Kevin, M.D. - Medical Weblog

More on Denial

Dr. Paul Rousseau from Arizona State University has written an interesting summary of the problem of denial of terminal illness, published in the Journal of Clinical Oncology, May, 2003.

Below are selections from the article, which should pique one's curiosity:

"Although denial may produce a focus of concern, it may also serve as a protective and adaptive mechanism to absorb deleterious and life-threatening information in a manageable and self-determined time frame."

"If denial is determined to be present but not impacting the patient's ability and desire to seek and accept help and is primarily an adaptive mechanism, it may be temporarily or permanently ignored."

"Denial can reduce emotional distress and permit time for patients to absorb the consequences of a life-threatening illness while completing unfinished life work."

Considering both harmless and harmful denial, he also relates strategies to help the patient suffering from so much denial that it "interferes with daily life and medical therapy."

Update: it looks like the JCO won't allow links to this article - my apologies. For those readers who tend to haunt medical libraries, the essay can be found in the Journal of Clinical Oncology, volume 21, pages 52-53, May 2003. I think I'm in denial over my webmaster skills...

Posted by Dr. Craig Hildreth | link | Comments (2) |

When patients deny illness

Much denial-blogging today. Alisha's mother-in-law won't accept physical limitations imposed by her cancer. Orac tries to help a patient who rejects her malignant biopsy results. What is denial, and how should we approach it? (Pause for a quick check - has the Cheerful Oncologist posted about this yet? No? I'd love to know what he thinks!) Here's Dr. Simon Wein, MD, of Memorial Sloan-Kettering Cancer Center:

"Evaluating Denial in Patients with Life-Threatening Illnesses"

"The idea of death, the fear of it, haunts the human animal like nothing else; it is a mainspring of human activity--activity designed largely to avoid the fatality of death . . . by denying in some way that it is the final destiny for man." -Ernest Becker, 1973

...Most seriously ill patients express denial at some point in their illness. Defense mechanisms are automatic, usually unconscious, processes that protect the individual from anxiety. In themselves, defense mechanisms are neither good nor bad.

...Dimsdale and Hackett proposed as a definition of denial, "the common goal of a variety of defenses, conscious or unconscious . . . a repudiation of all or a portion of the total available meaning of an illness in order to allay anxiety and to minimize distress." In this meaning, denial, like an umbrella, includes many defenses, such as distortion, forgetfulness, rationalization, humor, suppression, and so on. Implied in their definition is the belief that denial is not always bad or maladaptive.

...The most important features of denial are its fluidity and wide variation in clinical presentation. Denial can come and go as needed to protect the psyche. In a sense, it acts as a barometer of stress... The influence of cultural attitudes on denial is a difficult but important issue. Surveys[8] clearly demonstrate that there is widespread variation between countries and cultures in the willingness of physicians and families to give medical information to the patient. When people immigrate, this diversity of views can lead to conflicts, which typically center on tension between autonomy and paternalism.

Sometimes we note, tragically, that while the patient and family each are attempting to protect the other by pretended or imposed denial, in reality both parties are desperate to talk with each other. Such denial obstructs both communication and completion of life's tasks. The patient and family are denied a full sharing of their last moments together. The isolation can induce premature bereavement and can result in a more difficult grieving process for the surviving family members.

Those who favor paternalism argue that the truth will upset the patient unnecessarily, may cause despair and depression, and may even shorten the patient's life. There is some evidence to suggest that certain groups of patients who use denial or a "fighting spirit" to deal with their cancer are more likely to be free of disease and to have longer lives.[9] One patient whom I treated described her attitude to a life-threatening disease by saying, "Every day I'm up, I'm spitting in death's eyes." Is this "fighting spirit" of hers actually a form of denial?

In contrast, those who favor autonomy emphasize that patients should have the right to control their own destinies. Moreover, they believe that by making their own decisions and facing the hardships, patients can experience spiritual and psychological growth.

Is Denial Adaptive or Maladaptive?

We might then ask, is denial good or bad, adaptive or maladaptive? If it is adaptive, denial should reduce stress and anxiety and should improve functioning for the patient. It should alleviate depression without compromising medical care. Even if the ideals of self-awareness and spiritual growth are not achieved, denial should help the individual survive psychologically at that moment...

