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Oxycontin should be prescribed less often by doctors

Medications

March 29, 2010

Oxycontin is an oral pain medication that contains the single active ingredient oxycodone. Oxycodone is one of the most potent of the oral opiates, and has more euphoric effect than many other opiate analgesics.

Oxycontin is the most notorious prescription drug of abuse in the US, and for good reason. Though marketed as a sustained release medication, as much as 30% of the medication is absorbed immediately and the rest absorbed …

Why healthcare may not embrace the iPad

Kevin

Health Technology

March 29, 2010

The excitement and hype surrounding the announcement of Apple’s iPad have subsided for the time being, perhaps just a lull prior to the actual release in a few months. It’s expected that the iPad could make significant contributions to healthcare, such as potentially replacing the physician’s clipboard or medical textbooks.

However, we did disagree at times on the extent to which the iPad could penetrate the healthcare market, for a variety …

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Why healthcare may not embrace the iPad

Diet Coke and the AHA red dress endorsement

Kevin

Medical Education

March 29, 2010

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

A red dress jauntily displayed on cans of Diet Coke has become the latest symbol in the ongoing debate about pharmaceutical company support of research or CME.

But whose dress is it? The American Heart Association says it’s “not our red dress,” even as leading pharma critic Steven Nissen, MD, …

Jargon dominates medicine and how doctors verbalize nouns

Robert Wachter, MD

Physician

March 28, 2010

One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.”

Say whaa?

I’m pretty sure that the most valuable thing I’ve done …

Death in a hospital is not always comfortable

John Schumann, MD

Physician

March 28, 2010

In America, too many people die in the hospital.

I don’t mean that they die due to medical error or incompetence, though that’s always a hot topic of discussion amongst doctors, researchers, administrators, and regulators.

What I mean is that if you ask most people, they say they’d rather die at home, surrounded by their loved ones, drifting off to sleep painlessly after having had last rites administered (feel free to plug …

Patient questions during doctor visits are uncommon

Steve Wilkins, MPH

Patient

March 27, 2010

Ask your doctor. I think most of us would agree that is good advice, at least up to the point that we find ourselves sitting half naked on an exam table in our doctor’s office. Then the doctor walks in and for some reason many of us just “clam up.”

Patient question-asking during the primary care office visit was and continues to be an “index” of patient health information …

Guilt used in a positive manner can help with parenting

Claudia M. Gold, MD

Patient

March 27, 2010

In my pediatric practice, it is not uncommon for a mother, given the time, to move quickly away from telling me about her child’s behavior problem, to talk about herself, sharing vivid stories of emotional distress from her own life. I may suggest that this distress could make it difficult for her to deal with the challenging behavior of her child.

Rather than finding this statement helpful, she might collapse back …

Primary care access isn’t guaranteed by health insurance

Matthew Mintz, MD

Physician

March 26, 2010

An excellent article appeared recently in the Washington Post, entitled, “Having health insurance doesn’t ensure it will be easy to find a doctor,” where a young, otherwise healthy and insured woman discusses her extreme difficulty in finding a doctor in Washington, DC who will see her.

“I was just 23, basically healthy and, most important, insured. So I pulled out my computer, looked up the UnitedHealthcare list of pre-approved doctors …

10 salt reducing tips that can lower your blood pressure

Erin Marcus, MD

Patient

March 26, 2010

It’s hard for Cassandra Mathieu to describe her mother’s cooking without mentioning the salt shaker.

“I remember my mother used to cook with seasoning salt, garlic salt, every kind of salt you can imagine,” she said recently. “We grew up on salt.”

Cassandra grew up fixing food the same way, adding generous amounts of salt to dishes she prepared and to her food at the table. At age 42, she discovered her …

Cancer deaths are improving, but a cure remains distant

Kevin

Conditions and Diseases

March 26, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

Almost 40 years and 100 billion federal dollars have been invested in the “War On Cancer” since President Richard M. Nixon declared it, but the campaign is far from over, two researchers concluded this week in the Journal of the American Medical Association.

