Vol. 174 July 15, 2017 Dumb Government and Smart Guns

July 15, 2017

Gun violence injuries and deaths in the U.S. is a public health crisis.”   – AMA

Gun violence kills roughly 30,000 Americans each year, about as many people as car accidents. The federal government has been restricted in gathering and analyzing gun violence data since 1996 when a CDC study linked the presence of a gun in the house with an increased risk of homicide. The NRA responded with a successful lobbying effort to pass the restriction that the CDC may not use any money allocated to it for “activities that advocate or promote gun control.” It stripped $2.6 million from the CDC budget for firearm injury research. After the Newton School shooting in 2012 Obama issued an Executive Order (one of his relatively few) commanding the CDC to renew their research into gun violence and requested Congress to allocate $10 million for that. Congress never did, and research never resumed.

The NRA has also successfully limited the federal government’s ability to trace guns involved in crimes, “crime gun-tracing”. Some states have developed data bases of crime-gun tracing to identify sources of and reduce illegal gun trafficking. Massachusetts established crime-gun tracing in 2014, but has not published a meaningful analysis of the data which might lead to some action. The 2017 Massachusetts legislature has inserted into their budget proposal a request that the governor produce such an analytical report.

Doctors, particularly pediatricians, are keenly aware of the dangers of having guns in the  house. 90% of accidental gun injuries to children happen in a home with a gun. The American Academy of Pediatrics has explicitly recommended that pediatricians routinely ask gun-safety questions during health and wellness visits. But in 2011, Florida passed a “Privacy of Firearm Owners” law levying $10,000 fines and loss of medical license to any pediatrician that inquired about the presence of firearms in the house. The law was upheld by a Florida state court in 2014 based on “2nd Amendment infringement”. The law was just struck down this year by a Federal Appeals Court that ruled that “there was no evidence that the law infringed on the Second Amendment.” By the way, the Affordable Care Act (aka Obamacare… remember Obamacare?) specifically prohibits physicians from keeping records on gun ownership. an assurance to any paranoid, conspiracy-theory-believing gun owner that docs were now not in league with big government. (see “Docs vs. Glocks”, Scientific American, August 2015. pg. 10)

The solutions to gun violence deaths are mostly focussed on mass shootings including either/or/and:
1. eliminate mental illness,
2. eliminate terrorists,
3. eliminate humane treatment (put water boarding video of terrorists on You Tube),
4. eliminate Muslims,
5. eliminate political correctness  (utter the words “Radical Islam Terrorists” which Obama refused to say (sic.) (1)

The truth is that “mass shootings”, though a big part of media attention, are a small part of the  30,000 annual gun death toll. 62% of  gun deaths are due to suicides committed with guns that DO NOT BELONG to the victim (particularly among the young). Criminals steal about 250,000 guns per year. 1.7 million children live in homes with unlocked, loaded firearms. (2)

The NRA consistently raises the spectrum of the need for the home owner to have a means of self-defense, but a gun is 22 times more likely to be used in a criminal assault, an accidental death or injury, a suicide attempt, or a homicide than it is for self-defense. 61% of gun homicides are by people who know each other.(3)

Making a gun as smart as an iPhone is one way to prevent to a large portion of gun injuries and deaths. Previous attempts to develop such a smart gun have been fraught with problems, have been actively boycotted by gun manufacturers, and have been opposed by gun advocates and the NRA. Kai Kloepfer, a 15-year-old high school student in Colorado, in response to the Aurora theater shooting near his home, started a science project in 2015  to design a pistol that will only fire when a sensor in the grip recognizes the fingerprint of the owner. His project won awards, and Kloepfer delayed his entrance to MIT for a year when he got a grant to develop a working model of such a smart gun. By 2017 he successfully built and demonstrated a smart pistol. The gun takes 1 second to unlock, its battery lasts a year, a light indicates the battery status, and a second light indicates it is unlocked and ready to fire. Neither a child nor a thief can fire the gun. The owner may store up to 10 “authorized user” fingerprints (like for a spouse or domestic partner ). The smart gun is smart enough to NOT  connect with the internet, so it can not be hacked or hijacked.

The NRA response has been predictable: “NRA does not oppose new technological developments in firearms; however, we are opposed to government mandates that require the use of expensive, unreliable features, such as grips that would read your fingerprints before the gun will fire.”(2)

Hey, at least the NRA didn’t evoke the 2nd Amendment argument. That is progress!  Technology can deal with “expensive” and “unreliable”. Technology is far faster to upgrade than the Constitution.

