Food and Health Rethought

great read :)

The data below underscores how often doctors fail. It really indicates that if you have any type of serious ailment and any doubts about your doctor’s recommendations, a second opinion is critical. Doctors should be required to better keep up with the latest medical evidence and should be required to take tougher annual tests to ensure they are indeed up to date with reality.

The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process—from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment. Physician judgment is highly variable. 

Here is what Eddy has found in his research. Give a group of cardiologists high-quality coronary angiograms (a type of radiograph or x-ray) of typical patients and they will disagree about the diagnosis for about half of the patients. They will disagree with themselves on two successive readings of the same angiograms up to one-third of the time. Ask a group of experts to estimate the effect of colon-cancer screening on colon-cancer mortality and answers will range from five percent to 95 percent. 

Ask fifty cardiovascular surgeons to estimate the probabilities of various risks associated with xenografts (animal-tissue transplant) versus mechanical heart valves and you’ll get answers to the same question ranging from zero percent to about 50 percent. (Ask about the 10-year probability of valve failure with xenografts and you’ll get a range of three percent to 95 percent.) 

Give surgeons a written description of a surgical problem, and half of the group will recommend surgery, while the other half will not. Survey them again two years later and as many as 40 percent of the same surgeons will disagree with their previous opinions and change their recommendations. Research studies back up all of these findings, according to Eddy.

On average, Americans only receive about half of recommended medical care for common illnesses, according to research led by Elizabeth McGlynn, PhD, director of Rand’s Center for Research on Quality in Health Care. That means the average American receives care that fails to meet professional evidence-based standards about half of the time.

McGlynn and her colleagues examined thousands of patient medical records from around the country for physician performance on 439 indicators of quality of care for thirty acute and chronic conditions as well as preventive care, making the Rand study one of the largest of its kind ever undertaken.

Even though clinical guidelines exist for practices like these, McGlynn and her colleagues found something shocking: physicians get it right about 55 percent of the time across all medical conditions. In other words, patients receive recommended care only about 55 percent of the time, on average. It doesn’t matter whether that care is acute (to treat current illnesses), chronic (to treat and manage conditions that cause recurring illnesses, like diabetes and asthma) or preventive (to avert acute episodes like heart attack and stroke).

How well physicians did for any particular condition varied substantially, ranging from about 79 percent of recommended care delivered for early-stage cataracts to about 11 percent of recommended care for alcohol dependence. Physicians prescribe the recommended medication about 69 percent of the time, follow appropriate lab-testing recommendations about 62 percent of the time and follow appropriate surgical guidelines 57 percent of the time. Physicians adhere to recommended care guidelines 23 percent of the time for hip fracture, 25 percent of the time for atrial fibrillation, 39 percent for community-acquired pneumonia, 41 percent for urinary-tract infection and 45 percent for diabetes mellitus. 

Underuse of recommended services was actually more common than overuse: about 46 percent of patients did not receive recommended care, while about 11 percent of participants received care that was not recommended and was potentially harmful. 

Here is disturbing proof that physicians often fail to follow solid scientific evidence of what “quality care” is in providing common care that any of us might need:

• Only one-quarter of diabetes patients received essential blood-sugar tests. 
• Patients with hypertension failed to receive one-third the recommended care. 
• Coronary-artery-disease patients received only about two-thirds of the recommended care. 
• Just under two-thirds of eligible heart-attack patients received aspirin, which is proven to reduce the risk of death and stroke. 
• Only about two-thirds of elderly patients had received or been offered a pneumococcal vaccine (to help prevent them from developing pneumonia). 
• Scarcely more than one-third of eligible patients had been screened for colorectal cancer. 

Here’s a counterintuitive consequence: the more years of practice experience a physician has, the more out-of-date his or her practice patterns may be.

Many doctors are incompetent, or at the very least have recommended things to me or my family which were simply wrong - or disagreed with the opinions of better doctors who were subsequently proved to be correct. This article validates that feeling I have with data, so it’s nice on some level to see that… On the other hand, some doctors, are brilliant wonderful geniuses, so it’s important to know which sort of doctor you are dealing with, and even then, it’s important to be careful.

via twilightfades

onegirlnodiet:

OK. I sensationalized that title slightly. Point is my AMA Morning Rounds informs me that the study points to marked similarities in brain activities in food and drug addiction: 

The Los Angeles Times /Hartford Courant (4/5, Weir) reports, “A new study from the Yale Rudd Center for Food Policy & Obesity,” which was published online Monday in the Archives of General Psychiatry, found that addictions to food and drugs result in similar activity in the brain.” Before reaching this conclusion, researchers recruited “48 women with an average age of 21 who ranged from lean to obese.” The participants “took a test developed at the Rudd Center to measure food addiction, based on an established test for measuring drug addiction.” The researchers discovered that “the brains of subjects who scored higher on the food addiction scale exhibited neural activity similar to that seen in drug addicts, with greater activity in brain regions responsible for cravings and less activity in the regions that curb urges.”

