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GreenField’s Health Matters: April, 2005
Parenting Seminars: Connect With Your Kids
Our first two parenting seminars have been fantastic thanks to presenter Dr. Kathy Masarie. As noted below, we still have one final session and you do not need to have attended the prior sessions to participate. If you want to join us, space is limited, so call 503-292-9560 to register. We encourage parents, grandparents, aunts, uncles, and anyone with kids in their life to join us. Seminar 3: What about Boys?
Date & Time: Tuesday, May 10, 2005, 7:00 - 8:30 PM
Location: at Greenfield Health, 9427 SW Barnes Road, Suite 590
Cost: $25
Boys live in a tumultuous world today. Many boys conform to a strict "boy code" that does not allow them to express emotions with the exception of anger. Boys have higher rates of learning difficulties, school failure and violence. This seminar will address unique ways to connect to, communicate with, and support our boys more effectively.
First Tuesday at GreenField
Upcoming First Tuesdays are on May 3, June 7, and July 5. We start promptly at 5:30 PM. One of our doctors provides an overview and tour of the clinic, and answers questions. It is a great way to introduce new people to GreenField.
The Overuse of Vioxx and Other New Drugs
Why not take a medication that is over ten times as expensive as the alternative but provides no additional benefit? Seems like an odd question, but unfortunately that is the way US health care frequently functions. New, exceedingly expensive medications are heavily used despite little data to demonstrate that they provide a real advantage.
Take for example the previously popular, very expensive COX-2 inhibitor painkillers Vioxx, Celebrex, and Bextra that were heavily marketed directly to consumers. These drugs have never been shown to be more effective than older, very inexpensive non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin and Advil) and naproxen (Naprosyn and Aleve). The primary advantage of the expensive COX-2 inhibitors was supposed to be a reduction in the rate of stomach problems such as ulcers, but even this data was very weak and questionable. And now, after only a few years of use, they have been found to cause an increased risk of heart attacks and strokes when used on a regular basis. Vioxx was recalled in September 2004 while Celebrex and Bextra remain under a cloud of suspicion after data showed similar heightened risks. A recent study from Stanford and the University of Chicago found that the COX-2 inhibitors were prescribed to millions of patients not at risk of gastrointestinal bleeding, the main reason patients were told to switch from aspirin and other lower-cost painkillers such as ibuprofen and naproxen. COX-2 inhibitors cost 10 to 15 times as much as the drugs they replaced. Within a year of being introduced in 1999, Vioxx and Celebrex were both heavily promoted directly to consumers and brought in billions of dollars in revenue. Merck spent $161 million in 2000 on direct-to-consumer marketing of Vioxx. In addition, pharmaceutical representatives convinced doctors that these medications were actually stronger than standard NSAIDs and that they provided significant protection to the stomach. Neither claim was supported by strong data. The result? By 2000, 73% of patients on those medications were considered to be at low or very low risk of gastrointestinal problems and thus had no reason to use these newer, much more expensive drugs. This experience should give you pause as a health care consumer. At GreenField, we focus first and foremost on using the most effective medications available for the various conditions we treat. We also focus on choosing those medications that have the longest track record of safety. In many cases, that means using tried and true older medications that will save you money and provide equal if not better effectiveness and safety compared to newer heavily promoted alternatives. For example, we have always been cognizant of these issues with COX-2 inhibitors and we used them only sparingly. We also do not carry samples at GreenField for this reason - there are good studies that show that samples lead to the routine use of newer more expensive medications over the use of older, much less expensive but equally effective alternatives. We also seek to keep you as informed as possible about your choices as your input is obviously critical in any such decision made about your health care. There are real breakthroughs in the development of newer, much more effective classes of medications that would justify their higher costs, but such new medications should be studied extensively. As the FDA comes under increased pressure to approve new drugs more rapidly, we will see many more such cases. The unfortunate experience of the COX-2 inhibitors is replicated daily - it is not a problem confined to the COX-2 inhibitors, but is pervasive in the use of newer antibiotics, blood pressure medications, and other classes of medications. We should also not forget the financial downside of the excess use of such newer medications without proven benefit. The cost to you is enormous as your health care insurance premiums continue to rise at 3 to 4 times the rate of general inflation.
