The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none. Yikes. The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third ...

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Top stories in health and medicine, July 22, 2014From MedPage Today:

  1. Error: You Have No Payments from Pharma. The federal government has a word for physicians who don't have financial relationships with pharmaceutical and medical device manufacturers: "Error."
  2. Do the Eyes Really Have it in Diabetes? Novartis and Google garnered much media attention last week when they announced their partnership ...

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In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers. One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on ...

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Adverse events -- when bad things happen to patients because of what we as medical professionals do -- are a leading cause of suffering and death in the U.S. and globally.  Indeed, as I have written before, patient safety is a major issue in American health care, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical ...

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For scientists and researchers who are developing new treatments for disease, Data is power.  For patients, Data can mean empowerment.  Devices that track health indicators are readily available.  These devices can track heart rate, blood pressure, blood sugar and even respiratory rate and body temperature. In the Wall Street Journal, the medical applications of the Fitbit device are explored.  The Fitbit is a basic pedometer that tracks movement, steps taken, calories consumed ...

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When I was a boy, my dream was to become an airline pilot. The job seemed glamorous and exciting, and appeared to be held in high regard by all the people around me. I actually used to have a bit of an obsession with airplanes, and living so close to Heathrow Airport, had plenty of opportunities to see planes and visit the airport: both as a passenger and whenever we ...

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There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.” I was reminded of that when I read the recent research report and the accompanying editorial in the Annals ...

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Next in a series. The fundamental problem in health care delivery today is a highly dysfunctional payment system that leads to higher costs, lesser quality and reduced satisfaction. It also means less time between doctor and patient with the loss of “relationship medicine.” The core problem? Price controls and regulations that reduce the trust and core interactions between doctor and patient. The patient is no one’s customer and visit times ...

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I want to commend Mark Bittman on the underlying message in his recent editorial in the New York Times, "What Causes Weight Gain." Bittman suggests that as much as we need research to "determine precisely what causes diet related chronic illnesses," we also need a program that will get this "single, simple message across: eat real food." While we have yet to isolate what in our diet is contributing to ...

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Like many, we followed Apple's recent announcement about its Health app and HealthKit development platform with interest. In many ways, it echoed a vision -- of an ecosystem where personal health data formed a platform upon which many could develop apps that help people live healthy lives -- that we have supported for many years through the Robert Wood Johnson Foundation's Project HealthDesign. We were particularly ...

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Throwing the Hippocratic Oath in the trashThrowing the Hippocratic Oath in the trash An excerpt from The Demise of Medicine. The Dalai Lama has once been quoted as saying, “Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them.”  In a nutshell, the Hippocratic Oath can be summarized in this one phrase: “Primum non ...

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Michelle Obama recently wrote an opinion piece in the New York Times discussing her pet project of childhood obesity. Discussing the Special Supplemental Nutrition Program for WomenInfants, and Children, known as WIC, she criticized the House of Representatives for considering a bill that would allow white potatoes to be included in the list of foods that could be purchased with WIC funds. One ...

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I recently read some statistics that shocked me, but not really. In the U.S., 60% of medical students come from families with incomes in the top 20% of the nation. Meanwhile, only 3% come from families with incomes in the lowest 20%. Not much socioeconomic diversity in the house of medicine. Now, I realized early on that I didn’t have a lot of company in this respect, but I didn’t think ...

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Recently I was the only witness to testify against local medical marijuana legislation.  The bill, already endorsed by all members of the Council of the District of Columbia, would allow use of marijuana for “any condition for which treatment with medical marijuana would be beneficial, as determined by the patient’s physician.”  As I waited hours for my turn to highlight the medical evidence about marijuana’s health effects, I sat silently, taking in ...

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For the better part of the last two decades I have practiced psychiatry in a variety of different American health care systems, and over these years I have, on numerous occasions, heard psychiatric services referred to in manner that imply (often subtly) that such services are not medical care.  These references come not only from patients, but nurses and doctors (including myself) too. “Yes Mr. Jones you need to follow up ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old woman is evaluated for a prodrome of pain on tip of the nose followed by a painful eruption involving the right periorbital tissue. On physical examination, all vital signs are normal. There are grouped vesicles on an erythematous base on the tip of the nose and about the right eye. Which of ...

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The mission creep of maintenance of certification Up until 1988, being board certified in pediatrics was a voluntary process of passing the board exam once in a career. The American Board of Pediatrics (ABP) apparently realized this process didn’t make them much money, so in 1989, they abruptly ended “lifetime certification” and required an open book test and the associated fee every seven years.  I was in pediatric residency during this maintenance of certification ...

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Why you should love your doctor Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth. Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family. Doctors delay childbearing and starting their own families so they can care for your family. Doctors miss their own kids’ ballet recitals and baseball games ...

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The administration issued a report recently that says individuals who selected plans in the federal health insurance exchanges have a post-credit premium that is on average 76% less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies -- 46% are paying $50 or less. The administration also pointed out that 65% of individuals selecting the silver plan in the federal exchange chose ...

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You’d think, being land-based mammals, we’d all be able to agree on the basic fact that humans breathe air, and that newborn human babies ought to be born into the air.  You know, so they can breathe. That’s how human babies have always been born, and that’s how all other primates are born, and that’s how all other land mammals are born. (Hats off to our cetacean cousins for their ...

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