Kate Scannell, MD

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 06/08/2013

As a writer, I wish I could claim the title of this column as my own. But it rightly belongs to Dr. Michael A. LeNoir, an Oakland physician who is trying to educate patients and policymakers about approaching remedies for health disparities "from the bottom up, instead of the top down."

A "health disparity" usually refers to a higher burden of disease, disability, or mortality experienced by one subpopulation in comparison to another. In the U.S., health disparities are common, and they often reflect population differences characterized by race, ethnicity, gender, age or socioeconomic status.

For example, African-American men and women are more likely to die of heart disease and strokes than white people experiencing the same diseases. A recent study showed among preschool children hospitalized with asthma, 21 percent of white children were prescribed medications to prevent future hospitalizations, compared to only 2 percent of Hispanic and 7 percent of black children.

The troubling fact is that health disparities are many, widespread, long-standing and persistent. And studies rather consistently show that gaining access to a health care system does not necessarily ensure that patients will receive higher quality care. Racial and ethnic health disparities often persist even when insurance status is comparable -- a sobering acknowledgment as we approach near-universal coverage anticipated under the Affordable Care Act. Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 07/06/2012

Cora Sledge soberly recalled all the useless prayers she had offered up throughout her 80 years of hardscrabble living. Without a hint of self-pity, she recounted: "I used to pray to keep my ma and daddy safe, but that was no use. I prayed for gifts at Christmas and to win the school prize. I prayed to be slim, so no one would make fun of me. That didn't happen, either. I asked Jesus to protect my kids. Look what happened."

Yet somehow, despite all the tragedy that had seeped into her long life through small holes in her big prayers, Cora remained hopeful about her uncertain future. But her hopes now focused more internally, and her prayers reshaped around her longing to escape the assisted-living facility in which her children had abandoned her. She asked for her heart to be healed, all the while it stayed open and "ready to love." She explained, "I pray now like I did when I was a little girl -- not needing to understand. I ask for simple things. Let me not hurt. Let me not be hungry, or cold. Please keep my loneliness at bay."

I finished reading about Cora Sledge in Berkeley novelist Leslie Larson's moving (and comical) novel "Breaking Out of Bedlam" the same day that UC San Francisco researchers reported finding statistical associations between loneliness and an increased risk of dying among elderly people.  Read More 

By Dr. Kate Scannell, Syndicated columnist
First published in print: 12/25/2011

The top 10 medical stories chosen for 2011 are distinguished for their broad reach into people's lives. I look to the new year with hope that 2012's list contains much good health news for us.

Drug shortage: Our nationwide prescription drug shortage worsened this year, compromising some patients' health while also revealing systemic problems with pharmaceutical production and regulation. At least 250 drug shortages were reported, with hospitals facing worrisome scarcity of lifesaving medications including chemotherapies, heart drugs and antibiotics. An executive order signed in October by President Obama broadened the Food and Drug Administration's authority to expand its reporting of potential drug shortages, expedite regulatory reviews and monitor for opportunistic price-gouging on sales of scarce drugs. Still, the FDA cannot require pharmaceutical companies to resume or increase drug supplies -- and pharmaceutical companies are not legally obligated to do so.

Celebs help: Celebrities can influence societal views about health and disease. They can share the spotlight with public health issues to make them more visible to millions of people. The death of 27-year-old singer Amy Winehouse in July sadly illuminated the health hazards of excessive drinking. In November, the involuntary manslaughter conviction of Michael Jackson's physician cast a dark light on prescription drug abuse. When former first lady Betty Ford died in July, we were reminded about the power of one person's voice to speak truth to silence in changing how people viewed illnesses such as cancers and addictions.  Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 06/11/2011

FOOD AND health and safety issues cooked up more news within the last two weeks than Lindsay Lohan and Oprah Winfrey combined! Is the public appetite changing?

A toppled pyramid, fishy fish, killer bacteria stalking European food supplies, Ronald MacDonald's job threatened and the FDA taking heat on the back burner . . . how to digest it all?

Let's begin with the dismantling of the 2005 food pyramid --that charming but baffling icon developed by the U.S. Department of Agriculture (USDA) that was supposed to somehow guide us toward healthier nutritional habits. But few Americans could crack the mysterious code of the old-world pyramid and its six unlabeled columns, all the while our nation's obesity and diabetes epidemics swiftly expanded.

Americans puzzled over the nutritional significance of the staircase -- or escalator? -- appended to the pyramid. They were distracted by the disarticulated humanoid figure that loitered on it. Was it a mummy emerging from the pyramidal catacombs? Was its disarticulation merely metaphor for the entire icon's failure to articulate a coherent message about good nutrition? Why was it running away from "the five food groups" jumbled at the pyramid's base -- especially if they were supposed to be good for us? Sadly, in the wake of the food pyramid's recent dismantling, we may never find out. Read More 

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 05/28/2011

LAST WEEK, I visited Lainey Aldermen's fourth grade class at John Swett Elementary School in Martinez with two related goals in mind. The first was to demonstrate how writing could be fun and exciting, how it could lead to adventures and experiences in bigger worlds that existed "off the page." My second objective was to gain a better understanding of what young people think about doctors and health care -- their important perspectives are virtually absent from mainstream polls and surveys.