Read the full study here if you’re a science geek. 

WSJ coverage here.

Time coverage here.

CNN coverage here.

According to a nationwide study released by the Flagstaff, Arizona-based Translational Genomics Research Institute (TGen), meat and poultry from U.S.grocery stores have an unexpectedly high rate of dangerous disease-causing bacteria, including antibiotic resistant superbugs. In fact, almost half (47 percent) of all meat and poultry samples tests were contaminated with S. aureus.

What’s more, 52 percent of these contaminated meats contained superbugs, meaning the bacteria were resistant to multiple classes of antibiotics. That adds up to multi-antibiotic resistant Staph germs being present in about one out of every 4 samples of meat, chicken or turkey.

“For the first time, we know how much of our meat and poultry is contaminated with antibiotic-resistant Staph, and it is substantial,” Lance B. Price, Ph.D., senior author of the study and Director of TGen’s Center for Food Microbiology and Environmental Health, said in a statement to the media.

The research, published today in the journalClinical Infectious Diseases, is the first national investigation of antibiotic resistant S. aureus in the U.S. food supply.

The dirty truth many Americans — especially meat eaters — don’t want to face is that conditions on so-called industrial farms are not only often inhumane but downright sickening. Animals raised for slaughter are packed together densely and steadily fed low doses of antibiotics in their food. The new report concludes these industrial farms are the ideal breeding grounds fordrug-resistant bacteria that can move from animals to the human population.

I favor grass fed beef and pastured chickens.

it’s not that our bodies don’t get enough calcium, rather that they excrete too much of what they already have. 

High-protein foods such as meat, eggs and dairy make excessive demands on the kidneys, which in turn leach calcium from the body. 

 A study funded by the US National Dairy Council, for example, gave a group of postmenopausal women three 8oz glasses of skimmed milk a day for two years, then compared their bones with those of a control group of women not given the milk. The dairy group consumed 1,400mg of calcium a day, yet lost bone at twice the rate of the control group.

Most Chinese people eat and drink no dairy products, and get all their calcium from vegetables. Yet while they consume only half the calcium of Americans, osteoporosis is uncommon in China, despite an average life expectancy of 70. 

In South Africa, Bantu women who eat mostly plant protein and only 200-350mg of calcium a day have virtually no osteoporosis, despite bearing on average six children and breastfeeding for prolonged periods. 

There are irons concerns too.

half of all iron deficiency in US infants results from cows’ milk-induced intestinal bleeding - a staggering amount, since more than 15% of American under-twos suffer from iron-deficiency anaemia. The infants, it seems, drink so much milk (which is very low in iron) that they have little appetite left for foods containing iron; at the same time, the milk, by inducing gastrointestinal bleeding, causes iron loss.

the body may, when anticipating fatty or sweet foods, get primed for a big dose of calories. When those calories aren’t delivered, the body feels cheated and compensates by overeating, trying to achieve the sensation it expected to get from eating the delicious, high-calorie food it expected in the first place.

The scientists weren’t too surprised to find that people fell asleep faster when the bed rocked. But they were surprised at the big difference that rocking made in brain activity. Rocking increased the length of N2 sleep, a form of non-REM sleep that takes up about half of a good night’s rest. It also increased slow oscillations and “sleep spindles.” Sleep spindles are brief bursts of brain activity, which look like sudden up-and-down scribbles on an electroencephalogram.

“We were basically trying to find a scientific demonstration of this notion of rocking to sleep,”

The fact that the brain waves changed so much …was “totally unexpected.”

Sleep spindles are associated with tranquil sleep in noisy environments and may be a sign that the brain is trying to calm sleepers stuck in them. Spindles also have been linked with the ability to remember new information. And that is associated with the brain’s ability to rewire itself, known as brain plasticity.

Haha, it would be ridiculously fun to install an indoor hammock.