Monday, October 31, 2011

More Thoughts on Prostate-Cancer Screening

Some say the patient should still have a role in deciding whether or not to get a PSA test.

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LAP-BAND Ad Highlights Safety Compared to Bypass, Sleeve

In the June ASMBS-issue of Bariatric Times, Allergan, the makers of the LAP-BAND System, launched a new professional promotional campaign entitled: “The BOLD Facts”

This new campaign features LAGB’s Total Complication rate vs. Sleeve Gastrectomy and Gastric Bypass within one year of discharge from the “Baseline data from ASMBS-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database.” The study on bariatric surgeries was published by Eric J. DeMaria, M.D. in SOARD May 30, 2009. 

The Bariatric Outcomes Longitudinal DatabaseSM (BOLDSM) was developed to help ensure ongoing compliance with the center of excellence (COE) programs it administers and develop general knowledge about optimal bariatric surgery practices. BOLD is now the largest and most comprehensive repository of clinical bariatric surgery patient information.

The upshot of the first ad in this campaign is that laparoscopic bands have lower total complication rates when compared to gastric sleeves or gastric bypass surgeries.

Despite the claims about the safety of the sleeve and bypass, the band still comes out ahead in this study on a very large sample of patients across the nation.

The graphic below spells it out, but it bears repeating: Gastric sleeve surgeries had three times the complication rate of bands, and gastric bypass surgeries had four times the rate of complication compared to LAP-BAND Surgeries.

LAP-BAND's BOLD Facts

BOLD Facts from LAP-BAND Page 2

If you're interested in learning more about the safer bariatric surgery option, check out our page that compares LAP-BAND, Bypass and Sleeves and get free information about LAP-BAND Surgery.

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On Public Opinions on the Social Determinants of Health

Stephanie A. Robert and Bridget C. Booske (Univ. Wisconsin - Madison) have a new article out in the American Journal of Public Health entitled US Opinions on Health Determinants and Social Policy as Health Policy. Here is the Abstract: To...

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Trick or Treating Safety Tips this Halloween

If you're walking the neighborhood with your kids tonight, here are some tips to ensure your little superheroes stay safe.

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Congratulations to Sherman?s Dr. Bhatt!

Dr. Bhatt received the American Academy of Otolaryngology?Head and Neck Surgery (AAO-HNS) Presidential Citation Award.

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The Importance of Being Elderly?Some Thoughts on the Care of Geriatric Patients

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Report: Burn Pits Can?t Be Conclusively Linked to Health Consequences

Some groups say that there needs to be a registry of soldiers exposed to burn pits so their health can be monitored over time.

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The Third Dimension: Newly-posted Article in Press (video)

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New "Now is for LAP-BAND�" Ads Hit Magazines

A new series of advertisements for the LAP-BAND® System is running now in national magazines, including Better Homes and Gardens, Every Day with Rachel Ray, Good Housekeeping and more.

Our LAP-BAND® Representative sent us a couple samples of from the ad series, below. 

What do you think of the new ads? Tell us in the comments!

 LAP-BAND Is For NOW Hula Hoop Advertisement

 

LAP-BAND Is For Now Pool Ad

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Reversible Nutritional Hypogonadism in a 22-Year-Old Man

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To Our Readers: Watch for new entries coming soon?

After more than three years of blog postings, we are no longer adding posts. Our original aim was to bring many medical humanities voices, perspectives, and projects to the attention of those who are working in the field. To that end we published 78 invited entries by almost as many different authors. Our posts always [...]

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Milk Thistle and Mushroom Poisoning

If you’ve been fortunate to live in the parts of the US that were soggier than usually as of late – or unfortunate enough to have had flooding from hurricanes and tropical storms – then you’ve be noticing a tremendous burst of mushrooms. For mycologists – mushroom enthusiasts – there are two classic chestnuts: “There [...]

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New component to the 'F.A.S.T.' campaign?

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Walk a Mile in My Moccasins

Commentary by Amy Ellwood, MSW, LCSW; Professor of Family Medicine & Psychiatry, University of Nevada School of Medicine, Las Vegas, Nevada
Communicating Through Story
Storytelling has been around since the dawn of time. Before the invention of paper, the Gutenberg press, telephone, television, internet, Kindle, texting, tweeting, Skyping, and emailing, people communicated by actually talking to each [...]

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Interdisciplinary Arts Project in a Family Medicine Residency Training Program

...through the courses I took in the Department of Education I discovered academic researchers were exploring different theories of knowledge and research (Barone and Eisner, Clandinin and Connelly, Cole and Knowles, and Patton)): i.e. Qualitative Inquiry, Interdisciplinary Artistic Inquiry, and Reflexive Inquiry

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Sunday, October 30, 2011

Dr. Hitchcock Joins Weight Loss Surgical Center

Dr. Thomas Hitchcock is now at Weight Loss Surgical CenterToday, we announced that Dr. Thomas Hitchcock has joined Weight Loss Surgical Center as our fourth surgeon on our team specializing in laparoscopic adjustable gastric band procedures to help patients lose weight and keep it off.

Dr. Thomas Hitchcock is now performing LAP-BAND® Surgeries and follow-up care only at Weight Loss Surgical Center.

“Weight Loss Surgical Center is the only surgery practice in the Kansas City area that is currently specializing exclusively in adjustable gastric band surgery for weight loss,” said Dr. Hitchcock. "I believe that adjustable gastric bands are still the safest, most effective and the healthiest option over the long term.”

Dr. Hitchcock was involved with a variety of surgical procedures developed for weight loss through the years. He spent 3 decades helping people suffering from morbid obesity and has worked specifically with adjustable gastric band patients since 2004.

He is a Board Certified General Surgeon, a member of the American Society of Metabolic and Bariatric Surgery and a fellow of the American College of Surgeons.

Dr. Hitchcock joins Dr. Lawrence Drahota, Dr. Scott Ellison and Dr. Stanley Augustin with privileges to perform weight loss surgery for us at Blue Valley Hospital.

We have clinics in Overland Park, Topeka and Wichita, Kan.; Springfield, St. Peters, Independence and Kansas City, Mo.; West Des Moines and Council Bluffs, Iowa; and Omaha, Neb., for initial consultations and long-term post-operative follow-up care.

You can find out if you qualify for the adjustable gastric band procedure and learn more it by taking the our free weight loss surgery seminar.

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KA at U Minnesota and Michigan State

I’ll be giving a talk, “Homeopathy and Skepticism,” to skeptical students this Thursday, Oct 27, at the University of Minnesota (7:00 PM at MCB 3-120) and this Friday, Oct. 28, at Michigan State University (7:00 PM at Holmes Hall 106). Here is the abstract: Homeopathy is an extraordinary popular delusion that has persisted for more [...]

