Tag Archives: health

Returning to normal – can we get there from here?

The COVID-19 pandemic has led to unprecedented levels of government action to slow its spread and to mitigate its effects.

The new coronavirus appears to cause death in one to two percent of cases compared to about one death in 1,000 cases for influenza. But unlike influenza, there is currently no preventive vaccine or proven antiviral treatment. The new coronavirus overwhelmed hospital capacity in parts of Italy and threatened to do so in New York City.

With a vaccine still a mere wish and a year away at best, might we hope for “herd immunity”? With COVID-19, that would require 50 percent to 80 percent of the population to be immune by infection or vaccination. Based on current data, we are less than one percent of the way there.

Extreme social distancing in spring has prevented hospitals from being overwhelmed, so we did flatten the curve. Let’s hear it for solidarity!

But when can we “reopen” society? When the disease does not threaten to overwhelm hospitals, and case counts are low enough to be identified and isolated, and their contacts are identified.

How will reopening progress? Per the 10th Amendment of the Constitution, decisions for reopening areas are made at the state level, perhaps at local levels in states that delegate this authority. Some have already begun gradual reopening using the three phase scheme recommended by the Centers for Disease Control (CDC) as a guide.

As reopening progresses, governors will be looking for

  • Decreasing numbers of cases
  • Sufficient hospital bed and intensive-care bed capacity
  • Availability of personal protective equipment (PPE), particularly masks and gowns
  • Readily available testing
  • Sufficient public health investigative capacity

Expect incremental changes based on weighing risk of disease transmission against economic necessity. Activities might be allowed to recommence sequentially along these lines:

  • Medical procedures, starting with the most urgent
  • Businesses with minimal face-to-face customer interaction
  • Other businesses
  • Gatherings with moderate numbers of persons or face-to-face contact
  • Larger gatherings and restaurants

COVID-19 may have catalyzed some permanent changes, speeding the adoption of telecommuting in businesses and distance learning for more college courses. Sick-leave policies and social mores may get more people to stay home while suffering from respiratory infections, and people may more consistently observe cough etiquette. Perhaps a greeting that transmits fewer viruses than handshaking will be adopted. And maybe we’ll wash our hands more frequently and stop touching our faces unthinkingly.

We could get lucky: the virus might be seasonal, so that it fades away during the summer without human effort; or researchers might demonstrate the effectiveness of an antiviral drug that reduces morbidity and mortality without extraordinary social-distancing edicts.

Fondly should we hope, fervently should we pray…

PAUL R. CIESLAK, M.D., is a member of the Catholic Medical Association and a public health official for the state of Oregon. He lives with his wife and family in northeast Portland.

Real data — in real time — can advance health outcomes

September 11, 2001 changed a lot of people’s lives. For Ronac Mamtani, a senior in college about to launch his financial career at a firm across the street from the Twin Towers, that day crystalized for him his desire to help others and inspired his pivot to a future in medicine.

What I enjoyed most about my oncology training at Penn Medicine in Philadelphia was the specific training in clinical epidemiology and biostatistics. These fields have set the foundation for my research career. I tell people I wear two hats: I’m a medical oncologist who takes care of patients with bladder cancer, and I’m a health-outcomes researcher using “real-world data” — data captured outside clinical trials — to find a way to better understand risks and benefits of cancer therapy.

In oncology we rely heavily on clinical trials to make treatment recommendations, and that’s good. Clinical trials are the gold standard. The problem is that clinical trials are long and expensive. There are strict eligibility criteria, and fewer than five percent of cancer patients actually will participate.

Let’s say a clinical trial finds treatment A more effective than treatment B. I might have a patient who wants to know: should I take treatment A after treatment C, or before treatment C? Clinical trials often don’t answer questions about best sequence. With big data, I could answer that question. We can get data from electronic records, study treatment patterns, use advanced statistics to compare treatment groups, and define the optimal treatment sequence.

With data-driven research, we are applying cuttingedge analytics on large data sets derived from electronic records on millions of people to understand treatment effects. A familiar analogy would be Uber. You want to know the driver, the car, the location, how long, how much — and big data allows Uber to deliver all of this information quickly and efficiently. We want to use big data to determine the right drug, at the right place, at the right time, for the right person.

