How to eliminate head injury in football

Op-Ed August 21, 2010

Serious head injury in American football is commonplace and has received national attention within the last two years. The New York Giants quarterback, Eli Manning, is sitting out a few games due to head injury. Last season, star quarterback for the Florida Gators and Heisman Trophy winner, Tim Tebow, suffered yet another concussion that was witnessed by millions of sports fans, as did Super Bowl champ Ben Roethlisberger and many others.

Bryant Gumbel of HBO’s Real Sports was an import factor in bringing this problem to the mainstream. As a result of his show and subsequent coverage in the press, the NFL was pressured to make changes. There is now a mandatory time-off for players suffering concussion, and new posters have been placed in locker rooms. The concern is extending to off-the-field injuries as well. In 2009, then Tonight Show host Conan O’Brien gave head injury more national attention with his on-air concussion.

A recent study commissioned by the NFL found an astonishingly greater prevalence of Alzheimer’s-like memory loss in ex-NFL players. Young athletes in high school or lower grades are even more vulnerable to permanent brain damage after the initial concussion than adults. In addition, there is now new credible evidence from the same scientists at Boston University that Amyotrophic Lateral Sclerosis, ALS, also known as Lou Gehrig’s disease, is caused by head injury.

Concussions are one of the dirty secrets of football. What can be done to make America’s favorite sport safer?

The cause of the vast majority of concussions in football is the lack of enforcement of the rules dictating proper tackling and blocking. The helmet is currently used as the primary ramming tool, particularly at the higher levels, when in fact the facemask and helmet should theoretically never be used in contact. It is against the rules for a defensive player to dip his head and tackle headfirst with his helmet. On the offense, a proper block should use the arms and hands as the initial point of contact, and runners should not dip down and ram headfirst. In reality, however, virtually every block on the interior line and every running play uses the facemask and helmet as battering rams.

It would be quite feasible to enforce the existing rules of football that dictate the helmet should not be used as a weapon and the quality of play as seen by the spectator would not be diminished. Running backs should run with their facemasks up at all times. If a running back were to dip his head and spear forward, it should be a 15-yard penalty and loss of down. Likewise, offensive and defensive linemen should be penalized if their helmets clash.

The ground collisions with helmeted heads that cause injury cannot be easily prevented. However, a simple enforcement of the blocking, tackling, and running rules should eliminate a significant portion of the head (and spine) injuries in football. Also, preventing the premature return of head injured players will help reduce further injury as well.

Hines Ward of the Pittsburgh Steelers can lay out some the most vicious and entertaining blocks in all of football just by using his shoulder pads. Using the helmet as a weapon is cheating, unnecessary, and should be banned.

St Vincent’s hospital closure: The first of many across the country?

April 7, 2010

St. Vincent’s hospital in Greenwich Village, Manhattan, is closing due to mounting debt and New York State cuts in funding. St. Vincent’s is the last tertiary care catholic hospital in the city. How can a business entity with surplus demand go out of business due to lack of revenue? The answer lies in the low payment rates.

St. Vincent’s has been an important source of care for the area. It treated the wave of AIDS patients in the 1980’s, for example. Lately, it has become a magnet for the uninsured or poorly insured Medicaid population.

Hospitals survive by cost shifting the losses from the uninsured, Medicare, and Medicaid patients to the private insurance pool. That is why private insurance hospital bills are so exorbitant. The surrounding hospitals in Manhattan were siphoning off the lucrative private insurance patients and the higher mix surgical cases (e.g. coronary cases, orthopedic and spine, etc).

Bruce Nudell, PhD, healthcare analyst at UBS commented, “Medicare believes in applying financial pressure to hospitals so that they will manage their input costs. Overall Medicare margins in hospitals tend to be negative. In 2006 and 2007, for instance, overall Medicare margins in fee for service hospitals were between -5% and -6%…Unlike Medicare margins, which are currently negative, the payment to cost ratio for commercially insured inpatients is currently positive by around 32%”

The bigger story to this closure is that St. Vincent’s will likely be just the first of many across the country. Unemployment has caused a surge in the uninsured and Medicaid patients, while at the same time state revenues are down forcing budget cuts.  In Miami, proposals were made to close two of the Jackson Memorial hospitals.  In New York, other than St. Vincent’s, layoffs are pending in the public hospitals. In San Francisco, the prestigious UCSF medical center is running a deficit of more than $200 Million, although no plans to close UCSF have been announced.

