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Smart Use of Health Services

Walking better than chemotherapy

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A new study shows that walking dramatically improves outcomes in colon cancer.  In fact, walking was a better treatment than chemotherapy.

So... get a dog and put on your walking shoes!

Walking Improves Outcomes

The second study[2] is "ready for prime time" and applicable in your clinic if you are not doing it already. In this study, published in the Journal of Clinical Oncology in January, investigators identified 2300 people [with invasive, nonmetastatic colorectal cancer] and measured how much exercise they got before and after their diagnosis. This is fascinating data, showing that those people who were more physically active both before and after their diagnosis of colon cancer had much better outcomes.

These patients needed only a minimum 8.75 MET (metabolic equivalent) hours of recreational exercise per week, or the equivalent of 150 minutes a week of physical activity -- basically, walking. So, I often prescribe a dog for patients because they will have to walk their dog. Insurance won't cover that, by the way. We have tried.

If you engage in that much physical activity before and after [a colon cancer diagnosis] the risk reduction [in all-cause mortality] is 0.58. That is better than any chemotherapy we have ever given to anyone. Physical activity after diagnosis, and certainly pre- and post-, is better, but even if you just pick it up afterwards, you will have a significant improvement in outcome. If you are a couch potato and do not exercise, your risk goes the other way, to risk escalation, with a 1.36 hazard ratio [for all-cause mortality].

Last Updated on Wednesday, 20 March 2013 20:32

Robotic Surgery - No Benefit

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It looks like robotic surgery is just another expensive medical procedure that offers no benefits to patients but does generate more income for doctors, hospitals and device maker, an article in the NY Times reports.

The Journal of the American Medical Association has published the results of a large study comparing the use of robotic surgery with standard laparoscopic surgery for hysterectomy.  In spite of claims that robotic surgery was better in many ways, the study found little difference in the rate of complications, time in the hospital, recovery time or blood transfusion between the two groups.

Robotic surgery was significantly more expensive by thousands of dollars and this translated into more income for the medical industry and more expense for patients.  This is why you will hear advertisements from hospitals for robotic surgery.  They make more money from it.  However, there is no benefit and you pay the extra cost.

If you are offered robotic surgery, you should politely decline.


High Cost of Colonoscopy Anesthesia

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From the New York Times.

Patients who undergo colonoscopy usually receive anesthesia of some sort in order to “sleep” through the procedure. But as one Long Island couple discovered recently, it can be a very expensive nap.

Both husband and wife selected gastroenterologists who participated in their insurance plan to perform their cancer screenings. But in both cases, the gastroenterologists chose full anesthesia with Propofol, a powerful drug that must be administered by an anesthesiologist, instead of moderate, or “conscious,” sedation that often gastroenterologists can administer themselves.

And in both cases, the gastroenterologists were assisted in the procedure by anesthesiologists who were not covered by the couple’s insurance. They billed the couple’s insurance at rates far higher than any plan would reimburse — two to four times as high, experts say.

But there’s a bigger problem for consumers here, too. Many physicians who are not the primary contact with patients — like pathologists and radiologists as well as anesthesiologists — do not participate in health insurance plans. When they provide medical services at hospitals or outpatient centers, their charges may not be covered, or may be only partly covered, leaving even well-insured people with large, unexpected bills.

So, what to do if you need a colonoscopy?

CONSIDER ALTERNATIVES Other recommended colon cancer screening methods include the fecal occult blood test, which involves collecting stool samples at home, and sigmoidoscopy, in which a long, flexible tube with a tiny video camera is used to examine the lower colon. Indeed, a study published in The New England Journal of Medicine last week found that patients who underwent sigmoidoscopy had lower rates of colon cancer and lower cancer death rates.


Let's (Not) Get Physicals

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FOR decades, scientific research has shown that annual physical exams — and many of the screening tests that routinely accompany them — are in many ways pointless or (worse) dangerous, because they can lead to unneeded procedures. The last few years have produced a steady stream of new evidence against the utility of popular tests:

The New York Times has more...



The Top 5 Medical Expenses you Don't Need

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From the National Physician’s Alliance:

Top 5 Internal Medicine

* Lower Back Pain: Don’t do imaging for lower back pain within the first 6 weeks unless red flags are present.

* Screening: Don’t obtain blood chemistry panels (eg, basic metabolic panel) or urinalyses for screening in healthy adults who don’t have symptoms.

* EKGs: Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms.

* Cholesterol Lowering Drugs: Use only generic statins when initiating lipid-lowering drug therapy.

* Bone Density: Don’t use DEXA (bone density) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

Top 5 Pediatrics

* Throat Infections: Don’t prescribe antibiotics for pharyngitis (sore throat) unless the patient tests positive for streptococcus (Strep throat). [According to an article in Time, “Most cases of sore throat are viral, yet antibiotics are prescribed more than half the time, contributing to drug resistance and high costs.”

* Head Injuries: Don’t obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors [The risks of radiation exposure for kids far outweigh any benefits of scanning otherwise]

* Fluid in the Middle Ear: Don’t refer otitis media with effusion early in the course of the problem. [Again, most ear infections are viral and will go away on their own without antibiotics.]

* Cold Medications: Advise patients not to use cough and cold medications. [Recent studies have shown that these medications have no benefit and parents often use incorrect dosages, leading to harmful side-effects.]

* Asthma: Use inhaled corticosteroids (a steroid medication) to control asthma appropriately.

Top 5 Family Medicine

* Lower Back Pain: Don’t do imaging for lower back pain within the first 6 weeks unless red flags are present.

* Sinusitis: Don’t routinely prescribe antibiotics for acute mild to moderate sinusitis (inflammation of the sinuses) unless symptoms – which must include purulent (full of pus) nasal secretions AND maxillary (upper jaw bone) pain or facial or dental tenderness to percussion – last for 7 days OR symptoms worsen after initial clinical improvement. [The Time piece notes; “Despite the fact that most sinusitis is caused by a viral infection, antibiotics are still prescribed in more than 80% of outpatient cases. That adds up: each year sinusitis results in 16 million office visits and $5.8 billion in costs, even though viral infections will clear on their own.”]

* EKGs: Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms.

* Pap smears: Don’t perform Pap tests on patients younger than 21 years or in women have had a hysterectomy for benign disease.

* Bone scans: Don’t use DEXA (bone density) screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors.

Last Updated on Wednesday, 25 May 2011 22:12
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