My Health

Ho ho woes: Wrap rage results in lacerations and bad tempers

December 15, 2008 on 1:10 pm | In Uncategorized | Comments Off Images of colorfully wrapped presents under a Christmas tree are not supposed to trigger feelings of frustration and risks of possible injury. But trends in the packaging of many popular gifts have been diagnosed as the cause of this scenario -- what sometimes is called "wrap rage."

The real culprit, of course, is the "clamshell" or "oyster" packaging that encases many toys, electronics and other products. These hard plastic containers have emerged as a favorite of manufacturers and retailers because they protect items during shipping and prevent theft from store shelves, while still allowing shoppers to see what they are buying. The problem for consumers, though, is that these coverings are intensely difficult to remove -- often requiring tools, muscle and swearing. Sometimes the experience results in a trip to the hospital.

"I've worked in the emergency department on Christmas day for six out of the last 10 years. We certainly see lacerations. That's the most common thing. But we also see punctures," said David Ross, DO, an emergency physician at Penrose Hospital in Colorado Springs, Colo. He also is a spokesman for the American College of Emergency Physicians. "That clamshell packaging is absolutely diabolical."

As a response to this widespread sentiment, some firms are taking steps toward change. In November, several announced projects to address this maddening holiday exercise. Notably, Amazon.com launched an initiative to make 19 products available without the plastic hard shell. Instead, the items will be shipped in a single, easier-to-open cardboard box.

"I think we've all experienced the frustration that sometimes occurs when you try to get a new toy or electronics product out of its package," said Jeff Bezos in a statement. He is Amazon's founder and CEO. "It will take many years, but our vision is to offer our entire catalog of products in frustration-free packaging."

A video posted to Amazon's Web site demonstrates why the company is moving in this direction. The video shows how, with revised packaging, parents can open a Fisher-Price Imaginext Adventures Pirate Ship in 44 seconds. Its previous packaging required 11 minutes and two seconds.

Others, including Microsoft, have announced plans to follow suit.

Another holiday stressor

But these actions are about more than sheer irritation. Statistics show that packaging can be a health hazard.

According to the Consumer Product Safety Commission, an average of 6,000 people a year end up in the emergency department for packaging-related injuries. Many more get minor wounds from using sharp implements to extricate products.

Injuries sustained while trying to open packaging send about 6,000 people to the ED each year.

"You have to get a knife or scissors, and I have cut my hand on the plastic several times. You just cannot pull that stuff apart," said Ken Davis, MD, a family doctor in Conroe, Texas.

Even if blood is not drawn, wrap rage adds aggravation to the holiday season, a situation that has become a part of popular culture.

Since 2006, the magazine Consumer Reports has presented the most difficult-to-open products with an "oyster award." In addition, the otherwise placid Christian musician Sara Groves sings in her new song, "Toy Packaging," about resorting to dynamite after spending hours trying to set free a toy robot. Also, a mini-industry has emerged creating tools to ease the angst of this challenge.

"You cannot pull them apart with your nails or your teeth, and it takes away the fun when you get so angry at trying to get the thing open," said Toni Brayer, MD, a San Francisco internist who wrote about the issue on her blog (www.everythinghealth.net).

Physicians are hopeful about the potential of easier-to-open packaging to cut the incidence of holiday tension as well as minor and major injuries.

"Anything that can reduce stress during the holidays is a good idea for both parents and kids," said Kenneth Haller, MD, associate professor of pediatrics at Saint Louis University School of Medicine.

Many also said simpler packaging would be good for the environment. For example, the revised packaging shown in the Amazon video eliminates 36 inches of plastic-coated wire ties and 1,576.5 square inches of printed, corrugated package inserts.

"Not only does [the Amazon effort] have the potential to reduce temper tantrums, high blood pressure and the inappropriate use of language in front of children, it has a significant 'green' impact," said H. Garry Gardner, MD, a pediatrician at Children's Memorial Hospital in Chicago. He also chairs the American Academy of Pediatrics National Committee on Injury, Violence and Poison Prevention.