References:
1. “A Nation Captive To The Gun”, Garry Wills, Boston Globe 6/15/2016
2. “The Future of Everything”, Wall Street Journal, 2017, Geoffrey Fowler
3. Journal of Trauma and Acute Care Surgery, 1998

 

 


Vol. 155 October 1, 2016 Legalizing Recreational Marijuana?

October 1, 2016

Hub thumbnail 2015Massachusetts voters and 7 other states will be voting November 8 on proposed laws “legalizing, regulating, and taxing Marijuana”. All of these “binding” Questions have been placed on the ballots by “Initiative Petition” (grassroots’ signature campaigns … no pun intended).The proposed Massachusetts law will legalize for anyone 21 or older the possession of 1 ounce of marijuana outside a residence or up to 10 ounces inside a residence, of up to 6 marijuana plants, and of GIVING without payment 1 ounce or less to another person 21 or older. The actual bill fills 11 full pages which reflects not only the controversial issues surrounding the bill, but also the complexities of proposed regulations and taxation.  

Colorado legalized recreational marijuana four years ago, and its experiences (both positive and negative) are currently feeding both sides of the debate of the economic, social, and political consequences.

I will only summarize some of the medical issues (“the News”) with scant remarks about some other issues (”the Editorial”).

Marijuana is a gateway drug: Not really
Physician researchers studying substance abuse ( at least those pediatrician-scientists who present at conferences in Boston) consider nicotine, alcohol, and marijuana as almost equivalent “initial drugs of choice” in adolescents and young adults who become addicted to heroin or opiates. They speak of marijuana “heavy-users” ( more than one joint daily), not marijuana “addicts”, and they represent a small percentage of adolescent MJ users.

Marijuana is addictive: Maybe a little
About 9-10% of users become “dependent”, “need to have daily MJ to feel normal”. Those who start using MJ under the age of 21 are more likely to become dependent. The withdrawal symptoms when heavy users stop after many years are much less than those who stop use of opiates, heroin, alcohol, or even nicotine. No medications are necessary, and any troublesome symptoms usually respond to cognitive behavioral therapy (talking to a therapist). “Addictive behavior” such as crimes to obtain money and violent acts are not usually associated with MJ dependency.

Marijuana is safe: Yes
Lester Grinspoon, MD in his landmark books, “Marijuana Reconsidered” (1971) and “Marihuana (sic): The Forbidden Medicine ” (1991), stated that no one has ever died of a  marijuana overdose, and that statement still stands true.

Marijuana changes your brain: Yes, if under 21 yo.
This reason and the dangers of small children eating large amounts of edible MJ are the reasons the American Academy of Pediatrics opposes the legalization of MJ but NOT its decriminalization.

The Academy also recommends that marijuana be decriminalized, so that penalties for marijuana-related offenses are reduced to lesser criminal charges or civil penalties. Efforts to decriminalize marijuana should take place in conjunction with efforts to prevent marijuana use and promote early treatment of adolescents with marijuana use problems.”

Heavy use  of MJ before the age of 21 can change how the brain functions as revealed by functional MRIs (fMRI).  Heavy MJ use can actually change brain structure in areas associated with impulse control and “executive functions”. Some studies show a lowering of IQ by 8-9 points in heavy users. The long term effects of these structural changes in adolescents are being studied, but everyone seems to agree that MJ use should not be legalized for those under 21 years of age.

Marijuana can impair your driving: Perhaps
Studies do show that MJ can prolong your reaction time and reduce attention span (less so than alcohol – check out this YouTube video), so the opponents of legalization believe that the law will lead to more car accidents. The data on actual accidents, whether fatal or not, is not so clear. There is no standard method to measure “MJ intoxication”. Blood and urine tests measure MJ metabolites which can be present for up to 45-50 days after smoking a single joint (depending on age, weight, and belt size). These tests, since they depend on measuring metabolites, may not even turn positive until 24-48 AFTER a new user smokes a joint. Such tests can identify regular users, but there is no correlation between blood and urine test levels and the actual degree of impairment.  Remember, even the “gold standard” in drunk driving cases, Breathalyzer results, are not permitted to be entered as evidence in court because of variations in calibration and field administration.


