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Demystifying Medicine One Month at a Time

Category: preventive health (page 1 of 10)

# This is Our Lane

Dr. Judy Melinek

The American College of Physicians recently released an updated position paper on “Reducing Firearm Injuries and Deaths from Gun Violence in the United States.”

The College’s recommendations center around the notion that gun violence should be treated as a public health epidemic, and that it’s well within the purview of doctors and other health professionals to ask their patients about firearms—namely, do you own them, and if so, are they safely stored? Are they kept in a place where your children can’t get to them?

This makes sense to me, but I’m a doctor. I don’t hunt, nor have I ever owned a gun.

The College’s position makes some very uncomfortable—it’s not a medical issue, they say. This is about personal behavior. Choice. Individual rights.

The NRA sent a tweet in response to the position paper:

Told to “stay in our lane,” doctors have loudly declared #ThisisOurLane, and now have a Twitter handle and thousands upon thousands of tweets stating that it’s medical professionals who care for gunshot victims. Many sent pictures of themselves spattered with blood from taking care of gunshot victims in emergency rooms and operating suites.

One doctor, a forensic pathologist and medical examiner in Oakland, tweeted back to the NRA:

Understandably, Dr. Melinek’s tweet went viral, and she was interviewed the world over—from Africa to Australia—even on Amanpour.

Dr. Melinek was kind enough to speak with me—our interview occurred recently for #MedicalMonday on KWGS-Public Radio Tulsa, and drew a tremendous response.

Like Dr. Melinek, I find it frustrating that the NRA’s strong advocacy has had such a chilling effect on research into gun safety and gun violence in the U.S.

Shutting down attempts to gather more detailed information is a bully tactic of someone or something afraid of truth. How can people make informed decisions without really knowing the effects of gun ownership and use?

Advocate for gun rights all you want. But let the research be done.

Can your city become a Blue Zone?

 

Tulsa is on a roll. With recent announcements about the openings of Gathering Place and a new Amazon fulfillment center, good news abounds. This week we have another opportunity to keep it rolling.

On Tuesday and Wednesday, our city will host visitors from Blue Zones, who will be here to help determine whether our community has what it takes to become a Blue Zone city.

What are Blue Zones?

Explorer Dan Buettner traveled the world to find the places where people live the longest and healthiest. In these places, which he named Blue Zones, people routinely live to 100 years of age, while still active and engaged.

Buettner formed a company to share the knowledge and practices of Blue Zones, and these initiatives have spread across more than 40 U.S. cities in nine states.

Blue Zones projects are designed to unite our community behind a common goal: transforming environments so there are more ways to make healthy choices easier.

More places to walk and bike outdoors. More healthy foods. And more purpose. All of which leads to more years to enjoy it all.

The Blue Zones matrix is not a turnkey solution. Their experts work in a diverse array of communities and bring scaffolding upon which we can build our own programming. We Tulsans must lead the way on implementation and operation.

Buettner will provide the event’s keynote address in a public presentation 6 p.m. Tuesday at OU-Tulsa’s Perkins Auditorium at the Learning Center on the Schusterman Campus.

Wednesday there’s an event called “Wine @Five,” which celebrates the social health aspects of Blue Zone communities. In addition, you’ll have the opportunity to meet Blue Zones personnel and many of our community stakeholders, ask questions, and share ideas. That event will take place at 5 p.m. at TCC’s Center for Creativity.

RSVPs are encouraged but not required.

Both events are free and open to the public — you can learn more about them and RSVP at this website: go.bluezonesproject.com/tulsa.

We hear all the time about how dismal our health outcomes are in Oklahoma. More people smoke, are overweight, and suffer from diabetes, mental illness and cardiovascular diseases than national averages.

We are near the bottom in terms of life expectancy, health promoting behaviors and access to health care. Nationally, our model of health care has emphasized the dousing of fires (“rescue care”) rather than fire prevention.

When I talk to patients, I boil down prevention to a few simple precepts that are easy to say but harder to do. Regular practice turns them into healthy behaviors. They are:

  • Get enough sleep.
  • Move your body throughout the day.
  • Eat well — a healthy assortment of foods. Mostly plants, and not too much.
  • Interact socially. Isolation is not good for the body, soul or mind.
  • Take some time to reflect on what you are grateful for.

These behaviors are practiced in Blue Zones across the world. They are not unique to those areas, and they can be more easily achieved here in Tulsa.

If finding a way to make life healthier as a core value speaks to you, then come learn about Blue Zones.

In addition to the two public events I mentioned earlier, there will be several theme-based focus groups taking place throughout the region on June 27. You can learn more about these at go.bluezonesproject.com/tulsa.

This week’s Blue Zones visit to Tulsa did not happen by chance. Many partners have been involved in bringing the site visit to life — including Mayor G.T. Bynum’s Office, the Tulsa Regional Chamber and the Tulsa Health Department. Local businesses, nonprofits, foundations and educational institutions have contributed time, talent and money to bring Blue Zones to Tulsa.

Here’s hoping that Tulsans can live healthier and longer and keep our city on a roll.

