August 2, 2008
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To those who are confused, my hosting company changed servers and so this post was stuck on the old server. That is why I am reposting it. I have not gone nuts….well….I guess that is hard to say at the top of this post….
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Hey there gang. Hold on to your hats/hairpieces as we do another installment of “Ask Dr. Rob.”
Let me just say before I get started that the well is starting to run dry of questions for me to answer. Some folks have sent some real medical questions to me (which means they obviously don’t read the blog), but I haven’t gotten any good questions. PLEASE, if you would like me to entertain your question about whatever you like to know about, send it to dr.rob.questions(at)gmail(dot)com.
So I went back and rummaged through my mailbag (in a cyber-sort of way) and came upon this previously unanswered question from G. Xavier:
I’m eating a South Beach Diet meal replacement bar. The trouble is… I’m not on the south beach diet. What’s going to happen to me?
I would first like to comment your name, G. Xavier. Why the G? Did you have seven choices for names, the seventh of which was Xavier?
What name do you want:
A. Puffy
B. George W.
C. Retractable landing gear
D. Zoinks
E. Bob
F. Llama Breath
G. Xavier
Personally, I would have chosen C.
Regardless of how you came upon your name, typing G. Xavier is a pain in the gluteus maximus, so I will instead call you Puffy.
So what about Puffy’s question? What does science tell us about diet meal replacement bars? What does science tell us about this important subject?
A Brief History of the Diet Meal Replacement Bar
Ancient Times
To really understand the question, we must first delve back into the historical phenomenon known as DMRB (which is the scientific notation for the Diet Meal Replacement Bar).
On the left is what scientists believe to be the first known reference to a DMRB. It is a cave drawing found in southern Turkey and believed to be over 5,000 years old. The pictures around it show an overweight man running after an antelope and a thin man looking at this object. Archeologists believe that the little things coming up on the top are box tops and the scribble in the middle is a UPC symbol.
Jump ahead a few thousand years to ancient Greece, where the DMRB became a widespread phenomenon. It is said that Alexander the Great had a real problem keeping off the pounds, and became obsessed with finding the ultimate DMRB. He scoured the known world in search of a way to lose weight and keep the pounds off, but was unable to ever regain his boyish figure. He died in 323 BC from either malaria, typhoid, encephalitis, or a dangerously high LDL cholesterol level.
This is tragic, because a few years after Alexander’s death, Demosthenes discovered a way to mix olive oil, dates, and wheat flax in a way that not only tasted terrific, but also was low in trans-fat. He is known to many as the father of DMRB, and is pictured below carrying a DMRB in his right hand.
The Middle-Ages and Renaissance
Like many classical inventions, much of the knowledge of DMRB’s was lost after the fall of the Roman Empire. Not only did the barbarians’ sacking of Rome cause many scientific and cultural advances of the classical period to be lost for over a thousand years, but it also doomed people to an endless struggle with bulging love-handles.
The biggest tragedy of the middle ages was the loss of a huge segment of the population to the plague, or black death. This horrible disease is caused by a bacteria infesting the flea that lives on rats. Many have theorized as to why the plague spread so rapidly during this period, but not at other times. The latest research points to the fact that the high BMI that predominated made it difficult for people to run from rats and easy for fleas to hide in fat folds.
Despite repeated attempts by alchemists to turn goat livers into DMRB’s, the 
middle ages is felt to be a truly dark time for dietary supplements.
During the renaissance there was a veritable explosion of scientific discovery. The Medici family of Florence sponsored much of that work. But did they have influence on the development of weight-loss bars? The evidence is unclear, but some art historians believe that Michelangelo’s famous statue of David is holding a DMRB in his left hand. This would explain is amazing physique, but is still a subject of debate.
Modern Times
Even though the years between the Renaissance and today are filled with references to DMRB’s (the most famous of which was the one Napoleon Bonaparte hid under his lapel), very little progress was made until the birth of Dr. Robert Atkins, the founder of the famous Atkins Diet.
Dr. Atkins’ beliefs regarding diet flew in the face of the scientific thoughts of his day. At that time scientists felt that to lose weight, a diet of predominantly low-fat foods should be consumed. The low-fat diet works like this: the person consumes as much food tasting like cardboard that the very idea of food is repulsive and the person loses weight. This is a diet popular with goats (as pictured below), which is why you don’t see many fat goats.
Dr. Atkins, however, thought that food should taste better than cardboard, and so invented the low-carbohydrate diet. The foundation of this diet is the breakfast favorite, bacon. This diet works like this: the dieter eats so much food containing bacon that the idea of eating becomes repulsive and the person loses weight. This diet is very popular at hospital cafeterias.
A strong anti-bacon sentiment developed, and a new diet was invented: the South Beach Diet, with it’s revolutionary use of the DMRB. The idea is to eat only DMRB’s so that the very idea of food is repulsive and the person loses weight.
To Answer Your Question…
So, Puffy, what if you eat a DMRB and are not on the South Beach diet?
First off, doing this on a regular basis will cause weight loss. It has been shown scientifically that a person’s wallet gets significantly thinner when a person regularly eats DMRB’s.
