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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 …

Why rosiglitazone would not have been approved today

Larry Husten, PhD

Medications

March 7, 2010

Avandia continues to dominate cardiovascular-related news this week. Recently, the AHA and the ACC issued a highly detailed, thoughtful, though perhaps slightly over-diplomatic science advisory on TZDs and CV risk. Taking a completely opposite tack, GSK, in no mood to take prisoners, and apparently about to nominate itself for a Nobel Prize, issued a 30 page White Paper in response to the Senate report published on Saturday.

At the core …

Using CT scans to diagnose chest pain in the ER

John Mandrola, MD

Physician

March 6, 2010

During residency, there was always a case of misdiagnosed chest pain to discuss in conference. Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.

So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.

Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …

How doctors allow bias to affect patient care

Alex Lickerman, MD

Physician

March 5, 2010

Part three of a series. See also parts one and two.

Previously, I have suggested that patients should do their best to get their doctors as free from the influences of their biases as possible. In order to do that, patients (and doctors) need to recognize what forces are working against them.

Here’s what negatively influences a doctor’s decision making:

1. They fall behind in clinic. Your doctor may be naturally …

Becoming vegetarian can help fight high cholesterol

John Schumann, MD

Physician

March 5, 2010

I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.

I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.

Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a …

Young doctors gathered around the beer machine

Kevin

Medical Education

March 5, 2010

Originally published in MedPage Today

by Charles Bankhead

From time to time, I hear a “mature” person lament the sad state of affairs of the “next generation.” Sometimes I wonder whether the same concern should apply to the next generation of doctors.

I was at a cardiology meeting, and my schedule included a breakfast program. As I headed toward the meeting, I …

C Diff and antibiotic resistance in kids

Marya Zilberberg, MD, MPH

Medications

March 4, 2010

A recent story from the UK reported a school child who developed diarrhea and tested positive for C difficile.

The alarming thing is that there did not seem to be any explicit risk factors for this. The appalling thing is the mis-information by the story that, “children rarely become ill with C diff, which normally strikes elderly people in hospital.”

This is how things used to be, before the BI/NAP1/027 bug evolved …

Obesity treatment in family members should be contagious

Kenneth Lin, MD

Patient

March 4, 2010

The Framingham Heart Study is perhaps the most famous long-term medical study. As every medical student learns, starting in 1948, the lifestyle habits of thousands of residents of Framingham, Massachusetts were followed to determine important risk factors for cardiovascular disease.

It is because of this study that your physician can, with a few keystrokes, predict with great accuracy your risk of having a heart attack within the next 10 years and …

Hospitals can deliver low cost, high quality care

Kevin

Physician

March 4, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Many hospitals that spend relatively little per patient deliver good-quality care, researchers said.

Medicare data indicated that hospitals in the highest quartile of per-patient cost for initial treatment of pneumonia or congestive heart failure (CHF) did not have markedly lower readmission or risk-adjusted mortality rates than hospitals in the lowest …

Free iPhone medical apps that every doctor can use

Satish Misra, MD and Iltifat Husain, MD

Health Technology

March 3, 2010

by Iltifat Husain, Yousif Alkadhi, MD, and Satish Misra

If you’re a physician, medical student, or in any other health care related field, trying to find the best free medical apps for the iPhone is a hassle.

Apps such as “Dream Meanings”, “Relax Ocean waves”, and “Stool Scanner Lite” dominate the Top Free Medical Apps list in the App Store. Our top 10 iPhone medical apps list contains no such app, …

Health reform needs to end fee for service medicine

Pearl Korn

Health Policy

March 3, 2010

As the health reform debate rages on, the central issue of how to improve care while reducing costs remains unaddressed.

Fee-for-service has reduced doctors to assembly line pieceworkers, paid by the office visit and procedure rather than by effectiveness of treatment. The result is an inefficient, costly and dangerous system. It is not unusual for a five minute office visit, which excludes clinical examination or note taking. Many patients/consumers can be …

Placebo effect ethics in medical treatment

Kevin

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 …

Transgender patients face significant challenges in prison

Jeffrey Knuppel, MD

Patient

March 2, 2010

Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.

Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the …

The Danny Williams surgery shouldn’t be controversial

Kevin

Health Policy

March 2, 2010

Originally published in MedPage Today

by Michael Smith

OK, don’t take this the wrong way, but ….

Chill. Relax. Give the other guy the benefit of the doubt. Don’t jump to conclusions. And most of all, think before you speak, blog, natter, comment, or otherwise pontificate on issues of the day.

And when I say ‘think,’ I don’t mean trying to find the …

Medicare slashes pay to doctors, and what that really means

Wes Fisher, MD

Health Policy

March 1, 2010

What we’re learning from the 21% Medicare pay cut to physicians that occurred today:

* There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians’ payments.

* There’s was widespread political support for blocking the scheduled pay cuts to doctors, but central government control moves very slowly. That’s because doing so is expensive. For now, doctors have been …

Bipolar disorder and how Rebecca Riley could have been saved

Claudia M. Gold, MD

Medications

March 1, 2010

Carolyn Riley’s act of giving her daughter Rebecca an overdose of prescribed medication may have been the immediate cause of Rebecca’s death, the conclusion reached by the jury that convicted her of murder.

Even if, as the prosecutor argued, Carolyn and her husband concocted symptoms of mental illness and the psychiatrist, who diagnosed bipolar disorder, was a gullible enabler, the real guilty party in this story is, in my opinion, …

Medicare cuts will strengthen doctors’ negotiating position

Richard Reece, MD

Health Policy

March 1, 2010

Doctors will soon be wagging the reform dog.

Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, will also take more doctors.

As everybody knows, coverage does not equal access. This is most vividly illustrated in …

Your metformin may smell like dead fish

Kevin

Medications

March 1, 2010

Originally published in MedPage Today

An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned.

Metformin is known to cause adverse gastrointestinal effects such as diarrhea, nausea, vomiting, flatulence, distention, and abdominal pain. Those side effects “often necessitate discontinuing the drug,” a group of physicians and pharmacists …

Read more…

Your metformin may smell like dead fish

A nurse practitioner is valuable in hospice and palliative care

Kevin

Patient

February 28, 2010

by Patrice Villars

Recently, a physician colleague expressed her concern about signing routine hospice admission orders for her elderly patient with end stage heart failure. The routine ‘as needed’ (PRN) orders included phenobarbital, pentobarbital, haloperidol, lorazepam, and morphine. “The hospice nurses know more about this than I do, don’t they?” she said.

Yesterday, a longtime palliative care nurse told me she didn’t want to put her mother with end stage heart …