For denial to be judged as bad for the patient, it must contribute to maladaptive behaviors, such as anxiety, mania, depression, or inappropriate refusal of medical treatment.

Dr Wein recommends Orac's approach:

...to try to discover the cause of the patient's anxiety that is provoking the denial. For example, it may be fear of dying the way an old aunt did, fear of pain, or guilt. After several sessions of discussing these issues, the anxiety usually will be expressed...

Such therapies can be difficult to achieve as patients approach the end of life. However, some patients who remain in denial until the last days of life seem to suddenly "let go" and accept reality.

Posted by shrinkette | link | Comments (0) |

Monoclonal Antibody Therapy for Lymphoma

The role of targeted therapy in non-Hodgkin lymphoma (NHL) is being explored, tested, reported and argued about almost continuously in the medical oncology literature. Rituximab, a highly specific monoclonal antibody that binds to an antigen called CD20 on B-lymphocytes, is commercially available and has been studied extensively. It is quite active against both indolent and aggressive NHL.

Whether rituximab prolongs survival in this disease is still to be determined. Also unresolved, by the way, is when to use it, what other agents to use it with, how frequently to use it, how long to use it, and which patients will benefit the most from receiving it. This might just explain why clinical research against cancer takes a while to produce treatments that can be considered new standards of care!

To get a peek at how researchers are trying to resolve this issue, go to this report from the medical journal Blood. This study showed that previously untreated patients with advanced indolent lymphoma who received chemotherapy plus rituximab had a higher response rate, higher complete response rate, a prolonged time to progression, and a longer median time to treatment failure than patients who only received chemotherapy alone. Toxicity was no worse in the group treated with rituximab.

Sounds like the controversy is over, right?

Wrong - the reason why is outlined in this accompanying editorial. [Hint: read the last two sentences].

Results in the treatment of cancer must be examined as closely as a grove of olive trees found on the planet Mars, otherwise unbridled enthusiasm for a new treatment may lead to disappointment when it is finally compared to an older, more established regimen. Thus the clinical research of the medical oncologist plods along - no wonder there are so many gray-haired doctors out there!

Posted by Dr. Craig Hildreth | link | Comments (0) |

Blog Plugging

My alter-ego, The Cheerful Oncologist, has written a little post on the first and most important responsibility of the cancer specialist. To find out what this is, point your mouse here.

After you read it, feel free to commit floccinaucinihilipilification.

Posted by Dr. Craig Hildreth | link | Comments (0) |

65,000 Pounds Lost in Iowa!

Who says it is impossible to lose weight? By simply walking more (and eating a more healthy diet) 20,000 Iowans have lost over 65,000 pounds over the past three years.

The subjects are grouped in teams and record their steps by wearing a pedometer. The total distance walked by the group thus far: 4.8 million miles.

Many people think that in order to lose weight they must exercise vigorously. They then find it easy to make excuses for avoiding their activity (too expensive, too far to drive to the club, not enough time to change into the snazzy work-out duds, et cetera).

The importance of just increasing the number of steps walked in a day is cleared reflected in this simple program, entitled Lighten Up Iowa.

The take-home message - Walk more! Eat less! Don't try to do it alone - get a partner!

Posted by Dr. Craig Hildreth | link | Comments (0) |

Fatal crashes of medical helicopters

Accident rates are rising (NYT):

...the industry's rapid, competitive growth may also be exacting a toll. Federal regulators and some doctors worry that the pool of skilled helicopter pilots has become drained and that some of those flying are making poor decisions. In addition, some companies are flying older helicopters that lack the instruments needed to help pilots navigate safely. Of the 27 fatal medical helicopter accidents that occurred between 1998 and 2004, 21 were at night and often in bad weather, according to federal statistics."

Posted by shrinkette | link | Comments (1) |

Was Mom Right After All?

Researchers at the University of Nottingham, U.K., have released a study showing that normal weight women who skip breakfast have higher fasting levels of total and LDL cholesterol, and have impaired insulin sensitivity to a test meal - which raises serum glucose levels. The implications of this study are that women may not only gain weight, but increase their risk of heart disease and stroke by avoiding eating first thing in the morning.

