For the last couple of years I’ve made a commitment to donate blood every month or two at Cedars-Sinai.  Though I must admit the first few times I was scared by the whole experience, I almost look forward to it now.  The nurses treat the regulars like old friends, and the donors are treated to a mandatory break from their busy lives.  Since we can’t be productive, we listen to music, or watch TV, or pick a movie from their eclectic selection.  (Oddly enough, I’ve found that gory horror movies are my favorite when I’m donating.  Nothing distracts me more effectively from the fact that I’m being bled than a good vampire movie!)

I was donating last week when a nurse told me that their blood supply has been very low.  Several of the Metrolink crash survivors are at Cedars-Sinai and have used a lot of blood products.  That’s when I realized that it’s been two years since I last begged all of you to donate.

So please contact the Cedars-Sinai Blood Donor Facility and schedule an appointment to donate a little bag of liquid life.  If donating at Cedars is inconvenient, go to the Red Cross blood donation website and find a donation center near you.  You’ll be rewarded with juice and cookies and the best feeling you’ve had in a while.

Someone you’ll never meet is counting on it.

The first day of fall is three days away.  The kids are back in school, temperatures are dipping lower and the leaves on the trees in LA are doing nothing.  In this magical season a doctor’s thoughts turn to flu shots.

The flu shot is recommended for the following groups:

• Children aged 6 months until their 5th birthday,
• Pregnant women,
• People 50 years of age and older,
• People of any age with certain chronic health conditions (such as asthma, diabetes, or heart disease),
• People who live in nursing homes and other long-term care facilities,
• Household contacts of person at high risk for complications from influenza,
• Household contacts and out of home caregivers of children less than 6 months of age, and
• Health care workers

The following people should NOT receive the vaccine:

• People who have a severe allergy to chicken eggs,
• People who have had a severe reaction to an influenza vaccination,
• People who have developed Guillain-Barre syndrome within 6 weeks of getting an influenza vaccine,
• Children less than 6 months of age (influenza vaccine is not approved for this age group), and
• People who have a moderate to severe illness with a fever (they should wait until they recover to get vaccinated).

For everyone else it’s optional.  If you’re not in one of the above groups and want to avoid the flu, get vaccinated.  Our office has received this year’s flu vaccines.  If you’re a patient who wants one, please call for an appointment.

Learn more:

The Centers for Disease Control and Prevention 2008-09 Influenza Vaccine page

Arthroscopic surgery is a common treatment for moderate to severe knee arthritis.  Through scopes inserted through small incisions the knee is irrigated and irregularities in the cartilage are shaved off.

In fact, no study has ever demonstrated that this surgery is effective for arthritis.  Even worse, in a study in 2002 that randomized patients with knee arthritis to either arthroscopic surgery or sham surgery (in which skin incisions are made but nothing is done to the joint), the surgery group did no better than the sham surgery group.

Nevertheless, old habits die hard, especially when the habit is a very lucrative but ineffective procedure.

This week a study in the New England Journal of Medicine helped solidify the negative scientific data for arthroscopy for knee arthritis.  In the study patients with moderate to severe knee arthritis were assigned to two groups.  One group received arthroscopic knee surgery, physical therapy and medications.  The second group received only physical therapy and medications.  There was no difference in symptom scores between the two groups during the following 24 months.

Experts are now asking orthopedists to stop offering this procedure for arthritis patients.  Of course, many ethical doctors won’t do ineffective procedures, but others will simply shoot the messenger and criticize minor flaws in this study.  As long as some insurance companies pay the bill, some doctors will continue to offer it.

In a free society we can’t get rid of a bad product by shaming the providers.  We do it by educating the customers.

Learn more:

New York Times article:  A Study Revives a Debate on Arthritis Knee Surgery

New England Journal of Medicine study:  A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

Last month the Food and Drug Administration allowed food manufacturers to irradiate fresh lettuce and spinach to kill bacteria.  The decision resulted in some controversy and much press coverage.  (See link to LA Times article, below.)  The process involves shooting gamma rays through the produce in an amount enough to kill most bacteria but not enough to wilt the leaves or affect the taste.

Though food safety advocates have been recommending food irradiation for many years as a reliable way to decrease food-borne illness, the procedure has been persistently blocked by public fear and misunderstanding.

Few technologies are as distorted and maligned in the public imagination as radiation.  After all, if all you know about gamma rays is that they transformed scientist Bruce Banner into the Incredible Hulk, why would you possibly want them transforming your spinach?  (Don’t get me started about fears of cloning.)

The important thing to keep in mind is that irradiated food doesn’t give off radiation, just like you don’t become radioactive after a chest X ray.  Radiation goes through your chest, but no source of radiation ever enters your body, so you don’t emit radiation afterwards.  Similarly, irradiated lettuce is not itself a source of radiation.

So it was expected that the FDA’s announcement would lead to an outbreak of luddite hand-wringing.  An analyst for a political advocacy group (quoted in the article below) warned that “irradiation masks the unsanitary conditions of industrial agriculture.”  Well, sure, just as seatbelts mask the dangerous conditions of car accidents.  No one suggests that food irradiation should lead to more lax farming standards, just as seatbelts shouldn’t lull us into reckless driving.  The other criticism, typical of all new safety technologies, is that it’s not perfect.  That’s true.  The number of food-borne illness will decrease, but not to zero.

Safety derives from multiple redundant measures that each decreases our risk.  Food irradiation is a valuable and long-overdue common sense practice.

Learn more:

Los Angeles Times article:  Irradiating iceberg lettuce, spinach effective but not fail-safe; critics cite consequences