Second, if you happen to live in the town of North Beach, this food will change your personal polarity. This is very dangerous. Your personal polarity is determined in your DNA, which gets really annoyed when the polarity reverses. Your polarity determines all sorts of personality traits, such as: sense of humor, compassion, favorite color, and whether or not you put ketchup on your Taco. Personal polarity is not to be toyed with.
Third, occasional consumption of the South Beach DMRB will have some benefits: your skin will become a nicely-tanned hue, you will become much better at dancing to salsa music, and you will start hanging out with hot chicks in bathing suits. This has been my experience.
But despite the improvement to your social life, Puffy, I would not recommend eating South Beach DMRB’s when not on the diet.
Why?
I think you should do the Dr. Rob Diet.
The Dr. Rob Diet has absolutely no restrictions to what and how much you eat. You can have steak, cookies, jelly beans, and Little Debbie’s as much as you want. But, you have to read this blog every day.
The nausea-inducing effect of this blog is guaranteed to make you lose weight.
Thanks for the question, Puff-daddy.
PLEASE send me more material questions at dr.rob.questions(at)gmail(dot)com.
Posted in Ask Dr. Rob, Humor
1 Comment »
July 31, 2008
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I am a goof sometimes, but not always. Above is a picture of a little girl’s grave. She died of brain cancer. Yes, there is a rubber lobster in the picture too, but without that lobster, few would be looking at her grave.
Being a doctor is a fine thing to do, but there is always that uncomfortable companion of death. Even more uncomfortable is when death comes to the young.
So I ask you all to support/promote Zippy. Not a dime will go in my own pocket.
Give to his cause at http://www.firstgiving.com/funwithzippy
You can also buy all sorts of cool merchandise (thanks, Dr. Wes) at http://www.cafepress.com/medtees/5812834
All profits from the gear will go to Zippy’s fund. Other logos are coming soon. Thanks big-time to Robin Smith for making the logos (for free!).
If you want a visit, drop me a line….although the line is getting quite long.
Posted in Zippy
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July 30, 2008
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For her article on Doctor/Patient relationships Tara Parker-Pope, she asked me if I had any negative experience with patients and what I thought about the current state of this relationship. I wrote down my thoughts for her (and a quote did appear in the article) and she later suggested it may be a good blog post.
Good idea. I already did the work. So here it is:
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Tara:
I had one case where someone said they were “going to break my head open with a baseball bat.” It was for something very minor – I had seen this guy’s daughter and diagnosed them with an upper respiratory infection and a few days later they were diagnosed with “bronchitis” and given an antibiotic. This is the only case that I recall where they got specifically mad at me. We called the police. We also dismissed the family from the practice (of course). I strongly suspect that the guy had major emotional/psychological problems to begin with.
In general, patients are far more likely to get mad at the staff than at the doctors. I have had patients use profane language to my staff and say that they are going to tell me off when they saw me, only to have them be meek and quiet in the exam room. We have a rule, however, that abusing our staff in any way is a reason for dismissing a patient from the practice.
The most likely patients to get angry and frustrated are those who don’t come in very often. They don’t have much of a relationship with me or my staff, and so they don’t give us the benefit of the doubt when it comes to us running late or mixing things up. They are far more likely to just walk out without being seen.
I have noticed that patients are far more likely to question medical decisions than before. I think the information on the Internet has been a cause of this. Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is de-mystified. We are not as valued for what we know. So when patients come in with pre-conceived ideas about what we should do, they do get perturbed at us for “not listening.” I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.
I wonder if the trust that doctors have of their patients is also eroded. We are far more defensive in how we do things and much less likely to admit when we don’t know things. When doctors are afraid of being sued for any small mistake, they are more guarded in what they tell patients and I think the patients sense it. This is not as much the case in primary care, as I have an ongoing relationship with the majority of my patients, but it does take its toll.
I suspect the payment system has something to do with it. When patients don’t know what we charge for things (we are not allowed to disclose our fee schedules), they assume we are milking the system for all it’s worth. The fact that the majority of transaction happens below the surface devalues the visit. I think this is why many physicians’ experience is that the Medicaid population (which doesn’t pay at all) is the most demanding, while the self-pay seem to be the least. When you buy something at the store, there is an expectation of higher quality for higher cost. This holds the seller accountable for offering enough value for what they sell. When patients pay a small co-pay (or none at all), there is no financial accountability.
Still, I wonder if there really is an “epidemic of anger” towards doctors. Yes, there are stories of patients attacking doctors, but this may be more a fact that information flows freer than it ever did. It is kind of like how parents are all paranoid about letting their kids play in their yard because they may get abducted by a stranger. The risk is far less than most parents think. Overall, I have had very few negative interactions with my patients.
I hope this helps.
Rob
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There is an interesting video on the blog.
Thoughts?
Posted in Being a Doctor
8 Comments »
July 29, 2008
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It’s the American way: invest your money to secure your future. Put money into your IRA, 401-K, 529; invest online and maybe you can strike it big.
