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Walking better than chemotherapy

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A new study shows that walking dramatically improves outcomes in colon cancer.  In fact, walking was a better treatment than chemotherapy.

So... get a dog and put on your walking shoes!

Walking Improves Outcomes

The second study[2] is "ready for prime time" and applicable in your clinic if you are not doing it already. In this study, published in the Journal of Clinical Oncology in January, investigators identified 2300 people [with invasive, nonmetastatic colorectal cancer] and measured how much exercise they got before and after their diagnosis. This is fascinating data, showing that those people who were more physically active both before and after their diagnosis of colon cancer had much better outcomes.

These patients needed only a minimum 8.75 MET (metabolic equivalent) hours of recreational exercise per week, or the equivalent of 150 minutes a week of physical activity -- basically, walking. So, I often prescribe a dog for patients because they will have to walk their dog. Insurance won't cover that, by the way. We have tried.

If you engage in that much physical activity before and after [a colon cancer diagnosis] the risk reduction [in all-cause mortality] is 0.58. That is better than any chemotherapy we have ever given to anyone. Physical activity after diagnosis, and certainly pre- and post-, is better, but even if you just pick it up afterwards, you will have a significant improvement in outcome. If you are a couch potato and do not exercise, your risk goes the other way, to risk escalation, with a 1.36 hazard ratio [for all-cause mortality].

Last Updated on Wednesday, 20 March 2013 20:32

Robotic Surgery - No Benefit

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It looks like robotic surgery is just another expensive medical procedure that offers no benefits to patients but does generate more income for doctors, hospitals and device maker, an article in the NY Times reports.

The Journal of the American Medical Association has published the results of a large study comparing the use of robotic surgery with standard laparoscopic surgery for hysterectomy.  In spite of claims that robotic surgery was better in many ways, the study found little difference in the rate of complications, time in the hospital, recovery time or blood transfusion between the two groups.

Robotic surgery was significantly more expensive by thousands of dollars and this translated into more income for the medical industry and more expense for patients.  This is why you will hear advertisements from hospitals for robotic surgery.  They make more money from it.  However, there is no benefit and you pay the extra cost.

If you are offered robotic surgery, you should politely decline.


I have seen the future of health care... and it's not US

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I recently had the opportunity to accompany a friend to Bangkok for surgery.  She is caught in a typical bind.  She changed jobs and insurance but came up with a "pre-existing condition" so was unable to buy insurance.  However, she needed a hysterectomy.

The economics are simple and shocking.  The local hospital quoted her $40,000 for the surgery. Add in the doctor, radiologist, pathologist, anesthesiologist and all the others that come out of the woodwork to feed on the sick and we're looking at $50,000 plus.  This is not an easy out of pocket expense for anyone except the very rich (who are doing quite well, these days).

We investigated alternatives and came up with Bumrungrad International in Bangkok.  It's a world class medical facility accredited by the US based Joint Commission... the same organization which accredits US hospitals.  We arrived late Monday and had our appointment Tuesday morning.  She was seen by an experience board certified surgeon and specialist in laparoscopic surgery.  She was also seen by an Internist for medical clearance.  Lab, Chest X-ray, EKG and ultrasound were all completed the same day and surgery was scheduled for Wednesday morning.

Everyone we dealt with was extremely helpful and competent.  Everyone we dealt with spoke English fluently. The hospital is very well organized and more like a luxury hotel.  They have state of the art medical equipment and a computer information system for complete electronic medical records.  All of the tests and exams were entered into the EMR and were available to the doctors.  The internist had the EKG, chest x-ray and lab work on his computer within an hour.

Top quality care and service.  Bottom line... about one tenth of the cost of having the surgery in the US.

Last Updated on Wednesday, 29 December 2010 03:46

Health Affairs - Costs and Access to Health Care

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A new paper in Health Affairs titled "How Health Insurance Design Affects Access to Care and Costs, By Income, In Eleven Countries" gives us some valuable insight into the US health care system in comparison to ten other developed countries (and it doesn't look good for the US).

"Overall, the study found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design. US adults were the most likely to incur high medical expenses, even when insured, and to spend time on insurance paperwork and disputes or to have payments denied."

The Incidental Economist put together a good analysis and a few interesting charts from the results in the article.


Last Updated on Thursday, 18 November 2010 17:37