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Alpha Brain ? What?s Wrong with the Supplement Industry

There is an endless stream of supplement products on the market that are of questionable value. They tend to follow a similar pattern: put an essentially random assortment of vitamins, minerals, perhaps herbs and nutritional elements into a pill and then make whatever pseudo-health claims you want. Usually the claim is implied in the name [...]

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Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.2: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (cont. again)

“Strong Medicine”: Ted Kaptchuk and the Powerful Placebo At the beginning of the first edition of The Web that has no Weaver, published in 1983, author Ted Kaptchuk portended his eventual academic interest in the placebo: A story is told in China about a peasant who had worked as a maintenance man in a newly [...]

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Obesity briefs - Brain Proteins, School Food and Metabolic Surgery

Here are some news briefs on the obesity front from the weekend covering everything from a study about brain proteins' effect on weight to using bariatric surgery to treat metabolic diseases.

KC-Area Benefits Company Argues in Support of Bariatric Surgery Benefits: Midwestern Benefits Company Lockton has released a report encouraging employers to offer weight loss surgery benefits in addition to wellness programs.

Obesity regulating gene found? London researchers have identified a gene they claim regulates obesity. The gene was previously known to be linked to cholesterol and type 2 diabetes. This study found that it also influenced other genes that regulate BMI (body mass index), cholesterol and glucose and insulin levels. The study, which was pubished in Nature Genetics offers hopes for new treatments for metabolic diseases.

Overweight? It's all in your head:A story from the Weizmann Institute of Science, published in the May issue of Cell Metabolism, followed mice that were engineered to lack the protein tyrosine phosphatase epsilon (PTPe) and found that without PTPe, mice were better able to regulate their weight. They found that PTPe dampens signals from the hormone leptin in the hypothalamus, leading to reduced appetite and increased physical activity. Researchers know that obese people tend to have an exess of leptin in their blood.

The results of the study suggest that another part of the obesity puzzle involves leptin insensitivity and if scientists could inhibit PTPe, it could improve leptin response to reduce appetite and increase physical activity. Think about that next time someone says that you simply need to eat less and exercise more.

Can video games contribute to obesity? Danish and Canadian researchers watched teenage boys who played video games and compared them to similar boys who were not playing video games. If they played for an hour, video gamers would burn an extra 21 calories compared to the others, but when offered a snack, they would eat 80 more calories than the kids who did not play video games. 

Parents in Oman Worried about Childhood Obesity, School Lunches: Parents of children in Oman are fighting problems familiar in America: the impact of school lunches on childhood obesity. Specifically, they are looking to remove low-quality meats, french fries and fizzy drinks from private schoole menus.

Bariatric Surgery recommended for Metabolic Diseases: with recent recommendations from the FDA and the American Heart Association, lowering the Body Mass Index specifications for people to get weight loss surgery if they suffer from diabetes, the mainstream media is starting to pay attention. 

From the Orlando Sentinel:

One review study of 3,188 obese, Type 2 diabetics who had bariatric surgery found that 78 percent of them no longer had diabetes afterward, according to a 2009 report published in the American Journal of Medicine. And the disease still had not returned by the two-year follow-up.

Another randomized study of obese Type 2 diabetics, published in 2008 in the Journal of the American Medical Association, found that 73 percent of those who had gastric-banding procedures achieved remission of their diabetes, compared with only 13 percent using lifestyle and medication to treat their diabetes.

It is, however, important to note that one can never be rid entirely of diabetes and that remission is always a possibility. It is also important to note that while the article speaks of various bariatric procedures, surgeons at Weight Loss Surgical Center perform only laparascopic adjustable gastric banding, which does not involve cutting, stapling or re-routing of your digestive tract.

Alcohol addiction risk with gastric bypass: A study of a Sweedish database of bariatric patients revealed that bypass patients were twice as likely to need treatment for alcohol addiction. The article explains that bypassing part of the digestive tract allows for faster alcohol absorption and increased risk of dependency.

If you're suffering from the dangerous combination of obesity and diabetes, weight loss surgery may be an option to help. Learn more about diabetes and LAP-BAND Surgery today.

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Karsten Released October 25!

Karsten was�released off of Sombrero Beach in Marathon, Florida Keys and quickly swam away.� Pictured below in blue shirts are Mike Puto and Turtle Hospital staff Jo Ellen Basile, Tom Luebke, and Richie Moretti,�along with several of a group of environmental journalists visiting the Keys and the Hospital�this week (photo by Larry Benvenuti). Karsten is [...]

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11 Weight Loss Tips for 2011, Part 9: Visit your Doctor

This is the ninth in an 11-part series of weight loss tips for 2011. Yesterday, we talked about keeping a journal for weight loss. Today, we’re discussing talking to your healthcare provider.

Your doctor or healthcare provider probably knows a lot about weight loss. As obesity is the new American epidemic, healthcare professionals are more routinely treating obesity-related diseases. A really good doctor or nurse practitioner will go beyond just treating the symptoms and helping you figure out how to lose weight and keep it off.

There are many ways to go about this:

  • Visit your Primary Care Physician – This is always a great place to get started with any health concern, and remember that weight loss is not only a cosmetic issue; it’s a very important health issue. Many primary care physicians will assist you with a diet plan and help you monitor your progress.
  • Visit your gastric band fill practitioner – If you’re a gastric band patient, you really ought to follow your practitioners’ advice about routine care. Many healthcare providers who specialize in gastric band follow-up recommend monthly follow-up in the first year or so, and it’s important to return annually to check for potential problems and reinforce the education you received during the first year.
  • Attend a healthcare-focused weight loss support group – most bariatric programs realize the importance of regular follow-up care and support, so they host support groups. It’s a great way to get advice from all sorts of people struggling with similar problems as yourself.
  • Attend a specialized support group for your ailments – some medical groups have regular support groups for specific conditions, such as diabetes. Ask around, and you might find one that is a good fit for you.
  • Try a physician-assisted weight loss program – If your PCP does not have a regular weight loss program, ask for his or her assistance in finding one that specializes in weight loss. Most cities have several physicians who focus exclusively on weight loss and can teach you a lot about how your body uses food as energy and stores it as fat.

If you’re a regular reader of this blog, you certainly know that while everyone wants to look good and have energy, weight loss is more about improving your health. That’s why it is important to discuss it with your healthcare providers.

At Weight Loss Surgical Center, we help people lose weight with adjustable gastric banding surgery and a special focus on long-term support after surgery. If you would like to learn more about what we do, download our free kit of adjustable gastric band surgery information.

