My Doctor Medical Group

Why You Should Still Be Thinking About Bisphenol A (#BPA)

Paul Abramson MD — Mon, 24 Oct 2011 16:10:09 +0000

The concerning news about ongoing Bisphenol A (BPA) exposure in the US population continues to come from a variety of sources, including an editorial in the Huffington Post (1).

BPA is an organic compound used to make polycarbonate plastic and epoxy resins, and has been used in a wide variety of consumer products, from baby bottles to cash register receipt coatings. Concerns about the health effects of BPA started to appear in 2007 , and in 2010 Canada declared BPA a toxic substance. BPA is known to have estrogenic activity, which can disrupt the body’s own hormonal systems.

BPA is ubiquitous in consumer products, despite efforts to remove it from some, including liners of food cans (i.e. Campbells), coatings of store recepts, and dental sealants.

1. BPA exposure, especially in the perinatal period, may

have persistent effects on obesity;
adversely affect brain development and function;
predispose to addiction by altering dopaminergic funciton;
affect thyroid function;
predispose to breast cancer;
affect sexual and reproductive function adversely;
lead to prostate enlargement and possibly increase risk of prostate cancer. (2)

2. Despite efforts to remove BPA from human contact, recent research and news has found:

People absorb BPA through the skin via coated paper products like cash register receipts, even ones labeled “BPA-free” according to an article in Chemical and Engineering News (3);
BPA levels in the fetus are higher than in the mother (it’s bioconcentrated, at least in rats) (5);
An article just released in Pediatrics links in utero BPA exposure and neurobehavioral problems at 3 years in girls (4).

Effects on developing fetuses have been much more clearly demonstrated than on adults. But that doesn’t mean it’s not having effects – it’s just harder to show less dramatic effects.

Efforts to remove BPA from baby products are fine, but really inadequate. Like Europe, we need to take more aggressive action to remove BPA from our ecosystem completely. Until then, parents, parents-to-be, and probably every else needs to educate themselves and be very aware of products they are in contact with.

Paul Abramson MD

References:

(1) Sarnoff, Rachel. “BPA-Free? Not Exactly.” Huffington Post, 10/10/11.

(2) “Bisphenol A.” Wikipedia.

(3) “Bisphenol A is Ubiquitous in Recepts. Endocrine Disrupters: Researchers detect BPA in every receipt they collected from seven U.S. cities.” Chemical and Engineering News. 10/3/11.

(4) “Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children.” Pediatrics. 10/24/11.

(5) “Distribution of bisphenol A into tissues of adult, neonatal, and fetal Sprague–Dawley rats.” Toxicology and Applied Pharmacology. 9/15/11.

Integrative approaches to sclerosing cholangitis and ulcerative colitis

Paul Abramson MD — Fri, 14 Oct 2011 18:33:12 +0000

Andrew Weil, M.D. interviewed Dr. Abramson for an article on drweil.com on 10/14/2011.

Question:

“My husband has been diagnosted with sclerosing cholangitis and ulcerative colitis. What supplements or nutritional approaches could help him?”

Answer:

Primary sclerosing cholangitis is a chronic, progressive disorder that causes inflammation, scarring and damage to the bile ducts inside and outside the liver. If these changes block the flow of bile, the liver and gallbladder can be damaged, leading over time to liver failure. The cause is unknown.

Ulcerative colitis is an inflammatory bowel disease that usually accompanies primary sclerosing cholangitis. This autoimmune condition affects the lining of the large intestine, leading to bouts of inflammation, abdominal pain, rectal bleeding, and weight loss.

I discussed your question with Paul Abramson, M.D., an integrative physician in San Francisco and a Senior Fellow of the Arizona Center for Integrative Medicine. We agreed that while diet and supplements can help with management of these diseases, conventional gastroenterologists are key to effective treatment since pharmaceutical drugs, diagnostic imaging, endoscopy, and even surgery may be needed.

Dr. Abramson noted that individuals with sclerosing cholangitis should be tested for …

Click here to see the full article on drweil.com

The Quant Doctor’s Nightstand

Paul Abramson, MD — Sun, 18 Sep 2011 16:11:22 +0000

The latest post from my self-tracking blog: The Quantified Doctor, describing some of the devices we’re testing to see how they can empower patients take control of their own health.

