Health Matters

Health Matters - Healtheva, August 14, 2007, www.Healtheva.com

Pharma Advertising and TV Commercials

Most Americans probably find that the evening news on major TV networks is highly informative and educational!  I am not talking about world affairs, politics, sports or other current topics. I am referring to the 30 second and one minute prime time commercials, sponsored by major pharmaceutical companies, that run on TV. We all recognize the catchy sound bites, the riveting presentation, the excellent graphics, the superb animation; and of course the warnings about side effects that are rattled off at a pace that challenges the cognitive powers of most every one who is of normal intelligence. Thankfully, these commercials are repeated often and for those of us that are persistent it would stand to reason that we would over time be able to readily recite the symptoms and side effects verbatim–and I would suspect that a few of us would be able to do it even faster than in these commercials! We all know about Prilosec, Nexium (the purple pill), Lamisil, Lipitor and a host of other medications.

Medical Information Vs Medical Expertise

Now this information and education is not without its benefits. These days if you happent to casually complain about a specific ailment, it is not uncommon for a lay family member or a friend to quickly suggest that you should take a specific name brand medication to alleviate your specific health condition. Thankfully, these prescription drug/OTC commercials are making most of us into a highly informed and demanding class of health care consumers — with a sense of perceived expertise — all of this without having to go through the gruelling medical education and training. We understand the human anatomy much better, we understand a host of diseases, the full range of symptoms, we understand the side effects, we know that there are different treatment options and most importantly we know that we must consult our personal physician. We even know how to get more information in detail by visiting the web sites.  I am all for  a fully informed health care consumer.

Consumer Driven Prescription Drug Demand

As a result, is it possible that we may now go into our doctors offices knowing in advance our treatment options and the specific name brand medication that our physician should prescribe for the specific ailments that afflict us? Potentially, there may be an interesting paradigm shift and emerging trends already underway in modern consumer driven health care — largely as a result of the commoditization of health information and more importantly prescription drug information. Is it possible that the physician in this scenario is likely to become just a facilitator for obtaining a particular prescription medication since the patient ”understands” (or thinks he/she understands) the symptoms, the diagnosis and even thinks he /she has the “knowledge” to demand a specific name brand precription medication?   What are the policy and economic implications of a consumer driven health care in this scenario , specifically as it relates to prescription drug coverage and reimbursement?

Physician Patient Interaction

Fortunately, responsible physicians would choose to prescribe the prescription medication that in their judgment is best for the treatment of the patient considering the overall health of the patient rather than acceding to the demand for a specific brand of medication from a patient.  However, I would suspect that in the future physicians would have to spend more time with patients in explaining the treatment options and justifying the physicians choice of a specific prescription medication and or generic brands.

Patient Self Daignosis and Self Medication

Another ominous concern is:  Is it possible for individuals to indulge in self medication by ingesting commonly available over the counter medications without the benefit of their physicians advice? A prime example would be over the counter medications for symptoms of heart burn. Long term usage of certain OTC medications/drugs without the advice of a physician may lead to a negative impact on an individual’s health. Comments?

Health Matters-Healtheva, August 6, 2007, www.healtheva.com

A Compelling Case For Physicians To Maintain An Online Web Presence –The Web is the communication medium for Physicians to be discovered by their peers and their patients.

Patients Are Internet Savvy

In recent times patients have become very Internet savvy and patients now know how to use the Web to get information about the specific health matters that concern them –increasingly the patients visit the Web before setting up a doctor’s appointment and even after a visit to the doctor’s office. No one can deny that an informed patient is a better patient and a better health care consumer. In spite of certain administrative constraints imposed by most health care system, health insurers and employer sponsored health plans, the patient does have a choice of when to set up an appointment, which doctor/specialist to see and if not satisfied with the level of care to ultimately modify the plan or opt for a different plan when the next annual enrollment period opens up. In addition, the Internet savvy patient is likely to know the latest health news, the thought leaders shaping the cutting edge treatments and the researchers that are working diligently on breakthrough health care treatments, drugs, devices and treatment modalities at leading hospitals, research institutions and clinics.

Doctors In The Media        

The public is no doubt very familiar with a few articulate and telegenic doctors who have assumed larger than life TV persona. Most of us are familiar with Dr. Sanjay Gupta who often appears on CNN and Dr. Nancy Snyderman who appears on ABC news. These and a host of other famous personalities with an MD degree speak with authority on various health topics and in the process they do definitely serve the public good. The sound bites, TV clips and snippets of advice delivered by these TV doctor personalities during the evening news hour on one hand no doubt help the public to stay informed but on the other hand further drive the commoditization of health care information wherein by default every patient and every member of the lay public is often empowered to speak with some basic level of “information”.  

