This week at Harvard Medical School

Closing the Blog

2011-01-15T09:18:00.000-08:00

Hey Everyone,

thanks for reading. I hope that this was helpful in some sense. My schedule hasn't permitted me to continue this blog. Let's keep in touch.

Jason

Blog Entry 3: Smoking Health Risks Cont'd

2008-05-10T22:19:00.000-07:00

Dear friends, after a period of a lot of studying, I am picking up where I left off. I hope that this entry finds you well.

I will continue with the list of “smoking related diseases” that have strong evidence to establish causality according to the surgeon general.

Cardiovascular (Heart and Blood Vessels) Diseases

1) Atherosclerosis (clogged arteries)

2) Coronary Heart Disease (heart attacks)

3) Cerebrovascular (Blood vessels in your Brain)à(stroke)

4) Abdominal aorta aneurysm

Respiratory Diseases

1) Pneumonia

2) Acute respiratory infections

3) Maternal smoking reduces lung function in infants

4) Airway and alveolar injury

5) Impaired lung growth in adolescents

6) Accelerated decline in lung function

7) Coughing, phlegm, wheezing, shortness of breath

8) Adolescent asthma

9) Chronic Obstructive Pulmonary Disease (COPD)

Just a few words about some of these diseases. It seems unclear that smoking would affect your heart and blood vessels, but this is actually one of the scariest effects of smoking because it causes, heart attacks and strokes which is a big killer in the US.

Here are some images:

This is a clogged coronary artery under a microscope. You can how there’s no open center for blood to flow through. So a coronary artery is an artery that feeds the heart. If the coronary artery gets blocked, that’s when your heart cells die, and that’s a heart attack. (image from HMS Pathology Laboratory Notes)

In a similar way, a stroke, is when an artery going to the brain is clogged, and then a part of the brain dies. The black part in the middle is the dead brain cells. Smoking causes strokes. Image from: http://www.pathology.vcu.edu/WirSelfInst/neuro_medStudents/image/saved_green002.jpg

After talking and meeting patients with Chronic Obstructive Pulmonary Disease (COPD), I've realized that it’s really a sad condition. Some have such a hard time breathing they can’t even talk. One patient had to breathe oxygen through nasal tubes for most of his day. Another patient once told me that he wished that he had known that smoking caused his COPD. I asked him to describe his shortness of breath and it’s literally as if you can’t breathe, and you can’t get enough air in your lungs. Imagining this sort of experience is very scary.

The past couple weeks we have been learning about infectious diseases and smoking increases your risk for getting infections like the flu because your lungs can't clear the bugs. Smoking essentially damages the cilia in your lungs that clear many bugs out of your lungs.

It seems like a laundry list (and there’s one more to come), and you might say to yourself, yeah, yeah, smoking is bad for you. But hopefully, it is becoming clear that smoking causes malfunction in almost all of your bodily systems. Especially those that mean the most, your heart, your brain, and your lungs.

British physician Sir Richard Doll once said:

“That so many diseases - major and minor - should be related to smoking is one of the most astonishing findings of medical research in this century.” (Lecture Notes)

Blog 2.5: Obama Health Plan

2008-02-01T17:37:00.000-08:00

This was the week before “super Tuesday,” where most primary elections will be held to choose the candidates for presidency. Yesterday, we had a lecture by the current Obama Health plan advisor David Cutler. His talk was interesting and I thought I’d make a special posting.

Basically there are three components to reform the health care system.

More Coverage

The system needs to cover more people, but how do we get the money to do so? According the the Kaiser Family Foundation, 18% of the US population is uninsured. This is approximately 1 in every 5 people.[1] The Obama plan doesn’t support a single health plan, but does plan to make sure it’s affordable and accessible and that no American will be turned away from health care coverage.

Rationalize Health Care

Although our country spends a lot of money on health care, some estimates suggest that 50% of funds are wasted in an entrenched and inefficient system. There are many voices as to improve our bang-for-the-buck factor and the Obama plan attempts to do all of them. (health effectiveness research, electronic medical records, performance based reimbursements, re-insurance, disease management). Effectively, it’s moving towards bridging the implementation gap in our fragmented system.

Focus on Public Health

Bioterror, Obesity, and Smoking

Barriers

The number one barrier to this plan is Politics. The second is funding, and finally perhaps, the most influential factor is that people are scared of change when it comes to health care. For example, when people perceive of the possible negative downsides, people back off. However, to make fundamental changes, everyone has to be on board with the decision.

To read more about the Obama Health Plan: http://www.barackobama.com/issues/healthcare/#coverage-for-all

The Issue

For the democrat frontrunners, the health plans are not the issue. The ideas are great and do not differ too much. The issue is who can get this work done and get the majority on board with this idea. Although Dr. Cutler was Bill Clinton’s advisor in the past, he believes that if elected, Obama has more potential to make it happen because he has the trust of the people. It’s a matter if you believe in a top down approach with Hilary’s experience in the Senate, or a bottom up approach by appealing to the public and asking them to trust the government to make that change.

