This is one of those thing that, although I had never thought about it before, makes all the sense in the world when somebody points it out.

Check this out.  Obesity is virtually an epidemic across the U.S., but especially in the South. Guess what area of the country provides a disproportionate % of new Army recruits! You got it!

SO, how does that work out. It works out that only about half as many recruits are qualified to serve now as were qualified during WWII. Not good when there is no draft and you need soldiers.

AND. Training related injuries have gone way up as the result of the poor physical condition of, well, fat Southern recruits. And so have expenditures to treat these injuries.

Bottom Line. I am always amazed to hear about the myriad consequences that one variable can have on so many others. Would you ever have connected the words obesity and national security before?

You will now!

First, the survey data reported are from a nationally representative sample, rather than a “purposeful” sample of cancer patients. While random is usually good for general representation, talking to cancer patients might have made much more sense here. Given the nature of the sample, it is hardly surprising that the average citizen is not aware of the shortage of cancer drugs. Why would they be?

AND. What does one do with information like the finding that the average consumer would change treatment centers rather than accept a substitute cancer agent for one that was in short supply at their center? How would the average person be able to make the evaluation if this was a good move or a risky move?

Bottom Line. I have commented before on what I see as the risk of assuming patients should be evaluating information like physicians do. Making sophisticated medical choices. This research, which seems to ask the wrong questions of the wrong respondents, is a perfect example of such folly!

Check this out. What you will find is that over half of Hispanics in the U.S. report significant quality of life problems resulting from oral health issues. 57% is an important and daunting number. But it is not a final answer. Next steps in this ongoing research must gain an understanding of Why this percentage is so dreadfully high, and what can be done to improve this picture.

Bottom Line. While I often make fun of “awareness” as a road to nowhere, there are many cases where it is the first step in an important journey. This is one such case. Here we have a high incidence problem in a large percentage of our population. Getting something done to fix this, NOW, would seem to be a very high priority!

Two new films will be released in the coming months that are aimed at raising the public’s awareness of some serious problems related to the medical profession.

One that we have already talked about, Do No Harm, lays bare the “Hippocratic Hoax.” Physicians who have taken an oath to protect the lives of their patients but are taking their own lives through suicide because of the caustic U.S. system of medical education and care delivery. Robyn Symon, the film’s producer, tells me that the film will go into wide distribution this Fall. I’m looking forward to it.

The other, To Err is Human, we haven’t talked about. It is also revelatory, presenting in no uncertain terms the scandal of the huge number of deaths in the U.S. resulting from medical errors.

Both of these films use profound communications techniques to get their points across. Do No Harm shines a spotlight on individuals and families who have actually experienced physician suicides in their families. It lets them do the talking. Up close and personal.

To Err is Human shows that medical errors are the third leading cause of death in the United States, trailing only cancer and heart disease. The film places the raw numbers here into context by telling us that the deaths in the U.S. resulting from medical errors would fill an Arlington Cemetery each year.

Bottom Line. Watch both of these trailers. Each one is only a couple of minutes long. Ponder the importance of the point that each of these films makes.

Then ponder what happens after public awareness of each of these problems is increased. Does anything really change? 

Check this out. What you will see is an NYT article that I find surprising, and troublesome, at several levels.

First and foremost, you will learn that approximately 15.5 million Americans, 7% of our population, have taken antidepressants long term. Really long term. 5 years or more.

The plot thickens when you read that long term use of antidepressants has more than tripled since 2000, and that this trend is showing signs of acceleration rather than abatement.

BUT. The real kicker is the part of the story that explains that many of these patients have simply been “parked” on these medications. Translated, this means that they have been left taking the products long term because they and their doctors didn’t want to face the symptoms that can ensue when such medications are discontinued. Put another way, there has been no scientifically-based strategy developed for taking patients off of these products.

And then there is the little detail that most of these patients’ antidepressants are initiated by PCP’s, after a brief office visit, and often without symptoms that clearly indicate that the medication is needed. So, whether they actually “worked” initially, or any improvements seen were the result of tincture of time and/or placebo effect, is up for grabs. What is known for sure, however, is that the side effects that result from discontinuing the medications are very real.