Read more:
Next: Weight Loss Tip 10: Treat Illnesses Appropriately
Prev: Weight Loss Tip 8: Keep a Journal

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Cold Laser Physical Therapy

Dr. Gerry Diethelm came in this week to provide critical care patient Izzy with cold light physical therapy. This low-level laser uses light-emitting diodes to alter cellular function. Dr. Diethelm used settings to reduce joint pain Izzy may feel, and promote healthy tissue growth. Izzy was admitted in August with a boat propeller wound to [...]

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The Lap Band Empowered Chuck to Exercise

In our recent interviews, Independence Lap Band patient Chuck told us that before his band, he used to go to the gym, but didn't make it to the exercise floor very often.

After his lap band surgery, though, he felt like he had a tool to empower him to walk, then run, then exercise on an elliptical machine. Then he moved on to weights, and now he says he is obsessed.

When his success story started, he thought he would be excited to get into 38" jeans, but he has long ago thrown those out, needing smaller sizes as he approaches 200 pounds, down from 317.

Even with all his success, Chuck says he plans to rely on his Lap Band to make sure he maintains his success while he works on toning his body.

If you need help losing weight and would like to start your own weight loss journey, request your initial consultation with Weight Loss Surgical Center today.

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Elgin Gastroenterology Endoscopy Center Receives Quality Improvement Award

We are happy to announce that the Elgin Gastroenterology Endoscopy Center, a joint venture between Sherman Health and Elgin Gastroenterology, has received a 2011 Bernard A. Kershner Innovations in Quality Improvement Award given by the AAAHC.

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Cowboy

Around noon on October 13, we received a call from Captain Brian Stoner and Captain Rich Schaf of the Keys Cowboy Fishing Charter about a turtle missing a flipper. “He’s unable to dive and doesn’t look too good”, said Rich. We asked them to bring the turtle on board and meet us at the nearest [...]

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Weird trifecta

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Saturday, October 29, 2011

The Importance of Being Elderly?Some Thoughts on the Care of Geriatric Patients

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Turn that frown upside the F down

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The extremely fast/retarded triage note

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We?re investing in our community so our children will be the healthiest in the nation

One of my responsibilities at Children?s Hospital and Health System is to collect and report community benefit data for the system. Every year I am amazed how much our organization gives back to the community. The support and resources provide such a positive impact on the well-being of Wisconsin children.
In 2010, the health system provided [...]

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E-Mail from a former drug seeker

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Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.2: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (cont. again)

“Strong Medicine”: Ted Kaptchuk and the Powerful Placebo At the beginning of the first edition of The Web that has no Weaver, published in 1983, author Ted Kaptchuk portended his eventual academic interest in the placebo: A story is told in China about a peasant who had worked as a maintenance man in a newly [...]

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Weird trifecta

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Interdisciplinary Arts Project in a Family Medicine Residency Training Program

...through the courses I took in the Department of Education I discovered academic researchers were exploring different theories of knowledge and research (Barone and Eisner, Clandinin and Connelly, Cole and Knowles, and Patton)): i.e. Qualitative Inquiry, Interdisciplinary Artistic Inquiry, and Reflexive Inquiry

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Call for Papers: International Conference on Pain, Suffering and Health

*Call For Papers: * *International Conference on Pain, Suffering and Health* *27 April 2012* *The University of Hong Kong* The Centre for the Humanities and Medicine at The University of Hong Kong invites the submission of abstracts from across the...

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Quick thinking teachers save a child?s life

Recently there was a segment on the TODAY show about a young girl in Texas who was saved by the quick thinking of her teachers and the automated external defibrillator (AED) in the school. I encourage you to watch this interview with her parents about the rescue, caught on camera.
This story made me immediately think [...]

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Steve Jobs? cancer and pushing the limits of science-based medicine

Editor’s note: There is an update to this post. An Apple fanboy contemplates computers and mortality I’m a bit of an Apple fanboy and admit it freely. My history with Apple products goes way back to the early 1980s, when one of my housemates at college had an Apple IIe, which I would sometimes use [...]

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New component to the 'F.A.S.T.' campaign?

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Attributable Risk Estimate of Severe Psoriasis on Major Cardiovascular Events

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Steven Fowkes (Part 1 of 2): How to Cure Alzheimer?s and Herpes

A correspondent asked me to review a video presentation by Steven Fowkes, ?Nutrients for Better Mental Performance,? one segment of a 9-part series on preventing and curing Alzheimer?s that was mentioned recently by an SBM commenter. Fowkes is an organic chemist without a PhD; he says this means: I am not institutionalized [This begs for [...]

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The Impact of the Aging Population on Coronary Heart Disease in the United States

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Thirty-Second Annual Craig Hospital Hobie Day

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Ralph Anhold - The Comeback

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Kansas, Missouri Near Top on Obesity Scale

Trust for America's Health and the Robert Wood Johnson Foundation issued their annual obesity report today, and it ranked Kansas and Missouri in the top 20.

Missouri ranked as the 11th most obese state, while Kansas ranked 16th. The most obese states centered in the south. Mississippi ranked as the nation's most obese state.

Slightly more than 30 percent of Missouri residents are obese, placing the state just behind Michigan. 29 percent of Kansans are obese, more than doubling the amount of Kansans considered obese only 15 years ago.

Other states with Weight Loss Surgical Center LAP-BAND Clinics include Iowa, which ranked 20th, with 28.1% of its population being obese and Nebraska, which ranked 24th with 27.6% of its population being obese.

The report notes that adult obesity rates increased in 16 states this year and did not decline in any state. While four years ago only one state had obesity rates above 30 percent, today 12 states now have obesity rates over 30 percent. Obesity rates exceed 25 percent in more than two-thirds of states.

Much more detailed information about the report can be found at the Trust for America's Health website.

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Black Hairy Tongue: If You're Tongue Looks Like This, Brush It More Often

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AJM Editor-in-Chief previews the October 2011 issue (video)

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The Lap Band Empowered Chuck to Exercise

In our recent interviews, Independence Lap Band patient Chuck told us that before his band, he used to go to the gym, but didn't make it to the exercise floor very often.

After his lap band surgery, though, he felt like he had a tool to empower him to walk, then run, then exercise on an elliptical machine. Then he moved on to weights, and now he says he is obsessed.

When his success story started, he thought he would be excited to get into 38" jeans, but he has long ago thrown those out, needing smaller sizes as he approaches 200 pounds, down from 317.

Even with all his success, Chuck says he plans to rely on his Lap Band to make sure he maintains his success while he works on toning his body.

If you need help losing weight and would like to start your own weight loss journey, request your initial consultation with Weight Loss Surgical Center today.

