Physicians writing on KevinMD about the diseases they treat and the people who have them: cancer and its screening arguments, pain and the drugs that treat it, diabetes and the obesity argument, mental illness and who gets treated for it, and the decisions at the end of a life. Five maintained records draw on this archive: Cancer: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, End of life: what physicians say, in their own words, Diabetes and obesity: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.

Physical exam evidence and whether it’s still useful

Conditions and Diseases
March 15, 2010

A number of respected physicians have called for a renewed emphasis on the physical exam. Perhaps most prominently, Abraham Verghese has joined with colleagues at Stanford University to publicize the Stanford 25, a list of physical-exam maneuvers that they hold should be required of internal medicine residents.

These calls reflect in part the fear that checklist medicine will lead to doctors’ obsession with what Jerome Groopman calls the “iPatient” (the …

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Physical exam evidence and whether it’s still useful

PSA for prostate cancer screening is likely to continue

Conditions and Diseases
March 15, 2010

Originally published in MedPage Today

by Crystal Phend

The ASCO Genitourinary Cancers Symposium met recently, just after the American Cancer Society updated its prostate cancer screening guidelines to emphasize shared decision making and Congress heard testimony over use of prostate specific antigen (PSA) in prostate cancer screening.

Now urology is no stranger to debate. Controversy continues on overdiagnosis, overtreatment, and other issues raised …

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PSA for prostate cancer screening is likely to continue

PSA screening for prostate cancer debated in Congress

Conditions and Diseases
March 14, 2010

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

A day after the American Cancer Society (ACS) released updated prostate cancer screening guidelines, the group’s chief medical officer was before Congress urging the government to fund research into alternative screening methods for prostate cancer.

Otis Brawley, MD, an oncologist and chief medical officer for the ACS, told the House Oversight …

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PSA screening for prostate cancer debated in Congress

Autism in children can be missed early in life

Conditions and Diseases
March 11, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.

At six months, …

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Autism in children can be missed early in life

Evidence and the Eastern paradigm of medical treatment

Conditions and Diseases
March 7, 2010

Remember the trial a couple of years ago that showed that group support participation was associated with prolonged survival among women with metastatic breast cancer?

I’ve thought a lot about that over the years. Isn’t it interesting that something as simple as a supportive environment can make a difference in what researchers consider to be the hardest endpoint there is: survival? In our dualistic view of the human organism, we think …

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Evidence and the Eastern paradigm of medical treatment

Placebo effect ethics in medical treatment

Conditions and Diseases
March 3, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

The placebo effect is a real and therapeutic psychological phenomenon that, with more research, could be exploited more systematically in medical practice, said Australian researchers.

“There is not one placebo effect, but many,” wrote Damien Finniss, MSc, of the University of Sydney in Australia, and colleagues in the Feb. 20 …

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Placebo effect ethics in medical treatment

Why cancer screening is not a black or white decision

Conditions and Diseases
February 26, 2010

Last month I saw a 65 year-old woman with a mass in her kidney in clinic for follow up. She had recently transferred her medical care to our clinic after her insurance changed.

She came with a few medical problems including high blood pressure, tobacco use and arthritis — diseases which are the bread and butter of primary care medicine — but she also came with a history of a mass …

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Why cancer screening is not a black or white decision

What doctors do when they don’t know the answer

Conditions and Diseases
February 22, 2010

Part two of a series. See also part one.

Previously I’d discussed how most of the time diagnoses are relatively straightforward. But what do doctors do when a diagnosis isn’t immediately clear to them?

Likely one or more of the following:

1. Revert to “novice” thinking. Which, in fact, is completely appropriate. We’re taught in medical school that approximately 90% of all diagnoses are made from the history, so if we can’t …

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What doctors do when they don’t know the answer

Treating ADHD may not improve kids’ school grades

Conditions and Diseases
February 18, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Adhering to guidelines when treating children with attention deficit hyperactivity disorder (ADHD) relieved symptoms but had no effect on kids’ performance in school or in their relationships with others, researchers found.