The timing of the breakfast meal - cereal with 2% milk - made the difference in the metabolic test results. Women who ate the cereal before 0800 hours showed better test results than those who ate the same cereal between 1220 - 1330 hours.

I don't know if this is a cultural requirement, but all participants in the study got a chocolate-covered cookie between 1030 and 1100 hours. Hey, I'm lucky if I get to go to the bathroom during my office hours, let alone get a yummy cookie!

The news article is found here: "Eating Breakfast May Do a Heart Good"

Posted by Dr. Craig Hildreth | link | Comments (1) |

Global Anti-Smoking Pact Goes Into Effect
"A global treaty aimed at dissuading children from smoking and helping adults kick the habit came into force on Sunday with the United Nations saying it could save millions of lives." (via Yahoo Newsbv) The US has not yet signed the treaty.

Symptoms of nicotine withdrawal include:

(1) dysphoric or depressed mood
(2) Insomnia
(3) irritability, frustration, or anger
(4) anxiety
(5) difficulty concentrating
(6) restlessness
(7) decreased heart rate
(8) increased appetite or weight gain

(via DSM-4)

Info on treating nicotine withdrawal: here, here, and here.

Posted by shrinkette | link | Comments (3) |

Recurrent Non-Small Cell Lung Cancer: a Perplexing Problem

Treating non-small cell lung cancer (NSCLC) after it becomes resistant to chemotherapy has been the subject of intense scientific and clinical research. The study of targeted therapy, in which a drug or biological agent attaches only to a specific receptor on a malignant cell, led to the approval and release of the anilinoquinazolines gefitinib (Iressa) and erlotinib (Tarceva), for the treatment of patients with NSCLC who have failed or can no longer tolerate chemotherapy.

Posted by Dr. Craig Hildreth | link | Comments (0) |

Overmedicating the Elderly

A new study from the Journal of the American Geriatrics Society states that almost one in three seniors are receiving medications "deemed potentially inappropriate for older people".

Medicines on the list included antispasmodic drugs and propoxyphene. Several solutions to the problem are mentioned, all centered around good communication between doctor and patient, and knowledge of drug side effects in the elderly.

Posted by Dr. Craig Hildreth | link | Comments (1) |

Can a Book Inspire One to Become a Doctor?

Greetings to all of Kevin's readers (and I know you are many)!

Have you ever run into a high school or college student who is interested in becoming a doctor? It would seem that the opportunities for young people to "shadow" a practicing physician or scientist are readily available, and from my experience such exposure can push a youthful mind over the edge into a love and passion for medicine that will create a great doctor. I therefore encourage anyone who is asked to mentor young students to accept the challenge, and let them see what it is you do for a living. Both doctor and protege' can benefit from taking a peek inside each other's world.

Back in the day when I was wearing the freshman beanie, however, there were few opportunities for students to work with physicians. During college I just happened to serendipitously find a book published in 1965 by a young family physician describing his internship year. I read it several times, and it certainly influenced me toward a career in the healing art. Reading this book, Intern, by Doctor X, is a fascinating glance back into the past when doctors in training were not bothered by reading CT scans, or wading through a maze of anitbiotic choices, or placing stents - because these choices didn't exist. Doctors were overwhelmed with work back then - has anything changed?

There have been many accounts of a doctor's life written, but I believe this is one of the first books to gain popularity with the general public.

Posted by Dr. Craig Hildreth | link | Comments (2) |

The ethics of "Million Dollar Baby"

...and the right to refuse medical treatment, at Bioethics Discussion Blog.

Where was the patients physician? Where was the ethics committee to help educate the patient and physician (and, by the way, the viewing public) on the well established ethics and law? Where was the advocate of the disabled, the rehabilitation therapist to provide the patient with factual information of what could yet be done to help her live maybe a worthwhile life if she elected not to turn off the ventilator? Where was the chaplain to support her spiritually during this difficult decision-making time and perhaps get an understanding of her religious motivations? It certainly didn't require a friend to facilitate her death if this was not a lapse of reality. ..Maurice.