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The Importance of Being Elderly?Some Thoughts on the Care of Geriatric Patients

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The Cure

Legislative Alchemy In Legislative Alchemy I: Naturopathy, II: Chiropractic and III: Acupuncture, we learned how state legislatures transform scientifically implausible and unproven diagnostic methods and treatments into legal health care practices. Examples typical of the sheer nonsense found in both proposed and actual legislation include: Naturopathic health care [is] a system of health care practices [...]

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Makes me sick

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Friday, October 28, 2011

Female troubles

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11 Weight Loss Tips for 2011, Part 11: Reward Yourself

This is the final entry in an 11-part series of weight loss tips for 2011. Yesterday, we talked about what to do when you are sick while trying to lose weight. Today, we’re talking about appropriate ways to reward your efforts.

If you have a 100-pound weight loss goal, you may feel like a failure after losing only 5 pounds in a month. That is why it is important to look for small victories in a variety of ways and reward yourself along your weight loss journey.

Even if you have a difficult time creating and maintaining a weight loss plan, at the very least you should give yourself small goals that will lead you to the larger goal. If at the end of the first month you’ve lost 5 pounds and acknowledge that you attained your 5-pound monthly goal, you will not be as likely to be disappointed in the distance left toward your 100-pound total goal.

Don’t forget, also, that it is not just about the scale. If you’re diabetic, give yourself some glucose monitoring goals. If you have hypertension, give yourself some blood pressure reading goals. Give yourself some goals related to fitting into a certain pair of pants or by measuring different parts of your body for comparison.

Once you have established those benchmarks, you should set rewards or celebrations to motivate yourself, but be careful to not celebrate with food.

Though it seems like a cultural obligation to celebrate, everything with food, it really is not appropriate to celebrate weight loss with food. Here are a few other rewards for yourself when you meet a milestone goal:

  • Go to a movie
  • Take the scenic drive home from work
  • Buy a piece of jewelry to mark the occasion
  • Get a massage
  • Buy some clothes that fit now

Use your own likes and interests (and budget) to create a list of non-food rewards that will keep you motivated throughout your journey. Reward yourself every step of the way, and before you know it, you’ll have rewarded yourself all the way to your final weight loss goal.              

At Weight Loss Surgical Center, we help people lose weight with Lap Band and Realize Band Surgeries. If you would like to learn more about these bands, download our free kit of information about Lap Band and Realize Band Surgery.

Read more:
Prev: Weight Loss Tip 10: Treat Illnesses Appropriately

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On the Natural History and Suggested Management of Psychosomaticism

I am very pleased to be able to feature a piece of original writing here on MH Blog, authored by Julia Geynisman, a fourth-year medical student at the University of Michigan. The piece is entitled "The Natural History and Suggested...

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More Breast Cancer Awareness Month pseudoscience from (who else?) Joe Mercola

I have mixed emotions regarding Breast Cancer Awareness Month. On the one hand, I look forward to it because it provides us with a pretext to get out science-based messages about breast cancer and to highlight a lot of the cool science that we do at our cancer center. On the other hand, the quacks [...]

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Obesity briefs - Brain Proteins, School Food and Metabolic Surgery

Here are some news briefs on the obesity front from the weekend covering everything from a study about brain proteins' effect on weight to using bariatric surgery to treat metabolic diseases.

KC-Area Benefits Company Argues in Support of Bariatric Surgery Benefits: Midwestern Benefits Company Lockton has released a report encouraging employers to offer weight loss surgery benefits in addition to wellness programs.

Obesity regulating gene found? London researchers have identified a gene they claim regulates obesity. The gene was previously known to be linked to cholesterol and type 2 diabetes. This study found that it also influenced other genes that regulate BMI (body mass index), cholesterol and glucose and insulin levels. The study, which was pubished in Nature Genetics offers hopes for new treatments for metabolic diseases.

Overweight? It's all in your head:A story from the Weizmann Institute of Science, published in the May issue of Cell Metabolism, followed mice that were engineered to lack the protein tyrosine phosphatase epsilon (PTPe) and found that without PTPe, mice were better able to regulate their weight. They found that PTPe dampens signals from the hormone leptin in the hypothalamus, leading to reduced appetite and increased physical activity. Researchers know that obese people tend to have an exess of leptin in their blood.

The results of the study suggest that another part of the obesity puzzle involves leptin insensitivity and if scientists could inhibit PTPe, it could improve leptin response to reduce appetite and increase physical activity. Think about that next time someone says that you simply need to eat less and exercise more.

Can video games contribute to obesity? Danish and Canadian researchers watched teenage boys who played video games and compared them to similar boys who were not playing video games. If they played for an hour, video gamers would burn an extra 21 calories compared to the others, but when offered a snack, they would eat 80 more calories than the kids who did not play video games. 

Parents in Oman Worried about Childhood Obesity, School Lunches: Parents of children in Oman are fighting problems familiar in America: the impact of school lunches on childhood obesity. Specifically, they are looking to remove low-quality meats, french fries and fizzy drinks from private schoole menus.

Bariatric Surgery recommended for Metabolic Diseases: with recent recommendations from the FDA and the American Heart Association, lowering the Body Mass Index specifications for people to get weight loss surgery if they suffer from diabetes, the mainstream media is starting to pay attention. 

From the Orlando Sentinel:

One review study of 3,188 obese, Type 2 diabetics who had bariatric surgery found that 78 percent of them no longer had diabetes afterward, according to a 2009 report published in the American Journal of Medicine. And the disease still had not returned by the two-year follow-up.

Another randomized study of obese Type 2 diabetics, published in 2008 in the Journal of the American Medical Association, found that 73 percent of those who had gastric-banding procedures achieved remission of their diabetes, compared with only 13 percent using lifestyle and medication to treat their diabetes.

It is, however, important to note that one can never be rid entirely of diabetes and that remission is always a possibility. It is also important to note that while the article speaks of various bariatric procedures, surgeons at Weight Loss Surgical Center perform only laparascopic adjustable gastric banding, which does not involve cutting, stapling or re-routing of your digestive tract.

Alcohol addiction risk with gastric bypass: A study of a Sweedish database of bariatric patients revealed that bypass patients were twice as likely to need treatment for alcohol addiction. The article explains that bypassing part of the digestive tract allows for faster alcohol absorption and increased risk of dependency.

If you're suffering from the dangerous combination of obesity and diabetes, weight loss surgery may be an option to help. Learn more about diabetes and LAP-BAND Surgery today.

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Kroenke Sports and the Denver Nuggets

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Elsevier Health Careers: A Comprehensive Collection of Resources

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SurgeXperiences 318 now up at Life in the Fast Lane

SurgeXperiences 318 is now up at Life in the Fast Lane, an emergency medicine blog. This is a very cool edition with some surgical history interspersed with your usual lot of great surgical posts! Kindly contact me if you wish to host an upcoming edition.

