California's housing crunch is exacerbating a Public Health crisis -- a deadly hepatitis A outbreak among the homeless - The Washington Post

California's housing crunch is exacerbating a public health crisis -- a deadly hepatitis A outbreak among the homeless - The Washington Post

How is San Diego facing the challenges of Homelessness and Hepatitis A ?

Forum for Homelessness

The Outbreak of Hepatitis A

How to help the  Homeless .  Donate

AHF Offers Free Hepatitis A Vaccinations .  San Diego County

Your Local Health Department provides information about Hep A vaccinations. The free program is funded by the Federal Government via emergency funds through your local and/or state Dept of Health

Are Doctors wasting your precious time in their waiting room, and then rushing you through the examination?

A friend of a friend was quite upset about having to wait for prolonged periods of time in a physician's waiting room

As a physician , what I hear most is that patients  have to wait in the waiting room for etended waits, then in the exam room like our time doesn't matter, then the doctor pops in for a few minutes.  

What do you do while waiting? Read old magazines? (if your HMO doctor even has books or reading materials in the waiting room.}

Studies have shown 'health literacy' is a key ingredient for compliance, improved outcomes and understanding your health challenges. What better time than to have planned short courses, videos, and/or interactive augmented or virtual reality presentations for patients, which are entertaining as well as educational.  This  "empty" waiting room time is expensive and wasteful of patient's and doctor's time.  This time is ideal for guided education and can be modeled for precision medicine.  Precision medicine is not just high tech pharmacologic treatment. Precision medicine implies specific and accurate diagnosis and treatment.

2018 and Health 3.0 can provide this wealth of material quite . easily with electronic libraries available and synchronized by the electronic health record to select appropriate material for patients to read, or watch

Based upon diagnoses in your EHR educational monographs could automatically be printed for reading in the waiting room.

There exists the tools to overcome these deficiencies if recognized and addressed.  Are we applying technology where it is most needed?

This Infographic Shows How Only 10 Companies Own All The World’s Food Brands | GOOD Money

Just when you think there’s no end to the diversity of junk food lining supermarket aisles, an insanely detailed infographic comes along to set us all straight. Out of the hundreds of products at our disposal, only ten major corporations manufacture the bulk of what we toss in our shopping carts.

So whether you’re looking to stock up on anything from orange soda to latte-flavored potato chips, Mondelez, Kraft, Coca-Cola, Nestlé, PepsiCo, P&G, Johnson & Johnson, Mars, Danone, General Mills, Kellogg's, and Unilever own just about everything you could hope to buy. It seems that six degrees of separation theory has been proven after all, if only because we all drink Diet Coke every now and then.

Obviously, the horrors extend far beyond our own shattered daydreams. Massive corporations squash entrepreneurial diversity and make it nearly impossible for startups and small businesses to compete. According to Oxfam’s report, “The world’s largest food and beverage companies have a lot of power – but you have more. And because they’re not using theirs enough to help poor communities or the planet, you can use yours to change the way they do business.”

If you’re looking to avoid contributing to the Big 10 world takeover, try shopping at local farmers’ markets and maybe skip out on soda and highly processed foods altogether. Your body will thank you for it in the long run anyway.In order to visually elucidate that point, Oxfam International created a comprehensive infographic that reveals the extensive reach of the “Big 10” food and beverage companies. Unlikely ties between brands we largely don’t associate with one another show how easy it is to be misinformed about the American food system. For example, PepsiCo produces Quaker granola bars, and Nestlé makes Kit Kat bars but also frozen California Pizza Kitchen pies. To the surprise of many, Pineapple Fanta isn’t sourced straight from the mythical Fanta Islands, but canned right alongside Barq’s root beer at the Coca-Cola factory.

This Infographic Shows How Only 10 Companies Own All The World’s Food Brands | GOOD Money

Blood test can effectively rule out breast cancer, regardless of breast density:

 An important advancement in breast cancer detection in women with dense breast imaging.

Dense breast tissue: What it means to have dense breasts

Dense breast tissue is detected on a mammogram. Additional imaging tests are sometimes recommended for women with dense breasts.

By Mayo Clinic Staff

If a recent mammogram showed you have dense breast tissue, you may wonder what this means for your breast cancer risk. Doctors know dense breast tissue makes breast cancer screening more difficult and it may increase the risk of breast cancer.

