Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology. Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then? Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science. Molecular testing of the actual ...

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Promoting patient safety, preventing medical error, preventing physician error, preventing errors in diagnosis, preventing nurse error, preventing surgical error, preventing communication error, preventing health illiteracy error, preventing errors from language barriers, preventing laboratory error, preventing computer error, preventing patient mix-ups, preventing right and left side of body mix-ups, preventing mistakes, since mistakes are the stepping stones to failure. Recognizing human frailty, recognizing physician humanity, recognizing system fallibility, owning up to problems, ...

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Who is your favorite addict? I guess we have to talk about addiction as a preface to that question. Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh Day Adventists, and the like. All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction. Most people who become addicted to one drug often ...

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There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone. In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more. Then, in the 1970s, 80s, 90s, ...

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Most humans, even those who are educated, can read and write, and have studied some science, seem to have a hard time comprehending unpleasant future realities, absent personal experience. Some say that people learn most from their own mistakes. If true, that makes widespread prevention of anticipated calamities very difficult. And I am not only talking about people who are deeply into religion and superstition, and those who send politicians who proudly ...

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Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes. The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, ...

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All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies. Why? Because they are the only games in town, and both security and safety are top Maslow imperatives. The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a ...

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A law is a rule of conduct or action formally recognized as binding and enforced by a controlling authority. Law enforcement broadly refers to any system by which some members of society act in an organized manner to promote adherence to the law by discovering and punishing persons who violate the rules governing that society. The purposes of punishment for crimes include: 1. Punishment will stop them from committing further crimes. 2. Punishment ...

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Healthy, wealthy and wise. Or is it wise, wealthy, and healthy, or perhaps healthy, wise, and wealthy, or even wealthy, wise and healthy? Which came first, the chicken or the egg? Is there cause and effect? The question matters a lot because, these days, we are constantly talking about bona fide disparities in health -- by gender, race, ethnicity, geography, age, status of citizenship, and type or absence of insurance. But, ...

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"I gave at the office." I am an American taxpayer just like most of you, the audience. My tax dollars, and yours, fund the great majority of health-related research in the United States, mostly through the National Institutes of Health. Thus, I, and you, the taxpayers, own the results of that NIH funded research. We paid for it. Then, why, for goodness sake, do I, the owner, or my physician, another owner, have ...

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