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 …
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 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 …
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 …
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 …
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 …
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:
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 …
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 wish to be paid.
Thus, we now have, and have always had, rationing.
Anyone who does not agree is in some zone …
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 …
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 …
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 …
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 …
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 …
Should physicians strive to keep hospital beds full or empty?
Obviously, in an economically optimal situation, just like in the hotel business, the hospital beds that are “needed” and available should be kept pretty close to full, in order to cover fixed costs and balance the hospital budget.
A recent discussion board on another physician website has called attention to an alleged practice of both emergency physicians and hospital administrators being paid …
Primary care physicians, including pediatricians, are usually really nice people. But old baseball fans will remember that Leo Durocher famously said, “nice guys finish last.”
How true. And, as one result, the American healthcare system and the American people are the real losers.
A deliberate radical change in the behavior of American primary care physicians and their representative organizations could go a long way toward fixing our broken healthcare system.
Primary care physicians …
My old Canadian friend toxicologist Cliff Walberg was right when he famously said, “there is absolutely no limit to how revolting things can be.”
Remember that. It comes in handy, in addition to strong swear words, when stuff happens.
Case in point: I believe that every American deserves the right to choose to have a death with dignity and as pain-free as medical science and practice can provide.
To achieve that, patients and …
We were taught in grammar school that plagiarism is wrong. It is stealing someone else’s property.
Imagine in high school asking your mother to buy you “Cliff Notes” so you can copy it word for word. Mother would not have liked that, and it wouldn’t have been right.
To write an essay today, you’ll probably start with a search engine. Instantly, Mr. Google delivers many intelligent commentaries on anything, probably better than …
In 1911, George Bernard Shaw famously wrote “All professions are a conspiracy against the laity”.
One hundred years later, in 2011, I write “the MBA has done more to harm the public through bottom-line hospital administration than have many dread diseases.”
As an example, the continuing saga of this stent, that stent, the other stent placed into as many coronary and other arteries as often and as fast as possible does show …
Is there anything that we physicians can and should be doing to help with the huge problem of gun violence in America?
We all know it is nuts to sell guns and ammo to nuts, yet as a country we do it every day.
We all know that, in contrast to rifles and shotguns, the only moving targets for hand guns are people; that the Congress and president in this century legislated …
In 2003 in the BMJ, Wald and Law and a supporting editorial by then editor Richard Smith, proposed that 80% of heart attacks and strokes could be prevented by widespread use of a six drug polypill. The six ingredients were a statin, three low-dose antihypertensives (a thiazide, an ACE inhibitor and a beta blocker), folic acid, and aspirin.
Although there was a lot of derision at that time and there has …
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