Commoditization Of Health Information      

I am afraid that this commoditization of health information and daily dose of snippets of health information delivered over the tube on serious health issues and potential treatment options may be misconstrued by the patient and the public as “knowledge” — that is personal health knowledge on part of the patient about serious health issues and matters – whereas these health matters are best addressed in conjunction with a personal physician trained in the particular medical specialty with who the patient has a personal and professional connection.  There is a big difference between “information” that the patient may have about a particular health topic and the in depth “knowledge, training and experience” that the physician who is board certified to practice medicine in a particular specialty has.

Patient Expectations  

My take on this situation is that there is a need for almost every practicing physician to maintain his/her own professional presence on the Web so that their current patients and prospective patients can learn more about their personal doctor and feel equally comfortable that their own doctor is also well known through their doctor’s presence on the Web.  After all these days, patients in their 30s and 40s are searching for names for their newborn babies with a view to the name they choose being unique and easily searchable through Google search —- and not to be confused with others who have similar names. The patients are thinking ahead many years when they choose a name for their newborn children — with a view to endowing their offspring with an esily Google searchable name that would come up high on a search—given that — is it not then possible that they would like their doctor to have an easily searchable on line presence? Every one is very Internet savvy these days whether they are in their 20s, 30s, 40s, 50s, 60s and even 70s and increasingly most if not all of these demographic groups have access to broadband at home, in the office and even on the move via their wireless mobile devices.

Patient Behavioral Trends, Can I Find My Doctor On The Web?

We have arrived at an age where if you “Google” some one and they are not to be found on the Web, then either they do not exist or they must not be important! There is a paradigm shift in thinking on the part of the technically savvy patient that dictates that if some one Googles you, you must be found –and you must have many links to be considered important. Given this seminal trend, a practicing physician should recognize the compelling professional need for maintaining and actively managing their own professional presence on the Web. Another compelling reason is that if not now, at least a few years from now when these newborns grow to be teenagers and adults, then the demographics will definitely dictate that the physician should have an online presence.  So in essence it is a matter of time and in that case you might as well be ahead of the curve.

Establishing A Web Presence

A vibrant presence on the Web should enable the physician to provide detailed information to their current and prospective patients about the physician’s office, practice and areas of specialty, education, training, board certification and clinical interests, research interests, publications in journals, interviews by the local press and TV .  There are a few Web sites that provide detailed information about their doctor for a fee or provide the facility to search for a doctor by zip code or a geographical area. These sites do serve a valid purpose and additionally inform the public as to if the physician is in good standing and if the physician has certain disciplinary actions against them.

Does It Make Sense To Have Your Own Web Site?

Alternately, a case can be made for a physician to maintain his/her own Web site or be part of the Web site maintained by their practice group. However, an individual physician or even a practice group does not have the expertise in creating and maintaining Web sites nor should they allocate any significant resources and time to it. One way is to out source it. One challenge for a physician or for a practice group is to obtain a unique Web address– that is a URL –since most interesting and short Web names are taken and unavailable.  In addition, the Web name has to be kept up to date and renewed –and if not renewed in time the unique Web name is taken by some one else and is gone for ever. In addition, there are certain non trivial initial costs involved for set up of a web site and monthly/annual recurring charges for maintaining a web site.

Leveraging Physician Social Neworking Platforms For Establishing A Web Presence

An innovative site called Healtheva, provides a novel cost effective (it is free!) solution for the individual physician or a group of physicians to maintain a web presence without having to deal with all of the challenges and costs associated with maintaining their own Web site. Healtheva most importantly offers a suite of innovative services and technologies to the individual physician and or the physician group absolutely free of charge. Membership in the Healtheva community is free. Healtheva is an online community for doctors and life science researchers, that offers a unique platform for collaboration among physicians locally and globally — wherein the physician and or the researcher may connect with and communicate with only the individuals and peers of his/her own choosing or the entire membership.  Healtheva has been hailed by health care professionals as an innovative social networking site for doctors and compared by a prominent doctor to a leading social networking platform as “My Space for Doctors”. Here is a link to comments by a prominent MD on the Web about Healtheva: http://runningahospital.blogspot.com/2006/12/doctors-researchers-med-students-check.html

Healtheva, The Social Network For Doctors And Life Science Researchers

Healtheva offers the ability for a doctor to maintain a personal and rich profile on the site that is viewable by his/her peers internal to the site and even a profile that can be viewable on the Web. Most importantly, Healtheva offers a range of features that are innovative and of real practical utility. The Healtheva features enable the physician to post/save text, audio, video, podcasts and other content in their own space. In addition, Healtheva enables the physician and the researcher to save links to various research journal articles and web links in their own private space. With this feature you can selectively share these links with others in your professional network if you wish. Additionally, Healtheva provides a forum for the physician to post queries, comments and observations that can be viewed by others thus enhancing collaboration among the physician and life science research community.