Posted by shrinkette | link | Comments (0) |

Controlling chronic pain: One woman's story

Pain meds weren't enough:

Darcie Prestegard has spent much of her life coping with chronic pain, the result of a childhood accident. For years she tried to block it out, competing on the rodeo circuit despite constant sharp pains in her leg. Eventually she sought medical help for her discomfort. Surgery and various medications brought some relief, but the pain always returned. Her doctors said it might never go away completely. A pain rehabilitation program taught Prestegard how to control the pain that was dominating her life. (via MayoClinic.com)

Posted by shrinkette | link | Comments (0) |

Welcome, Cheerful Oncologist

He's joining me here, guest-blogging till Thursday. (Thanks, C.O.!)

Posted by shrinkette | link | Comments (0) |

Intueri hosts the next Grand Rounds

Please send your submissions to me at maria at intueri dot org with a title of “Grand Rounds Submission". And send them in before 6:00PM PST (that’s 9:00PM for you Eastern Seaboard peeps) on February 28th, 2005.

Posted by shrinkette | link | Comments (0) |

"Will the longevity granted to us by modern medicine be a curse or a blessing?"

Dr. George Vaillant, MD, directs the Study of Adult Development at Harvard University. He's searching for "a theoretical framework, as well as data, for understanding how older people end up fulfilled or not." Among his findings:

* It is not the bad things that happen to us that doom us; it is the good people who happen to us at any age that facilitate enjoyable old age.
* Healing relationships are facilitated by a capacity for gratitude, for forgiveness, and for taking people inside. (By this metaphor I mean becoming eternally enriched by loving a particular person.)
* A good marriage at age 50 predicted positive aging at 80. But surprisingly, low cholesterol levels at age 50 did not.
* Alcohol abuse-unrelated to unhappy childhood-consistently predicted unsuccessful aging, in part because alcoholism damaged future social supports.
* Learning to play and create after retirement and learning to gain younger friends as we lose older ones add more to life's enjoyment than retirement income.
* Objective good physical health was less important to successful aging than subjective good health. By this I mean that it is all right to be ill as long as you do not feel sick. (via About.com)

Ah, but what about those who do feel sick? That's our challenge...

For more, see Dr. Vaillant's book, Aging Well.

Posted by shrinkette | link | Comments (0) |

Thanks, Dr. Kevin!

I'm a psychiatrist who blogs from Eugene, Oregon. I'm surprised to be over here! (I've never "guest-blogged" before.) I think I'll be posting the way I usually do, but I'll have an eye out for more medically-oriented topics. (I'm especially interested in how people cope with all sorts of things, including medical problems...)

Posted by shrinkette | link |

In absentia

I will be away for a few days. But fear not, loyal readers - our favorite blogging psychiatrist, shrinkette, will kindly be guest-blogging in my absence. Enjoy!

Update:
Dr. Craig Hildreth, The Cheerful Oncologist, will also be guest-blogging. Enjoy both of these unique medical blogging voices in the next few days.

Posted by Kevin | link | Comments (0) |

A woman who had suffered a massive heart attack died after hospital personnel moved her out of a trauma room to accommodate a flu-stricken Michael Jackson
Big surprise, the family is now suing Jackson and the hospital. Chris Rangel comments:

The problem is that like the majority of medical lawsuits this case has little if any merit. It is standard procedure to disconnect the patient from the ventilator and ventilate by hand whenever a critically ill patient is moved. It is standard procedure to move a critically ill but stable patient in the ER to a smaller/alternative room to make space for new patients (some of whom may be critically ill themselves and not stable). It is standard procedure to limit visitation of a critically ill patient to two family members at a time.

Posted by Kevin | link | Comments (0) |

In the trauma room: Columbus man kills his two children, then kills himself
Dr. Bard-Parker was there. Incredible.

Posted by Kevin | link | Comments (0) |

2,000 defibrillators are being recalled
"The company said the machines may not correctly analyze a patient's
heart rhythm, possibly preventing the machine from defibrillating the
heart when it is needed."

