Entries for February 2009

By Bernadine Healy, M.D.

Doctors are supposed to be nosy. It's not just that they examine your naked body inside and out and record all its imperfections. Physicians are trained to peer into your life, past and present, and ask all sorts of sensitive, if not uncomfortable, questions. Have you ever used marijuana or cocaine? How about steroids? How many sexual partners? Ever had a sexually transmitted disease? An abortion? Had sex with the same sex? How much do you smoke or drink? Have you used Botox or had plastic surgery? Have you been depressed or been treated for mental illness? And how about your marriage—or marriages?

You get the gist; the experience is intrusive. But the doctor-patient relationship was never meant to be other than confidential and privileged and solely for the benefit of the patient. Patients expect it, or they would not be forthcoming. And doctors take the Hippocratic oath, pledging to hold sacred their patients' secrets. This pledge of confidentiality, however, is now challenged by a world where computers rule and health information falls into many hands. One might well ask whether medical privacy is just too outmoded a concept for today's information-hungry world.

By Bernadine Healy, M.D.

As February is heart month, February 6 has been designated National Wear Red Day as a way to encourage all of us—men and women, young and old—to think about and pamper that wonderful, hardworking, four-chambered gift. The occasion prompted me to go back and reread a "valentine to the heart" I wrote for U.S. News several years ago, the gist of which I offer again here.

At some level, everyone is an expert on the heart, which has a mind of its own. It is prone to flutter in response to a kiss, skip a few beats in the klieg lights, brace itself in the face of treachery, and slow during slumber—except, of course, as it races and pounds during a nasty dream. And while in today's secular times the heart has lost much of the cachet it once had as the mansion of the soul, it has not lost its grip on us as a romantic symbol of life. We still speak of happy hearts, good hearts, heavy hearts, and brave hearts. We have all felt heartache and have even been heartsick. We've suffered when our heart's desires were not fulfilled and been bewildered by those who are heartless. Our own hearts rally for those who are the lionhearted, and we yearn along with the Tin Man in his desperation for a heart. We see goodness in the heartland and know instinctively that home is where the heart is.

By Bernadine Healy, M.D.

Puff the Magic Dragon—in his naughtier incarnation—bit the dust when President Barack Obama recently made it clear that he is against legalizing marijuana. His message was delivered on his website, Change.gov, even before he placed his hand on the Lincoln Bible. Astonishingly, legalization of marijuana ranked as Priority No. 1 for the new administration among the thousands of possible actions voted upon on the website by the public. Yes, even above stem cell research, the war in Iraq, and Wall Street bailouts. Obama's prompt no to the query "Will you consider legalizing marijuana so that the government can regulate it, tax it, put age limits on it, and create millions of new jobs and create a billion-dollar industry right here in the U.S.?" dashed the hopes of many who thought our young, hip, new president—who long ago dabbled in the stuff and, by his own admission, inhaled—would come to marijuana's rescue.

By Bernadine Healy, M.D.

The good news about coronary artery disease is that fewer people are having—or dying from—heart attacks in the prime of life. And those who have heart attacks are likely to survive and live on into ripe old age. The challenge, however, is that many of these heart attack survivors are left with weakened hearts that, over time, quietly give out, creating a virtual epidemic of chronic congestive heart failure in the elderly. Heart failure now accounts for a million hospitalizations a year and carries a high mortality—and has replaced heart attacks as the lethal face of cardiovascular disease in most of the Western world.

This evolution from heart attack to heart failure was made stark by a study from Canada reported last month in the Journal of the American College of Cardiology that, for five years. monitored nearly 8,000 men and women over age 65 who had survived their first heart attack. Not only did three quarters of the study patients develop heart failure, but close to 40 percent of them died from it. The tricky thing about heart failure in this older population is that its symptoms of fatigue, shortness of breath, and even swollen ankles all too often are attributed to age rather than a lethal cardiac condition. And up to half of those who succumb to heart failure do so suddenly and unexpectedly.