Progress is not always exciting... But still takes effort

Here at the big meeting - we seem to cover a lot of the same subjects, but every year things move forward.

The sharing and mutual education from around the world, the involvement of more specialties and Allied Health professionals will make best patient care and outcomes.

I am learning so much about successes and challenges of colleagues. Very excited about more minimally invasive approaches, new tools, new thinking.

It's how we improve exponentially faster than by experience alone - instead, it's "experience together"!!

At the Annual ASMBS meeting - San Diego

It is always a treat to run into friends from training, and to see those people who we follow virtually on emails, phone calls, etc.  The first part of the week is dedicated to Allied Health Professionals - and the work they do to keep programs on track is impressive.  Change happens with deliberate effort.  This is a group with passion, focused on delivering high value, high quality care.

The new quality initiative with American College of Surgeons (MBSAQIP) is the next step in making progress for the care we all aspire to.

I wish patients and administrators could see this stuff happen, but the results will speak for themselves!  Data is not easy to obtain for long term care, or for complex disease and treatment.  This new project makes it more affordable, less cumbersome, more useful.

Making progress with Regional Chapter ASMBS ND, SD, WY, MT

Last week (the Saturday of Memorial Day weekend)  Dr Lloyd Stegemann of ASMBS and Joe Nadglowski, President of Obesity Action Coalition gave up time with their families to help Surgeons and Allied Health Practitioners from Colorado, South Dakota, North Dakota, Wyoming, and Montana start Chapters of ASMBS.

Colorado is populous enough to do its own Chapter, but the rest of us are coordinating to form a Dakota/Yellowstone Region chapter.  One surgeon drove through the early morning hours after being on call the night before - from South Dakota!  That is commitment, and I am very proud to be associated with such devoted caregivers.  More to come on this after our national meeting in a couple of weeks!

MOST IMPORTANTLY!!!  The influence we can all have together - our competition is not other towns, surgeons, or hospitals - it is limited access to care...

I am excited to help lots of people in our region join OAC, and to make a difference in the health of so many.  If we are able, we will partner with employers, insurers, hospitals, equipment makers, and legislators to eliminate the institutional bias that keeps people from evidence based care!

Please take some time to explore the links over on the right side of the Blog.  I am learning WordPress, and will be making this more dynamic, but the basics are not hard to find.

Thank you for caring, thank you MORE for signing up for OAC, and making your voice count!

Video Blog about Obesity Action Coalition (OAC) and advocacy!

Bullying - the role of weight bias

Joe Nadglowski commentary about weight bias and bullying

Thanks for another great piece of writing! The OAC continues to lead...

Sleeve coverage great link. And I am a man of mystery!

I am more active on my Twitter feed of late - will get more active here soon!

This link is the official ASMBS, SAGES, Obesity Society, and ASBP response to Centers for Medicare and Medicaid Services regarding Access to Care for Sleeve Gastrectomy.

asmbs.org/2012/04/asmbs-…

The link to comment has a button at the top of the page to select the comment period.  If you commented lately, you will need to "reset" to the more recent group to find yourself.  Apparently, I am not allowed to reference myself as a patient, so some of my comment was "redacted"!

Wow!  I feel like a spy!

Call to Action: irresponsible Medicare denial of Sleeve coverage

Ok - I have been neglectful of this blog!  Have been retweeting a lot of the interesting stuff I see online, instead of posting links here.  Some good stuff on @bonuslife

I will post again soon with report from trip to DC for advocacy, but want to call URGENT ATTENTION to all about Medicare's unbelievable rejection of coverage for Sleeve Gastrectomy just yesterday.

HERE IS THE LINK FOR YOU TO COMMENT (may have to copy and paste to browser)

Many thanks to the leadership of ASMBS for their call to action.

The entire text of the decisions can be found here:  http://go.cms.gov/Hel9dT

You can comment easily - just use the button on the top right of the page.


Here is my public comment - but please post your own - every person counts (and it can be short!)

Subject: Public Comment for Bariatric Surgery for the Treatment of Morbid Obesity

This is a notification that CMS has received your comment, as stated below, for the subject topic.
First Name: Walter
Last Name: Medlin MD
Email: --------

Comment: As a metabolic surgeon, and sleeve gastrectomy patient myself, I am distressed at the number of avoidable deaths this policy will cause. I have many Medicare patients who are waiting for this coverage for various reasons. 


Many are poor candidates for the adjustable gastric band due to large hiatal hernias or fear of the variable outcomes with bands. Some of these also have had celiac or inflammatory bowel disease, or nephrolithiasis, or extensive small bowel adhesions that greatly increase the risk of gastric bypass. 


This policy forces our seniors into a bad choice, and I speak from personal experience. This rightfully will be construed as an economic and discriminatory decision, setting the bar unnecessarily higher than for other disease treatments. 


While I agree that study of all our treatments should continue, it is frankly outrageous that this well studied, widely adopted intervention is rationed from our most worthy citizens. 


Unfortunately, I will have to bring obituaries to my Senators and Representative. This is a dangerous, harmful decision. I respectfully request that you immediately provide full coverage in line with STAMPEDE trial criteria.

Address #1: 2800 10th Avenue North
Address #2: 
City: Billings
State: Montana
Zip: 59107
Phone: 4062382500
Fax: 
Organization: Billings Clinic












Here is my letter to our Montana Senators.  Many thanks to their team for wonderful visit last week!  I didn't think it would be this soon that we had a crisis to discuss!








Dear Senators Tester and Baucus,

It was very nice to meet with you and your staff last week.  

I hope you will ask Medicare officials to listen carefully and respond to comments on their decision to deny coverage to millions of Americans for Sleeve Gastrectomy.

As a surgeon with the means to pay, I went into my own pocket to receive this care, but most of my patients do not have that option.  It really is terrible to see them suffer needlessly when we have effective, durable, evidence proven treatments that are life saving and life altering.

My blog and Twitter posts may be a bit too passionate, but I hope your team might review the links to the cooler heads at ASMBS, and stop this policy that hides bias between the lines of "we need more studies".  That sounded hollow coming from the tobacco industry, and from opponents of safety systems in cars.  It sounds no better coming from our Medicare administrators.

Thanks!

Walt Medlin MD

Billings, MT

blog - www.bonuslife.net

Twitter @Bonuslife 

Below is the email I am sending out to Bellingham PeaceHealth St Joseph Medical Center Physicians and Allied Health Practitioners today...