The Massachusetts Medical Society opposes  the legalization of recreational marijuana because of 1) “the addictive nature of marijuana”, 2) “the adverse effects on developing brains”, and 3) “the appeal of edibles to youngsters”.

The effect of legalization on youth access to marijuana is a controversial subject that is dismissed by pediatric researchers.

“Adolescents and pre-adolescents already have open access to MJ. Legalizing it won’t change that.”
It is worth remembering that Dr. Grinspoon got interested in the medical effects of marijuana when his son was undergoing chemotherapy, and MJ reduced his nausea greatly. Lester’s wife easily bought that MJ in a Newton schoolyard in the 60s.

That reality that MJ distribution and sales will become a big business is why proponents are pushing its tax revenue upside. Opponents are concerned that “Big Tobacco” or other nefarious organizations will take over the MJ market.

My vote:
I will vote “NO” on Question 4 in Massachusetts proposing the  “Legalization, Regulation, and Taxation of Marijuana” primarily because of its unknown consequences that should become clearer in time (even just a year or two would help). Also, our state’s less than stellar track record in satisfactorily implementing the much smaller program of legalizing medical marijuana ( 59 pages of regulations in 2013 and several public missteps) gives me real pause about how it could all play out.

I think that the recreational use of marijuana will eventually be legalized in Massachusetts, and that there can be some real benefits of such a change.  But, I also think that there is too much that is vague and/or capable of manipulation in this proposed law, even at 11 pages long.


Vol. 153 September 1, 2016 Is Nothing Sacred? No, Not in Medicine.

September 1, 2016

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It can be frustrating and unsettling when after years of telling us that something is good…or bad for you, doctors then tell us that the opposite is true! “Redefining the truth” is the essence of science, particularly the science of medicine. The medical mantra is: Keep studying, keep collecting data, keep analyzing, and if the “truth” changes, report it!
Here are some more revisions of the truth as examples.

Baby Dolls and Teen Pregnancies
Giving high school students a baby doll to take of care for several weeks is touted as a deterrent to teen-age pregnancies. The sophisticated doll is programmed to cry, make demands, go to sleep (or not), etc. just like a real baby. Students are instructed to care for it 24/7 as if it were a real baby. The expectation is that such a “reality-check” would make teen agers more aware of the burdens of caring for an infant and that would convince them to use effective birth control.

A recent report in the British Medical Journal documented that the average teen age pregnancy rate in those who cared for a doll stayed the same or even INCREASED in some schools. The article speculates that the positive, loving experience that some teens had and the extra attention they received while caring for the doll caused this. The company that makes the dolls quickly switched its marketing pitch from “reducing teen pregnancy” to “teaching quality infant care”.

Get the Lead Out”
The high level of lead in the water in Flint, Michigan in 2015 immediately raised an alarming concern about “poisoned children”.  A blood lead level of 5 micrograms per deciliter is considered “a threshold for official action as a “precautionary principle” according to public health experts.   5% of the kids in Flint had blood lead levels of 5-10 micrograms per deciliter.  The increase from 2.4% having a level over 5 in 2013 to 4.9% of kids tested in 2015 raised the public health alarm.

It is well known that the body can excrete lead. If the input of lead (ingested in food, water, or dirt or breathed in from car exhausts) exceeds the excretion rate and the blood lead level reaches 40-69 micrograms per deciliter then outpatient treatment is recommended, even though the person is asymptomatic. Blood levels above 70 can cause symptoms and are treated by hospitalization. None of the Flint children had lead levels over 40.

Lead performs no essential function in our bodies and chronically high levels can cause neurological damage, so it is incumbent of public health officials (and politicians) to prevent prolonged exposure, but these children have NOT been damaged. They will, I am sure, be monitored and studied for years to come to see if there is any subtle effect of these low lead levels. Because that’s what medical science does.

Lowering Blood Pressure in Intermediate-Risk Persons Without Heart Disease with Two Drugs Did Not Decrease the Rates of Major Cardio-vascular Events

NEJM 374:21 May 26, 2016,pg. 2009-2019

Lowering Cholesterol in Intermediate-Risk Persons Without Heart Disease and Normal Lipid Levels With One Drug Decreased the Risk of a Major Cardio-Vascular Event from 4.7% to 3.6% (a 25% reduction)

same NEJM issue pg. 2012-2031

Lowering Blood Pressure AND Cholesterol in the same study as above with Three Drugs Decreased the Risk of Some Major Cardio-vascular Events from 5.0% to 3.6% (a 30% reduction)

same NEJM issue pg. 2032-2043

Like Fox Radio, “We report the news. You decide.”

