Ib. Successful Patient: Learning About The Flu

     Last Tuesday I attended a lecture at a premier medical school given by two eminent microbiologists. The focus of the lecture was to educate the attendees about the flu and the risks of a possible worldwide infection (pandemic).

     Viruses cannot live outside the host. If human beings become immune to the virus, the virus will become extinct in humans. The smallpox virus killed over 300 million people in the 20th century. Through worldwide innoculations, the smallpox virus could no longer infect humans. Therefore, the smallpox virus is now extinct because there are no longer any human hosts it could infect.

     Viruses cause illness in humans by invading cells and replicating within the cells. The virus then spreads to other cells. Unless the immune system can control the virus, the virus will infect every cell and overrun the body. In some cases, death can result. Viruses are fought with the body’s natural immune systems or through vaccines. Vaccines stimulate the body’s immune system to produce antibodies to fight the disease. The viruses are isolated and then killed (inactivated) or weakened but live (attenuated). These killed or weakened viruses trick the immune system into an immune response namely the production of antibodies. The immune system does not distinguish between harmless dead or weakened viruses and a fully functioning virus. The immune response produces antibodies from the vaccine so when the fully functioning virus hits, it is met with antibodies which kills the virus before it can replicate throughout the body. Without the vaccine, the body cannot produce antibodies fast enough to stop the spread in the body of the virus.  

     The flu is a virus. A virus is smaller than bacteria or parasites. In fact, viruses are so small that if it were the size of a 3×5 index card, the cell would be the size of the old World Trade Center. The flu is classified as ”A” type and “B” type. “A” types are subject to antigenic shifts. This means the virus has the ability to jump from animals to humans. A “B” type flu virus is a human virus that cannot jump from animals to humans. ”A” type flu viruses can reside in birds, horses, pigs, whales, reindeer, seals and camels before jumping to humans.

     The 1918 Spanish flu killed 675,000 people in the US and 50 million worldwide. The high death toll could be attributed to the lack of knowledge about the flu. Health authorities believed the flu was a bacterial infection. Even if antibiotics existed in 1918, they would have been useless against the flu virus. Antibiotics are effective only against bacterial infections but are ineffective against viruses. The flu virus was not isolated until 1933. It is hard to believe how far medical science has come in the 90 years since the 1918 flu.

     The “A” flu virus has 16 different subtypes. There are currently 3 types of flu viruses circulating in the human population. These are H1, H2 and H3. The H1 and H3 strains were included in this year’s flu shots.

     The worry in public health circles is the H5 bird flu. There is currently no vaccine for humans for this flu virus. Various antiviral drugs may help if there is an outbreak. Currently, microbiologists report there has been no jump of the bird flu to humans. Of the 175 cases reported in humans worldwide, all had close contact with chickens or other birds. The bird flu has not yet appeared in the US. The scientific thinking is that the infection of the 175 people was caused by ingestion of infected birds without proper cooking. This released massive amounts of the bird flu virus into the bodies of the victims. Heat through proper cooking will kill the virus.

     The 1918 flu virus although extinct contained certain genetic proteins that made it lethal in humans. If that genetic protein combined with other flu viruses, a health problem could result. The best current scientific evidence is that the bird flu will not jump to humans but constant mutations in the virus requires significant monitoring.

     To summarize, 1) get your flu shot every year, 2) the bird flu is not currently a significant risk of jumping to humans from human contact and 3) chicken is safe to eat as long as it is cooked thoroughly. Chicken should be cooked thoroughly to avoid a bacterial disease called salmonella poisoning.    

 

Ia. Successful Patient: How To Be One

      In my opening remarks, I tried to bring patients to the realization that medical services are dispensed in an inefficient manner. This inefficiency is largely due to the fact that the US medical system is broken and sorely in need of reform. Reform of the medical system will not happen soon. Therefore, we patients must adapt to the current medical system by maximizing the benefits of the medical advice given. Only then can we be successful patients.

     Some of my friends who are medical doctors tell me that many patients are uneducated or unwilling to learn basic principles of the science of good health. These doctors have told me that many of their patients know more about their car than they know about their bodies. Anecdotal conversations with one physician revealed that some patients service their cars every 6 months but do not get physical exams at least once a year.

