Legalizing marijuana, an opinion from a former JAMA editor

Medications
May 23, 2010

While I was still the editor of JAMA, I was in Boston in January, 1997, to do my regular teaching at Harvard. I dropped in to see my friend Jerry Kassirer, the editor of the New England Journal of Medicine. Little did I know that Jerry was in the midst of a firestorm of protest for his just-published editorial called “Federal Foolishness and Marijuana.” Jerry told me that he received …

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Legalizing marijuana, an opinion from a former JAMA editor

Evidence based medicine at the expense of the art of medicine

Physician
May 23, 2010

Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at …

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Evidence based medicine at the expense of the art of medicine

Radiation and whether cell phone towers are dangerous

Conditions and Diseases
May 22, 2010

Radiation. Powerful enough to turn Dr. Bruce Banner (Bill Bixby) into The Incredible Hulk (Lou Ferrigno), or meek Peter Parker (Tobey Maguire) into The Amazing Spider-Man (still Tobey Maguire, but more buff and spandexed). It also obliterated two cities in Japan, and continues to contribute to cancers near Chernobyl. It’s sciency, strong, and scary. No wonder it creates so much apprehension.

We’re all living every day surrounded by radiation sources, and …

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Radiation and whether cell phone towers are dangerous

Medical imaging is increasing in cancer patients

Conditions and Diseases
May 22, 2010

by Kristina Fiore

Medical imaging for cancer patients and resulting costs have increased over the last decade, particularly in positron emission tomography (PET), researchers have found.

Annually, use of the diagnostic screen rose significantly between 1999 and 2006 — ranging from 36% in lung cancer to 54% in breast cancer, Kevin A. Schulman, MD, of Duke University, and colleagues reported in the April 29 Journal of the American Medical Association.

Imaging costs also …

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Medical imaging is increasing in cancer patients

Joint Commission hospital inspections have improved

Physician
May 22, 2010

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly.

Hospitals were given a couple of years’ notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the …

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Joint Commission hospital inspections have improved

Allergy drug recommendations for patients on a budget

Conditions and Diseases
May 21, 2010

Ahhh spring.

The lovely blooms unfurling. The trees budding.

It’s enough to make a girl get tears in her eyes.

And sneezes in her nose.

And itching on her face.

Yes, it’s allergy season again — but what can you do to make yourself more comfortable without emptying your wallet?

1. Avoidance. Close the windows. Make someone else cut the grass. Stay inside. (Yes, I hate this one too- let’s move on.)

2. Neti pot or other nasal saline rinsing. LOVE …

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Allergy drug recommendations for patients on a budget

Ethics of futile care

Physician
May 21, 2010

The bioethics community has been working on defining the concept of medically futile care for more than a quarter of a century, yet the debate continues. The way in which the current notion of medical futility becomes folded into the proposed healthcare reform bills is at a critical point.

Sophisticated medical technology that is at once life-saving, life-prolonging as well as death-prolonging has created populations which, in the past, would have …

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Ethics of futile care

House, M.D. physician technical advisor interview

Social Media in Medicine
May 21, 2010

by Ryan DuBosar

“House, M.D.,” is the least realistic medical drama on television. That doesn’t bother Lisa Sanders, ACP Member, one of the show’s technical advisors.

The lead character, Gregory House, MD, verbally abuses patients, goes overboard ordering tests and above all, he’s “a jerk,” Dr. Sanders said. But after all, it’s television, and the former CBS news producer turned med student turned Yale professor understands the difference between reality and good …

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House, M.D. physician technical advisor interview

Patients with dementia and when they should stop driving

Conditions and Diseases
May 20, 2010

A common clinical problem in aging is when should driving a motor vehicle be discontinued. When does driving become a significant safety hazard as cognition and motor skills decline?

The American Academy of Neurology recently published a Practice Parameter update: Evaluation and management of driving risk in dementia. This important review provides clinicians and family members with assistance in making an accurate and timely decision.

The authors of the guideline review research …

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Patients with dementia and when they should stop driving

Father of a patient with a sudden brain hemorrhage

Conditions and Diseases
May 20, 2010

She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history.

