Future doctors unaware of own obesity bias

Two of five medical students have a bias against obese people and they don't even know it,  according to a study by researchers at Wake Forest Baptist Medical Center in Winston-Salem. The study is published online in the Journal of Academic Medicine. 

“Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese,” said Dr. David Miller, associate professor of internal medicine and lead author of the study.

The three-year study included more than 300 third-year medical students from 2008 through 2011. The students were from 25 states and 12 other countries. 

Researchers used a computer program called the Weight Implicit Association Test to measures students’ unconscious preferences for “fat” or “thin” individuals. Students also answered a survey assessing their conscious weight-related preferences. 

Overall, 39 percent of medical students had a moderate-to-strong unconscious anti-fat bias as  compared to 17 percent who had a moderate-to-strong anti-thin bias. Less than 25 percent of students were aware of their biases.

The study didn't specify which teaching strategies are most effective, but to combat prejudice, doctors have to acknowledge its existence, Miller said.

At Wake Forest, all third-year medical students in the family medicine program must complete the online Weight Implicit Association Test and then participate in an in-class discussion of their experience with bias. 

“Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school,” Miller said. “Previous research has shown that ... Doctors are more likely to assume that obese individuals won’t follow treatment plans, and they are less likely to respect obese patients than average-weight patients.”

The study was funded by a grant from the National Cancer Institute. Co-authors are Dr. John Spangler, Mara Vitolins, Stephen Davis, Edward Ip, Gail Marion, and Sonia Crandall of Wake Forest.

Cancer patients want to talk with doctors about costs

Researchers at Duke Cancer Institute have found that most cancer patients would like to talk about the cost of care with their doctors, but they often don't because they fear the discussion could compromise the quality of their treatment.

But patients who do bring up the subject of finances believe it helps decrease their costs. 

Researchers surveyed about 300 insured patients treated at Duke and affiliated clinics in rural North Carolina. 

Dr. Yousuf Zafar, assistant professor at Duke and lead author of the study, said 57 percent of participants in the survey said they wanted to talk about treatment costs with their doctors, but only 19 percent actually had that conversation.

“There’s a real disconnect,” Zafar said. “Even people with the highest needs aren’t bringing up costs as part of the decision-making process.”

Some respondents said they were embarrassed to bring up cost. Others didn’t think it was something their doctor could help with or should worry about. Twenty-eight percent said they wanted the best possible care regardless of cost. 

“We found that when patients did talk about costs with their doctors, many felt they gained something from the discussion – that their expenses were reduced,” Zafar said. 

Zafar said this suggests the "perceived barriers to the cost conversation aren't real" and that doctors should have tools to identify patients who need financial help and direct them to appropriate resources.

“With today’s evolving health insurance landscape, cancer treatment-related costs to patients are more important than ever,” Zafar said. “...Knowing that patients want to have these discussions should give us confidence in making this a routine practice.” 

The research will be presented June 3 at the 2013 Annual Meeting of the American Society of Clinical Oncology in Chicago. 

The study was funded by the Duke Cancer Institute Cancer Control Pilot Studies Award, the Duke Clinical Research Institute Comparative Effectiveness Research KM1 Award, and an American Cancer Society Mentored Research Scholar Grant.

New Medicaid billing system may have problems

A state audit has found that the new North Carolina Medicaid billing system, called NCTracks, may not be ready for its scheduled July 1 launch. The program to test the system was "seriously flawed," the audit found.

Here's a link to an article about the audit in our sister newspaper, the News & Observer in Raleigh: http://projects.newsobserver.com/under_the_dome/state_audit_faults_testing_of_new_medicaid_billing_system

Read more here: http://projects.newsobserver.com/under_the_dome/state_audit_faults_testing_of_new_medicaid_billing_system#storylink=cpy

Terrie Hall speaks from experience about the harmful effects of smoking

This week, a 52-year-old Lexington, N.C., grandmother will receive the Surgeon General’s Medallion, one of the highest honors in public health. 

You'll recognize Terrie Hall from the startling anti-smoking commercials she has appeared in as part of the "Tips from Former Smokers" national tobacco education campaign. 

A lifelong smoker, Hall developed mouth cancer and throat cancer that led to surgery to remove her larynx. She has a permanent stoma, or hole in her throat, and a voice prosthesis that must be replaced every few years.

She'll will receive the award in a ceremony Wednesday morning in Washington.