Bottom Line. So, what are the learnings here as related to physician mindset? There are actually a few very simple but very important ones. First and most profoundly, what we see here is physicians taking a path of least resistance at two key points in antidepressant therapy. First, they often write prescriptions for these products simply to get distressed patients out of their offices. AND. Then, they leave patients “parked” on these medications since they don’t want to brave the possible problems that can be encountered with discontinuance. 

 Oh. And then there is the little detail that while “science” has researched many obscure little issues in medicine, the development of a rational strategy for antidepressant discontinuation remains largely unresearched. 

 Path of least resistance again? Probably!

Check this out. What you will read is an ENT’s questioning of why the heck the American public listens to medical opinions from celebrity entertainers. Although this piece will still leave you scratching your head on this question, it will fill in a few pieces of the puzzle.

Such as. Reading an entertainer’s comments on health matters makes people think that they have pierced the veil and have gained insights into the celebrity’s private life. How chummy.

Also, TV, magazines, etc. offer up shows and articles reporting celebrities’ opinions on health matters such as vaccination. By doing so, they clearly support the celebrities’ ability to comment meaningfully on such issues.

Bottom Line. All of this leads me to a question. Do we want to support celebrities’ expressing healthcare opinions, so that they can help us in our patient communication and persuasion efforts? Or do we want to try to convince consumers that they should pay absolutely no attention to what celebrities opine about healthcare so that these sources of misinformation can be silenced once and for all?

I’m going with option B!

Want to find out whether this is true and what it might mean?  Check this out.

What you will see is a blog post in which a physician notes that healthcare insurance companies have a conflict of interests, in that the more procedures and medicines they approve, the less money they make. Nothing especially newsworthy there.

She also goes on to note that insurance companies need more “transparency,” since they don’t tell patients or their physicians why they are denying coverage. Sounds like a valid point, even if knowing the reasons for denial is not likely to make the patient feel much better.

The real kicker here is the news that a medical director formerly employed by Aetna admitted under oath that he “sometimes” did not bother to look at a patient’s medical records before denying coverage. Wow!!!

Bottom Line.  Put all of the above together and you can start to understand why several states are beginning investigations into Aetna’s approval process, with the examination of other health insurance companies likely to follow apace.

I am not sure if the house of cards is going to crumble, but the walls are likely to be shaken a bit.

Given many women’s preferences for a female Ob/Gyn, this sounds like a really goofy question. BUT. Our old friend, Gynecologist Jen Gunter, makes a couple of interesting observations here.

First, she notes that some physicians have actually voiced that question, expressing concern that the lack of “diversity” resulting from the vast preponderance of women in this specialty will lead to it somehow becoming “weakened.”

Second, she notes that even in a predominantly female specialty, women still make almost $50,000 less than men because the men are still “in charge.”

Bottom Line. Dr. Gunter says she will know when things have gotten less out of kilter in her specialty when a woman becomes president of ACOG, the sex-based pay disparity is eliminated, and no one asks her if she is a nurse. 

Stay tuned!

Check this out. It is an insightful piece written by a female physician who wrestles with whether she should tell her child’s pediatrician that she is a doctor. It frankly never occurred to me that anyone would have a hesitancy about doing this “reveal,” but what do I know?

Bottom Line. BUT. The writer’s perspective was changed entirely when one of her own patients’ mothers handled the reveal in a very tactful way. 

Yet another important element of the mindset of the physician!

That is sort of a trick question, right? The real underlying question here is whether it should matter what a doctor looks like.

SO. Check this out. What you will see is a blog post from a Psychiatrist. The post wanders around a little bit, but comes down to the opinion that it should NOT matter what a doctor looks like. Again, there is that “should” word that I never know what to do with. It always seems to refer to the way things might be in a perfect world, but never have been and never will be.

However. Admitted into the blog are comments that many patients are more comfortable working with HCP’s that look like them, talk like them, etc.

Bottom Line. Interesting stuff. Drill down and realize that “look like” has two meanings. At first read, the focus here seems to be whether or not the doctor’s appearance conforms to generally accepted social norms. Using the photo above as a test case here, we would probably say that this is not what a doctor should look like. I don’t know that I have ever seen a doctor with a nose ring.

On the other hand, for certain social subgroups, this hypothetical physician’s appearance might be just what they are looking for in an HCP.

In brief, matching social norms and matching me can be two very different ways of evaluating a physician’s appearance. And in America in 2018, a physician’s appearance DOES matter!