Critics of the new health insurance reform law argue that it will further stress the system with Medicare cuts and expansions of the Medicaid population. More than a dozen State Attorneys Generals have recently filed lawsuits challenging the constitutionality of the federal government requiring states to spend more without providing federal funding.

For a thorough discussion of the looming problem in Florida, The HCC interviewed Dr. William O’Neill, Dean of Clinical Affairs at the University of Miami medical center.

The “Botax” and mammogram guidelines

Dr. Jennifer Walden, one of the leading plastic and reconstructive surgeons in New York, discusses her opposition to the “Botax” tax on cosmetic plastic surgery proposed in the Senate healthcare reform bill. She also addresses the controversial recent AHRQ guidelines that recommended against routine mammography for women under the age of 50.

We met Dr. Walden at The White House. The interview may be viewed below.

Tips for an optimal annual physical exam

Many people schedule their annual physical for either the end of the year or the start of the year. Your doctor undoubtedly delegates most of the tests and data collection to the staff, and they are often improperly performed. Some common mistakes to keep an eye out for are the following:

• Make sure all of the staff washes their hands.
• Make sure the nurse actually measures your height and weight. You likely lie to yourself about both and the nurse should not take your word for it.
• Make sure the ECG leads are actually placed on the ankles and not on the abdomen. Nurses and most doctors often do not understand the artifacts caused by improper leads and they only glance at the ECG to look for obvious rhythm disorders. For an ECG to be of use in identifying old infarcts, the leads have to be properly placed across the chest, both arms, and both legs.
• When they draw the blood, have them penetrate the vein at a 90-degree right angle, not close to parallel to the skin at an acute angle. A right angle works better and is less painful.
• Make sure the doctor checks the soles of your feet the pulses in ankles. Ask your doctor to measure the “Ankle/brachial index” to pick up peripheral vascular disease in the legs.
• Make sure the doctor looks in your ears. You probably have cerumen (wax) and you will hear those iPods better if the canals are clean. Use hydrogen peroxide dipped in Q-tips to gently clean your ears without compacting the wax deeper, or see an ear doctor if you have the luxury.
• Particularly if you are Caucasian, make sure the doctor looks for nevi (moles) and signs of skin damage from the sun. If you are over age 40 or are younger with fair skin, this is very important. Have the doctor chart the lesions found. If you have any doubt, just go to a dermatologist and have the lesion removed. For widespread skin damage, photodynamic therapy works well.
• If you are over age 50, go to an eye doctor to have a real eye exam where your pupils are dilated by drops. Your primary care doctor is just going through the motions by looking in your undilated eyes and cannot see much at all other than cataracts. Signs of early eye disease that will lead to blindness can only be seen when the pupils are dilated.
• Ask about adult vaccinations for diseases such as shingles, flu, pneumonia, etc. Financial reasons have caused most primary care offices to stop administering vaccines.
• If your doctor recommends any form of medication to prevent a cardiology problem, such as high cholesterol or high blood pressure, get a second opinion and search http://www.currentmedicine.tv/ for the topic. In general, get a second opinion before starting any new therapy.

Weeks later, if the laboratory testing company tries to bill you, do not pay. They are not allowed to bill you for the balance of what insurance does not pay as long as your doctor is “in network”. Be generous with your doctor, however. Most primary care doctors are underpaid.

Seasonal flu vaccination program

October 21

Councilmember Alan Gerson is sponsoring regional seasonal flue shots to be administered. These are NOT the swine flue, or H1N1, shots.

To learn more, view the video and also call Alan Gerson’s office at (212) 788-7722

Foods that make you hungry and obese

September 17

If you were raised in America, the following video may very well help you add years to your life. Dr. Louis Aronne explains how the gastric hormones react to high-sugar fast-burning carbohydrate meals to generate hunger shortly after eating and how higher protein diets put off the hunger pains longer.