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Call for Papers: International Conference on Pain, Suffering and Health

*Call For Papers: * *International Conference on Pain, Suffering and Health* *27 April 2012* *The University of Hong Kong* The Centre for the Humanities and Medicine at The University of Hong Kong invites the submission of abstracts from across the...

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SurgeXperiences 323 up at Unbounded Medicine

SurgeXperiences 323 is now up at “Unbounded Medicine“. Thanks to Dr Jon, we have a FIFA World Cup 2010 themed edition! If you would like to be part of SurgeXperiences, you can Host an edition, kindly contact me. Submit your blog post via this form. Submit someone else?s� noteworthy post via this form.

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Brad Pitt Can Save Health Care

Brad Pitt has an approach to data and performance that could save health care. That's right: Brad Pitt. Yes, the same Brad Pitt that started his career on the daytime soap opera�Another World; played the cool thief in the Oceans series of films; then the goofy fitness trainer in Burn After Reading and topped it off by marrying Hollywood femme fatale, Angelina Jolie. Handsome, charming, master of self-deprecating humour, and now saviour of the health care system; Is there nothing he can?t do?

You see, Brad Pitt has the opportunity to teach us the tools needed to fix the Canadian health care system. Where did he get these magic tools to fix health care? Pitt is featured in the role of Billy Beane in the recently released Hollywood film Moneyball. Truthfully it is actually Billy Beane that has the tools to fix healthcare. Brad Pitt will just show us how to use them. However had I said, ?Billy Beane will show us how to fix health care,? you would have quit reading. Because unless you follow baseball you?ve most likely never heard of Billy Beane. Brad Pitt you?ve heard of. And while Billy Beane is quite the hunk himself, he?s not quite in Pitt?s league. In fact he?s in the American League.

Based on the book of the same name, Moneyball tells the story of Major League Baseball's Oakland Athletics in the early 2000s. �As Oakland?s general manager, Beane?s job was to create a winning team with a severely constrained payroll at the same time as the competition were doubling theirs. Essentially the new owners asked him to do ?a lot more with a lot less?.

Sound familiar?

I?m an emergency physician. In healthcare we are asked to do more with less almost daily.

?See more patients in the emergency department; but with fewer beds.?

?Do more surgeries; but with the same number of operating room hours.?

?Take care of sicker and more patients; but with the same number of staff.?

To be clear, baseball isn't the health care system. In health care we can close on the weekend. We can make people wait. We can put patients in beds in the hallway. Pressed to save money, we buy cheaper IV cannulas although the staff don?t like them. Maybe we don?t open all the beds on a ward to save on nursing costs. We used to be able to run a deficit, but increasingly those days are over.

Baseball is different. It plays by a different set of rules. They can?t tell ticket holders, ?Stadium?s full. You?ll have to wait in the hallway.? They can?t buy lower quality bats and gloves just to save money. They can?t say, ?We don?t have enough money to pay all the players for tonight?s game. Let?s leave right field open.? And they definitely can?t say, ?We?re not going to play on weekends. Or this summer for that matter?.

Forced to compete with the major league - literally and figuratively - payrolls of the New York Yankees and Boston Red Sox, Beane needs to figure out a new way to do business. What does he do with his team and its paltry budget? He takes The A?s, with their lowest or next to lowest payroll in the league, to winning the most games than any other team but one. They make the playoffs 3 years in a row. The A?s set the American League record for most consecutive wins in a season. And along the way they almost eliminate from the playoffs the richest team in baseball, the Yankees.

How does he do it?

He uses data: a lot of data. First he scans the data for any indicators of performance others in the league aren?t looking at. He determines which player attributes add value (runs for his side, prevented runs for opponents) to his team; and which do not. He looks at the traditional way of how the scouts identify excellence, and obsesses over how to turn the art of player selection and development into more of a science. He takes age-old problems and examines them from a different perspective. All of this analysis derives from the enormous amount of data available in baseball. Beane demonstrates that using the available data to arrive at new insights about the ideal players at the least cost creates a competitive advantage. In short, Beane takes his small budget team and turns it into a�big-ticket winner.

We can do the same in health care. And some high-performing organizations already have: Group Health Cooperative in Seattle and environs; Intermountain Health headquartered in Utah; the Geisinger Health System in Pennsylvania; Kaiser Permanente. Many factors account for their overall excellence, but a common feature is using data to drive improvement.

Health care in Canada has more than enough money. Throwing more money at our problems won?t fix them.�We need to move away from the old business model. We need to ask different questions of the data to discover why some health systems are performing at a higher level given the same set of circumstances. What is working? What isn?t? What changes do we have to make to maximize the human and financial resources to ensure better health for our population? What are we doing that doesn?t contribute to better health? If what we?re currently doing isn?t working, let?s try something different.

You don't have to like baseball to relate to Moneyball. You don?t even have to like sports. All you need is to work in a system that is asking for more with fewer resources. Or work in a system that you believe could be doing a better job than it currently is. Then you'll be hooked.

Go out and see Moneyball in the movie theatre. It?s a great film and an even greater story. Almost as good as the book on which it's based.

And if you don?t like it, and you don?t see a connection between sports and health care? At least you get to see Brad Pitt.

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On Structural Barriers to Interdisciplinarity

Jonathan Kahn (Hamline Univ. Law), an attorney and an historian of science, has a new paper out in the latest issue of one of my favorite journals, Perspectives in Biology & Medicine. The paper is entitled The Two (Institutional) Cultures:...

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We?re investing in our community so our children will be the healthiest in the nation

One of my responsibilities at Children?s Hospital and Health System is to collect and report community benefit data for the system. Every year I am amazed how much our organization gives back to the community. The support and resources provide such a positive impact on the well-being of Wisconsin children.
In 2010, the health system provided [...]

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Tips for Easy Healthy Recipes

If you would like an straightforward method to offer pleasure in an exceedingly healthy everyday life for your family then one in every of the right ways to try and do it?s by preparing home-cooked foods by the utilization of straightforward Healthy Recipes. You?ll considerably perk up the health gains by staying in to own [...]


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Pup

On September 3, Tim Hannah was out lobster hunting off Grassy Key and saw little Pup hanging out under a coral ledge. He thought it was odd that Pup didn’t swim away but thought he� just might�be taking a rest. Twenty minutes later, when Tim swam by again, he took a closer look and saw [...]

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A.M. Vitals: HPV Vaccine Now Recommended for Boys, Too

Also: more listeriosis deaths; Lilly pulls a sepsis drug; Mississippi amendment would declare a fertilized egg a person.

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Why Exercise Is Important to Lose Weight?