Private philanthropy empowers innovation in medicine. It provides us flexibility to pursue out-of-the-box thinking and get projects off the ground. Equally important is that philanthropy plays a role in healing. It allows patients and their families to be a part of moving innovation forward.

And private philanthropy is directly improving the way we make decisions in clinic by providing funding to develop predictive analytics that we can apply to big data sets. We can analyze the shared experiences of millions of patients who were not eligible for clinical trials. We can do this in front of a computer and get answers quickly.

RONAC MAMTANI, M.D., M.S.C.E., is a medical oncologist who cares for patients with bladder cancer at the Abramson Cancer Center at Penn Medicine. He also is a health outcomes researcher using “real-world data” – data captured outside of clinical trials – to find ways to better understand the risks and benefits of cancer therapy.

Protect yourself from respiratory viruses

Coronavirus and the influenza epidemic have highlighted the need to be smart about our exposure to respiratory viruses. Two public health organizations — the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) — stand out as credible resources for the latest news about these epidemics.

Respiratory viruses spread through respiratory droplets emitted by persons who are coughing or sneezing. People of all ages can be infected, but older people and those with pre-existing medical conditions are especially vulnerable to severe complications. 

How do I protect myself? One of the first things you can do is to make sure you are up to date on the flu vaccine and the pneumonia vaccine. Avoid exposure to people who have a respiratory virus.

The CDC recommends everyday preventive actions, including:

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing
  • If soap and water are not available, use a hand sanitizer with at least 60 percent alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed hands
  • Avoid close contact with sick people.
  • Stay home when sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using regular household cleaning spray or wipe.

How effective is hand sanitizer? Alcohol based hand sanitizers can provide a level of protection, but the alcohol within them evaporates fast — and so does its protections. The application of sanitizer you used after touching a doorknob will likely kill the germs on your hand currently, but five minutes later you may not be protected. 

Should I wear a mask? The WHO acknowledges that wearing masks might be useful if you’re sick in order to prevent you from sneezing or coughing into somebody’s face. However, they add that a mask that is used to prevent an infection is sometimes not very effective because people take it off to eat, they are prone to be worn improperly, and if they get wet and somebody sneezes on that mask it could pass through.

What if I think I have a respiratory virus? Symptoms can include fever, cough, and shortness of breath. The CDC reports that symptoms may appear in as few as two days or as long as 14 days after exposure. If your symptoms worsen and you plan to go to a doctor’s office, call ahead and explain your situation so they can take appropriate infection controls.

SUSAN LOCKE, M.D., is the Healthnetwork Foundation medical director. She is board certified in both internal medicine and psychiatry, having earned her undergraduate degree from Yale University and her medical degree from Cornell University Medical College.

Vaping – a danger at any age

November saw the passing of Robert C. Norris, one of several actors to portray the iconic Marlboro Man, at 90 years of age. While Norris was never a smoker, his rugged and masculine branding in cigarette advertising enticed many folks to smoke. Like much of the Old West, the habit of cigarette smoking has faded from a high of 45 percent of adults in 1965 to a much improved 14 percent in 2017. This laudable public health accomplishment was achieved by widespread taxation, legislation, and education making it expensive, inconvenient, and “uncool” to smoke in America. However, this success also created a void in the market, which has recently been filled by vaping.

Vaping, synonymous with e-cigarette use, describes the act of inhaling aerosolized nicotine and flavoring from a small handheld battery-powered device with a liquid chamber. The liquid is propylene glycol or glycerol (used as smoke in model trains and Christmas or Halloween decorations). The nicotine content in each pod, while variable, is usually equal to one pack of cigarettes.

Use of these devices has skyrocketed as the percentage of adults who vaped at least once increased from 3.3 percent to 15 percent between 2010 and 2016. Unfortunately, illegal use among adolescents has risen even faster, with 28 percent of high schoolers and even 11 percent of middle schoolers vaping in 2017. Many misconceptions exist about vaping: for example, two-thirds of adolescent vapers don’t realize they are inhaling nicotine. Even among adults, many begin vaping as a strategy to quit smoking despite recent studies demonstrating no evidence that it helps.