Dr. John Henning Schumann is president of the University of Oklahoma — Tulsa.

 

In Medicine, Less is Often More

Dr. Rita Redberg at #Lown 2016

Dr. Rita Redberg at #Lown 2016

Fewer visits.

Fewer tests.

Less harm from what we find, and less harm from any subsequent treatments.

Less cost.

More engagement with your own health, and what you can do to make it great. You can do it yourself.

Reducing Harm in Health Care

Gary Cohen, Co-Founder and President Health Care Without Harm, photographed in Charlestown, Mass., Friday, Sept 18, 2015, at The Spaulding Rehabilitation Hospital, one of the first hospitals built embracing Cohen's advocacy of self-sustaining, environmentally responsible healthcare networks. (Credit: John D. & Catherine T. MacArthur Foundation)

credit: MacArthur Foundation

When we talk about harm in the world of health care, we’re usually referring to patients and the facilities in which we provide care. These are the ‘typical’ things we hope to avoid, not only because they are bad outcomes, but because they now carry the specter of financial penalties when they occur:

  • medication errors
  • wrong side surgeries
  • hospital mishaps, like falls
  • missing a diagnosis
  • hospital-acquired infections and those induced by medical hardware

But Gary Cohen of the advocacy coalition Health Care Without Harm takes a much broader view of the harms that health enterprises can cause. Founded in 1996, HCWH is now a multi-national coalition of health care enterprises, governmental and non-governmental agencies, and other advocacy groups.

Cohen and HCWH have had some amazing successes. In less than two decades, HCWH has been able to reduce the number of medical waste incinerators in the U.S from more than 5000 to fewer than 100. Why should we care? It turns out that burning medical waste pours tons of the harmful chemical dioxin into the environment.

Another example: The formerly ubiquitous mercury thermometer. They used to break all the time. Fun to play with the drops of mercury, but highly toxic. Neurotoxic, in fact. And when mercury gets in our water supply, the fatty fish we eat (salmon, swordfish, tuna, mackerel, even shark) slowly poison us — which is why pregnant women and children are advised to avoid eating fresh fish in more than minute quantities.

HCWH was able to make the case that there are technological alternatives to mercury thermometers — that work just as well and are much, much safer. And they’ve been successful. When’s the last time you saw or used a mercury thermometer?

For this tireless advocacy, which also includes making hospital food supplies safer and hospital buildings themselves green and super safe (think natural disasters), Cohen was awarded a MacArthur Foundation Fellowship (think ‘genius grant’) last Fall.

You can hear an interview with Cohen here — give a listen and broaden your perspective on reducing harm in health care.

A New Hero

I have a new hero. Her name is Mona Hanna-Attisha, MD, MPH.

monahannaattishaDr. Hanna-Attisha is a pediatrician in Flint, Michigan. She grew up in a suburb of Detroit. She graduated from the University of Michigan before attending medical school at Michigan State University. During her clinical years (the 3rd and 4th years of medical school), she spent many months at Hurley Medical Center in Flint, which serves as a clinical training site for MSU medical students (far from the flagship campus — something I can relate to).

As you may know from recent news, Flint has had some problems — especially due to an overabundance of lead in its drinking water.

For cost-saving reasons, the city of Flint switched the source of its drinking water from the Detroit system to the Flint River in April 2014. Almost immediately residents of the town began noticing the water looked, smelled, and tasted different. It took nearly a year and half for both state and federal officials to acknowledge that there was too much lead in the Flint water — repeatedly questioning the evidence that it was so.

That’s where our new hero comes in.

Dr. Hanna-Attisha directs a pediatric residency training program at Hurley. There are 190 pediatric residency training programs in the United States, training in total about 2600 pediatricians every year.

I can relate to this part of her job — my most recent role was directing an Internal Medicine residency. Though the medical issues are different (kids vs. adults), residency program directors have three essential jobs: recruiting medical school graduates, charting the learning curriculum, and making sure the program stays accredited.

Program Directors become role models for trainees. We try to inspire and motivate residents, offering career and life advice during what is a demanding three year training curriclum.

On top of clearly being good at this role for her residents (7 per class for a total of 20 or so residents), Dr. Hanna-Attisha uses her MPH training to do science — in this particular case epidemiology.

She combed through records at her medical center and discovered that lead levels measured in children’s blood in Flint (as part of routine pediatric care) had on average nearly doubled since the time of the water source switch. Though her claims were at first disputed by state officials, Dr. Hanna-Attisha kept at it, talking to parents, hospital leadership, and advocating with state and federal officials.

In the end, the simple elegance of her team’s science got the message across. The story has now received national attention, including the declaration of a federally-recognized ‘State of Emergency’ in Flint over its water supply.

I was researching Dr. Hanna-Attisha, and came across this TED-like talk she gave at a Michigan State College of Medicine event in 2014. It predates the Flint water story, but it shows her to be a dedicated public servant — not only committed to her trainees and her patients, but beyond that to questioning the very core of what makes people unhealthy: the social determinants of health.

Take a look and let me know what you think.

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