A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised. What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by ...

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As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore. We raced in the ...

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It is near impossible to escape the commanding news headlines: The horrific details that are emerging about the years of violent captivity of three women in a home in Ohio; The fifteen year old Californian teenager who was allegedly sexually assaulted by three boys and then committed suicide last September. And, internationally, the tragic case of a 23 year old woman who was gang raped and beaten to ...

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You get to know people after a few days in paradise, sitting on lawn chairs in front of the pool. You talk about where you're from and your kids (if you have them). You might spout off about your job or friends. These are the pleasant conversations exchanged between vacationing strangers. You may learn that one of them has taken ill: woken up perchance on a beautiful idyllic ...

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The Atlantic this week published a provocative article entitled “The Robot Will See You Now.”  Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care.  In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?” The IT version of health includes continuous medical monitoring (i.e. your watch will ...

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asco-logoEveryone’s talking about health care costs these days. The presentations usually start with a chart of rising health care expenditures, the tip of the line pointing skywards. Next come exhaustive (and exhausting) tables, more charts, all punctuated with a final shrug of uncertainty from the speaker: what’s the solution to rising costs? Of course, there isn’t just one. But in the morass ...

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So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security ...

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So how’s my new practice going?  In some ways things are going about as well as they could.  My patients are amazed when I answer their emails or (even more surprisingly) answer the phone. "Hello, this is Dr. Lamberts," I say.  This usually results in a long pause, followed by a confused and timid voice saying something like, “well…uh…I was expecting to get Jamie.” Yet I am often able to deal with ...

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obese airplanes Recently the wires have been active with suggestions that people with obesity pay more for airline travel. This discussion was prompted by a Samoan airline announcing that they would begin charging passengers by the pound. It was also stimulated by Bharat Bhatta, an economist from Norway suggesting that heavier passengers pay a surcharge while lighter passengers are offered discounts. The logical argument ...

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Dear HIPAA: I’m sure you get a lot of hate mail, especially from folks in my profession, so when you got this letter from me you probably assumed it was more of the same.  Let me reassure you: I am not one of those docs.  I do think patient privacy is important, and actually found you quite useful when facing unwanted probing questions from family members.  I believe the only way ...

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