Establishing Your Own Physician Blog At Healtheva

Every member of Healtheva is automatically also provided the tools for creating and naming their own Weblog, that is a Blog — with the individual having the choice to maintain a blog if they choose to do so. Blogs are becoming a popular vehicle for professional and thoughtful expression on serious health matters and currently a number of prominent physicians have their own blogs. Blogs are another avenue for a physician and a researcher to maintain a dynamic online presence. Maintaining personal blogs on various dedicated blogging sites involves initial set up and monthly charges. However, at Healtheva membership is free and every member may maintain their own personal blog for free! Every physician and researcher who wishes to have an online public presence — to be discovered by their peers and their patients — should seriously consider joining Healtheva and fully utilize the comprehensive range of innovative features that Healtheva has to offer.  With Healtheva, you are in control and you have the option of projecting your professional persona on the web in the manner you choose; and even updating your profile and your presence as often as you wish. Visit www.Healtheva.com to become a member.

Health and Humor: Is there a place for humor in the health care field? Does Humor Heal?

In the health care field, it is common to interface with individuals who face tough times as a result of various types of health conditions and concerns that either affect the individual directly or affect some one they love. These situations are often trying for the individual, the family, friends and even the health care professional.  Is there a place for humor in a professional and serious setting to ease the concerns of the individual and help them get through tough times?  

For example, I have had a few blood tests in my life and I have observed other individuals going through this simple lab procedure. It is not uncommon for the affected individual or the phlebotomy technician to crack a small joke or make some type of humorous observation during this simple procedure to ease the tension.  It seems, that most people like a little bit of reassurance and personal connection before they allow the phlebotomy technician to poke them with a needle! Now imagine a very serious medical procedure and the trepidation of the patient as he/she gets ready for it. It would seem that there may be great value for the patient and the physician to connect and may be appropriate comments coupled with a little bit of humor may help. Similarly, I have also noticed that when I visit the my dentists office, either the dental assistant or the dentist puts me at ease by making comments and observations that are funny.  It does help to have a sense of humor if you plan to undergo a root canal.

 The question, then is what is considered appropriate humor in a trying circumstance? We all know about Jay Leno and David Letterman, the late night veteran entertainers who started as stand up comedians. They make us laugh with their one liners and these often resonate with most of us because they relate to current events. We have a choice each night of selecting Leno or Letterman before we blissfully fall asleep.   Stand up comedians play to their audience and experienced comedians know how to psyche out their live audience in the first few minutes of their routine and how to connect with the audience. Naturally, the health care professional faces a different kind of setting and must know how to calibrate a little bit of humor to the individual patient while at all times maintaining his/her professionalism in very trying situations.

Recently in my travels, I came across David Naster who is a highly regarded stand up comedian.  David has been making people laugh for a long time and that is to be expected of a comedian. However, David has the ability to make people laugh in a wholesome way without being extremely offensive, rude or insensitive. I listened to his jokes and came to realize that there is more to David Naster than just his humor— he has an underlying sense of caring, thoughtfulness, decency and humanity.  He has the ability to connect with the audience by appealing to their intellect and their funny bone at the same time. You can easily see from his jokes and his style of delivery that in order to laugh you have to be a little bit smart. In order to get it, you have to think! Thinking engages the individual and the laughter he generates is as a result of appealing a little bit to the individual’s intellect.

David is the author of a book titled “You Just Have to Laugh through Tough Times”. This is sort of a guide book for using humor through illness, injury, grief and danger. Larry King, the host of CNN’s Larry King Live had this to say about David Naster’s book “Not only has David made me laugh, (I should know, we’ve worked together) he spreads it’s magic. Funny is funny, but to find the humor in troubled times and still laugh, is the gift of this book”.  David also has a video titled “Using humor to make tough times better” For any one interested in the book or the video, they are available at www.naster.com or at www.amazon.com

David says that “laughter heals” and backs up his statement by quoting a study published in the American Journal of Medical Sciences and further stating that “laughter stimulates the immune system., offsetting the effects of stress by lowering serum cortisol levels and increasing the amount of activated T lymphocytes — in other words laughter heals’ Dr. Bernie Siegel, M.D. author of the book, Love Medicine and Miracles has this to say about David Naster’s book “ Love may be the building block of life, but laughter is the mortar that holds your life together. Read this book and learn to survive” Now those are pretty strong endorsements of David and his book.

I did not know about the Association of Applied and Therapeutic Humor, AATH till recently. David’s book won an award from AATH. The association, AATH defines therapeutic humor as “Any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity or incongruity of life’s situations. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, social or spiritual.” To learn more about how humor may be applied in a thoughtful and caring way in various situations including in the health care field and in treating patients with serious illness, visit www.aath.org

 David is a great motivational speaker who has performed for grieving children, firefighters, hospitals and in other settings where humor was deemed necessary by the host organization to alleviate trying situations in various communities. He recently had several performances on board the cruise ship the Norwegian Sun of the Norwegian Cruise Line and — in the audience were several physicians who were on board to attend CME@SEA, Continuing Medical Education courses.  It seemed like the physicians as well as many other passengers appreciated David Naster’s humor. It was therapeutic.