My Reflections

First of all, there are great ideas to dramatically reform Health Care, but this plan attempts to work within the current system to make changes competing groups are willing to accept. The ideas are there, it’s a matter of implementation and working through insurance companies, and powerful interest groups in order to make change. I think if the people are willing to take a risk for change, the benefits could outweigh the risk. There’s an idea that most people tend to choose the familiar and the realistic goals because that’s what they think is achievable. However if we are going to reform healthcare, people are going to have to be able to accept change for the possibility of a greater future. And I do agree that the power to make lasting change lies within the people.

Secondly, the debate needs to emphasize preventive health. A huge burden of disease is due to preventable diseases and we as a society are bearing all the costs. No matter what level of efficiency the medical system attains, there’s just no way to keep up with the demand without an honest effort towards preventive health care. Smoking and Obesity are bankrupting the system. (stay tuned for more on this)

Finally, Vote! I sent in my absentee ballot this week. This is a momentous event in not just American History, but effectively, world history, and we have the opportunity to participate in it. If we don’t vote, nobody who makes decisions will listen to our needs. Whether you are a democrat, republican or independent, I urge you and your friends and family to vote.

If you’ve read this far, I want to let you know that there are polls to vote at the bottom of this page. Please take 20 seconds to respond. I’m curious to see how many of us (my friends and family) are uninsured.

[1] http://www.kff.org/uninsured/upload/7451-03.pdf

Week 2: Smoking Risks

2008-01-28T23:38:00.000-08:00

Blog Entry 2: Smoking Risks

So this week is about smoking. I will do a three part series on smoking, because it is the #1 preventable cause of death in the US. I’m just trying to give you information so that you can better choose your health. In the first two weeks, I’m going highlight the risks that one takes in lighting a cigarette. And week three will be practical steps that one could take to quit, if one so desires.

The purpose of this series is not to tell you to quit smoking. It’s to inform you of all the risks associated with smoking. I believe that we as a society know that ‘smoking is bad’ but we don’t know all the specifics. Hopefully by then end of this, you can read the facts, and as an educated individual make your rational decision based on those facts.

The health impact of tobacco use in 2008 is as follows:

1) #1 preventable cause of death in the US

a. smoking related deaths are the number one preventable cause of death. This means that if we don’t smoke we can prevent the smoking related diseases that cause death. It’s simple.

2) Responsible for 1 in 5 deaths (438,000 each year)

a. out of five people who die today, one of them died because of smoking.

3) 1/3-1/2 of smokers die of a smoking related disease

b. This means that let’s just say you have 3 friends who smoke. One of them will die of a smoking related disease.

So what are the “smoking related diseases”? I will list the ones that have strong evidence to establish causality.

“Smoking causes ________ cancer”

1) Lung

2) Laryngeal (voice box)

3) Oral cavity and pharyngeal (throat)

4) Esophageal

5) Pancreatic

6) Bladder and Kidney

7) Cervical

8) Endometrial

9) Stomach

10 Acute leukemia

some images of cancer: to make visible the invisible

Fig 1. Lung Cancer
Fig 2. Laryngeal Cancer
Fig 3. Oral cavity cancer
Fig 4. Esophageal Cancer

We all knew about lung cancer, but did we know about the rest? This is just cancer. Next week will be other diseases.

“Smoking injures almost all bodily organs, and tragically this injury often leads to incurable disease and death.” Surgeon General’s Report on Tobacco 2004

Most data from a lecture at HMS and the Surgeon General’s Report:

http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/chapters.htm

Images from:

http://images.medicinenet.com/images/Lung_8_01.gif

http://content.answers.com/main/content/wp/en/thumb/2/21/190px-Esophageal_adenoca.jpg

http://www.hopkinsmedicine.org/headneckcancer/images/oralpic.jpg

http://www.chicagovoicecenter.com/img34.gif

Week 1: Our Behavior

2008-01-20T20:21:00.000-08:00

Here we go now! Blog Entry Week One.

This week is about how our behavior is one of the most important factors that determines your health. Text will be minimal and I’m going to highlight only one or two main points per week. So check it.

This shows that behavioral patterns contribute 40% to premature death. This is more than genetic disposition, social circumstances, environmental exposure and health care. Thus our health depends less on our genes, than our behavior. If you have a rare genetic condition, then yes, your genes will contribute to more of your health outcome, but for most of us, our behavior is a bigger factor. Let me also point out that health care accounts for only 10% of our health outcome. That means what I can do as a doctor is only 10%, whereas what you can do is 40%. So if you think of splurging when you are young and expecting the doctor to fix all of your health problems with a pill, think again.

Of deaths caused by Behavior (not genetics, social circumstances, or environment), smoking is the leading cause, followed by obesity. So the next couple weeks will be about smoking, then obesity.

One of my patients this week with congestive heart failure, told me that he wished someone had told him these things before. So here I am trying to tell you. Education is empowerment.

That’s all folks.

The figures were taken from this paper. (I will cite all more sources and if you want the primary source, send me an email).

Greetings!

2008-01-13T17:45:00.000-08:00

to my lovely friends and family,

After much thought, I've decided to start blogging about what I learn in medical school. These are things that I want to share with all of you because I think we all should know, not just me as a medical student. I would tell you each individually, but this will reach more of you in less time. and feel free to recommend the site to anyone. So here's my attempt at democratizing education.

jason