Saturday, 4 June 2016

Princess Health and  June 4th, 2016 Busiest Weekend of The Year. Princessiccia

Princess Health and June 4th, 2016 Busiest Weekend of The Year. Princessiccia

June 4th, 2016 Busiest Weekend of The Year

The last two days have been insanely busy. And not just for me. It's easily the busiest weekend of the entire year in this area. Anchored by a nationally recognized Herb Festival, car shows, Relay For Life and several other big events. Naturally, this translates to my busiest weekend of the year.

I finished my downtown broadcast last night then headed uptown to the big Battle of The Burger cook-off to emcee the final part of the event--the announcements of the winners! By the time I got back home it had been a fifteen and a half hour day.

I managed almost seven hours sleep last night before getting up early in order to be ready for my first of two location broadcasts from different events. As soon as my broadcast commitments were complete, I ran into the store--grabbed a coffee and a few grocery items, and headed home to prepare lunch and finish preparing for my evening gig as the dj for a wedding reception.

The time between my last broadcast and when I needed to start setting up for the reception was too short. I stopped by Irene and Allen's place on the way to the gig. It was a fast visit with them and my youngest daughter--and my grandson, Noah. I also had a thirty minute window to get this blog written and posted. I started the blog and quickly realized it wasn't going to happen like I envisioned. Noah wanted my attention, of course! And he gets it! When the power dropped for ten seconds, resetting the computer, I decided this circumstance was beyond my control.

Tonight's reception went well. It's a major workout, too. Loading the sound equipment into the vehicle, loading in, setting up, tearing down, loading out and then delivering it back where it's stored (and it's big and heavy) is a bigger workout than any intentional workout I've experienced.

The blog and my dinner (super late--see Tweet below) required a much later time than I prefer.

I will be getting at least eight hours sleep tonight, maybe more.

I'm just glad I made it through the schedule.

I can rest now!

Today, like yesterday, I maintained the integrity of my calorie budget, I remained abstinent from refined sugar, I exceeded my #watergoal and I certainly had a workout. I'll be sore tomorrow, for sure!

Are you ready to discover the difference 8 weeks can make? Join us for the next session of weight loss group accountability and support and find out! I co-facilitate this exclusive support group with two Life Coaches, Gerri Helms and Kathleen Lynn Miles. This is something different. Different makes a BIG difference. You don't need to go it alone. There's an amazing team waiting for you to join. Space is limited, so don't wait! We keep the group size limited for maximum effectiveness, hence "exclusive." If you have any questions-- send me a Facebook message or email: transformation.road@gmail.com

Both groups are combined into the same "secret" Facebook group-The consideration to make when deciding on Monday or Tuesday is simply your schedule. The weekly one hour Monday call is 7pm Eastern-6pm Central-5pm Mountain and 4pm Pacific. The Tuesday night call is an hour later at 8pm Eastern-7pm Central-6pm Mountain and 5pm Pacific. I hope you'll join us!!

Monday night registration - http://lifecoachgerri.com/events/june-6-group/

Tuesday night registration - http://lifecoachgerri.com/events/june-7-group/

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Thank you for reading and your continued support,
Strength,
Sean

Princess Health and Bacteria that can't be treated by any antibiotic now in U.S.; Kentucky ranks first in one type of antibiotic-resistant infection. Princessiccia

A colorized scanning  of E.Coli
Credit: CDC/Jancie Haney Carr
For the first time, researchers have found a person in the United States carrying bacteria that can't be treated by "last resort" antibiotics.

The antibiotic-resistant bacteria found in the 49-year-old Pennsylvania woman's urine was from a strain of E.coli bacteria that is resistant to an antibiotic called colistin, a last-resort drug with serious side effects that is used only when other antibiotics don't work.

For example, colistin is used to treat the superbug carbapenem-resistant Enterobacteriaceae, commonly called CRE, which health officials call a "nightmare bacteria."

