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Posts Tagged ‘nutrition’

Adult “Selective Eating Disorder” to be included in DSM-V?

December 23, 2010 3 comments

Via John Goodman comes a story at LA Weekly reporting that the next released edition of the Diagnostic and Statistical Manual of Mental Disorders might include picky eating, or “Selective Eating Disorder.”  One of the lead researchers into the “causes and severity of the disorder” explains it thusly:

She went on to explain that these finicky eaters often reject food not because of taste, but rather because they find the look or smell unappealing or have negative physical or emotional childhood associations with food.

I know I’m only one-eighth of the way to being a medical professional and so might be missing out on something here, but it seems to me that what she’s saying is that sometimes people base their eating decisions on subjective personal preferences about the food in question.

Heaven forfend!

The implication seems to be that if you don’t like a given food for reasons other than taste, you may have a mental illness.  I wonder if that covers my avoidance of foods like deep-fried Twinkies for the sake of my health.

Much ado about vegetables

October 1, 2010 1 comment

Good nutrition, I’m told, is an important part of maintaining good health, staving off chronic disease, and feeling better.  Pundits, policy wonks, and the professoriate never tire of telling us this, especially at medical schools.  One of the ways in which we as North Americans are to eat better is to increase our consumption of vegetables.

Increasing consumption of produce, especially among poorer demographics who are less able to bear the increased cost of fruit and vegetables relative to less healthy options, is a goal around which there is much government activity, from food stamp subsidies, to state-supported farmers’ markets, to Michelle Obama’s efforts to reduce childhood obesity.

Imagine my surprise, then, to learn that alongside its non-trivial efforts to get Americans (including poorer Americans) to eat more vegetables, the federal government subjects imported vegetables to a 20% tariff.

One hand encourageth healthy eating, whilst the other taxeth the living daylights out of it.  Though I must say, this seems like a perfect way to make a dent in some of my classmates’ protectionist tendencies.

***

Of course, you can make vegetables as cheap as you like, but uptake will be limited unless people like eating them, and don’t have to spend inordinate amounts of time preparing them.  And on these criteria, certain elements of the healthy eating movement may have undermined their own cause by focusing on fresh produces and farmers’ markets to the exclusion of another, more convenient option:  frozen vegetables.  Megan McArdle explains.

And what post about vegetables would be complete without the shocking true story behind Canada’s most successful fake advertising campaign… for broccoli.  Having seen those ads, I can only admire their pure marketing genius.

Cavalcade of Risk #112: The Cavalcade Gets Schooled

August 24, 2010 5 comments

It truly is an honour to have been asked to host the 112th edition of the Cavalcade of Risk blog carnival!  After all, I am but a lowly, economics-trained fledgling first-year medical student who has been blogging here for less than six months (still considerably longer than my time as a med student to date!) and who still has the occasional blog formatting issue or two.

The excitement surrounding the start of medical school is far from wearing off; as a result of that continued excitement, I decided to take the Cavalcade with me to classes.  Remember:  everything you read here is fair game for the final (and the licensing exam)!

Cavalcade of Risk #112:  Medical School Edition

Behaviour and the Brain

The workers' comp adjuster described this case as "a major headache."

Brains are important.  There are several pre-clinical courses that deal with them, and not just because the subject has a starring role in the licensing exam (and on the menu at the Bistro Zombie).  The brain is the seat of our behaviour, emotion, rational capacity, and risk assessment capability.  Even with this fascinating organ working at full tilt, dealing with risk rationally can be difficult.  Of course, we humans are far from perfectly rational, which makes for even greater challenges.  GrrlScientist links to a TED talk in which a researcher tries to gain insight into the root of human irrationality by examining decision-making in monkeys.  [CONGRESS JOKE DELETED]

Regulatory Compliance

Perhaps the most fun part of medical school orientation is the parade of sessions required by law, by the university, or by the medical school, for little other purpose than to be able to check off a box and say “the students are aware of the policy.”

If legislation had animal mascots, you would be looking at the HIPAA Hippo and the Son of HIPAA Hippo HIPAA Hippo

Of course, some of this compliance information is actually high-stakes.  For instance, this year’s HIPAA training session included a portion on medical identity theft red flags.  However, as well-trained and as eagle-eyed as the medical students are, you are your best first line of defence when it comes to preventing medical identity theft.  Ryan from CashMoneyLife has a post that explains how patients can both detect and protect themselves from medical identity theft.

