Psychiatrist Maria wonders if hospitalizing patients at low clinical suspicion for suicide is a form of defensive medicine:

Some psychiatrists routinely hospitalize patients (through coercion, either with or without the "help" of friends, family, et al.) who endorse suicidality when "clinical suspicion is low" that the individual will actually commit the act. The belief is that if someone is in the hospital, the risk of suicide drops significantly"”after all, the ...

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Celebrex: The new ad

John Mack does the dissection.

A recent study suggests so, although I thought that routine preventive maintenance were covered in most high-deductible plans.

As big buckets of money:

"There is a big bucket of money sitting in every office. Every time you go in, you reach your hand in the bucket and grab a handful. The more times you are in, the more money goes in your pocket. Every time you make a call, you are looking to make more money."

Once again, a detailed look at cancer screening - this time breast cancer. Despite the recent ACP recommendations, it may just come down to this:

In addition, the elephant in the room that no one wants to acknowledge is the medical-legal climate. One of the most common causes of lawsuits, if not the most common, is failure to diagnose breast cancer. What primary care doctor has the cojones ...

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Pharma box office

The WSJ Health Blog chronicles which pharma reps are getting the physicians' attention.

Roy Poses looks behind the scenes at medical schools:

Dr Goldman reveals that in the typical medical school, the most important criterion for faculty success if generation of external funding, that is, generation of fees for clinical work, or of grants from external sponsors. Whether a faculty member is good at patient care, teaching, or research, or whether he or she upholds the highest professional standards, is secondary.
Matthew ...

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MedPage Today interviews two prominent cardiologists on its impact.

Will the COURAGE trial change practice? Unlikely. It's the same idea as watchful waiting, patients generally like to have interventions done - despite the (lack of) evidence:

Listen, one of the arteries feeding your heart is clogged up with plaque. I know you've got a little bit of chest pain, but we've got good evidence that clearing out the artery and putting in a stent isn't going ...

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Lost in the coverage are the IBS sufferers who depended on Zelnorm:

Some IBS patients say they have been calling the FDA asking for the drug's return to market. Jeffrey Roberts, founder of the Irritable Bowel Syndrome Self Help and Support Group, says he is encouraging the Web-based organization's 20,000 members to write to the FDA to complain.

Other patients are returning to the makeshift remedies they used ...

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An op-ed in the WSJ once again shows the flaws in our current physician reimbursement system:

One would be hard-pressed to find a lawyer in the U.S. today who does not keep client records electronically. Ditto for accountants, architects, engineers and virtually every other profession. Yet although the computer is ubiquitous and studies show that electronic medical record systems have the capacity to improve quality and greatly reduce medical ...

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This dog is dying fast, according to Ed Silverman:

Pfizer's Jeff Kindler promises new DTC ads will be more responsible. Just this week, he debuted a new Celebrex ad that, while lengthy and dull, does emphasize risk. Selling Exubera to the public will be just as challenging. "It's Not Really A Bong" isn't a catchy slogan.

Device DTC ads

John Mack says the FDA is asleep at the switch and device-makers are taking advantage.

Dr. Crippen is not happy, and rants about midwives in the UK:

Hewitt is pushing women towards home-deliveries. She marches under the banner of "choice" but the real agenda is cost-cutting. Dr Crippen believes that any woman electing to have a home delivery is taking risks with her own life and with the life of her baby. The baby does not have a choice. The time will come that brain ...

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From CNN:

It's hard out there for drug sales reps--particularly if they work in places where gaining access to doctors is becoming increasingly difficult . . .

. . . "We weren't allowed to leave samples: not tissue boxes or anything," said Abrahamsen, speaking at iiBig conference in Atlantic City, N.J. late last month "We weren't allowed past the receptionist."
(via Peter Rost)

Hospital CEO Paul Levy sees some light up ahead on primary care.

Sid Schwab ponders this question.

The latest and greatest technology isn't necessarily better medicine:

Computer-aided detection systems not only failed to detect more breast cancer in women who had screening mammograms, researchers report in tomorrow's New England Journal of Medicine, but it also may have harmed them by generating a higher number of false-positive readings, resulting in significantly more call-backs for repeat mammograms and biopsies.

All the steps to prevent this wrong-site surgery went awry.

Defensive medicine

What is defensive medicine? Defensive medicine is the deviation from sound medical practice to avoid the threat of malpractice litigation. According to a 2005 study in JAMA, over 90 percent of physicians surveyed admitted to practicing defensive medicine. This can range from "positive" defensive medicine, like ordering unnecessary tests, referring to consultants, or performing unneeded procedures; to "negative" defensive medicine, like avoiding high-risk patients or procedures. Read more...

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