I’ve been involved in several boisterous Twitter debates about vaccines, at least to the extent that one can debate using snippets of 140 characters or less. I’ve also been a "super moderator" at a very large Internet message board for many years and have seen my share of passionate vaccine debates there. I’ve been a pediatrician for over 30 years and trained in the subspecialty of pediatric infectious diseases before ...

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From MedPage Today:

  1. ACA Enrollees Sicker Than Average? Offering a first glimpse of the healthcare needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first 2 months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance.
  2. Endocrinologists React to ...

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During a recent lunch with my daughter, a senior at the University of Maryland, she shared her frustration with a question she often receives: “So, what are your plans for next year?” She commented that while her life experiences through present day have been memorable, each stage has been predictable. Now, for the first time, she has more questions than answers. This ambivalence -- this fear of what’s ahead -- ...

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The government dropped a gigantic dataset: details on nearly every single procedure performed by a U.S. doctor on a Medicare patient. The release was greeted with some serious gnashing of teeth, at least as far as doctors were concerned. The American Medical Association, which has always been staunchly opposed to the release of this sort of data, made sure it's objection was -- again -- on the record. MedPage Today leads ...

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The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food. He lived alone, hated his job, saw few people, had no friends -- so he told me at every visit. His visits ...

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I’ve been thinking about EMRs, electronic medical records, lately. It’s a subject, despite some professional experience, I don’t feel particularly close to. In fact, if anything, they are a source of consternation. As an industry insider, I see them as an expensive albatross around our collective neck. As a human centered design adviser, I see them as an encumbrance for both providers and patients. And, as a patient I see ...

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What affects hospital CEO pay the most: Patient satisfaction Dan Diamond (@ddiamond) tweeted this slide from a lecture by Harvard’s Ashish K. Jha at this year’s Association for Healthcare Journalist’s Annual Meeting in Denver. The slide shows how CEO incomes are affected by different variables and contains a few interesting tidbits of information. First, hospital CEOs earn around $600,000. Far more than most physicians. Second, hospital CEO salaries are not significantly affected by multiple ...

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There are few certainties in medicine. But treating rotator cuff injuries has revealed one to me: People with rotator cuff tears don’t sleep well. If you want a glimpse into the life-altering symptoms of shoulder pain, just ask one of these patients how many times a night he or she wakes up with pain. Hearing the answer, it’s easy to see that improving the ability to sleep through the ...

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The statistics tell us that our children are getting sicker and sicker. Attention deficit hyperactivity disorder (ADHD) has more than tripled in just 20 years: It is now diagnosed in 11 percent of all kids, and in an astounding 20 percent of teenage boys. Autism is also on a rapid rise.  The latest reported rate suggests that it occurs in one in every 68 kids -- 20 years ago it ...

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From MedPage Today:

  1. Docs' Medicare Pay Totals Now Public. or the first time, totals of what Medicare pays individual healthcare providers are now freely available to download and browse on a government website.
  2. Fewer Americans Struggling With Medical Debt. The percentage of people in families having problems paying their medical bills continues to tick downward.
  3. Naloxone 'Stigma' a Barrier to Prescribing? Although ...

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The horse that came into my life has made me think about many things from a different perspective. I have learned about the horse’s subtle ways of communicating, her extrasensory (compared to our own) perception, and her instincts of flight. I have also become more aware of the energy I bring to my relationship with her. With no learned tricks or horse management skills, I have established a way of ...

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The joint statement on laboring in water and delivering in water (the latter also known as immersion births) from the American Academy Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) is making the rounds. I’ve linked to the full statement above, but in essence it says that some women find laboring in water helpful for pain relief (in the first stage of labor it reduces the need ...

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I am all for transparency when it comes to health care. So when Medicare announced that it would tell the public how much doctors are paid to treat Medicare patients, my first thought was "hooray." Another victory for consumer information. Then I began to think about this in more depth. The Centers for Medicare and Medicaid Services (CMS), in response to a ruling in a federal case in Florida ...

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If you live in the rural U.S., you probably face relatively limited access to the wonders of American health care.  There won’t be as many physicians per capita offering you their services.  This paucity of health care professionals will be especially stark for subspecialty care.  There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio. This undersupply of physicians ...

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What health care can learn from Katzs Delicatessen Sometime during the last year of the second millennium, I wrote my last letter in response to the last letter I have ever received. It’s been email ever since. I don’t recall making a conscious decision to stop writing letters. It just happened. I cannot pinpoint the exact date when my work memos, agendas, proposals and various notes, disappeared from my desk ...

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Technology finds its way into our lives not so much in big flashy ways as little ones. Oh, I can do this a little bit faster now, isn't that cool? Wow, isn't this convenient? Oh, isn't this a huge risk to my privacy? Oftentimes, when I start talking about Linux or scripting or the command line or any number of tech subjects that seem increasingly esoteric, I get blank stares from ...

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Let's talk internal medicine maintenance of certification (MOC). I recertified back in 2011, and it was an onerous process capped off with a challenging exam.  Thankfully I passed, and I'm good until 2022. Since then, the American Board of Internal Medicine has made maintenance of certification a more "continuous" process, and is sparking some outcry among physicians.  Wes Fisher has multiple posts on his site ...

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The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status. While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon. Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering ...

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From MedPage Today:

  1. USPSTF Praised for Preeclampsia Guidance. When it comes to whether or not to treat women at high risk for preeclampsia with low-dose aspirin therapy, the U.S. Preventive Services Task Force (USPSTF) guidelines are spot on.
  2. Early Signs of Stroke Missed in Many Cases. Many strokes may be missed in emergency departments (EDs) in the days before the problems become obvious.

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Sometimes it seems that life is unfair and the odds are stacked incredibly against us.  More than 1 in 3 persons will get cancer.  The chance of survival if you get lung, pancreatic or brain tumors is pathetically small.  The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers. However, there are remarkable stories of hope.  Here ...

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