What is value in cancer care? It depends. Value. A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care -- especially in cancer care -- is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person's value is clearly another person's concern. At the crux ...

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Old age is no place for sissies. -Bette Davis “I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!” She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had ...

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Unfortunately, measles is in the news again. Measles is a very contagious viral illness that causes a high fever, rash, cough, and a runny nose. Complications include pneumonia, brain inflammation and death. Prior to 1963 there were hundreds of thousands of measles cases in the U.S. annually, causing hundreds of deaths. In 1963 the measles vaccine was introduced, leading to an immediate decrease of measles cases in this country. In 2000 measles was ...

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After prostate cancer treatment: What about intimacy for men? I had just started the sexual health clinic at Massachusetts General Hospital (MGH) when I was approached to meet with a group of prostate cancer survivors. I was hesitant at first -- my interests were in female cancer survivors who had experienced sexual dysfunction. This was partly because I had assumed men had an easier time accessing information on ...

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The holiday season is well underway. This is the time of year for celebrating with family and close friends and reflecting on what is truly important to us. It can also be a  time of significant stress, inevitable over-eating and deviation from our usual routines. Essentially, the holidays can be hazardous to your health and this is particularly true when it comes to your gastrointestinal (GI) system. So what can ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril. On physical examination, temperature is 37.5 °C (99.5 °F), ...

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Youre fine: Thats the hardest diagnosis to make A thought provoking article in the November, 2014 edition of Pediatrics highlights a growing problem with modern medicine: Just because we can make a diagnosis doesn’t mean we should. The article, titled “Overdiagnosis: How our compulsion for diagnosis may be harming our children,” has been made available for free to everyone. It’s fairly dense and technical, but if you’ve been following this blog ...

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McKinsey & Company recently issued a report on effective means of fighting hyper-endemic obesity in the modern world. Among other things, they concluded that "implementing an obesity-abatement program on the required scale will not be easy." I presume that is intended to be somber, but the magnitude of understatement makes it almost funny. And sad. No, it will not be easy -- not in the world as it is. In the ...

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One of my residents presented some research that she had completed under my supervision. Since I left the staff of the U.S. Preventive Services Task Force four years ago, it has been my sense that the Task Force has substantially lowered its evidence "bar" for recommending a preventive service, an impression confirmed in private discussions with colleagues who closely follow the group's activities. In a JAMA editorial published last year, Drs. ...

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Why millennials need some heart education Lately, I’ve been hearing an awful lot about millennials, and how they’re the up-and-coming sector of our economy. So I did some research: I discovered that they’re nearly 80 million strong, and aged between 17 and 34 years. Far too young to be able to impact their heart health, right? New data from the NIH’s ongoing Coronary Artery Risk Development in Young Adults ...

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