March 2010

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Cancer deaths are improving, but a cure remains distant

in Conditions | 3 responses

Originally published in MedPage Todayby Joyce Frieden, MedPage Today News EditorCancer deaths are improving, but a cure remains distantAlmost 40 years and 100 billion federal dollars have been invested in the "War On Cancer" since President Richard M. Nixon declared it, but the campaign is far from over, two researchers concluded this week in the Journal of the American Medical Association."These funds have been more than matched by ...

Primary care is disproportionally hurt by Medicare cuts

in Physician | 14 responses

Doctors don't garner much sympathy when they rail against the perpetual threat of Medicare reimbursement cuts.In a story from CNNMoney.com, a primary care physician provides some stark reality.In an independent solo primary care practice, employing an office staff and two nurse practitioners for instance, fixed costs add up to $60,000 per month. A 21% cut in Medicare reimbursement, assuming an average sized Medicare panel, can take away ...

VBAC rates are low, but are obstetricians to blame?

by | in Conditions | 45 responses

My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn't because she is showing signs of a late-developing handicap or extraordinary ability for her age - it's because she came into the world as a vaginal birth after Cesarean section (VBAC), delivered by a certified nurse midwife.Although more than three-quarters of women who choose a trial of labor over a repeat Cesarean ...

VBAC should not be a woman’s right

by | in Conditions | 51 responses

VBAC activists are clinging to their resentment and aggressively ignoring reality.Amy Romano at Science & Sensibility asks the bizarre question: Do women need to know the uterine rupture rate to make informed choices about VBAC? It's bizarre because she implies that this is a medical question and that the answer is unknown. However, this is a legal question and the answer has been clearly established by the courts. Not ...

Cancer side effects are being ignored by the media

in Conditions | 2 responses

Originally published in MedPage Todayby John Gever, MedPage Today Senior EditorCancer side effects are being ignored by the media When the mainstream media report on cancer treatments, they seldom note that aggressive therapies may fail or cause severe side effects, researchers said.Analyzing more than 400 articles about cancer in major newspapers and magazines, investigators at the University of Pennsylvania found that adverse outcomes or palliative care were hardly ...

Government-controlled health insurance may politicize health

by | in Policy | 28 responses

During President Obama's final push for "universal health care" legislation, his biggest obstacle was not Republicans but rather anti-abortion Democrats let by Congressman Bart Stupak (D-Michigan).Stupak eventually reached a last-minute deal with the White House on federal funding of abortion services. But no one should be surprised that under government-controlled health insurance, medical coverage decisions will be based on political considerations. Rather, the recent wrangling over abortion will be ...

Doctors need protected time away from the pager

in Physician | 10 responses

When nurses sign out during the end of shift, it's done so in a quiet setting.Contrast that to medical residents -- at least when I was a resident 8 years ago -- where pager interruptions during sign out were the norm.PookieMD compares the situation to the "sterile cockpit" that airline pilots enjoy: "Pilots have the sterile cockpit–a situation in which, if the plane is below 10,000 feet, only conversation ...

Allopathic medicine has alternative medicine roots

by | in Conditions | 18 responses

Whether we like it or not, the lines between allopathic and alternative medicine continue to blur. Just last week I recommended glucosamine-chondroitin to a patient who suffers from osteoarthritis and wrote a prescription for Lovaza, a prescription-strength preparation of fish oil. And today I was asked about red yeast rice from a patient interested in controlling her cholesterol through “natural means.”Like nutrition, complementary and alternative medicine, or CAM, is somewhat ...

Health reform should make conservatives very happy

in Policy | 33 responses

Let's get one thing out of the way.The health care reform bill that passed the House this past Sunday, and will be fixed via reconciliation in the Senate, is a moderate, relatively incremental approach to fixing our health care system.Conservatives are up in arms, as they have been during the entire process, and are lining up lawsuits and trying to gather momentum to repeal the bill.And I'm asking myself, ...