Posted by Kevin | link | Comments (0) |

The complex manual dexterity required to be a stellar video gamer and minimally invasive surgeon are strikingly similar
"Dr. Rosser, 50, practices what he preaches. He keeps an Xbox, along with PlayStation 2 and GameCube consoles, just a few strides from the operating room so he can warm up with a favorite, Super Monkey Ball, just before surgery."

Posted by Kevin | link | Comments (0) |

"Soul murder is a small price to pay for a good story."
An essay criticizing the media's often tabloid-like coverage of health information. After all, stories about catastrophes sell more papers than those about safe care. Some points:

Professor Tallis said there had been many other instances of "disgraceful" treatment in the press, with the "unhuman pursuit of the human story." He said, "Numerous doctors have been hounded and when they have been exonerated of crimes, no apology has been issued."

He also criticised what he considered journalists' failure to put things that go wrong in perspective . . . "two unfortunate events out of tens of millions of transactions do not amount to a trend."

He also criticised what he saw as the media's practice of giving equal weight to individuals involved in controversy and people in a position to give authoritative comment. A world expert on vaccination reporting a carefully controlled study of 1.5 million children who had received a vaccine would be given the same airtime as a mother convinced that her child had been harmed by the vaccine, he said.

An "infantile preference for conspiracy theories over data" had worldwide consequences, he said. The credence given to the theories of US virologist Peter Duesberg—that HIV does not cause AIDS—by the Sunday Times and others in the 1990s, was still having an effect. "The after-echo is Thabo Mbeki's hostility to antivirals in South Africa, costing perhaps 100 000 unnecessary deaths a year, 35 000 of them children."

Posted by Kevin | link | Comments (1) |

Does Hollywood accurately portray disease?
Not surprisingly, the answer is more than likely, no.

Posted by Kevin | link | Comments (0) |

In the UK, 17,402 operations were cancelled at short notice for non-clinical reasons during a four-month period
"Operations may be cancelled at the last minute if a bed is no longer going to be available, or if staff are needed elsewhere."

Posted by Kevin | link | Comments (0) |

It took one year to recruit a neurosurgeon in Illinois after his predecessors left due to a hostile malpractice climate
"I didn't think we'd be able to do it this rapidly."

Posted by Kevin | link | Comments (0) |

Malpractice rates in Texas will decrease an average of 14 percent
"The Doctors Company, a physician-owned medical malpractice carrier, will file with the Texas Department of Insurance to decrease its average rate level.

Ninety percent of the company's current Texas insureds will receive rate reductions. Although some reductions will range up to 30 percent, the average decrease for insureds at $200,000/$600,000 limits of liability is 14 percent."

Note that Texas has caps on non-economic damages.

Posted by Kevin | link | Comments (2) |

Almost a third of the members of a government panel that voted last week to let the pain pills Celebrex, Bextra and Vioxx stay on the market recently consulted for the makers of the drugs
"Without the votes of those 10 members, the committee would have voted 12 to 8 that Bextra should be withdrawn and 14 to 8 that Vioxx should not return to the market. The 10 advisers with company ties voted 9 to 1 to keep Bextra on the market and 9 to 1 for Vioxx's return."

Posted by Kevin | link | Comments (0) |

DTC advertising gets a wrist slap from the FDA
"The majority of the FDA advisory panel on cox-2 inhibitors, drugs that include Bextra, Celebrex, and Vioxx, called for a ban on all cox-2 advertising. The agency is unlikely to follow that recommendation. 'Such a ban would be almost certainly illegal. The FDA has no statutory authority to ban advertising. Even if it were to have such authority, such a ban would almost certainly be unconstitutional,' said Daniel Troy, the FDA's former chief counsel."

Posted by Kevin | link | Comments (0) |

When the veins of a severed penis cannot be reattached in a timely fashion, surgeons apply live leeches to suck up the blood
That's good to know (via Dr. Charles).

Posted by Kevin | link | Comments (1) |

A no-fault model of malpractice could more consistently compensate victims of avoidable mishaps and more effectively reduce error and incompetence
Although it makes the most sense, it is unlikely to happen here. As the article states: "Americans are used to blaming someone - in this case, doctors - when something goes wrong."