These include BodyTrack, Zeo, Bodymedia, Withings, Emwave, and others.

While the devices are fun and interesting, what’s more interesting is the increased self-awareness and insight that can come from self-tracking.

Click here to read “The Quant Doctor’s Nightstand” from quantdoctor.com.

Remote Medical Care for International #Travel? Can I have a physician on call?

Paul Abramson, MD — Sun, 17 Jul 2011 08:47:26 +0000

I was interviewed for an article on Dr. Andrew Weil’s drweil.com:

“Yes, it is possible to arrange remote medical consultation while you’re traveling abroad. I discussed your question with Paul Abramson, M.D., an integrative medical doctor and travel medicine specialist in San Francisco who is a graduate Senior Fellow of the Arizona Center for Integrative Medicine. He told me that a variety of services are available via e-mail, telephone or Skype. They vary in scope, cost and the kinds of assistance provided.

Dr. Abramson said that one option is to find a travel medicine doctor who can do your pre-travel consultation in person and then agree to help you remotely if you need any assistance. He said that he offers this service to his own patients …”

Click here to read the whole story on drweil.com

Or click the “travel medicine” link to the left to find out more about how we can help you travel safely.

(excerpt from drweil.com)

Why I book flights with Dr. in front of my name – NYT interview featuring Paul Abramson MD

Paul Abramson, MD — Wed, 25 May 2011 07:30:27 +0000

Exerpt from “When Doctors are Called to the Rescue in Midflight” in the New York Times, May 24, 2011, by Katie Hafner:

Since the earliest days of commercial aviation, airlines have coped with medical emergencies in flight by calling on physicians who happen to be passengers. And as more people travel by air, the number of emergencies has risen accordingly. [...]

But physicians who get a firsthand look at the kits say the contents vary.

“With some planes, it’s a hospital in a box, and they have everything you could ever want,” said Dr. Paul Abramson, a primary care physician in San Francisco. “But often they look like they’ve been picked over.”

Dr. Abramson said one kit he was given had implements for ventilating a patient unable to breathe, but no bag to push air into the patient — a situation akin to having a gasoline nozzle and tank, but no fuel.

Another kit contained only enough intravenous saline solution to rehydrate a baby, not the 200-pound man he was tending. [...]

Dr. Abramson, the San Francisco physician, has answered so many emergency calls on planes that he now carries some basic medications in his toiletries bag whenever he flies, including antihistamines, prednisone, sedatives and painkillers, all “just in case they don’t have it.”

He also books his flights with “Dr.” in front of his name. “That’s so that if I’m asleep, they might wake me,” he said. And he doesn’t take sleeping pills or drink alcohol in flight. “The last thing you want to do is be woken up and not be with it,” Dr. Abramson said.

“I kind of like doing it,” he continued. “Because it’s what I do, and it seems helpful, and it’s interesting to make do with whatever minimal resources you have.”

Dr. Abramson occasionally receives letters of thanks from the airline, and once received a free domestic ticket. “That was the best,” he said.

See the full article here:

http://www.nytimes.com/2011/05/24/health/24doctors.html

Dr. Paul Abramson is the founder and medical director of My Doctor Medical Group in San Francisco.

We also offer physician travel medicine consultation and remote medical support during travel to our patients, hoping to help them avoid in-flight and other travel emergencies. Contact us for details.

Follow @paulabramsonMD on Twitter

How to stay healthy when traveling abroad; via @drweil #travel #health

Paul Abramson, MD — Sat, 02 Apr 2011 08:32:17 +0000

I was interviewed for an article on Dr. Andrew Weil’s drweil.com:

I am planning a trip to sub-Saharan Africa next year. I understand I will need to get some vaccines. How do I find out which ones? Do I really have to have the shots? What other health risks should I be concerned about? And what medications apart from my prescriptions do you suggest I take with me?

