Archive for August, 2012

Patrick J. Skerrett

The Cheesecake Factory: a model for health care?

In a new essay entitled “Big Med,” physician-author Atul Gawande muses in The New Yorker if The Cheesecake Factory and other successful chain restaurants could serve as a model for improving health care. He wondered how a large restaurant could deliver “a range of services to millions of people at a reasonable cost and with a consistent level of quality,” while hospitals and other parts of the U.S. health care system can’t. The experience prompted Dr. Gawande to meet with managers, cooks, and other workers at a Boston-area Cheesecake Factory to see how it delivers good food and a good dining experience time after time. He then goes on to compare the restaurant’s procedures with what goes on in hospitals.

Howard LeWine, M.D.

Diabetes can strike—hard—even when weight is normal

We tend to think of type 2 diabetes as a disease that afflicts people who are overweight. But it can also appear in people with perfectly healthy weights—and be more deadly in them. A study published in the Journal of the American Medical Association indicates that normal-weight people diagnosed with type 2 diabetes have double the risk of dying from heart disease and other causes than overweight people with diabetes. Such apparent “protection” by excess weight has been called the obesity paradox. It’s been seen with other conditions, like heart failure and end-stage kidney disease. That doesn’t mean gaining weight is a healthy strategy. Instead, it probably means that something else besides weight—like the amount of fat around the waist—may be contributing to the onset and severity of type 2 diabetes. These new findings underscore the importance of strength training for everyone, no matter what their weight.

Heidi Godman

Self-help videos to stop vertigo work for some, not all

A condition called benign paroxysmal positional vertigo (BPPV) causes bursts of intense dizziness. It happens when tiny crystals of calcium carbonate in one part of your inner ear become dislodged and float into another part of the ear. A simple set of physical motions called the Epley maneuver can move the crystals into another ear chamber, where they’ll be absorbed by the body. The maneuver is so simple it can be done at home. Writing in the journal Neurology, researchers looked at how people were using YouTube videos of the maneuver to treat their vertigo at home. I watched one of the videos and tried the maneuver. It didn’t work for me. But I did some investigating to find out why, and have some tips to improve your odds of success.

Robert Shmerling, M.D.

Cataract removal linked to fewer hip fractures

There are several good reasons to have cataracts fixed. Restoring clear, colorful vision certainly tops the list. A study published today in the Journal of the American Medical Association (JAMA) adds another benefit—a lower risk of breaking a hip. Researchers analyzed the effect of cataract surgery on the frequency of hip fracture in the following year. Among more than a million adults ages 65 and older who had cataracts, the frequency of hip fracture was 16% lower among those who had cataract surgery compared with those who didn’t have it, and the reduction in risk was even greater (23%) if the cataract was severe. Besides the immediate benefit of improved vision on everyday activities, and the longer-term one of preventing broken hips, cataract surgery may have other, less obvious benefits. These include more independence, better physical fitness, and better mental health.