She was at home, preparing to visit her doctor for a scheduled visit, when she collapsed. Because she didn’t drive, her elderly father had planned on swinging by to pick her up. He had just called …

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Father of a patient with a sudden brain hemorrhage

Diabetes prevention can be led by health insurance companies

Conditions and Diseases
May 20, 2010

Whether I’m wearing my health policy hat or seeing patients in the office, one condition continues to surface as a source of concern and frustration.

Diabetes, one of the nation’s most serious and costly health burdens, now affects almost 25 million people in this country — a conservative estimate. Another million new cases are diagnosed each year.

Three years ago, the American Diabetes Association estimated the total diabetes cost in the U.S. …

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Diabetes prevention can be led by health insurance companies

Ritalin and Adderall to improve college grades

Medications
May 19, 2010

I watched 60 Minutes on CBS recently, and was surprised to hear how many college students are using stimulants like methylphenidate (Ritalin)  and amphetamine/dextroamphetamine (Adderall) to get better grades.

These drugs are amphetamines, and Schedule 2 drugs that require a written prescription, cannot be faxed or called into pharmacies, and are considered to have high abuse and addiction potential by the FDA.   They have the same type of effect on the …

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Ritalin and Adderall to improve college grades

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End of life blogging benefits and the questions it raises

Social Media in Medicine
May 19, 2010

With Eva and Alicia, both women were very young, 25 and 28, respectively. And for anyone who knows the history of American bioethics will realize young women, severe illness and dying seem to bring about a intense focus of cultural awareness (see Schiavo, Cruzan, Quinlan).

It struck me how the open sharing of the decline of their health towards death may signal …

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End of life blogging benefits and the questions it raises

Female genital cutting complications

Conditions and Diseases
May 19, 2010

by Todd Neale

Clinicians should actively persuade families not to participate in the ritual cutting of female genitalia, the American Academy of Pediatrics urged.

However, the organization suggested that legislatures and doctors might ultimately consider legalizing ritual “nicks” to satisfy cultural or religious demands without more serious and problematic cutting.

The centuries-old practice, which is illegal in the U.S. and several other developed countries, carries with it a host of physical and psychological …

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Female genital cutting complications

Defensive medicine starts early in residency training

Physician
May 19, 2010

Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients.

I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some …

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Defensive medicine starts early in residency training

ACP: Can medical societies interact ethically with commercial entities?

Health Policy
May 18, 2010

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by Steven Weinberger, MD, FACP

acp-logoThe Council of Medical Specialty Societies (CMSS) recently developed its “Code for Interactions with Companies,” which outlined the principles that should guide relationships between medical societies and commercial entities, including pharmaceutical companies and medical device manufacturers. Although a subsequent editorial in the New …

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ACP: Can medical societies interact ethically with commercial entities?

Why primary care doesn’t appeal to this medical student

Medical Education
May 18, 2010

I try to read as much as I can of everything floating around the medical blogosphere. I think the most recurrent topic I come across is why current medical students aren’t choosing to go into primary care.

It’s a great topic that relates to health care reform, making it ripe for medical bloggers to comment on relentlessly. Probably the most often cited reason is low reimbursement for primary care (read: primary …

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Why primary care doesn’t appeal to this medical student

Children with DNR orders and the liability risk for schools

Patient
May 18, 2010

by Crystal Phend

When children with complex chronic diseases have do-not-attempt-resuscitation orders in place, schools should honor them, the American Academy of Pediatrics urged.

More children with diseases that may involve sudden and potentially fatal attacks are attending school due to legal and societal trends over the past decade, according to a statement in the May issue of Pediatrics.

While these requests are honored in hospitals and nursing homes, schools may find it …

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Children with DNR orders and the liability risk for schools

Burnout is common to teaching violin and practicing medicine

Medical Education
May 18, 2010

I went to medical school and know something about what it’s like to work in clinical environments.

I’ve recently started reading blogs and articles about “physician burnout” and I can’t help but notice that there’s a lot of blame being placed on “the system”. Doesn’t this kind of storytelling just reinforce that physicians are victims? I’d like to see physicians adopt a way of thinking that will enable them to create …

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Burnout is common to teaching violin and practicing medicine

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