In the United States, laws require doctors in some states to inform women when mammograms show they have dense breasts. But just what women should do in response isn't clear.

What is dense breast tissue?

Dense breast tissue refers to the appearance of breast tissue on a mammogram. It's a normal and common finding.

Breast tissue is composed of milk glands, milk ducts and supportive tissue (dense breast tissue), and fatty tissue (nondense breast tissue). When viewed on a mammogram, women with dense breasts have more dense tissue than fatty tissue.

On a mammogram, nondense breast tissue appears dark and transparent. Dense breast tissue appears as a solid white area on a mammogram, which makes it difficult to see through.

Ref:

Breast density does not impact the ability of Videssa® Breast to detect breast cancer in women under age 50

This information is intended only as general, and patients must confer with their physician for interpretation of images and followup testing and/or treamtent

Blood test can effectively rule out breast cancer, regardless of breast density: With over a 99 percent negative predictive value, a liquid biopsy test can help clinicians manage difficult-to-diagnose dense breast patients -- ScienceDaily

Is the free healthcare system in Canada ineffective?

Is the free healthcare system in Canada ineffective?

Steve Murdoch, worked at Sun Life Financial Canada (1996-2014)

I live in Canada.. The biggest misconception is that Canada has long wait times for life threatening events. This is not true at all. For most elective surgeries such as arthroscopy on your knee or even a full knee replacement etc., you will wait. If you are diagnosed with cancer and need surgery tomorrow, you will get it. If we are under age 65 we still pay for prescription drugs but rules differ by province.

Health care costs per capita in the US are more than 50% higher than anywhere else in the world (according to WHO). From my perspective, I blame insurance companies and the litigation lawyers that defend them for the high costs. An American citizen who needs a knee replacement, for example, can fly to Panama stay in a state of the art hospital run by USA trained doctors and pay less than half for their surgery.

The real problem the US has to grapple with is not how to give universal health care but how to deal with the blow to the economy from the removal of 300+ million health insurance policies and a bunch of unemployed lawyers.

Sometime, somewhere, somehow, someone will have to rip the band aid off.

(4/1) Home - Quora

A Woman Went Blind After Stem Cells Were Injected in Her Eyes

Color photgraph of Retina Following Stem Cell Transplant

Last year, a 77-year-old woman traveled to a clinic in Georgia to have stem cells injected in her eyes. She came in hope of a cure—or at least something that could help her macular degeneration, which causes a dark spot to appear in the center of vision.

The procedure was supposed to work like this: The clinic would take fat from her belly, separate out stem cells that naturally occur in fat, and inject them into her eyes to regenerate damaged tissue. The procedure cost $8,900. It had not been approved by the Food and Drug Administration and was not covered by insurance. To pay out of pocket, she had to raise money on a crowdfunding site.

Her vision did not get better. It got much worse. Within three months, her retinas—the eye’s layer of light-sensitive cells—had peeled away from the rest of her eyes. As a result, she can only make out hand motions in her right eye and light in the left, according to a recent case report. She could no longer walk on her own.

In March, eye doctors based primarily at the Bascom Palmer Eye Institute in Miami had published a widely covered report describing three eerily similar cases: Three elderly women with macular degeneration got stem cells derived from their own fat injected into their eyes at a different stem-cell clinic in Florida. The same thing happened: Their retinas became detached, and they went blind. The doctors ended up examining the 77-year-old woman too, which led to the recent case report describing her condition.

And there are likely even more cases. Since writing the first report, says Ajay Kuriyan, an author on the report and now a retinal specialist at the University of Rochester, eye doctors around the country have come forward with similar stories of stem-cell injections gone awry. They are now preparing an article describing the additional cases.

“It’s just not a professional thing to take an unproven intervention and inject it in both eyes.”

A precautionary note:

1. No competent ophthalmologist treats both eyes simultaneously, even with approved treatments.
2. All credible treatments have been studied with a verifiable, repeatable study approved by the FDA.

Always ask the treating physician for scientific peer reviewed articles.
Always ask for a written consent form.  It should list all possible side effects and complications. This is an accepted standard of care.  Absent this document the provider is guilty of malpractice, and it would be indefensible in court.

Always ask your physician for a referral to a local ophthalmologist, (BOARD CERTIFIED) for his opinion.