“Get the Fat Out…But Which Fat?”
The British Medical Journal published an article in April written by a team of scientists at NIH headed by Christopher Ramsden, called the “Indiana Jones of biology” because he specializes in excavating old studies, particularly those that go against our “mainstream government-sanctioned health advice”. He unearthed a 1968 five-year, tightly controlled study of over nine thousand participants randomly assigned to either a vegetable oil based diet or a standard animal fat diet.

The study documents that eating vegetable fats instead of animal fats did NOT, repeat did NOT, reduce the risk of heart disease or death. Substituting a vegetable oil diet ( about half of the saturated fat of the standard diet) did lower the average blood cholesterol by 14%, BUT the risk of death INcreased 22% for every 30 points the cholesterol fell! 

Dr. Robert Franz of the Mayo Clinic, the son of the organizer of the 1968 study, speculates that his father’s team was disappointed that they could find no benefit of the vegetable oil diet, and so didn’t publish it widely. An accompanying editorial in the BMJ concluded that “ the benefits of choosing polyunsaturated fat over saturated fat seem a little less certain than we thought.”

Again like Fox Radio:  “We report the news. You decide.”

“Worried About Peanut Allergy in Your Family?
Avoid Peanuts! No, NO, Eat Them as Early as You Can!”
The experts use to say “no solid foods to infants before age 4 to 6 months.”
Experts now say “do not delay solid foods beyond 4 to 6 months.”

In the past 10 years childhood peanut allergy has doubled from 1.4% to 3% (still small).
The experts use to say that “if you’re worried about peanut allergy in your child do not give peanut food until age 3 years”.
Experts now say “give the infant peanut food as early as 4 months of age.”

A 2015 study in the New England Journal of Medicine showed that consumption of peanut food at 4 months of age reduced the development of a peanut allergy (documented by skin-prick tests) by 70% – 86%!!

“We should no longer recommend avoidance of allergenic foods in infants.”


Vol. 152 August 1, 2016 It’s Not the Screen Time, It’s the Content.

August 1, 2016

Hub thumbnail 2015

“Playing rapid action video games benefits the mental skills of processing information, switching between tasks, and visualizing the rotation of an object.”
                 Scientific American, July 2016


What?!
“Shooting zombies and repelling aliens can lead to lasting improvement in some mental skills.” (1)

Bavelier while a graduate student in the 1990s developed a computerized psychological test of the ability to see an individual shape in a busy visual scene. He tested it first on himself, expected to get an “average score”,  and  got a perfect score. He next tested Green, his mentor who also unexpectedly got a perfect score. They figured something was wrong with the computer program, but they could not identify a bug. After a number of Green’s non-psychological buddies also scored perfect results they spent some time in looking for the reason. The only common denominator among the group was that each had spent more than 10 hours a week playing the video game Team Fortress Classic. That discovery launched them, and others, into 15 years of investigations into the cognitive effects of playing fast-paced “shooter” video games.

According to various studies video game playing can boost a variety of cognitive skills:

  • improve focus on visual details (like reading fine print in a contract or on a prescription bottle)
  • heighten awareness of visual contrast (help drive in a thick fog)
  • enhance mental rotation of objects (get that odd-shaped couch through the door)
  • improve audio and visual multitasking (read a menu while conversing with a dinner partner)
  • improve reaction time to unexpected events by 10%
  • increase the number of correct decisions made under pressure
  • improve specific attention in fast changing visual fields (better control of attention)

One study found that laparoscopic surgeons who were also game players could complete surgery faster with the same precision or quality as non-gamers . I remember many years ago learning that the Israeli Army realized that video game players made the best tank commanders.

Obsessive game playing (“binging”) is NOT needed to boost the brain, and the American Academy of Pediatrics has made recommendations for preventing excessive use of all media by children.   Short, daily intervals of play on fast-action games can reap cognitive benefits. Many so-called “brain games” marketed for improving cognitive skills do not live up to their claims. According to these researchers fast-action video games can because:
1. they are fun,
2. they have careful pacing and levels of play (reduces frustrations of early failures),
3.they require increasing attentional control as the game proceeds,
4. they consistently challenge the player,
5. they provide the successful gamer rewards on different time scales (promotes planning for short and long-term objectives).