Controversy surrounds the vaping trend as the marketing of these products appear to directly target youths with flavors like “bubble gum” and “unicorn poop.” The sleek design of these devices, making them look like a cell phone attachment or USB drive, gives them a discreet appearance that youths desire. Despite vaping products being illegal for adolescents, studies show that 87 percent of daily vapers started before 18 years of age. Thankfully, many legislative efforts to curb juvenile marketing are underway.

The most disturbing news regarding vaping is the growing reports of EVALI (E-cigarette/Vaping product-use Associated Lung Injury), which has caused 52 deaths and 2,409 hospitalizations in 26 states through 2019. The exact cause of this condition is unknown but is frequently related to aftermarket adaptations of the vaping liquid, especially the addition of marijuana. Patients who suffer from EVALI can become gravely ill and frequently require mechanical ventilation, antibiotics, and systemic steroids.

Vaping’s addictive nature, marketing to the youth, and demonstrably grave health outcomes should cause all, particularly parents, to oppose its rising trend. “Unicorn poop” is best left as an unspoken detail of fairy tales rather than a contaminant in the lungs of our children.

ANDREW J. MULLALLY, M.D., is a family physician who co-hosts the Doctor, Doctor program on EWTN Radio, and practices at Credo Family Medicine in Fort Wayne, IN.

Accessing the miracle of regenerative medicine

Regenerative medicine and unlocking stem cell biology will open many doors toward treating patients with orthopedic problems (and hopefully, one day, help patients avoid invasive surgeries). Philanthropy is pivotal in helping fund some of the important projects that sometimes cannot be funded through the NIH or other sources.

As a surgeon and a scientist, I see the field of regenerative medicine as extremely exciting because we are on the cusp of understanding stem cell biology. We are getting a window into how Mother Nature regenerates. It’s exciting because we have possibly unlocked certain mysteries of how cells differentiate into specific types of tissue. And once we understand it better—through basic hard work and science—we can steer those cells to do what we want them to do, which will help people avoid complicated and painful surgeries.

In orthopedic surgery we deal with things like broken body parts, muscle defects, spinal issues, bone fractures. Much of what we do is reconstructive surgery. If you tear your ACL, we can replace the torn ligament with a piece of tendon from another part of the knee. If you have spinal stenosis, we can do a spinal fusion. If your hips or knees are terribly arthritic, we can replace them. This is the current convention, and it gives many people tremendous relief from pain and suffering. But the next frontier should be not reconstruction, but regeneration. With the right amount of research, we will be able to regenerate cartilage, bones, tendons, muscle.

The field of regenerative medicine is evolving, and many institutions are looking at it, including Brigham. We aim to be one of the innovators and leaders in this field. Within our department’s vision is to launch a premier center for regenerative medicine, and we are in the process of recruiting a new director to spearhead the program.

Philanthropy is enormously helpful in these massive endeavors. Researchers are constantly endeavoring to get grants through the National Institutes of Health (NIH), which is our main vehicle for funding. But only about 10-15 percent of grants submitted actually get funded. Philanthropy is a way to bridge the gap so that scientists can do their research without having to constantly watch grant funding, having to let people go, and interrupting their studies.

DR. JAMES KANG, chairman of the department of orthopedic surgery at Brigham and Women’s Hospital (BWH) in Boston, specializes in spinal surgery. As a surgeon/clinician/scientist, he is an internationally recognized leader in intervertebral disc degeneration research, having done pioneering work in the biology and molecular mechanisms of disc degeneration, as well as devising novel therapeutic interventions using stem cells and gene therapy.

Back pain – the downside of being upright

In any group of people, asking about back pain will produce nods and frowns. About 80 percent of adults experience low back pain at some point in their life, and it’s the most common cause of job-related disability, a leading contributor to missed work days. About 20 percent of people affected by acute low back pain develop chronic pain.