     The first step toward being a successful patient is to be proactive with your health. This requires patient preparation. As with every profession, the medical profession has its own vocabulary with which patients need some familiarity. This does not mean for the patient to run out and buy the latest edition of Gray’s Anatomy. It does mean however, a frequent use of the internet. For example, my dad thought he may have a hernia. He made an appointment with his primary care physician for the doctor to evaluate his discomfort. Before he went to the doctor, I went on the internet to learn: a) what is a hernia? ,b) what are the different types of hernias? ,c) what are the treatments for hernias? and d) this is important, what are the risks if I have a hernia but fail to correct it? Armed with this information, the doctor’s diagnosis and treatment made sense to my dad and our family. Remember, there is a waiting room full of patients that the doctor has to see. He or she has 15 minutes to explain the diagnosis, treatment and answer any questions you may have. Without proactive preparation as a patient, the doctor’s 15 minutes is merely a directive not a dialog.

     Just as car owners buy magazines and manuals for their cars to better understand what is under the hood, the successful patient needs to continue or begin their education so as to better understand “what is under his or her hood.” This does not require the successful patient to go back to school or to spend a lot of money. How can this be done? The modern hospitals have recognized that patient education is not only good business but increases satisfied patient outcomes and reduces malpractice litigation. One noted NYC hospital has introduced a no cost mini-medical school for anyone wanting to learn more about medical sciences. Lectures are given by medical school professors with materials given to medical school students. The focus of these lectures, however, is not to diagnose ailments but rather to educate patients about medical ailments and the medical jargon associated with the discussion. The author of this blog will be attending a 2 hour lecture next week on the possible pandemic associated with the bird flu.

     To reiterate, these lectures are not intended to preempt a doctor’s diagnosis or treatment of the flu. It is however, intended to educate the patient about: a) What is the bird flu? b) How is it transmitted? c) What are the treatments? and d) know what is fact and what is rumor. I will report next week on this blog about what is fact and what is fiction about the bird flu. Finally these lectures give the patient the vocabulary needed to comprehend the news, avoid the flu if possible and if necessary, seek and understand medical advice. This is the beginning prototype of the successful patient.

 

BROKEN US MEDICAL SYSTEM

      This blog will endeavor to open up for discussion 2 primary issues facing consumers (patients) serviced by the broken US medical system: I. How to maximize your medical advice within the limited time given to patients by doctors, and II. How to reform the existing US medical system so that quality medical care is available to everyone at a price that is affordable.

              I. Maximizing Your Medical Advice

                 You make an appointment with your doctor and wait to be called. Finally when you are called, the doctor spends 10 minutes with you examining and explaining your ailment and your treatment. You say you understand but do you? You fill the prescription but don’t know what the medicine does or the side effects. Your doctor simply does not have the time to explain all you need to know to determine if the medicine is appropriate. By appropriate, I mean every medicine has side effects. You as the patient have to be in charge of your own body and make informed decisions regarding your care. Most doctors are caring professionals but cannot spend the time to push you up the learning curve.

This blog will attempt to give straight forward advice and knowledge to help educate you when seeing your doctor. You are not competing with your doctor but rather becoming an educated consumer of medical care who makes your doctor’s advice more meaningful.  For example, you should know that if you have a virus, antibiotics do not work. Antibiotics only work on bacterial infections. You should ask, is the infection viral or bacterial? When the doctor gives you the answer that it is a viral infection you will know antibiotics will not be prescribed because they will only work on bacterial infections.

I am attending a series of lectures at a leading medical school and will report on this blog what I have learned so that we can together be better informed consumers of medical services.

          II. Reforming US Medical System

              I will comment frequently about the weaknesses of the US medical system and how to reform it.

The major problem with our medical system is the cost explosion. Only people who are employed and have access to a large medical pool can afford medical insurance. Employers subsidize their employees’ cost to make employee premiums reasonable. However, employer provided healthcare is a historical accident. During WWII, wages were frozen by price controls. Raises could not be given so benefits such as free medical insurance was provided instead. Today, medical insurance is very expensive even to the employed with healthcare benefits. No other western country provides healthcare the way it is paid for in the US. For a working family with no employer subsidized healthcare, the cost is prohibitive. For example, Aetna’s individual POS policy for southern NY is $9,696 for an individual per year and $28,840 for a family per year. This is not affordable healthcare.

The costs are continuing to rise at a rate far in excess of the inflation rate and by the year 2015, $1 in every $5 spent in the US will be spent on healthcare. Reform is long overdue. Politicians will only move on healthcare issues if there is a groundswell from the electorate. I will be posting ideas for reform on this blog. 

Lastly, if quality medical care is a citizen’s right just like the right to vote, then the US Government and state government must be major players in the medical reform movement. If quality medical care is merely a privilege not a right, then the private sector restrained only by market forces will continue to maximize profits. Unless demand decreases (which is not likely with the aging of the baby boomers) medical costs will continue to sap the economic strength of this country. Since most states prohibit a hospital to refuse to treat a patient without medical insurance, it seems clear that this country has determined quality medical care to be a right not merely a privilege. I will post my ideas for reform on this blog.