The content of the game is very important. Violent, aggressive action games can adversely influence children’s attitudes and behavior. Games involving action sports, real-time strategy (like StarCraft), 3-D puzzles (like Portal 2),or “Prosocial” games that involve cooperation rather than competition are listed as examples of “brain-boosters” by these researchers.

They did not include their opinion of Minecraft , an open-ended, creative game that has captured the imagination of millions of children. This fast-paced, multi-level, 3-D building block game is too hard for this adult to understand or follow. One grandchild agrees and has started an instructional website “Minecraft4Momz” . Take a look on YouTube.

References:
1. The Brain-Boosting Power of Video Games, Sci Am; July 2016, D. Bavelier, Prof. of Psychology, University of Rochester and C.S. Green, Asst. Prof. of Psychology, University of Wisconsin


Vol. 149 June 1, 2016 Jargon Update, Placebo Prices May Count, and Visual Acuity in Kids and Baseball Players

June 1, 2016

Hub thumbnail 2015Jargon Update

Babylag” : the sleep deprivation symptoms experienced by 50% (gender not identified) of new parents; worse than jet lag because they can be cumulative.

“Brobats” : Robots, six times the size of human sperm cells, that move and turn by wriggling their tails; aka MagnetoSperm; may eventually be used to deliver drugs through the bloodstream.

Connectomics” : the study of “connectopathies” like Alzheimer’s, schizophrenia, depression, and autism spectrum disorders; spurred by the increasing use of functional MRIs (fMRI) as a non-invasive brain imaging.

Placebome” (pronounced Pla-SE-bom): the network of 10 genes that predisposes people to respond to a placebo; moving forward on personalized medicine is a long-standing goal of he Human Genome Project.

Placebos believed to be expensive may work better than those believed to be cheaper.

One or two of those 10 genes may be associated with what’s in your wallet.   The Washington Post (1/29/16, Bernstein) “To Your Health” blog reports that investigators “found that the patients performed better on motor skills tests when they believed they were on the expensive drug, an effect that increased when they were given the expensive placebo first.” The Los Angeles Times (1/29/16, Kaplan) “Science Now” blog reports that investigators “also used functional MRI scans to assess the patients’ brain activity and found that the ‘cheap’ placebo prompted more action than the ‘expensive’ one.” The blog adds that “to the researchers, this was a sign that the patients expected less from the placebo they believed cost less, so their brains responded by doing more work.” (Huh ???) There is much more to the placebo story; a story too complex to tell in a single paragraph or understand from a single study..

Outdoor activity for prevention of myopia in children (at least in Chinese children)

The prevalence of myopia (nearsightedness) increases throughout childhood, particularly during and after puberty. Myopia often progresses as children grow older and high levels of myopia are associated with an increased risk of sight-threatening complications later in life (eg, myopic macular degeneration and retinal detachment). In a study published in JAMA; 314, October 2015 , 1913 school children in China were randomized (by school) to an additional daily 40-minute outdoor class or usual activity . The cumulative incidence rate of myopia over three years was lower in the intervention group compared with the control group (30 versus 40 percent). This is the first study to suggest an effective preventative strategy.

Increasing the amount of time children spend outdoors is a simple intervention and could be a strategy to reduce the risk of developing myopia and/or slow its progression. The effect was related to just being outdoors and had nothing to do with sports or activity.This is yet another good reason to reinstitute recess periods in elementary schools. The mechanism of the preventative effect of being outdoors is unclear. Some think that lack of exposure to sunlight for long periods is associated with myopia. Myopia is more common in high-income regions of the world presumably because those people spend less time outdoors.  “Myopia, once believed to be almost totally genetic, is in fact a socially determined disease,” and is increasing in prevalence. (SciAm June 2016, p.80)

Speaking of outdoor eyesight

Wade Boggs, whose number was just retired by the Boston Red Sox, shared “better than normal” visual acuity with fellow Baseball Hall of Famer Ted Williams. “Normal vision” (20/20) is being able to see at 20 feet what most people see at 20 feet. As the letter size increases going up the Snellen chart (designed in 1862) the denominator number increases. If you have 20/100 vision you can see clearly at 20 feet what most others can see at 100 feet. Wade Boggs’ visual acuity during his baseball career was 20/12. He could see the blue dot of the MLB logo on the ball as it rotated toward him! That and several other factors apparently accounted for his superb hitting. (Wade’s favorite game as a child was the early video “Pong” which was one of several hand-eye-coordination games that he played.)

