During the month of October 2010, I facilitated a series of discussions on health topics at The Jones Library, Inc. in Amherst, MA. My goal was to broach subjects involving some controversy or confusion and to encourage discourse.

Cancer Screenings. I opened with last year’s announcement from the United States Preventive Task Force that after years of reviewing studies, the USPSTF found  “moderate or high certainty” that teaching self-exams “has no net benefit or that the harms outweigh the benefits” and that women can wait until 50 years of age to get biennial mammograms.  This announcement was met with much concern.

The American Cancer Society and the American College of Obstetricians and Gynecologists still recommend breast self-exams for women over 20 and mammograms for women over 40.

The Comprehensive Breast Center at Baystate Health does not accept the revised recommendations and continues to follow guidelines as put forth by the American Cancer Society and others. BH CBC’s Medical Director Grace Makari-Judson, MD states, “All women should be taught the signs and symptoms of breast cancer and report concerns to their health care provider.”

I expanded the topic to review changing guidelines for PAP, PSA and DRE tests and reticence to perform routine lung CT scans. These changes have an unsettling effect, to say the least.

That story about breast cancer—call it the ‘relentless progression’ mind model—is easy to grasp, makes intuitive sense and offers a degree of comfort: Every cancer is curable as long as you catch it in time.~ Convincing the Public to Accept New Medical Guidelines

The discussion turned to evidence-based medicine: don’t we want our clinicians to be consulting medical literature and basing decisions on the evidence?

Evidence takes time to develop and evaluate. The new American Psychiatric Association guidelines for depression treatments are based upon reviews of 13,000 research articles from 1999-2006.  In other words, these guidelines are given a great deal of thought.

So, what was up with the breast cancer screening announcement?  Why was that so hard?  Is it due to last year’s efforts toward health care reform”

“I can say honestly, absolutely, the word ‘cost’ was not in the room, it was not mentioned, it was not uttered.”  As for any political motivation, [USPSTF vice chair Diana] Petitti [MD, MPH] pleaded “woeful” ignorance of the specifics of healthcare reform legislation. She said she didn’t even know that the USPSTF was referenced in the healthcare reform bills, and when she heard that the recommendations would be published the week of a major vote in the Senate, she was shocked. ~Medpage Today

In this discussion, participants voiced different concerns. They were sincerely interested in the topic and were respectful of others’ opinions. Turnout was smaller than I expected, but the result was an intimate, thoughtful conversation.

Electronic Health Record.  The second discussion yielded an even smaller turnout, but that didn’t surprise me. The topic was the Electronic Health Record–a hot topic for medical librarians, but the public may not be as attentive to this shift in records management. I opened with the Bush Administration’s Executive Order (Apr 2004) to achieve widespread adoption of interoperable EHRs by 2014. In President Obama’s first address to the nation (Jan 2009), he reiterated the commitment to “computerized the nation’s health records in five years”.

I demonstrated that we have a long way to go, passing around a copy of Table 2 from the article “Use of Electronic Health Records in US Hospitals” ( Jha AK et al. N Engl J Med. (2009)).

I did my best to explain the nebulous “meaningful use” by stating that health care providers will need to demonstrate how the use of the electronic health record:

• Improves the quality of care
• Improves care coordination
• Improves the health of population
• Reduces health disparities
• Engages patients and families
• Ensures privacy and security

Here’s another case wherein it isn’t enough to be using tools (electronic health records); we need to demonstrate that these tools are helping us meet our end goals.  We touched on the emergence of the personal health record (PHR).  In general, participants had a “wait and see” attitude toward the EHR and the PHR.

Probiotics.  For my third talk, I began with a search on  probiotics on MedlinePlus.gov.  I selected 6-7 links to explore.  We looked at the Art and Science of Natural Products from the National Center for Complementary and Alternative Medicine and at specific information on Bifidobacteria and Lactobacillus from the Natural Medicines Comprehensive Database.  I chose several links detailing current research related to specific conditions.

I explained evidence grading systems and shared information from subscription database Natural Standard .

As of that talk, probiotics earned some A’s for

Reducing adverse effects of antibiotic use, particularly in reducing growth of Clostridium difficile bacteria (common complication in elderly) and Helicobacter pylori (cause of stomach ulcers).

Preventing eczema in children when mothers take probiotics during pregnancy and breastfeeding, and supplementing infants.  Children do differ in responsiveness to specific probiotics products.

lots of B’s and C’s…too many to list here…

and a couple of D’s for

Preventing bacterial infection translocation—passage of bacteria from the gut to other areas of the body during surgery.

Treating diarrhea for all HIV patients on antiretroviral therapy—well tolerated but may not be reducing gastrointestinal symptoms.

Improving fertility through effects on vaginal conditions during in vitro fertilization.

There is a lack of evidence for interactions with drugs, herbs and supplements.  And those that partake of probiotics should be cautious of allergies to dairy products and potential problems with gas due to corrective activity in the colon.

I was interested to hear from some of the participants that doctors are starting to explore the clinical usage of probiotics.

I finished up with the press release regarding  Nestle’s settlement with the FTC.   Oh, Nestle!