To find out how you too can blog for free, visit www.healtheva.com  Healtheva is the premier online community for doctors, health care professionals and life science researchers.  

Air Travel:  Passage of new European Union, EU laws will improve the air travel experience of individuals with disabilities. 

            If you have ever traveled internationally with an older person or a disabled person, then you will truly appreciate the challenges that one faces in transiting through a European airport. International air travel by an individual who is aged or disabled without being accompanied by a relative, friend or chaperone is extremely challenging if not daunting. The large number of immigrants from India, China and other parts of the world who are settled in the United States recognize the difficulty that their aged, infirm and disabled parents/relatives face when they visit the US and make the long and arduous round trip from these countries. Similarly, the US based disabled/aged traveler has had to contend with varying standards in Europe to visit different countries in Europe either for pleasure or for business. The new EU laws enacted this week are likely to make international air travel easier for the disabled/aged traveler.

  In the US we do have certain standards mandated by Federal law that the commercial air lines must meet and this makes travel for the disabled and/or older individual somewhat easier — since there is a reasonable expectation of a minimum standard of facilities and service that should be provided by the airline and the airport. The US Federal law mandates airport accessibility and services. The guidelines for consumer protection, accessibility and service are managed by the Aviation Consumer Protection Division of the Department of Transportation, DOT. Generally, in the US the disabled traveler is presumed to have the same rights for air travel as a non disabled traveler and airlines may not deny passage except under very special circumstances. Similarly, there are federal standards for surface travel by public carriers and facility access.

These US guidelines for consumer protection of travelers can be found at:

http://airconsumer.ost.dot.gov/publications/horizons.htm#Planning

            The European Union has finally passed new rules that would no longer allow airlines and holiday companies to refuse to fly travelers because of their disability. The passage of these rules is a milestone event that disabled/aged individuals in Europe and indeed all over the world can celebrate. British Labor Member of Parliament, Hon. Robert Evans who strongly advocated the passage of the new law by the European Parliament said that “It is incredible that people with reduced mobility have suffered neglect and maltreatment in airports as recently as 2007” He said the time had come to pass a law since “voluntary agreements are not a proper substitution for the law”.         

The European Disability Forum, an organization that champions the rights of travelers with disabilities, is encouraging disabled travelers and companions traveling with them to aggressively demand that the new EU rules be enforced by the air lines to ensure that the new law is effective in overcoming this long standing discrimination — if necessary by filing complaints with the airlines and the airport authorities. There is an urgent need for similar laws and aggressive enforcement in a number of other countries so that the disabled traveler has a seamless travel experience where ever they travel internationally. The new EU law is likely to spur business and more importantly leisure travel by individuals who are aged and or disabled but have the financial means and the desire to see the world.  

To find out how you too can blog for free: Visit www.healtheva.com , The social network for doctors and life science researchers.

Travel Medicine:  Tips for Healthy Air Travel

Here are a few tips for maintaining your health and comfort when you travel by air on any of the major commercial air lines. These days it is often difficult to get direct flights especially if you opt for cheap fares over the Internet. In my travels, I have been on numerous direct flights that range from about 6 hours to over 14 hours. More recently, I find that taking connecting flights is actually better for the cardio vascular circulation as compared to non stop direct flights which tend to be hard on the legs and the back. Whether you are an economy class passenger, a business class passenger or a first class passenger you should be aware that air travel presents certain risks to the cardio vascular system unless the traveler takes certain basic precautions to achieve good circulation during flight.

If you are not under time pressure, I recommend that you take a connecting flight with at least an hour or two in between the flights.  This gives you the time to walk around the airport and may be grab something to eat before you get on the next flight segment.  I find that this break improves my attitude and helps me tolerate the flights much better. I suffer from an occasional acute sciatica problem in my left leg and with my condition a break in the journey is really helpful. Getting a middle seat is excruciatingly painful. I tend to choose an aisle seat preferably on the right side of the plane so that I can periodically stretch my left leg and relive the sciatica pain that often results from sitting in a fixed position for a long time. Also, I find it beneficial to get up at least once in 30 minutes to just to stretch a bit.

I have tried the various exercises that the airlines recommend and I have found these exercises to be helpful in relieving the discomfort from my sciatica pain. These exercises are designed to keep good circulation and blood flow to extremities of the body, especially the legs. These exercises are very helpful and can be done while seated.

Generally you find pictorial illustration of these exercises in the in-flight magazines. It helps to review these exercises in advance and generally plan out an exercise program that suits your particular needs. Here are a few links to various exercises that major airlines recommend. 