Back pain is often associated with general degeneration of the spine due to normal wear and tear with aging. The discs begin to lose fluid and flexibility, which decrease their ability to cushion the spine. The likelihood of back pain also increases among people who are not physically fit. An increasing amount of research points to a hereditary component, identified by DNA analysis of families with widespread back pain. Jobs that require heavy lifting, pushing, or pulling have a higher incidence of back pain. At the opposite end of the physical demand spectrum, a desk job may also contribute to back pain, as the sitting position increases the pressure within the lumbar discs. Finally, there is clear evidence that smoking leads to premature degeneration of the lumbar discs, with an increased likelihood of back pain.

Fortunately, surgery is rarely indicated, and there are a multitude of useful nonsurgical treatments, including the application of heat and/or cold and massage. Recommendation for bed rest should be limited, as those who avoid bed rest are more likely to improve faster. Other common treatment methods include over-the-counter medications, physical therapy, and spinal manipulation. More involved but less frequent options can include spinal injections provided in a pain clinic.

Once chronic back pain has developed, the emphasis should be on maximizing symptom management. For those with a desk job, standing and walking frequently during the work day can be very helpful. Ergonomically designed furniture, such as standing desks and lumbar support chairs, may help to reduce symptoms, with particular attention to the most appropriate height for the work surface.

The benefits of a regular exercise program as the most effective tool for management of chronic back pain have been clearly demonstrated. The most important factor is to identify an individual program that works best, and then remain committed to it. This can include walking, swimming, cycling, yoga, low-impact aerobics, and many other regimens.

Affliction of back pain has been noted throughout human history. With our upright posture, the spine bears significant stress regardless of our level of activity. The future of spine care will be best focused on improved means of preventing the degenerative changes that lead to back pain, as well as identification of the most effective and consistent means of diminishing its impact.

TIMOTHY MILLEA, M.D. has practiced as an orthopedic spine surgeon in the Quad Cities area of Iowa and Illinois since 1992. He is an active member of the Catholic Medical Association and serves on the board of directors, as well as being CMA’s state representative for Iowa, and president of the St. Thomas Aquinas Guild of the Quad Cities.

HealthNetwork came to our rescue like no other

There are so many benefits to being a Legatus member. One that I consider a Godsend is Healthnetwork Foundation. Many years ago, Walter and I became Healthnetwork GOLD supporters, as I thought that it would be a great safety net – an organization we could count on when we needed medical help.

It is scary as you get older and see more friends and family struggle with serious health issues, and the overwhelming indecision they face while trying to grasp their new reality. Where do they go for medical care, how do they get there, and whom do they see? All these decisions need to be made in a very short time, while they try and make sense of a diagnosis.

We are so grateful for Healthnetwork. We know from experience they will provide advice on where the right experts are. And, they will quickly jump into securing appointments with experts when we need them.

I had a heart attack a few years ago in Florida, and Walter called Healthnetwork. Without hesitation, Healthnetwork medical coordinators rallied and made connections on our behalf at Cleveland Clinic (#1 heart center as ranked by US News & World Report). Ultimately, I stayed in Florida for treatment, but we were reassured by the swiftness and compassion shared by our coordinator during a very stressful time.

Another time, our daughter, an anesthesiologist, was very concerned about her baby daughter’s soft spot which had not closed. I knew that we needed to get Healthnetwork involved. She asked for more information about the issue and Healthnetwork’s medical director provided research on the condition. They also identified experts who were available to see our granddaughter. She is now a very busy 12-year-old and a champion swimmer.

Walter and I are blessed with good health. Healthnetwork has proven very resourceful in providing physician referrals during the times we needed them most. We have also asked for help for dear friends. One friend had a serious heart issue. Because of Healthnetwork, he was put under the care of Mayo Clinic and lived another seven-plus years.

There are many more stories of families they have helped. Those who call upon Healthnetwork receive an outstanding level of care. Families have the privacy to explore their options. Healthnetwork offers guidance and connections at a very critical time. Because of our gratitude for the life-changing connections we have seen, we have increased our support levels with Healthnetwork.

