Procedure-based medicine has been disproportionately reimbursed for years. If the cuts are redistributed to primary care and E&M visits, I don't have a problem with it:

The Bush administration says it plans sweeping changes in Medicare payments to hospitals that could cut payments by 20 percent to 30 percent for many complex treatments and new technologies.

The changes, the biggest since the current payment system was adopted ...

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Apparently they weren't too forthcoming with information:

"What do you need this information for?" he said. "Let me tell you where I'm coming from. When I take my car to the mechanic, and he says this and this and this is wrong with the carburetor, I don't even listen. I'm not a mechanic. So what good will this information do you? You're not a doctor."

WashPost talks about how religious beliefs affects treatment decisions:

Patients around the country describe similar experiences -- being shocked, judged, humiliated, frightened and angered when they have encountered health-care workers who are overt in some religious beliefs.

Sometimes providers proselytize gay or unmarried patients but do provide care. Sometimes they refuse to fill prescriptions for birth control or morning-after pills but refer patients elsewhere. Other times they refuse ...

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The demise of the brachial plexus clinic can have serious implications for Baylor.

One problem - if this went through, no one would take on difficult patients or hard-to-control diseases:

The way physicians are paid is how stockbrokers used to be paid about a decade ago, Udall said.

"“They were paid on transactions, they were paid for selling or buying the shares,"” he said. "“They weren't paid based on whether the stocks did well. A few years ago, they changed that."”

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Another sign of an overmedicated society:

The breakfast buffet at Camp Echo starts at a picnic table covered in gingham-patterned oil cloth. Here, children jostle for their morning medications: Zoloft for depression, Abilify for bipolar disorder, Guanfacine for twitchy eyes and a host of medications for attention deficit disorder.

A quick gulp of water, a greeting from the nurse, and the youngsters move on to the next table ...

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Some are advising against malaria prophylaxis:

Some homeopathic practices tell people they need not take conventional anti-malaria drugs in high-risk parts of the world, an investigation by BBC2's Newsnight has revealed.

Instead, the clinics say that their remedies are sufficient to protect against malaria.

Here are results from a recent survey:

. . . only 37.6 percent said they would choose to enter primary care again if they could start their careers over. Over one-third said they would go into a surgical or diagnostic specialty instead. Meanwhile, 28.6 percent said they would not choose to go into medicine.
(via a reader tip)

Medpundit’s back

Welcome back! The medical blogosphere has been somewhat empty in your absence.

December 2004 - Analysis of Reggie White's death, and the connection between sleep apnea and heart disease:

There has been some connection between coronary artery disease and sleep apnea, although the data is far from robust. A study done in the 1980's suggested an odds ratio of 2.0 for angina in those with sleep apnea.

Another found a significantly increased risk of myocardial infarction for those in the ...

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November 2004 - The all-time most commented post on this blog. A virtual support board for ice-eaters:

Pica is defined as an appetite for substances not fit for food, such as clay or paper products. Pagophagia is specifically pica for ice, and studies show this to be a specific indicator for iron deficiency anemia. The latter study studied 55 patients with iron-deficiency anemia. Thirty two (58%) had pica, and ...

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How the plaintiff's lawyer spins a loss into a "victory":

"This was actually a major victory for plaintiffs across the country as this was the first time that the jury was asked if Merck failed to warn the patients about the dangers of Vioxx and the answer was yes by a unanimous verdict," said Galpern. "Unfortunately they found that Vioxx did not cause Mrs. Doherty's heart attacks, and we ...

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The battle about the pharmacists' right to prescribe continues:

We believe any changes to the powers of pharmacists should be very limited, perhaps to allowing them to adjust dosages or renew a prescription without consulting a physician. We oppose giving pharmacists permission to assess what is wrong with a patient and then to prescribe medication. Pharmacists don't have the diagnostic training of doctors.

A fee-for-service system will inevitably lead some physicians to "create" more visits. After all, more visits = more revenue. Advising a yearly routine colonoscopy however, such as in this case, is crossing the line.

That being said, routine visits do have a place. For instance, I routinely see all my hypertensives and diabetics every 3-6 months (depending on their severity). That's not churning, it's just ...

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They're talking about it in Texas:

Doctors who perform illegal abortions in Texas could be subject to the death penalty because of the way the Legislature has strung together recent statutes, according to the state's top prosecutor association.

By defining a fetus as "an individual" in 2003, and then making it a criminal act in 2005 to perform certain abortions, legislators might have unintentionally created a scenario in which ...

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Concord Monitor:

Bennett is an outspoken, self-made man and a scrapper who's unafraid of big fights. He made news by donating his $4 million collection of antique cars to benefit his alma mater, Harvard, and then for leading the fight to reduce the millions of dollars in bonuses paid to the managers of Harvard's $19 billion endowment. He also won a half-million-dollar award from a man who claimed that Bennett ...

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Talk about a tirade. Certainly one unhappy man.

They actually contain traces of Viagra:

The FDA warned consumers not to buy or use seven of the so-called dietary supplements, sold online to treat impotence and enhance sexual performance. The list includes a product called Zimaxx, which FDA testing showed contains sildenafil, the same active ingredient in Viagra.

Rare case studies suggests that it may make brain injured patients more alert.

Wonderful news.

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