Although parents and teachers noted significant improvements in symptoms among ADHD kids (P<0.001) in a special treatment program, there …

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Treating ADHD may not improve kids’ school grades

Treating atrial fibrillation with catheter ablation on TV may not be ethical

Conditions and Diseases
February 17, 2010

Mauricio Arruda performed a live atrial fibrillation ablation at University Hospitals in Cleveland on the Today Show recently.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like atrial fibrillation and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy …

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Treating atrial fibrillation with catheter ablation on TV may not be ethical

Magnetic resonance imaging (fMRI) for persistent vegetative state

Conditions and Diseases
February 17, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Researchers in England are reporting they have been able to establish limited communication with a man in a persistent vegetative state by using functional magnetic resonance imaging (fMRI).

The 34-year-old man was able to answer simple Yes or No questions by imagining different types of activity, which caused changes …

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Magnetic resonance imaging (fMRI) for persistent vegetative state

Don’t fall into the dementia trap when treating a developmental disability

Conditions and Diseases
February 16, 2010

by Lockup Doc

In addition to correctional psychiatry, I spend about half of my professional time treating patients with developmental and intellectual disabilities (mental retardation). The majority of my patients have severe or profound mental retardation and are completely nonverbal.

Over the years I have observed that when many of them are admitted to the hospital for acute medical or surgical problems, because they are severely cognitively and functionally impaired, they are …

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Don’t fall into the dementia trap when treating a developmental disability

Why The Biggest Loser uses CT scans to help contestants lose weight

Conditions and Diseases
February 15, 2010

Originally published in MedPage Today

by Cole Petrochko

The train wreck has become an integral part of reality TV programming, and that’s terrible. As much as I’ve learned on the internet about the “Snooki Punch” fiasco from MTV’s Jersey Shore, there’s little to watching a household of adults thrown together under a wacky premise turn into overgrown, throat-seeking children under lights and a camera, except on the one-season CBS show Kid …

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Why The Biggest Loser uses CT scans to help contestants lose weight

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How overly aggressive cancer awareness can backfire

Conditions and Diseases
February 12, 2010

The American Cancer Society has designated this weekend “Suits and Sneakers Awareness Weekend,” as part of the annual Coaches vs. Cancer program that will feature well-dressed basketball coaches wearing “sneakers instead of dress shoes with their usual game attire during weekend games to demonstrate their support for the Society and the fight against cancer.” The idea is to encourage people to exercise and eat a healthy diet to reduce their …

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How overly aggressive cancer awareness can backfire

Neuroscience explains why changing addictive behavior is so difficult

Conditions and Diseases
February 12, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

By the end of January, many New Year’s resolutions have been tossed out with the leftover holiday cookies. That’s because change is hard — and neuroscientists are learning why.

Advances in neuroimaging have enabled researchers to peer inside the brains of addicts and patients with addictive behaviors. They can see in …

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Neuroscience explains why changing addictive behavior is so difficult

Doctors have an ethical obligation to treat complications from a transplant operation performed abroad

Conditions and Diseases
February 11, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Patients who travel to foreign countries for organ transplants may return with more problems than they left with — and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.

“Medical tourism” has been on the rise as demand for organs outpaces supply and U.S. …

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Doctors have an ethical obligation to treat complications from a transplant operation performed abroad

When doctors can’t figure out what’s wrong with a patient

Conditions and Diseases
February 10, 2010

Part one of a series.

The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn’t because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the …

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When doctors can’t figure out what’s wrong with a patient

Similarities between H1N1 flu pandemic conspiracies and the Y2K bug

Conditions and Diseases
February 10, 2010

Originally published in MedPage Today

by Mike Himowitz

When I read Michael Smith’s account of European politicians taking WHO to the woodshed for allegedly conspiring with vaccine makers to overinflate the danger from H1N1 pandemic flu, I was reminded of a similar — and equally silly — argument that occurred exactly a decade ago.

In the early days of 2000, you …

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Similarities between H1N1 flu pandemic conspiracies and the Y2K bug

The power of a doctor’s choice of words in explaining CPR

Conditions and Diseases
February 8, 2010

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that …

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The power of a doctor’s choice of words in explaining CPR

How hypertension increases the risk of dementia

Conditions and Diseases
February 7, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities.

Data from an offshoot of the Women’s Health Initiative found that participants’ baseline blood pressure was strongly correlated with volume of lesions in their brains’ white matter, according to Lewis …

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How hypertension increases the risk of dementia

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