Nearly half of patients who become infected with CRE die from it, Lena H. Sun and Brady Dennis report for The Washington Post.

The Pennsylvania woman was able to be treated with other antibiotics, but the discovery of the colistin-resistant strain has placed health officials on alert.

Health officials say it's not time to panic, but there is great concern that this colistin-resistance gene could spread to other bacteria that are also antibiotic-resistant creating many more bacteria strains that are untreatable, reports the Post.

The colistin-resistant strain was first found in pigs, raw pork and a few people in China in November. It has also been found in Europe.

�It basically shows us that the end of the road isn�t very far away for antibiotics � that we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections for which we do not have antibiotics,� CDC Director Tom Frieden told the Post.

Separate research found that the same colistin-resistant strain was found in a sample from one pig intestine in the United States. Colistin is widely used in Chinese livestock, but is not used in the United States, though plenty other antibiotics are, Tom Philpott reports for Mother Jones.

"Around 80 percent of the antibiotics sold in the United States go to livestock farms, and of that, 60 percent are considered crucial to human medicine," Philpott writes. Farmers mostly use antibiotics to help their livestock grow faster.

Yohei Doi, an infectious-disease doctor at the University of Pittsburgh, told the Post that he thought the widespread use of the antibiotic in Chinese livestock is likely what has led to the bacteria evolving and gaining resistance to the drug, and then leaping from livestock to humans through food.

Dr. Kevin Kavanagh, a retired physician and chairman of HealthWatch USA, said he isn't convinced that the U.S. pig was infected by livestock from China. He noted that colistin is commonly used to treat CRE, cystic fibrosis and that a form of colistin can be found in many over-the-counter topical antibiotics.

"It's probably more likely that the pig in the U.S. obtained this from the farmer's medicine cabinet than from another pig in China," Kavanagh said.

Experts in infectious diseases have called for action to curb the overuse of antibiotics in livestock worldwide. They have also warned that if these antibiotic-resistant bacteria continue to spread, treatment options could be severely limited.

Kavanagh  recognized the importance of research around the overuse of antibiotics in livestock but said that he thought more emphasis should be placed on the human side of healthcare related to antibiotic-resistance bacteria than the agriculture side of it.

 "The foremost emphasis should be placed on controlling antibiotic usage, controlling the spread of these organisms and surveillance of these organisms. ... We don't really know how many infections exist because we have a fragmented reporting system, but you know how many cows there are in each county," he said.

The federal Centers for Disease Control and Prevention estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year, and 23,000 die.

Kentucky ranked first in MRSA cases, July 2014 - June 2015.
HealthWatchUSA
Kentucky has one of the highest prescribing rates of antibiotics in the nation and also leads the nation in another antibiotic resistant infection called MRSA (methicillin-resistant staphylococcus areus).

"Overuse of antibiotics has got to stop," says Kavanagh said. "The use of antibiotics needs to be curtailed to only when it is necessary. ... Every time you take an antibiotic you remove your good bacteria and run a real risk of activating a superbug in your body which can cause you extreme harm and even death. You should only take antibiotics when you have to take them."

Pharmaceutical companies have stepped away from developing new antibiotics because they aren't very profitable. But William Schaffner, medical director of the National Foundation for Infectious Diseasestold WebMD, "The Infectious Diseases Society of America has been working with Congress and with industry to create incentives for the pharmaceutical industry to reopen its antibiotic research laboratories."

In addition, "Late last year, as part of a broader budget deal, Congress agreed to give hundreds of millions of dollars to the federal agencies engaged in the battle against antibiotic-resistant bacteria," reports the Post.

Princess Health and Prevention is the key to surviving tick season in Kentucky, which runs through August; here are some tips. Princessiccia

By Melissa Patrick
Kentucky Health News

With outdoor summer activities in full swing, it's important to remember that tick season, which runs from mid-March through August in Kentucky, is upon us.

