Everyone knows the stirring heroic story by now of the kidnapping and rescue of Captain Richard Phillips. But there is a medical back story that has been submerged beneath the tremendous skill shown by the Navy SEALS. That is the endurance of Captain Phillips himself.     

Consider that Phillips was held captive on the Maersk Alabama lifeboat for 5 days beginning last Wednesday, and during that time, he was reportedly subject to temperatures approaching 100 degrees. It is doubtful that he received much food or drink, and he was clearly under great stress. I doubt he slept more than a few hours per night.

These medical observations only deepen my admiration for this man and his acts of heroism. He was clearly dehydrated, undernourished, and exhausted at the time of his rescue, and during his previous attempt at escape. He is not only a man of great courage, but also one of stamina and strength.  

From a purely physiological point of view, we all have an untapped reserve of strength and endurance that may help us to survive under challenging circumstances. As I described in my book “False Alarm; the Truth About the Epidemic of Fear,” the mechanism is known as fight or flight, or acute stress response. In response to a bodily threat we experience an outpouring of hormones, adrenaline, noradrenaline, the steroid cortisol. Our eyes dilate to see better, our hearts beat faster and harder, we are ready to fight or to flee.  
 
None of us will ever respond any better than Captain Phillips did. His body was as strong as his mental resolve. 
 
Consider that this man is 53 years old, older than this doctor. Compare that with the Navy SEALS, many of whom are in their late teens or early twenties and in top physical condition. Phillips appears to be in good physical condition, but not compared to one of the SEALS. I don’t know whether Phillips exercises regularly, but I suspect he does, and he looks fit. But nothing could have prepared him for this ordeal, except for his great courage, and the spare powerpack that the body and brain have known as fight or flight. A good thing for America, Phillips and the navy chose to fight.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Can you believe that nine patients in the Austin, Texas-area used the emergency room 2,678 times over the past five years? This fact, reported by the Integrated Care Collaboration, is simply unbelievable until you consider that eight of the nine had a drug abuse problem, and were not doubt using the ER to make sure they had their fix of pain pills.

But this finding points to a larger problem; that our ERs are clogged, that they are often filled with patients for the wrong reasons, that ERs have a limited surge capacity in the event of a catastrophe. At a time when President Obama is considering expanding health coverage to all, the question is how to ease the overuse of ERs so more could be accomodated in a way that isn’t so expensive.

Consider that an average ER visit costs the hospital between $500 and $1000. Consider that ERs are NOT filled with the uninsured. A 2008 study showed that ONLY 14 percent of ER visits involve patients without health insurance. More than 50 percent of visits (most often for minor complaints) are for people who earn more than four times poverty level, and that 29 percent of the people going to ERs are not only insured, they also have regular doctors. Doctors that they can’t get in to see!

We have a growing shortage of doctors – especially primary care doctors. A Texas survey revealed that 60 percent of primary care doctors opted out of accepting Medicare last year. Approximately the same percentage of New York’s primary care doctors are also dropping Medicare. The increasing number of doctors dropping insurance will lead to even more ER visits, as will expanding the number of patients who are covered by insurance.

Imagine what will happen if we decrease reimbursements to doctors (and hospitals) further. ERs will be flooded, and no one will get taken care of.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

One size fits all — isn’t that what we all want? And at a time of exorbitant medical costs, isn’t it practical that scientists have developed the mega-pill that cures all our ills and keeps us from having heart attacks and strokes? I wish it were that easy!

A new study from Canada and India published in the prestigious journal Lancet and presented at the American College of Cardiology meetings takes a look at a pill that combines aspirin, statin, and three blood pressure pills (a beta blocker, an ace inhibitor, and a diuretic) in patients with heart risk factors. The study took place over 12 weeks and showed that the ultimate combo drug continued to lower cholesterol, blood pressure, and be as well tolerated as the drugs taken alone.

Not only that, the results project out to a decreased risk of stroke by 48 percent and heart disease by 62 percent over a longer period.

The obvious advantages are in terms of patient compliance and low cost. But the disadvantages are also worth considering. As I’ve seen in my medical practice, for all combo pills, the problem is not knowing which pill is doing what, and if there is a side effect, which component is causing it. A patient may develop a problem and stop the pill and then refuse to take any of the drugs that make it up. Decisions like that can end up being more expensive in the long run, in terms of health care outcome.

And despite cardiac risk factors, some patients need one of these drugs and not the other. The diuretic may cause electrolyte abnormalities, dry people out, or make them urinate frequently. Not everyone tolerates this the same. Altace can cause a cough and the beta blocker may make some dizzy. In the final analysis, the “one size fits all” approach may not be as cost effective as it first appears.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

My “beef” with a study just released in the Archives of Internal Medicine on the supposed dangers of red meat is not with the study itself, but with the conclusions that we might too easily draw from it.