Publicly held companies are increasingly under pressure to produce in the short-term to keep their investors happy. The bottom line is to achieve as high of profits as possible. Long-term plans are often given up to maximize
So what happens when these companies are inserted into a dysfunctional healthcare system? Insurers, pharmaceuticals, and device manufacturers are among the publicly-held companies through which a huge amount of cash is flowing. Is it any wonder why reform is slow to happen?
Think about it. What are things in the system that bother you the most?
What is the reason for these things? I don’t think there is an evil conspiracy behind it. I see companies doing what they need to do to make a profit. This isn’t wrong. These companies are morally obligated to maximize the financial returns for their investors. and they give best return when they take the most money out of the system. This is not evil, it is what they are supposed to do.
So should we really believe that a system can be reformed where some of the biggest players in the industry are doing everything they can to take as much money as possible? We can’t expect them to act any other way - not because they are greedy and evil, but because of the high pressure to produce on the short-term. All of those with these companies in their portfolio expect it.
I am aware of the fact that some of the insurance companies are non-profits: specifically Blue Cross/Blue Shield. Why this has not caused them to have a bigger view of things is difficult to say. In my experience, they behave exactly the same as the for-profit companies; they delay payment, deny procedures, and require paperwork just like the publicly traded companies.
To me, this is one of the best arguments for more government involvement in this area. To say “it should be a free market” sounds nice to some, but there isn’t anything to suggest that less regulation would cause cost to come down - it would simply make profits go up. The goal of healthcare should not be to provide a good investment opportunity for people. One of the biggest challenges ahead of anyone who is going to try to reform healthcare will be to plug the holes where money is spilling out of the system.
Even if it hurts my portfolio.
Posted in American Medicine
6 Comments »
July 28, 2008
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I am confused.
I got a letter in the mail from American Correctional Officer. The simple fact that I got a mailing from this organization piqued my interest (and mysteriously made me a touch nervous); but when I opened it, I was very surprised at the contents:
Dear Doctor:
As part of our approved physician network, you may see one or more of our members as patients. The American Correctional Officer is committed to providing physicians, as well as members and their families, with the most current information on prescription medications. As part of this commitment, we are pleased to provide you with this information regarding Fibromyalgia and LYRICA (pregabalin) Capsules CV. LYRICA is available to our members through their current health plan.
The letter goes on to explain to me what the symptoms of Fibromyalgia are, as well as the American College of Rheumatology criteria for diagnosis of this disorder. It also informs me that LYRICA is the only agent approved for the management of Fibromyalgia. Finally, there is a full PI for the drug enclosed along with the letter.
Now, I may just be an overly-suspicious kind of guy, but it seems odd that an organization for prison guards would be so interested in the Fibromyalgia treatment of their members. I do actually take care of prison guards, and do not recall Fibromyalgia being epidemic in this population. Wouldn’t it make sense to go after a costlier disease such as diabetes or heart disease? What makes the ACO so keen on Fibromyalgia?
I also do not recall ever receiving other bits of educational material from the American Correctional Officer organization. If they are committed to providing me valuable information (because I may take care of their members), why have they not sent me anything else? Besides, why would I find this organization a trustworthy source of information on disease. It may come as a surprise, but the American Correctional Officer is not the first place I would turn to when I have questions about how to treat disease.
So what’s up? It’s obvious. Pfizer has some sort of deal with this organization to send out letters to physicians with the letterhead of the American Correctional Officer. This makes it much more likely that I would read it and perhaps think about LYRICA for my next Fibromyalgia patient (which is extremely unlikely to be a correctional officer). What does the ACO get out of it? I am not sure, but I suspect they are not doing it out of the kindness of their heart.
What’s next? Will I get a letter from the Circus Workers Union to promote prostate health? Will I get a phone call from the Fraternal Order of Police (during dinner) reminding me to lower cholesterol using Lipitor? Bob Dole promoting Viagra? No wait, they did that one.
At least the American Correction Officer could have gotten Martha Stewart to be their spokesperson.
I hear she has Fibromyalgia.
Posted in American Medicine
8 Comments »
Personally, I would have chosen C.
Jump ahead a few thousand years to ancient Greece, where the DMRB became a widespread phenomenon. It is said that Alexander the Great had a real problem keeping off the pounds, and became obsessed with finding the ultimate DMRB. He scoured the known world in search of a way to lose weight and keep the pounds off, but was unable to ever regain his boyish figure. He died in 323 BC from either malaria, typhoid, encephalitis, or a dangerously high LDL cholesterol level.
middle ages is felt to be a truly dark time for dietary supplements.
Second, if you happen to live in the town of North Beach, this food will change your personal polarity. This is very dangerous. Your personal polarity is determined in your DNA, which gets really annoyed when the polarity reverses. Your polarity determines all sorts of personality traits, such as: sense of humor, compassion, favorite color, and whether or not you put ketchup on your Taco. Personal polarity is not to be toyed with.
Third, occasional consumption of the South Beach DMRB will have some benefits: your skin will become a nicely-tanned hue, you will become much better at dancing to salsa music, and you will start hanging out with hot chicks in bathing suits. This has been my experience.
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