Dear Colleagues,

It has been an honor to work with you all these last 2 ½ years. Though I have consulted on over 200 patients for obesity and metabolic issues, we have only been able to take 12 to surgery here locally, because of a variety of factors beyond my control. My practice closes this Friday. Dr. Bachman has agreed to take over my charts for clerical continuity, with the understanding that specialty Bariatric care is appropriately referred to regional providers. I include a partial list below, and encourage you to use these providers for your own liability protection when patients are complex.

I have been asked to start a Bariatric Surgical program at Billings Clinic in Montana, to complement their World-Class Endocrinology service. I will still get to do Trauma and General surgery as well, so will be fully engaged and supported in a tertiary center.

My only regret is knowing that many will continue to suffer and die needlessly without treatment here in Bellingham. Many just do not have the resources to travel. Most patients now do have excellent coverage – it simply is a matter of finding the location that accepts it.

I hope to keep making my blog a valuable place to send patients to explore links and resources www.bonuslife.net
And my Twitter is @bonuslife

Again, many thanks for being so supportive. Please continue to speak up for this group that is so stigmatized and unfairly marginalized by society and industry. Your compassion alone makes a difference, your timely referral saves lives!

To quote Goethe – “Knowing is not enough, we must apply. Willing is not enough, we must do”
Or to paraphrase - Actions speak louder than words!!!
Sincerely, gratefully,
Walt Medlin


REFERENCE FOR REGIONAL RESOURCES------

University of Washington – has 4 world class surgeons who I know well. They are the best of the best.
800-326-5300 for Medicon, or 206-598-2274 for the clinic.
(http://uwmedicine.washington.edu/Patient-Care/Our-Services/Medical-Services/Bariatric-Surgery/Pages/default.aspx)

www.pugetsoundbariatrics.com based in Edmonds, with office also in Barkley area.
Drs Landerholm, Billing, and Crouthamel are excellent, though a bit controversial with same-day surgery for sleeve gastrectomy.
I do not believe they take Medicare, but do have preferred provider status with PeaceHealth. 800-558-6514

www.NorthStarMedicalSpecialists.com our local Medical program with Dr Tony Burden (at Lakeway entrance to I-5 N) 676-1696
Dr David Lauter comes up from Bellevue, and does take Medicare with his Center of Excellence at Overlake

www.nwwls.com in Everett has until recently been only Lap-Band (which is falling out of favor). Drs Michaelson, Chock, and Montgomery are now adding full spectrum care, including Sleeve Gastrectomy and Gastric Bypass. They are a great clinic, and nearest actual OR facility. 800-350-2263

www.ghc.org Group Health covers many of our Whatcom County neighbors, and does a great job, though the out-of-pocket expense is >$1,400

Swedish, Virginia Mason, Evergreen and Northwest Hospitals all have excellent programs as well, with Center of Excellence certification.

Madigan Army Medical Center is actually a national leader. I highly recommend them for your patients with Veteran’s benefits (and spouses)
http://www.mamc.amedd.army.mil/gensurg/referrals.htm



Dietitian Support - Rachel Akins RD at South Campus has extensive experience with the Group Health Program.

www.accomplishbariatric.com is a Seattle based telephone Dietitian counseling service that I have used with great results. They are very cost effective, though not usually covered by insurance (4 sessions are less than $300 though!)


Psychological Support – Marlene Sexton LMFT has been our local professional, and runs a highly regarded support group as well.

Free support group (which all post op patients should attend at least a few times each year) is 7PM the first Wednesday each month at the HEC.

Shame on you KIRO-TV!

This is the most frequent comment after the article/video - and that about sums it up...

Join the Obesity Action Coalition - we need to fight ignorance with education. Stigma is being used here to fuel sensationalism, but we can use this as a starting point for engagement. If KIRO has integrity, they will follow this up with a series of the VALUE of care for Metabolic and Obesity related conditions and mortality.

KIRO-TV Seattle piece that will raise your blood pressure!

I grew up with this sort of loaded language around gender and racial discrimination being widespread. Now those are reduced a bit, or hidden under deeper "coded" language in the media, or hidden from the public view. Discrimination with weight is still open, raw and ugly... and allowed because it is still a commonly held view.

The worst thing about this is the sexism - the hissing voiceover that implies spoiled lazy women, and reeks of the old "welfare queen" name calling. Our country is defended by WHOLE FAMILIES who make sacrifices, and they deserve to be treated with dignity.

I have been interviewed several times for TV and print. It is obvious that those interviewed here were given the impression that this was going to be a fair piece. I dare KIRO to release the full unedited interview tapes, so we can see how this trap was set. Investigative journalism should not be cowardly.

Very Sad - Meds have risks, too

This is not to minimize risks of surgery....

I have had several patients with increased Blood Pressure as a side effect of Phentermine.


Death of Bubba Smith - coroner report on E Online

Hormonal impact on dieters regain - more evidence

Australian Study of long term hunger hormone changes after Diet

"Our study has provided clues as to why obese people who have lost weight often relapse. The relapse has a strong physiological basis and is not simply the result of the voluntary resumption of old habits," he said.
Dr Proietto said although health promotion campaigns recommended obese people adopt lifestyle changes such as to be more active, they were unlikely to lead to reversal of the obesity epidemic.

Caregivers are slowly getting the word - but ingrained opinions will still be shaping (distorting) medical practice for some time... Institutions have to help change practice with guidelines and with appropriate coverage. Hopefully Secretary Sebelius of HHS will show leadership!

Stigma allows Georgia to Discriminate against Obese

It is hard to believe a State could get away with cutting access to care across the board to any other disease.


CNN Video - thanks to ASMBS for spreading



"Sorry, we no longer can afford chemo, we won't pay"

"You made a decision to become pregnant, we won't pay"

"You crashed your car while over the speed limit, we won't pay"

"Cardiac stents have a rate of restenosis and failure, we won't pay"


We will look back at this years from now with the same disbelief that we have now for other forms of institutionalized discrimination.



.

Adjusted or Maladjusted?

Appetite is so much more than just hunger. Stress creates a desire for food in my life that is recognizably different from sustenance. Luckily, I get to have a front row seat to the struggles of others - sort of a built in support group. Life is always going to be a challenge, but the self image we take forward has a lot of influence.