The FDA has drafted guidelines on how to oversee stem-cell clinics. The agency says stem cells do not have to be regulated as drugs as long as clinics follow certain standards, like if they only minimally manipulate the cells and don’t change their purpose in the body. For example, transferring fat from the belly to breasts would not fall under FDA purview because the fat is still acting as fat. But if stem cells are being separated from fat and then injected to treat a disease, then the FDA may have reason to step in.

Remember if it sounds too good to be true, it probably is not.

New York Times Article

The National Eye Institute and the National Institute for Health fund many of these studies.

Clinical Trials lists all current research and the phase of study.

1. Clinical Study of Subretinal Transplantation of Human Embryo Stem Cell Derived Retinal Pigment Epitheliums in Treatment of Macular Degeneration Diseases

2. Treatment of Dry Age Related Macular Degeneration Disease With Retinal Pigment Epithelium Derived From Human Embryonic Stem Cells

3. Study of Subretinal Implantation of Human Embryonic Stem Cell-Derived RPE Cells in Advanced Dry AMD

Stem cell treatments are successful for specific disease. It is not a generic or 'miracle' panacea.

Gary M. Levin is a Board Certified Ophthalmologist.  He blogs regularly on topics related to health issues, diseases and health reform. Comments are welcome.

The View from Here

The View from Here

One of my other lesser known blogs is "The View from Here".  My topics there are in a slightly different realm.  I was reviewing it last night and came across several germane topics for Health Train Express.

When the Doctor Doesn’t Look Like You (or me)

So, your doctor doesn't look like you ?  Don't sweat it !

For more than 50 years, international medical school 

graduates have filled the gaps in the physician work force

 in the United States. Currently, they make up fully 

one-quarter of all practicing physicians, and 

although a majority 

are foreign-born, approximately 20 percent are 

American citizens who have chosen to go abroad, most 

notably to the Caribbean, for medical school.

Regardless of whether they are United States citizens, 

all international graduates must go through an arduous 

regulatory process before practicing in this country, a 

process that includes verification of medical school 

diplomas and transcripts, residency training in 

American hospitals and the same national three-

part licensing exams and specialty tests that their 

medical school counterparts in this country take. 

Many go on to choose specialties or work in the rural 

and disadvantaged geographic locations that their 

American counterparts shun. International graduates, 

for example, now account for nearly 30 percent of all 

primary care doctors, a specialty that has had increasing 

difficulties attracting American medical 

students...........................

Now researchers from the Foundation for Advancement of

 International Medical Education and Research in 

Philadelphia have published the first study incorporating 

new research methods for evaluating the performance 

of large groups of physicians. And it turns out that contrary 

to certain individuals’ worst fears, accent or nationality 

did not affect patient outcomes. Rather, the main factor 

was being board-certified: completing a full residency at an 

accredited training program, passing written and, depending 

on the specialty, oral examinations, and having proof of 

experience with a defined set of clinical problems and technical 

procedures.

Foreign medical graduates also tend to 'cluster' choosing to practice in like minded communities, Asian, Phillipino, Latino, Jewish, and other minorities. These demographics also tend to refer internally when possible.

Racial prejudice exists even in health care.

Teaching Doctors the Art of Negotiation - The New York Times

Doctors negotiate every day, almost constantly — sometimes dramatically, often imperceptibly. They hold family meetings to resolve sensitive end-of-life issues. They address barriers to medication adherence. They encourage patients to receive uncomfortable screenings like colonoscopies and mammograms. They refuse treatments that are requested but not medically indicated. Yet they receive almost no formal instruction in how to do so.

Dealing with medical colleagues creates an additional layer of negotiating complexity—especially in busy academic centers with competing demands on specialists’ time. Medicine is increasingly a team sport. In 1970, only about 2.5 full-time clinical staff cared for the average hospital patient; today, that number is greater than 15.

Doctors consult other doctors many times a day to discuss potential treatment options and decide on the best course of action. They work closely with residents, students, nurses, physician assistants, care coordinators and others to implement those plans. At each interaction, opportunities for collegiality and efficiency — or rancor and resentment — abound. That can mean the difference between a timely or delayed blood draw, accepting or refusing a consult, or getting those biopsy results today versus tomorrow.

Recognizing the importance of negotiation, medical schools are starting to invest in communication training for students — and it seems to be paying off. Research suggests communication training can improve patient adherence, diagnostic accuracy and chronic disease management. But good communication, by itself, is only part of the solution. We need to teach doctors how to negotiate.

