The Medicine Bag NewsOK.com Blogging Community

 You can be forgiven for thinking yesterday was anything more than a nice day to watch college hoops.

It was, but it also was National Doctor’s Day.

The American Medical Association uses the day to honor the more than 900,000 physicians in the United States.

“On this day of tribute, Americans can express appreciation for physicians’ continued commitment to providing exceptional medical care,” according to an AMA release.

The nation’s doctors, throughout almost 1 billion patient visits annually, are called to be healers, confidants and advocates, the AMA says.

The organization also says two-thirds of U.S. doctors provide some form of charity care and in 2006 were ranked the nation’s most trusted occupation.

Furthermore, the AMA says:

• Ninety percent of patients say they are very satisfied with their doctor.
• Americans’ life expectancy has increased by seven years since 1960.
• There has been a 77 percent decrease in the infant mortality rate since 1950.
• There has been a 63 percent decrease in the overall death rate for heart disease since 1950.
• There has been a 72 percent decrease in the overall death rate for stroke since 1950.
• There has been a 14 percent decrease in the overall death rates for cancer since 1990.

Do you consider the medical profession admirable and respectable? Do you respect your physician? Are you satisfied with him/her? Drop me a line at The Medicine Bag blog at http://blog.newsok.com/health.  

Now back to basketball!

Jeff Raymond, Medical Writer

USA Today had an interesting story yesterday about how the popularity of angioplasty, a commonly performed procedure in which doctors use a balloon to open blocked coronary arteries, may be eroding.

“The rise of angioplasty procedures has leveled off and appears to be on the decline,” Duke University’s Eric Peterson, who reviewed results of the analysis by the National Cardiovascular Data Registry, told the newspaper.

Three studies in the last two years that indicate that angioplasty may be no more beneficial than medication, and may be riskier. According to the newspaper, the research suggests angioplasty is used too often and its benefits don’t justify the procedure’s $10,000 to $12,000 cost.

The newspaper’s analyses found:

• The number of annual procedures performed each year has declined by 10% to 15% over the last two years.

• Angioplasty and stent use began dropping in June 2006, after two “landmark” studies cast doubt on them. Doctors often implant stents — both bare metal and drug-coated — after angioplasty to keep the artery open.

Angioplasty is used to treat the terrible chest pain, called angina, that comes from a heart without enough oxygen.  The slight decline is important because Centers for Medicare and Medicaid Services guidelines seek to have angioplasty available within 90 minutes of a patient’s arrival at the hospital. This is often called door-to-balloon time.

Many medical authorities tout the benefits of angioplasty.

Because hearts suffer from an inadequate blood supply, Bonnie Weiner, president of the Society for Coronary Angiography, told the newspaper, “(Angioplasty) is very effective at achieving more blood flow to the heart.” 

“I personally wasn’t surprised by the results,” says Michael Rich, a cardiologist at Washington University School of Medicine in St. Louis who will debate the study at the heart meeting.

Michael Rich, a cardiologist at Washington University School of Medicine in St. Louis, said angioplasty won’t prolong a person’s life or decrease the risk of a heart attack but will decrease the symptoms of one.

“The analyses conducted for the newspaper also reflect what may be the beginning of a broader change in medicine: a move toward ‘evidence-based’ care drawing on reams of data from medical research and patient treatment,” USA Today reported.

Jeff Raymond, Medical Writer

Researchers have seen that weight-loss surgery appears to cure type 2 diabetes, which they have attributed to the huge drop in pounds. After all, being overweight is a risk factor for diabetes, and losing weight can effectively take care of the problem.  

An article that appeared in a supplement to last month’s issue of Diabetes Care argues that the bowel is the site of mechanisms that lead to diabetes.

The study’s author, Dr. Francesco Rubino of New York-Presbyterian Hospital/Weill Cornell Medical Center, presents evidence on the mechanisms of diabetes control after surgery.

“Clinical studies have shown that procedures that simply restrict the stomach’s size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese,” according to a press release.

Rubino’s previously has shown that the main way gastrointestinal bypass controls diabetes is by skirting the upper small intestine — the duodenum and jejunum.

“It has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism,” according to the release.

Rubino’s findings suggest bypassing the upper intestine may work by reversing abnormalities of blood glucose regulation.

He guesses the upper intestine of diabetic patients may be the site where an “abnormal signal” is produced that causes or predisposes one to diabetes.

Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease,” he said.

What do you think of using surgery to treat diabetes? Have you had an experience with it? Leave me a comment at http://blog.newsok.com/health.

Jeff Raymond, Medical Writer

 Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.

A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.

The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.

Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.

The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.

And health care costs show no signs of flattening or decreasing.

Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.

Fidelity recommends:

- Creating an individual retirement plan

- Starting early and maximizing opportunities to save

- Assessing health status and becoming a smarter consumer of health care

- Determining details of any employer-sponsored coverage

- Understanding the financial impact of health care costs on Social Security income

Jeff Raymond, Medical Writer

If you’re interested in keeping tabs on your doctor, HealthGrades now offers a notification service.

The Web site, www.healthgrades.com, is best known for its hospital ratings. But given the information it compiles, a physician notification service is a natural addition.

The “Watchdog” e-mail alert service costs $4.95 a month.  

Notification items include board certification, disciplinary actions, malpractice suits and patient safety reviews.

Would you monitor your doctor? Would you pay to have someone notify you of lawsuits and other information of interest? Leave a comment at The Medicine Bag blog at http://blog.newsok.com/health. I’d like to hear what you think.

HealthGrades maintains quality profiles on almost every practicing physician in the country. The profile includes information on the doctor’s medical training, patient ratings, state and federal sanctions, malpractice judgments (in 15 states), procedure costs and hospital affiliations.

Subscribers to the service receive e-mail alerts when a physician’s information changes. Comprehensive physician profiles cost $29.95.

Jeff Raymond, Medical Writer