American dog tick
Ticks hang out in tall grass, woods, low-hanging tree limbs and weeds just waiting to attach themselves to you or your pets to "feed," a polite way to say they want to suck some blood. And while that is reason enough to avoid them, the real problem is that ticks can carry potentially life-threatening infections, like Lyme disease, Rocky Mountain spotted fever and Erlichiosis.

"The most prevalent tick-borne disease in Kentucky is and has been for a long time Rocky Mountain spotted fever," or RMSF, Grayson Brown, director of the University of Kentucky Public Health Entomology Laboratory, told Kentucky Health News. "We get somewhere between 10 and 30 cases of that a year."

RMSF is transmitted by the American dog tick, which is about the size of a pencil eraser. It is the second most common tick in the state, according to Kentucky Pest News. The greatest risk of getting RMSF in Kentucky is in the western part of the state, near the Land Between the Lakes, said Brown.

RMSF usually begins with a sudden onset of fever and headache that appear from two to 14 days after being bitten by an infected tick. Other symptoms can include nausea, muscle pain, lack of appetite and a rash that occurs two to five days after the fever. RMSF can be fatal in the first eight days of symptoms if not treated correctly, according to the federal Centers for Disease Control and Prevention.
Lone Star Tick, all images Wikipedia

Kentucky's most common tick is an aggressive biter called the lone star tick, which is also about the size of a pencil eraser, says Kentucky Pest News.

The saliva from this tick can produces painful, itchy areas that can become infected from scratching. It can transmit Erlichiosis, a Lyme-like disease that can cause fever, headache, chills, muscle pain and in some cases a rash. These symptoms usually show up one to two weeks after being bitten by an infected tick. It can also transmit RMSF.

And though it is not very common, Kentucky is also home to the blacklegged tick, which is known to transmit Lyme disease. This tick is much smaller than the other two more common ones.

"The number of Lyme disease cases is increasing quite rapidly, with 13 or so last year that were reported," Brown said. "The blacklegged tick is found most commonly around rivers and so the river areas, along the Ohio River, the Kentucky River . . . that is where the biggest risk is going to be.

Black-legged Tick
Symptoms of Lyme disease can range from mild to severe and include fever, headache, fatigue and a skin rash that looks like a bull's-eye, although not everyone has this rash, says the CDC. If left untreated, the infection can spread to joints, the heart or the nervous system. Lyme disease is most prevalent in the Northeast, Mid-Atlantic and Upper Midwestern states, so be mindful if you travel.

Infection from these diseases is unlikely in Kentucky because very few ticks in the state are infected with their respective diseases. And even if the ticks are infected, they must be attached and feeding for at least 12 to 24 hours to transmit its infection, says Kentucky Pest News. This makes self-inspection and prompt removal of ticks an important line of defense against these diseases.

Getting a tick borne disease in Kentucky "is something like the risk of getting struck by lightning," Brown said.

The best way to avoid being bitten by ticks is to use "common sense precautions," Brown said. Here are some tips:
  • Keep grass and shrubs trimmed, and clear away any overgrown vegetation in your yard;
  • Don't walk through uncut fields, brush and overgrown areas;
  • Walk in the center of hiking trails;
  • Wear light-colored clothing, which make it easier to spot ticks;
  • Wear long pants tucked into boots or socks and tuck your shirt into your pants;
  • Place a band of duct tape, sticky side out, around your lower legs to trap ticks;
  • Use tick repellent that has DEET or picaridin in it or use permethrin-based clothing sprays;
  • Do a body and clothing check at the end of each day;
  • Take a warm soapy shower after potential exposure;
  • Check your pets.
It is also important to promptly and properly remove ticks by grasping them as close to the skin as possible with tweezers and then pulling straight out with gentle, even pressure. Multiple sources say to not use petroleum jelly, gasoline, hot matches or other "folk" methods to remove ticks. Once removed, wash the bite area, apply antiseptic and cover with a Band-Aid.

