“Eco-Friendly” (Mercury) Fluorescent Bulbs – How to Dispose of Safely

570A patient recently called after finding one of those curly, new fluorescent  “environmentally friendly” bulbs that had broken in her house.  She was concerned as she had heard that they are toxic when exposed to air.

Indeed they are!

The EPA has an excellent website for just this situation and what to do in case of breakage of a compact fluorescent light bulb or CFLs.

After reading all of the pertinent information, I feel as though there must be a good joke here somewhere…

How many decon-haz-mat suits do you need to change a light bulb?

Mercury is a known neurotoxin and a potential carcinogen.  Although the mercury contained in the new bulbs is only about 1% of that found in the old-fashioned thermometers, I feel more comfortable in a house full of tiny people with the good old incandescent bulbs.   Yes, they are not nearly as energy-efficient, but they do make your skin much prettier in the evening!

In case you have a breakage, here are the basics:

1. Remove all people and pets from the vicinity for at least 10 minutes.

2. Turn off your central air conditioning and open windows for several hours.

3. Without touching, carefully place broken parts in an airtight jar/plastic bag.

4. Use duct tape to get up those really tiny bits.

5. Wipe down area with wet paper towels & then place all refuse in the jar/bag.

6. Place the jar/bag outside & then later to the recycling center. (The recycling center – like you need something else to do but this is a hazardous material and must be disposed of properly.)

7.  Avoid vacuuming as this aerosolizes the toxic particles, but if you must then throw out the bag filters with your bulb and clean machine up the wazoo.

8.  Wash your hands.

9.  Go shopping for nicer bulbs.

In the end, light bulb jokes are not all that funny.

Tylenol Linked to Developmental Delay (Yes) / Autism (Maybe)

tylenol-acetaminophen-dangers“Our findings suggest that Tylenol/acetaminophen/paracetamol might not be as harmless as we think,” said the lead doctor on a study in the International Journal of Epidemiology.

Frequent use may be linked to poorer language skills and behavior problems among their children, according to the study. “Long-term use of (acetaminophen) increased the risk of behavior problems by 70 percent at age three,” the researcher said. “That is considerable.”

The developmental problems seen in this study align with symptoms of autism spectrum disorder, though the children had not been diagnosed at age three.

As the most popular over-the-counter drug in the U.S., Tylenol has been extensively studied in relation to premature birth and miscarriage, with no connections found.

But its maker Johnson & Johnson periodically comes under fire for the drug’s small therapeutic index – that is, the difference between an effective dose and a dangerous dose is quite small. So interest in investigating the drug persists.

The new study is the first to look at young children whose mothers took Tylenol while pregnant. Close to four percent of women took Tylenol for at least 28 days total during pregnancy. Their children seemed to have poorer motor skills than kids whose mothers had taken the drug fewer times or not at all. Tylenol-exposed kids also tended to start walking later, have poorer communication and language skills and more behavior problems.

It’s difficult to define risks for pregnant women and their children, since rigorous tests and controlled studies of drug exposure aren’t ethical. All researchers can do is closely observe women in the real world. But this study involved a large number of women.

Researchers also looked for any link to ibuprofen/Motrin. They found no development problems tied to ibuprofen.

Value in Medicine – What is the Mark?

1(Article I wrote for the Society of Physician Entrepreneurs)

Hospitals, imaging centers, physicians and laboratories set arbitrary pricing to cover costs, waste, salaries, slush funds, etc but this “price” has nothing to do with value. Obviously the patient receives the service or product that they need but not at the price it is worth. The price is decided by the cost of doing business, meeting owner expectations, business models, etc.. The price should be based on a blend of cost and outcomes. This is the concept of value based care.

The real value of the service or procedure or test is based on cost, reasonable expenses and what a person will pay for the item on the open market. For instance, would you pay $100 for a lollipop? Certainly not. But if Picasso took the same lollipop and modified it with some paint and signed it in pen, would you then pay $100 for essentially the same material? I would even though it is just a lollipop with some paint from a hobby store.

True value in a purely market-driven forum is derived from perceived value and necessity. As a society we have a duty to one another through our unspoken social contract not to price gouge but this is exactly what happens in our current system. The only ones who are protected from the inflated prices are those who cooperate through the use of commercial insurance and insiders like other physicians. It will take decades to topple the current regime. No one likes to be dethroned and people hold onto their money sources tighter than they hold onto their children.

As an example of how difficult it is to change cultures to accept “what should be” or “what is inherently right” look to the civil rights issue. Equality among men strikes at the essence of morality with a deeper cut than the right to health care. Unfortunately, our current medical system is operating in a circa 1950s mentality as noted in the landmark case Brown v. Board of Education. We have a “separate but equal” payer system – there is a disconnect between cost and value.

As consumers and members of the same human family, we need to find an avenue to challenge the status quo billing practices through:
1. our selection of providers, i.e. those who contract directly with patients and earn their living with each encounter;
2. mediation or arbitration or small claims court to fight for reasonable par pricing;
3. value based medical systems, i.e. clinics, that market to patients by demonstrating their outcomes and remedies for adverse events.

On a personal note, even as an insider, I am currently “negotiating” with a large national pediatric group on the invoice for my newborn son’s 36 hour stay in the hospital after delivery. If I had been the attending (I am a pediatrician,) the total bill would have been $850 as submitted to insurance with the expectation that I would received ~75% of the charge. This group charged me $2900+ for the same service. I am looking at avenues to challenge their pricing to reflect what is fair market value. I feel bad for all the families who do not know how to negotiate the bill. I am looking into a small claims case for price gouging.

Toddlers Understand Another Person’s Intentions

wittle_toddler_timsteph_by_batman_defeats_all-d6seyzfToddlers can judge a person’s intention. When one person tries to harm someone else but did not succeed, the youngsters were less likely to help that person at a later time.

But when they observed a person accidentally cause harm to another, they were more willing to help that person.

“It had been thought for a long time that it was at a later age, only around age 5 or 6, that children become conscious of other people’s intentions,” said Amrisha Vaish, one of the study’s authors and a developmental psychologist at the Max Planck Institute. “To help those who help others is actually a very sophisticated ability.”

The research appears in the journal Child Development.

And we all thought their little misbehaviors were innocent….

Giving Thanks

7-Ways-to-Give-Thanks1Yesterday was a wonderful day to pause and give thanks. We all have so much to be thankful for. It seems funny that on a day of rest, thanks and giving we prepare for Black Friday. Ah, the tug-a-war of life…

I am grateful for my wife, children, family, friends and patients. Each day I look forward to see what everyone will teach me and hope I am open to hear the lessons and respond with respect rather than fear. We can all get in our own way through pride, self-absorption and slothfulness.

Living an examined life is hard and many fool themselves into thinking they are wise when, in reality, they are sophomoric.

So I give thanks to all of us who can admit they are the young fools at heart. Each day we get the chance to say thank you, be of service to someone and forgive others. Take these opportunities to grow and be true to yourself by using your talents, self-discipline and optimism.

Don’t forget and end up upside down like Black Friday. Have a wonderful ‘young’ day!