My attitude will never be sunny all the time, but if I can trust myself to listen, the down days won't spiral out of control. Unrealistic expectations get me in trouble, but happen less as experience finally gives me perspective. Those with innate maturity are lucky!

Anyhow, hope this helps if you are having that sense of being overwhelmed...

What it means for me in practical terms is relieving stress (mostly with exercise) and using Mindfulness to recognize the opportunity here and now to simply be with the situation, without struggling - even if just for one breath (and it's always one breath!)

Risks of meds - new data

Pancreatitis and pancreatic cancer risk with newer Diabetes Meds

Recent articles Bariatric/Obesity care and access

Hypertension

STOP Obesity Alliance Director Christine Ferguson, J.D.

Importance of Acceptance vs Rejection

Obesity in Pregnancy - Infection Risks

Mild Obesity much more Risky in South Asians...

This is one of the primary reasons I relocated to Bellingham. This article confirms in Canada what the research in India and China have been saying for several years.

McMaster University research for increased susceptibility in South Asians with mild obesity

Unfortunately, the epidemic of Diabetes and Metabolic Syndrome seems to be ignored by the politicians and public health officials in British Columbia. Other provinces recognize the role of surgery in effective treatment, and the need for large scale, coordinated efforts to combat this. Maybe it is latent racism against immigrants, because the medical leaders in Vancouver are certainly fighting the good fight to make the facts known in the halls of power.

What needs to happen is for the community to speak out - and be heard "loud and clear"...

"Many Canadians of South Asian descent -- as well as those of Aboriginal, African and Chinese descent -- are experiencing historic levels of risk for heart disease and stroke. It is only through research like this that we can learn how better to treat and prevent these diseases, so lives are not cut short," said Mary Lewis, vice-president, research, advocacy and health promotion of the Heart and Stroke Foundation of Ontario. "The Heart and Stroke Foundation of Ontario is proud to support such important work."
Dr. Arya Sharma, director of the Canadian Obesity Network and a co-author of the study said: "This study helps explain why South Asians experience weight-related health problems at lower BMI levels than Caucasians. For the clinician, this also means that individuals of South Asian heritage need to be screened for the presence of heart disease and diabetes at lower BMIs."

Indeed - screening and research are important - but deploying known effective tools should not be delayed. Lives are being lost unneccesarily - every day. Why doesn't BC allow 5,000 operations per year, instead of 50?

We are killing ourselves with inactivity and obesity related diseases

Importance of muscle mass in insulin resistance

GET TO THE GYM, OR DIG A DITCH!!!! Anything to build muscle...


Declining US life expectancy from middle aged inactivity and obesity

Gastric Bypass food preference changes?

Study from UK for fat intake

Lots of people talk about how food tastes a bit different. I thought my cheese habit was high fat, but maybe it's still better than it used to be!

When will Obesity become a conservative hot button?

Conservatives should care about obesity for their own valid reasons

When they run the country "like a business" we had better make sure our employees (and wards) are cheap to keep, and very productive! It's not cost of health care that's a problem, it's lack of value.

We will get more "Bang for the Buck" from Evidence based medicine - and obesity care has the very best evidence! (thanks to Dr Dixon, as well as Dr Rubino, Cohen, Schauer, Morton, Shikora, Pories, Sugerman, Buchwald... too many to list on one screen!)

Looking forward to visiting ANYONE in DC willing to take leadership on access to care. Many thanks to Rep Edolphus Towns for giving us a great start on the Obamacare side. You sir, are a leader!

Dentists and Diabetes detection

Here is a nice article, with several older related articles on the sidebar.

Look back to older posts for the millions of undiagnosed diabetics in the literature.

Periodontal disease, and point of care Hemoglobin A1c testing

Incontinence treatments - not all benign

Careful of the implants...

I have seen too many women getting consultation for bariatric surgery who had unsuccessful bladder slings, when the intraabdominal pressure of obesity was a more likely cause.

Exercise, baby! No, really...

To fight obesity, even babies should exercise

I really like this... free range toddlers sounds a bit dangerous, but most of us were pretty wild and roamed free as kids. I definitely spent much more time in front of the TV with each year.

Caregiver shortages

This is only one factor leading to problems. Productivity and limited hours and aging population will have effects, too.

Health Reform leading to increasing shortages of Providers

Several interesting articles - obesity, health care, DM

This is a big stack of articles, but all worth a read!



Physicians Best Managers of Hospitals

Obesity is a Killer in Nonsmoking Women

Weight Loss Surgery effective against PCOS infertility

Obesity Help Seattle Event homepage

Pre-pregnancy diet effects offspring - Mouse study

Link Between Obesity, Chronic Illness, and Bullying?

Set Point for Mood?

Epidemic of Fatty Liver Disease

So much news - here's a taste! (more to follow)

I have a lot of stories and updates from last week's meeting of the ASMBS and Monday"s OAC Capitol Hill visit...

Things to give news on:

Essential Health Benefit - next few months are crucial for access to care! - Expect this to be the theme of many future posts.
PLEASE lend your voice - it really makes a difference when legislators hear directly from you!!!

The CHOICE Campaign is one way to have immediate impact Click here to sign the open letter

Rural access to care - new ASMBS President Dr Robin Blackstone is personally involved in making the Center of Excellence system work for patients and programs.

Surgery for Metabolic Disease in Class I Obesity (BMI 30-35), and the limitations of BMI to make individual health decisions
There are large studies underway which likely will deliver the highest level of evidence to support care - but they are not yet completed. Many other studies without true randomization already clearly show benefits.

Duodenal Switch - getting much more exposure in debates and as viable alternative to Gastric Bypass in selected groups


State by state advocacy and networks growing

New national advocacy programs and networks of organizations working together

As we always expect - vigorous exchange of ideas for new approaches and tools - this is maybe more conservative than in previous meetings, but there is still a lot of work going forward

Excellent basic science keynote and public health keynote

Recession seems to be impacting growth, but perhaps less enthusiasm for the Adjustable Gastric Band is slowing some programs, also.

Gastric Plication / Imbrication experience growing - promising data even over several years in some overseas reports



I have several pages of notes, that may just get put up with minimal editing to at least minimize my procrastination! It is a blog, after all, not an epistle!

Forgive me for "dropping names" in future posts, but so many of these folks work so tremendously hard and are so smart - they deserve massive credit!!!! My only worry is incomplete notes - don't want to offend anyone by failing to recognize!