We are a society that looks for bad guys. Rather than improve our overall diet and exercise more regularly, and live a healthier lifestyle, we look for culprits, health criminals that we can blame.

Cigarettes are an obvious target, and cigarettes deserve our medical scorn. Alcohol too, though in recent years we have been trying to give limited amounts of alcohol a respected place (not entirely successfully) in a healthy lifestyle by pointing to its affects at improving circulation. Red meat, on the other hand, has always been seen as unhealthy, though acceptable in limited amounts.

Now along comes a new study from the National Cancer Institute and National Institutes of Health published in the Archives of Internal Medicine looking at how half a million men and women ages 50 to 71 showed a modest increase in mortality from cancer, heart disease and other causes associated with high portions of red meat and processed meat.

The study attempted to control important variables such as exercise and overall diet, but in my opinion, it is very limited because of its survey design. It’s not prospective or randomized, despite large numbers. Epidemiological survey studies like these are preliminary; they need to be followed up by many vigorous, scientific studies before any firm conclusions are drawn.

Though white meat may be preferable, it is also not clear what may have caused the differences in mortality in the study. It may not be the red meat itself but could be the fat, or the steroids, antibiotics, and other chemicals we regularly pump into our meat.

Remember, red meat contains many essential vitamins, including C, D and B12, and is a major source of iron and protein. It is an important source of nutrition for many who would not or cannot afford to get it any other way. Red meat may be especially important for those who are anemic, and for pregnant women.

The bottom line here — red meat in moderation is still safe, but limit portion size and eat a well-balanced diet whenever possible. You can find the same kind of sage advice on the blog of our knowledgeable dietician, Tanya Zuckerbrot, and in the pages of The Hot Latin Diet, written by our esteemed health editor, Dr. Manny Alvarez.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

What can we learn from actress Natasha Richardson’s awful skiing accident this week?  Dr. Steven Flanagan, director of Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center where I work, rightly characterized Richardson’s sudden loss of consciousness after seeming fine at first as possibly “talk and die syndrome.” He was quoted right here on FoxNews.com as describing the likely buildup of blood in the head that may have overwhelmed her consciousness and caused her to blackout after first seeming to be okay.

What else can we learn? That a person can be alive and thriving one minute and have her life snuffed out the next? Who among us doesn’t know that skiing is a dangerous sport? It has been several years since a blow to my knee convinced me not to take any more chances with my livelihood and health.  Unfortunately, not everyone sees it that way.

Not knowing the details, I can’t say whether she was taking chances, whether this terrible accident could have been avoided. I can’t say whether she had a hidden aneurysm in her brain that predisposed her to a bleed, or even whether prompt medical intervention, drainage and anti-inflammatory medications and life support can still bring her back. We are all hoping to find out that she is back awake and speaking with visitors tomorrow.

As is usual with celebrities, the media reports so far have been shrouded in mystery and contradiction, ranging from minor injury to looming death. As these are sorted out over the next few days, it is worth reminding readers just how often we learn incorrect facts about medicine from the sudden illnesses of those we admire.

Whatever actually happened to Natasha Richardson, and whatever happens from here, there are a few important conclusions we can already draw. 1. Skiing is a dangerous sport which can injure more than your legs. 2. The brain is a closed compartment with no outlet for blood or swelling until the swelling subsides and the blood is reabsorbed. 3. If the brain itself is not damaged, but only swollen or compressed by blood, then there is still hope for her survival.

The latest reports say that she has been flown from Quebec to New York City, and I can attest to the fact that there are medical centers here with the ability to bring people back from a deep coma.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Stem cells are cells which haven’t yet differentiated and become specialized into organs or people. Stem cell research is a complex and controversial topic, too complex to analyze effectively in a blog entry, or even a thick textbook. But given all the hysteria, hype and distortion surrounding the issue, I wanted to make a few points for the sake of clarity.

*  President Obama’s order this week does not change legality — it is already legal to conduct research on embryos. It is still not legal to create embryonic stem cells for the purpose of research, nor should it be. What is involved here is conducting research on embryos that have been produced privately for the purpose of in vitro fertilization, but have not ended up being used. Previously the funding was mostly private, now there will be increases in federal funding. At a time when private research money is shrinking, this may help the research to continue.
*  At the same time, advances in treatments have come not in embryonic stem cells, but in adult stem cells that have been manipulated genetically to regain their earlier potential before they began to differentiate. Embryonic stem cells hold promise because they haven’t yet differentiated and may be manipulated to do so in therapeutic directions. But this potential hasn’t been realized in part because the body tends to reject these cells as foreign. In contrast, using a body’s own stem cells or umbilical cord blood circumvents the risk of rejection, since a body won’t reject its own cells.
*  The current debate reminds me of the waste in creating excess embryos for no real medical purpose in the first place. We need stricter regulations on in vitro fertilization, not only so that no more pathetic stories like Octomom occur, but also because life is precious and should not be initiated only to be wasted in this spirit of excess.  IVF for an otherwise childless couple can be a wonderful thing, but it must be well monitored and carefully regulated.
*  It is preferable for embryos to be used for research rather than discarded, even with limited potential to lead to cures, and only with the understanding that no embryos should be created for research purposes.

