More medicine does not equal better medicine. Until there is conclusive evidence, there should be no rationale for a routine, screening chest CT scan.

About $200,000:

An average sales person costs a pharmaceutical company about $200,000 including salary and benefits such as a car, said Mike Luby, president and CEO of TargetRx. He said that the challenging business environment means it is imperative for drug makers' sales forces are as effective as possible.
(via PharmaGossip)

Street Anatomy talks about this subset of medical illustrators:

With the increase in the number of malpractice and personal injury suits it's becoming increasingly important to provide adequate visual representation in order to effectively convey medical information to a jury. Can you imagine taking complex medical/clinical information and interpreting it so that a jury with an average high school science education can understand? This is exactly what a medical-legal illustrator ...

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A view from both sides, and why cases are settled:

An offer to settle out of court is often a financial decision that has nothing to do with guilt or innocence. Barrows call it "buying out the risk.

"We know statistically half of these cases will have jury outcomes," she explains. "We choose not to put some of these cases through the jury process. Once you go to trial, ...

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Many physicians have lousy business sense. Not this one:

"I've always been a successful businessman," said Matlock, who received an MBA in health care from the University of California at Irvine in 2000. "I understand the value of branding."

Matlock said his licensing agreements are necessary to protect his intellectual property rights. "I understand how to capitalize on an opportunity. Why should I give it away?"

A patient is upset that drug reps prance in to see the physician, while he (or she) is stuck waiting:

The situation is, patients are waiting in the doctor's waiting room, the doctor is running 30 to 45 minutes late, and the room is crowded.

In prance pharmaceutical reps, one after another. They are permitted to enter the inner office to see the doctor without waiting. Some are carrying ...

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Where is this? Right here at home. More on the military health system:

I spoke to one Army doctor the other day - a chief of family practice at a good-sized facility. Let's call him Dr. Jonah. He oversees about a dozen doctors, each with at least 21 patients per day.

Which sounds like a lot - until you consider that he's got a patient ...

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Is drug regulation in the name of safety going overboard? And for those who support "Medicare for all", how is this supposed to be better than the restrictions that are currently in place? Scott Gottlieb in the WSJ:

Once the FDA is granted the authority to simply impose these RiskMAPs on drug companies, there will be a lot of political pressure on the agency to constrain prescription writing in ...

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John Irvine looks at media spin on both sides of the fence.

Maggie Mahar defends the VA (which I am well aware is a separate entity from Walter Reed), whose reputation is being damaged in this scandal.

Graham:
"And of the 5 hospitals I've rotated through, the VA has had the best security (translation: the most annoying passwords) of any place I've been. Is it perfect, not at ...

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Some hospitals have on-call administrators and doctors to support physicians when an error has been made. A step in the right direction.

Superhero syndrome

Sam Blackman comments on a case series where children were injured wearing superhero costumes:

Five cases of serious injuries to children wearing superhero costumes, involving extreme risk-taking behaviour, are presented here. Although children have always displayed behaviour seemingly unwise to the adult eye, the advent of superhero role models can give unrealistic expectations to the child, which may lead to serious injury.The children we saw have all had to contemplate ...

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If this is his first episode, he likely would need 3 months of Coumadin.

More on DVT's.

Update:
Dr. Charles comments.

I'm big into personal responsibility, and I believe that individual mandates are the most feasible, realistic way to address the issue of the uninsured. A newspaper in Iowa is discussing some pros and cons to this approach:

I dislike the word "mandate." I prefer to say residents of Massachusetts are expected to take individual responsibility for their health. It's like the approach Iowa uses for automobile insurance. In Iowa, ...

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An EMT's job hangs in the balance because he did just that.

Fascinating article from New York Magazine about the inner workings of a malpractice case. The plaintiff firm specializes in cases involving brain-damaged infants:

When Fitzgerald started doing "med-mal" cases in the early eighties, after a career in landlord-tenant law"”"lucrative but not rewarding," he says"”firms like Fitzgerald that charged a contingency fee could take about a third of any award. Now their take is capped by law at a ...

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They have a "if it ain't broke, don't fix it" mentality.

The government-funded VA system is in bad shape as well:

Soldiers and veterans report bureaucratic disarray similar to Walter Reed's: indifferent, untrained staff; lost paperwork; medical appointments that drop from the computers; and long waits for consultations.
Update from around the blogosphere -

Volokh:
"If private companies had mismanaged outpatient care for veterans the way the V.A. system has, there would be strong calls from all the usual quarters ...

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A physician responds to a recent WSJ article on the difficulty of recruiting physician to practice in rural areas:

When a foreign medical graduate has the same access to opportunities across the country as a citizen would, there is no incentive for them to even consider an area like ours. What ends up happening is a snowball effect: We can't staff our facilities, and those who are here ...

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They are taking a more active role in reducing hospital errors.

House, M.D. expert Scott Morrison blogs weekly about the show. He writes about three rare cases in AMA's Virtual Mentor. (via GruntDoc)

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