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Drug reps know what doctors are prescribing

Kevin

Medications

November 24, 2010

An excerpt from White Coat, Black Hat.

by Carl Elliott

[Michael] Oldani worked as a rep in the late 1980s and the 1990s, a period when the drug industry was undergoing key transformations. Its ethos was changing from that of the country-club establishment to the aggressive, new-money entrepreneur.

Impressed by the success of AIDS activists in pushing for faster drug approvals, the drug industry increased pressure …

Why comparing healthcare access to food is a false analogy

Marya Zilberberg, MD, MPH

Health Policy

November 23, 2010

When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period.

And I had to stay home because I could not stop praying to the porcelain Goddess during a bout of a particularly nasty flu, despite a vaccination. I actually took pride in my health record, and attributed it directly to being rather sickly as a child. …

There is no routine procedure in general surgery

Jeffrey Parks, MD

Physician

November 23, 2010

The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.

One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …

Diabetes and leg amputations in McAllen, Texas

Merrill Goozner

Conditions and Diseases

November 23, 2010

The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.

This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen’s rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen’s rate.

McAllen became notorious earlier …

ACP: Health care innovation in the Affordable Care Act

American College of Physicians

Health Policy

November 23, 2010

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

by John Tooker, MD, MBA, MACP

The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have the real potential to improve health and health care and, lower costs.

Two recent reports remind us of the …

Noninvasive fat removal in plastic surgery

Anthony Youn, MD

Conditions and Diseases

November 23, 2010

One of the hottest things in plastic surgery is noninvasive fat removal.

I’ve mentioned on Rachael Ray Showthat fat removal without any invasiveness is the ‘holy grail’ of plastic surgery, and I still stand by it. I’ve gone over the Zerona a few times, but what about Zeltiq, a.k.a. Cryolipolysis? Does this device actually remove fat without surgery or needles?

Well, let’s review the different fat removing technologies:

1. Diet and exercise. The …

Why you should care about prison healthcare

Jan Gurley, MD

Patient

November 22, 2010

It was kind of amazing how little coverage the recent report on healthcare in our prison systems got. Heck, you may be thinking, I don’t think that’s amazing – why waste airtime on that topic – why should I fret and worry about the healthcare that prisoners get when my child is burning up with fever and coughing up a lung and I can’t even afford to take her to …

Breast cancer transforms a doctor in training to patient in an instant

Kevin

Conditions and Diseases

November 22, 2010

by Jessica Tekla Les, MD

During my third year of medical school I was performing a routine breast exam, more for practice than anything else. I was trying the concentric-circles-around-the-nipple technique, one of several I’d been taught. About halfway through the right breast I found a lima-bean-sized lump, not far from the breastbone. I took liberties with this particular exam. I poked the lump, tried to …

Will primary care be saved by the community health center?

Allen Perkins, MD

Physician

November 22, 2010

As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center.

Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic …

Do online physician rating sites help patients to choose a good doctor?

Kevin Pho, MD

KevinMD

November 22, 2010

The following op-ed was published on October 27th, 2010 in USA Today.

When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.

Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a “detailed background report” or a “profile” of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against …

Depression and whether a behavioral problem is mental illness

Dr. Joe Kosterich

Conditions and Diseases

November 22, 2010

It has been said that depression is the epidemic of the 21^st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.

The number of Americans prescribed an antidepressant doubled between 1996 and 2005 and those being …

Trust your life records to an unnamed chain of software vendors

Margalit Gur-Arie

Health Technology

November 21, 2010

Every day millions of Americans and billions of people around the globe are routinely accepting colorful pieces of paper in return for their labor and placing those hard earned possessions in modern glass buildings whose owners they do not know.

It took a few hundred years to change how business transactions are conducted, but today, there is very little apprehension about depositing one’s wealth in a bank. Public trust in both …

Do posters in the hospital really help patients?

Jaan Sidorov, MD

Health Policy

November 21, 2010

The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine.

We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my …

Routine use of sleep medication for children

Claudia M. Gold, MD

Medications

November 21, 2010

A recent study published in the journal Sleep Medicine revealed that most child psychiatrists prescribe medication for sleep at least once a month, despite the fact that no sleep medications are approved for use in children. The study was funded by Sanofi-Aventis, makers of Ambien.

Managing sleep is one of the greatest challenges of being a parent. It represents the first major separation and can be fraught with complex ambivalent feelings. …

Cardiothoracic surgery has a shortage of surgeons

Kevin

Physician

November 20, 2010

by Shawn Vuong

Some time in the years 2002-2005, cardiothoracic surgery hit the wall.

The specialty’s big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over trained surgeons who were no longer in demand. The interventional cardiologist had come along and started stenting coronary arteries, saving patients from the chest opening …

Quinine, artemisinin and our debt to traditional medical healers

Kevin

Medications

November 20, 2010

An excerpt from Sustaining Life: How Human Health Depends on Biodiversity.

by Eric Chivian, MD and Aaron Bernstein, MD

Ethnobotany, that is, the scientific study of the use of plants by native cultures, including their use as medicines, can be said to have begun with Carl Linnaeus, who in the 1730s published Flora Lapponica, his detailed account of plant use by the Lappish, or Sami, people, …

When does the duty to provide emergency medical care end?

Kevin

Physician

November 20, 2010

by Lyle Denniston

Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an …

Taxing soft drinks to combat obesity

Arya M. Sharma, MD

Patient

November 19, 2010

One commonly heard propositions to combat the obesity epidemic is to tax soft drinks. No doubt, sugary soft drinks are a common and important source of “empty” calories, but will taxing soft drinks really reduce obesity rates?

This assumption was now examined by Yale University’s Jason Fletcher and colleagues, in a paper just published in Contemporary Economic Policy.

The researchers collected information on taxation of soft drinks with respect to specific excise …

Read more…

Taxing soft drinks to combat obesity

Caregiving requires that caregivers need practical and emotional support

Kenneth Lin, MD

Patient

November 19, 2010

Mr. B, the patient who first stirred my interest in family medicine, was a spry former World War Two fighter pilot who came to the ER complaining of an irregular heart beat. I remember him regaling me with stories about the Battle of Britain while his wife dutifully stood by his side in the chaos of the crowded emergency room at a private hospital affiliated with my medical school.

It was …

Never hesitate to seek a second medical opinion

Eric Van De Graaff, MD

Patient

November 19, 2010

To celebrate your 50th birthday you head to your doctor’s office to get your yearly exam. He rewards you for your diligence by poking and prodding you, sticking you with needles, and arranging for a colonoscopy (happy birthday!). He also sends you for a stress test out of concern about your strong family history of premature heart disease.

A slightly abnormal treadmill test leads to …

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