United Airlines: http://www.united.com/page/article/0,1360,3114,00.html

The United Airlines article has several excellent and easy to follow illustrations for doing the In-flight exercises which consist of Knee Flexion, Knee Extension, Dorsiflexion, Plantar Flexion, Inversion and Eversion

American Airlines:

http://www.aa.com/aa/pubcontent/en_US/travelInformation/specialAssistance/healthAndWellbeing.jsp 

US Airways:   

http://www.usairways.com/awa/content/traveltools/traveltips/healthytravel.aspx 

US Airways article has several recommendations that are helpful but no illustrations for any of the exercises.

There are very good reasons for taking some basic precautions while traveling in order to maintain good health, avoid discomfort or an adverse life threatening situation that can develop as a result of a clot formation from prolonged sitting and physical inactivity. Here are a few good reasons:

 Research has shown that the physical characteristics of the blood change during air travel.  The blood becomes more viscous and the coagulation properties of the blood increase leading to slower blood flow through the vascular system, especially through the legs. In addition the ingestion of alcohol modifies the blood flow characteristics and this presents a higher level of risk. A good remedy is to avoid alcohol and stick to drinking copious quantities of water to keep the body well hydrated and maintain beneficial blood flow properties.

The probability for a clot or clots to form in the vascular system is enhanced during air travel where the passenger is forced into a fixed and sedentary position for long periods of time. Blood clots may form in different sizes and there may be multiple blood clots. Once a clot is formed, it may travel through the vascular system to different parts of the body causing various adverse symptoms and even death. Clots in the legs are referred to Deep Vein Thrombosis, DVT and clots in the lungs are referred to a pulmonary embolism, PE. In certain cases, clots may form in the arterial system and may cause heart failure and cerebrovascular (brain) problems including stroke. Statistics show that about 5% of the air travelers are susceptible to these adverse events -that is about one in twenty! This is a non trivial high number, that should cause travellers to take this issue of potential blood clot formation seriuosly.  Patients with certain prexisting conditions may be at a higher risk and should consult their personal physician prior to embarking on air travel. So it does truly help to take proactive steps to maintain good blood flow and circulation during air travel, especially on long domestic and international flights where the prolonged exposure to physical inactivity presents a higher probability for adverse events such as DVT, PE, heart attack or stroke.

To find out how you too can blog for free and share your personal comments and insights with others : Visit www.healtheva.com , The social network for doctors and life science researchers.

“Health Matters” is a Healtheva Blog that periodically posts personal comments and observations by the author on various health care related topics of current interest. Members of the Healtheva community and others are invited to contribute their insights, observations and comments on any of the different posts on Health Matters, a Healtheva Blog.

Healtheva provides a social networking platform for doctors and life science researchers. For additional information visit: www.healtheva.com

To find out how you too can blog for free and share your personal comments and insights with others : Visit www.healtheva.com , The social network for doctors and life science researchers.

Medical Care Aboard Cruise Ships: Know In Advance What To Expect

Periodically there are news reports about outbreaks of illness, especially gastro intestinal ailments aboard cruise ships. On my recent one week long cruise trip to Alaska, I was concerned about potential GI tract infections, on board sanitation and emergency medical help should the need arise either on board or on shore at a remote location. Individuals suffering from irritable bowel syndrome, IBD, Ulcerative Colitis, Chron’s disease and other pre existing conditions may especially be prone to gastro intestinal distress, infection. Therefore travelers pre-disposed to some type of GI tract distress and infections may need to take special precautions on board a cruise ship. I am especially referring here to the GI tract and I do not intend to ignore other serious ailments or health conditions including heart attack, stroke and serious injury. It is natural to pick on the GI tract as it is most vulnerable to infections from food, water and improper sanitation. Additionally the GI tract is over taxed from exuberant indulgence and excessive consumption of the unlimited food that is available on board.

Sure Alaska is part of the United States and we should be glad that we bought this pristine land with its unparalleled beauty from Russia for a great bargain — However, it would surprise most of us to know that a number of ports of call in Alaska, such as Skagway (population about 900), do not have a hospital or a full time doctor for the residents.  At best some of these cities/towns have a clinic staffed by nurse practitioners. If there is a life threatening emergency the residents are routinely airlifted to Juneau or some other location within the state or out of the state.  It is even surprising that in Skagway the cruise ships can not plug in to the local electrical power grid while in port and must continue to run their engines to maintain their own electrical power. This brings me to the point that the best care you are likely to get on the high seas or even while in port is what the cruise line itself can provide! So it would make sense for the traveler to know the on board medical capabilities of the particular cruise ship, its reputation and more importantly if the cruise line fully conforms to the regulations and standards required of all cruise ships that sail within the US or to US ports of call, even if they are registered in a different country and sail under a foreign flag.