Negotiation, in this context, is not about winning or losing, or haggling over price or scare resources. It’s about exploring underlying interests and positions to bring parties together in a constructive way. It’s about creative, innovative thinking to create lasting value and forge strong professional relationships. It’s about investigating what is behind positions that may seem irrational at first to understand the problem behind the problem.

The medical profession is no longer one in which doctors dictate a given treatment course to patients, who are then expected to follow it. Rather, clinicians and patients deliberate about treatment options, weigh costs and benefits together, and determine the best course of action. This approach requires eliciting patient concerns and addressing underlying fears to arrive at the most effective strategy for maximizing health and well-being. As diseases like H.I.V. and some cancers that were once uniformly fatal become chronic conditions, and a greater diversity of treatment options becomes available, the ability to negotiate long-term care plans will only grow in importance.

Healthcare Stole the American Dream - Here’s How We Get it Back | Dave C..., Bay Area Cancer Patient.. 

Health Train Express   Remove Healthcare Stole the American Dream - Here’s How We Get it Back | Dave C... 17 hours ago  .  Save  .  Twitter  .  Facebook Healthcare Stole the American Dream - Here’s How We Get it Back |   TEDx TalkThanks to Rob Lambert M.D. a pioneer in direct primary care for bringing this to m.. Read More → Bay Area Cancer Patient Confronts and Embraces His Right to Die | State of Health | KQED News Something all patients should know if you live in California and five other states, Oregon,  District of Columbia,Vermont, Washington and California. It is an ..Read More → Best preventive care? Get vaccines, and don't smoke - 20 hours ago  .  Save  .  Twitter  .  Facebook Doctors giving regular checkups will get the most bang for their buck if they advise adults to quit smoking, convince teens to never start, and keep children

The American Health System is Shameful

Guest Post from Quora

What do foreigners admire about the U.S. healthcare system? What part of their healthcare do they wish was more like the United States’?

Steve Grocott, Political insider /investor / businessman

Answered 21h ago

I am a American who largely lives outside of the US, I split my time between New Zealand, Australia and the US. I buy travellers health insurance when going home for a few months each year. I have used the universal healthcare in about 5 countries over the years. Even as a tourist it is usually free or heavily subsidised and of good quality. I have come to think the concept of a user pays healthcare system is about as useful as a user pays police system. The benefits to the economy, society and community of free healthcare far outweighs the profit system used in America.

I can’t imagine any country that looks at the American healthcare system, and thinks “we should only offer drugs and surgery to those than can afford it, we should send debt collectors after victims of accidents we have treated while they are still recovering “ it boils down to what kind of society you wish to live in. Millions of tourists each year are put off by the requirement to purchase additional Healthcare on top of flights and accommodation when visiting America. The only reason to keep the system is the huge profits made by drug companies, hospitals and insurance companies.

The Revised Declaration of Geneva: The Modern-Day Physician’s Pledge

A newly revised version of the Declaration of Geneva was adopted by the World Medical Association (WMA) General Assembly on October 14, 2017, in Chicago.

As the contemporary successor to the 2500-year-old Hippocratic Oath, the Declaration of Geneva, which was adopted by the World Medical Association (WMA) at its second General Assembly in 1948,¹ outlines in concise terms the professional duties of physicians and affirms the ethical principles of the global medical profession. The current version of the Declaration, which had to this point been amended only minimally in the nearly 70 years since its adoption, addresses a number of key ethical parameters relating to the patient-physician relationship, medical confidentiality, respect for teachers and colleagues, and other issues. A newly revised version adopted by the WMA General Assembly on October 14, 2017, includes several important changes and additions (Supplement).

• AS A MEMBER OF THE MEDICAL PROFESSION:
• I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
• THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
• I WILL RESPECT the autonomy and dignity of my patient;
• I WILL MAINTAIN the utmost respect for human life;
• I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;
• I WILL RESPECT the secrets that are confided in me, even after the patient has died;
• I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
• I WILL FOSTER the honour and noble traditions of the medical profession;
• I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
• I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
• I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
• I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
• I MAKE THESE PROMISES solemnly, freely, and upon my honour.

For 2500 years The Hippocratic Oath has been referenced as the 'gold standard' of medical ethics.  

HIPPOCRATIC OATH: MODERN VERSION

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Ethical Principles for Medical Research

The Revised Declaration of Geneva: The Modern-Day Physician’s Pledge | Law and Medicine | JAMA | The JAMA Network