Our Health Data Rights

My colleague, Alan Greene, has been in the lead with a group of professionals putting forth a declaration of health data rights and, as founder of eDoc, I am completely in support of it. He points out that more than 7 percent of abnormal tests results fall through the cracks, according to a study released today in the Archives of Internal Medicine. According to Alan, as quoted today in his blog: "Whether we use this power to track our family’s medications, BMIs, lead levels, vaccines, or allergies, by being more actively engaged I believe we can make better health choices, reduce costs, reduce errors, and enjoy better health. Too often, bureaucracy, old thinking, or paternalistic concerns keep people from having their own health data or from
having the courage to act on it. I believe this is about to change. On June 22, 2009, we released a Declaration of Health Data Rights a profound, simple statement that, among other things, we all have the right – the license – to take possession of a complete copy of our health data without delay and at minimal cost, in a computable form if our lab data or pharmacy records or growth charts or other health data exist in that form....This doesn’t mean that we won’t value physicians and others who have devoted their lives to a study of health, but it does mean that we will engage with them in a new and more effective way...I hear concerns from some doctors that patients shouldn’t have a set of keys: they won’t make safe drivers. And it would be dangerous, for instance, for patients to be able to get worrisome lab results or biopsy results without someone present to reassure them. As I’ve heard more than once, what if this led to suicidal behavior? Yes, I think it’s valuable to have support when getting bad news, but I also think the choice of whether to have support, when, and what kind belongs to the person getting the news. Our routine of keeping people in the dark until we are ready for them to get information is too a high price to pay. What if people misinterpret or misuse their own health data in less extreme situations? No one has a greater interest in an individual’s health than that individual and their loved ones. Armed with up-to-date data, they are free to consult experts and other resources as they wish. Our health is our responsibility, and having our own data is essential to taking charge.

The Declaration of Health Rights is simple, clear, and self-evident – but I expect the implications of this Declaration will continue to unfold over the years to come What if people misinterpret or misuse their own health data in less extreme situations? No one has a greater interest in an individual’s health than that individual and their loved ones. Armed with up-to-date data, they are free to consult experts and other resources as they wish. Our health is our responsibility, and having our own data is essential to taking charge...One natural extension of this will be people’s ability to order lab tests for themselves. Of course, insurance will only pay for the tests if the situation warrants, but if your child has a sore throat and a fever, why shouldn’t you be able to order a strep test? Or if you’re a parent in your thirties or forties and have high cholesterol, why shouldn’t you be able to have your child’s cholesterol levels checked? We live in a country that allows people to smoke cigarettes and carry guns. Having our health data is far less dangerous and carries with it the possibility of great good. Let’s shake hands; let’s pick up our keys.

To learn more about the Declaration of Health Data Rights, click here.

To become a signer of the Declaration, click here."

Thanks, Alan, for stating this so well. I couldn't do it better than you, so thanks for allowing me to quote you!

Recent Heart Attack? Consider Cardiac Rehab!

Cardiac rehabilitation, or guided exercise under direction of a physical therapist, is a valuable yet underutilzed therapy for patients suffering a heart attack. Importantly, in those patients with ongoing risk factors related to obesity and insulin resistance/diabetes, aggressive cardiac rehab was recently shown to be especially effective.

Specifically, two groups of patients were enrolled in high intesity (5-7 days weekly of 45-60 minutes exercise) versus standard (3 days weekly of 25-40 minutes exercise).

High intensity patients lost more than twice as much weight over 5 months as standard patients (18 pounds vs. 8 pounds and had significantly greater reductions in 2 major cardiac risk factors -- waist circumference and insulin resistance. At 1 year, both groups had gained a couple of pounds over 5-month weights, but total body-fat percentages in the aggressive group remained significantly lower than initial readings. Other cardiac risk factors changed too - including decreased insulin resistance, increased HDL (good) cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to HDL (good) cholesterol.

Overall then, patients who took advantage of their motivation after heart attack to aggressively address exercise goals reduced potential risk factors and set the tone for a healthier life. If you have been a heart attack sufferer, ask your doctor about cardiac rehab. If you are not a heart attack sufferer but have risks, ask your doctor about trying a program like this on your own.