When you unwrap the real science from the politics and postering, there is less controversy, and less negative emotion.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

In practically everyone’s favorite original Star Trek episode (and later film), Ricardo Montalban plays the leader of a master race of genetically engineered superheroes from the late 20th century, who consider themselves superior to others in a brutal way that is reminiscent of the Nazis.

The Montalban character was the first person I thought of when I reported on the news today that Dr. Jeff Steinberg, a pioneer of In Vitro fertilization in the 1970s, is now running the LA Fertility Institutes where he is planning to allow prospective parents to choose their baby’s traits (they are already choosing gender).

I have many concerns about this trend, especially when I consider it in the wake of the massively irresponsible medical care offered to Octomom Nadye Suleman by Octodoc Dr. Michael Kamrava.  The American Society of Reproductive Medicine has enough on its hands trying to limit the number of embryos implanted to one or two, without having to consider how they are being genetically altered or chosen to please some narcissistic parent.

Has everyone forgotten in this mad rush for media attention that the real purpose in IVF is to offer the possibility of a child (a blessing) to otherwise childless parents?

Dr. Leon Kass, President of the President’s Council on Bioethics until 2005, was concerned about this very problem in a report he issued before stepping down. If you allow parent’s to choose the traits of their children, where do you draw the line?

The process is also bound to be quite expensive. IVF already costs more than $10,000 per IVF cycle. If you add one from column A, one from column B choices of traits, how many more billions is that going to cost our overburdened health care system.

I also look at making designer babies from the perspective of a doctor trying to make responsible decisions in order to help my patients. What happened to the Hippocratic Oath? How many arbitrary and willful choices about a child’s genetic makeup could lead to unexpected negative outcomes? We need more regulation of doctors in the IVF world so that this doesn’t happen.

The real purpose of Preimplantation Genetic Diagnosis, as the procedure is called, is to identify genetic defects in embryos created through IVF before implanting them. This makes sense, and since more  embryos than can be used are always harvested, has been used since the 1980s to prevent unanticipated diseases like Cystic Fibrosis, Down Syndrome, Tay-Sachs disease, sickle cell anemia, and Huntington disease. The technique can also be used to help choose embryos that are more likely to survive a pregnancy.

But as genetic diagnostics improves, and even gene splicing to identify and treat diseases before they occur becomes an exciting option, a slippery slope is created. On the downside of this slope awaits Montalban’s group, ominously named The Botany Bay Colony.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

The Institute of Medicine, a prestigious body, has released a new report building on previous reports issued between 2001-2004 which have all concluded that the lack of health insurance in our society is putting a lot of pressure on our current health care system and leading to skyrocketing costs. The current report concludes that when local rates of people without insurance are relatively high, even people with insurance have difficulty obtaining needed care.                                                      

According to the report, the number of people who have health insurance continues to drop, while employment-based coverage — the principle source of insurance for most Americans — is failing. The average amount of money that employees paid for year for family coverage has doubled in the past decade to $3,354 in 2008. The IOM committee concludes that if there is no intervention, the decline in health coverage will continue, costing the health care system more money down the line in terms of delayed diagnoses and poor outcomes.   

My take is somewhat different.  Here’s why:
 
*  I don’t assume that increased health coverage automatically leads to improved health outcomes. Our system is currently clogged with insured patients who overuse their coverage precisely because they don’t feel the pain in their pocketbooks. Recent studies have shown that it is these folks who unnecessarily fill our ERs, often with minor ailments.
*  There is a great and growing shortage of doctors, especially primary care doctors. Current medical school graduating classes average only 2 percent going into primary care. So who is going to practice all the preventative medicine that IOM has in mind by extending insurance coverage?
*   The current system of health care is far too intervention-oriented. This means that we wait until people get sick and then use our insurance coverage to absorb the cost of disease-modeled intervention. Did you know that over $460 billion – that’s right BILLION – was spent last year in the U.S. on cardiac and vascular interventions. Until we transition to a real preventative-oriented model, where hospitals are NOT the focus, extending coverage will only extend the problem.
*  Making the system more prevention oriented is not a function of extending a generic disease model to more people. Instead, it means disruptive innovation, altering the system itself, with a new focus on prevention through the use of genetic technology, biotechnology, personalized medicine, and most importantly, increased development and use of screening tools that lead to catching a cancer or heart disease before it occurs, or at least before expensive chemotherapy or elaborate stenting procedures are required.
*  With the current managed care/employer-driven health model, there is no way to protect the patient/consumer from shoddy care. Extending that will only extend the shoddy care.
 
