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The CMG Voice

Does Coffee Prevent Liver Disease?

Posted Monday, February 5, 2018 by Gene Moen

We have written another blog post regarding a meta-analysis of studies focused on various possible health benefits of moderate coffee consumption. Here is another one, which may cause readers to wonder whether we are part of the Starbucks public relations team. A recent article in Medical News Today focuses only on coffee and the liver. The conclusion: the evidence is very strong that consuming 4 cups of coffee a day keeps the liver doctor away.

The article was about an event held at the Society of Medicine in London, chaired by Prof. Graeme Alexander, a senior advisor to the British Liver Trust of University College London. At the event, there was discussion about the rise of liver disease: an estimated 31,000 people in the U.S. die each year from cirrhosis. This is presumed to result from excess alcohol, calorie, and fat intake. And a major problem with liver disease is that it is often non-symptomatic, which means it is often undiagnosed until treatment is not effective.

Dr. Alexander stated about this problem “Liver disease is on the rise across Europe, and it is important that we understand how coffee, one of the most popular drinks in the world, and diet affects the disease.” Research papers discussed at the conference included one that suggested that coffee drinking, versus no coffee consumption, is associated with a 40% reduction in liver cancer risk. Another study found a 25-70% reduction in liver cirrhosis risk.

While recognizing that coffee may be good for the liver, there is uncertainty as to “why.” As one participant asked “How does coffee weave this hepatic magic?” There are some theories bouncing around. One is that caffeine might be involved, with a focus on paraxanthine (one of caffeine’s main metabolites). It decreased the synthesis of connective tissue growth, which in turn may decelerate the development of liver fibrosis, alcoholic cirrhosis, and cancer.

A major problem with this theory is that consumption of tea – which also contains caffeine — does not seem to have the same liver benefits as coffee. Another theory points to other constituents of coffee (kahweol and cafestol) because there is some evidence that these compounds may provide some anti-cancer effects.

There may be a range of compounds and mechanisms involved which benefit the liver, and whatever the scientific explanation, many researchers now think that having a few cups of coffee every day is just what your liver wanted for Christmas.

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In home primary care visits hope to improve health care, save money

Posted Tuesday, January 30, 2018 by Tyler Goldberg-Hoss

As many of us know, health care in our country is not perfect. One problem involves access to primary care, and the corresponding problem of people with non-emergent health care needs resorting to the local emergency department for help.

Concurrently, there has been an increase in the availability and use of technology in health care, including telemedicine – the ability to provide care to patients remotely. This has been the subject of recent blog posts here and here.

In this context, a community health center in Washington, D.C. has started a pilot program which brings primary care services to the homes of folks who can’t or won’t make it to primary care visits, and who are risks to use the local ER instead.

As described in a recent NPR article, a medical assistant goes to a patient’s home with a suitcase full of equipment to check his vital signs, and with a laptop which connects virtually with a doctor in another part of town. The medical assistant takes and records the patient’s blood pressure and pulse, weighs him, and listens to his lungs. While this is going on, a doctor is “seeing” the patient through the laptop, considering the new vital signs, and recommending treatment.

The purpose of such programs is at least two fold. First, health care organizations want to figure out a way to provide preventative care services to patients who either can’t make such visits (whether due to mobility, work, childcare, or some other reason). Offering in home telemetry-based services will hopefully make the population healthier.

Second, it will save money in the long run, not only as a result of a healthier population, but also with a reduction in the amount of non-emergent ER visits.

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Americans have low opinion of health care offered, ability of government to fix it

Posted Thursday, January 25, 2018 by Tyler Goldberg-Hoss

A recent poll found that 48% of Americans named health care as the top problem for the government to focus on in 2018. However, of those who named health care the top problem, 70% of them had little to no confidence that government will make improvements.

Reasons for dissatisfaction include particularly the cost of insurance and what that insurance actually covers. Many Americans still cannot afford even the most basic plans, and those who can afford a plan often need procedures that are not covered by it.

You can read an article on this new poll here:

In new poll, health care is the issue that won’t go away

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Drug overdoses bring life expectancy down in US for second straight year

Posted Monday, January 22, 2018 by Tyler Goldberg-Hoss

Recently released government figures show, for the second year in a row, that the life expectancy of an American is lower than it was the year before.

The culprit: drug overdose deaths, particularly involving opioids. As has been reported in recent blog posts, the opioid epidemic is continuing to ravage communities across the country, with municipalities in recent months filing lawsuits on behalf of their communities against both the maker of the medications and also, in at least one circumstance, the commission responsible for overseeing the safety of patients and medications.

Of note, usually when life expectancy dips down one year it rebounds the next. The last two year drop was in 1962-63, and the last time there was a three year decline was in 1916-1918 during the worst flu pandemic in modern history.

You can read more about this here:

Soaring overdose deaths cut U.S. life expectancy for 2nd straight year

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Are Medical Tests Useful? Not Necessarily.

Posted Friday, January 19, 2018 by Gene Moen

Dr. James Salwitz recently wrote a blog post about the tendency of doctors to over-test. He pointed out that ordering myriad tests will not necessarily provide for better medical care. The worst example, he wrote, is the ordering of an invasive test where the results won’t change what will be done to help the patient.

He cites an example of an 89-year old patient in whom lung nodules were found in a chest x-ray, probably from cancer metastasis. The doctor recommended a biopsy. When the patient asked what would happen if they proved to be cancerous, the answer was, of course, expensive and debilitating treatment that might prolong her life for a short while — or might not. The patient declined.

He blames part of the tendency to over-test for unlikely or extraordinarily rare conditions on the personality characteristics of doctors, coupled with their training. Physicians want to have a standard of exactitude, which is often not reasonable or practical. He writes “[doctors] stay awake at night because of a small probability that an obscure diagnosis might be missed because blood was not drawn, an x-ray not taken, or an orifice not invaded.” There is a tendency to expand the differential diagnosis to include diseases whose likelihood is remote.

The question that should be asked, says Dr. Salwitz, is: will the test results likely change the care that is provided?

In cases where patients are already very ill with a particular disease, should doctors be looking for other disease conditions? Dr. Salwitz cites the example of a patient with lung cancer, who presented with symptoms that might indicate unstable heart disease. So a cardiac catheterization was performed, with the result that the intravenous dye caused him to have sudden kidney failure. Dr. Salwitz points out that, before they invaded his heart and damaged his kidneys, they should have asked “Are we going to fix the coronary arteries of a patient with advanced lung cancer?”

Dr. Salwitz decries the tendency, often pushed by relatives, to continue to order x-rays and labs, even though the medical condition of the patient is beyond remediation. Intrusive testing, rather than comfort control, is the theme.

Rather than assuming that more tests are better, he says it is better to have a clear understanding of how a particular test is going to change the care plan. “A test only has value if it improves life.”

In his article, Dr. Salwitz does not comment on the dilemma of whether tests results are certain enough to justify changes in medical care. Examples are recent recommendations to pull back from routine breast imaging and PSA test reliance, because so often the results of false positives — expensive and often dangerous treatment — may outweigh the benefits of diagnosis.

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