Month: July 2016

Is Genetically Modified Food Safe?

By Mark A. Kelley, MD |07/25/16

Genetically Modified (GM) Food is a major breakthrough, but, like many discoveries, it has created controversy.

All living things, whether plants or animals, face many challenges to their survival: climate, predators, competition for food etc. Genes that give an organism a survival advantage are passed on to future generations.

There are many examples. Some plants develop their own natural insect repellent. Birds and fish have different colors to attract mates or to hide from predators. Bacteria develop resistance to antibiotics.

Science has now developed laboratory techniques to insert new genes into the DNA of some plants and animals. The goal is to make the food supply more productive. Plants can be changed to be more resistant to drought, heat, and insects. Farm animals can be bred to grow with less feed, water etc.

These biologically engineered animals are termed “Genetically Modified Organisms” or GMOs. You may see foods labeled as “GM” (or GMO) -free”. That means that the plant or animal has not been genetically modified by laboratory techniques.

What are the advantages of GM foods?
With climate change and expansion of the world population, many experts feel that we will need more efficient ways to grow food. Extremes of weather, and shortages of fertile land and water could all contribute to a food shortage. If we can genetically modify plants and animals to adapt to these challenges, the food supply may still thrive.

What are the risks of GM foods? So far, GM foods have proven very safe. One reason is that they must undergo safety tests before they can be introduced into the food chain. The food must be proven safe for human consumption and the plants and animals must not disrupt the environment. One common concern, especially for plants, is whether the new version can cause allergic reactions.

Can the new genes in the plant or animals be transmitted to humans? Eating a food product does not transmit genes. Every food has billions of genes that have no biologic way to mingle with our own genes. However, to artificially change a plant of animal gene, viruses are used to transmit the new DNA. . Some have argued that such viruses might linger in the food and infect humans. This theory has not been proven after decades of research. However, even if that were true, viruses have produced natural genetic changes in plants and animals for millions of years.. So far, humans have suffered so ill effects.

What are the dangers to the environment?
The GM organism could be so successful that it alters the natural balances in the environment. The organism may crowd out competitors or breed with them. We have seen this happen naturally when animals or plants from other continents have reached the US. With no competitors in their new land , these foreign organisms can spread rapidly. Examples include the zebra mussel in the Great Lakes and the Japanese beetle – found in almost every state. So far, no significant “outbreak” has happened with GM organisms.

Based on current information, these are the “take-home” messages about GM food:

• GM technology has improved food production, making food more affordable and available. With increasing pressure on the food supply, it is likely that more GM food will be developed.

• Most countries, including the US, regulate these products carefully, as they do other sources of food.

• The safety record of these GM foods has remained excellent , but the experience has only been over a few decades. Careful surveillance should continue.

• Before GMOs, we made serious mistakes in our food supply. Examples include applying harmful pesticides, and feeding animals growth-enhancing antibiotics that cause the life-threatening infections in food.

• The lesson is that we should always pay close attention to the safety of our food supply. GMOs are no exception. They have many benefits and minimal, if any risks to our health. Whether GMOs will threaten other organisms and the environment remains unknown.

You can learn more about GMOs from the Scientific American and the World Health Organization.

The “Conversation Project” — Planning for the Future

By Mark A. Kelley, MD |07/15/16

Most of us make future plans about careers, finances, retirement etc.   However, few of us plan for the end of our lives.

Medical science has made great strides in treating complex diseases like cancer, heart failure and diabetes. Nonetheless, for these chronic diseases, complete cures remain the exception, rather than the rule.

If you have helped someone with life-threatening disease, you know the stress involved. As the disease progresses and end of life is near, many difficult issues arise: Is a cure still possible?   Will more treatment be helpful?   Will the treatment be worth the result? Will the end come soon?

As an intensive care physician, I have seen patients and their families grapple with these dilemmas in “crisis mode”. This happens when a gravely ill patient’s wishes at the end of life were never discussed. Now, with very little background information, the family and physicians must make some decisions to guide the patient through life-threatening challenges.