Diabetes, Insulin, Obesity more linkage, also smoking...

New Article




smoking, satiety article

Canadian First Nations - rising Diabetes rates over 20%

A diabetes epidemic is affecting First Nations people, especially women in their prime reproductive years, according to a new study in CMAJ (Canadian Medical Association Journal). The incidence of diabetes was more than 4 times higher in First Nations women compared to non-First Nations women

First Nations Diabetes in Canada

"What is clear is that the rapid appearance of type 2 diabetes particularly among First Nations people and other indigenous and developing populations has been precipitated by environmental rather than genetic factors," state the authors. "Its long term solution will require effective primary prevention initiatives that are population-based and driven by public health and community initiatives."

Maybe the authors would like to consider the genetic vulnerability of the First Nations ethnic groups, as we are seeing in South Asian ethnic groups... Then we could consider the combination of environment and genetics - acknowledging the complexity of the epidemic.

The community initiatives are building, but only with advocacy.

Male Testosterone recovery after Gastric Bypass

Testosterone recovery in Men


There's an older article on the blog about erectile dysfunction and recovery, this is a bit different, and newer.
One of these is the older article - I didn't dig back thru my old posts to compare...

Utah testosterone study

Boston/Philadelphia Urology study on sexual function

Breast Cancer Death Risk - proven almost 70% worse in Obese

Breast Cancer survival difference

but is this an appropriate conclusion? You be the judge!

She (study lead auhor Christina Dieli-Conwright, PhD ) continued, "With the obesity epidemic on the rise, weight management programs using exercise and diet are vital in cancer prevention and survivorship."

Clearly to withold Weight Loss Surgery in such a patient is discriminatory based on Evidence. That's the evidence that all our insurance companies and hospitals are not mandated (yet) to follow.

Please raise your voice - join the OAC (Obesity Action Coalition), write a letter every week to a hospital board member, an elected official, an HR executive. Retweet! anything helps - and silence kills

Striking Genetics Editorial, and bigoted comments

Genetics editorial

This is a fairly simple editorial to help explain the susceptibility to obesity, but look at the seething hate and ignorance in the comments.

Wow, we have a long way to go. I got real grief from a nurse the other day because she believes the risks are too high. Well, it's better to show 'em than tell 'em! When we get good results over and over, I feel sure she will believe.

Unfortunately, Bellingham has long been neglected for dedicated Bariatric care, so a lot of patients have been "ad hoc" treated. Our docs are generally only seeing a patient rarely, and the treating surgeons are quite varied, from all around the seattle area and even North America - from Ohio to Mexico, even a few who went to Spain.

A Long Way to Understanding Obesity

Here is a little secret your doc won't easily give up... We know a LOT about HOW diseases happen, but we don't know exactly why! What is the difference? Well, just because I can't tell you how you got appendicitis - doesn't mean we can't save your life from it.

Not all diseases are preventable all the time, or I wouldn't be up at night taking out appy's! Also, diseases that we have known causes for still happen.

My point is that childhood obesity EFFECTIVE TREATMENT should not wait for full understanding. Keep working on it, scientists, but let's get the multidisciplinary treatment teams together and do something in the meantime.

If your kid needed a life saving kidney transplant, how old would you require him or her to be to prepare and consent for surgery?

Childhood Obesity Research - YAY!

Lethal Inactivity - Beyond Exercise

Dr James Levine - Mayo Clinic Article NYT

I have read ( and probably blogged) about his research before. This is particularly good.

I had a "standing desk" in Duluth, and it was wonderful. Almost made one of his homemade treadmill desks - just for 1 mile per hour non-exercise energy expenditure.

This is how we redesign our society from the bottom up!

Dietitian's dilemma

Many very certain lectures have been given on this subject.... - Beware certainty! Even though I am quite certain of the data with bariatric surgery, we are only beginning to understand HOW things work.

High fructose may not be the answer

Also, beware the non-surgeon's lack of data on the single case, short term success (also frequently brought out for lectures to convince you that it's just a willpower problem)

Yale's Rudd Center on regain risk

Unfortunately, the Rudd Center doesn't seem to get quoted on the relative success rate of surgery at 20 years (still an average of 50% excess weight off) versus their database of 800 patients (collected from around the world) at one year...

Ask your dietitian for long term data in their practice!

Weight Loss Surgery superior for Diabetes, Heart Disease?

Cardiovascular superior results

Your primary doc will soon be following the data in "Pay for Performance" Unfortunately, too many people die needlessly every day of disease that was avoidable with CURRENT evidence and techniques.

As Dr Adams says in the article - while surgery will always have some risk, in those with Type 2 Diabetes, the non-operative risk is actually much higher.

I am continuing to offer physician education in clinics, as well as at conferences, dinners, and elsewhere. Please encourage your primary and specialty providers to educate themselves!

I recently heard an esteemed local endocrinologist make the excuse "well, I don't know much about surgery". I am scandalized that one could purport to be an expert in a disease and be willfully ignorant of a therapy that could put over half of his patients into full remission. Yes, discrimination is that strong even among docs!

IF YOUR DOC HAD A PILL THIS EFFECTIVE, HE OR SHE WOULD KNOW EVERYTHING ABOUT IT! Don't let them hide.

Older patients benefit from surgery

Minnesota study of over 65 patients

I have operated on several patients as old as 73 - definitely have to take extra time for individual goals and risks, but these folks are often the ones with the very worst mobility limitations, and daily pain.

Diabetes - Quote from the National Institute of Health

Gastric bypass and other bariatric surgeries to treat extreme obesity may resolve type 2 diabetes independently of weight loss, opening the door to discovery and to new therapeutic options for some individuals.

Diabetes strategic research plans for NIH

Article about the strategic plan

NIH Obesity Strategic Plan

Then they go on to mostly talk about strategies that don't involve remission... well, be glad you have control over your own health in some way. People feel disempowered because insurance is difficult, but there are almost always options.

Science Genetic Control of Diabetes

It's great that research will be taking us forward. Years will pass, and if you are diabetic right now, the disease is hurting you faster than the research will produce more than the tools we have in front of us. If you want your diabetes in remission, there is a tool available.


Science Insulin Sensitivity

Good Reason to wear your CPAP!

Mortality of sleep apnea in elderly improves with CPAP use

Of course, probably the best thing is to put the disease into remission.