Are you interested in losing weight? If you are, you may be in the process of developing a weight loss plan for yourself. For many individuals, a weight loss plan is a guide that they can follow and one that may help to give them motivation. If this is your first time developing a weight [...]


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11 Weight Loss Tips for 2011, Part 9: Visit your Doctor

This is the ninth in an 11-part series of weight loss tips for 2011. Yesterday, we talked about keeping a journal for weight loss. Today, we’re discussing talking to your healthcare provider.

Your doctor or healthcare provider probably knows a lot about weight loss. As obesity is the new American epidemic, healthcare professionals are more routinely treating obesity-related diseases. A really good doctor or nurse practitioner will go beyond just treating the symptoms and helping you figure out how to lose weight and keep it off.

There are many ways to go about this:

  • Visit your Primary Care Physician – This is always a great place to get started with any health concern, and remember that weight loss is not only a cosmetic issue; it’s a very important health issue. Many primary care physicians will assist you with a diet plan and help you monitor your progress.
  • Visit your gastric band fill practitioner – If you’re a gastric band patient, you really ought to follow your practitioners’ advice about routine care. Many healthcare providers who specialize in gastric band follow-up recommend monthly follow-up in the first year or so, and it’s important to return annually to check for potential problems and reinforce the education you received during the first year.
  • Attend a healthcare-focused weight loss support group – most bariatric programs realize the importance of regular follow-up care and support, so they host support groups. It’s a great way to get advice from all sorts of people struggling with similar problems as yourself.
  • Attend a specialized support group for your ailments – some medical groups have regular support groups for specific conditions, such as diabetes. Ask around, and you might find one that is a good fit for you.
  • Try a physician-assisted weight loss program – If your PCP does not have a regular weight loss program, ask for his or her assistance in finding one that specializes in weight loss. Most cities have several physicians who focus exclusively on weight loss and can teach you a lot about how your body uses food as energy and stores it as fat.

If you’re a regular reader of this blog, you certainly know that while everyone wants to look good and have energy, weight loss is more about improving your health. That’s why it is important to discuss it with your healthcare providers.

At Weight Loss Surgical Center, we help people lose weight with adjustable gastric banding surgery and a special focus on long-term support after surgery. If you would like to learn more about what we do, download our free kit of adjustable gastric band surgery information.

Read more:
Next: Weight Loss Tip 10: Treat Illnesses Appropriately
Prev: Weight Loss Tip 8: Keep a Journal

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Coming to Terms with Performance Data: My Hero, Duke Snider, Was Not As Good As Mickey Mantle and Willie Mays

Duke Snider died at the end of February. He was my first sports hero. I grew up in a family of Brooklyn Dodger fans, and the Duke was their star center fielder from 1947 through 1957. That was the Dodgers? last year in Brooklyn; their owner, Walter O?Malley, having failed to extort a big new ballpark from the borough (some things never change), uprooted the franchise and planted it in Los Angeles. Snider?s career waned after the move ? he turned 32 in his first season in LA, was hobbled by a bad knee, and became a part-time player. My memories of him go back only to 1959, when he had his last good year (23 home runs, 88 runs batted in, .308 batting average in only 370 at bats, about two-thirds of a full-time-equivalent season).

Professional and college football and basketball dominate the contemporary American sports scene, but in the 1950s, baseball was king, described without irony as the national pastime. The epicenter of major league baseball in the 1950s was New York, home to three excellent teams: the Yankees of the American League, and the Dodgers and Giants of the National League. From 1949 through 1957 at least one of the three was in the World Series every year, and in 7 of those years there were two. (The streak extended through 1966 after the exodus.) The (Damn) Yankees won most often ? 5 straight titles from 1949 through 1953, and another in 1956. They beat the Dodgers in 1947, 1949, 1952, 1953, and 1956, and the Giants in 1951. The Dodgers beat the Yankees for their lone title in 1955, while the Giants won the previous year over Cleveland.

By a remarkable coincidence, all three teams had a great center fielder. Willie Mays, Mickey Mantle, Duke Snider: all Hall of Famers, home run hitters who could run and field. None was homegrown. Mantle was from rural Oklahoma. Mays was from Alabama, lucky enough to be born in 1931 (as was Mantle) and just 16 when Jackie Robinson broke the major league colour barrier as a Dodger. Snider was from California, home of year-round baseball weather and Mecca for Steinbeck?s desperate dust bowl Okies who left families like the Mantles behind to rot their lungs out in the mines. The Duke was five years older than the other two and joined the Dodgers with Robinson in 1947. Mantle came up in 1951 as a teenager, while Mays had barely turned 20 when promoted that same year. Mays missed all of 1952 and 1953 serving in the military, but from 1954 through 1957 all three were in their prime, captivating the metropolis with their exploits, each claiming the devotion of millions of fans. Who was best: the Mick, Willie, or the Duke?

I had no doubt of course; I was a wide-eyed kid giddy with the first bonding to a team and hero. The Duke was best. Didn?t he hit 40 home runs 5 years in a row ? something neither Mantle nor Mays accomplished? Wasn?t he the best player on the team that won six pennants in a decade? Didn?t Yankee manager Casey Stengel exclaim that Snider made the finest catch he?d ever seen?

My belief was unshakable, mirroring the devotion of fans of Mantle and Mays. And for those of you wondering what this has to do with health care, here is where our tale really begins.

There are people who love baseball and people who hate baseball and people who don?t care about baseball, but one thing is undeniable: it is the most data-rich of all sports, and has been for over a century. Visionaries created and refined baseball databases from the 1870s onward. But there was very little creative use of the data, and the descriptive statistics hardened into conventional wisdom, the outlines of which are familiar to even casual fans. On offence, batting average, home runs, runs batted in, and stolen bases defined a player?s excellence; on defence, fielding average (percentage of error-free balls handled); and for pitchers, wins and losses, strikeouts, and earned run average. Want to know how good a player is? Look at these numbers.

There were occasional attempts to mine baseball data in the early decades of the 20th century, and some debates about which statistics were the most reliable predictors of performance. Analysis of these flat-file, paper records was hugely labour intensive, almost Dickensian, done mainly by hobbyists. Eventually some pioneers dug a little deeper and began to see things a little differently. One of these was Branch Rickey, the studious Dodger general manager who shepherded Jackie Robinson into the big leagues. A number of amateur baseball historians and statisticians assembled databases and compiled encyclopaedias of player records (the first was published in 1951). Occasionally someone would publish a quirky analysis in an obscure journal or write a largely unread book.

