Talking to… Dr. An Pham

Dr. An Pham, a pulmonologist from Pennsylvania, USA, shares his opinion on stress and quality of sleep, tobacco taxation, and advancements in procedures and drugs in the treatment of pulmonary conditions.

M3 Global Research is currently conducting studies on various pulmonology-related topics. If you are a pulmonologist or internal medicine physician specialising in pulmonology and practising in the US, please contact M3_US_support@eu.m3.com. If you are not a member of our panel already and are interested in participating in healthcare market research, you can register here.

What inspired you to specialise in pulmonology and what is the most interesting aspect of working in this area?

I did a rotation with a wonderful pulmonologist who became my mentor and made me want to follow in his footsteps.

You are certified in sleep medicine. What are your thoughts on new trends like home sleep tests, for example? Currently, the American Academy of Sleep Medicine recommends home sleep tests should be used in conjunction with a comprehensive sleep evaluation to diagnose obstructive sleep apnoea (OSA).

Mixed feelings. Most of the time this works out, but a lot of times the results come back inconclusive and have to be repeated. Additionally, the Apnoea Hypopnea Index (AHI) is frequently underestimated, which impacts treatment decisions, especially for borderline cases.

Short sleep duration has been associated with a variety of adverse cardiovascular outcomes in cross-sectional and small prospective studies. As someone with more than 20 years of medical practice, during your career have you noticed much indication of lifestyle directly influencing quality of sleep and resulting in other health issues? 

That varies from individual to individual. In general, yes, to some degree, but many patients don’t even realise that.

The percentage of the population in the United States that smoke has declined from 20.9% in 2005 to 15.5% in 2016. However, cigarette smoking remains the leading cause of preventable disease and death in the country. Do you agree with measures trying to address this? The Australian government, for example, has announced it will raise tax on tobacco by 12.5% every year from 2017-2020. Would you agree with something similar being put in place in the US?

Mixed feelings. The effect of cigarettes on health is no longer a secret, so if someone chooses to smoke he or she is willing to take that risk. It’s the same with alcohol. I’m not sure where to draw the line as far as controlling what people do with their lives.

In your opinion, how has technology improved the treatment of pulmonary diseases in the last decade?

 Lung transplants and interventional pulmonology have advanced significantly. Older patients can now be candidates for lung transplants. Many patients can now avoid surgery given new intervention bronchoscopy procedures. Also, new drugs, especially the biologic agents, have improved patient outcomes significantly.

 

Talking to… Dr. Devika Umashanker

Dr. Devika Umashanker is an Obesity Medicine specialist practising in the US. In this interview with the M3 Blog, she speaks about fat-shaming, personalisation of treatment, the use of MDTs in the management of obesity issues, and taxing sugary products. Read the full interview below.

What inspired you to specialise in obesity medicine?

After completion of residency I worked as a hospitalist for a couple of years during which I noticed that the underlying cause of many of my admissions was obesity. During medical school or residency, there was not a significant amount of time allocated to teaching obesity medicine or nutrition. After studying the subject on my own and going to various conferences on obesity medicine, I was fascinated and intrigued with the sub specialty, which then led me to pursue a fellowship in obesity medicine at Weill Cornell Medical College.

If you look at data shared by The World Obesity Federation, it is clear there are differences between the percentage of obese adults in each country around the world. What could influence the level of obesity from country to country?

In my opinion, possible factors influencing the level of obesity from country to country are access to food, access to care and being able to treat obese patients effectively.

Further data shows the differences between the percentage of obese men and women in every country. Biologically, are there main differences between male and female metabolisms?

Women tend to have greater adipose tissue compared to men. Increased adipose tissue leads to increased insulin resistance, increased inflammatory markers, and decreased adiponectin levels, which all play a role in the pathogenesis of obesity and affect metabolism.

Would you say that the treatment for obesity must be personalised? In what way?

The treatment of obesity must be personalised because each patient is different. For example, each patient with obesity has a different set of comorbidities and a different combination of medications treating their comorbidities, which then leads to a different treatment plan.

Data shows that on current trends 2.7 billion adults worldwide will suffer from overweight and obesity by 2025. In your opinion, what would be the main points to work on in order to treat and prevent obesity?

The main points to treat and prevent obesity are early intervention, nutrition and exercise counselling, availability of anti-obesity medications, and universal insurance coverage for bariatric surgery, when appropriate.

What is your opinion on taxing sugary drinks, a measure that has recently been approved in the UK? Do you believe the impact will be significant? Are there other similar measures that you think would have a bigger impact?

In my opinion, obesity is similar to cancer. Obesity decreases quality of life, increases mortality, and individuals die from the complications associated with obesity. If cigarettes are taxed to prevent consumers from purchasing the product to reduce lung associated disease such as lung cancer and COPD, we should strongly think about the impact that taxing sugary drinks will have on our consumers in regards to obesity. In my opinion, I think the impact will be significant as it will make the consumer think twice before purchasing a sugary drink. Would taxing sugary drinks eliminate obesity? The answer is no. However, it may be a good starting point to consider.