This would be a great study for the very elderly with gastric plication... We are certainly reluctant to do anything with patients over the age of 75 - will try to get more information on these issues at the upcoming ASMBS (American Society for Metabolic and Bariatric Surgery) meeting.

Diabetes and Cancer link

cancer risks of diabetes

Mice aren't all the same either!

Turns out we don't even know as much as we thought about mice... and so many are out jumping to conclusions on very little detail in humans. Let's be careful with the knowledge we have - life doesn't have many guarantees.

Not all skinny mice live longer

Liposuction for shaping, not for fat reduction

This is clarifying - we have seen it individually - nice to know that there is a study to validate.

Fat comes back other places after liposuction

Polycystic Ovary Syndrome (PCOS) and Infertility Links

We are learning more about the vulnerability of different people to certain diseases. Why some are Diabetic with just modest excess weight is one of the most important.

Fat tissue is an active endocrine organ - making and processing signals that the body uses to regulate energy sensitive tasks, especially. Female and even male fertility are very sensitive to these changes, but not in the same way for everyone.

PCOS and diabetes risk - characterizing the mechanisms

Obesity Action Coalition review article on Infertility

Obesity in pregnancy - Health of the Newborn

Iron deficiency, possible effects and causes

Technology that will make a real difference - comfort and colonoscopy

As someone who has done hundreds of colonoscopies, I am really looking forward to this finding its way into our working endosuites.

As someone who has had 3 colonoscopies, I hope my next one can be done without sedation.

Advanced Colonoscope using fiberoptic nanotechnology

Canadian Outreach Day Plans

Saturday May 21 we are planning an outreach day in the Vancouver area. More to follow as times get set, and invites sent out.

Here is one of the recent Vancouver Sun articles on WLS... 2011 is ticking by.

Access issue in Lower Mainland BC worsens

Call for "Dirty Dozen" Ignoring Evidence for Diabetes, Obesity Access to Care

I have been saving some of these up last few weeks on call - hoping to get PeaceHealth to change its out of date access to care restrictions that are anything but "evidence based" (quote from PeaceHealth Mission Statement)

If you want to send me your organization's absurd restrictions, I will post a "dirty dozen worst plans in Washington State' after the ObesityHelp meeting in Seattle this June.


HERE ARE SOME GREAT EXAMPLES OF THE EVIDENCE TO FOLLOW (just in case any executives happen to read this post)


ASMBS statement for Access to Care


Britain's National Health Service Diabetes Study

Wow! Here's a great quote from a socialized medicine perspective!

Alberic Fiennes, a bariatric surgeon and chairman of the National Bariatric Surgery Registry (NBSR) Data Committee, said the treatment should be made more widely available on the NHS.

"An approach that limits treatment to a fraction of those who would benefit is one which the NHS will rue in years to come as these patients become an unsustainable burden on the health service," he said.

"Prevention strategy alone has proved ineffective; there are at least two generations of morbidly obese patients who are now presenting with diabetes, stroke, heart disease and cancer for whom preventative measures are utterly irrelevant."

International Diabetes Federation Statement

IDF press release


Increased Heart Disease Risk for Teens

Arkansas State Employee coverage

Pregnancy, newborn risks, hysterectomy risks

I am always talking with my OB/Gyn colleagues about preoperative liquid diets like we use for Bariatric surgery to get "room" to work inside the abdomen. Here is data to show that the heavier abdomen is truly a more hostile surgical environment.

If you want to find out more about a 2-4 week high protein, low calorie liquid diet, I will try to post on that with a later edit to this date... or you can call our office 360-752-9888.

Articles from UK

Cancer risks and Diabetes - we can intervene

Here is real opportunity to save lives - forward to your Human Resources or legislator.

Major Increase in Cancer risk for Diabetics

Why everyone has to learn about QALY

This is ridiculous - to not consider the cost of a medication, but then demand that other types of care be subjected to "cost effectiveness" tests... We need a level playing field for what value taxpayers and patients are getting - Quality Adjusted Life Years, or QALY is the way to do that.

Please see the quote from Dr David Flum at University of Washington in the article from day 1 of the NYC Diabetes Conference.

A billion dollars for less than 2 more months of life?

The data is Here... more NYC Summit

Nobel Laureates speaking as keynotes, Swedish long term data

I think we can say definitively that the science is in! There is always more to learn for exact mechanisms, and refining techniques. Insurers and the government may hedge because of perceived costs, but for most individuals the question is answered. Your life and health are better with surgical control of Diabetes and Obesity. To deny this is to simply put money ahead of people...


even the American Heart Association recognizes the benefit

News from NYC Diabetes Summit

Cost effectiveness of surgery for Diabetes

Profound Emotional Suffering - worldwide now

It is inspiring to see a researcher who is so sensitive to the impact of society's dysfunctional judgements. So many of us internalize that incredibly demeaning and disempowering hatred. I guess the only upside is what going through hell can teach you about compassion...

Traditionally tolerant societies showing intolerance, anti-obesity attitudes

Brain response article

There are a lot of related links to older articles on the sidebar, too.

enhanced reward response in vulnerable children with family history of obesity

Science is just beginning to appreciate individual genetic neural and behavioral variability - we are all similar, but not the same!

Mortality of medications

I get asked about the mortality of surgery quite often, but will your diabetes doc tell you the mortality rate of their treatment?

Turns out some meds increase the death rate

excess DEATHS with popular Diabetes meds



Here are some selected quotes from the link----

"431 excess deaths for every 100,000 patients who receive rosiglitazone rather than pioglitazone"

"Given that there are about 3.8 million prescriptions for rosiglitazone dispensed annually in the United States, "the effect on public health may be considerable," they warn."

In an accompanying editorial, Victor Montori and Nilay Shah from the Mayo Clinic in the US argue that the rosiglitazone story "says much about how healthcare has become less about promoting patients' interests, alleviating illness, promoting function and independence, and curing disease, and much more about promoting other interests, including those of the drug industry."

Somebody correct my math - that gives 16,378 deaths from this med....


NOW - if we do the math for DEATH from gastric bypass, that is 0.003, or 3 per thousand. if 3.8 million diabetics all had surgery, the mortality would be 11,400 - BUT the diabetes resolution rate is almost 90%! So at the end of a year (using a conservative 80%) then over 3 million people would be off ALL diabetic meds.

Ouch.

