Complementary and alternative medicine need more randomized trials

Meds
February 1, 2012

Since I dedicated an entire issue of JAMA on Nov. 11, 1998 to the theme of Complementary and Alternative Medicine in an effort to move CAM into the mainstream, I keep hoping that some of the numerous CAM offerings will make it out of the realm of anecdotal and placebo-healer-effect, and successfully through randomized controlled clinical trials.

So I got excited when I saw the BMJ Evidence Centre via …

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Complementary and alternative medicine need more randomized trials

How long do you expect to live?

Physician
January 14, 2012

To just what age do you expect to live? You haven’t thought about it? I bet you have. Would you like to live as long as Methuselah?

Television’s “Today Show” antes up centenarians to celebrate from time to time. There are about 70,000 American outliers past the age of 100. But that’s out of a population of some 311,000,000 people.

The most sensible place I know to read about this conundrum of …

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How long do you expect to live?

I’m proud that I’ve never had an MRI or CT scan

Physician
December 26, 2011

What is your personal experience with MRIs? Was your last one fun? How much did it cost whoever paid for it? Did it make a real difference in your outcome?

I am a 78-year-old American man in robust general health and with good comprehensive health insurance all my adult life and I have never had an MRI.

Until 2010, I had also never had a CT scan. And I’m proud of that.

Why …

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I’m proud that I’ve never had an MRI or CT scan

Why the future of the American medical profession is looking good

Physician
December 12, 2011

“I’m not a doctor, but I play one on TV.” It seems that everybody wants either to be a doctor or to play doctor.

There are “doctoring” nurse practitioners who some derogatorily call noctors; there are RNs who get a PhD, and are thus Doctors of Philosophy; and then there are those new DNPs, Doctors of Nursing Practice.

Of course, there are Doctors of Pharmacy, Doctors of Chiropractic, Doctors of Podiatry, …

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Why the future of the American medical profession is looking good

Is there truth to the unintended consequences of hospitalists?

Physician
December 5, 2011

When I first learned that the U.S. was going to develop a new specialty, the hospitalist, I was very pleased.

I had long believed from study and direct observation that some of the better healthcare systems in Europe were benefited in a major way by the general separation of office and hospital medical practices and practitioners.

In the U.S., historically most patients have been taken care of by physicians practicing medicine in …

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Is there truth to the unintended consequences of hospitalists?

Health IT has problems, but is worth the price

Tech
November 29, 2011

I started working with computers in medicine in 1963. I was a Captain in the United States Army Medical Corps in San Francisco when a Lieutenant Colonel told me to “automate the California Tumor Tissue Registry.”

I said, “Yes, Sir. How would I do that?” He told me to walk across the Presidio parking lot and go into a building that had a big machine in it that is called a …

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Health IT has problems, but is worth the price

Is it possible to implement a list of essential health benefits?

Policy
November 6, 2011

What is an essential health benefit? I suppose that is a health or medical action, product, or process that should be paid for by someone other than the patient, in a society that provides so-called “third party coverage.”

Many very smart people and strong organizations have struggled with this issue for many decades.

Prior answers, such as they are, have come from staff model HMOs like Kaiser Permanente, the Veterans Health Administration, …

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Is it possible to implement a list of essential health benefits?

How to control health care costs in the USA

Policy
November 1, 2011

We are finally in the midst of American football season again, after so many dull months. Are you ready for: “We’re Number 1; we’re Number 1”?

School pride; conference pride; regional pride; confirmation of identity; proof of manhood.

Think Summer Olympics in London, 2012. As the Gold Medals add up, the chants will ring out … U.S.A, U.S.A.

Goose bumps; spine tingles; national pride.

Years back, when John McKay coached the USC Trojans, he …

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How to control health care costs in the USA

Why doctors should be careful on Twitter

Social media
October 20, 2011

Doctor, do you Tweet?

No, not really. I registered on Twitter some years ago and began but did not keep it up, although I do have a number of Twitter followers. When I first checked Twitter out, the dominant drivel of narcissists pretty much turned me off.

Were you also slow to start using the Internet?

No, I quickly recognized a huge upside to a well-utilized Internet, so we were very early …

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Why doctors should be careful on Twitter

Doctor, do you have enough money?

Physician
September 30, 2011

Are you paid fairly for what you do?

How much are your services actually worth?

Of course you are worth more than you are paid. Enough money is never enough.