            The North American cruise industry makes up the largest segment of the global cruise market with nearly 75% of the embarkations being at US ports and 77% of the travelers being US residents. The cruise industry estimates that in 2010 there will be 20.7 million cruise travelers up from about 10.8 million travelers in 2004.  The US Coast Guard enforces maritime safety requirements while the CDC, the Center for Disease Control has regulatory responsibilities for public health and sanitation aboard all cruise ships within the
US and for ships bound to US ports from foreign ports. The CDC has an established Vessel Sanitation Program, called VSP.

Here is an excerpt from the CDC regarding its program to regulate sanitation and public health aboard cruise ships: “In 1975, in response to several large gastrointestinal disease outbreaks on cruise ships, CDC established the VSP, a joint cooperative program with the cruise industry, to achieve a high level of sanitation and minimize the risk of gastrointestinal (GI) disease on cruise ships (6). The VSP encourages the cruise industry to establish and maintain a comprehensive sanitation program, including surveillance for acute gastroenteritis (AGE). The VSP staff conducts biannual, unannounced sanitation inspections on U.S.-bound cruise ships with international itineraries carrying 13 or more passengers. The VSP also engages in the design and construction of new ships, as well as retrofitting older ones to enhance facilities and provisions that promote shipboard sanitation and public health (6).

The VSP shipboard sanitation inspections cover the following areas of public health interest: 1) water supply storage, distribution, disinfection and protection; 2) spas and pools disinfection and filtration; 3) food handling, including storage, preparation, and service; 4) potential for contamination of food, water and ice; 5) personal hygiene and sanitation practices of crew; 6) general cleanliness and condition of the ship, and 7) ship training programs in environmental and public health practices. An inspection score of 86 or higher (out of 100) indicates an acceptable level of sanitation. In general, the higher the score, the higher the level of sanitation, but this score does not reflect the risk of acquiring gastrointestinal disease. The VSP could recommend or require that a cruise ship not sail if sanitation deficiencies could pose a public health threat. The VSP posts most recent sanitation scores and reports for specific cruise ships on its website: http://www.cdc.gov/nceh/vsp/desc/brochure.htm (6).U.S. Federal Quarantine Regulations require that, 24 hours before arrival at a U.S port, vessels notify public health authorities of onboard incidents of death, diarrhea (defined as at least 3 stools in a 24-hour period), and certain febrile syndromes of public health significance (6,7). The VSP receives reports of AGE and may respond with an epidemiologic and environmental investigation if at least 3% of passengers and/or crew members seek medical attention for AGE, or if an unusual GI illness occurs (6). Surveillance and response for reports of onboard deaths and febrile syndromes of public health concern are conducted by CDC Quarantine Stations, located at major U.S. ports of entry and land border crossings and administered by the Division of Global Migration and Quarantine in Atlanta (7).”

            Here are five proactive steps the cruise traveler can take to be prepared for an adverse medical event:

1. Check the sanitation score before you book your passage:  I recommend travelers to first check the most recent sanitation scores of the cruise ship and the overall record of the cruise line by visiting the CDC’s VSP web site:  http://www.cdc.gov/nceh/vsp/desc/brochure.htm before you book your cruise.

2. Take personal responsibility to maintain a sanitary and sterile environment around you: The cruise industry takes the need to maintain sanitation as a very serious shared responsibility, where the best results can only be achieved if each and every one of the passengers fully co-operates in following prescribed sanitary procedures.  All of the passengers are required to sanitize their hands before boarding, before meals and before de-embarkation. The cruise staff is very serious about this and they are there to supervise these simple procedures. It just makes perfect sense! 

3. Check the cruise ship’s medical facilities and capabilities in advance: Travelers aboard a cruise ship, especially individuals with a serious pre existing health condition should be aware of the medical facilities available aboard cruise ships. Do not expect that you will have the same standard of care and facilities available as that of a major urban hospital/medical facility. Check with the cruise line to see if the particular cruise ship you are sailing on meets the CDC standards for on board medical facilities. This may be extremely relevant if you are sailing with individuals who have a chronic health condition or if the individuals are at risk due to age and other health factors.

Ship Board Medical Facility Standards:

Here is an excerpt from the CDC about the standards for on board medical facilities. “In 2000, the Cruise Ship and Maritime Medicine Section of the American College of Emergency Physicians (ACEP) published ACEP Health Care Guidelines on Cruise Ship Medical Facilities, a consensus report on appropriate facilities and staffing able to provide basic medical and emergency services aboard cruise ships, within the recognized limitations of the offshore environment (8). These guidelines include provisions for medical facility design on cruise ships, including guidelines for an isolation room to manage communicable diseases, diagnostic and emergency medical equipment, formulary, staff number and qualifications, and a health, hygiene and safety program for medical personnel (8). Large cruise lines that operate in the
United States or are members of the International Council for Cruise Lines (ICCL) meet or exceed the ACEP guideline standards. Medical facilities on ICCL member vessels can be equated to community urgent care centers, with the ability to perform basic diagnostics such as blood chemistries, complete blood counts, urinalyses, chest x-rays, and EKGs (3,9). An estimated 95% of illnesses seen in cruise ship medical facilities can be treated onboard; however, passengers with serious problems such as myocardial infarction or cerebrovascular accidents need to be transferred to shoreside hospitals after stabilization (10). Cruise travelers should note that ACEP guidelines for large cruise lines may not be followed by smaller ships or those run by independent operators; on such ships there may be no medical provisions onboard. Cruise ship travelers with chronic diseases or those who may require comprehensive medical care during travel should consult with their health-care providers and notify the cruise line of special needs before travel (9).”

