Archive for April, 2008

Probiotics, Yogurt, and Deceptive Marketing

Wednesday, April 23rd, 2008

Deceptive marketing and advertising sometimes gets punished, though not often enough, especially when it comes to food claims. Pinkberry, a frozen yogurt chain hit it big after opening its first store in West Hollywood when it started selling “chilly bliss” and “swirly goodness,” products it claimed to be healthy, nonfat, all-natural, but did not state what it contained. The unproven health benefits attributed to yogurt that were previously posted on the walls of Pinkberry (e.g., cures colon cancer, fights yeast infections) have since been removed. See this site.

The California Department of Food and Agriculture determined that Pinkberry, sold as yogurt, did not contain the requisite amount of bacterial cultures per ounce to fit the definition. According to the Los Angeles Times, Pinkberry’s product had only 69,000 bacterial cultures per gram, compared to 200,000 for Baskin-Robbins. The National Yogurt Association (NYA) established its own criteria for live and active culture yogurt. In order for manufacturers to carry their Live and Active Culture seal, refrigerated yogurt products must contain at least 100 million cultures per gram at the time of manufacture, and frozen yogurt products must contain 10 million cultures per gram at the time of manufacture. Pinkberry (and Red Mango, too) now enjoy the NYA seal of approval.

But the specific health benefits of live cultures, now called probiotics have not yet been determined. Even Dannon got in trouble over claims that the benefits of its probiotics were “clinically and scientifically” proven.

After a class action lawsuit was filed last year accusing the company of deceptive marketing, Pinkberry posted 23 ingredients on its website, including sugars, additives, preservatives, emulsifiers, artificial coloring and flavoring. The case was settled just two weeks ago, early April, 2008. According to the New York Times, Pinkberry agreed to donate $750,000 to hunger and children’s charities, but Ray Gallo, a lawyer for the plaintiff, remarked, “Personally, I would have preferred that the money go toward consumer advocacy against misleading food marketers.”

Quotes: On Being a Physician

Sunday, April 20th, 2008

From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.

And

It is unnecessary – perhaps dangerous – in medicine to be too clever.

Sir Robert Hutchison

To throw open the mind’s door and allow diseases to enter into consideration each time that we are called to a bed side is foolish in the attempt, and impossible in the performance. Each case should lead us to arrange before the mind’s eye a selected group of reasonably probable causes for the symptoms complained of and for the signs discovered. What we select should depend upon the clues furnished us by the patient himself or by the results of our own examination.

Richard C. Cabot, MD
Differential Diagnosis, Philadelphia, WB Saunders, 1915

Each trade and profession “ridden by the routine of… craft.” “The priest becomes a form; the attorney a statute-book; the mechanic a machine; the sailor a rope of the ship.” (And the doctor an MRI scan?)

Emerson in The American Scholar, comment by Cynthia Ozick

Go to the patient, because that’s where the diagnosis is (à la Willie Sutton on why he robbed banks: “because that’s where the money is”).

William S. Dock, MD

New medicines and new methods of cure always work miracles for a while.

William Heberden

Medicine is like a woman who changes with the fashions.

Auguste Bier

Diagnosis is a system of more or less accurate guessing in which the end-point achieved is a name. These names applied to disease come to assume the importance of specific entities, whereas they are for the most part no more than insecure and therefore temporary conceptions.

Sir Thomas Lewis, Reflections of Medical Education. The Lancet, 1944

He is the best physician who is the most ingenious inspirer of hope.

Samuel Taylor Coleridge

The Hospital Discharge

Friday, April 4th, 2008

Some words on being discharged: Remember to retrieve your medications before discharge (your personal supply will most likely have been taken from you on admission).

Obviously, you cannot be discharged from a hospital because your caregivers find you difficult. Moreover, you cannot be discharged absent reasonable medical judgment that you are well enough to leave. This latter rule is fortified by the malpractice statutes. Furthermore, you may request further hospitalization if you do not feel well enough to be discharged or transferred. If you are a Medicare and Medicaid patients, The Federal Government has ruled that before discharge, you have a legal right to demand further inpatient care, if you sincerely feel you are not well enough to leave. Fortunately, this issue rarely comes up. (In general, the less time you spend in the hospital, the better, considering the perils of hospital-acquired infections.)

At times, although your experience can be likened to incarceration, your confinement was voluntary and not court-ordered: the hospital is Not a prison. You cannot be kept there against your wishes for a single hour, nor can you be prevented, as some patients believe, from leaving on the basis of an unpaid bill or lack of insurance. You can fire your doctor or walk out the door any time you are fed up with your treatment or for any compelling personal reason. In this case the hospital quite reasonably, for reasons of liability, requires you to sign a release stating that you are leaving “AMA” (against medical advice).

On balance, however, nothing beats good rapport with the staff, your doctors, nurses, interns, residents, and technicians. Hospitalization should be remembered as, if not necessarily a happy, at least a health-restoring experience. You can be assertive, yet remain as polite and cooperative as you expect your caregivers to be. Never forget, you may be the patient, but you are also a paying customer, and have the right to demand the best medical care available.