Choosing between Lasik and Lasek eye surgery

Physician
June 5, 2010

by Tim Harwood

Hundreds of thousands of people each year are taking the plunge and choosing to have the life changing procedure that is laser eye surgery.

It is currently the most popular elective surgery in the world and the number of people having it done is likely to increase as the procedure becomes safer and more accurate. If you yourself are considering having laser eye surgery, then you will almost …

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Choosing between Lasik and Lasek eye surgery

Will healthcare reform survive the Supreme Court?

Health Policy
June 5, 2010

by Joyce Frieden

Partisan wrangling aside, the Supreme Court will have to address serious constitutional questions about the healthcare reform law, and it’s far from clear how the justices will decide the issues, legal scholars say.

So far, 21 state attorneys general are suing to overturn the law on constitutional grounds. One of their arguments is that by forcing individuals to either buy health insurance or pay a fine, the law violates …

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Will healthcare reform survive the Supreme Court?

Adoption lessons after Artyom Savelyev

Patient
June 5, 2010

The trauma for Artyom continues. After having been given up to an orphanage by his alcoholic mother who lost her parental rights, being adopted by a US family, sent back to Russia alone when his adoptive mother allegedly was unable to cope with his psychological problems, he has now become the object of a tug-of war between Russia and the US over his citizenship. His future seems to hold unimaginable …

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Adoption lessons after Artyom Savelyev

How health reform will help breastfeeding mothers

Conditions and Diseases
June 4, 2010

Pharmaceutical companies and their shareholders are always looking for the next “blockbuster” drug, the label given to a drug that generates more than $1 billion of revenue per year.

Blockbuster drugs don’t necessarily have to save many (or any) lives – slick marketing more than compensates for marginal improvements in treatment efficacy — but they do need to target conditions that are common enough that millions of patients will buy them. …

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How health reform will help breastfeeding mothers

Machine and technology fixation is why health costs are high

Health Policy
June 4, 2010

Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.

If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to …

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Machine and technology fixation is why health costs are high

Doctors can report bad drug ads to the FDA

Medications
June 4, 2010

by John Gever

A new FDA program seeks to enlist healthcare professionals in flagging improper sales tactics for prescription drugs.

Although the agency calls the program “Bad Ad,” its interest goes beyond broadcast and print advertisements to include misleading in-person presentations.

Housed within the Division of Drug Marketing, Advertising, and Communication (DDMAC), the program is intended to increase the number of eyes and ears available to monitor pharmaceutical companies’ promotional activities — especially …

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Doctors can report bad drug ads to the FDA

Can children really have bipolar disorder?

Conditions and Diseases
June 4, 2010

by James Baker, MD

Using the diagnosis “bipolar disorder” for children with problems in mood has been controversial ever since a surge in its use in the mid-1990’s.

A recent article in the Los Angeles Times gives the pros and cons on the use of “bipolar disorder” in children through the opinions of two psychiatrists on opposite sides of the controversy.

The problem with using “bipolar” is that it requires a too-loose interpretation …

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Can children really have bipolar disorder?

Shingles vaccine and the price of preventive care

Conditions and Diseases
June 3, 2010

They say an ounce of prevention is worth a pound of cure, but is that still true in today’s money? Recently I had an illuminating conversation with a patient that got me thinking about how I may try to answer this question. This is the first in a short series on the price of preventive health care.

Mr. GR, as I will call him, had recently turned 60 years young. Though he …

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Shingles vaccine and the price of preventive care

MKSAP: A 50-year-old woman is evaluated for a rash on the back of her elbows and knees

Conditions and Diseases
June 3, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 50-year-old woman is evaluated for a rash on the back of her elbows and knees. A similar rash has occurred in the past, with her first episode as a young adult. She has used over-the-counter hydrocortisone cream without relief. She does not smoke or drink and is otherwise healthy.