Speaking the language of vaccines (ICAAC and IDSA joint meeting)

December 8, 2008 on 1:03 pm | In Uncategorized | Comments Off Childhood vaccines are entangled in a vast public controversy, and doctors often find themselves helping perplexed parents sort through misinformation before making a decision on immunization.

Mindful of these discussions, a panel of physicians and journalists offered pointers to those on the front lines during the joint meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America, held Oct. 25-28 in Washington, D.C.

Panelist Paul Offit, MD, director of the Vaccine Education Center at the Children's Hospital in Philadelphia, believes one way to address parents' fears is for physicians to sharpen their message and stop using the scientific language of the many reports that have found no link between autism and the measles, mumps and rubella vaccine.

A developer of the vaccine RotaTeq and author of Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, Dr. Offit said the language of science can confuse lay people. Instead, physicians should ratchet up the message and state their point emphatically -- that the vaccine does not cause autism, he said.

"After you have done 10 studies and spent millions of dollars looking for the association between autism and MMR, I think you can be a little more definitive in your language."

One conversation at a time

Simon Dobson, MD, clinical associate professor of pediatrics at British Columbia Children's Hospital in Vancouver, often has what he calls the "eyeball-to-eyeball" conversation with a parent who is concerned about immunizations.

He recommends patience and good listening skills. Parents are often worried about something close to home, he said. "If you can nail that family myth or whatever it is that concerns them, the rest is easy."

A drop in MMR vaccination rates in the United Kingdom has led to outbreaks of measles.

Most worried parents relate stories about growing up knowing a child who had autism or another disability. After all, many panelists noted, because of vaccines, measles and other serious childhood diseases have never been seen by parents, or even many physicians, while autism is much more in evidence.

But the more difficult cases involve parents who have been "bombarded by the media," Dr. Dobson said. "They just don't know what to do and are paralyzed by indecision."

He, too, recommends cutting back on scientific evidence when discussing vaccine benefits. "I would go on and on about the benefits of the vaccine and the risk of the disease, and parents would get a glazed look."

Instead, he tries to tap parents' imaginations and urge them to think about what could happen if they forgo vaccines for their children. The anti-vaccine people use anecdotes, he said. "But we get the anecdotes beaten out of us in medical school." Nevertheless, he noted, "I can tell a tragic story. It has a great impact on parents."

For example, he asks parents to imagine what might happen if their child grows up to do good works in far-off countries where diseases such as polio are still endemic. If the child is not immunized, he or she could become infected, he relates.

"Parents may think of me as pompous -- a windbag in the pay of the government, big pharma and big business -- but they do respect my opinion," he said.

No link has been found between autism and the MMR vaccine.

Also remember the conversations can take place over several office visits, Dr. Dobson said. "You don't need to do it all in one go. This is particularly true in the primary care setting."

British journalist Vivienne Parry, who also served on the UK Joint Committee on Vaccination and Immunisation, noted that the drop in the MMR vaccination rate in her country has led to outbreaks of disease. "People are much more afraid of autism than they are of measles."

Parry urged physicians to stand up in support of vaccines. "It has distressed me to see Paul Offit out there by himself," she said, referring to Dr. Offit's outspoken defense of vaccine safety, which has made him a target of anti-vaccine activists and the recipient of death threats. "Where are the other physicians supporting him?"

Physicians need to engage patients with simple and emotional language, she added. "You need to understand where the problems are coming from. The fears are natural. You need to think about that when you are communicating with patients."

Dr. Offit said he would like to see a recasting of the characters in this ongoing drama. Now, the anti-vaccine people are often identified as the only ones who care about children. "I just wish the story was told a different way," he said. As a result of the suspicion being raised that vaccines are connected to autism, "we continue to divert resources away from more promising leads."