The CDC has recommended washing tick-infested clothes and then drying them for one hour, but new research, published online in the journal Ticks and Tick-borne Diseases, says putting dry, tick-infected clothes in a hot dryer and spinning them for six minutes will kill them, Ann Lukits reports for The Wall Street Journal.

Brown said May is the month when you are most likely to encounter "pathogen-bearing ticks," but you can still get infected at other times. Tick season generally runs through August

He also noted that tick-borne diseases primarily occur in rural settings because wildlife, especially deer, often covered in ticks, and field mice, because ticks can transmit diseases to them and then the infected mice can infect other ticks as they feed.

"So if you are really worried about those things," Brown said, "pay attention to the wildlife that you have or that you attract to your property."

Friday, 3 June 2016

Princess Health and  June 3rd, 2016 Please, Hold Your Applause. Princessiccia

Princess Health and June 3rd, 2016 Please, Hold Your Applause. Princessiccia

June 3rd, 2016 Please, Hold Your Applause

I was feeling great yesterday. It was a very productive day at the studio and simply a solid day all the way around. I'm doing well on the no caffeine after 3pm rule. I was seriously poised to be in bed at another reasonable early bedtime--one that would give me a minimum seven hours sleep.

When the evening came, that's when it all changed.

I was working on a special project last night. I decided to get that done, because seriously, it had to be done last night, then dinner--then bed. 

The plan? Be in bed by 9:30pm.

When the project started going long--and I kept trying to hurry it along, I knew I was in trouble. I finished the work at 9:17pm--and I still needed dinner. 

Three things were in play: I was H.ungry--too long between food. I was A.ngry at myself for not anticipating/calculating the project would take 50% longer than expected. And I was T.ired.

That's three of the big one's from the HALT acronym-- you know, don't get too Hungry, Angry, Lonely or Tired, and if you do, recognize the need for support.

At the same time this is happening, I'm receiving messages of congrats on this new importance level surrounding my sleep schedule. Richard messaged: "Applause, Sean! You're evolving in fantastic areas!"

Please, hold your applause.

Night three and I've already sacrificed the integrity of my sleep schedule.

I was really too hard on myself. I wouldn't turn to a friend and say the kinds of things I was saying to myself last night, and lucky for me--before it could get worse, I reached for support.

One of the many wonderful benefits of being in a relationship with a therapist is the perspective she's able to offer in situations like this--and she did offer some valuable perspective. I appreciated her words very much.

I calmed down, felt better--and decided, I wasn't cooking-instead, I stopped in to dine at a restaurant two blocks from my apartment.  

Kristin added, "Hey, remember, when you get home, your blog is already finished. You can go to bed quicker!" 

Oh wow, that's right!!

Hey, I might like this new blogging schedule after all!

I still managed almost five hours sleep. It wasn't enough, but enough to survive. And I'll continue doing better along the way. 

Today has been non-stop since the alarm sounded at 4:30am. I snoozed until 5am before bouncing up and immediately recognizing the difference between last night and the two previous. Profound difference.

I did my radio show from 6-9am, then made my way to Bartlesville about an hour away to do a remote location broadcast on a different radio station for a company that contracts me to do their voice work. Today I was their on location spokesperson, too!

I made my way back to the studio this afternoon, after 3pm, to do production items I may have missed while I was away--and now, I have an evening broadcast in Downtown Ponca City at a huge annual event.

I'll be getting my required seven hours sleep tonight, there's not a doubt in my mind. I'm looking forward to that rested feeling I felt for two days. Today hasn't felt rested. It's amazing how two extra hours of sleep (seven instead of five), makes such a profound difference for me.

It does!

I'm maintaining the integrity of my calorie budget. I'm remaining abstinent from refined sugar, I'm hitting and exceeding my water goal and oh, about the exercise--I've had and continue to get plenty today in the course of these two location broadcasts.

And, as far as my sleep schedule goes, I'm making huge shifts in my perspective and importance level. Things are going to come up for me, like on-air weather coverage and circumstances like last night. It's simply a part of what I do for a living. Maintaining a high importance level in the better rest department isn't the same as maintaining the integrity of a calorie budget.