“These funds have been more than matched by …

VBAC rates are low, but are obstetricians to blame?

Kenneth Lin, MD

Conditions and Diseases

March 25, 2010

My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn’t because she is showing signs of a late-developing handicap or extraordinary ability for her age – it’s because she came into the world as a vaginal birth after Cesarean section (VBAC), delivered by a certified nurse midwife.

Although more than three-quarters of women who choose a trial of labor over a repeat Cesarean …

VBAC should not be a woman’s right

Amy Tuteur, MD

Conditions and Diseases

March 25, 2010

VBAC activists are clinging to their resentment and aggressively ignoring reality.

Amy Romano at Science & Sensibility asks the bizarre question: Do women need to know the uterine rupture rate to make informed choices about VBAC? It’s bizarre because she implies that this is a medical question and that the answer is unknown. However, this is a legal question and the answer has been clearly established by the courts. Not …

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VBAC should not be a woman’s right

Cancer side effects are being ignored by the media

Kevin

Conditions and Diseases

March 25, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

When the mainstream media report on cancer treatments, they seldom note that aggressive therapies may fail or cause severe side effects, researchers said.

Analyzing more than 400 articles about cancer in major newspapers and magazines, investigators at the University of Pennsylvania found that adverse outcomes or palliative care were hardly …

Government-controlled health insurance may politicize health

Paul Hsieh, MD

Health Policy

March 25, 2010

During President Obama’s final push for “universal health care” legislation, his biggest obstacle was not Republicans but rather anti-abortion Democrats let by Congressman Bart Stupak (D-Michigan).

Stupak eventually reached a last-minute deal with the White House on federal funding of abortion services. But no one should be surprised that under government-controlled health insurance, medical coverage decisions will be based on political considerations. Rather, the recent wrangling over abortion will be …

Allopathic medicine has alternative medicine roots

Shantanu Nundy, MD

Conditions and Diseases

March 24, 2010

Whether we like it or not, the lines between allopathic and alternative medicine continue to blur. Just last week I recommended glucosamine-chondroitin to a patient who suffers from osteoarthritis and wrote a prescription for Lovaza, a prescription-strength preparation of fish oil. And today I was asked about red yeast rice from a patient interested in controlling her cholesterol through “natural means.”

Like nutrition, complementary and alternative medicine, or CAM, is somewhat …

Health reform should make conservatives very happy

Kevin

Health Policy

March 24, 2010

Let’s get one thing out of the way.

The health care reform bill that passed the House this past Sunday, and will be fixed via reconciliation in the Senate, is a moderate, relatively incremental approach to fixing our health care system.

Conservatives are up in arms, as they have been during the entire process, and are lining up lawsuits and trying to gather momentum to repeal the bill.

And I’m asking myself, …

ED can predict heart death

Kevin

Physician

March 24, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

Patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications, researchers found.

In men who reported ED at baseline, all-cause mortality during a median follow-up of four years was double that seen …

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ED can predict heart death

Archeology skills work in medicine

Edwin Leap, MD

Patient

March 23, 2010

I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)

My kids and I walk the red-clay paths and look down …

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Archeology skills work in medicine

Tax credits and new patient care models in health reform

Kevin

Health Policy

March 23, 2010

by Robin Tang

Sunday, March 22, 2010, marked the passage of the Health Care and Education Affordability Reconciliation Act (H.R. 4872) by the House by a narrow 219-212 margin, with no Republicans voting in favor. Whether you think the bill is good, bad, sustainable, or even constitutional, we can agree this was a historic day.

Putting politics aside, I want to highlight two parts of the bill that aren’t getting enough …

Palliative care shows the importance of language

Kevin

Physician

March 23, 2010

by Patrice Villars

The best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication.

What if, in our kind, well-meaning …

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