COPD awareness is growing, but information gap persists

December 8, 2008 on 1:03 pm | In Uncategorized | Comments Off Washington -- Awareness of chronic obstructive pulmonary disease is on the rise, but few patients have a good understanding of its origins or of available treatment, according to a new survey.

Although 64% of respondents to the HealthStyles questionnaire mailed early last summer had heard of the disease -- compared with 49% four years earlier -- only half recognized that it is a leading cause of death, and just 44% knew it could be treated.

In addition, while 74% correctly identified shortness of breath as a symptom, only 5% recognized chronic cough as an additional symptom. Although smoking is a major risk factor, most survey respondents were unaware of this fact. And only 22% of current smokers reported recognizing they are at greater risk.

However, COPD typically affects those who are current or former smokers, with most older than 45.

The survey was conducted by the public relations firm Porter Novelli, and the data were analyzed by the National Heart, Lung and Blood Institute. Results were released Nov. 13.

Chronic obstructive pulmonary disease typically affects current or former smokers older than 45.

COPD is the fourth leading cause of death in the United States, affecting an estimated 24 million people, with only about half diagnosed.

Despite having recognizable symptoms, such as dyspnea, chronic cough or sputum production, and a decline in level of activity, about 12 million people remain undiagnosed, according to the NHLBI. Although other major causes of death have been declining, COPD mortality continues to climb.

NHLBI launched a campaign last year aimed at increasing awareness and underscoring the benefits of early detection and treatment in slowing the disease. Primary care physicians were identified as lead players in the campaign.

Asking questions of patients suspected of having COPD is a good first step for physicians, said Gail Weinmann, MD, deputy director of the Division of Lung Diseases at NHLBI. "The disease is insidious at the onset, and often patients attribute their symptoms to aging."

Physicians should zero in on how far a patient can walk as a sign of diminished lung capacity and whether the patient has a cough, she advised.

If patients are at risk, whether because of smoking, working in a dusty environment or having a family history of the disease, spirometry is the main diagnostic tool, she added. "There are some accurate, inexpensive devices available."

Uncomplicated COPD can be handled by the primary care physician, said Dr. Weinmann, with bronchodilators and inhaled glucocorticosteroids the most commonly prescribed treatments. Since influenza can present a major health problem for patients with COPD, yearly flu immunization is an important preventive step, she added. Pneumonia vaccine is also appropriate for some patients.

"We are encouraged that people are becoming more aware of the term COPD," said NHLBI Director Elizabeth G. Nabel, MD.

"But the survey also indicates that we, as a public health community, have much more work to do to promote greater understanding of the disease, its symptoms and risk factors, so that we can improve rates of diagnosis and treatment."

Report calls for greater access to smoking-cessation programs

December 8, 2008 on 1:03 pm | In Uncategorized | Comments Off Treatments to help people quit smoking should be paid for by insurance and offered routinely in the health care setting, according to a document issued last month by a coalition of public health officials, consumer health advocates and business leaders. Funding for quit lines also should be increased, according to the report by the National Working Group for ACTTION (Access to Cessation Treatment for Tobacco In Our Nation). The goal is the provision of comprehensive tobacco cessation services to 50% of smokers by 2015 and 100% by 2020.

"[Smokers] are making quit attempts, but they make missteps and are unaware of the resources that are out there," said Judy Monroe, MD, Indiana's state health commissioner and one of the group's members.

According to the "Call for ACTTION," only 30% of smokers who want to quit use proven treatments, and only one in 50 employers offers cessation programs. This document calls for businesses to provide access to smoking cessation, increase awareness of the availability of these services among staff and offer incentives to access them. Public health organizations should promote using evidence-based treatments for quitting and include tobacco-use treatment performance measures in "pay for performance." Health care systems should establish strategies to make it more likely that all patients are screened for tobacco use and offered treatment as appropriate.

