Top stories in health and medicine, June 20, 2014From MedPage Today:

  1. The Uninsured: 33 Million and Counting. In the last full year before the Affordable Care Act went into effect, more than 33 million Americans had been without health insurance for more than a year, according to CDC survey.
  2. Gross Anatomy: A Real Twisted Heart. It's nothing but heartache for ...

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If you read my articles, then you likely know about the scam known as pay-for-performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it. In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept.  Folks who perform ...

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It is time for American physicians to rise up It's time for the American physician to stand up. We will no longer bend to the tyranny of bureaucracy, the venom of litigation, or the naivete of legislation.  For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills.  Our experience standing in the line of fire dwarfs ...

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While there are many creative people who go into medicine, the challenge of turning experience into innovation can be stifling. My classmates at Johns Hopkins, fellow residents at Harvard, and peers came from a wide variety of backgrounds. But medical school, internship, and residency don’t afford students much time to tinker around. “Free time” in academic medicine means working in a lab with the “publish or perish” dictum hanging over one’s ...

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After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA.  Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true.  The place is a mess. Let’s start with the computer system.  The VA medical record system has been held up as an example of an effective EMR system, in which ...

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Recently I had dinner with a friend of mine who, decades ago, had sat on my doctoral dissertation committee. At one point we touched on my dissertation, which covered the health issues of Baltimore's homeless teens. "You always had an uncanny connection with homeless kids," my friend said. "You really understood them." I gazed out the window, seeing the homeless people with their shopping carts in the park across the street. Then I ...

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Carrie is a 72-year-old retired real estate agent with a high school education. She raised three kids, but they do not talk to her anymore.  Since her husband died, Carrie has lived alone.  A melanoma was removed from her right shoulder 2 years ago.  In my office, we stare at the CT scan display of a mass in her right lung. “What does that mean?” “Well, we wouldn’t know for sure until ...

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Top stories in health and medicine, June 19, 2014From MedPage Today:

  1. Do Thiazides Trigger Metabolic Side Effects in Older Adults? Metabolic adverse events were relatively common among older, predominantly male veterans who started taking a thiazide diuretic for hypertension.
  2. Insurers Push Back Against Growing Cost of Cancer Tx. Some cancer patients and their insurers are seeing their bills for chemotherapy ...

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A woman experienced symptoms of a stroke: facial droop, dysarthria, arm weakness and reduced fine motor control.  She  recorded these symptoms in a real time video, which is now on YouTube.  Several days prior, she experienced similar symptoms that were dismissed by physicians.  After this episode, she was correctly diagnosed with a transient ischemic attack, and now on appropriate medications.  But I agree with Dr. Markku Kaste with the World Stroke ...

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Mass murders are becoming a depressingly familiar routine in the United States -- we can now expect to experience a media grabbing shooting about once a month. And the frequency can only increase as future cohorts of copycat killers are spawned by the seductive opportunity to temporarily gain the spotlight. Amidst the anguish and heartbreak felt by the victims' families, there are always two haunting questions. What motivates someone to kill ...

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Cancer screening in those with metastatic disease“Your cancer has come back.” These are words no one treated for cancer wants to hear, yet they are words I have said far too often in my own career. In this case, I had said this to a patient I had cared for ever since her initial diagnosis. At that time, she had stage III breast cancer. After her surgery, ...

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There is a recent and interesting piece in the Wall Street Journal by an orthopedic surgeon, Dr. Craviotto, about the maddening aspect of forced mandates and bureaucratic requirements in medicine that seem to have very little to do with actual medical care and more about hoops through which we must jump that seemingly lead to nowhere. While I do find the bureaucracy of medicine in the United States insane versus the Canadian ...

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I've been a practicing oncologist for all of seven months, and so was surprised when my chief asked that I take part in our quality review panel. The quality review panel is an internal group that is tasked with the responsibility of looking into allegations that a patient's care was not in keeping with best practice or what is generally considered the standard of care. Cases (often in the form ...

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In 2010, I lost my mother to cancer.  She was a fighter and had survived well past her prognosis, but her hospital costs outlived her. Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the ...

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Dr. Oz testifies before the Senate Commerce, Science, and Transportation Committee and gets grilled by Sen. Claire McCaskill, a former prosecutor.  As the senator puts it, Dr. Oz has a huge megaphone, which he could use to promote evidence-based health practices.  Instead, he squanders this opportunity by endorsing products of questionable value. 

A prostate cancer breakthrough: The good and not so good newsThe annual meeting of the American Society of Clinical Oncology is a place where many commercial interests jostle for attention to make their latest promising therapy the star of the show. But a standard widely available generic drug stole the show by producing incredible results in improving survival for men with advanced prostate cancer. And that has some of us ...

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Top stories in health and medicine, June 18, 2014From MedPage Today:

  1. Is There an Rx for High Drug Prices? In the U.S., rising prescription drug prices are the law -- at least that's the way it looks to Leonard Saltz, MD, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center in New York City.
  2. Targets Tightened for Kids' Type ...

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The prevailing sentiment in pop-culture nutrition -- propagated in books, blogs, and blather; documentaries and diatribes -- is that everything we thought we knew about diet and health until yesterday is wrong. Actually, we have a much bigger problem than that. To one degree or another, everything we thought we knew about nutrition is right -- and we are obligated to do something about it, or stay fat and sick. That's ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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The technology industry has been buzzing of late because of the big players entering the wearable sensor market. We are very familiar with Misfit and Nike’s Fitbit for some time. Others investing into the sector include Intel, Microsoft,  Apple and Samsung. There is no doubt that the inertia for fitness trackers is undergoing modulation. This is a result of both a dampening of the initial "wow" factor by consumers and a maturation of the market. Recalls of Nike Fitbits ...

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