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Thank you for reading and your continued support,
Strength,
Sean
Princess Health and  Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers. Princessiccia

Princess Health and Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers. Princessiccia

By Melissa Patrick
Kentucky Health News

A health-care advocacy group says the redesign of the Medicaid program should build on the expansion of eligibility and not include any more costs for patients.

�Kentucky has made tremendous gains in improving the health of its people since the expansion of Medicaid. More Kentuckians are receiving preventive services, substance use treatment and other critically needed care than ever before,� Emily Beauregard, executive director of Kentucky Voices for Health, said in a news release. �Any changes to the program should build on this success.�

Under federal health reform, then-Gov. Steve Beshear expanded Medicaid to households with incomes up to 138 percent of the federal poverty level, which added about 400,000 more Kentuckians to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020. In all, about 1.3 million Kentuckians get free health care through Medicaid.

Gov. Matt Bevin has said the state can't afford to have more than a fourth of its population on Medicaid and has charged his administration to come up with a revised program that will improve health outcomes while making the expansion financially sustainable. Bevin hopes to accomplish this through a waiver from the federal government.

Bevin has said he favors a waiver program like Indiana's, which includes premiums and co-pays in some tiers of coverage, but has also said that he is not limited by this model and will develop a waiver to best fit the needs of Kentucky.

Kentucky Voices for Health is a coalition  of organizations that favor federal health reform, some of of which lobby the government. It said changes should engage consumers in their care and develop new ways to deliver care, without any obstacles to coverage such as premiums.

�Coverage is foundational,� Rich Seckel, executive director of Kentucky Equal Justice Center, said in the release. �It empowers us with tools to achieve and maintain health.�

The coalition also said the program should focus on coordination of care in areas with high use, and build on Kentucky's Health Data Trust, which provides complete and transparent information about healthcare utilization and outcomes to improve public health and quality of care delivery. Click here for the full report.

The group stressed the importance of meaningful stakeholder input to ensure the waiver is designed to meet the unique needs of Kentucky. So far, the administration has had no formal stakeholder meetings on the issue.

Under federal law, states seeking a waiver must hold at least two public hearings; one before it is submitted to the Centers for Medicare and Medicaid Services and the second after CMS accepts the application.

Amanda Stamper, press secretary to Bevin, told The Courier-Journal that the administration welcomed "this sort of thoughtful input," and when asked if the waiver would include any premiums or co-pays said, "Everything is on the table and no decisions have been finalized."

Princess Health and Clinical Practice Guidelines: Still Conflicted After All These Years. Princessiccia

Background: Untrustworthy Clinical Practice Guidelines

Since the 1990s, clinicians have been exhorted to follow clinical practice guidelines (CPGs) to improve their decision-making and patients' outcomes.  When Dr Wally Smith and I started teaching a short course (often at the Society for Medical Decision Making meetings) about changing physician behavior, we naively set out to improve decisions by increasing adherence to such guidelines.  We first thought that physicians' apparent shortcomings in guideline adherence were due to their lack of knowledge of the guidelines and the underlying evidence, and to their human cognitive limitations.

That approach, however, failed to yield ways to improve adherence.  After a while, it occurred to us that there might be other reasons physicians did not follow guidelines, including their lack of trust of the guidelines or the evidence supposedly incorporated within them.  We learned that integrity of  the clinical evidence base has been severely degraded due to the manipulation of clinical studies by those with vested interests, and the outright suppression of trials for which manipulation does not produce the desired results.

Furthermore, as we became less naive, we learned that the integrity of the guideline development process was also suspect, again due to the influence of those with vested interest.  No wonder physicians were suspicious of guidelines, and resisted adhering to them.