Posted by Kevin | link | Comments (3) |

Why a tracheostomy for the Pope?

As you have heard, the Pope underwent a tracheotomy for respiratory distress. It was stressed by the Vatican that it was not done as an emergency measure. Just to clarify, the procedure where the hole is being created is called a tracheotomy, while the hole itself is called a tracheostomy.

From UptoDate, here are some advantages and disadvantages between the tracheostomy and intubation for mechanical ventilation:



Why was the tracheostomy done so early in hospitalization? One study compared early (less than 48 hours) versus late tracheostomy in respiratory failure:

Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group.

At what point would the tracheostomy be reversed? First, mechanical ventilation would have to be weaned (i.e. the pneumonia would have to resolve to such a point where the Pope can breathe on his own). UptoDate lists the other conditions that are required before the tracheostomy is reversed:

* No upper airway obstruction.
* The ability to clear secretions which are neither too copious nor too thick.
* The presence of an effective cough.

Posted by Kevin | link | Comments (0) |

The Pope will be undergoing a tracheotomy
Some are speculating that he is suffering from secondary bacterial pneumonia related to influenza. Streptococcus pneumoniae and Staphylococcus aureus are the two most common bacteria implicated. More from UptoDate:

The hallmark of the clinical presentation in patients with secondary bacterial pneumonia is the exacerbation of fever and respiratory symptoms after initial improvement in the symptoms of acute influenza. Fever may abate for one day or more after two to three days of acute influenza, but, instead of continuing to improve, the patient with secondary bacterial pneumonia relapses with higher fevers, cough, production of purulent sputum, and radiographic evidence of pulmonary infiltrates.

More was previously written here.

Update:
Dr. Sanjay Gupta of CNN comments.

Posted by Kevin | link | Comments (1) |

A study estimates that only one of six malpractice claims had any valid basis

Posted by Kevin | link | Comments (1) |

Docs still have room for improvement when policing themselves
"New Hanover Regional Medical Center allowed a surgeon with known alcohol and psychiatric problems to operate on hundreds of patients, scores of whom apparently got an operation different from the one they were promised – and different from the one that Medicare, Medicaid and private insurance companies were billed for."

Posted by Kevin | link | Comments (0) |

Galen's back with some perspective on ibuprofen's relative safety
"The media is a powerful tool in educating the public of possible risks, but it doesn't always use this power efficiently. Watching media reports tends to distort the watchers assessment of risk, leading us to focus on the least appropriate of issues."

Posted by Kevin | link | Comments (0) |

PointofLaw.com responds to the NY Times piece on malpractice

Yesterday's article takes a fairly standard attack on tort reform, popularized by some who read this blog. Walter Olson responds:

In any event, consider the centerpiece graphic of the Times piece, which plots the rise of rates and payouts since 1975 based on data from the highly regarded firm of A.M. Best. (I suggest keeping it open in a second window.) If I were trying to get people to believe that there's no connection between high courtroom payouts and high rates charged for malpractice insurance, I must say this is the very last chart I'd ever let them see, because it tends so strongly to show the two lining up together over the long term.

Ted Frank also comments:

Opponents of medical malpractice reform make a variety of assertions about the subject in an effort to persuade. But if all of these assertions are true, then trial lawyers are wasting their time lobbying and issuing press releases. They have the power to solve the medical malpractice insurance crisis by themselves—and can make more money doing it.

Posted by Kevin | link | Comments (4) |

Medpundit links to a couple of websites that tries to get behind the often inadequate health reporting by major media
The first is Behind the Medical Headlines:

Welcome to Behind the Medical Headlines, which has been developed by the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh, to provide authoritative and independent expert commentaries on topical medical matters reported in the international media.

Next is Media Doctor:

Media Doctor reviews current news items about medical treatments, assesses their quality using a standardised rating scale and presents reviews of good and bad examples of reports on this web site. It is anticipated that these independent and objective critiques will improve journalistic practices in reporting new medications and treatments in Australia.

Posted by Kevin | link | Comments (0) |

Terry Schiavo's parents and husband square off in court today over whether he is fit to be her guardian
The saga continues.

