Monday, June 27, 2011

The Dangers of Flying: skin cancer in the air

I got a Facebook question recently from one of my airline pilot friends about the amount of radiation that flight crews receive from being in the stratosphere during airplane flights. 

As a dermatologist I can't tell you the number of skin cancers that I have removed from pilots over the years.  I know I tend to attract pilots as patients given my own helicopter flying, but the number of individual tumors is huge.

And I'm not just talking about the typical basal cell and squamous cell carcinoma -- melanoma is not an infrequent finding. 

So how much radiation do you receive in an airplane? 

Well check out this cool website from the FAA:  Called a Galactic Radiation Calculator, it will give you the amount of radiation your body will be exposed to while in the air.

Most of the information is self explanatory, but you will need the airport identifiers of your destination and arrival airport.  For play you can use New York's JFK (KJFK) and Dallas/Fort Worth International Airport (KDFW).  But if you want to use the ones from your own travel information there are resources on Google.

Next you will need the altitude of the flight.  Now the pilot will usually tell you this during the flight briefing near the beginning of the flight (about the time he or she will tell you to keep your seat belt fastened if you're in your seat).  If you want to play, then just use 39000 feet.

One thing that you might not have is the time of your descent... just use 25 minutes as a good guide.

Then you're good to go.  Push calculate and you will get a result in a funky number of microsieverts.  What's that? Well there's a cool table on Wikipedia that will allow you to compare how much radiation you received in comparison with common things like dental x-rays and being exposed to a nuclear reactor.

Cool tool.  But the take home message is that pilots and those that spend a lot of time in airplanes are exposed to higher doses of radiation and therefore have a higher risk of skin cancer.

Wear that sunscreen! (oh...and fasten your seat belt)

Sunday, June 26, 2011

What my children will never see? Things disappearing from the doctor's office

On a recent trip to Austin I flipped through the worn copy of Spirit magazine in the seat back of a Southwest Airlines 737 and saw this nice article about babies -- and specifically what they see and understand very early in life.

I love my two young kids, and although they both aren't as young as they used to be (neither am I), I love to share with them new experiences, sights, and the general joys of life.

I think all parents must feel the same way.  There is just something about seeing the the glint of newness and understanding in the small eyes of a child.  

But today I began to wonder about things our children will never see, particularly related to health care. We have on our own list from when we were growing up, but it's certainly different now.

From polio, mumps, and small pox:  thankfully they are all distant memories.  As a dermatologist I do get to see some of the unusual but still rather rare diseases (measles, for instant) that I heard about in my childhood.

But children today will miss out on many things that are common place in our day to day lives.

Here's my list (feel free to add or subtract in the comment box below):

1) Marcus Welby:  hometown physicians in private practice that take care of families for decades will be a thing of the past.  I've written about my good friend John Keller, MD, a family physician in the small rural town of Fairfield,  Texas before here.  Practicing for over 50 years in one place, he will probably be the last "Marcus Welby" doctor that I know.  And my children will never see that.  Only on re-runs. 

2) Chicken Pox:  childhood vaccination makes this common disorder now very rare.  And, if we're lucky, shingles or herpes zoster will also be a painful encounter our kids will not have to endure.

3) Rectal thermometers:  I'm sure someone will comment that these are still around.  The last time my kids were sick it seemed like someone just shot their head with a laser thermometer -- nurses don't even have to touch the patient any more.  Novel idea.

4) White hats:  speaking of nurses -- what about those white hats?  I mention them occasionally and finally someone in my office told me that she wasn't sure it was politically correct to talk about them anymore.  I'm not sure I understand that, but I've changed my workplace banter after their expressed concern.

5) Prescription pads:  Ok, I know this is maybe a tad progressive.  But in our  paperless office we don't write prescriptions by hand any more.  We send everything electronically using an e-prescribing application.  And, frankly, everyone loves it including my staff, patients, and finally me. I know there are some slow adopters out there, but Medicare and other insurance carriers will drive that train.  Paper prescription pads? They'll be gone.

6) Drug company pens:  Yes, the pharmaceutical company give aways (not just pens: but dummy plastic models of the skin, Post It notes, stethoscope labels, you name it) are all gone.  No longer will kids see a Viagra pen or a Lipitor flashlight.  New pharma rules prohibit these types of "inducements" because some bureaucrat thinks that supplying a pen will induce the doctor to use that pen to write an expensive prescription.  Personally, I think this is stupid.  Maybe doctors shouldn't be taken on golf junkets or expensive dinners...but a pen.  Really.

