Sunday, 20 July 2014

Overtreatment and Waste

Aseem Malhotra has written a good piece in today's Observer on Stressful Hospital Syndrome and waste and over-treatment in medicine,
  • As a profession we have also been guilty – unwittingly or otherwise – of exaggerating the benefits of medications often perceived as magic pills by patients when their benefits are often modest at best. This also detracts from more meaningful lifestyle interventions by giving the public the illusion of protection.
He is quite stinging in his criticism (and in my opinion, accurate).  He also offers a source of solution,
  • In an effort to curb the unsustainable healthcare costs, estimated to reach a staggering $4.6trn by 2020, a campaign known as Choosing Wisely is gaining momentum in the US. Part of the campaign involves communicating with patients that more expensive medicine doesn't necessarily mean better medicine. And this is reflected by the evidence that four fifths of new drugs are later found to be copies of old onesnot surprising perhaps when pharmaceutical companies spend twice as much on marketing new medications as on research.
 As always, follow the money, especially when YOU are the source of the gain for others!

"Stressful Hospital" Syndrome

What is  interesting in this article is that many of the drivers are arguably endemic in the daily life of many of us:
  • Nearly one fifth of Medicare patients discharged from a hospital — approximately 2.6 million seniors — have an acute medical problem within the subsequent 30 days that necessitates another hospitalization. These recently discharged patients have heightened risks of myriad conditions, many of which appear to have little in common with the initial diagnosis. For example, among patients admitted for treatment of heart failure, pneumonia, or chronic obstructive pulmonary disease (COPD), the cause of readmission is the same as that of the index admission for only 37%, 29%, and 36%, respectively.1 The causes of readmission, regardless of the original admitting diagnosis, commonly include heart failure, pneumonia, COPD, infection, gastrointestinal conditions, mental illness, metabolic derangements, and trauma Proportions of Rehospitalizations for Causes Other Than the Condition at Initial Discharge.). The breadth of these readmission diagnoses has been shown in studies using administrative claims and those using chart reviews. Thus, this observation is not likely to be merely the result of variation in coding. Further evidence of the distinctiveness of this syndrome is that information about the severity of the original acute illness predicts poorly which patients will have an adverse medical event soon after discharge and require readmission.

    How might the post-hospital syndrome emerge? Hospitalized patients are not only enduring an acute illness, which can markedly perturb physiological systems, but are experiencing substantial stress. During hospitalization, patients are commonly deprived of sleep, experience disruption of normal circadian rhythms, are nourished poorly, have pain and discomfort, confront a baffling array of mentally challenging situations, receive medications that can alter cognition and physical function, and become deconditioned by bed rest or inactivity. Each of these perturbations can adversely affect health and contribute to substantial impairments during the early recovery period, an inability to fend off disease, and susceptibility to mental error.
These drivers will be familiar to those who hang around the paleosphere.  Think 'resilience' when attempting to improve your health (adaptability trumps 'adapted'), the foundations of which are laid down by attention to sleep, nutrition, exercise and stress levels.

Thursday, 17 July 2014

Obesity; More Than Just 'Calories'?

It would appear that simply cutting out 'calories in' via radical surgery isn't properly understood.  It is premised on a naive 'mechanical' model and the results/success achieved are inconsistent.  But now,
  • ...a slew of high-profile animal studies is identifying potential mechanisms in how the gut adapts to its strange new configuration: with sweeping changes in bacterial populations, bile acids, hormone secretions and tissue growth. The hope is that more research on what happens after bariatric surgery will enable physicians to identify who will respond best — and even lead to ways of altering metabolism without resorting to the knife.

Get a load of that last line!  Who'da thunk it?

When we look after/keep animals and plants, no one questions the wisdom of subjecting them to conditions similar to their 'ancestral' past.  Yet we assume our own inherent adaptability means we can subject ourselves to incredibly novel foods and physical environments with little detriment to our health.


When Scientists Back The Wrong Horse

Check out @nytimeswell's Tweet '3 Things to Know About Niacin and Heart Health':

  • Recent studies published in The New England Journal of Medicine are adding to concerns about the safety and effectiveness of niacin, a popular drug for the prevention of cardiovascular disease. The studies reveal that although this B vitamin can reduce triglyceride levels, raise “good” cholesterol levels (HDL) and reduce “bad” cholesterol levels (LDL), it does not produce the benefits that patients and their doctors might expect. And the studies are revealing serious harms.

A lack of quality in the original trials is indicative of the wider problems of transparency in medicine..., oh, and follow the money.  You need to remember;

Policies need to be analyzed in terms of the incentives they create, rather than the hopes that inspired them.

The real kicker for me though is this line:
  • "No study is perfect, and for niacin advocates, many of whom have spent their careers promoting and prescribing the drug, the results of the new trials evoked disbelief."
Yup.

Wednesday, 16 July 2014

Can a Bodybuilder Be a Gymnast?

We've had a few of these 'body builder does X' type films on here before.  This is a great two parter which doubles up as a tutorial for those of you aspiring to do a muscle up:

(Part 1 of 2): http://youtu.be/KJx7wjqjPPg

Me?  I can pull off multiple MUs on both bar and rings.  A reverse grip MU on the bar still evades me though!

Nest of Giants

A great film from Vice.TV about Iceland's strongmen,  from Jon Pall Sigmarsson (who shed body weight for the WSM specifically to target the more athletic, speed- and endurance-oriented events) to the legend that is Magnus Ver Magnusson.

There is also an interesting aside looking at a new fitness trend taking off amongst Iceland's youth which builds upon a more functional application of strength (using strength oriented apparatus on an assault course).  JPS would be proud!

The Giants of Iceland: 


Monday, 23 June 2014

Rule of Thumb

Wise words from @RoyalStatSoc:

https://twitter.com/RoyalStatSoc/status/481003493931884544