Of course, to get that done, a thousand surgeons would have to operate on almost 400 diabetic patients a year, every year for a decade - which is about double the current rate of bariatric surgery for obesity.

Good update on technology

No magic bullets in the pipeline

This is an article from the New York Times that summarizes the limitations of many promising advanced innovations. What we have is actually pretty great with gastric bypass and related operations, and it will be pretty hard to actually "beat" them in the long term.

Toughest study yet on Gastric Banding problems

This may have some of the limitations pointed out by the Allergan rep, but still, there are more problems with Bands than we were hoping for. While Gastric Bypass has its very real risks, the weight loss and Diabetes control are far superior..

I think the perspective of most surgeons is that the average person greatly overestimates the short term risks, but underestimates the long term consequences of the choice. This doesn't mean "be afraid", it means "be prepared".

self compassion

worth living as your own best friend

This perfectly echos the "take Responsibility, but don't need Blame and Shame" message we have been saying for years

Very nice to see it validated!

Early Diabetic Deaths, US vs Canada

50 year old Diabetic loses 6 YEARS of life expectancy


Certainly different climates, as well as food policy

Obesity Cancer risk - Breast

Health Day article

Dr Rubino's study

You could fly to New York and participate...

Can't wait for results!

We are very quickly headed toward individualized access to care, guided by disease and risk, rather than a BMI number...

Role for Plication? Preop Weight for other procedures.

I think any program would more highly recommend gastric bypass, which has a proven track record, and durability. But, if the patient won't accept the best, we should still offer options.

These sisters have been in the news for their transplant - I didn't realize they had an obesity issue. Thanks to Dr Bachenberg for sending me the link!


Need to lose major weight to qualify for an operation

I have yet to see the research article this newspaper refers to, but it is not a surprise. Programs see this, and my recent visit to my old program in Duluth confirmed our experience there. Many Band patients are quite happy though, and I will continue to place them, with as much informed consent as humanly possible.

Gastric Bypass more effective than Band

Excellent NPR story

Listen to this!!!

Great Jane Brody Advice

She has been writing sensibly about healthy living for a long time - I remember articles from my college days.

This one is just a great summary - so often things are made over-complicated.

New Government Guidelines

Bioenterics Intragastric Balloon Removal Video

We plan to offer removal for those who have had them inserted out of country.

Why I had Weight Loss Surgery

Rising Rates of Stroke in Middle Age

It's not quite as dramatic a risk factor as Diabetes, but my Hypertension scared me to death. It's much better controlled now, so I'll probably get hit by a bus!

Seriously though, these risks are important. Real lives are destroyed. When we talk about "comparing the relative risk of surgery to that of non-surgery" keep articles like this one in mind.

Shout out to all who attended the benefit last night for Ali McCabe in Duluth - sorry to miss the party!

Need for systematic disease management

The biggest problem here is a lack of an integrated health system that keeps the medical "to do" list prioritized based on evidence based impact. Instead we play "whack-a-mole" with whatever happens to stay on the patient's mind...


Gestational Diabetes and later risks

126 Million Americans with Diabetes or Glucose Intolerance

America does have awesome medical capability, we just don't deliver it where it's needed! This is where other systems get a lot more bang for the bucks they put in.

Economic Study of Obesity Cost

Very High cost of obesity to the Individual

Very sorry that this is not common knowledge....
So many patients don't think they are worth the investment, or that they will see benefit.

Paying for healthcare goes against the grain for many of us - but the hard truth in this economy is that help is NOT necessarily on the way from government, employers, or institutions (argh!)

What is to be done? We have to work in a community for advocacy, but not expect immediate results.

In the short term, my goal is to provide service as affordably as possible. This means keeping materials and handouts fairly basic, and depending on people to use online access to "extras" Every cost moderating decision we make helps keep us from having a "gold plated" price structure. We aim to be a bit like Costco - clean, friendly, value based. If you want posh surroundings, we can recommend a couple of really nice hotels!!!

Diabetes and Breast Cancer Survival

We are learning more every year about increased incidence, and increased lethality of many types of cancer with rising BMI, especially from younger ages.

link to article

There's a lot to be studied before making conclusions about what might be the cause, much less what might be an effective intervention. These articles always end with "keep good blood sugar control", but who knows if that will change anything. I certainly wouldn't endorse Bariatric Surgery in a particular disease finding, but we DO know that overall survival increases after surgical intervention from the Swedish Obese Subjects (SOS) trial, and from large studies by Dr Christou in Quebec and Dr Buchwald in Minnesota, among many others..

Breakfast yes, maybe not breakfast feast!

It's so easy to go overboard...
I think we are metabolically more complex than the argument that all calories are treated exactly the same, but look out for anyone who is selling a diet based on some magic "combination" or timing that is going to let you consume twice as much!

Article on "Big" breakfast not being helpful for later reduction

Treat Sitting Like Carbs?

sounds like a good idea - looking to see more studies to reinforce

article link

I had a "standing desk" in my office in Duluth, mainly to keep myself alert, but plan to build one to use in Bellingham (my accountant has a nice one)

Obesity Discrimination in Presidential Politics

Awareness coming to the media

As a professional, I have experienced hiring discrimination based on obesity, and it's probably even worse with working class jobs.

Governor Christie is a multi millionaire!

Nice synopsis of the limits of Sleeve

Just doing some reading of back issue links, and I think this article gives a good insight into the "art" of surgery and medicine that we physicians have to deal with when the data is not sufficient to give all answers.

I agree with the author though - the sleeve is a reasonable balance of risk vs benefit for a large number of patients, but they should each understand that there is a chance that it may require future revision. "Failure" of the operation does not mean that the patient, surgeon or the operation deserves any "blame" however. Unfortunately, it is usually the poor patient who blames him or herself - often unfairly.

No perfect operations, including sleeve!

"SLIMBRICATION" - Dr Dan Cottam Salt Lake City

Wow - what a great visit on Friday to see Dr Dan Cottam perform a laparoscopic gastric imbrication. This is a very exciting newer procedure that is probably the least invasive intervention yet. It will be some time before we have good medium and long term data though.

In the meantime, expect to see it offered in people who have a failed Lap Band, or who are reluctant to have the Gastric Bypass or Sleeve procedures.

Here is his great video - likely soon he will be performing a combination sleeve and imbrication - Slimbrication!