We encourage other Legates to reach out to Healthnetwork. They are a phenomenal team whose resources are just what is needed when one is faced with stymying medical issues.

WALTER AND JANET KNYSZ are Legates of the Detroit Chapter

Crisis in healthcare – a Catholic perspective on reform

The healthcare crisis in America Today is twofold: ethical and economic.

The ethical crisis is the denial of the sanctity of human life from conception to natural death that has resulted in the abortion of tens of millions of unborn Americans and the physician-mediated deaths of many seriously disabled and terminally ill patients by physician-assisted suicide in the nine jurisdictions where it is legal. 

Additionally, the constitutional right to religious liberty and freedom of conscience is denied those who refuse to comply with federal mandates to provide patients with contraceptive/abortifacient drugs. No proposal for healthcare reform can receive Catholic support if it does not uphold the universal and inalienable right to life and religious liberty.

The economic crisis arises from control of healthcare financing by third parties, (government, insurance industry, unions, and large employers). For the last 50 years this system has insulated patients from the actual costs of care and removed the normal economic incentive to shop based on price and value, thereby contributing to the astronomical rise in costs. Although healthcare outcomes have certainly improved for most people, the rising costs have led to problems of affordability and access for too many Americans. This system is unsustainable. 

Political decisions made over the next 12 – 24 months will likely determine the foreseeable future of healthcare delivery in America. The current national debate focuses on two fundamental proposals: a government controlled, single-payer system vs. a patient-controlled, competitive free-market system.

Those promoting a government-controlled system of healthcare delivery insist upon universal access to contraception and abortion. Based upon experience with the Affordable Care Act, no one would be exempt from compliance with the mandates for care determined by the federal government (i.e., one-payer, one ethic). In contrast, in a patient-oriented, free market system, options would be available to avoid cooperation with evil (room for pro-life ethics).

No government-controlled health care program has proven capable of “bending the cost curve” downward to rein in unsustainable rising costs.

However, evidence from a landmark 1982 RAND study demonstrates that giving patients freedom and choice to control their health care, including financing reduces costs. Also, newer innovations for financing care including health savings accounts, employer-sponsored health reimbursement arrangements, direct primary care, and healthcare sharing ministries, all show promise for lowering costs and increasing access while maintaining high-quality care and enhancing the doctor-patient relationship.

As Catholic lay leaders we have a duty to uphold our faith in our work and in the public square. If we come together to address this crisis in healthcare, and if every Catholic employer offered one or more of the above patient-centered, market-driven innovative options in a faith-based health plan, we would begin the transformation of our healthcare delivery system, defending human dignity and religious liberty while restoring a culture of life in America.

STEVEN WHITE, M.D. has been in the private practice of pulmonary medicine for 35 years. He is a past-president of the Catholic Medical Association and currently serves as chair of the CMA Healthcare Policy Committee.

Bladder, prostate developments more precise

REAL-TIME BLADDER MONITOR

It can be quite burdensome for a person with an overactive bladder or bladder-leakage problem to endure the diagnostic process. He has to come to the clinic, get undressed in an unnatural environment, empty the bladder, get a catheter, refill the bladder with room temp water, urinate… The whole experience causes embarrassment, anxiety, and discomfort for the patient. Furthermore, it’s not a natural situation and really doesn’t allow us to accurately assess what happens in the real world— when the person is exercising, or out running errands.

I’m enthused about the new UroMonitor which we are developing. It’s like a Fitbit for the bladder. It requires a simple insertion, and then we get real-time, real-world data that tells us what is happening in the patient’s bladder. And he doesn’t even have to come to Cleveland Clinic. He can have the monitor inserted locally, then do a virtual consult with an expert here. It has the potential to help tens of millions of people who are affected by bladder issues.

400,000 MEN COULD AVOID BIOPSY

Another thing I’m excited about is a new blood test for prostate cancer screening we’re developing. I have to disclose it’s being formulated by Cleveland Diagnostics, which Cleveland Clinic owns part of, within which I have no personal financial stake.