Questions and comments welcome as always!

Problems with your “Z’s”: New research on treatment of persistent insomnia – help is more than just medication.

The May 20th issue of JAMA (Journal of the American Medical Association) includes an article on treatments for persistent insomnia. Insomnia is the most common of all the sleep disorders and is described as having problems with the ability to gain sufficient sleep or to feel rested and characterized by difficulty getting to sleep or staying asleep. Insomnia may be situational, recurrent, or chronic. Most people know if they have problems with sleep, and most of us have had personal experience with occasional bouts of insomnia.

Lack of adequate sleep over time, or persistent insomnia, can have a very big impact on daily functioning; it will lower your quality of life and can contribute to various health and emotional problems. When untreated, insomnia can also contribute to major depression and other physical problems. When you get behind the wheel with not enough quality sleep, you not only put your life at risk, but those around you as well. A large number of auto accidents are attributed to driving while drowsy. Although it may be tempting to use alcohol as a sleep aid, it will work in the opposite way and create insomnia and other health-related issues as well. And…of course this will not help your driving either!

Here are some sleep-promoting tips that can work well to help you get into a healthy sleep routine:

1. Maintain a regular bedtime and awakening time schedule including weekends. Get up about the same time every day, regardless of what time you fell asleep.
2. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime many include a warm bath or shower, aroma therapy, reading, or listening to soothing music.
3. Sleep in a room that is dark, quiet, comfortable, and cool; sleep on comfortable mattress and pillows.
4. Use your bedroom only for sleep and sex. Have work materials, computers, and TVs in another room.
5. Finish eating at least 2-3 hours prior to your regular bedtime.
6. Avoid caffeine within 6 hours; alcohol & smoking within 2 hours of bedtime.
7. Exercise regularly; finish a few hours before bedtime.
8. Avoid naps.
9. Go to bed only when sleepy. Lay in bed only for sleeping, not for work or watching TV.
10. Designate another time to write down problems & possible solutions in the late afternoon or early evening, not close to bedtime.
11. After 10-15 minutes of not being able to get to sleep, go to another room to read or watch TV until sleepy.

This latest research in JAMA shows that CBT (Cognitive Behavioral Therapy), a structured form of psychological treatment that focuses on modifying thoughts and behavioral patterns, was effective for treating persistent insomnia. The addition of a sleep medication to CBT treatment like zolpidem (generic name for a prescription sleep medication) produced some benefits, although such benefits were modest to treatment outcomes. Such findings suggest CBT may provide an added benefit in treatment of insomnia.

Since you are awake anyway, sign on and leave a comment about how your sleep is going. All comments from those who are sleep-deprived and others are always welcome. Sweet Dreams!

Tips for Vegetarians

Some people decide to become vegetarians. There may be a personal philosophy against killing animals for food, religious convictions or a desire to eat a very healthy diet. There are different types of vegetarians. All avoid animal products, but some will eat dairy foods (Lacto-vegetarian), eggs (Ovo-vegetarian) and others will eat none of these (Vegan). Some vegetarians will eat fish (Pesco-vegetarian). Being a healthy vegetarian and getting all essential nutrients in the diet takes knowledge and effort. If done right, studies show that vegetarians are leaner, have a lower blood pressure, lower cholesterol and lower blood sugar.

Vitamin B12 is naturally only present in animal foods. Since it is added to fortified grains and cereal, vegetarians can still get B12 from food. Adequate iron is hard to come by for menstuating female vegetarians. Spinach and other greens do have some iron but it is not well absorbed. B vitamin and iron supplements may be taken to ensure good nutrition. Protein is the building block of most tissue, and getting all of the essential amino acids (what constitutes protein) from vegetables takes knowledge and a willingness to eat a variety of foods, especially beans, brown rice, nuts and greens.

As our global population continues to grow and our "carbon footprint" is measured, it is likely that more people will become vegetarians. This will be a good thing as long as a rich and diverse vegetarian diet is followed.