Physiology

The Physiology of the Medical Student

“Phys” is all about how stuff works.  The typical first-year physiology course is a detailed overview of how the body works under normal conditions.  It’s easy to take for granted the complexity and intricacy of the processes that keep us alive, in part because most of the time, it all works without any effort on our part (knock on wood).

Protecting the normal physiology of business partnerships is the subject of the next post.  Jacob at My Personal Finance Journey explains how a combination of buy-sell agreements and properly-structured life insurance contracts can be used to make small business partnership succession go much more smoothly with much less effort at a stage where there will already be so much in flux.

Histology

The upperclassmen tell me that we look at a lot of slides in histology. As you can see, I'm trying to get a head start.

Histology, the study of tissues, typically involves lots of staining, sketching, and microscopy.  While advances in technology means that some slides are digitized for ease of review, there’s still plenty of opportunity to get your hands dirty with “the real deal,” just like the Disease Management Care Blog did with his submission to this week’s Cavalcade.  Dr. Jaan Sidorov has found the National Association of Insurance Commissioner’s “Blank” proposal defining the medical-loss ratio, stained it, and put it under the digital microscope for all to view.

Pharmacology

Is it just me, or do four of these look like they're glitter-filled?

I’ve always been impressed by the ability of nearly every physician I know to rattle off drug names (and their indications, side effects, etc.) with seemingly perfect, instantaneous recall.  I’d imagine that the months-long pharmacology course in year 2 has something to do with that.  “Better living through chemistry” can be tricky to achieve if you don’t know your chemicals.

Jason Shafrin, the Healthcare Economist, describes one set of efforts to improve the benefits of pharmacological therapy by involving pharmacists more directly with the patient’s medication therapy management.

Pathology

Not to be confused with "path-ology," a course taught at schools of engineering and urban planning.

“Path” examines how the body’s structures respond to a variety of stimuli, usually bad ones.  It seeks to answer the questions “what’s going on here?  What’s wrong?  What do these cells do when we [injure/mutate/slander] them?”  In this vein, the ever-intrepid InsureBloggers emerge from their basement labs to look at one state’s new PPACA-created Pre-existing Condition Insurance Pool, and provide a concise and focused overview of its pathologies.

Anatomy

I’m fortunate to be able to use so much of the material from my undergraduate vertebrate anatomy class to review terms for medical school anatomy.  Despite the fact that, in college, we worked on cows and cats instead of humans, the similarities between the vertebrates are such that a comparative approach to anatomy can yield great dividends.  For instance, courtesy of National Geographic TV, I know of a whale anatomist who works out of a human medical school in New York City.

First-year anatomy: a whale of a good time? Or the course that will have you sitting in lab all sad and blubbering?

Joel, our next poster, uses the techniques of comparative insurance anatomy to arrive at this tongue-in-cheek “Plea For Car Insurance Reform.”  As with the vertebrates, insights from one area of the insurance world may be able to tell you something about the others.

Biostatistics and Epidemiology

The Notwithstanding Blog would like to remind all visitors to wash their hands and observe universal precautions during their visit

Biostats teaches medical students how to use quantitative tools at a basic level.  Being able to critically evaluate new biomedical research is a crucial tool for those of us entering medicine at this time of seemingly-exponential change.  Epidemiology more broadly examines health status and disease in the aggregate, including surveillance of epidemics and monitoring of health trends.  Careful use of the tools of these fields can allow one to make reasonable predictions about the future of wellness trends and epidemics, or, if you’re Louise of Colorado Health Insurance Insider, the future of PPACA-grandfathered insurance plans.

Extracurriculars

The range of extra-curricular activities at SUMS (Sorta Urban Med School) seems nearly endless.  There are running clubs, research opportunities, student government positions, specialty interest groups… the list goes on.  However, one set of time-honoured activities among medical students is health outreach and education within the local community.  Many medical schools are located in or near areas in which there are major problems with access to healthcare and accurate health information; students can and do rise to the challenge of filling those gaps as best as they can.

