correct.

The important fact that needs attention is that in the high fat diet, lipoproteins levels did not get worse. Instead, HDL (the good cholesterol) actually increased. In the low fat group, neither the blood glucose nor lipoproteins showed any improvement.

For the follow-up study, all 61 participants stayed in the study. This means or should indicate that the quality of the data is more dependable than most studies. How many more years are we going to have to wait to see the results of a larger study that can give further validity to this? Won't happen in the USA.

Watch What Hospitals Do With MRSA

This is not unexpected. What was called MRSA for infections acquired by patients while in the hospital has now been termed HAIs (hospital acquired infections). I like the title given to the article in Medscape, “Medicare Reimbursement Change Spurs Prevention, Work-Arounds.” Work-arounds is what we can expect from hospitals so that they will be reimbursed for something Medicare has deemed non-reimbursable.

Approximately half of the hospitals participating in a report published in the May issue of the American Journal of Infection Control increased their attention of how such infections (HAIs) were coded for billing. Instead of doing increasing measurers to prevent HAIs, coding for other billable infections was where they paid attention. It is no wonder that people are concerned about hospital safety since the hospitals care only about the profits they can accumulate.

I quote from the article, “"Our findings were generally positive, suggesting the policies have led not only to an enhanced focus on targeted HAIs with greater efforts toward surveillance and education but also to changes in practice from front-line staff as reported by infection preventionists," the authors write.

However, the results also include persuasive evidence of hospitals "gaming the system," according to Peter Pronovost, MD, PhD, director of the Armstrong Institute for Patient Safety and Quality and Johns Hopkins Medicine Senior Vice President for Patient Safety and Quality, Baltimore, Maryland.”

It is disturbing as a patient to see statements like “gaming the system.” This means that the coding is apparently working for them to obtain reimbursements they would otherwise be denied by Medicare. Read the article here.

I will now get into another even more disturbing aspect that this causing. I had intended on writing about this from another perspective. However, this does explain why the hospitals have through the American Hospital Association, sent a formal letter to the Centers for Medicare and Medicaid Services asking that delays be granted in meeting the “Meaningful Use” criteria that is scheduled to begin later this year.

The “Meaningful Use” came into existence as apart of a government program (the American Recovery and Reinvestment Act of 2009 (ARRA)) in which billions of dollars were set aside to aid medical providers shift from paper records to electronic records. When the providers could prove they had reached certain stages of meaningful use, they would receive reimbursement from the government to cover the expense of implementation.

During stage one of meaningful use providers needed to demonstrate that an interface was in place so patients could access their own medical records, via the internet, securely and privately. For hospitals, that access needed to be provided within four days of a patient's discharge. Read the AHA communication here in a PDF file. (Adobe Reader required)

Now that it is almost ready for stage two (starts Jan 2013), patients have asked for quicker access, meaning within at least 24 hours for theirs, their spouses, or their childrens records. We want to know what took happened, with whom, and how it happened. This is important if post discharge problems occur and we want to discern where the problems may have arisen from and who may be responsible. However, the American Hospital Association if attempting to delay these provisions and has asked for a 30 day limit for patient access. The AHA also wants three years to each stage instead of the two years currently mandated.

Fortunately, it is easy to figure out why they want the 30 day window. They want the extra time to “doctor” the records to “game the system”, prevent things from being available to the patients, and thus their lawyers, for events that should have been reported, but weren't. They need time to hide these and more. Yes, the hospitals are nefarious for misdirection and covering up what should have been reported. This is why when you are hospitalized, if you are able, record everything, or have another family member record what they observe. Hospitals count on this not happening because they know most patients do not have this mind-set.

Hospitals also need the time to recode and balance bill. They are sure to increase a number here and there for items seldom, if ever counted. Hospitals also have become adept at changing a coding number to get more money than should be charged. Therefore, if they deliver the records to you as soon as you are discharged, they will not have time to make all the changes they want. Plus an event that needs to be hidden may be in plain site. If by chance, the AHA request for 30 days is denied, you may end up in the hospital for a day or two more than normal while they adjust your records. Excuses for additional time in the hospital can be easily fabricated. Remember, the profit margin needs to be met for each patient as well as preventing future problems from your records.

Read the article here by Trisha Torrey. Then follow the links provided by here to others that are pointing out problems. I must also encourage you to read this blog from The Health Care Blog. This also takes you to other blogs that you should read.  Carefully follow the link to the letter from Trisha's blog.  I admit I cannot get it to work for me otherwise.

If you do not follow Regina Holliday, she has a lot to say about the current disaster in our hospitals and obtaining the medical records for her deceased husband. Her situation should make you desire to take action. Read these three blogs by Regina, one, two, and three.

If it takes some time to read all this, then you should have had time to consider your course of action. I have sent my emails to my congressional people.