Why Pregnant Women Should Get the H1N1 Vaccine By Amy Tuteur M.D. http://www.kevinmd.com/blog/2009/10/pregnant-women-h1n1-flu-vaccine.html WANTED: A partner for richer or poorer and for better or worse and absolutely, positively in sickness and in health. I love this column from the Boston Globe, and you’ll see why: Will he hold your purse? By Robin Schoenthaler October 4, 2009 As a breast cancer doctor, I’ve learned how to spot a devoted husband -- a skill I try to share with my single and searching girlfriends. “Everything I know about marriage I learned in my cancer clinic.” I’ve been known to say this to my friends, maybe more than once, maybe even causing some of them to grind their teeth and grumble about Robin and Her Infernal Life Lessons. I can’t help myself. I’ve worked as a breast cancer doctor for 20 years, I’ve watched thousands of couples cope with every conceivable (and sometimes unimaginable) kind of crisis, and I’ve seen all kinds of marriages, including those that rise like a beacon out of the scorched-earth terror that is a cancer clinic. It’s a privilege to witness these couples, but the downside is I find myself muttering under my breath when my single female friends show me their ads for online dating. “Must like long walks on beach at sunset, cats,” they write, or “French food, kayaking, travel.” Or a perennial favorite: “Looking for fishing buddy; must be good with bait.” These ads make me want to climb onto my cancer doctor soapbox and proclaim, “Finding friends with fine fishing poles may be great in the short term. But what you really want to look for is somebody who will hold your purse in the cancer clinic.” It’s one of the biggest take-home lessons from my years as an oncologist: When you’re a single woman picturing the guy of your dreams, what matters a heck of lot more than how he handles a kayak is how he handles things when you’re sick. And one shining example of this is how a guy deals with your purse. I became acquainted with what I’ve come to call great “purse partners” at a cancer clinic in Waltham. Every day these husbands drove their wives in for their radiation treatments, and every day these couples sat side by side in the waiting room, without much fuss and without much chitchat. Each wife, when her name was called, would stand, take a breath, and hand her purse over to her husband. Then she’d disappear into the recesses of the radiation room, leaving behind a stony-faced man holding what was typically a white vinyl pocketbook. On his lap. The guy -- usually retired from the trades, a grandfather a dozen times over, a Sox fan since date of conception -- sat there silently with that purse. He didn’t read, he didn’t talk, he just sat there with the knowledge that 20 feet away technologists were preparing to program an unimaginably complicated X-ray machine and aim it at the mother of his kids. I’d walk by and catch him staring into space, holding hard onto the pocketbook, his big gnarled knuckles clamped around the clasp, and think, “What a prince.” I’ve worked at cancer clinics all around Boston since then, and I’ve seen purse partners from every walk of life, every age and stage. Of course, not every great guy accompanies his wife to her oncology appointment every day -- some husbands are home holding down the fort, or out earning a paycheck and paying the health insurance premiums -- but I continue to have a soft spot for the pocketbook guy. Men like him make me want to rewrite dating ads from scratch. WANTED: A partner for richer or poorer and for better or worse and absolutely, positively in sickness and in health. A partner for fishing and French food and beach walks and kayak trips, but also for phone calls from physicians with biopsy results. A guy who knows that while much of marriage is a 50-50 give-and-take, sometimes it’s more like 80-20, and that’s OK, even when the 80-20 phase goes on and on. A man who truly doesn’t care what somebody’s breast looks like after cancer surgery, or at least will never reveal that he’s given it a moment’s thought. A guy who’s got some comfort level with secretions and knows the value of a cool, damp washcloth. A partner who knows to remove the computer mouse from a woman’s hand when she types phrases like “breast cancer death sentence” in a Google search. And, most of all, a partner who will sit in a cancer clinic waiting room and hold hard onto the purse on his lap. Robin Schoenthaler is a radiation oncologist at the MGH Department of Radiation Oncology at Emerson Hospital in Concord. http://www.boston.com/bostonglobe/magazine/articles/2009/10/04/will_he_hold_your_purse/  Dear Wonderful Women! Just a reminder to you that October is Breast Cancer Awareness Month, and if you haven't done it lately, it's time to schedule your yearly mammogram!! Yeah, yeah, it's not fun, but I can tell you from personal experience, breast cancer is a pretty scary experience. And don't think you're safe just because your mother, grandmother, or sisters never had it. No one in my family had had breast cancer, but there I was, with a diagnosis that knocked the wind out of my sails. But I was lucky: It was discovered early - through a routine mammogram - and a radical mastectomy was all the treatment I needed. No radiation, no chemo. It's been 12 ½ years since the diagnosis/surgery, and I'm in great shape. Tomorrow is my mammogram appointment. I hope to see you there! Love and life!! Karen PS: Don't forget regular self exams, too!  