These outreach projects can range in tone from the humour-filled to the gravely serious.  Julie Ferguson at Workers’ Comp Insider shares a feel-good breast cancer awareness video, along with some other chuckle-inducing medical parody videos.  David Williams, host of Cavalcade of Risk #113 in two weeks, posts a guest piece about the lies and dangers of so-called “pro-ana” websites.

Material unrelated to the course that nevertheless shows up on the final because it’s the professor’s niche research interest

"Syllabus? What syllabus?"

One of the risks of starting medical school, with its concomitant classes and extra-curricular activities, is that it will affect your blogging output.  Nonetheless, I plan to stick around.  I invite all of you CoR readers to poke around the rest of this site.  If you like what you see (and even if you don’t), I’d love nothing better than to have you stick around with me!

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Cavalcade of Risk #113 will be hosted at the Health Business Blog.

Around the Mediverse: July 17, 2010

July 17, 2010 Leave a comment

Fun tidbits, health-related and otherwise, from around the ‘tubes:

  • How do the media deal with new research?  How should the media, or anyone else for that matter, interpret new research?  Unfortunately, the New York times only devotes a couple of paragraphs to this first question, but even that is enough to illuminate the complex web of incentives facing those in the science communications industry, and what it means for the science coverage that you see.  A blogger at Foreign Policy provides some useful advice in response to the second question.
  • File these under “overutilization” for sure:  Dinosaur accuses the American College of Obstetrics and Gynecology of “usurping” primary care’s scope of practice with new guidelines recommending OB/GYN visits for younger teenagers; MD Whistleblower blows the whistle on various “pre-emptive” CT scans that are being advertised to patients despite the fact that they don’t do much good for anyone.
  • Science-Based Medicine writes a rebuttal to a Slate piece linked to in the last edition of AtM:  Why Big Pharma should not buy your doctor lunch.  SBM also featured some well-written commentary about new CMS head Don Berwick, touching on his lax attitude towards pseudoscience, and the Central Berwick Paradox of supporting unlimited patient choice and top-down government rationing.  Or something like that.

Around the Mediverse: July 8, 2010

July 8, 2010 3 comments

Fun tidbits, health-related and otherwise, from around the ‘tubes:

  • Some questions have emerged about Supreme Court nominee Elena Kagan.  Reason asks if she would ban books.  Bloggers at the Volokh Conspiracy touch on what is arguably Kagan’s political manipulation of a medical specialty society’s statement on abortion.  It should be said that the American College of Obstetrics and Gynecology comes out looking worse than the nominee.
  • Though the response to the Deepwater Horizon spill has arguably been insufficiently aggressive, here are two commentators who argue that children should be taught to better express and receive aggression.
  • What is a “scientific consensus?”  Reason’s Ronald Bailey takes on this issue.  Along the way, we stumble onto this gem of a web page explaining the relationship between animal models of carcinogenic toxicity and the actual exposure of humans to those substances.  Much more non-technical than I made it sound.  Do give it a read if only to attenuate your own “cancer panic” over some of those chemicals.
  • David Williams at the Health Business Blog reminds everyone that hospital visits should be BYOMD.
  • Two recent guest posts at KevinMD point out that the concept of the patient-centered medical home is probably way overhyped, given the current evidence “for” it.

The UCSF-Altria imbroglio

July 2, 2010 1 comment

As the New York Times, its Prescriptions blog, and the San Francisco Chronicle have been reporting, there’s been a scandal of slightly more-than-minor size involving the UCSF Chancellor’s stock holdings.  Dr. Susan Desmond-Hellmann — the oncologist at the head of UCSF’ — disclosed shareholdings in the area of $100,000 in Altria, the company formerly known as Phillip Morris that makes most of its money from tobacco-related products.  Since that disclosure, followed promptly by divestment, Dr. Desmond-Hellmann’s holdings in health products/pharmaceutical companies and fast food companies — this time to the tune of millions of dollars — have come to light.  The investments were apparently made by a third-party financial advisor without her knowledge, and this advisor has since been instructed to purge her shareholdings in alcohol, tobacco, and firearms manufacturers.

Reading these articles prompted me to consider one of my earliest posts here, in which I argued that there is nothing unethical, unseemly, or untoward about life/health insurance companies holding shares in fast food companies.  Does the same argument apply to Dr. Desmond-Hellmann’s holdings?