And then along came Bill James, who changed baseball forever (though like Newton, if he saw farther than others it was because he stood on the shoulders of giants, equipped with a tool they never had ? the mainframe and later the microcomputer). He was the first baseball stathead rock star. In 1977 he began self-publishing mimeographed little books called the Bill James Baseball Abstract, full of statistical analyses and observations about player performance. Gradually the books developed a bit of a cult following, and his big break came in 1982 when a media conglomerate offered to publish them. Thus was born the popular science of baseball statistical analysis, which in essence can be reduced to a simple quest: explaining performance by relating inputs (the players) to outputs (what happens during each of the hundreds of discrete events that define a game) to outcomes (which team wins and how often).

Why James, and why then? James is smart and analytical, but he is also a master of what health care folks call knowledge translation. He is a very good writer with very good judgment about how to spend his time, proportionate to the importance of the question. He is an iconoclast unafraid to challenge settled wisdom, and he is prepared to revise his own judgments based on deeper examination of the data (hence his flip-flop about whether Lefty Grove or Walter Johnson was the greatest pitcher of all time). He is part historian, part numbers geek, and part story teller. He knows how to program simulations and he is careful not to overinterpret his findings. He recognizes that statistics cannot explain everything, that character and fortune and context matter. I have read a lot of (probably too many) baseball books, including compilations of arcane statistical papers by researchers more technically advanced than James. But none offers the pleasure I get from reading a James essay. He is the Atul Gawande[1] of baseball writing (actually, Atul Gawande is the Bill James of medical writing), whose prose matches his analytic talents, and who has a journalist?s nose for the good story.

I cannot say why the statistical revolution that swept baseball took off in the 1980s, but there is one clearly important factor: money. Baseball salaries began to rise sharply in the 1970s due to the players? union victories in arbitration hearings and the courts that ended lifetime indenture to a single club. In 1975 the average salary was $45,000; in 1980, $144,000; in 1985, $372,000; in 2010, $3,340,000[2]. The freedom (not absolute, but considerable) to market one?s talents to the highest bidder shifted bargaining power from owners to players. Adjusted for inflation, in 2010 dollars Snider?s peak salary was $314,000; Mantle?s, $707,000; and Mays?s $855,000[3]. Today an average center fielder with ten years of experience would earn a minimum of $6 to 8 million; a star with our trio?s credentials could get as much as $25 to $30 million[4].

Buying and paying players became high-stakes games. With more teams (the number of franchises rose from 16 in 1961 to 26 in 1977; there are now 30) and freer player movement, more variables came into play. How long should you sign a good player, and when do you start to discount for age? Do you lock into long term contracts with young but unproven players or try to buy championships by signing expensive, experienced talent on the open market? Do the best players come out of college or do they begin their journeys through the minor leagues right after high school? Is the number of innings pitched correlated with arm injuries? Do you go after speed or power?

These weren?t new questions but the price of bad judgment had become dramatically higher. There were a lot of frenzied, ill-considered decisions in the early days; in fact there still are[5]. A pitcher with one great year might score a huge, multi-year contract and never excel again. It was a new game and everyone had different theories about what counted in performance and how to predict future success. When players were bound for life to one team, the focus was on scouting sandlots and the low minor leagues to assess the talent and sign the Next Big One. Major league salaries were mainly based on retrospective, time-lagged data ? you got paid this year for what you did last year. And what you did last year was thought to be revealed by the standard numbers ? res ipse locitur. The traditional statistics defined performance; there was no more to it.

Except there was. Over the past quarter century or so, baseball statistical research and analysis has transformed the game. There are arguments about how much it has mattered and whether the database and the computer program are superior to real time, live observation and human judgment and what is often labelled ?the intangibles.? (Cue discussion on the ?art of medicine?.) Not even the nerdiest stathead believes that statistical analysis explains all outcomes or predicts future performance with a high degree of certainty. Baseball history is littered with sudden and inexplicable spikes and plunges in individual performance[6]. An arm goes lame (my second hero, Dodger pitcher Don Drysdale, at age 32); a player is coaxed into playing too soon after an injury (Dizzy Dean)[7]; a player falls prey to extracurricular vices (Doc Gooden, Daryl Strawberry); pitchers find an irreparable hole in a promising player?s swing (Joe Charbonneau); suddenly a fine pitcher can?t throw a strike (Steve Blass); a player who performs modestly for 6 years becomes a monster hitter in his 7th and even better in his 8th (Jose Bautista). Baseball is not checkers, and players are not robots. It is a game of mind and the body, unified by failure. The best hitters fail to reach base 6 times in 10. The best pitchers yield two to three runs a game. Great teams lose 35% of the time.

Which brings us back to Duke Snider. Before sabermetrics ? so named for the Society for American Baseball Research, which really does exist and thrive ? you?d just look on the back of the baseball cards, scan the records, and argue for your hero. You could point to unadjusted statistics and infer false equivalencies. And you could explain away the big-dot statistics if you felt like it ? ?yeah, maybe he only hit .270, but he was great when the game was on the line[8].? The less comprehensive and nuanced the data, the easier it was to make a pretty good case for Snider being right up there with the Mick and Willie. But when you crunch the numbers, adjust for the ballpark characteristics (as in case-mix adjustment), look harder at the defensive data (not just proportion of balls caught, but how many gotten to, as in population-based outcomes), and follow the arc of a career (not just the best years, but the slope of the early ascent and the late decline), the evidence becomes inescapable. Duke Snider was not as good as Mantle and Mays, and the performance gap is substantial. In his very best years, he accounted for 2 to 4 fewer additional wins for the Dodgers than Mays contributed to the Giants or Mantle to the Yankees in their best years[9]. That?s huge, because a fine player (like Snider) having a terrific year will add about 4 extra wins to his team?s total, and an otherworldly player (like Mantle or Mays) will add 7. And that is all that matters.

This doesn?t make Duke Snider any less of a hero to me[10], but truth stared me in the face, and I had a choice: deny it, or face it. Whether a fan like me changes his mind because of the evidence really doesn?t matter. But it surely would matter if I were a general manager of a baseball team. There were constant rumours of the New York teams swapping center fielders. If the Yankees or Giants had traded theirs for Snider, it would have been a monumental mistake (especially for Mays, who was not only better, but lasted longer, a high-performing player until 1970; Mantle was done in by bad knees and excesses worthy of Charlie Sheen). High-performing teams pay attention to all the evidence that can get. The purpose of studying baseball data is to understand what creates success.

The purpose of studying health care data is to understand what creates success. In baseball, success is very simply defined: did the team win the game, and in a 162 game season, did it win more games than the other teams? In health care, success is not quite so one-dimensional, but the concept is in principle the same: did the intervention add a greater benefit (quality of life, length of life, comfort) than an alternative? Did it deliver the benefit at an equal or lesser cost than a similar benefit produced by other means?