Joanie in New Jersey shares her experience buying prescription drugs directly from a pharmacy in Canada: Here is the update on my daughter’s meds. Feel free to pass this on so that others will know what a rip off the pharmaceutical companies are pulling on Americans. The company that manufactured her drug changed the formula, and the old one was no longer available. The new one was not effective for her. Consequently, her symptoms returned and she became quite ill again. Well, since the Internet is the door to the world, I went online. I put in the name of the old drug and there it was (!), available from an international pharmacy in Canada. Now, here is the rip off: When she bought it here, through her insurance, she was charged a $65 copay for about 200 capsules. When we ordered it directly from the Canadian company, the total cost for 100 was $29US. If you can get 100 for $29 and the copay was $65 for 200, it appears that the copay actually pays for the drug. So, what the insurance paid to the manufacturer was pure profit! Oh, by the way the drug is sold over the counter in Canada. Here they treat it like it is some big-time cancer drug! When you buy just one bottle from the Canadian pharmacy, there is a shipping charge. But if you buy more than a certain amount, shipping is free! Rationing vs. Change 08/18/2009
 Kevin Pho, M.D. New Hampshire-based Kevin Pho, M.D., believes most physicians – especially family docs, like himself – will welcome comparative effectiveness research, but drug and device companies “will be resistant.” Specialists, too, might balk because, he believes, some testing and procedures they do might not be “deemed necessary.” In an interview for Progress Magazine, Pho told me he currently pays for a service providing online, peer-reviewed, evidence-based data to help him make everyday decisions on patient care. He, for one, will be quite pleased when he can access a larger, free service. “Physicians need an authoritative source of unbiased data, untainted by the influence of drug companies and device manufacturers,” Pho wrote in a recent post on his blog, www.kevinmd.com/blog/. Will the publication of data collected through CER result in the rationing of care? Maybe, Pho says, but that might not be such a bad thing. There's no reason to assume changing care will be equal to reducing care. If we know what works and what doesn’t, for whom and under what conditions, he says, change will benefit the patient, not hurt him or her. Pho believes advertising agencies and other media have sold patients the myth that, when it comes to health care, #1/ more is better, and #2/ the newest care is always best. Not so fast, says Pho. A number of important, large-scale recent studies (see Dartmouth Atlas 2008) have shown that sometimes more care can be harmful. As for new drugs, don’t forget that, just because they’re on the market, there’s no guarantee they will work for you. “We need to break that myth,” he says. “Older, more established treatments may actually be better. It’s a difficult concept for some patients to grasp.” Think Eastern medicine and herbal remedies. Maybe your grandmother was right about the benefits of cod liver oil. And, and OTC drug is a whole lot cheaper than some of the fancy drugs you see advertised on television. If it works, why not use it? Think of all the drugs that have been taken off the market in recent years because they were either ineffective or potentially harmful. “There’s no point paying for treatments you know won’t work,” he said, in the interview. “Realistically, to control health care costs, the medical community will have to make some big decisions, and the best way is to make unbiased decisions with unbiased data and recommendations,” he wrote on his blog. Is that rationing? Or, just making good use of experience? To read more of Kevin Pho’s comments on health care, go to his blog, www.kevinmd.com/blog/. Read this before you take that next pill... 08/18/2009
 If you’re like me, you thought when a drug or medical procedure is approved by the FDA, it works, right? Wrong! The FDA certifies the drug won’t hurt you, not that it will help you. To discover which drugs, diagnostic tests as well as surgical and therapeutic procedures work, and under what circumstances, we must rely on the people that sell them, and on the experience of the docs who use them. Obviously, that information could be incomplete or biased. And, even if it isn’t, it might take a long time to gather, sort and distribute. So, at the advice of all kinds of high-level medical think tanks in place for many years, the Obama administration added a provision to the American Recovery and Reinvestment Act of 2009, to set up a mechanism to fund research examining all kinds of public records, clinical trials, legal records and other information. Eventually, we should have evidence that will lead to