"> v


and here is the link to his YouTube Channel



I have also started a WMedlinMD YouTube Channel, though it currently has instructional lectures, not an updated information session. My old information session from 2007 is linked on the right side of this page, and here. Since it was on Google Video, I havent' figured out how to put it on YouTube yet...


CHAPTER 1 - INTRO / BMI



CHAPTER 2 - BAND & BYPASS OPERATIONS



CHAPTER 3 - LAPAROSCOPY




CHAPTER 4 - BENEFITS AND RISKS




CHAPTER 5 - SUCCESS HABITS



CHAPTER 6 - CHALLENGES




CHAPTER 7 - PROGRAM STEPS, SUMMARY

Doing some Canadian reading

I have been getting acquainted with Vancouver a bit over the last year. I have avoided making too many direct contacts for fear of the lack of control of my billing as an employee surgeon. Now that I am independent, we can set some reasonable prices for consultation and Lap Band fills, followup for Out-of-Country patients, etc (planning to offer Vertical Sleeve Gastrectomy and Gastric Imbrication for competitive prices)


Anyhow, I found Dr Yoni Freedhoff's blog through CTV... havent' contacted him yet, but he is absolutely on base regarding the loss of access to care for Ontario residents!

Shout out to my friends in Thunder Bay!

False savings in access-restricting "cost containment" measures by Ontario


DR YONI'S BLOG

Provocative topics

CNBC "Ban Obese Workers? video!!!

Subsidizing Obesity Video

"Downside of Downsizing"

I have mixed emotions about these opinions, and definitely think the first video is over the line...

FDA news - results!

NYT approval article


Lap Band Approval for BMI>30

ABC news video

BMI 30 data to FDA - BIG NEWS

New York Times article on Allergan proposal

Nice links for resistance exercise, diabetes, adolescents

resistance training for kids


Diabetes best response - Exercise including resistance

Diabetes epidemic Half all adults


VIDEO Adolescent surgery

Next Information Seminar Tues Nov 30, 6:00 PM

Same address - Health Education Center 3333 Squalicum Parkway, Bellingham


360-752-9888
Our NEW OFFICE PHONE is working, and appointments being taken
(if you need to be seen before Dec 9, call PeaceHealth Cordata 738-2200)



Here is a link to a Bloomberg story about Diabetes in India

Video Link India Diabetes

I have only watched it once.. didn't hear all the audio.
Note that the surgeon interviewed is listed as a "Metabolic Surgeon"!

Welcome to Pacific Diabetes and Weight Loss Surgery!

We are getting this address turned into a real website in the coming weeks. Look forward to seeing you at our first information seminar on Tuesday October 26 - at the St Luke's Health Education Center at 3333 Squalicum Parkway in Bellingham, Wa (just a block west of PeaceHealth St Joseph Medical Center).

We will be doing at least two information sessions per month once we get the practice officially started on December 10th, so don't worry if you miss this first one - there will be more opportunities!

Our new contact and office location will be published in future newspaper ads (and here online), but until December 9th, I am still seeing patients at PeaceHealth Cordata General Surgery clinic - at 4545 Cordata Parkway - 360-738-2200.



Side note - I am getting a "comment" message from a postoperative patient who wants to see me, but don't have an email address to reply to - please call office, or email wmedlinmd@gmail.com - thanks!


Our online ad is in rotation this week at http://www.bellinghamherald.com/

More on medical weight management

This make some sense - much of what we do in behavioral counselling doesn't require a medical degree.

That doesn't mean you don't need a doc for your health, though!

TOPS article

Telephone counselling effective

Genetics and Obesity

Get ready for a lot more information like this in the next few years! True understanding is going to take decades to develop, though, and the complexity means that there will likely never be a single "magic pill"... Different people have different vulnerability (and different environments) - as well as different health effects from the same "disease"

Multicenter Genetic Study

Arthritis and Obesity - impact on productivity?

This is not surprising, but I don't see some employers recognizing the link, or the very significant impact on their most experienced workers. "Blue collar" industries are actually pretty far ahead on this issue, because they have experience with so many other work fitness issues (my best experience was a tour and interaction with the Bath Iron Works shipbuilding facility in Maine...)

Arthritis article

UNDER CONSTRUCTION!!!!

THIS BLOG WILL BE TURNING INTO A FULL WEBSITE SOON

STARTING DECEMBER 10TH, I WILL BE OPENING A NEW PRACTICE IN BELLINGHAM, MOVING FROM PEACEHEALTH MEDICAL GROUP. UNTIL THAT TIME, I CONTINUE AT PHMG TO SEE PATIENTS IN CONSULTATION FOR ALL TYPES OF SURGERY, INCLUDING BARIATRIC SURGERY, AND TO PERFORM ALL TYPES OF BARIATRIC SURGERY EXCEPT DUODENAL SWITCH, WHICH I PLAN TO ADD IN 2011.

THE NEW PRACTICE WILL CONTINUE TO INCLUDE GENERAL SURGERY CARE, AND POSTOPERATIVE CARE OF PREVIOUS BARIATRIC PROCEDURES.

STAY TUNED FOR MORE!

Irony from Ontario

Diabetes risks for pregnancy, baby in Ontario

The blind eye of policy as it relates to evidence. The quote at the end is just priceless - a glib pronouncement about prioritizing Diabetes prevention and treatment (as related to a very expensive study) in the same year that Ontario slashes the access of its patients to out of country care.

The real message is that millions are available to study and publish, but don't actually treat the greater population. Sorry for our Ontario peers - you are victims, but not alone in the world of policy hypocrisy.

Just to clarify - we need research, it just needs to translate into rational care. At some point, "we need more information" becomes a delaying tactic at the Governmental Level...


When your Minister of Health takes action based on evidence of Diabetes remission (hint hint) - I will eagerly highlight that here, too!

Canadian Diabetes Summit Article

Average 5 year wait for surgery

This is only counting patients in the queue, of course!

Estimates quoted here of major cost savings for treating diabetes with surgery in appropriate patients, also.