My overarching plan was to merge both goals by teaching the students how to write a structured essay, and asking them to focus it on their experiences with doctors or hospitals. I told them I would include their opinions in this newspaper column, hoping to provide them a concrete experience of witnessing their words being carried beyond the classroom into a larger public conversation.

And, of course, I learned many amazing things during my visit.  Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 04/02/2011

BY NOW, most of us know what a "GPS" is -- at least those of us who tend to get lost and require a "global positioning system" to navigate us toward our desired destination. But how many of us are familiar with the "CPGs" our doctors use to navigate our medical care?

A CPG is a "Clinical Practice Guideline," and it functions like a GPS for doctors and patients. For example, when a medical decision must be made for a diabetic patient, the doctor might consult a "CPG for diabetes" to select a course of management among several options. Depending on that course, the CPG could navigate doctors toward ordering certain tests or prescribing particular medications.

CPGs are created by a hodgepodge of private and public organizations that share some interest in the focus of the CPG. So, for example, the American Diabetes Association creates CPGs regarding diabetes management. The Academy of Ambulatory Foot and Ankle Surgery issues guidelines concerning ingrown toenails. More than 1,000 CPGs exist, spanning a vast array of medical disorders including heart disease, arthritis, thyroid problems, high blood pressure and various cancers.

Ideally, organizations volunteering to create guidelines do us a favor, because it is impossible for most doctors to keep up with the thousands of new research findings published each year in medical journals. We doctors tend to welcome CPGs that are written by groups of professionals who have expertly reviewed, analyzed, distilled, synthesized and translated complex research findings into useful clinical practice recommendations.

It's important to understand about CPGs because doctors frequently rely upon them to determine what happens to you when you're sick.  Read More 

By Dr. Kate Scannell
First Published: March 24, 2011

My 20-year old patient had been suffering a slow, painful death expected to occur within the next few days. Alone in his drab room on a county hospital’s AIDS ward in California in the mid-1980s, he had been praying to see his father and mother one final time. He fantasized about them rushing into the hospital, assembling around his deathbed, holding his hands and easing his transition from this world.

He had last seen his parents several years before at the family homestead in the rural south. Standing on the front porch where he had been exiled moments after admitting his homosexuality, he saw his father’s angry face behind the slamming screen door, his mother’s piercing stare through the front window.

But, in the end, he carried those final imagesof his parents to his grave. Neither of them had responded to his pleas for a bedside visit, accepted offers of airfare to California gifted by an AIDS advocacy group, or taken opportunities to speak with their son by phone.

And yet, days before he died, he had the experience of “being saved” by Elizabeth Taylor. He had seen her on television, witnessed her embrace of a gay man with AIDS, and heard her unflinching support for AIDS research to seek cures for people who suffered with HIV infections.

Without first-hand experience of the early AIDS epidemic, it may be difficult now to appreciate Elizabeth Taylor’s heroism back then.  Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 03/20/2011

I AM IN DETROIT visiting family, and I’ve got sports on the brain.

Last night, we watched a local news report about former Red Wing hockey star Bob Probert who died last July at age 45 with a bad heart and battered brain. His celebrity on the ice rink had derived as much from his skill with his fists as with his stick.

Earlier this month, Probert’s brain was examined and found to exhibit “chronic traumatic encephalopathy” or “CTE” – a degenerative brain disease originally noted in boxers and, more recently, football players. Caused by repetitive or severe head trauma, CTE can manifest as dementia, memory loss, depression, aggression, and suicidal behavior. According to his wife, Probert had displayed problems with short-term memory and a quick temper.

During a commercial break, one of my sisters commented upon the increasing violence she’d witnessed during her own sons’ school sports activities. “But the parents are often worse than their kids,” she said.  Read More 

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 02/20/2011

FOR YEARS, I've been writing a book about medical practices that were later found to be wrongheaded, useless or dangerous. It's been a sobering and unsettling project, causing me to question the scientific foundation of my profession a few too many times.

But I am trying to how we doctors sometimes get it all so very wrong. How under our watch, enormous myths can sneak unnoticed into our clinical textbooks and remain there for decades.How our doctorly habits or routines sometimes bypass critical scrutiny and seamlessly morph into "standard medical practice." I am searching for instructive clues to these discomforting mysteries, keeping patients in center vision, hoping to help resolve what I can.

Preparing for this book, I have been collecting medical journal articles whose solid research findings blew some piece of conventional medical dogma out of the water and into oblivion. My collection is housed within a file cabinet labeled "Oops!" that expands at an ever-increasing rate. And today I added to that collection a study from last week's Journal of the American Medical Association (JAMA) that upends thinking about a type of breast cancer surgery routinely performed on tens of thousands of women each year. Read More 

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 02/06/2011

READING FOUR newspapers over breakfast each morning may turn out to be the most effective weight-loss regime in history. Simultaneously digesting the daily news about our food supply's safety and quality, our nation's expanding obesity epidemic, and the pharmaceutical industry's efforts to capitalize on the latter can generate significant appetite suppression.

Last week delivered a remarkable serving of health-related food news. After spreading it all out on the table for the purpose of writing this column . . . well, it left me feeling unsatisfied and hungry for something not on the menu: a coherent logic about healthy eating. Read More