lists of what works and what doesn’t, under a variety of circumstances. A daunting task, to be sure. Nobody believes such information will be available soon. But, the government will take it one step at a time. From my own research on the subject, most doctors welcome the program. Obviously this will be a long-term research project but it’s built on a program begun in 1989 by President George H.W. Bush, to give you an idea of how long this concept has been kicked around. It’s not new, nor is it unique to the US. Other countries have had similar programs in place for years. Although in its infancy, the very concept of comparative effectiveness research has added fuel to the fire on talk radio, giving the likes of Rush Limbaugh et al, “proof” health care reform will limit care! When you think about it, doesn’t the word reform mean re + form, implying change? The hundreds of health care experts (including representatives from many related industries) who wrote the legislation, as well as the Congress that passed it, must believe this particular change will be for the better. For an explainer on the pros and cons of comparative effectiveness research (CER), click here to read a fairly short story I wrote recently for Progress Magazine, an ezine published by Sigma Xi, the science research society. This piece looks specifically at the concerns of minorities, who, to be sure, do not want to be left out of any studies. To make sure they’re included, Congress included a special provision into the final draft of the bill that was enacted into law on February 17, 2009. Stay tuned. Young adult cancer patients have a new weapon against the insidious disease waging war on their bodies: Humor! For a look at what they call "cancertainment," see this week's Newsweek Magazine. Here's an excerpt from A Malignant Melanoma Walks into a Bar...: About 70,000 people between the ages of 18 and 40 are diagnosed with cancer every year, representing about 6 percent of all new cancer cases. About 10,000 young adults die from cancer annually, more than from any other disease. This is not the best statistic to stumble on when you are looking online for hope, as I did in September 2006 after my doctor told me he found a growth in my colon. There I was—nonsmoker, athlete, young—diagnosed with colon cancer, the disease that more commonly afflicts overweight, elderly men. And all I could think was: how inconvenient. I was a travel writer and had just scheduled trips to Rome and Cologne for the following week. Bummer. I would have to reschedule those flights. Read the entire story at http://www.newsweek.com/id/209319 Getting Reform Right 08/14/2009
Here’s a rather prophetic story I wrote for the Fall 2004 issue of the Harvard Public Health Review. It outlines health reform principles discussed in Getting Health Reform Right: A Guide to Improving Performance and Equity, a book written by four Harvard professors, presumably for developing nations. But, maybe not. _______ Four HSPH experts highlight the importance of social values, politics, organization, and economic considerations to health system reform in a new book, Getting Health Reform Right: A Guide to Improving Performance and Equity. Published by Oxford University Press, the uniquely multidisciplinary "repair manual" takes reformers step by step through the complexities of patching up and replacing broken systems. "The world is littered with failed reform efforts," observes Marc J. Roberts, one of the quartet and a professor of political economy and health policy. But given the enormous needs, notes his colleague, Peter Berman, professor of population and international health economics, "We have no choice but to do better." Despite what the United States spends to stay healthy--about $1.5 trillion a year, more than any other nation--this country ranked 37th among Western nations in one 2000 World Health Organization report that factored in quality and disparities in care among the insured and uninsured. When you consider that 2.8 billion people--more than half the population of all developing countries--live on less than $2 a day, you get an inkling of how little people in, say, Tanzania or Honduras have to spend on medical care, let alone prevention. If a wealthy, stable country like the U.S. can't provide good health services to all its citizens, what can resource-poor countries hope to accomplish? See Getting Health Reform Right for the complete story. Health Care Reform, anyone? 08/13/2009
 I don't think we can ignore the 800-pound gorilla in the room any longer. It's time to weigh in on the topic of the moment, health care reform. Over the next few days, I will be posting my own thoughts, as well as yours and those of other bloggers. Be sure to click on Comments, to add your thoughts. The above poster came from One Good Move, a very interesting site: http://onegoodmove.org/movabletype/mt-search.cgi?blog_id=1&tag=healthcare&limit=20 Got brain? 05/22/2009
Don't miss "At Card Table, Clues to a Lucid Old Age"in today's New York Times: http://www.nytimes.com/2009/05/22/health/research/22brain.html?_r=1&hp | Blogger Profile
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