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...

Here's an image of what they would look like.

The problem is with the public. A variety of papers examining Hillarycare's first attempt blames the American people for, i) being too selfish; ii) having an excess of self-interest; and, iii) an inability to accept change.

Has anything changed today? Unlikely.

Pfizer's patent for Lipitor continues until 2010. Find out how they're taking advantage of this.

Living with cancer

Newsweek writer Jonathan Alter gives a heartbreaking account of his battle with lymphoma. (via Freakonomics)

By giving them a medal:

Just ask yourself: if you are on the fence about donating an organ, does the thought of a commemorative medal sway your opinion at all?

Major media has largely ignored the potential harms of cancer screening. The WSJ wisely addresses it:

While it may seem like a no-brainer to get a lung scan to find cancer early, it isn't clear whether doing so will prolong your life. As a result, patients need to be aware of the risks of the screening procedure itself. One concern is radiation exposure. Each low-dose lung CT scan ...

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According to Joe Paduda, a policy wonk with little or no clinical experience. Please educate him.

The ACP with a more nuanced approach, suggesting that women in their 40's discuss mammograms with their physician.

Kudos to the ACP for making women "stop and think about the decision."

With the recent hype on breast MRIs and chest CTs for lung cancer screening, urging the public to think about the potential risks of evidence-bereft screening is the correct, and long overdue, approach.

Update:

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