For Additional information visit the CDC web site: http://wwwn.cdc.gov/travel/yellowBookCh7-CruiseShip.aspx

4. Carry your own prescription medications: Do not expect that the cruise ship will have all medications and prescriptions available. It is best to carry an adequate supply of all prescription medications. Additionally, certain over the counter medications may not be available in each port.

5. Maintain with you the contact information of your physician and hospital: Be sure to carry with you the contact information of your physician, physician specialists and hospital information in the event you or the doctor on board needs to contact them.

Healthy individual or patients with chronic IBD, ulcerative colitis, heart disease, hypertension and diabetes can take precautions to avoid being inflicted with some type of gastric infection and distress when they travel by carefully watching what they eat and following a few sanitary procedures. It is better to be prepared for a medical emergency rather than be surprised by an adverse event. Checking out the availability of medical facilities ahead of time at each place on your itinerary and on board the cruise ship will enable you to be prepared for any medical emergency. If you are prepared and have a plan of action, you will be able to enjoy your travel. Share your experiences with the Healtheva  community. Healtheva is a community for doctors and life science researchers. www.Healtheva.com  Bon Voyage!

To find out how you too can blog for free and share your personal comments and insights with others : Visit www.healtheva.com , The social network for doctors and life science researchers.

A GREAT WAY TO COMPLETE CME REQUIREMENTS FOR DOCTORS

CONTINUING MEDICAL EDUCATION ON BOARD A CRUISE SHIP 

In the United States each State maintains its own licensure board for the practice of medicine within its jurisdiction. The State legislatures have mandated that doctors must complete certain hours of continuing medical education, CME, between the license renewal periods in order to be granted the license by the State Licensure Board to practice medicine within the State. The CME credits units/hours required for re-licensure vary by each State. However, the trends definitely point to increased number of CME hours that must be completed between licensure periods. Clearly the CME requirement serves the public good —- as it is intended to ensure that doctors take the time to maintain their competence and stay abreast of the latest advances in knowledge in the science of medicine.

The CME courses must be taught by organizations accredited by the Accreditation Council for Continuing Medical Education, ACCME.   The mission of the ACCME is “is the identification, development, and promotion of standards for quality continuing medical education (CME) utilized by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities”. Further information about ACCME may be found at http://www.accme.org/  A number of countries have CME requirements of their own and a number of other countries are adopting the requirements and standards for license renewal with the provision that certain required hours of continuing medical education, CME must be completed for renewal of license to practice medicine.  

The physician must balance the requirement for completion of the prescribed CME hours against his/her busy practice and family life. Often this results in putting off the completion of the CME requirements till the last minute. The number of CME hours required for licensure in each biennial licensure period is increasing which would no doubt put added pressure on the physician to allocate the proper time from their busy schedule.

For example, in the State of Pennsylvania, for the licensure period renewal period begining January 1, 2005 proof of completion of 25 credit hours of CME in the preceding biennial period begining January 1, 2003 through December 31, 2004 was required. The 25 hours of CME may be completed in AMA PRA Category 1 or AMA PRA Category 2 and must include 3 hours of patient safety and risk management. Now looking again at Pennsylvania the requirements for licensure renewal period beginning January 1, 2007– proof of completion of 100 credit hours of continuing medical education in the preceding biennial period running January 1, 2005, through December 31, 2006, is required for licensure renewal for medical doctors. The Pennsylvania regulations state that to renew a medical license, a physician will need:

– 100 total credit hours of CME in the two-year license cycle

– A minimum of 20 of the total credit hours in Category 1

– 12 credit hours in the areas of patient safety or risk management (either Category 1 or Category 2)

Similarly other states have new regulations that require additional CME hours.   A number of organizations are offering accredited CME education in a convenient format where the physician is easily able to combine CME hours with a little bit of relaxation, exotic vacations and quality time with the family.  A popular format is the teaching of CME courses aboard a cruise ship while the ship is cruising to popular and exotic vacation destinations. There is definitely some value for the ability to complete the required CME hours in the company of peers in your profession without interruption from the office —- secure in the knowledge that your family is close by and they are just having a great time aboard the cruise ship while you are completing the CME requirements. Once in port there are a few CME activities but mostly it is fun and relaxation with the family, friends and professionals either through organized tours or independent activities of your choosing.

