The Avandia-crusader has some enemies:

We had an endocrinologist in our office a few days ago . . . and his comment was that Dr. Nissen is "the Michael Moore of the medical industry." Strong words. Mr. Moore is a crusader against the big and rich for the protection of the little guy (in his opinion). The problem is (in my opinion) that Mr. Moore does not ...

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Paul Levy comments on Atul Gawande's column on nursing homes.

A study suggests skipping the CT scan altogether in clear-cut cases:

Pre-operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis, the investigator advised. "If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned." These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.

An editorial from the AAFP suggests that the US statin guidelines are too stringent and not cost-efficient when compared to other countries:

Although the American guideline saved a few more lives than the New Zealand guideline, it did so at great cost. If the least expensive statins cost $200 per year, the drug costs associated with the American guideline would be $198,000 to prevent one death, compared with $108,000 for ...

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One reason why physicians continue to suffer political loss after loss.

Harvard Pilgrim CEO Charlie Baker is open to suggestions.

Can it be fast, good, and cheap? Well, that seems to be impossible.

#1 Dinosaur takes offense at this stereotype:

First of all, how legible is the handwriting of the average adult in any profession today? Who knows? How much longhand writing does anyone do anymore anyway? Not much. Handwriting fatigues the more you write, so being expected to write the equivalent of up to 15 pages by hand daily (hospital notes and prescriptions, not to mention office notes for those of ...

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Killer quote from an article on the benefits of being a PA.

Risperdal Legos

A new low, drug marketing on children's toys.

This ER doc argues that nurses' unions are carrying more legislative weight:

As the nursing union shouts "patient advocacy," they are trying to implement healthcare policy that actually hurts the poorest, sickest, neediest members of our society (I'll elaborate as needed). The whole while, the AMA/CMA (made up of mostly people who are completely out of touch with young physicians) asks for money, but does nothing to help their ...

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Low reimbursement and malpractice fears are cited amongst the reasons for this troubling finding:

Another potential factor, the authors say, is that there might be fewer doctors doing the test, which could lead to long delays in women getting appointments. The authors referred to a recent Institute of Medicine report that speculated that low reimbursements by insurers and increased malpractice litigation against radiologists who read mammograms could be limiting ...

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The Lancet says don't panic, and wait for a randomized study due out in 2009.

WSJ's The Numbers Guy explains meta-analysis studies.

Read more for continuing Avandia coverage here at Kevin, M.D.

Update -
Dr. Wes:
"I only know that if I had submitted a meta-analysis to the New England Journal of Medicine regarding any other drug, it likely would have ...

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Business is will be picking up for plaintiff attorneys:

In a research note to clients, pharmaceutical analyst Mark Purcell of Deutsche Bank said that in the Avandia situation, "parallels will inevitably be drawn to the ongoing Vioxx litigation," in which he said market analysts have assumed as much as $10 billion in liability for Merck.

"Assuming just half this liability for Avandia would reduce the (Glaxo) market capitalization by ...

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Nothing that hasn't been discussed here recently:

In 2005, for example, Medicare paid a typical primary care provider practicing in Chicago, Ill, $89.64 for a typical, half-hour office visit for a patient with a moderately complex condition (CPT code 99214). That same year in the same city, Medicare paid $226.63 to a gastroenterologist taking the same amount of time to perform a colonoscopy in an outpatient department and $422.90 to ...

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Perspective from Dr. Charles.

A woman takes an ambulance to the ER for a pregnancy test. With her Medicaid, she must have thought that health care was free.

IV drug abusers can get free Narcan to give to their friends if they overdose.

Somebody always pays.

Losing lawyers try to re-litigate cases against a hospital that they have already lost.

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