International travel, especially to developing countries in Africa, Southeast Asia and South America, can offer great experiences, but can also present a variety of health risks. You might prepare by consulting a physician who specializes in travel medicine, a field that focuses on the prevention and management of health issues for international travelers

I discussed your questions with Paul Abramson, M.D., an integrative medical doctor and travel medicine specialist in San Francisco who is a graduate Senior Fellow of the Arizona Center for Integrative Medicine. Dr. Abramson suggests …

Click here to read the whole story on drweil.com

Or click the “travel medicine” link to the left to find out more about how we can help you travel safely.

(excerpt from drweil.com)

Anatomy of a hospital ‘bounce-back’ #preventreadmissions

Paul Abramson, MD — Sun, 06 Mar 2011 10:42:47 +0000

Published at Fierce Healthcare on March 5, 2010

As a physician who works as a hospitalist and a primary-care doctor, I understand the complexity of discharging a patient from the hospital, and all the moving pieces that must come together to successfully transition a patient back to the outpatient setting. If even one link in the chain fails, a patient often ends up back in the emergency department and/or readmitted to the hospital as, in
hospital-speak, a “bounce-back.”

These readmissions are like a canary in a coal mine, alerting us that our hospital-outpatient continuum is seriously disconnected and dysfunctional. And Medicare is now tracking readmissions for several diagnoses while threatening to withhold payment to hospitals for readmissions.

Read more at Fierce Healthcare by clicking here

Reconnecting #healthcare through health information exchange #HIE

Paul Abramson, MD — Wed, 15 Sep 2010 09:34:16 +0000

Published at Hospital Impact on September 15, 2010

The clinical scenario is familiar to many doctors.

An elderly man arrives at California Pacific Medical Center’s emergency department in San Francisco at 11 p.m. on a Saturday by ambulance, unconscious and severely ill. A neighbor had called 911 after he failed to answer the phone or door. No friends or relatives are available, and the man has never visited this emergency department before.

The treating doctors must start from scratch to diagnose and treat this patient, with no knowledge of his other physicians, past medical history, medications, or previous medical care. This process is expensive and inefficient, because historical information is missing.

The case of the $517 chest x-ray #healthcare #prices

Paul Abramson, MD — Mon, 30 Aug 2010 09:13:47 +0000

Part 1 in a Series. So the story goes like this. A patient of mine needed a chest x-ray. He doesn’t have health insurance, so rather than just give him a requisition and send him to the local hospital, I decided to do a little calling around on his behalf to find out what the damage would be…

Vendor #1: A well-known local hospital

I called up the radiology department and asked them how much a PA and Lateral Chest X-ray would cost. “I don’t know – we don’t have that information” I was told by the clerk. The radiologist gave me the same answer. They both said I should just send the patient over and he would find out the cost when he received the bill.

That seemed a little dumb. Since when do we go into stores and buy things without knowing the price?

So after 4 additional phone calls and about 2 hours, my assistant and I finally reached Bob who is in charge of uninsured patient billing. He was able to tell me the price: $517.

For a PA and Lateral Chest x-ray.

For cash paying patients who pay at the time of service and know to ask for the
“20-20″ discount by name, the price ends up being reduced to $310.20. But you have to know the secret code word.

Time to receive report in my office: 2-3 days.

Quality: Good

Vendor #2: Free-Standing Private Radiology Office (call us if you wish to know which one)

I called up and the receiptionist answered on the first ring. I asked how much for a PA and Lateral Chest x-ray.

An immediate answer: $73.

Time to receive report in my office: 1 hour.

Quality: Just as Good

So my quesiton is this. How can the hospital be charging 4.25 times as much as the place down the street to cash-paying patients, for the same product and actually inferior response time? (or 7 times as much without the secret code word). I know, “cost shifting” is a common refrain. But that just doesn’t fly any more.

And what’s more disturbing, how can it be so difficult to find out the price when you call up and ask?

So many doctors just send their patients to the hospital x-ray department or lab without thinking that it may bankrupt them. And many doctors have no idea that the price spread can be so great.

It’s time we developed some more price transparency in health care. I know there are companies trying to create online price comparison databases. That is good, but really every entity should be required to have front-line staff know the prices
for every service they offer. That way patients and doctors can make rational decisions about how to get each patient what they need.