I don't know how many of you readers are old enough to remember the frequent use of open chest cardiac massage, first successfully performed in 1901. It began as a way to resuscitate suddenly dead people, assuming that their hearts had arrested or fibrillated. The surgeon would open the chest between ribs 5 and 6 and rhythmically squeeze the heart to move the blood and re-establish life. Sometimes it worked; usually ...

Read more...

I grew up in the American Deep South, in Lower Alabama, with Jim Crow and Old Crow, where fire-breathing preachers, Harper Lee, Truman Capote, and I all knew that one may never kill a mockingbird. And in that day and place, the "War on Drugs" was actively waged county by county. The drug was alcohol and the method of war was called "local option." Every several years, the Baptists and the ...

Read more...

It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future. The inexorable upward trend line is unsustainable. In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health. They were:

  1. Use intensive medical therapy instead of coronary artery bypass grafts ...

    Read more...

How can you determine whether you are in a "developed" or a "developing" country? We used to call these latter "un- or underdeveloped" or "3rd world" countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic. If one objectively examines all 20 dozen or so of the world's countries, a geographer would divide them into either north or south of the Equator. And if, ...

Read more...

The next time I receive medical care, I want to know how much it will cost before I agree that it will be done -- and that includes no matter who pays the bill. And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody. You say it is beyond your control to know? I say, insist. Rise up, ...

Read more...

Imagine an America with no health insurance companies. What do health insurance companies do? They take as much money as possible from people who want health insurance coverage. They pay out as little money as possible -- so-called medical loss -- to settle claims from creditors for health services and products that have been delivered. They keep as much money as possible for the incomes of their executives and other employees, and to ...

Read more...

Doctor, do you know a lot about human nutrition? You said "yes?" Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson's infamous quote "you lie" is applicable. American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don't know or care much about a topic, it often gets short shrift. I ...

Read more...

Autopsies establish truth, detect change, provide hard data, instruct learners, and promote justice. Yet, they seem poorly valued in modern America except in many TV crime shows like "CSI." Dr. Donna Hoyert of the CDC, in August 2011, profiled the dramatic changes in American autopsy rates, noting that while forensic autopsies remain common, hospital autopsies for patients with diseases, especially in the elderly, have almost disappeared. In evaluating medical quality, ...

Read more...

Are you a recovering alcoholic? Be honest. How about a recovering nicotine addict, or recovering from an addiction to some illegal drug, or maybe addiction to gambling, or sex, or football, or even your computer screen, or Angry Birds? I have worked in the addiction field most of my professional life. For me, addiction to a chemical includes physical and mental dependence, tolerance, withdrawal, and, of course, drug seeking behavior, despite recognized ...

Read more...

There seems to be a deep, even innate, need on the part of many young men to actually, or vicariously, strike out at other people to cause pain and injury while striving to dominate. In 1996, I wrote an editorial entitled "Blunt Force Violence in America" describing "a modern continuum from street fights to barroom brawls to domestic child, spousal, and elder abuse, to ultimate fighting to extreme fighting, to ...

Read more...