Will we – you and me and our parents and neighbors – be a significant force in quelling the tide of over-testing for the early detection of disease?
When you have had cancer as many times as I have, you become suspicious that there are more cancer cells inside you waiting for some obscure signal to make them leap into action and start multiplying out of control. So you develop a …
Have cancer screening tests been oversold?
A recent Canadian study showed that the youngest children in each grade (born in the earliest month of the Canadian grade cutoff: December) were 30% more likely to be diagnosed with ADHD than the oldest children (born in January). For girls, who overall have a lower incidence of ADHD, the difference was even more pronounced: 70%.
Interestingly, the overall rate of ADHD diagnosis in the sampling of children from this Canadian …
The conundrum between maturity and ADHD
I have a confession to make.
As soon as I finished reading the Annual Report to the Nation recently, I got up from my desk and took a walk for 20 minutes.
What, might you ask, compelled me to do this?
The answer is what made me take a walk is the same reason I am writing this follow-up commentary. Sitting …
Lower your cancer risk and take a walk
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated for a 1-year history of progressive exertional dyspnea. She does not smoke cigarettes or use illicit drugs. The patient has a history of obesity and has used various appetite suppressants but takes no other medications. She has no significant family or …
MKSAP: 54-year-old woman with progressive exertional dyspnea
In recent years, childhood overweight and obesity statistics have received a good deal of media attention, but this has done little to slow their rise. Data from the National Health and Nutrition Examination Survey shows that nearly 1 in 5 children aged 2-19 are obese. Even more concerning, since 1980 obesity rates have tripled in the 6-11 and 12-19 age groups.
Our …
Bearing the burden of the uphill battle against childhood obesity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura, since age 16 years. She has an average of three attacks each month and consistently experiences an attack 2 days prior to menstruation; this headache is more difficult to …
MKSAP: 36-year-old woman with a history of migraine
Against the backdrop of life as it is really lived, the decision to breast-feed or bottle-feed is minuscule.
Whether or not you decide to breast-feed your baby — and for how long — is, in the scheme of things, just one decision out of a million. And ultimately, you should do what works best for you and your family.
Full disclosure here: I never wanted to breast feed. I don’t know why. …
Breast feeding and the mismatch between idealism and realism
One pitfall of some of the incredible medical advances over the last century is that we too often forget what it was like before.
Before penicillin in the 1940s, thousands died of simple infections. Before a cure for polio in the mid-‘50s, tens of thousands were sickened, killed or disabled.
And before outpatient dialysis became widely available in 1972 – 40 years ago this year – 100,000 Americans died of kidney failure …
Reducing the need for dialysis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.
On physical examination, the patient is uncooperative and …
MKSAP: 32-year-old man is disoriented, combative, and agitated
The healthcare needs and challenges presented by the nation’s returning veterans are complex and critical.
That’s not news to all, yet not all clinicians realize how close and relevant the issues actually are. More than half of all returning veterans are treated outside of the military healthcare system and the VA, which means community-based clinicians are on the front lines of care delivery to veterans.
Very often, this also now means that …
Improving healthcare for veterans on college campuses
I am sitting at home and the popular show American Idol is on. Randy Jackson has a red shirt on, which is color coordinated with a large red Coca-Cola cup. J-Lo is sitting by his side, also with a red Coca-Cola cup. Same with Steven Tyler. When one of the artists takes the stage, there is a large red moving video banner promoting Coca-Cola. It’s called product placement and it …
Is Coca-Cola on American Idol contributing to childhood obesity?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old man is evaluated for concerns noted by his wife of a marked change in overall behavior over the past 6 months, including deterioration in his general hygiene and episodes of talking to imaginary people. His employer has also raised concerns about his work performance. The patient has also noted intermittent tingling in the …
MKSAP: 27-year-old man with a marked change in overall behavior
Pain is the result of a physiological series of electrical and chemical events that occur in the body. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
Pain receptors are bare nerve endings that are widely distributed throughout the body in the skin and mucous membranes. When pain receptors are …
Cancer pain is often undertreated
ADVERTISEMENT
Despite remarkable changes in technology, only 20% of patients who could benefit from hearing aids actually wear them. Reasons vary, but include a lack of awareness among patients and physicians, fear of stigmatization, and failure to recognize the immense value of hearing aids on social life and productivity.
Hearing loss affects 36 million Americans according to the National Institute on Deafness and other Communication Disorders (NIDCD). One third of people …
Hearing loss affects more people than you think
A Miami Herald story, heralds “Prostate cancer hits younger men.” You know right away how this one is going to play out.
The story begins by profiling a 48-year old man with prostate cancer. It says his “doctor ordered the test as a routine practice for his male patients.” There isn’t any discussion about how such ordering as a routine practice doesn’t demonstrate the kind of shared decision-making model that the …
Cancer screening stories need to report on the uncertainties
Recently I have become interested in the obesity epidemic plaguing our country. I’ve actually been interested in obesity and co-morbid psychiatric illness since residency, but recently my interest has been revived. I read that Medicare is going to be reimbursing health care practitioners for obesity counseling and screening. My initial thought was that this is a positive step in the right direction. But the cynic in …
The problem with obesity counseling
She knew she was supposed to be careful about getting pregnant, although truthfully she didn’t think it could happen because of her blood pressure and kidney problems. The nurses at the county clinic started her on the pill, but her blood pressure went all crazy. They asked her to come back on a Wednesday night when the doctor was there. The doctor asked lots of questions and spent a lot …
Planned Parenthood can’t accept Medicaid in Texas: Why we should care
Does muscle weakness improve after disc surgery?
For an NFL fan arguably the best thing that could happen to your team is to sign Peyton Manning and have him perform at or near his pre-injury level. The corollary is that one of the worst things to happen to your team would be to take a huge salary cap hit to get a Peyton Manning with such weak throwing arm that even …
Will Peyton Manning ever fully recover from his spinal nerve injury?
As a veteran of World War II, my grandfather was a GI Bill success story, the first man to go to college from his impoverished neighborhood in Jersey City thanks to government at its finest. A card-carrying member of the state teachers’ union, and a politically active Democrat for most of his life, it came as something of a shock to me when, after a few decades of observing big …
A radiologist disagrees with the breast cancer screening guidelines
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Colorectal cancer is the second leading cause of cancer-related deaths for men and women in the United States. Although the effectiveness of colorectal cancer screening in reducing deaths is supported by the available evidence, only about 60 percent of American adults aged 50 and older get screened.
A new …
ACP reminds physicians to assess risk, screen for colorectal cancer
Get free updates delivered free to your inbox.