The Conversation Project” is addressing this problem. The objective is to facilitate discussion about patient’s goals well before any crisis. The conversation between the patient and his/her family and physician assures that everyone involved knows the patients’ desires.

The Conversation Project describes research showing that patients want this discussion but need help.

1. 90% of people think that talking about end of life care with their loved ones is important—only 27% do.

2. 82% say it is important to put their wishes in writing but only 23 % have done so.

3. If seriously ill, 80% of people would discuss end of life care with their doctor, but only 7% actually do.

The “Conversation Project” has developed tools to facilitate communication about end of life care. Personally, I have found their approach helpful with both my patients and my family.   The best time to begin the conversation is when there is no pressure for an immediate decision.   Ideally, the patient feels well, and family members and physicians can participate.

The most important part of this conversation is for informed patients to set their objectives for the end of life. Patient preferences vary and can even change depending on circumstances. For example, one third of adults would continue treatment even if their disease were incurable. However, other factors can change that decision.   Over 52% of patients with incurable disease would stop treatment if they must depend on a family member for care.

In a third example, some patients would prefer to stop treatment but continue anyway. They do not want their loved ones to remember them as “giving up”.   I have found that this dilemma can often be solved by a candid discussion with the patient, physician and family members together. In this session, the doctor discusses the medical facts, and the patient describes his/he true feelings and desires. With everyone hearing the same important information, the family usually rallies in support of the patient’s decisions.

These circumstances can differ and the details are very personal. However, there is only one “best” outcome: that each patient communicates their plans and desires for the end of life.   That important action assures that the patient’s wishes are fulfilled and greatly reduces emotional stress for all.

Have you and your family had “The Conversation”?   Check out the Project website (http://theconversationproject.org) for some valuable tips.

 

Preventing vs. Detecting Disease — What is the Difference?

By Mark A. Kelley, MD |07/11/16

For decades, the public has been educated that prevention is the best way to reduce the risk of disease.

From time to time, news articles describe how some tests or procedures may not be effective in preventing medical conditions. This can be confusing because the reports may not explain the difference between preventing a disease versus detecting it.

Prevention reduces the chance of ever getting a disease. Examples include public measures like clean water; vaccines against smallpox and polio; and lifestyle habits like not smoking. All these significantly reduce the risk of disease.

Detection of disease is a different strategy. If the patient already has the disease or condition, early detection may improve outcome, For example, early detection is particularly important in treating infections. The correct antibiotic, given early, has a much better chance of eliminating the infection before it can spread. In another example, early detection of high blood pressure or high cholesterol can lead to treatment that reduces the risk of heart attacks and stroke.

Some of the recent controversies have been about the early detection of cancer. This is an evolving strategy. Most cancers start as small tumors and cause no symptoms until they grow large or spread. In theory, finding and eliminating these early tumors could result in higher cure rates.

For the most common cancers, this strategy has been effective … but with some uncertainties.

“Early Detection” Success

Cervical Cancer: The Pap smear of the cervix has detected early, curable cancer in thousands of women. Early detection has transformed cervical cancer from an incurable disease to one with a very high cure rate.

Colon cancer: This slow-growing tumor, if detected early, is also highly curable. The detection tools are testing for blood in the stool or looking for tumors inside the colon periodically with a flexible scope.

Skin Cancer: There are multiple forms of skin cancer but in nearly every circumstance, early detection improves cure. The “test” is easy: examination of the skin by a trained expert and when necessary, skin biopsies to determine diagnosis.

“Early Detection” Success – Some Controversy

Breast Cancer: Mammography and related breast imaging technologies are excellent for detecting early breast cancer and this early detection saves lives. However, experts can disagree on the age a woman should begin this testing, or how often it should be performed. These decisions may depend on the woman’s risk for breast cancer based on family history and other factors.