Yes and no.

In my mind, the most problematic of her stocks are the pharmaceutical and health products companies.  These firms are probably vendors or research sponsors at UCSF, or have the potential to be.  The Chancellor’s shareholdings in these firms are substantial, and the potential for a conflict of interest is definitely present.  As one of the ethicists quoted by the Chronicle points out, recusal from decisions that would trigger this conflict may be all that is required, but continuing to hold the shares certainly creates the appearance of impropriety.  While some have pointed out that physician-industry relationships aren’t always eeevvvilll, as others would have us believe, there is a difference between productive collaboration of the sort Dr. Rich discusses and passive shareholding of the sort at question here.

I personally find her other shareholdings to be less objectionable.  Alcohol, firearms, soft drinks, and fast food are all legal products that can be used or abused, depending on who is doing the ab/using.  I see nothing intrinsically “evil” about them that should force medical leaders to steer clear.  Many of these firms (McDonalds, Pepsi, etc.) are also components of major equity indices, and as such may well have been chosen for that reason.  It’s highly unlikely that they will be directly involved with UCSF as vendors, donors, or sponsors, though I could be wrong about this.  Tobacco, however, doesn’t pass the smell test with me, especially not when we’re discussing an oncologist.  Arguably, it’s the only one of the products in question that is inescapably harmful regardless of how it’s used.  Of course, I would be remiss if I didn’t point out that there are lots of anti-smoking groups out there who have let their love for tax revenue outweigh their desire to reduce smoking.  This doesn’t make Dr. Desmond-Hellmann’s Altria holdings more palatable, in my view.  It just places them in the context of “how worse could it be/what company is she in.”

There is a growing obsession with rooting out conflicts of interest in healthcare, often under the rubric of reducing “waste and fraud.”  Much of this is a good thing, though as people like Dr. Rich point out, this obsession comes with a risk of harmful side effects.  More and more attention seems to be paid to “who owns which shares.”  Given that companies like McDonalds, Pepsi, and Altria are major blue-chip companies that are components of the DJIA/S&P 500 — thus likely to be held by many people and institutions — and targets for public health activists, it will be interesting to see how this plays out in the future, and where the line will be drawn for medical professionals who want to be perceived as “ethical investors.”

Around the Mediverse: May 13, 2010

May 13, 2010 Leave a comment

Fun tidbits, health-related and otherwise, from around the ‘tubes:

  • Unconfirmed:  15th century world maps labeled the location of what would later be called “America” with the warning “Here There Be Litigiousness.”  WhiteCoat links to an AMA report that looks at key differences between the US medmal system and those of other developed countries, with an eye to what differences may or may not translate into improvement in the US.  Great Z’s brings us the details of a case in which drugmakers were found liable for Hep C contracted by patients whose physician reused needles when administering the drug.  A guest post at KevinMD gives tips on how to survive a deposition during a medical malpractice case.  Edwin Leap reminds us that a large part of being a physician is the ultimate accountability for patient care… and that this accountability has to be compensated.
  • Jason Shafrin at Healthcare Economist runs down the math of running into a terrorist.  Bottom line:  don’t sweat it.
  • Greece and the Euro continue to be in the news:  what does it mean for us on this side of the pond?  Greg Mankiw links to an article that claims that crises such as that in Greece show that we cannot have democracy, nation-states, and globalization together.  Reason talks debt, deficit, inflation, and the future of America’s fiscal situation.  On a lighter note, Mark Perry shares a video showing what you can learn about economic communities if you literally follow the money.
  • The Health Affairs blog presents a proposal to “Reinvent The Primary Care Workweek.”  Importantly, they realize that the quality of the job is at least as important as payment in getting more students to choose primary care fields.  Of course, a patient load that small means that you need more people to join the ranks pretty quickly after implementing the model.  Seems like a good idea, but we’ll see what happens.
  • Finally for this week, Scott Greenfield brings us a lengthy, compelling, and disturbing story from the Village Voice that takes an inside look into incentives and operations at the patrol level in New York City’s 81st precinct.  From a political/legal/libertarian point of view, it’s frightening.  If you insist on putting a health policy lens on it, call it what happens when you implement the ultimate pay-for-performance system alongside the ultimate EMR.  Enjoy…
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