Here's a link to the story I wrote about her last year:

http://www.charlotteobserver.com/2012/05/21/3257516/nc-woman-sends-anti-smoking-message.html

Charlotte fundraiser features Lee Woodruff

Lee Woodruff, wife of ABC News correspondent Bob Woodruff, will be in Charlotte Feb. 14 to help raise money for patient rehabilitation efforts at Carolinas Rehabilitation. The fundraiser is at noon at Charlotte Country Club.

The Woodruffs co-wrote the 2007 book, “In An Instant: A Family's Journey of Love and Healing,” about the roadside bomb in Iraq that left Bob Woodruff with severe brain injury. Since then they founded the Bob Woodruff Foundation (ReMIND.org) to assist wounded service members and their families in receiving the long-term care they need and help them successfully reintegrate into their communities.

Lee Woodruff, who now works as a contributing editor for CBS This Morning, is also the author of "Perfectly Imperfect: A Life in Progress," a personal look at the many roles played by a modern American wife, mother, daughter and friend. 

Most recently, she published a novel, “Those We Love Most,” about a family that deals with the tragedy of having their young son hit by a car driven by a teenager in their neighborhood. 

Tickets are on sale for $50 each. Order by calling Kelly Osborne at 704-355-1955.

Charlotte party for epilepsy, mustache shaving

Charlotteans are invited to a viewing party Friday to watch CNN's "Situation Room," where Republican stategist Alex Castellanos will shave his 41-year-old mustache in support of epilepsy research.

Castellanos, a former Morehead scholar at UNC Chapel Hill, will shave his mustache live at 4 p.m. to honor a challenge he made last month with friend David Axelrod, President Obama's senior campaign strategist.

The arrangement began before the election when Axelrod appeared on on MSNBC's "Morning Joe" with Joe Scarborough and bet his facial hair that Obama would win Michigan, Minnesota, and Pennsylvania in the presidential election -- which he did.

Instead of growing a mustache, as he had promised, Scarborough said he would donate $10,000 to Citizens United for Research in Epilepsy, the charity founded by Axelrod's wife, Susan. The couple has a daughter with epilepsy.

In response, Axelrod said he would still shave his 40-year-old mustache if they could raise $1 million for CURE. The money came in, and Axelrod shaved his mustache in December, live on "Morning Joe."

That same day, Castellanos announced he would also shave his longtime mustache if CURE could recruit 500 new donors in a month. The challenge drew 527 new donors, who raised more than $115,000 for CURE.

Hosts for the viewing party are Bodgan Ewendt, executive director for CURE, and his wife, Jackie, who have a home in Charlotte. The party is open to the public and starts at 3 p.m. at Hampton Inn & Suites SouthPark at Phillips Place. RSVP at Jackie@cureepilepsy.org.

Is making the bed hazardous to your health?

If you don't like making the bed, here's a good excuse not to.

Researchers at Wake Forest Baptist Medical Center in Winston-Salem have associated the act of applying a fitted sheet to the mattress with a malady called "sheet fitting palsy."

They've identified the injury in people who spend a long period of time repeatedly trying to pull a fitted bed sheet over the corner of a mattress.

Caused by continuously flexing the wrist, the injury results in a tiny stroke in the artery of the hand and blood clots that cut off blood flow to the median nerve, producing numbness or weakness.

A case study was described by Wake Forest neurologist Dr. Francis Walker and colleagues in the September issue of the journal Clinical Neuromuscular Disease.

The victim was an active 73-year-old woman who was unable to slip the last corner of a fitted sheet over a mattress and had to ask her granddaughter for help. Sometimes she noticed a "pins and needles" feeling in her hand, but didn't think much of it. After she shook her hand, it would go away.

A few weeks later, when she tried to make the bed again, she tried without success to get the fitted sheet on. To her surprise, her thumb dropped down, limp, when she moved her hand from the bed corner. She couldn't tie her shoe or button a sleeve with her right hand.

Dr. Mary Lyles suspected acute carpal tunnel syndrome and called Walker to perform nerve conduction studies and an ultrasound.

Walker's study showed something few physicians have seen, the report said. "High resolution color flow Doppler showed a rare persistent median artery that had blood flow in it in the forearm, but not at the wrist where it was next to a swollen, injured median nerve."

Shortly after those tests, the patient had surgery to relive some of the pressure on the nerve, but her thumb remained limp. The surgeon advised her to strengthen it by going through the motions of her everyday activities. Just trying them could be helpful.

Slowly that strategy worked. It took nearly a year for the nerve in her wrist to grow the new pathways that allowed her to open and close a bag clip.

Researchers say the injury has also been reported in basketball players and people who perform a lot of push ups -- because of trauma to the wrist.