Tuesday, August 12, 2014

MOC the Pablum for the masses of the ABMS

MOC is all just Pablum for the masses and there is no better analogy: see: 
ANother invention that SEEMED a good idea which is NOT!

Is Pablum Necessary? New recommendations on what baby's first foods should be (hint: it doesn't include infant cereal) 
by Teresa Pitman 
In the 1920s, many babies were being fed with homemade formulas that consisted primarily of sweetened cow’s milk and water. Doctors at Toronto’s Hospital for Sick Children wanted to find a baby food that could supplement this formula, as many babies of the time showed signs of vitamin deficiencies and malnourishment. 
In 1931, they invented Pablum, a powder that could be mixed with water or milk and spoon-fed to even quite young babies. The original ingredients included: ground wheat, oatmeal, cornmeal, wheat germ, bone meal, brewer’s yeast and alfalfa plus added vitamins and minerals. It was the first infant cereal, and it quickly became the standard first food for babies. 
Over time, many companies began producing their own variations. Because of concerns about allergic reactions, most now use just a single grain (such as oats or rice). 
But times have changed. As more babies are once again being breastfed, and the quality of formulas available to parents has improved, recommendations about adding complementary foods have also changed. The Canadian Pediatric Society and the World Health Organization now both recommend that babies be exclusively breastfed for six months, and then continue breastfeeding with added solid foods for two years and beyond. 
When a baby starts on solid foods at six months or later, there’s no need for a highly processed, semi-liquid food like Pablum or another infant cereal. These babies are ready for REAL food! In fact, the World Health Organization recommends that babies be offered the foods that are part of the family’s usual healthy diet. 
- See more at: http://www.babypost.com/babies/infant-developme...

Saturday, August 9, 2014

Putting Quality on the Global Health Agenda-NEJM & IOM crap

I read the article praising Institute of medicine political statements from the NEJM and wrote the following (naturally not accepted for publication). I used real definitions to define the problem, not politically motivated ones:
Placing the “mea culpa” in real terms regarding "quality healthcare".
The recent perspective on quality in healthcare continues to miss many essential realities. Quality is also defined as:”A measure of excellence or a state of being free from defects, deficiencies and significant variations.”
Rehashing the Institute in Medicine’s particular brand of definition, emphasizing: “it is safe, effective, patient-centered, efficient, timely, and equitable” simply does NOT describe modern medical care:
Safe: The very nature of healthcare (surgery, drug administration, anesthesia and procedures) is extremely dangerous, while this fact is typically minimized in expectations and when obtaining informed consent.
Effective: Typically the patient’s ability for self-healing is only promoted by treatment, typically introducing drugs and procedure related specific known dangers in the process-often as dangerous as the disease itself.
Patient centered: Increasingly emphasis decries utility of preventive care including PSA, mammograms, pelvic and even routine yearly physical exams-emphasizing cost effectiveness over patient centricity.
Efficient and timely: would require maintenance and preventive care-currently not emphasized-see above.
Equitable: you cannot purchase health, only health care. Poverty and lifestyle remains after healthcare, as a causative factor.

By failing to recognize that quality healthcare starts with having health and maintenance, whereby the patient is the primary source of health, we will never get past placing blame on physicians and health care systems for inadequate quality. Physicians cannot consistently replace that, which is already lost. The continued emphasis on “adverse outcomes” blaming heathcare systems, ignores the many patient centered causes of sickness including poverty, handguns, rampant drug, tobacco and alcohol abuse, obesity and multiple other life style choices including “extreme” and professional sports-which are not typically terminated by the patient, even after problems are treated and causality confronted. Adverse outcome continues to be defined as anything less than an optimal desired (advertised) outcome typically=restitutio ad integrum! This “failure” is not equal to malpractice, deficient or even inadequate care. Patients come to hospitals, when problems become severe and baseline health is marginal, increasing the risks from receiving care.
The example of the inability to decrease maternal mortality by financing all deliveries in hospitals is not surprising, as provision of care introduces specific risks (a la Semmelwiess or modern expected risks): I.e. failure to provide adequate pre and postpartum care, C/section rate risks are certainly as, or even more important, than delivery in a hospital vs home . We need to quite blindly accepting corporate definitions from the IOM or elsewhere and accepting all blame for complications.

As an anesthesiologist and for example, where the expectation is to provide general anesthesia (versus no anesthesia needed) for a MRI scan, in the most extremely hostile physical environment known, to merely “take a picture”, expected complications will always prevail and provide “adverse outcomes”. It is time to capture all inherent/statistical/expected risks and start tabulating adverse outcomes based in the real world.

This is the article available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1402157
Putting Quality on the Global Health Agenda
Kirstin W. Scott, M.Phil., and Ashish K. Jha, M.D., M.P.H.
n engl j med 371;1 nejm.org july 3, 2014

Thursday, August 7, 2014

Public Health & Policy MOC: Dissecting the Issues MedpageToday

Public Health & Policy

MOC: Dissecting the Issues

Published: Aug 6, 2014
Paul Kempen, MD, PhD, has been actively investigating the certification industry and background, introducing the term "regulatory capture," which he defines as the use of laws to create compliance with corporate self- serving programs. Kempen is an anesthesiologist now in private community practice after decades of academic practice. He regularly posts atwww.Changeboardrecert.com and his blog.

SEE: http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/47085?xid=nl_mpt_DHE_2014-08-07&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g821443d0r&userid=821443&email=daraparvez%40gmail.com&mu_id=6133776&utm_term=Daily