In 2011, the prestigious Institute of Medicine released a report on the development of  better standards to produce more trustworthy guidelines (Clinical Practice Guidelines We Can Trust.  Link here.)  We posted about that report here, but noted that it was receiving little other attention, an example of the anechoic effect.  The IOM report cited conflicts of interest (COIs) affecting the guideline development process as a major reason such guidelines might be untrustworthy, and suggested a variety of ways to reduce COIs affecting guidelines.

These included in particular:
- Guideline committee members should disclose their conflicts of interest in detail, and these should appear in the guidelines (Standard 2.1, 2.2)
- The number of conflicted committee members should be minimized, and in no case should be a majority of the committee (2.3, 2.4)
- Funders should have no role in guideline development (2.4)

This week, an original article(1) and editorial(2) in PLoS Medicine discussed how guidelines published since the report was produced addressed conflicts of interest.

Article Summary

Below I summarized the article, but presented results somewhat differently than did the authors.

Design

Campsall et al did a cross-sectional study of clinical practice guidelines that appeared in the US Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse in 2012 from national or international organizations, excluding guidelines produced by organizations restricted to allied health professionals, guidelines produced by corporations, or guidelines that had no specific recommendations.  They obtained information from the guidelines, the organizations' websites, and surveys sent to the organizations.

Study Population

The study population was 290 guidelines produced by 95 organizations. The response rate for the surveys was 68%.  The organizations were primarily professional societies (67%) or disease advocacy groups (21%).

My comment is that therefore this study assessed guidelines mainly produced by non-profit organizations which ostensibly uphold health care professionals' values and/or primarily support patients' interests.

Industry Funding

63% of organizations reported receiving funds from biomedical companies.  (It was not clear whether the remainder denied receiving such funding, or provided no information about funding.)

My comment is that the majority of such ostensibly "do-gooder" organizations are nonetheless at least somewhat supported by commercial firms that market health care products, presumably mainly drugs or devices.

Conflict of Interest Policies

Please note that the authors provided results to emphasize the positive, for example, they provided the proportion of organizations which provided specific types of information about COIs or had particular policies to reduce COIs.  In most cases, I simply did subtractions to emphasize the negative.  Furthermore, the authors further emphasized the positive by choice of denominator, as noted below.

20% of organizations did not provide any information about conflict of interest policies, and 7% asserted the existence of such policies, but did not disclose them.  A majority, 55%, did not have disclosed policies that specifically dealt with with conflicts of interest affecting guidelines.

My comment is thus that a majority of these do-gooder organizations did not apparently even begin to address, at least in terms of clear, transparent written policy, the recommendations of the IOM report on trustworthy guidelines.

Measures to Improve Guidelines Trustworthiness by Decreasing Influence of Conflicts of Interest

The authors provided the number of organizations with disclosed policies that addressed particular issues of concern to the IOM in their report on trustworthy guidelines, but made the proportions of such organizations seem larger by using as a denominator the number of organizations that disclosed their entire policies, rather than the total number of organizations which produced the guidelines.

Therefore, they found that of the 60 (out of 95 total) organizations that fully disclosed their conflict of interest policies:
98% required committee members to disclose conflicts of interest;
90% required review of conflicts of interest before guideline publication; 
68% required that a majority of guideline committee members be free of conflicts of interest;
92% reported publishing committee members' conflicts of interest within guidelines;
78% did not allow direct industry funding of guideline development
82% did not allow industry participation in selection of committee members
67% did not allow industry to review guidelines prior to publication.

That all sound good, but consider what happens when one uses the total sample of organizations in the denominators.

Therefore, the article also found that of all 95 organizations that produced the guidelines of interest:

38% did not require CPG committee members to disclose conflicts of interest
43% did not require review of committee members' conflicts of interest prior to guidelines development
57% did not require that a majority of guideline committee members be free of conflicts
44% did not report publishing committee members' conflicts of interest within guidelines
48% did not report preventing direct industry funding of guidelines
51% did not report preventing industry participation in selection of committee members
61% did not report preventing industry review of guidelines prior to publication.

