His approach makes the most sense, but the chance of Giuliani (or any Republican) getting elected in 2008 is slim:

People would shop around for plans that suit them best - young, healthy people may opt for the equivalent of liability insurance, while the ill or risk-averse might choose a fuller coverage plan. Those who take good care of themselves would, like good drivers, benefit from financial savings. And insurance ...

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David Hogberg says the well-publicized case of Edith Isabel Rodriguez, dying in the ER waiting room, may be a preview of government-run health care.

John Mack rails against pharma-sponsored CME. Realistically, if physicians had to pay to attend their own CME lectures, no one would go.

Ask Dr. Wiki?

Doctors getting their medical information from Wikipedia? Michelle Au hopes not:

Hey, I love me some internet, and I don't know how people did research and traded information without it. But man, trusting Dr. Wiki is taking it one step too far. He's like the chiropractor that takes out ads on the subway.

By focusing so much on safety, the FDA may be stifling R&D:

"Who is going to bring a new, improved version of Avandia to market," asks Ruffolo, given the likely trial-size FDA is going to request? How will any company be able to prove that their drug doesn't have the safety issues associated with Avandia, if these (whether or not they are real) only become apparent from Steve Nissen's ...

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Apparently, a record judgment wasn't enough:

A Kane County jury recently awarded $1.3 million in a malpractice case against Sherman Hospital in Elgin.

Lawyers said was it was a record-high verdict for this type of case in Kane County, but soon the plaintiff may be asking for much more.

Well, that was much ado about nothing:

"There is a reasonable suspicion we better learn more and watch this affair more closely before we launch into massive use of this drug," said Jules Hirsch, a panel member and professor at Rockefeller University in New York, according to Dow Jones.

While the FDA is not required to follow its committees' advice, it usually does so. And most observers think ...

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Ovarian cancer

A consensus opinion has emerged, with emphasis on detecting the early symptoms. The trouble is, these symptoms are vague, and early diagnosis may be difficult:

Despite this, in all these years, after performing or referring for thousands of sonograms (and not a few ca125 tests) in what I believe is an optimally aggressive screening approach for ovarian cancer in symptomatic women, I have yet to diagnose a single ...

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E-mail and medicine

"The revolution will be e-mailed," says a gleeful op-ed in the NEJM. Medicine is about 10 years late to the party. That's nothing to celebrate.

Midwives are facing rising malpractice costs which birth centers are finding harder to cope with:

Another reason that we are losing birth centers is because they, and CNMs more generally, face rising malpractice insurance costs that make continued operation financially infeasible. Midwifery care costs insurance companies less that hospital births, but this makes it harder for birth centers to offset the rising costs of their insurance. Also, obstetricians are increasingly ...

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(via Health Care BS)

The dilemma facing private practice cardiologists today:

As such, he refuses to perform what Happyman calls the "trifecta" of ECHO, stress test and holter on every person that walks through the door. This left him the option of seeing, as he puts it "100 patients a day". He is now joining a practice at a hospital across town.

So the message appears to be that if you are ...

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A recent study confirms what has been suggested here and elsewhere - there is a pro-screening bias in the media, which often comes from the journal articles themselves:

We identified 854 articles, and 143 were eligible for the study. Most were original research. Benefits were mentioned more often than harms (96% vs. 62%, P<0.001). p="0.03).
(via Schwitzer)

Must read op-ed on the effects of the Lucia case in Florida:

Dr. Haedicke was on call for Memorial Hospital and came in to see her. He evaluated her, drained her abdomen, ordered antibiotics and consulted four other physicians (who were also sued) to evaluate her condition. Her own surgeon returned to Tampa later that afternoon to assume care. Dr. Haedicke had seen her for a total of five hours.

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I have written previously about the importance of your Google reputation. Now, there are some firms to specialized in clearing up negative or misinformation. The WSJ with more:

Ms. Parascandola set out to minimize the bad publicity. She hired a company called ReputationDefender Inc. that promises to help individuals "search and destroy" negative information about them on the Internet. Businesses and others have long employed so-called ...

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VA "facts"

Single-payer cheerleaders often point to the VA's pseudo single-payer system to support their cause. However, can their statistics even be trusted?

Some have suggested this to be a mechanism to control health care costs. I actually think this is a good idea, and would provide global standards to reduce practice variation.

As I stated in my defensive medicine piece, the presence of evidence-based global standards of care would also help in reducing defensive medicine:

A simpler way would be to have clinical, evidence-based, guidelines globally applied to malpractice ...

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Doctors who continue to do this are akin to gamblers.

It worked. 15 physicians responded to the recruiting ballad.

So-called "mystery shoppers" are secretly taking notes about waiting room service:

The note-taker is a mystery shopper, one of a new breed of hospital employees in Boston and nationwide who secretly watch fellow workers to see whether patients are treated courteously and helpfully.

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