There are countless examples of how the use and refinement of data has changed both how baseball is understood and how it is played. Many are, mutatis mutandis, applicable to health care. Among them:

  • It used to be thought that successfully stealing a base increased the expected number of runs by a certain amount and being caught stealing decreased expected runs by the same amount. Not so - it takes over two successful steals to offset the damage caused by being thrown out once. Think of screening program results: you have to subtract the harm caused by false positives and false negatives from the benefit resulting from true positives to estimate overall value.
  • For pitchers, wins and losses used to define performance. But a pitcher?s won-loss record is subject to factors beyond his control. In 1990, sportswriters voted Bob Welch the American League?s best pitcher because he won 27 games and lost 6. His earned run average ? the number of earned runs[11] he gave up per 9 innings pitched ? was 2.91. That same year, Roger Clemens won 21, lost 6, and had an earned run average of 1.93 ? a full run better per game, a gargantuan margin. At the time few of the baseball writers who voted for the award winner were familiar with the new analytics and were consequently stuck on the wrong indicators of performance. Twenty years later, Seattle?s Felix Hernandez, (13-12, 2.27) won the same award over C.C. Sabathia (21-8, 3.18) and David Price (19-6, 2.73). Hernandez was fully deserving: he pitched fabulously on a lousy team, he pitched more innings, and he struck out more batters than his competitors. It wasn?t Hernandez?s fault that his teammates couldn?t hit, depriving him of wins and saddling him with losses despite his own terrific work. That he won is an indicator of the widespread adoption of Jamesian metrics by most of the baseball writers of America. Similarly, the primary care physician who labours mightily and well to manage frail elderly patients may be performing at a higher level than others who achieve better outcomes under less difficult circumstances.
  • Environment matters. The Colorado Rockies play in Denver, the mile-high city. Before changes were made to the park dimensions, Coors Field was a hitters? paradise; balls carry farther at altitude. Ordinary players would hit 40 home runs a year because they played half their games there. Baseball analysts now routinely factor in park characteristics to calculate equivalent performances. A San Diego Padre who batted .270 with 25 home runs and 85 runs batted could be the equal of a player with .300 ? 37 ? 115 in Denver. This is analogous to adjusting for neighbourhood and/or socio-economic status characteristics when assessing the performance of health care organizations or individuals.

I could go on and on about how baseball statistics have evolved, about the data that foretold that Wally Bunker?s 19-5 record as a 19-year old rookie pitcher in 1964 would be his career best. (He didn?t strike enough guys out. The more balls in play, the greater the chance the batter will reach base and score.) But these are stories for another day, to be crafted for the purpose of applying sports wisdom and insight to health care. Do the data tell a different story http://testurl.com about a hospital?s excellence than its reputation? Do academic credentials predict performance? Does cardiac surgery contribute as much to quality of life as exercise? Do MCAT results correlate with clinical outcomes? Deciding on how much to spend on diagnostic imaging is no different from deciding on how much to pay your 8th-inning set-up reliever ? it?s a question of value for money, with value defined as results.

Learning from the evidence and validating the meaningful indicators of high performance baseball players didn?t shake my admiration for Duke Snider. I still thought he was great, he was a Dodger, and just because I could no longer declare him the best was no reason to give him up as a hero. Maybe, had I remained ignorant of baseball science, I might have persisted in my misconception of his worth and derived some psychic satisfaction from my continued delusion. That?s too high a price to pay ? even for sports fans, whose loyalties and faith-based misconceptions ultimately don?t matter all that much. Not to overstate it, but learning to make informed judgments about sports is not bad training for making informed judgments about more important things, like whether you would want to be treated in a hospital where half the staff don?t wash their hands properly. You might love your local surgeons but before you let them do Whipple procedures, look at the data.

The assembly of high quality, validated databases; public reporting on performance; and sophisticated data analysis have upset the old order of things in baseball and other sports and settled many a debate about the absolute and relative value of players. These advances have knocked the reputations of some players down a peg and elevated the reputations of others whose subtler talents would have consigned them to obscurity. But the greatest contribution has been to improve the quality of the game by substituting evidence for superstitions, democratizing opportunities and changing decisions at all levels in service of higher performance.

Health care should aspire to no less.

Footnotes

  1. Gawande is a surgeon at Harvard and a staff writer at the New Yorker (and you thought Bo Jackson was versatile when he played professional baseball and professional football at the same time). He has written remarkably compelling analyses of what?s wrong with American health care. See The cost conundrum: What a Texas town can teach us about health care,? The New Yorker June 1, 2009, ; ?The hot spotters: Can we lower medical costs by giving the neediest patients better care?,? The New Yorker January 24, 2011.
  2. Baseball almanac
  3. MLB Salary Database
  4. There is a limit to how much even the wealthiest of teams will pay any player. Alex Rodriguez of the Yankees gets about $30 million a year. The benchmark will be tested by Albert Pujols, the St. Louis Cardinals first baseman whose performance during his first decade was arguably as consistently high as any player in history.
  5. A contemporary example is Vernon Wells, whom the Toronto Blue Jays signed to a 7 year, $126 million dollar contract in 2007. Even at his peak this was shockingly excessive; even more shockingly, despite declining performance over the past three years, the Jays were able to ship Wells and his contract to the Los Angeles Angels, a wealthy and usually successful team. Which proves yet again that the rich are very different from you and me.
  6. This was the case even before the steroid era, which explains a good deal of the performances that defied the laws of gravity in the 1990s and early 2000s, although we are unlikely ever to obtain good data on who was using what performance-enhancing substances.
  7. A line drive in the 1937 All-Star game broke Dean?s toe. He came back to soon, altered his pitching mechanics, ruined his arm, and was done at 26.
  8. Naturally, this, too became a researchable phenomenon. The databases are now so complete that one can analyze a player?s situational performance. For instance, how does a batter do when the game is close and it is the 7th inning or later? Even with all of these data, one runs into small-N problems, and some argue that clutch hitting may simply be an artefact of random statistical variation. Someone among the thousands of players will turn out to hit unusually well or unusually poorly in such circumstances. Interestingly, Snider and Mantle hit very well in the World Series, while Mays was dismal.
  9. One of the great modern statistics computes how many wins a player contributes to his team beyond what an average player at that position would contribute.
  10. When ? if ? you grow up, you take off the rose-tinted glasses, and reality is not always pretty. Duke was convicted of tax evasion for not reporting income from autograph signings. He played before athletes got rich, and his retirement plan ? an avocado farm ? failed. That he cheated is indefensible; he was no Jean Valjean, but that he thought he had to cheat is sad. And on the upside ? this is honest-to-god?s truth ? he took up knitting to while away the time in hotel rooms when he worked as a broadcaster.
  11. Earned runs are those scored without benefit of fielding errors.
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