Thursday, May 27, 2010

Obesity Action Coalition - new campaign

I just got a paper copy of the magazine yesterday.

Your Weight Matters website

Not sure if it is replacing their regular magazine, or a separate publication, but it is very well written, and I think the campaign is admirable! We have to be empowered as a group, and this is how it happens!

There is a great article about Minorities - covering cultural and genetic issues. The Airline seat policy controversy is thoroughly addressed, and there are other great articles on advocacy, preop anxiety, and postop nutrition and mobility challenges.

I really commend OAC for taking on the controversies of Fattertainment and Childhood obesity also. Bigotry survives in our society by hiding in the shadows - those who struggled against all sorts of discrimination in decades and centuries past are very strong shoulders to stand on, but they have also shown that it requires real courage and active work!

Data doesn't lie, but it can fail to tell the whole story

article about HealthGrades Bariatric report (includes link to report)

These ratings are based on "expected" outcomes, but I can tell you from experience that the heroic Docs who run our University and major referral hospitals are taking care of unmeasurable levels of complexity in some patients. That does not make them automatically the best, but it is worth taking into consideration BEYOND the data.

My own personal care will not be chosen simply on the "star system", but I think these databases will continue to be more useful every year.

Excellent Blog Article from SCOAP

Return on Investment for Quality

This is really worth reading.
See previous post - SCOAP puts Washington State at the forefront of collaborative quality improvement.

Wednesday, May 26, 2010

Medications have risks, too

Liver Damage in 13 patients with Xenical/Alli

CBS link

This may or may not be the end of this story. We will only have to trust the FDA - Fen/Phen took a few years to have its major risks identified. 36 million people may have had prescriptions, but probably not 1 in 100 are taking it long term. How different would the data look if it ends up with 130, or even 1300 people injured out of 500,000 taking it more than a year? The benefit of taking this drug is not demonstrated to extend life expectancy (no non-surgical method has). What is the risk/benefit calculation if there is only minimal benefit???

I am not terribly worried about this drug, but the "next" med that actually has as much effect as Fen-Phen. Any new really effective med will sell like hotcakes (and be prescribed liberally). Any drug maker is in a huge rush to get to market for the BILLIIONS of dollars they will make with a winner. Just be careful with new things, whether operations or meds.

The sleeve gastrectomy only has a few large groups published more than 5 years out, but has been performed for more than 10 years... We have a lot to learn about exact techniques and effectiveness and patient selection, but the long-term issues seem to be limited to Reflux.

Thursday, May 06, 2010

Racism in BMI criteria?- need for new research to be reflected in Access to Care

92 million Diabetics in China

Here is the abstract of the New England Journal article

and even more than that on the borderline (148 million) note that the BMI's are much lower than the 1991 NIH criteria - see Dr Rubino videos below

This uncomfortable question is getting around the surgical community - if there is disease despite lower BMI, does using BMI as an exclusion for coverage constitute racism on the part of of providers and insurers? The NIH criteria were set in 1991 as expert opinion, which should/could be updated now with data from actual additional research (as loudly called for by many on that original panel!)

Washington State should be very proud

Tuesday I was able to attend the annual retreat for hospitals and medical centers involved in a massive coordinated safety and effectiveness group known as SCOAP (Surgical Care and Outcomes Assessment Program).

SCOAP homepage

Surgeons and anesthesiologists have been at the forefront of most major advances in systematic care improvement, from the residency training model, to hospital standards, to outcomes/evidence based care. Dr. David Flum is the brilliant leader of this, but I was just as impressed at the commitment of docs from around the state (from tiny critical access hospitals, to military hospitals, to huge University and regional medical centers) to take the time and contribute in so many ways to make the care of our fellow citizens better every day. It is measurable, and they have the data to prove it! These powerful cooperative tools require a lot from those who already give 110%. I am honored to know them, and hope that my hospital can participate soon.

The famous Atul Gawande MD, MPH was there as the keynote speaker (along with the Washington State Patient Safety Conference group), and gave a great lecture about Checklists in quality care. He stressed that the goal is quality, and the tools should not be confused with the mission. His articles are always insightful, and well written.

My former residency chairman Anthony Senagore MD MS MBA gave an invited lecture about recovery from colon surgery (Enhanced recovery protocol), and a great deal of new research is just starting to be applied - getting people back on their feet quicker, and avoiding costly and dangerous problems during the healing process. Thanks also to Dr Patch Dellinger for making the data on Surgical Site Infection more understandable.

Thanks also to Governor Chris Gregoire for the video greeting, and for funding the Governor's Life Science Discovery Fund that helps support all this.

Diabetes and Vascular disease

It's well known that most death from clinically severe ("morbid") obesity and from diabetes is related to heart and vascular disease - but this is a hint at HOW they are linked beyond just cholesterol and inflammation.

Your arteries may be suffering insulin resistance, too

ScienceDaily (May 4, 2010) — In people with insulin resistance or full-blown diabetes, an inability to keep blood sugar levels under control isn't the only problem by far. A new report in the May issue of Cell Metabolism, a Cell Press publication, shows that our arteries suffer the effects of insulin resistance, too, just for entirely different reasons.