"Ending tobacco addiction is crucial to our nation's health and its economic well-being," said John M. Clymer, president of Partnership for Prevention, the organization that coordinated this group and the writing of the report.

In a related development, the American Cancer Society and the organization's Cancer Action Network issued a statement Nov. 23 to mark the 10th anniversary of the master settlement agreement between the tobacco industry and 46 states. This group is calling for states to renew their commitment to using this money for tobacco-prevention programs, going smoke-free, increasing taxes on tobacco and expanding access to cessation tools.

The American Medical Association has copious anti-smoking policies and supports health insurance coverage for pharmacologic and behavioral treatment of nicotine dependence. It also encourages physicians to incorporate smoking-cessation efforts into medical care by asking all patients whether they use tobacco and providing counseling on quitting to those who do.

Research urged for medication overuse headaches

December 8, 2008 on 1:03 pm | In Uncategorized | Comments Off The problem of medication overuse headaches is global and in need of prevention strategies. Such pain, which is associated with the excessive use of drugs to control it, should be the focus of research to determine the best treatment course, states a collection of papers examining the incidence of the condition in eight nations. It was published in a supplement to the November Cephalalgia.

"MOH is associated with severe disability, unmet treatment need and little clinical data to support current management strategies," said David W. Dodick, MD, editor of the collection and author of the main paper. He is also a professor of neurology at Mayo Clinic Arizona in Scottsdale and president-elect of the American Headache Society.

Current strategies usually involve convincing affected patients to discontinue headache medications and helping them through the detoxification period. This process can involve other pharmaceuticals, lifestyle changes, mental health services or alternative therapies.

"It's really important that they understand that they're not likely to get better if they don't get off their daily symptomatic medicine," said Morris Maizels, MD, a family physician and director of Kaiser Permanente's Woodland Hills Headache Clinic in California. "And they need to know that the first week or two they may actually be worse."

This circumstance can be particularly hard for the many patients who have multiple pain-related conditions. For example, the paper on MOH incidence in Germany reported epidemiological data indicating those with chronic headache also often have low back pain.

Patients with chronic headaches often have low back pain.

Depression and anxiety are common in this patient population worldwide, and more than one medication frequently plays a role. Relapse is not uncommon.

"These people ... need a lot of intervention, and they're difficult to manage," said R. Allan Purdy, MD, co-author on the Canadian-focused paper. He is a professor of medicine at Dalhousie University Faculty of Medicine in Halifax, Nova Scotia. "It's worth investing the time, although even if you do everything right, some [patients] may not get better."

An emerging approach increasingly chosen by some headache experts is prescribing drugs that prevent migraine to ease patients through the difficult transition period. Others favor using steroids and analgesics, although strategies vary widely with little evidence supporting one over another. Because of this, most see an urgent need for more research to get a better handle on the difficulty.

"We don't know what the mechanism of MOH is. We don't know why some people get it, and others don't. And we need controlled trials to know the best way to help people get better," said Stephen Silberstein, MD, professor of neurology at Jefferson Medical College of Thomas Jefferson University and director of the Jefferson Headache Center in Philadelphia. He also co-wrote the main paper with Dr. Dodick.

The authors of these papers called for increased emphasis on identifying those at risk for developing this type of headache and educating them on the issue to make it less likely medication overuse will occur. Patient diaries should record symptoms as well as drugs taken. Restrictions should be placed on the use of acute meds.

"Physicians need to be vigilant about what medications they prescribe for migraine and other kinds of headaches and what over-the-counter medications patients are taking," Dr. Dodick said.

According to the other papers in the supplement, causes, prevalence and treatment of medication overuse headache are determined largely by a country's culture and accessibility to acute treatments. For example, the syndrome was less common in India, where patients tend to choose topical pain balms. Codeine and caffeine are not used in combination painkillers in Japan, meaning these products do not play a role in MOH there as they do in North America and Europe.