“The market decides.”

But, in medicine, there is no way that it is a “free market”; the American medical marketplace is historically rigged by innumerable visible and, to the average person, invisible factors.

We live in one world. Ask Detroit about wages for making American …

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Doctor, do you have enough money?

It is a rare medical news story that gets high marks

Physician
September 29, 2011

Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites.

Is any of it worth my time, my attention, or even a change in my knowledge, attitude, behavior, or medical practice? How can I quickly tell?

A medical journalist from Minnesota named Gary Schwitzer recognized this problem many years ago and created a service that …

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It is a rare medical news story that gets high marks

Who are the most powerful people in American medicine?

Policy
September 8, 2011

Almost everyone I know considers the American healthcare system to be a horrible mess, although some that are deeply into it are quite happy with it. It serves their interests well.

Many do have big-time power.

There are lots of candidates for the “most powerful” title.

How about Regina Benjamin, the Surgeon General of the United States Public Health Service?

Maybe Kathleen Sebelius, the Secretary of Health and Human Services?

Consider Howard Koh, the Assistant …

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Who are the most powerful people in American medicine?

The effect of therapeutic touch is based on pure chance

Patient
August 28, 2011

There is no “alternative medicine.” There is only medicine:

  • Medicine that has been tested and found to be safe and effective. Use it; pay for it.
  • And, medicine that has been tested and found to be unsafe or ineffective. Don’t use it; don’t pay for it.
  • And, medicine for which there is some plausible reason to believe that it might be safe and effective. Test it and then place it into one …

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The effect of therapeutic touch is based on pure chance

The interests of doctors and patients sometimes conflict

Policy
August 22, 2011

Organized American medicine would like for physicians to “speak with one voice.”

If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful voice indeed.

Arnold (Bud) Relman, the esteemed former editor of the New England Journal of Medicine, once rightly told the International Committee of Medical Journal Editors that physicians speak with many …

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The interests of doctors and patients sometimes conflict

Peer review at medical journals, from a former JAMA editor

Physician
August 19, 2011

Picture this: A medical journal receives an unsolicited manuscript from an unknown author, and then … Type 1 medical journal.

The peer review process employed by Type 1 medical journals uses secret, anonymous peer reviewers working behind an opaque shield hiding clueless and spineless editors who may use either no reviewers, or a few cronies, or those reviewers known to be opposed or known to be in favor of some …

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Peer review at medical journals, from a former JAMA editor

A cream to fight obesity is being ignored

Meds
August 7, 2011

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …

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A cream to fight obesity is being ignored

Tobacco cigarettes should be sold only in pharmacies to people with a permit

Meds
July 31, 2011

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream.

Of course, it is true that some of the Iceland bankers, poorly regulated and without scruples, were even more predatory than many of the American Wall Street investment bankers, taking the money and running to lead a pack of nations into international fiscal calamity, a …

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Tobacco cigarettes should be sold only in pharmacies to people with a permit

When well people seek medical attention in a system designed to care for the sick

Patient
July 30, 2011

Over the past several decades, there has been a shift in the kinds of patients seeking medical care.

The progression has been from sick to early sick to well to worried well to worried sick.

The reasons are beyond the scope of this article. There is a subtle and hidden, but potentially very damaging, factor operating in the diagnostic process when large numbers of well people seek medical attention in a …

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When well people seek medical attention in a system designed to care for the sick

Do physicians have the courage to implement comparative effectiveness?

Policy
July 8, 2011

Comparative effectiveness outcome studies have shown that while percutaneous coronary intervention (PCI) may be more effective than optimal medical therapy (OMT) for treatment of acute coronary syndrome, it is not more effective for treatment of stable ischemic heart disease.

Results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, published in 2007 and 2008 in the NEJM, demonstrated that PCI did not improve survival or prevent myocardial …

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Do physicians have the courage to implement comparative effectiveness?

Why Jack Kevorkian had a profoundly correct message

Physician
July 6, 2011

Although Jack Kevorkian was only a few years older than I was, and we both practiced pathology in southern California for many of the same years, I never met Dr. Kevorkian.

I found him from a distance to be a deeply odd character, and a profoundly flawed messenger but with a profoundly correct message.

I can’t improve on the quick summary of Jack Kevorkian by an unnamed author that the New …

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Why Jack Kevorkian had a profoundly correct message

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