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MKSAP: A 50-year-old woman is evaluated for a rash on the back of her elbows and knees

BMI should be routinely measured in pediatric patients

Physician
June 3, 2010

by Emily P. Walker

Physicians should record body mass index (BMI) of their pediatric patients during routine offices visits, according to a sweeping new plan laid out by a White House task force on ways to shrink childhood obesity rates over the next 20 years.

The inter-agency President’s Task Force on Childhood Obesity was formed three months ago as part of the Let’s Move! initiative and was given 90 days to draft …

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BMI should be routinely measured in pediatric patients

Patients who attempt suicide and withdrawal of medical care

Conditions and Diseases
June 2, 2010

If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life?

Not from a legal standpoint, and not if you are living in the United States.

A middle-aged man with a long standing history of depression decides to end his life. He puts a large caliber gun straight to his forehead …

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Patients who attempt suicide and withdrawal of medical care

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Patients who are dying and their awareness of death

Patient
June 2, 2010

by Brad Stuart, MD

Rob Pardi’s comments in Pallimed affected me deeply. His honesty, integrity, and willingness to share were so impressive that I feel reluctant to take issue with anything he had to say. Yet today I find myself somewhat in conflict with his message.

Rob’s wife, a palliative care doctor, died of cancer recently and her story, published in the New York Times made it sound as if …

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Patients who are dying and their awareness of death

Questions patients should be asking their doctors

Patient
June 2, 2010

An excerpt from Top 5 Questions to Ask Your Doctor

by Sagar Nigwekar, MD and James Sutton, RPA-C

Tips for Talking to Your Doctor

Entering a doctor’s office can be like entering a different world. There are often “rules” and “protocols” that the doctor, nurses, and staff follow that you may not be familiar with. This book offers some very helpful questions for you to have an intelligent conversation with …

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Questions patients should be asking their doctors

Working overtime can increase coronary artery disease risk

Physician
June 2, 2010

by Todd Neale

British civil servants working three to four hours longer than usual per day appear to have an increased risk of having a coronary heart disease event, a prospective cohort study showed.

After accounting for traditional cardiovascular risk factors and other variables, those working 11 to 12 hours per day had a 56 percent greater risk of coronary death, nonfatal myocardial infarction, or angina than those who worked normal hours, …

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Working overtime can increase coronary artery disease risk

Prevention improves health and lowers healthcare costs

Health Policy
June 2, 2010

Prevention is the key to both better health and lower healthcare costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate overuse.

Today, the U.S. basically has a medical care system rather than a health care …

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Prevention improves health and lowers healthcare costs

Academic internal medicine as a physician career choice

Medical Education
June 1, 2010

I received a wonderful inquisitive e-mail from a 1st year medical student.  He aspires to an academic internal medicine career and, as a non-traditional student with an MPH, has realistic goals.  He asks:

What scares me is the prospect of going into a relatively low-paying specialty in such a non-lucrative practice environment with such massive educational debt.  Are there any other challenges to going into internal medicine that are unique to …

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Academic internal medicine as a physician career choice

Nurse practitioners, doctors, and the lost art of diagnosis

Conditions and Diseases
June 1, 2010

The topic of nurse practitioners in the context of primary care has been resurgent of late, most notably in this post by Maggie Mahar. Much of the conversation is dominated by assertions such as this:

…Nurse Practitioners have the needed training and that, in fact, doctors who have gone through the full medical school curriculum are over-qualified for a job that, today, is more about coordinating …

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Nurse practitioners, doctors, and the lost art of diagnosis

Cholesterol can be improved by eating nuts

Physician
June 1, 2010

by Todd Neale

Eating nuts improves blood lipid levels, which may help stave off heart disease, researchers found.

In a pooled analysis of 25 intervention trials, eating an average of 67 grams of nuts a day (2.4 ounces) reduced total cholesterol by 5.9% and LDL cholesterol by 7.4% (P<0.001 for both), according to Joan Sabaté, MD, DrPH, of Loma Linda University in California, and colleagues.

The ratios of total to HDL cholesterol and …

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Cholesterol can be improved by eating nuts

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