Not a good day for the Drug Industry (and later update)

Increase in nonfatal heart attacks and stroke with Meridia - and NO change in survival

Contrast with proven survival benefits with surgery - see previous posts and Vancouver Sun article for Diabetes remission (Archives of Surgery source)


UPDATE late October - (now that Meridia is withdrawn from the market)

Qnexa FDA rejection (2 drugs in one week - not much left in "pipeline"

Here's a quote from the end... of the article

"If there isn't any kind of path forward for this drug I think it is going to shut down all obesity drug development for a decade," said Dr. Tim Garvey of the University of Alabama. Garvey conducted two clinical trials of Qnexa and has consulted for Vivus.
"Why would a company put all that investment into developing a drug if the FDA signals they aren't willing to approve it," he said.
With U.S. obesity rates nearing 35 percent among adults, doctors and public health officials say new weight-loss therapies are desperately needed. And even a modestly effective drug could have blockbuster potential.
But the search for a drug that helps patients safely shed pounds has been largely unsuccessful. Two weeks ago Abbott Laboratories withdrew its pill Meridia from U.S. and Canadian markets after regulators said it increased the risk of heart attack and stroke.


The answer is that Phen-Fen had 18 MILLION prescriptions, and made a lot of people money, even if there was ultimately more harm than good out of it... The drug companies will keep trying, as they should, but there is no "silver bullet" - even surgery is not a cure, but a tool.

Gastric Plication - more to come!

Dr Dan Cottam VIDEO

Don't have to lift heavy weights at gym -Yay!

Lighter Weights are effective

One less barrier to getting in the gym - easier on the joints... also allows some variety!!!

Waist circumference (abdominal fat distribution) articles

German study on Diabetes risk in BMI>25

Double mortality rate in those with "normal" BMI, but thicker waist

BMI not as reliable in elderly (UCLA)

Thicker waist Independent risk factor in Arthritis progression

Evidence at Endocrinology conference - Gastric Bypass Superior

Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better Than Diet, Study Finds

And yet the last paragraph (see link) Dr Korner appears to have an attitude of "well, we will research this" rather that "we need to get THIS tool to the sick people who need it" Maybe I am overly sensitive, likely her statements are very selectively edited (ie., maybe it is the reporter's bias), but where is the call to action for the excellent tool we already have?

Are researchers only interested in supporting the pharmaceutical industry? I honestly don't think so, but you would be hard pressed to show evidence otherwise from this article.

If your endocrinologist, dietitian, insurer, or employer want to ignore evidence, you need to get this article to them by registered mail!

More articles on epigenetics, life expectancy

Intrauterine environment important for later obesity risk

One of many studies showing that it's not just the DNA, but the womb that are important factors in predisposition to obesity.

(and another annoying "headless" photo - dehumanizing heavy people, and making the excuse of privacy)


Below are articles to bring to your HR director at work (especially the last one - shows them they are not just losing money having increased health costs...) Many seem to ignore the fact that newly treated WLS patients are often the most enthusiastic, loyal employees! Also, those who are the sickest are least likely to change jobs, due to worry about any new job not covering pre-existing conditions. Companies need to invest in treating this disease - but they need to be educated, and offered organized programs. To their credit, some insurers are actually working on this (I will deny saying most nice things about insurers, but they are not all bad)

Increasing Loss of Life to Obesity




Obese Employees Take More Sick Leave



Finally, I had a very nice visit tonight with a support group at Virginia Mason, and last night with the group here in Bellingham. Both groups are super impressive - both with good listening leaders, and great sharing, discussions, and real SUPPORT! I certainly felt supported as a patient - thanks!

More evidence on individual vulnerability to obesity

link to report on Science Daily

Tell your skinny friends - we're not all wired the same! This doesn't mean we can stop worrying about lifestyle, food choices, etc - but hopefully will keep people from completely blaming themselves... (see at least 5 posts below for the theme of "taking responsibility without shame/blame"!!!)

SIMPLE Timer tools for Eating, Separating Fluids from Solid

I saw a great timer/ eating utensil set at ASMBS meeting last week - I think they are very useful looking, and sure to get even more refined. I look forward to getting feedback from users.


I haven't had too much problem eating too fast, but know that is a long term issue for patients. Actually, I think many eat so fast in 10 minutes that they can't finish a reasonable amount of food, then get "hungry" an hour later (or spend 20 minutes washing down food with immediate liquids) , then next thing you know, they are "grazers"!!!

This tool for the Treo/Palm platform helped me watch time go by over a 30 minute timer for meals. Kept me pacing my bites, then a followup 45 minute clock reminded me when I could drink after my last bite.

It is very easy to set up all sorts of custom timers - and tickles me that it is borrowed from the meditation world! This is mindfulness! Seriously, though, I do try to meditate, but exercise seems to be my main meditation.


Found a similarly reviewed product for those with an iPhone or iPod Touch - looks to be just as good. I can honestly say this type of tool may save people a lot of painful drift away from healthy habits.

Here are some comments on it



Finally - FOOD LOG, and EXERCISE LOG are critical for me - but I have NO fancy, or even basic software.... Just make an entry every day in my Calendar (on Palm, but will migrate to Google Calendar when get new smart phone..) and put my meal time and a basic description under the "note" attached to the "food Log" event. Super Easy, Super Fast - but totally on the record!

With exercise, I just enter it directly on the Calendar as an event - "Run 30*** Northshore Trail, Lift C/S/T (my abbreviation for Chest/Shoulder/Triceps)*** 6 sets, 15 minutes Weight ___ @ gym

I only put down my weight a couple times a week, but do get on the scale every day. My other "Lifts" are B/B for Back/Bicep, and L/A for Legs/Abdominals. For me, a three way breakdown keeps the lifting brief enough that I get it done in 15-30 minutes, so have very little excuse not to get it in at least 3 times per week. If I try to do it all at once, it gets overwhelming. That's where everyone has to figure out what works for their life and personality.


Keep it simple, but don't try to live totally unstructured!!! We all need SELF support first and foremost.

Infertility, Cardiac risks

Just a quick couple of links to come back to later - want to spend some time on the maternal issue from Quebec data showing improved obesity rates in children born after mom had Bariatric Surgery (duodenal switch in that clinic)

We just had a great lecture two weeks ago from a Seattle OB/Gyn whose clinic has stopped doing IVF in any patient over BMI 50 - looks like those in the article below have even tighter criteria.

In vitro fertilization failure rates in obese moms





Also, this issue is in the news today after a major Diabetes Conference just ended. 100,000 extra heart attacks, failure, strokes, deaths possible with this single drug - wow! It is very commonly used. I don't think we have enough respect for how complex the systems are that we manipulate. Surgery is certain to have risks, but they are not usually so insidious.

Avandia bad outcomes for 100,000 - Event rate more than 1 in 60?

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.

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.

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.