Medical myths

Can't say for sure if you are right suggesting it's all about who
gets the money, but the situation where I work(big city public teaching
hospital in QLD) in Australia is presumably similar to yours - enough to
compare at least. Here are some the cost related facts, and observations,
as I know them:

1] Each bed has a hospital supplied phone(HSP)-buttons on the hand
piece style.

2] The HSP works automatically to receive calls in – no cost.

3] Calls to the HSP are channeled through the ward reception, not
direct to the patient.

4] A purchase must be made to use the HSP to make calls out, and
debit system then applies.

5] The point of purchase for the debit system authority to make calls
out, is several floors away, in a private enterprise "shop", along with
other retailers.

6] The HSP does work for a limited number of “free” calls, such as
contact to get one's TV connected(about 9 AUD per day), and staff to staff
related numbers. Emergency alarm button systems independent of HSPs are at
each bed.

7] Patients make few out calls on HSP due to the inconvenient nature
of out call activation and costs.

8] About 95% of patients in the <60 years age group have mobile
phone with them, and use them with great variety in their compliance with
the edict to have said mobiles turned off in clinical areas. There have
been innumerable instances where the edict was corrupted by the patient
taking their mobile, together with their IMED® infusion device to a non-
clinical area to make a call.

9] The age group >80 years are generally neither mobile phone
users or owners in hospital.

10] The >80 years group are the most compliant with the edict to
turn mobile phones off, due to not possessing them in the first place. Yet
they are subject to any effects of mobiles caused by others.

11] The >80 years group do often use the hospital supplied phone,
in response to calls directed to the bedside by ward reception.

12] Distance from the hospital is a factor in Australia, and it is
not unusual for patients to come from “the regions” where consultants, and
indeed people, are hard to find. Relatives sometimes demand to be put
through immediately, because they are calling from “woop woop”(common AU
slang word denoting distant rural place), mindful of the pending costs.
This demand is discouraged, since clinical matters cannot be subject to
extra-mural competing interests. A call back at hospital expense is often
the best option.

13] About 98% of nursing staff have mobile phones, yet some nursing
staff members expect to use the reception and publicly funded nursing
time, to be put in contact with a spouse or significant other, for non-
urgent matters, using the hospital phones.

14] Mobile phones, with their electromagnetic radiation(EMR)
emissions vary enormously in design and capability, while the infusion and
other devices are almost completely under the control of hospital
purchasers, and manufacturers.

15] Complaints about invasion of privacy from both patients and
hospital staff, caused by the photographic and recording capability of
mobile phones do increasingly occur.

16] There are many well known electronically controlled devices, each
with alarm capability, hence each competing with mobile phone ring sounds,
operating at the bedside in non-critical surgical wards, and the number is
increasing each year:-

1. electronically positioned bed.
2. pressure sore prevention mattress
3. fluid infusion device(up to eight separate lines each with alarm)
4. analgesic infusion device
5. oxygen humidifier
6. vacuum dressing device
7. oxygen saturation device
8. blood pressure monitor
9. thermometer
10. sequential pressure anti-embolism stockings
11. odour controlling negative ion generator.

Distinguishing alarms from each of the above is often difficult, and
directional properties of alarms are non-existent. Yet nurses often
subscribe to the myth of distinguish-ability without any research
evidence.

17] Patients are often drug affected by centralCNS drugs, and can
confuse sights and sounds to their own detriment. One recalls a case where
the patient heard her bedside phone, reached over to what her drugs led
her to believe was the hand set, only to place her hand into the opening
of the swinging lid of the poorly located, yet well intended, bedside
sharps container.

18] Doctors, lawyers, professors of physics, and such elite
professionals, are rare patients in public hospitals.

19] Doctors(anesthetists excepted) do not directly program,observe,
and document infusion rates and volumes on wards. They merely prescribe
them. Nurses do the rest. Doctors don't even have access to the drugs
room.

20] Doctors as staff members, use mobile phones frequently, yet
responsibly, tempting the conclusion that the real reason doctors are so
confident about the safety of mobile phones, is their own wish to use such
phones, rather than a detailed appreciation of the general surgical ward
situation.

In conclusion, my guess is that even if the hospital could make money
from the liberalization of mobile phones, as your post suggests, that
would in no way mean that the total of the issues with mobile phones would
be resolved to the satisfaction of all. Some very important issues are
only camouflaged by EMR and cost considerations.

