George Lundberg, MD

George Lundberg is a physician.

August 19, 2011Aug 19, 20112

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…

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 …

Meds

A cream to fight obesity is being ignored

George Lundberg, MD

August 7, 2011Aug 7, 20112

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…

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 …

Conditions

How prevalent are false diagnoses of disease?

Clifton Meador, MD & George Lundberg, MD

July 31, 2011Jul 31, 20113

Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system. One of the consequences of this influx of well people (and the…

Recently, we expressed concern about the effects on the accuracy of the diagnostic process of the increasing numbers of well and worried well entering the medical care system.

One of the consequences of this influx of well people (and the concomitant reduction in disease prevalence) is the generation of more false positive test results and false diagnoses of nonexistent diseases.

The medical literature is filled with studies on the accuracy of …

Meds

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

George Lundberg, MD

July 31, 2011Jul 31, 201118

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…

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 …

Patients

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

George Lundberg, MD

July 30, 2011Jul 30, 20112

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…

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 …

Policy

Do physicians have the courage to implement comparative effectiveness?

George Lundberg, MD

July 8, 2011Jul 8, 20119

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…

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 …

Physicians

Why Jack Kevorkian had a profoundly correct message

George Lundberg, MD

July 6, 2011Jul 6, 201110

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…

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 …

Patients

The best diagnostic medical device is right in your own home

George Lundberg, MD

June 20, 2011Jun 20, 201111

What is the year 2011's best diagnostic and therapeutic medical device? Is it the PET scan with special bells and whistles to detect early Alzheimer's? Is it the robotic surgery that reams out the worst prostate cancers remotely? Is it…

What is the year 2011’s best diagnostic and therapeutic medical device?

Is it the PET scan with special bells and whistles to detect early Alzheimer’s?

Is it the robotic surgery that reams out the worst prostate cancers remotely?

Is it the Total Genomic Analysis that predicts what your genetic future holds?

Is it the GI endoscope that checks out your innards from stem to stern?

Is it the latest drug-eluting stent that promises to …

Meds

The accidental genius of homeopathy thrives

George Lundberg, MD

June 16, 2011Jun 16, 201137

All thoughtful physicians I know consider the historical theory and philosophy of homeopathy to be rubbish, balderdash, preposterous, BS, or, politely, NOT PLAUSIBLE; thus, not even worth testing for safety and efficacy. Then, why, when one asks Mr. Google by…

Then, why, when one asks Mr. Google by entering … Homeopathy … and clicking, does one receive 9.9 million results?

And, why does the National Health Service of the U.K. continue to fund homeopathic hospitals, clinics, and treatments?

And why are …

Conditions

Why are sore throats cultured, and why are antibiotics administered?

George Lundberg, MD

June 2, 2011Jun 2, 201139

Why do physicians order laboratory tests? Reasons include: to make a diagnosis, to confirm a clinical opinion, insecurity, patient and family pressure, concern for liability, to guide therapy, habit. Case in point. Throat culture. Sore throat is one of the…

Why do physicians order laboratory tests? Reasons include: to make a diagnosis, to confirm a clinical opinion, insecurity, patient and family pressure, concern for liability, to guide therapy, habit.

Case in point. Throat culture.

Sore throat is one of the most common human illnesses. Most are caused by viruses. Fewer than 10% seem to be caused by Streptococcus. But around 10 to 20% of clinically well children, when cultured, have Streptococci …

Policy

Can ACOs reinvent the American health care system?

George Lundberg, MD

May 26, 2011May 26, 20118

The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward. Two recent headlines focus the problem: New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care…

The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward.

Two recent headlines focus the problem:

New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care

And, CNN Money, May 11, 2011 reports “Your family’s healthcare costs $19,393.” That is for a family of four, which has a median income of $75,700 — before taxes.

Opportunity …

Physicians

Journals need to explain the reasons behind a retraction

George Lundberg, MD

May 13, 2011May 13, 2011

Researchers want us to believe that science is transparent and self-correcting. When someone makes a mistake, he or she owns up to it. That's what corrections and retractions are for. But that's not what happens at some medical journals. Instead,…

Researchers want us to believe that science is transparent and self-correcting. When someone makes a mistake, he or she owns up to it. That’s what corrections and retractions are for.

But that’s not what happens at some medical journals.

Instead, retraction notices read like doublespeak:

“The authors have identified inconsistencies within the data that may have affected the results of the study.”

That one turned out to be because of faked data. You …

Policy

Does the Affordable Care Act give the American people what they want?