ED can predict heart death

in Physician | no responses

Originally published in MedPage Todayby Joyce Frieden, MedPage Today News EditorED can predict heart death Patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications, researchers found.In men who reported ED at baseline, all-cause mortality during a median follow-up of four years was double that seen ...

PSA screening for prostate cancer will continue

in Conditions | 7 responses

Is the tide finally turning on PSA screening for prostate cancer?Search "PSA prostate screening" on this blog, and you'll find a variety of opinions on this controversial issue. There's no definitive data that PSA screening saves lives from prostate cancer, and indeed, can lead to further, invasive, tests that can cause men significant discomfort.Medical societies are divided on the issue; primary care groups like the USPSTF recommend against ...

Archeology skills work in medicine

by | in Patient | no responses

I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)My kids and I walk the red-clay paths and look down ...

Tax credits and new patient care models in health reform

in Policy | 4 responses

by Robin TangSunday, March 22, 2010, marked the passage of the Health Care and Education Affordability Reconciliation Act (H.R. 4872) by the House by a narrow 219-212 margin, with no Republicans voting in favor. Whether you think the bill is good, bad, sustainable, or even constitutional, we can agree this was a historic day.Putting politics aside, I want to highlight two parts of the bill that aren’t getting enough ...

Palliative care shows the importance of language

in Physician | 5 responses

by Patrice VillarsThe best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication.What if, in our kind, well-meaning ...

Healthcare reform will be challenged in states

in Policy | 8 responses

Originally published in MedPage Todayby Joyce Frieden, MedPage Today News EditorWith the House and Senate now in basic agreement on healthcare reform and President Barack Obama about to sign the underlying bill into law, opponents are gearing up to challenge the legislation on a variety of fronts.Healthcare reform will be challenged in states This effort was beginning even before Sunday's House vote sent the Senate ...

Patient input in their treatment should be valued by doctors

in Patient | 10 responses

Thanks all who responded to my recent USA Today piece, Patient-satisfaction surveys have drawbacks.But in a letter published in the paper yesterday, a reader from Oklahoma City was quite unhappy with my take.Mark R. Heaton writes, somewhat angrily:

Dr. Kevin Pho's recent opinion piece was not only arrogant but also grossly naive.His basic premise was twofold:• Doctors know best and should therefore ignore patient feedback regarding possible tests and treatments.• ...

ACP: To whom are physicians accountable?

in Education | 5 responses

The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACPACP: To whom are physicians accountable? The New England Journal of Medicine‘s March 11 issue included an interesting “Clinical Decisions” article. Looking at a hypothetical case of an endocrinologist with time-unlimited board certification, the editors posed the question of whether he should voluntarily ...

Futile care has human and financial costs

by | in Physician | 13 responses

I haven't ever saved a life. No doctor has. We may prolong the inevitable, but we don't save anyone. We aren't immortal, and weren't meant to be. We die. All things do. Plants, animals, even stars. Death is as much a part of life as birth. And yet, at times people chase medical science as if we have immortality in all our gadgets and pills.Why am I writing this?A few ...

CNN op-ed: Health reform passes, but what’s next?

in Policy | 13 responses

Welcome readers from CNN.com.Health care reform passed the House last night, but that only marks a new chapter in the conversation to fix our health system, not the end of the debate.CNN op ed: Health reform passes, but whats next?My take on health reform was published today on CNN.com. Much more work needs to be done to ensure that there is enough primary care access to meet ...

Health care reform passes the House in a historic vote

in Policy | 2 responses

Originally published in MedPage TodayHealth care reform passes the House in a historic vote After a year-long struggle and often-raucus partisan debate, the House of Representatives passed an historic health care reform package late Sunday night.The vote on the last of the two bills in the package was 220-211. All 178 Republicans, along with 33 Democrats, voted against the measure. The margin was similar on the other measure; both ...

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