Lung Cancer: Until recently, there was no early detection test for this common tumor. Recent research has suggested that periodic CT scans of the lung can detect early, curable cancer in current or former smokers. However, some experts think this recommendation is preliminary until more results are known.

“Early Detection” – More Controversy

Prostate Cancer: This malignancy grows slowly and is common in elderly men. A blood test called the PSA, when abnormal, suggests prostate cancer but the diagnosis must be confirmed with biopsies. Even if the biopsies confirm the diagnosis, it is often unclear when or how to treat prostate cancer since it is usually not very aggressive. This has made policy-makers wary of recommending the PSA since, so far, the test has not improved the cure rate. However many men and their physicians still monitor PSA levels.

Prevention and detection of disease are important to discuss with your doctor. As medical science gains new insights, some new recommendations may evolve.

However, one recommendation will never change: pay attention to your health and take the steps that can keep you healthy.

For more information about cancer screening tests, visit the website Choosing Wisely.

Does Your Physician Know What You Pay for Healthcare?

By Mark A. Kelley, MD |07/05/16

All of us should understand our own health care costs. However, as we have discussed here before, the issues can be complicated: e.g. insurance premiums, deductibles, co-pays, etc.

Physicians have a different perspective. Like any professional, they focus on how they are paid. Insurance companies require doctors to submit many details with their bills. Physicians rely on sophisticated billing systems to furnish that information, because without it, they are not paid. In a nutshell, patients worry about paying the bills and doctors worry about sending out the bills.

This raises a key question. How much do doctors know about your insurance and what you must pay?

Of course, the doctor can explain his/her own bills to you. Your doctor’s office has checked your insurance and knows how they should bill your insurance company.   Surprisingly, the doctor may not know much your hospital insurance coverage, or your deductible. Most physicians and their staffs have not been trained to gather this information because it does not affect physician payment.

But things have changed. With high deductible insurance plans, patients have more risk for out-of-pocket costs. A blood test, x-ray, or medication can come with a large bill if it drops into your deductible.

The prices may astound you. A friend recently enrolled in a high deductible insurance plan. She refilled prescription, which previously cost her $40 co-pay. With her new insurance, she had to pay $250 for the same refill because it was part of her deductible. The price was so high because the insurance company passed all the drug cost on to her.

Why is this important?   It is wise to know what you are paying for — and health care is no exception. Health care bills can mount quickly and squeeze the family budget. Sometimes, families face the tough choice of either paying the rent or seeing the doctor.

Physicians are seeing more of their patients struggling with health care bills. This pressure may discourage them from seeking medical care. Tight finances are becoming a health care risk, even for families with decent incomes.

How can patients and doctors work together to control the “costs of care”?

Here are a few suggestions:

1. Know the details of your own insurance policy, especially “out-of-pocket costs”such as co-pays, coinsurance and deductibles. If you have any questions or concerns, contact your insurance company.

2. When your doctor recommends a test, procedure, or treatment, make sure you know what it involves, why you need it, how effective it will be and how soon it must happen. These are questions that any good doctor would be glad to answer.  The timing of the test or procedure may be important if you have already paid out your deductible before the end of the year. In that case, you may not have to pay anything for the service.

3. Cost may (or may not) influence your decision to get a test or procedure. For example, for an urgent life-saving procedure, cost may not even enter your mind. However, some tests or procedures may not be so convincing. In those cases, cost might influence your decision. If so, discuss the cost issue with your doctor who may suggest less expensive alternatives. The timing, location and type of service may all influence the cost: most often for planned (elective) procedures, x-rays, or some medications.

4. If health costs worry you, talk to your doctor. Don’t be afraid to bring up the issue. You are not alone. Many more patients are asking about costs these days. Physicians welcome solving these challenges with you. They can be very helpful if they understand your concerns.

Learn how physicians are addressing this problem on the website Costs of Care.

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