Ted Williams, the other fantastic Red Sox hitter, had 20/15 vision. He could see the stitches on the hurtling baseball. The two had very different batting stances and styles, but were good friends. After several attempts by Ted to “correct” young Wade’s stance and swing they resolved to mostly talk about fishing.

Speaking of video games

PCs are apparently passé to babies. Most are using smartphones or tablets. In a 2013 survey of nearly 1500 U.S. parents 40% of children UNDER 2 years of age used a mobile device, an increase from 10% in 2011. (66% watched TV – no increase since 2011) Most of this was probably due to the rapid increase in smartphones in those families. Smartphone use of educational media for children up to 8 yo. in lower-income families tripled between 2011 and 2013 while PC use decreased. The same study revealed that 28% of parents felt that children’s device use decreased the time they spent with their kids while 12% felt it increased their time with them.

A study of over a thousand 13-17 year olds by the same Common Sense Media organization revealed that in 2012 the  vast majority of teenagers had their own cell phone (82%) including 41% who say they have a “smart” phone, meaning they can use it to “check email, download apps, or go online.”  Cell phone ownership varied by age (74% of 13 to 14-year olds, compared to 87% of 15 to 17-year-olds), and by income (74% of lower-income youth, compared to 84% and 86% of middle- and upper-income youth). There were no significant differences in cell phone ownership by race or by parent education. Surprisingly, the teenagers who were surveyed preferred face-to-face communication (49%) over texting (33%), but other studies have shown that the fear of being “left out” seems to compel the use of social networking via devices.

Read the rest of this entry »


Vol. 142 February 15, 2016 Tech Update

February 15, 2016

Hub thumbnail 2015

A drop of blood for 100+ tests!
A company called Theranos, founded by a Stanford University drop-out, has developed a nanotechnology system for testing a finger prick of blood for anything from standard cholesterol level to still-developing genetic analysis. It is being test marketed in California by Walgreens pharmacy. Theranos plans to charge 50% of the Medicare/Medicaid reimbursement for the tests.

HealthSpot Station : A walk-in kiosk in a mall or drugstore with high-def video conferencing, a stethoscope, a thermometer, and a blood pressure cuff for immediate evaluation of non-emergencies; they accept insurance, including Medicare.

A 3-D printer creates a bioresorbable airway splint for an infant
A two-month old infant with congenital anomalies of the trachea and surrounding blood vessels had a local collapse of his tracheobronchial tree which could not be kept open with conventional ventilation. A hose, similar to the design of a vacuum cleaner hose, but much smaller of course, was fabricated by a 3-D printer. Seven days after insertion, weaning from his artificial ventilation was started. He was discharged from the hospital 21 days later after corrective vascular surgery.

Wearable fitness monitors – a $2 billion business
The early ones only counted steps. In the rush to self-quantify ourselves more and more measurements have been added to these wrist bands that now talk to our smartphones. Three different wrist bands can give three different counts. Sleep scientists pooh-pooh the wrist-worn sleep monitors. But, people buy them … as motivational devices, not scientific ones. If you add on the seductive social networks to share your data with all your friends, you have entered into the realm of what some would call  “fitness by humiliation”. If you subscribe to conspiracy theories you might wonder where all that personal data ends up? Who looks at it? Who owns it? No one knows. No one does, … yet.  In the spirit of full disclosure I admit that last year’s Christmas present of a Fitbit bracelet sits on my bureau, not my wrist.  I discovered that I took about 3000 steps a day, every day. It never changed, and it didn’t count my Pilates exercises well, so I took it off.

Maybe my doctor should have texted me
A Johns Hopkins study showed that 81% of 48 men and women with risk factors for heart disease receiving an automated, “personalized” text message “from their doctor” successfully reached their 10,000 steps a day goal. Only 44% of those in the control group who received no messages met that goal. Sample message: “Jon, you are on track to have a VERY ACTIVE day! OUTSTANDING! We might as well call you LeBron James!” (I kid you not. You can’t make this stuff up.)

First to market telemedicine for profit- aka “Uber for Doctors”
FIRST OPINION – For $9 a month a patient can text health questions to a pre-matched physician any time of day and expect a response in 5 minutes.

TELADOC – Your insurance company offers you a video or phone consult with a physician 24/7.

DOCTOR ON DEMAND  – An app that connects doctors with patients who are sick to help them decide if they have to be seen by a health professional or just need to take an Advil. Medical histories are stored in an encrypted database.