Competing interests:
None declared

Say what you will about Drs. Vreeman and Carroll, but they are
presenting
their work in the public venue in the time honored tradition of peer
review.
You may agree with them or not, but calling them "stupid" and
"irresponsible"
is unworthy of this forum and the hallmark of someone with little of value
to
say.

If you read the manuscript carefully, they did not perform "only" a
Google
search. They searched the medical literature AND Google. I am sure that
there were instances when no peer reviewed literature could be found. In
that
case, what would you have them do? At least they tried to continue to
look
for evidence before saying that none exists.

Another person claims that they were "shameful" for saying that "Lack
of
supporting evidence [should] be taken to refute a hypothesis." They did
no
such thing. A careful read shows that Drs. Vreeman and Carroll said that
lack
of any evidence should lead us to question the veracity of the "myth".
Why
should we claim something to be true that has no scientific evidence
behind
it? Is that not "shameful" science?

Yes, another person points to a very recent manuscript showing that
newer
cell phones may interfere with medical equipment. First of all, you
cannot
fault the authors for not citing it, when this paper appeared after theirs
was
accepted. They could not have "ignored" something that was not published
yet. Moreover, Drs. Vreeman and Carroll do not say that cell phones
cannot
interfere with medical equipment. They say the myth is "Mobile phones
create considerable electromagnetic interference in hospitals". We can
parse
the meaning of "considerable", but from my read of their manuscript, I
take it
to mean life-threatening. And, as they say, no reported deaths have ever
occurred from cell phone use, nor any serious injuries. Moreover, they
appear to be against banning cell phones from hospitals indiscriminately,
not
for removal of all restrictions. This bears out in interviews they have
given. It
is of note that the very paper you describe as damning evidence of cell
phones as death machines recommends in its conclusion that the "one
meter" rule continue. Even that paper does not recommend banning cell
phones, but instead concludes we should continue to keep them one meter
away from equipment. Is it shameful? Stupid? Irresponsible?

I applaud the BMJ for keeping this forum free for open discourse.
But you do
nothing to promote your arguments and everything to lessen the chance to
move debate forward by name calling and childish behavior. You have every

right to argue your points and offer alternative theories backed up by
evidence. But let's give the authors, the journal, and the peer review
process
the respect they deserve.

Competing interests:
None declared

While I am all for dispelling a few myths, the means to do so should be solidly grounded. Relying solely on the iconoclastic paper by Valtin in respect of minimum water intake risks throwing the baby out with the bathwater. A later report by the US National Academy of Sciences (http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10925 for a press release overview) reinforces the point that adequate hydration is achieved through a number of routes but that average fluid intake is of the order of 3.0 litres (101 fluid ounces) and 2.2 l. (74 fl. ozs.) for 19-30 year old men and women respectively.

Perhaps we should be offering informed guidance rather than (potentially) suggesting giving up water drinking entirely.

Competing interests:
None declared

I note the response of Wilson to this article. I also note that the article in "Critical Care" indicates the following: "Critical care equipment is vulnerable to EMI by new-generation wireless telecommunication technologies with median distances of about 3 cm." The 3 metres suggested in Wilson's response relates to a single episode.

Indeed, the authors in "Critical Care" sensibly suggest an inner limit of 1 m from critical care equipment.

To accuse the authors of the present article of "stipidity and irresponsibility" seems inappropriate. They have legitimately raised issues for discussion and pointed out the possible advantages of being able to use mobile telephony in the health care setting, rather than just accepting "conventional wisdom".

The fact that labouring ladies sometimes text others during childbirth does not seem relevant to the discussion here. CTG (cardiotocograph) machines are probably not "critical care" devices, and in any event, continuous CTG monitoring is not always clinically indicated. Affording women the opportunity to communicate with their friends at a difficult time seems like a good idea to me. For many young women today, SMS is the mode of choice.

As to the separate issue of hydration; physiologically, the mythical 70 kg man needs about 2 L of water intake each day. Unless he is being fasted, a good deal of that intake is an ingredient of various foods. Thus the suggestion that 8 glasses of water a day is excessive might be correct. However, we also need to consider the environmental factors. In the Australian summer for example, physical workers and sportspeople exercising in the outdoors often consume three or four litres of water in order to maintain their wellbeing.

Competing interests:
None declared