by Michael SmithIt's a classic good-news, bad-news story.The vaccine against shingles, already shown to be effective, is both safe and well-tolerated, researchers found after following more than 38,000 participants in the randomized trial that led to the 2006 approval of the vaccine.On the other hand, few people are getting the vaccine, and for a variety of reasons -- including its cost -- researchers noted in a separate study. Both analyses ...
May 2010
All Stories
Waterbirth dangers to newly born babies
Waterbirth has become a central component of "natural" childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don't need a medical degree to appreciate the idiocy of birth in water. The most critical task for the newborn is to take its first breath.Inhaling a mouthful of fecally contaminated water instead of air is profoundly dangerous. Not surprisingly, as the popularity of waterbirth has grown, ...
German doctors go on strike, should American physicians follow?
Doctors are angry.Some are unhappy with health reform, and others worry that reform didn't go far enough.Bob Doherty, in his ACP Advocate Blog, wrote how many physicians are unhappy with the American Medical Association for instance, noting, "there is no doubt that some doctors are angry, very angry, at the AMA. A blog search comes up with dozens of posts about how the AMA has betrayed doctors. It is ...
St. Vincent’s Hospital closes, and Greenwich Village suffers
by Danielle Ofri, MD, PhDLocking the entrance to the emergency room: there could not have been a more potent image to the final day of St. Vincent’s Hospital in New York City.After 160 years, St. Vincent’s closed because of financial problems. It was the only hospital serving Greenwich Village and the last Catholic hospital in Manhattan.The closing of a hospital can feel like a death in the family. A hospital ...
A medical student chooses dermatology because of family
by an anonymous medical studentAs of today, I am one month from adding those long sought-after and hard-earned initials to my name, M.D.. I matched at my number one choice in a very competitive “lifestyle specialty,” have a fabulous husband who has helped me through the emotional turmoil that is medical school, and two young boys who make me laugh and smile every day. I sit here, where ...
Standardizing claims can save billions of dollars
by Joyce FriedenA standardized claim form and a single set of submission and payment rules for all health plans could save the U.S. healthcare system $7 billion annually, a study has found."Although not all costs of excessive administrative complexity have been captured in our study, both real costs in billing operations and opportunity costs in physicians' practices are significant," Bonnie B. Blanchfield, ScD, of Massachusetts General Hospital in Boston, and ...
Rental housing can worsen your health
Whenever I diagnose a person with asthma or allergies, I usually ask a few questions about his or her living environment. Is there shag carpeting in the bedroom? Is the air conditioning filter changed every month? Is there evidence of roaches and other vermin? I ask these questions because mold, dust mites, animal saliva and insect droppings can worsen the symptoms of asthma and other illnesses.But some of my patients ...
Primary care innovation needs more than money
Much has been recently made about the bureaucratic obstacles that primary care doctors face. With good reason.The impetus was a recent New England Journal of Medicine paper from Richard J. Baron that I mentioned recently.The New York Times' Pauline Chen interviewed Dr. Baron, who shared some interesting insights on what needs to be done.He contrasts the inertia in primary care to drug manufacturing. If you took ...
When will cost effectiveness ever be acceptable in US healthcare?
Cancer. The Big C. No one wants money to stand in the way of curing a patient.But real life is messier. Many new treatments for cancer are pricey yet provide only marginal gains over existing therapies in life expectancy and/or quality of life. Forty thousand dollars for a cure is not a real dilemma for policymakers -- the same spend for an extra six weeks of life is another story.In ...
Voluntary simplicity can ease the stress of American life
by Aldebra Schroll, MDWho hasn't heard the story of a friend or acquaintance who retires only to become seriously ill or die soon after?Are we working ourselves to death? For anyone who has ever wondered "is this worth it?" a move is afoot to question the concept of the American work ethic. We are currently the most overworked society on the globe. The United States has surpassed Japan as the ...
Definition of health includes social well-being
by Emily P. WalkerI was covering an FDA tobacco meeting a while back when I heard a Howard Koh, MD, assistant secretary of health at the Department of Health and Human Services (HHS) start his speech with the World Health Organization's definition of health."Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."That ...
Failing to prevent disease in patients costs lives
An excerpt from Stay Healthy At Every Age: What Your Doctor Wants You to Know.When you were growing up, somebody probably told you that “an ounce of prevention is worth a pound of cure.”Many of us have learned from experience how much better it is to prevent a bad thing from happening than to try to fix the consequences once it has happened. Most people can agree that prevention ...
Physicians who aren’t good at business won’t survive
A business degree should be a pre-requisite for medical school.Extreme? Perhaps, but doctors who have some business acumen will have the best chance to thrive in the medical landscape after health reform.Marketing and the art of negotiation will soon play just as important a role as the diagnosis and treatment of patients.In a recent Washington Post article, Michael R. Yochelson, associate medical director of the neurological program at ...
Health blog posts of the week, ending May 23, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. How to use sex to teach CPR2. Patient wants an apology, not money, after medical malpractice3. Why primary care doesn’t appeal to this medical student4. Doctors may be forced to accept Medicare rates to stay licensed5. Medical students who choose primary care lose millions in income
Communication and coordination of care needs to be compensated
by Arthur Chernoff, MDRichard Baron is a primary care physician the Philadelphia area.He published a paper in the New England Journal of Medicine entitled “What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice," and discussed recently on KevinMD.com. Dr. Baron conclusively demonstrates that there is a deluge of uncompensated work performed by physicians in the outpatient arena. This comes as no surprise ...
Legalizing marijuana, an opinion from a former JAMA editor
While I was still the editor of JAMA, I was in Boston in January, 1997, to do my regular teaching at Harvard. I dropped in to see my friend Jerry Kassirer, the editor of the New England Journal of Medicine. Little did I know that Jerry was in the midst of a firestorm of protest for his just-published editorial called "Federal Foolishness and Marijuana." Jerry told me that he received ...
Evidence based medicine at the expense of the art of medicine
Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at ...
Radiation and whether cell phone towers are dangerous
Radiation. Powerful enough to turn Dr. Bruce Banner (Bill Bixby) into The Incredible Hulk (Lou Ferrigno), or meek Peter Parker (Tobey Maguire) into The Amazing Spider-Man (still Tobey Maguire, but more buff and spandexed). It also obliterated two cities in Japan, and continues to contribute to cancers near Chernobyl. It’s sciency, strong, and scary. No wonder it creates so much apprehension.We’re all living every day surrounded by radiation sources, and ...
Medical imaging is increasing in cancer patients
by Kristina FioreMedical imaging for cancer patients and resulting costs have increased over the last decade, particularly in positron emission tomography (PET), researchers have found.Annually, use of the diagnostic screen rose significantly between 1999 and 2006 -- ranging from 36% in lung cancer to 54% in breast cancer, Kevin A. Schulman, MD, of Duke University, and colleagues reported in the April 29 Journal of the American Medical Association.Imaging costs also ...
Joint Commission hospital inspections have improved
Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly.Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