Posted by Kevin | link | Comments (2) |

"Unnecessary spending will continue until we have a reliable system of medical justice that protects reasonable decisions - like prescribing aspirin instead of a CAT scan for a headache."
"Said Dr. Alan Sager, a co-author of the Boston University study, '[W]e need to demand that health care gets reshaped in ways that encourage and persuade doctors to take charge of spending money more carefully [and] ... weed out clinical waste.' Sager also noted that 'waste comes from unnecessary care, defensive medicine, excessive paperwork born of mistrust between insurers and doctors, as well as theft and fraud.'"

A study suggests that unless defensive medicine is reigned in, health care costs will continue to spiral. After all, a CT scan for a headache is much easier to defend in court than clinical suspicion (via Common Good).

Posted by Kevin | link | Comments (11) |

There is a lack of PET scanners in the UK
There are 10 PET scanners on the UK, and 80 in Germany. To put that in perspective, there are 80 in the state of Florida alone.

Posted by Kevin | link | Comments (1) |

Television drug advertising is about promotion, not education
"It furthers the notion that there's a pill for every ill and that the road to better health begins with self-diagnosis and treatment.

But many consumers, say doctors, are not asking questions so much as simply asking for the drug. And doctors usually comply – 75 percent according to one study."

Posted by Kevin | link | Comments (0) |

Instapundit's wife is out of the hospital
The discharge was predictably held up by paperwork. A former nurse comments on the hospital experience, both from the patients' and staff's view.

Posted by Kevin | link | Comments (2) |

The CDC is starting to get worried about bird flu

Posted by Kevin | link | Comments (0) |

An in-depth story, behind the scenes at Pfizer
"Every weekday, some 38,000 Pfizer Inc. sales reps fan out around the globe. Armed with briefcases full of free drug samples, reams of clinical data, and lavish expense accounts for wining and dining their quarry, the reps infiltrate doctors' offices and hospitals. Their goal: to persuade medical professionals the world over to make Pfizer drugs the treatment of choice for their patients' aches and pains . . .

Each of Pfizer's sales reps costs close to $170,000 per year including car, computer, and benefits . . . That figure doesn't change a lot if the company's sales are soaring or falling. So a big-selling drug can generate fantastic margins as sales ramp up. Pfizer generated an astonishing $45 billion in gross profits last year. That works out to $1.2 million per sales rep."

Posted by Kevin | link | Comments (0) |

Grand Rounds 22 is now up
Come get your weekly best of the medical blogosphere.

Posted by Kevin | link | Comments (0) |

Docs are still skeptical about rapid opiate detox
"It's like treating someone in the hospital with high blood sugar with insulin and then discharging him from the hospital without the insulin."

This was touched upon last month.

Posted by Kevin | link | Comments (0) |

Gift certificates for breast cancer screening
"REACH for Breast Health is offering a $10 gift certificate to a local supermarket to every woman who completes breast screening who has never had a mammogram, or who has not had one in over two years."

It's come down to this - paying people to maintain their health.

Posted by Kevin | link | Comments (2) |

There are many who are willing to take the risk of Vioxx in the quest for pain relief
It would be tough to prescribe it in today's litigious environment, no matter how much the patients want it. I wonder if someone can introduce a legal waiver that patients can sign (an informed consent of sorts), which will make many physicians more comfortable prescribing it.

Posted by Kevin | link | Comments (1) |

EMRs are overrated and erodes the doctor patient relationship
"In our clinic, the computer monitors are placed so that the doctor can watch the screen or the patient, but not both. Frankly, it's not much of a contest. The monitors are mesmerizing, with their colors and windows, boxes and beeps, menus of pills ripe for the prescribing. Walk down the row of offices and you see the patients looking at their doctors, and the doctors looking at their screens.

Last week, when the system crashed, we looked at our patients instead."

Posted by Kevin | link | Comments (2) |

Two die after overdosing on cold medicine
In this case, they took Coricidin, which contained dextromethorphan - don't forget it's a chemical relative to morphine.

Posted by Kevin | link | Comments (2) |