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Migraine in Children Can Lead to Reduced Performance in School

Posted on 11. May, 2013 by wisdom.

In an article titled “Migraine and migraine subtypes in preadolescent children Association with school performance,” appearing in Neurology in 2012 by Marco A. Arruda and Marcelo E. Bigal, a discussion is made that children with migraine may have below average school performance than kids who do not have headaches.

The study looked at 5,671 children ages 5 to 12 from Brazil and found that those with migraine were 30% more likely to have below average school performance than those children with no headaches. The researchers collected information from the student’s teachers on their performance and also completed a questionnaire screening for emotional and behavioral problems. Further, the researchers interviewed parents of the students from medical history and other potential useful information.

Of the 5,671 children around 0.6% had chronic migraine occurring 15 or more days per month and 9% had episodic migraine.

The researchers found that the link between migraine and poor performance in school was even stronger for children with migraines that were more severe, lasted longer, or for children with chronic migraine.

The researchers believe that for those children having headaches with migraine features this is a serious problem and needs to be taken seriously. Further, children need to receive medical treatment and attention.

I believe that this study is accurate although it would be interesting to see a similar study of teenagers. For those who suffer from migraines you may want to see some of my previously posts such as Migraines – Cause and Effect and Daily Preventative Therapies Can Reduce Migraine.

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Oklahoma Dentist Disciplinary Database

Posted on 28. Apr, 2013 by wisdom.

A lot of media publicity has occurred regarding a case that appeared last month where patients of an oral surgeon in Oklahoma were asked to get tested for HIV and hepatitis after it was found that potentially lax sterilization procedures were used. More on this case is discussed over at Dental Patients Warned of Possible HIV and Hepatitis Exposure Due to Oral Surgeon’s Practices for example.

The Tulsa World has been prompted to publish a searchable database of all disciplinary actions taken against dentists, in the state of Oklahoma from January 2000, to January 2013, after the case involving lax sterilization procedures came to light. In that case one patient had four third molars (wisdom teeth) removed and was allegedly given sedation by a dental assistant who should not have been giving sedation. She later developed an infection and liver problems.

The Tulsa Word seems to be publishing the database to allow patients to better research dentists and make determinations of who they may decide to see to perform their dental work. Most cases that involve disciplinary actions against a dentist by a State Board of Dentistry do not receive quite the amount of media scrutiny as the case did discussed previously.

A description of the Tusla World’s findings is in the article by Casey Smith and Ziva Branstetter titled “Sunday: 68 Oklahoma dentists disciplined since 2000, World finds,” published on April 27, 2013,  located over at http://www.tulsaworld.com/article.aspx/Sunday_68_Oklahoma_dentists_disciplined_since_2000/20130427_296_sunda_99885

The article states

“The state agency responsible for disciplining dentists took at least 98 actions against dentists during that time for violations of the state dental act and other laws including substance abuse, improper prescribing practices and allowing assistants to perform work for which they were not licensed. Other circumstances involved dentists who violated the terms of their board probations, made improper sexual contact or remarks to patients, had misleading advertisements or took part in Medicaid fraud.”

Additional Source: DrBicuspid. “65 Okla. patients test positive for hepatitis C,” April 26, 2013, located at http://www.drbicuspid.com/index.aspx?sec=sup&sub=hyg&pag=dis&ItemID=313209

Update: See this article for more details from Tulsa World titled “Oklahoma State Board of Dentistry took action against 68 dentists during past 13 years,” by Casey Smith and Ziva Branstetter, April 28, 2013,  http://www.tulsaworld.com/article.aspx/Oklahoma_State_Board_of_Dentistry_took_action_against/20130428_11_A1_ULNSxc325718

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Justice and Fairness in the U.S. Healthcare System

Posted on 30. Mar, 2013 by wisdom.

An interesting article appears in the Fall 2012 issue of the “The Journal of Law, Medicine & Ethics” titled “Justice and Fairness: A Critical Element in U.S. Health System Reform,” written by Paul T. Menzel.

In the article Paul discusses how unfettered competitive markets in health insurance generate market failure. The market failure of course is the fact that in an unfettered competitive market, health insurance will inevitably be out of reach for many (even most) of those who desire and need it most.

In the article Paul discusses a term he coins the Just Sharing principle

“The financial burdens of medical misfortunes ought to be shared equally by well and ill alike, unless individuals can be reasonably expected to control those misfortunes by their own choices.”

Paul goes on to say

“Just Sharing is incompatible with pre-existing condition exclusions, high degree of premium variation by subscriber risk, rescission of insurance when a subscriber becomes high-cost, and other market segmentation devices that inevitably arise in an unfettered competitive insurance market, creating market failure. If one only bars insurers from using these devices, however, then the “death spiral” for insurance begins: community-rated premiums lead even more of the likely well to forego insurance, which this raises premiums for remaining subscribers even more, and the cycle deepens. Basic insurance must be made mandatory for a competitive market to avoid leaving many of those who most need insurance high and dry. The heart of the moral objection to leaving many high and dry is that the likely well ought to contribute more to insurance than their individual risk situation alone warrants. That is, a good share of the expense of illness should be shared by well and ill alike.”

In the middle of the article Paul goes onto a discussion of what he coins the Equal Opportunity for Welfare along with the Emergency Medical Treatment and Active Labor Act. I won’t go into all these details here so I encourage you to read the article.

Later in the article Paul addresses the issue of comparative cost effectiveness.

“Suppose that for treating a given condition, two treatments are equally effective but not equally cost-effective; one carries higher cost for the same likely benefit. If I am required to contribute funding through mandated insurance, my assistance and investment is being partly wasted if it is devoted to care that is no more effective but costs more. If people are going to be required to share in the expenses of those who fall ill and need care, then plans and providers owe them a commitment not to waste their financial support. And covering less cost-effective treatments for a given condition, not just the more cost-effective measures for the same prospective patients, is — let’s be clear and accurate here — a waste.”