My comment is that thus the results suggested that substantial numbers of organizations that produced CPGs did not demonstrate that they were committed to measures that would improve guidelines trustworthiness by reducing the influence of conflicts of interest.

Disclosure of Conflicts of Interest Within Guidelines

Again, it was necessary to recalculate some proportions using the full population of guidelines reviewed as the denominator.

Of the 290 guidelines reviewed:
65% "included disclosure statements regarding direct funding and support"
37% specifically disclosed the absence or presence of direct funding from biomedical companies
However,
49% did not disclose committee members' financial relationships
99% did not disclose relevant financial relationships of the organization (that is, institutional conflicts of interest) that produced the guidelines as a whole

My comment is that substantial numbers of published guidelines were not clearly produced so as to increase their trustworthiness by reducing the influence of conflicts of interest on them. 

Did the Guidelines Follow the Organizations' Stated Policies?


The authors commendably provided information about whether the guidelines produced by organizations that disclosed conflict of interest policies followed those polices.  They found:

16% of organizations "that reported that committee member conflicts of interested were published in guidelines" produced guidelines that did not include committee members' COI disclosure

61% of organizations that "reported the majority of committee members must be free of conflicts of interest" produced guidelines by committees with majorities of conflicted members

6% of organizations that "reported that industry partners were not permitted to directly fund clinical practice guideline development" produced guidelines which disclosed such funding.

My comment is that thus even of the organizations that stated they had policies in place to improve the trustworthiness of the guidelines they produced by reducing the influence of conflicts of interest, they allowed guidelines to be produced that did not follow those policies.

Authors' Conclusion

Financial relationships between organizations that produce clinical practice guidelines and the biomedical industry appear to be common. These relationships are important because they may influence, through guideline usage, the practice of large numbers of healthcare providers. We believe that to effectively manage conflicts of interest, organizations that produce clinical practice guidelines need to develop robust conflict of interest policies that include procedures for managing violations of the policy, make the policies publicly available, and disclose all financial relationships with biomedical companies.

Editorialists' Conclusion

The editorial by Bastian(2) was sharper in tone.  It included an observation that reinforced my confession of naivete above:

With hindsight, I think those of us encouraging better methodology for guideline development in the 1990s took the issue of disclosure of financial interests too much for granted. It seemed so self-evident, it got barely a mention even in national policy on guideline development

She also noted that the Campsall study did not address all the ways conflicts of interest can influence guideline development:

Stelfox and colleagues focus particularly on the organizational conflicts of interest of guideline producers and their policies. They examine the financial interests of the organizations, but not of the individuals employed within those organizations. This same blind spot is evident when it comes to policies about committee members; the financial interests of the organizations that individuals represent tend to be disregarded. Yet these can be substantial, including for patients� organizations.
She noted that the failure of guidelines to report their developers' conflicts of interest is a continuing problem.  The rate of failure to report found by Campsall et al was

about the same rate that Taylor and Giles found in 2004 and Norris and colleagues found in 2010.

Finally, she emphasized that we are still a long way from having guidelines that health care professionals and patients can trust:

Guideline processes without adequate financial conflict management have to become unacceptable to a far wider circle. They need to become unacceptable to influential committee members, to the medical journals that lend so many guidelines additional standing and reach, and to the membership of the professional societies that produce them. Until that happens, for guidelines as for clinical research, it�s a case of caveat lector: let the reader beware.

My Summary

So should physicians trust clinical practice guidelines?  At least this article suggests they ought to be very very skeptical of them.  The IOM report meant to improve the trustworthiness of practice guidelines seems to be honored mainly in the breach.  The likelihood that any given guideline was produced so as to reduce the influence of conflicts of interest on it is low.  Even organizations that ostensibly put professional values and patients first in their efforts to develop guidelines seem to often be financially beholden to companies that want to sell drugs and devices.  Physicians and patients ought to be concerned that most new clinical practice guidelines may be as much about marketing commercial products as improving medical practice or patients' outcomes.