How can physicians treating obesity benefit from working with different healthcare professionals, such as psychologists and psychiatrists, nutritionists, physical education professionals etc?  

Working with a multi-disciplinary team including psychologists, exercise physiologists, bariatric surgeons and nutritionists is the most effective way to treat individuals with obesity.

What do you think about so-called ‘fat-shaming’ by healthcare professionals towards patients dealing with obesity? How can this be tackled?

I think ‘medical fat-shaming’ is prevalent in the medical community, but this can be tackled through education on the pathophysiology of obesity. Obesity is not volitional but rather a disease. Neuro hormonal dysregulation and hormonal imbalances play a significant role in obesity and as a medical community we need to come together and understand this universal concept.

 Is there anything you would like to add?

Obesity medicine has come a long way but we still have a long way to go.

Single-Payer Healthcare System

Welcome to the October edition of ‘Inside M3 Insights’!

This month, we are sharing the results of one insider survey carried out by MDLinx, with nearly 900 physicians and advanced practice clinicians in the United States.

The purpose of this survey was to find out what healthcare professionals think about the latest healthcare reform, which was carried out by the Republicans to replace the Affordable Care Act.

The survey asked for a comparison between the multiple-payer system and a single-payer system sych as Medicare for All model proposed by Sen. B. Sanders.

If you’re not part of M3 Global Research’s medical panel yet, we invite you to register and share your thoughts and opinions with the wider medical community

You can access the results of the study below.

 

Inside M3 Insights

OCTOBER 11: World Obesity Day

World Obesity Day

New figures indicate the annual cost of treating the consequences of obesity will reach US$1.2 trillion globally by 2025.

11th October is World Obesity Day and is marked in 2017 for the third time. It was launched to stimulate discussion and support practical actions to help people achieve and maintain a healthy weight and reverse the global obesity crisis.

The World Obesity Federation along with global health leaders, including The Lancet and the World Health Organization, shine a spotlight on staggering costs and continued impact of obesity, including new data showing the continued increase in childhood obesity and the financial consequences of untreated obesity at all ages.

New World Obesity Federation data demonstrates how investing in the prevention, early intervention and treatment of obesity is a cost-effective action for governments and health services. Investment can also help to achieve the 2025 targets set by the World Health Organization to halt the rise in obesity and to achieve a 25% relative reduction in mortality from NCDs.

healthy weight

Untreated, obesity is responsible for a significant proportion of non-communicable diseases (NCDs) including heart disease, diabetes, liver disease and many types of cancer. The global annual medical cost of treating these serious consequences of obesity is expected to reach US$1.2 trillion per year by 2025 .

The World Obesity Federation is using World Obesity Day, 11th October, to urge governments, health service providers, insurers and philanthropic organisations to prioritise investment in tackling obesity.  This means:

1) Investing in treatment services to support people affected by obesity

2) Early intervention to improve the success of treatment and

3) Prevention to reduce the need for treatment.

For more information, access the World Obesity Day website.

*All rights belong to the World Obesity Federation. We would like to thank the World Obesity Federation for sharing this content with us.

Bullying, undermining and harassment at work

August’s Monthly Pulse question was about bullying, undermining and harassment at work. Around one in five doctors in the UK’s NHS say they have been bullied or harassed in the workplace, with the British Orthopaedic Trainee Association (BOTA) reporting that 73% trainees had witnessed bullying, undermining or harassment at work. Most incidents go unreported, often because staff are afraid to raise concerns or they believe nothing will happen. This situation seems to be a common issue worldwide.

BOTA‘s #HammerItOut campaign, which aims to highlight the issue, uses the following definitions: Undermining is behaviour that subverts, weakens or wears away confidenceBullying is behaviour that hurts or frightens someone who is less powerful, often forcing them to do something they do not want to do. Bullying and harassment means any unwanted behaviour that makes someone feel intimidated, humiliated or offended.

The question we delivered to our medical community in August was the following:

Have you ever experienced or witnessed bullying, undermining or harassment at work?

In Europe the analysis was conducted amongst 5,016 M3 members in the UK, France, Germany, Italy and Spain. 65% of the healthcare professional surveyed have experienced or witnessed bullying, undermining and harassment at work. Bulling and harassment was most prevalent in the UK and France at 78% and 73% respectively. On the other hand, Italy has the lowest incidence.

The cross-continental analysis shows that 73% of healthcare professionals surveyed in USA have witnessed the same situation. Bullying and harassment was most prevalent in Canada at 85% while Europe has the lowest incidence at 35%.

By registering with M3 Global Research you will receive the Monthly Pulse directly to your inbox and you will be able to give your personal opinion about relevant healthcare related issue and compare your thoughts with your colleagues around the World.

harassment at work

Monthly Pulse