 
Let me give you an example of how the current system doesn’t work – (as if you don’t know it already from your own health care difficulties):

A producer here at Fox had an earache – he wanted to see his primary care doctor, but the doctor was all jammed up with patients. So he went to a mini-medicine mart, a doc-in-the-box, and was quickly given an antibiotic, and his ear has started to improve.

But ears are tricky, and are easy to misdiagnose or mistreat. I send many of my patients so afflicted to ear specialists. The producer may not have needed the antibiotic or he may need more care than just an antibiotic. Either way, I am wary of the care he received, and am concerned that in the end he could end up costing the health care system more money, and himself more aggravation, than if his primary doctor had been available. And keep in mind that his doctor WAS not tied up with the uninsured, but with the kind of coverage that IOM thinks should be extended to more people.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

The more I hear about Dr. Michael Kamrava, who practices some facsimile of reproductive medicine in California, the more outraged I become.

From what I’ve been reading, I am already convinced that he should probably be considered for malpractice based on the Nadya Suleman case because of a departure from standard medical practice. Consider that the American Society for Reproductive Medicine suggests one or two embryo transfers maximum for a woman of Nadya’s age (33), and she received six embryos. Consider that in vitro fertilization, a billion dollar industry which has doubled in terms of procedures to 135,000 with 50,000 live births over the past decade, has also been policed increasingly by the ASRM and that multiple births (triplets or more) have decreased from 7 percent to 2 percent over this period of time. We don’t have proper laws in the U.S. to police medical criminals like Octodoc, but we do have standards of care.

A malpractice claim is unlikely though, because the patient, Nadya Suleman, doesn’t seem inclined to bring a suit. But even if she signed a consent for the embryo transfer, it also seems likely that she is suffering from a psychiatric disorder and was not correctly informed about the risks. Does Nadya know that the risk of postpartum depression in a normal woman, even without her social and financial difficulties, is close to 25 percent?

I was getting ready to blog about the need for the state of California to go after Octodoc’s license on ethical grounds (each state has a medical ethics committee which governs licensure), when I heard about the second case. A 49-year-old woman was apparently impregnated by seven donor eggs (from a woman in her twenties which increases their chance of being viable substantially). She is now carrying quadruplets.

The ASRM suggests no more than five embryos for a woman in her 40s, and if you add to that the fact that the woman herself reportedly only wanted one child, and at her age is at risk for medical complications including high blood pressure and stroke, the handling of her case appears to be another abomination.

Octodoc’s low success rate at successful births is no excuse for tawdry practices. I’m glad to hear that ASRM is investigating him. The state of California should stop him in his tracks.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

How afraid should we be of peanuts and peanut butter? The answer is: Not as afraid as we currently are. Before the current scare, we were already overly fearful of peanut allergies. True, peanut allergy is the most common cause of food-related death, but this tragic event is very rare, affecting approximately one per 830,000 children with food allergy every year. The prevalence of peanut allergy is about 1percent — this incidence appears to be on the rise, but the perception of allergy even where it doesn’t truly exist is rising even faster. This exaggerated perception is due to fear. As I describe in my book “False Alarm: the Truth About the Epidemic of Fear,” we tend to personalize and hype publically-touted risks, and peanut allergy is a prime example.

Now, along comes Peanut Corp. of America, with its unsanitary conditions, primed for contamination, and worse, its history of knowingly shipping salmonella-laced products to manufacturers. With all the attention this problem has received, it is hard to believe that the contaminated peanut butter traced to the Georgia plant is only a small amount of the total $800 million in annual sales by the peanut butter companies in the United States. Common peanut butter products including Jif, Skippy and Peter Pan are not affected, though peanut butter sales overall are down 25 percent and continue to drop. Keep in mind that though the bacterial outbreak has been linked to just 575 cases and 8 deaths, more than 1,500 products have now been recalled by the FDA. This may be a wise precaution, but it is also important that we in the news media learn to properly context this kind of message so we don’t spread unnecessary fear.

I believe it is important that we learn a new language of risk.

It is possible to publically expose shoddy and even criminal practices among our food manufacturers without this leading automatically to the conclusion that all of our food is unsafe. If you still have a recalled peanut cookie or cracker in your closet, and you accidentally bite into it, the chances of you becoming ill from a harbored salmonella is extremely small.

Terrorists of all kind can kill us. But the fear and perceived risk they spread is always far greater than the actual risk.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com