Lifestyle Intervention to Improve Health
Many believe that health is over-medicalized - that too often medications are used for 'treatment' when the root causes are lifestyle choices such as poor diet, lack of exercise, or lack of simple preventive measures being used. On the other hand, there also exists a lot of skepticism about whether or not individuals can adhere to such lifestyle changes. In a study published in Decembers American Journal of Cardiology , a 12-week lifestyle intervention helped an ethnically diverse group of adults with high blood pressure (hypertension) , high cholesterol ( hyperlipidemia ) , and elevated blood sugar ( hyperglycemia ) reach their treatment goal's and risk factor's without using drug therapy. The intervention included exercise and practical dietary changes. These results refute the notion that intensive lifestyle intervention is not worth the effort. Therapeutic lifestyle changes can generally be implemented less expensively than most medications and, unlike drug therapy, favorably affect multiple risk factors simultaneously improving an individuals overall risk profile. A list of conditions that have been shown to improve with or be prevented by good dietary and exercise practices include high blood pressure, diabetes, sleep apnea, insomnia, depression, congestive heart failure, overall cardiovascular risk (the risk of heart attacks and strokes), arthritis, emphysema, osteroporosis, and many others. Osteoporosis is a very interesting example of this point. Biphosphonates (such as the Fosamax) are a commonly used medications to "treat" osteoporosis - to help strengthen the bones in order to avoid fractures. They are expensive and they have significant side effects. Interesting however, weight-bearing exercise combined with appropriate amounts of dietary calcium and vitamin D provide greater improvements in bone density than do these medications. Thus relatively aggressive daily exercise should be the first line of treatment of reduced bone density, as it should for the other conditions noted above. Year after year, the data on the positive effects of very good dietary and exercise habits continues to come forth. We believe that these lifestyle interventions are the best foundation that each individual can create for her or his long term health.
Understanding Your Lab Tests: Thyroid Disorders
Continuing our push to help you understand you lab tests, this month we are focusing on thyroid testing. Please note that in past Health Matters, we have provided specific information on the: - Complete Blood Count
- Compete Metabolic Panel
- Lipid Panel
The thyroid is a small, butterfly-shaped gland in your neck situated just below the Adam's apple. The thyroid's role is to produce thyroid hormone which important in controlling the body's overall metabolism. There are two types of thyroid hormone - thyroxine (or T4) and triiodothyronine (or T3). The production of thyroid hormones by the thyroid gland is controlled by the pituitary gland in the brain. The pituitary gland produces thyroid stimulating hormone (TSH) which in turn tells the thyroid to make thyroid hormone. If the pituitary senses that the body's metabolism needs to be higher, it produces more TSH. If the pituitary senses that the body's metabolism needs to be lowered, it produces less TSH which decreases the thyroid's production of thyroid hormone. The pituitary's monitoring of the body's metabolism and the effect of thyroid hormone on the body's cells to change metabolism are extremely complicated and still not well understood. Because of its effect on body metabolism, people frequently want to explain obesity and feelings of lethargy, fatigue, or malaise on thyroid deficiency. However, this is rarely the case - these conditions are rarely due to thyroid deficiency and much more commonly due to lifestyle habits and/or various psychosocial problems meaning a combination of psychological issues and social stressors. What are common thyroid diseases?
About 20 million Americans have some form of thyroid disease. These are the most common: - Hyperthyroidism—Hyperthyroidism means you have too much thyroid hormone. This makes your body use energy faster than it should.
- Hypothyroidism—Hypothyroidism means you have too little thyroid hormone. This makes your body use energy more slowly than it should.
- Thyroiditis—Thyroiditis means the thyroid gland is inflamed. Thyroiditis can have several symptoms such as fever and pain, but it can also occur as subtle findings of hypo- or hyperthyroidism.
