If I were punched by an unknown man in an elevator there would be little doubt that my assailant would be prosecuted. If the trauma were enough to cause me to lose consciousness, meaning I suffered brain trauma, my attacker would likely be charged with aggravated assault. No one would be surprised if he received jail time. No one would think twice if he lost his job. However, if I ...

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One thousand dollars per pill? A single treatment course for hepatitis C virus to cost $83,000? How can those prices be justified? The drug-discovery process is a long one, fraught with disappointments and massive investment, no matter what the outcome. Some pharmaceutical companies argue that the high prices charged for their rare “blockbuster” drugs help them recover research and development costs. While drug pricing and drug access are contentious and controversial issues -- ones ...

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Searching for health and fitness apps on the iTunes app store turns up approximately 2,200 results. There are calorie counters, activity trackers, heart rate monitors, virtual fitness coaches and every other conceivable permutation. The quantity should grow even larger thanks to Apple’s latest product release, the Apple Watch, a wrist wearable computer that tracks health and fitness information. One question, though: Are the users of these apps any healthier as a ...

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Dont spank your children. Do these 5 things instead. In my mind it’s no wonder the American Academy of Pediatrics has a statement against spanking. Spanking, in the simplest form, is the act of hitting a child, using physical force to try to get a different outcome. Thing is, spanking is an ineffective discipline tool in the long run and research shows it’s damaging to a child’s mental health. ...

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While there are plenty of valid reasons to be skeptical about the Affordable Care Act, regardless of where you fall on the political spectrum, it’s hard to argue that imposing an individual mandate to purchase insurance won’t result in more people obtaining coverage. According to the results of a recent survey conducted by the Centers for Disease Control and Prevention (CDC), that’s precisely what’s happened. Based on results of the National ...

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The case A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: "I want to give up custody of my son." The patient is well dressed -- and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone. According to the patient, she is a single mother with no support system. Her son’s father deserted ...

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Top stories in health and medicine, September 24, 2014From MedPage Today:

  1. Key Updates for Angina, NSTEMI. The American Heart Association and American College of Cardiology released an update of their guidelines for unstable angina and non-ST segment elevation myocardial infarction (NSTEMI).
  2. Metformin and TSH: Is There a Link? Metformin seemed to further diminish levels of thyroid-stimulating hormone (TSH) in diabetic ...

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Part of a series. Patients need doctors that take time to listen which means a limited number of patients under care. Employers need programs that reduce costs and ideally improve the health of their staff. These apparently disparate needs can come together in a new model for effective company-sponsored primary care programs. Those of you who have followed this series know that I am an advocate for PCPs finding ways to ...

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In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to ...

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As a recently retired physician, I still maintain an interest in medical research, though I have to ask myself: Why? Surely not just from the point of view of a potential future patient. But not from the point of view of a practicing physician either. Perhaps I keep up just from a lifetime of habit?  Or is there something I miss about my old job? These thoughts came to mind as ...

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Responding to a medical student in pain This evening, I read a post written by a woman who finds herself feeling alone, depressed, desperate, and afraid of losing herself as she goes through medical school. This post is my response to that woman. Dear colleague and friend, You are not alone. You are far from home. You are far from your family. You are far from the desert, the open ...

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The astronauts are halfway to Mars when suddenly one of them develops abdominal pain and requires surgery. What will they do? According to NASA, a miniature robot capable of assisting in surgery has been developed, tested in pigs, and is soon to be trialed in a weightless environment. The robot, which weighs less than 1 pound, can be inserted into the abdomen via the umbilicus and controlled remotely. The press release from ...

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Let’s talk about expectations. And I’m talking the Dickens’ kind. When you watch television, the food flaunts itself before you. Tempting you with golden buns and perfectly placed pickles. The models eating those perfectly styled burgers are the same -- airbrushed to perfection. Most often, limbs are stretched to unrealistic proportions and curves are molded and erased to fit someone’s view of beauty. When someone first takes the baby steps to venture into ...

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Top stories in health and medicine, September 23, 2014From MedPage Today:

  1. One Insurer Holds Obamacare Fate in Two States. Here's a health law pop quiz: Which two states have the least successful Obamacare health insurance exchanges?
  2. RT Regimens Preserve QOL in Prostate Ca. Almost 90% of men with localized prostate cancer remained sexually active 5 years after treatment with blood ...

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In a study in the American Journal of Infection Control, researchers coated a gloved hand in E. coli.  One person with the E. coli glove then they shook hands, high-fived, and fist bumped another person with a sterile glove.  Transfer of E. coli to the sterile glove was measured. Results:

  • highest transfer of bacteria: handshake
  • lowest transfer of bacteria: fist bump (high five was in the middle)
  • difference: fist bump less than 10% of ...

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Scientist J. Robert Oppenheimer once said, "There are children playing in the streets who could solve some of my top problems in physics, because they have modes of sensory perception that I lost long ago." Like physics, medicine has its share of problems, namely cost control. Like children, we must open our perception to the problem of cost control to consider other possibilities that better account for the issue than the theories ...

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There is much talk about cynicism in medicine, and I remember being confronted by it almost from the beginning. In fact, I still remember how shocked I was the first time I heard a provider describe a patient in a disparaging matter. We were responding to a 911 call regarding a woman in her 30s who was feeling short of breath. I remember being worried; she seemed too young to be ...

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I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop ...

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Patient appreciation: Why I still love being a doctor Judging from recent articlessurveys, and blog posts, the medical profession is remarkably demoralized. Typical complaints range from “feeling like a beaten dog” to “living in humiliating servitude,” to being forced to practice “treadmill medicine.” Interestingly, the public response to these complaints is largely indifferent. The prevailing attitude (if the comments sections of online articles and blog posts are representative) seems ...

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She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War ...

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