The current US presidential race has made it evident that we have a lot of disgruntled citizens, many of whom believe our system is rigged to favor the "establishment."  I suggest that the more we know about clinical practice guidelines, the more it appears that the health care system is rigged to favor certain parts of the "establishment," the big corporations that market drugs and devices, and their paid part-time hands within medical societies and patient advocacy groups who have turned these ostensibly idealistic, do gooder organizations into part-time marketing machines.

The huge and complex web of individual and institutional conflicts of interest that binds much of the health care system, the government, and industry may be good for the insiders, but is stifling improvement in our dysfunctional health care system.  True health care reform would first expose these conflicts, then reduce or better yet, eliminate them, and make health care more about helping patients and less about making money by marketing commercial products.

Musical Interlude

To dispel the darkness a bit, Paul Simon, "Still Crazy After All These Years," 1992 acoustic version:





References

1.  Campsall P et al.  Financial relationships between organizations that produce clinical practice guidelines and the biomedical industry: a cross-sectional study.  PLoS Medicine 2016; DOI;10.1371/journal.pmed.1002029    Link here.

2.  Bastien H. Nondisclosure of financial interest in clinical practice guideline development: an intractable problem? PLoS Medicine 2016;  DOI;10.1371/journal.pmed.1002030  Link here.

Princess Health and Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture. Princessiccia

By Melissa Patrick
Kentucky Health News

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of in the County Health Rankings for the state have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map)
Clinton County ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. �We recognize that. We saw that in our kids,� Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a report to be aired soon about the coalition.�And if we don�t change something now, we�re going to be going to the funeral home for kids a lot younger.�

So, with the help of the Foundation for a Healthy Kentucky, they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children.

�The coalition came together [according to] Aristotle�s thinking, that the whole is greater than the sum of its parts,� Brewington told KET. �We have a lot of great groups, that do a lot of great things, but if everyone is going for the same goal, and the resources are not combined, you�re not going to accomplish anything. And once we get everybody together and on the same page, by combining resources, we�ve been able to do some great things.�

Paula Little, assistant superintendent and supervisor of instruction for Clinton County schools, told KET that the coalition recognized most of the county's health issues stemmed from obesity, and decided to focus their efforts on the children in the community to change their culture.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Little said.

Many of the coalition�s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day-care programs.

The coalition has worked with the schools to improve nutrition. Fruits and vegetables are now served every day with every meal. The schools also began offering supper to students during the school year and has since served over 6,400 meals. The program began last October.

Recognizing that an estimated 38 percent of Clinton County's children live in low-income families, the coalition launched a summer food program that delivers breakfast and lunch in a retrofitted school bus called the Bus Stop Caf� to areas in the county with high student populations.

The Healthy Hometown Coalition has also implemented school-based health clinics, which provides for the healthcare needs of students through a public-private partnership while they are at school. The clinics are run by the Cumberland Family Medical Center. In addition to providing clinical care, the clinics provide body mass index assessments and provide nutrition and obesity counseling.

�It�s about accessibility,� Brewington said. �It�s about the kid who has a cough and needs to see a doctor, but the parent can�t take off from work. ...It's about having healthcare right there where the child is the majority of the time."

Not mentioned in the KET report is that Clinton County schools implemented a comprehensive smoke-free policy last year that will go into effect in July. The policy will ban smoking on school property both during school hours and during school sponsored events, and also includes electronic cigarettes and all vapor products.

The coalition is working to change the culture of its community so that a healthy lifestyle becomes the norm, and not the exception.

�When you�re attempting to change a culture, and change the way people live, that�s a very long process,� Little said. �And it has to be something that�s consistent, that�s ongoing, and it has to be a message that children hear everywhere they go in the community.�

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the Clinton County News that often celebrates individual success stories. The coalition also sponsors community events, and has built a new playground.

�What makes me feel good about it is that I know there�s a real need here,� Speck told KET. �There�s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we�re making an improvement.