We know that the current screening for prostate cancer, which has been around for decades, is far from perfect. It results in a large number of false positives, which lead to prostate biopsies. It also leads to over-detection of low-grade cancers that we’d rather not know about because most of them don’t need to be treated.

This new blood test is far better at determining who might have a higher-grade cancer that does need treatment. We have studied this and validated our findings in a second study, and we’re just about to publish our findings in medical journals. It’s very exciting.

There are about 1 million biopsies every year—and this blood test could eliminate the need for 40 percent of them. That’s 400,000 men who won’t need to go through this uncomfortable procedure and its associated risks. Instead we’ll have a much better diagnostic test for every man, not just those who come to Cleveland Clinic.

PHILANTHROPY’S DIFFERENCE

The National Institutes of Health budget has been restricted in recent years. For example, they only fund 8 percent of all cancer research grant requests. In such a restrictive environment, it’s impossible without philanthropic support to do the high-level research that could improve patients’ lives. We must supplement what’s received from government grants, or we simply wouldn’t have enough. A much-needed philanthropic gift we recently received from Healthnetwork and its partners, just opened the scope of what we can do and the number of lives we can affect.

ERIC KLEIN, MD, is chair of the Glickman Urological and Kidney Institute at Cleveland Clinic, one of Healthnetwork’s GOLD hospitals. Dr. Klein was given a Healthnetwork Service Excellence Award for his outstanding patient care. Cleveland Clinic’s urology program is ranked No. 1 in the specialty.

Avert major risk factors for heart attack

You can control your risk of heart attack, the number-one killer of Americans, even if you were dealt a bad genetic hand with a family history of heart attacks, bypass surgery, or coronary stent placement.

A large majority of people who sustain heart attacks before age 40 are smokers. Even a few puffs on a cigarette initiate abnormal changes in the lining of arteries. Continued smoking promotes cholesterol-plaque buildup, plaque instability, and eventually plaque rupture that triggers blood clots. When the clot blocks a coronary (heart muscle) artery, a major heart attack results. Fatal abnormal heart rhythms can occur just seconds after a heart attack begins. If you don’t want a heart attack, don’t smoke!

Study after study has definitively proven that high cholesterol, particularly LDL (“bad”) cholesterol, is highly correlated with coronary artery disease and coronary events. The American College of Cardiology (ACC) and the American Heart Association provide easy-to-use risk calculators online. Guidelines recommend that if your 10-year risk of atherosclerotic cardiovascular disease is greater than 7.5 percent, then a cholesterol-lowering medicine called a “statin” should strongly be considered. Statins prevent thousands of heart attacks each year and cause no side effects in 95 percent of patients. A survey at a recent national ACC meeting found that well over half of all cardiologists attending were taking a statin. Maybe they know something? A statin may be right for you.

Diabetes is a major risk factor, and nearly 90% of patients with diabetes are overweight. If every person diagnosed with diabetes lost 15 percent of their body weight, most would no longer even have diabetes. Staying near ideal body weight, along with exercise, will dramatically lower your risk of getting diabetes – and a heart attack.

High blood pressure (>130/80) contributes to heart attack risk. Salt restriction, weight loss if needed, and exercise are the first line of treatment, but most people will still need medicine. Dozens of highly effective meds are affordable – there’s no reason to have high blood pressure in 2019, but sometimes it may take 3 or 4 different medications to achieve that goal.

Next, everybody’s favorite subject – diet. Nutritional guidelines keep changing, but there are certain dietary recommendations for preventing heart disease that are unlikely to change. Minimize red meat, and avoid processed meat. Eat more fatty fish like salmon, but skip fried fish! Eat lots of vegetables. Avoid fast food. Reduce your carbohydrate load to prevent hunger and weight gain. It is really that simple.

Lack of physical activity compromises life. Regular exercise prolongs life, lowers blood pressure, keeps weight in check, increases brain endorphins to bolster mood, and lowers risk of cardiovascular disease for a more productive earthly life to better serve the Lord.

DAVID A. KAMINSKAS practices cardiology in Fort Wayne, Indiana and is the treasurer of the Dr. Jerome Lejeune Catholic Medical Guild of Northeast Indiana.