George Lundberg, MD

May 3, 2011May 3, 201124

Now here's a novel idea. What if someone asked the American people, or a demographically representative group of it, what it wants from healthcare. That would be called "market research." Ask the public what it wants, listen carefully, and then…

Now here’s a novel idea. What if someone asked the American people, or a demographically representative group of it, what it wants from healthcare. That would be called “market research.”

Ask the public what it wants, listen carefully, and then give it to them.

Turns out that the New York-based Commonwealth Fund has done just that.

In brief they found:

72% of American adults believe that our healthcare system needs to be fundamentally changed

…

Tech

Organizations that link their IT systems to share electronic health records

George Lundberg, MD

April 29, 2011Apr 29, 20116

Glory be. There's good news tonight in American healthcare. It did not come from laws, regulations, or government edict, although there has been much government activity in the field; it did not come from the behemoths of information technology like…

Glory be. There’s good news tonight in American healthcare.

It did not come from laws, regulations, or government edict, although there has been much government activity in the field; it did not come from the behemoths of information technology like Google, Microsoft, Oracle or Cisco, although much hard work in IT did precede it; it did not come from the for-profit healthcare industry giants like GE, Big Pharma, United Healthcare, or …

Physicians

A market driven success story of participatory medicine

George Lundberg, MD

April 27, 2011Apr 27, 20112

The United States does not have enough money to give all medical and healthcare products and services to everyone who wants them, whether or not they need them, right now, especially at the prices that those in the medical-industrial complex…

Thus, we now have, and have always had, rationing.

Anyone who does not agree is in some zone …

Physicians

If American physicians were to speak with one voice, what would they say?

George Lundberg, MD

April 18, 2011Apr 18, 201123

Who speaks for American physicians? I really don't know? Do you? I used to think and say that the American Medical Association (AMA) spoke for American physicians. Of course, that was when I was an employee of the AMA. I…

Who speaks for American physicians? I really don’t know? Do you?

I used to think and say that the American Medical Association (AMA) spoke for American physicians. Of course, that was when I was an employee of the AMA.

I disclose that I remain a more than four decade-long member of the AMA, and I believe that it should speak for American physicians. But physicians speak with many voices; most are fiercely …

Meds

The FDA does not approve the uses of drugs

George Lundberg, MD

April 8, 2011Apr 8, 20115

Many people believe that the Food and Drug Administration (FDA) of the United States approves uses of drugs. It does not. This confusion comes from insufficient clarity of language. The FDA does approve whether or not a prescription drug can…

Many people believe that the Food and Drug Administration (FDA) of the United States approves uses of drugs. It does not.

This confusion comes from insufficient clarity of language.

The FDA does approve whether or not a prescription drug can be manufactured, marketed, and sold, the language on the label, and the claims of advertising.

Drug manufacturers must use an elaborate, detailed, lengthy, and very …

Physicians

Reductionism and daily medical practice

George Lundberg, MD

March 28, 2011Mar 28, 20116

The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete. The basic premise of reductionism is that by breaking down (or…

The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete.

The basic premise of reductionism is that by breaking down (or “reducing”) complex biological or medical phenomena into their many parts, one is much more likely to understand a single cause and devise a cure.

Historically, the invention of the microscope, the defining …

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Reductionism and daily medical practice

Conditions

Screening for Alzheimer’s is a diagnostic bridge to nowhere

George Lundberg, MD

March 26, 2011Mar 26, 20116

Doctor, do you really want to know if your patient has a chronic, slowly progressive, fatal, debilitating disease for which you have no effective intervention? Patient, do you really want to know if you have a chronic, slowly progressive, fatal,…

Doctor, do you really want to know if your patient has a chronic, slowly progressive, fatal, debilitating disease for which you have no effective intervention?

Patient, do you really want to know if you have a chronic, slowly progressive, fatal, debilitating disease for which medicine has no effective intervention?

If you two together (along with family members) answer yes to that question, then the florbetapir-assisted PET scan of the brain for amyloid …

Policy

The Institute of Medicine (IOM) is independent and authoritative

George Lundberg, MD

March 22, 2011Mar 22, 20114

On Oct. 14, 1988, I published a Special Communication by Irvine H. Page, one of the founders of the Institute of Medicine (IOM) in JAMA. Dr. Page criticized the IOM at age 18 for failing to live up to the…

On Oct. 14, 1988, I published a Special Communication by Irvine H. Page, one of the founders of the Institute of Medicine (IOM) in JAMA. Dr. Page criticized the IOM at age 18 for failing to live up to the vision of its founders. This was accompanied by a rejoinder and a prospective by then IOM President Samuel O. Thier. My editorial was entitled “Still Needed — A National Academy …