- Goiters—A thyroid goiter is a dramatic enlargement of the thyroid gland. This rarely happens in developed countries because we supplement salt with iodine, and it is iodine deficiency that most commonly causes goiters.
What tests are used to detect a problem with the thyroid?
The most commonly used first test used to detect a problem with your thyroid gland is a TSH (thyroid stimulating hormone) test. If your TSH level is abnormal, a free T4 and free T3 will generally be checked as well. - TSH (thyroid stimulating hormone)—used to test for low thyroid (hypothyroidism) and high thyroid (hyperthyroidism), to screen newborns for hypothyroidism, and monitor thyroid replacement therapy.
- Free T4 (thyroxine)—used to test for hypothyroidism and hyperthyroidism and commonly used to screen newborns for hypothyroidism.
- Free T3 (triiodothyronine)—to test for hyperthyroidism.
When are these tests ordered?
Because the symptoms of thyroid problems are frequently very vague, we will order a TSH as a screening test when symptoms might resemble those of a thyroid condition. For instance, signs of hypothyroidism include fatigue, weight gain, cold intolerance, and skin dryness. Signs of hyperthyroidism include fatigue, weight loss, heat intolerance, and nervousness. There is not a lot of national consensus about whether we should be screening for thyroid disorders with routine TSH testing. At GreenField, we generally recommend TSH screening for women over the age of 50. The US Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for thyroid disease in adults.
Email Guidelines
This is a general reminder about using email. Please remember... - When emailing us, make sure to include your full name (first and last) so that we are sure to know who you are. This will help us avoid delays and errors.
- Do not use email if you need a rapid response from us - in those cases, please call us. While we will always try to get back to you within a relatively short period of time during business hours, there are times when it may be up to 24 hours before we can respond. Outside of business hours, one of us is on call at all times to help you.
- If you have a sensitive item you need to discuss, please either use our secure messaging system by going onto our web site and signing in as a patient, call us, or schedule a visit.
- If you do email us and don't hear back, please do give us a call. Email is fairly reliable, but it may be that your email was lost in cyberspace, was caught in a spam filter, or that we inadvertently dropped the ball. Our intent is to serve you well, and we don't want you to be frustrated - we want you to feel comfortable calling us at any time.
An E-Visit Update
As you know, at GreenField, email care and "e-visits" are a normal part of our work. We were one of the first practices in the country to provide e-care and we still provide more e-connectivity to our patients than almost any other practice in the US. Last year, Providence Health Plan began reimbursing for e-visits - Providence Health Plan provides a percentage of the reimbursement for the e-visit while you - the patient - are responsible for the balance or 'co-payment' for the e-visit. Since one of the many things your Annual Fee covers is e-care, we will not bill you personally for those charges. On the other hand, because only a small percentage of our email communication meets the formal criteria for an e-visit, we do not anticipate the reimbursement of e-mail care to affect our Annual Fee. While no other health plan has a formal reimbursement policy for e-visits, we have started to submit bills to other insurers in hopes that we can "lead the charge" to bring e-visits into the mainstream for our community. Therefore, you may receive an "Explanation of Benefits" from your insurance company regarding our charge to them. Please be assured that we will not be billing you directly for the e-visit. Sincerely,
Your GreenField Health Team:
Beth Davis, your Benefits Coordinator and Biller (email)
Chuck Kilo, MD (email)
Cynthia Ferrier, MD (email)
Dia Gaede, CMA, your Health Coordinator (email)
Elizabeth Hays, MD (email)
Eric Murray, MD (email)
Jill Arena, your Clinic Administrator (email)
Joel Swartzmiller, IT Manager (email)
Pam Mockenhaupt, CMA, your Health Coordinator (email)
Ron Potrue, Clinic Management Consultant (email)
Shelly Banta, your Clinic Manager (email)
Tiana Schmitt, MA, your Health Coordinator (email) --------------------------- GreenField Health System
9427 SW Barnes Road, Suite 590
Portland, OR 97225
Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.greenfieldhealth.com questions, concerns, comments appreciated:
questions@greenfieldhealth.com
© 2003-2005 GreenField Health
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