FIRST LINE – For $25 up front and $15 a month you get unlimited consultations by video chat or messaging. New participants get 24 hours (total) of free texting with a doctor anytime between 8 a.m. and 10 p.m. A house call is available for $199. No insurance coverage…yet.

PCP iPhone cartoon

“There’s an app for it” – before you contact a doctor
ResApp – Determines the cause of a cough by listening to you cough into the phone. Has 90% accuracy in diagnosing pneumonia or asthma. (Ed. note: pediatricians have been making these diagnoses over the phone for years; plus croup of course)

Priori – Predicts bipolar episodes before they happen. It is always “on” and monitoring the speed and patterns of the patient’s speech when he/she is using the phone normally. Doctors will receive an alert based on the speech patterns when intervention is needed. In Beta testing this year.

ApneaApp – Diagnoses when the sleeping patient periodically stops breathing by bouncing inaudible sonar waves off the patient’s body back to the phone. The reflected waves are analyzed to determine if sleep apnea is occurring. It was correct in 32 out of 37 tests in a sleep lab, and is about to be tested in the home setting.

In honor of Valentine’s Day – a few random facts about sex (some from the Framingham Study)
Sexual intercourse burns only about 85-150 calories, though it can get your heart rate up there in the “aerobic” range.
Heart rate and blood pressure peak very early in the act.
Having sex is about the equivalent of walking up two flights of stairs.
Men who had intercourse twice a week had a lower risk of cardiovascular events then those who had less frequency.
Having a heart attack during sex is about a million to one risk if you are a non-smoker and non-diabetic.

HAPPY PRESIDENTS’ DAY
I probably should have written about a few Presidential medical fun facts … like Garfield’s death resulting from medical malpractice, etc. … Maybe next year.


Vol. 140 January 15, 2016 A Review of 2015 Hubslist Blogs

January 15, 2016

Hub thumbnail 2015

 

Click on the date to see the full blog

 

January 1 – 5 out of 10 of my resolutions were “kept”. You guess which ones.

January 15 – 6 reasons why patients are non-compliant , excuse me, “non-adherent”- the new PC term, with their medications.

February 1 – incidence of sudden death while watching the Super Bowl (Patriot fans probably don’t have to worry about that THIS year.)

February 15 – some myths revealed about cholesterol in your diet, global warming, measles vaccination rates, herbal supplements, and Dr. Oz, vendor of snake oil(s).

March 1 – 8 new causes of death caused by cigarette smoking added to the previously identified 12; a total of 20.

April 1 – Athena Health purchases MySpace which raises more concerns about privacy of health care data (April Fools edition).

April 15 – what does a “board certified physician” mean, and what does it have to do with Presidential candidates (Rand Paul)?

May 1 – physicians’ prognoses are often too optimistic for the same reasons patients’ are.

May 15 – E-cigarettes open new avenues for adolescent use of marijuana and synthetic cannabinoids (“bath salts”).

June 1 – annual review of sunscreens and bug repellents plus less universities providing student access to tanning booths.

June 15 – new forensic techniques of identifying individuals by bacterial, viral, and DNA “fingerprints”.

July 1 – 6 positive access outcomes and 4 positive health care delivery outcomes of Obamacare at 5 years of age.

July 15 – dangers of synthetic cannabinoids (attn: Chandler Jones?) and the minimal (“pending”) review of sunscreens by FDA.

August 1 – two websites with the best “symptom diagnosis” track record for helpfulness, and the one that is the worst.

August 15 – [ family vacation in a lighthouse without electricity or running water]
DSC01581

September 1 – why new drugs cost so much, no “gay gene” identified yet, and the myths of low testosterone, chronic Lyme, and  8 glasses of water a day.

September 15 – The health benefits of our “microbiome” and the “microbiome” of the New York City subway.

October 1 – the misleading, untruthful attacks on Planned Parenthood.

October 15 – the scope and magnitude of adverse effects of dietary supplements.

November 1 – transgender, transsexual, transvestite, and hermaphrodite, oh my!

November 15 – toddlers shooting people and other “norms” of gun deaths – “By Degrees“.

December 1 – changing advice about what NOT to eat during the holidays.

December 15 – the benefits of research using fetal tissue, short history of political attacks on Planned Parenthood, and why if you are NOT fat and live a long life you should thank your parents.

HAPPY NEW YEAR


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