7) Ties:  Though not mainstream, health care workers are quickly adopting the casual Friday look in the medical office and the hospital room.  Why?  Well those ties were shown to carry germs.  So scrubs and casual shirts are now considered appropriate dress code for health care workers.  

8) The Co-Pay:  Well, it's not gone yet, but more and more insurance products are "high deductible" health plans.  It used to be that patients could pay $20 and get all the health care they could milk out of a 15 minute visit.  Those days are disappearing as the most popular insurance product sold in our home state last year was one with a $3000 deductible.  Patients and physicians are now more cautious in their health care decisions.  That's a good thing.  The bad news is that every care component falls directly to the bottom line.  

Feel free to add or subtract from this list.  Hopefully there will be exciting improvements in our health care delivery system, new drugs to treat disease, and exciting technologies to cure our ailments that replace the items on the list.  

We can always hope.

- Posted using BlogPress from my iPad

Friday, June 17, 2011

Does Google give the wrong information on health care decisions?

Clearly using the internet to research any topic is valuable.  

Whether it's a new book you're thinking about buying on Amazon, researching the latest and greatest high definition television, or finding the value of your used car, the internet is a wealth of information.  

We all know that websites track our activity, constantly downloading cookies that both help and hinder our web experience.  They allow us to instantly be put into our "Recommendations" page on, but they also may contribute to mining our website activity and delivering us pop up ads.

But the latest use of complicated algorithms by search engines like Google resembles the ultimate over the shoulder look from big brother.  

In an effort to better put you in touch with the information you are searching, search engines have started to place context "relevant" items high in the search list.  That is, the search engine tracks both your searches and websites visited and then computes what search results would be the most relevant -- just for you.

This means that even though we might search the same topic, we might both be given a different set of results.

Now most of the time this is good.  

If you are hungry for catfish, searching for this crusty fried fatty protein would probably lead to restaurants that are near your home.  If you are a health fanatic (read: you aren't familiar with the word "fried") then you might find links to recipes for grilled fish.

Now all of this sounds really helpful. 

But instead of the results providing a broad spectrum of information, they are actually providing information that is more focused -- just for you.

Imagine for a moment that you are somewhat of a conspiracy theorist.  If you search the word set "birth certificate," you might find yourself immersed in the world of the Birther's and President Obama's long guarded secret certificate.  You could have very well been really searching for the office of your local county clerk where you could download a copy of your own vital record.

These types of results are especially concerning in health care.

Now think about this scenario:  you are somewhat of a natural and alternative medicine follower.  You just returned from visiting your primary care doctor and she gives you your mammogram results.  It looks like you might have breast cancer.

You do what most patient's do:  you search breast cancer on Google.  

Given your past search patterns on health foods, alternative medicine, herbal products, and acupuncture, an article on "prune juice as a cure for breast cancer" pops up.  Further search of this bizarre topical combination begins to reinforce your findings:  there might be a link for a cure between this fruit juice and a breast malignancy.

So instead of providing a comprehensive analysis of breast cancer treatments, the algorithms have begun to reinforce your preconceived (pre-searched) thoughts on alternative medicine.

Now this isn't an attack on alternative medicine, rather it's meant to demonstrate how the internet can focus one's mind on a solution quickly rather than providing all of the necessary information to make the best decision.  

And the scary part?  There is very little you can do about it.

These algorithms are proprietary and aren't really subject to easy manipulation.  They are meant to reflect who you are and what you generally search for;  and they do a very good job.

Yes, you can log off and then log on with another name, try a different browser, search for other types of topics for awhile, or even replace the computer, but because many use the local ip address as the pointer for determining which results to deliver, this would all be done in vain.

Probably the best advice is to cognitively realize that this is happening when you perform a search.  So don't stop with the first articles or links that are returned.

Dig deeper and go off the search engine directed path a little.  Force Google to go deeper into other topics by continuing to search different but similar keywords.  

And know that ultimately you are in charge of your search experience.  Don't believe everything you see or hear;  have a healthy respect that it's good to challenge the information you are given.