Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long. Surgeon and writer, Atul Gawande, explores the medicalization of ageing and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and ...

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I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer. Epidemiological studies are whodunits, too. Except you don’t know who has been killed, what the murder weapon is, or who the killer is. You only know that a murder may have happened. A study found a higher incidence of breast cancer with ...

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I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5,500 percent. Just because something isn’t suspicious doesn’t mean that it isn’t odd. Shkreli is a perfect poster child for rapacious ...

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In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value -- above and beyond anything else -- the general radiologist. Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the ...

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The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save ...

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Britain’s health secretary wants to uncharm his way to a revolution. To galvanize support for a seven-day National Health Service (NHS), which the NHS was before Jeremy Hunt’s radical plans, and still is, he asserted that thousands die because there is a shortage of senior doctors during weekends. This is an expedient interpretation of a study which showed that mortality was higher in patients admitted on weekends. Hunt ignored the
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Recently, I was dining with elite radiologists. In that uncomfortable silence between dessert and the check, I said, “radiology must shift the traditional paradigm by creating value streams using disruptive innovation to leverage population health to build strong ecosystems and a robust ectoplasm.” I was experimenting if excreted verbiage hastens the check. Instead, it sparked a vigorous conversation about disruptive innovation, compelling me to drink more cognac. In health care, no two ...

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The Lown Institute advocates rational use of medical resources. This is a noble goal and worthy of the attention of radiologists. It was recently RightCare Action Week: Here are five simple things any radiologist can do that week, and the following weeks. This will improve patient care by avoiding unnecessary tests. 1. Speak to the referring clinician, at least sometimes, if not often, perhaps twice a day. The conversation need ...

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Recently, I was speaking with a less is more advocate. He used his superior knowledge of statistics -- he had an MPH -- to debunk randomized controlled trials. We discussed overdiagnosis, overtreatment, and the shakiness of medical sciences. We spoke about measuring the quality of physicians. I remarked that quality metrics have as much evidence as Garcinia Cambogia -- we had just laughed about Dr. Oz. I expected a chuckle. Instead, ...

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Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person disease: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false ...

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