Popular destinations for CME on the high seas are Alaska, Caribbean, Europe and other exotic locales near and far. Major cruise lines work with organizations that offer accredited CME courses to offer various package deals that include free companion fares and amenities. The cruise lines provide secure and private space on board to ensure that the CME at sea experience is uninterrupted by other travelers aboard the cruise ship. The CME courses to popular destinations are booked well in advance and it is important to plan well in advance.  There are a number of accredited companies that offer CME courses and often they combine the CME courses with courses in wealth management and financial planning.  

A recent sailing where a CME course was offered was aboard the Norwegian Sun, an excellent ship that is part of the fleet of the Norwegian Cruise Lines —– which cruised roundtrip from Vancouver to Alaska through the inside passage stopping at Ketchikan, Juneau and Skagway from July 15^th through July 22^nd, 2007. This CME course was offered by the organization CME@Sea. For more information visit http://www.cmeatsea.org/.

There are a number of other companies that offer similar CME courses for doctors on other cruise lines to various destinations.  There are even courses for Registered Nurses. Even if you are not a doctor or a nurse, you may still be able to attend the CME course to enhance your understanding of various specialties and topics. This experience may be great for Hospital Administrators and other office staff. Check with the organization that offers these continuing medical education courses to see if they will accept you as a delegate. This may be a great way for others in the health care industry to understand the advances in medical sciences / life sciences to better relate to practicing physicians with who they interact in the health care profession.

I encourage doctors, life science researchers and other health care professionals in the global Healtheva community to check the CME courses at Sea. Healtheva is a community for doctors and life science researchers. www.healtheva.com. Healtheva provides a platform for doctors and life science researchers to communicate and collaborate globally. It is possible for members of the Healtheva community to coordinate their CME courses and may be even form their own special groups to sail together to select and exotic destinations. Healtheva offers the perfect  social networking platform for doctors and life science researchers to organize their own CME group to the destination of their choice.  Check it out!   

Bon Voyage!!

To find out how you too can blog for free and share your personal comments and insights with others : Visit www.healtheva.com , The social network for doctors and life science researchers.

Sophia Merit Scholarships Inc., a Silicon Valley based chaitable non profit organization offers scholarships for needy and deserving students in India who wish to pursue degrees in Medicine and Engineering.  Sophia is a 501(3) (c) organization incorporated in California and contributions to this non profit organization are tax deductible under IRS rules.  The organization is run by individuals with impeccable credentials whose only motivation is to serve.  I encourage people from the Healtheva community who have an interest in promoting education in medicine and the life sciences to seriously consider Sophia in their annual chaitable giving plans.  Healtheva is an online global community that enables collaboration among doctors and life science researchers. www.healtheva.com

Here is an Appeal and Contact Information:

OUR HUMBLE APPEAL 

SOPHIA SCHOLARS ENGINEERING

MEDICINE

 DONORS ILLUMINATING THE LIVES OF SOPHIA SCHOLARS

 Adult Acute Myeloid Leukemia Patients In Desperate Need for Matching Donors 

 The incidence of AML, Acute Myeloid Leukemia in South Asian adults is being highlighted by frequent and desperate appeals for bone marrow transplants through emails and other appeals for donors to come forward. Local Temples and other places where people gather in various social settings are a place for physically connecting with the donors and taking samples for matching.  However, there is a need for raising the awareness in the community and for building an online data base/registry rather than ad hoc appeals from individual patients, their family and friends.

The South Asian community is small in numbers and relatively dispersed over the country. The likely hood of getting a match within the South Asian community is much better than within the entire US population. For a patient in desperate need time is of the essence.  There is no formal mechanism to reach the entire community for seeking donors and there should be. There is definitely a need for a South Asian Bone Marrow Donor Registry that spans the entire community in the USA so that the patient in need can be matched instantly with a willing donor who has pre-registered.

According to the National Cancer Institute, “Adult acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes abnormal myeloblasts (a type of white blood cell), red blood cells, or platelets.  Adult acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of acute leukemia in adults. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia” 

 Additionally according to the National Cancer Institute the possible risk factors for AML include the following:

·         Being male.

·         Smoking, especially after age 60.

·         Having had treatment with chemotherapy or radiation therapy in the past.

·         Having had treatment for childhood acute lymphoblastic leukemia (ALL) in the past.

·         Being exposed to atomic bomb radiation or the chemical benzene.

·         Having a history of a blood disorder such as myelodysplastic syndrome.

For additional information on AML, please see the following link:

http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/patient

To find out how you too can blog for free and share your personal comments and insights with others : Visit www.healtheva.com , The social network for doctors and life science researchers.