“This is exactly how various parties in European health care systems that provide care which is typically as effective as that in the U.S. but at little more than half the cost put the matter. The statement that “inefficiency is unethical” made by Marc Danzon, head of the WHO Regional Office for Europe, has become a kind of dictum in European circles. Efficiency is not a moral luxury. It is a moral obligation.”

The article by Paul certainly covers some interesting points and is worth the read.

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Unnecessary Medical Care and Over Used Tests: The Choosing Wisely Campaign

Posted on 15. Mar, 2013 by wisdom.

The Choosing Wisely Campaign is an initiative which I believe I first heard about in late 2010 launched by the ACR (American College of Radiation as the Imaging Wisely Campaign) The Imagely Wisely Campaign was designed to have people aware of the fact that certain medical imaging tests such as CT exams were sometimes over used and did not always have to be used in some instances. It seems that the Choosing Wisely Campaign was launched by the ABIM Foundation which is an organization designed to advance medical professionalism to improve patient care. In April 2012 the Choosing Wisely Campaign released some lists of tests and procedures commonly done in 9 medical professions that should be questioned.  In February 2013 an additional 18 lists of tests or procedures were released. The press release is located at http://www.choosingwisely.org/wp-content/uploads/2013/02/021513_CW-Phase-II-Press-Release-FINAL.pdf

On the website of the Choosing Wisely Campaign it states

“An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.”

Consumer Reports is involved in helping to disseminate information to patients in a more readable format. On the about page of the campaign the following bullet points are presented.

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

The patient lists are located over at http://www.choosingwisely.org/doctor-patient-lists/ On this page are lists by the specialty societies currently participating which are supposed to be for doctors. There are also lists for for patients which consumer reports has helped to write along with the specialty societies. Both of these list are informative.

As an example of things provided in the list let’s take a look at the Colonscopy list for patients http://www.choosingwisely.org/doctor-patient-lists/colonoscopy/. The list states that having more than one colonscopy in a span of 5 to 10 years is not usually necessary. It also describes how colonscopy can in rare instances cause complications such as a tear in the colon and heavy bleeding. The list also provides some advice on how someone can protect themselves from colon cancer such as by changing their lifestyle and report any potential warning signs to a doctor.

As another example of things provided in the list let’s now take a look at the list for doctors from the American College of Radiology http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/. The list states that a CT should not be performed in a child with suspect appendicitis unless an ultrasound has been considered. The list also advocates against performing an x-ray in an ambulatory patient is not warranted unless something in the patient’s history or presentation suggests it.

I have previously discussed on this blog in the post How to Protect Yourself from Abusive Doctors how patients should work with their family medicine doctor to make sure tests and treatments advocated for by other doctors in other specialties is using the latest evidence. I have also addressed this in this post Tips to Prevent Medical Errors – AHRQ.

It is clear that is almost impossible for patients to accurately assess the need for and quality of care. Hence, I have also advocated for reviewing guidelines provide by the National Institute for Health and Clinical Excellence of the U.K.

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Aggressive Dental Marketing Practices

Posted on 12. Mar, 2013 by wisdom.

Several years ago I posted a controversial post titled Dental Practices of some Dentists Websites Online is Questionable. In this post I discussed how I am frustrated by website users who register on forums and post topics and reply to topics with a signature that includes an html link to their (or a client’s) website. I called this a questionable search engine optimization strategy. Unfortunately this tactic continues to rage on and I actively have to fight it off and know that other website owners do so as well.

Recently, I have become a bit irrated by a particular website: wisdomteethremoval.com. This website essentially has the same domain name as mine teethremoval.com except it has a wisdom added on to the front. Now clearly I deem this website as in direct competition with my website and attempting to divert attention away from my website.

Now this website is also engaging in some Aggressive Search Engine Optimization Strategies. The website runs an answers page http://www.wisdomteethremoval.com/answers. If you look carefully at the questions and answers in this page you will see that they are being copied and pasted directly from Yahoo Answers.

1) From http://www.wisdomteethremoval.com/answers/question/what-happens-when-you-get-your-wisdom-teeth-out/

2) From http://answers.yahoo.com/question/index?qid=20091210180305AAYUyK6

This copying and pasting of yahoo answers occurs numerous times. Even so somehow when you Google for a keyword such as “wisdom teeth removal answers” wisdomteethremoval.com is the first website that comes up!

If you do a similar Bing search for “wisdom teeth removal answers” wisdomteethremoval.com shows up as the first entry on page 3.

The other tactic this website is engaging in is essentially link spamming posts where comments are not moderated.

For example see

1) http://propeller.org.uk/blog/Get-ready-once-again-we-will-be-singing-in-aid-of-charity

There is a link to wisdomteethremoval.com using the keyword remove wisdom teeth as seen above and notice how it is surrounded by people spamming viagra and cialis.

2) http://thefoodproject.org/blog/2012/10/17/common-boston-event?page=4

There is a link to wisdomteethremoval.com using the keyword getting wisdom teeth pulled as seen above and notice how it is surrounded by people spamming North Face products and workers compensation insurance.

If you do a Google search for “wisdom teeth removal” you will see that wisdomteethremoval.com shows up 2nd on page 1 (at least for me at the time of this posting). Now I am not sure at all how wisdomteethremoval.com is ranking so highly in Google. If you do a similar Bing search for “wisdom teeth removal” wisdomteethremoval.com does not show up on the first several pages.

I was under the impression that these Aggressive Search Engine Optimization Strategies as described above should not be employed. However, we have a case here where they are being employed and seem to be working quite successfully in Google.

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