A couple of centuries ago, when I was a graduate student in biochemistry and later a med tech, we thought about a lab test as a CBC or a blood sugar that produces a numerical result. Period.Later, I learned and wrote that there were at least nine separate vital steps in the performance of a laboratory test and that the analysis that produces a result was important but that so ...
George Lundberg, MD
If physician decisions were based strictly on Cochrane
First, a disclosure. I am President and Board Chair of the not-for-profit Lundberg Institute in California, which is dedicated to Archie Cochrane.What would happen if we in American healthcare actually followed the teachings of the revered Archie Cochrane? I'm sorry. You don't know what those teachings are? ... and you don't even know who Archie Cochrane was? Oh my ...Click www.lundberginstitute.org, no registration required, and then click to ...
8 ways to elude a malpractice lawsuit
So you want not to be decimated by a malpractice lawsuit? I understand that, and I agree. Here are eight ways to elude that destiny.Way number 1. Don't do malpractice.Way number 2. Care deeply about your patients; and let them know by your actions that you really do care.Way number 3. Communicate diligently with your patients so that you and they are on the same page and understand together what ...
Patients and physicians should screen for cancer, but cautiously
To screen or not to screen? That is not the question.The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a ...
How ordering lab tests may raise costs with little quality impact
Why do physicians order lab tests? As reported in JAMA some years ago from a survey of hundreds of resident physicians at the Los Angeles County/University of Southern California Medical Center, the traditional reasons are: diagnosis 37%, monitoring 33%, screening 32%, previous abnormal result 12%, prognosis 7%, education 2%, and medicolegal (at this large public hospital) only 1%. Okay, that all makes some sense.In order to confirm these findings, I ...
Why the expansion of Alzheimer’s may not be helpful
You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer's.Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer's victims -- and on taxpayer money yet.It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed ...
There is no alternative medicine, only unproven medicine
There is no Alternative Medicine.Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.So I went to Mr. Google in 2010 and entered ... Alternative Medicine ... and clicked -- 41,200,000 results; entered Complementary and Alternative Medicine, click -- 3,210,000 results; entered CAM, click -- 191,000,000 results, but that's not fair; CAM can stand for many unrelated topics.Let's ...
Should consumers have easy, direct access to genetic tests?
Should consumers have easy, direct access to genetic tests? So asked a recent survey on MedPage Today. After nearly 1,000 people voted, the tally was: Yes 37%; No 30%; it depends on the test 32%.Of course this survey is "unscientific," meaning anyone who sees it may (or may not) vote so there is obvious selection bias. Nonetheless, since the number voting is hefty, it is worth looking at.I am impressed ...
Stop eating before you become obese
We all know that obesity is a huge and growing (no puns intended) problem in the U.S. and most other developed countries.The proven harmful consequences of obesity to the individual and the public health, as well as to the national treasuries, are devastating. The solutions are both simple and complex.For most adults who are of normal weight (BMI under 25), simply maintain your normal weight. If you are overweight (BMI ...
A fundamentally new approach to treating glioblastoma multiforme
Only rarely does an experienced editor get a spine tingle from a new paper. For the first time ever, today, I predict that a Nobel Prize for medicine will be awarded to J. Martin Brown, DPhil, Oxford, a professor at Stanford University School of Medicine.Professor Brown and his colleagues have discovered and reported a fundamentally new approach to the treatment of solid tumors, beginning with the devastating glioblastoma multiforme.Here is ...
Randomized controlled clinical trials and the Human Genome Project
First, relevant disclosures: I work half-time as editor-at-large at MedPage Today in Little Falls, N.J., and I work half-time as editor-in-chief of Cancer Commons from CollabRx in Palo Alto.Many of you know that I was the editor at JAMA for 17 years and at Medscape for 10 years. You also know that I have been a strong advocate for evidence-based medicine (EBM) for decades and have trumpeted the large randomized ...
8 reasons why healthcare costs are rising
In early June, 2010, MedPage Today posted a survey question asking readers to identify the primary driver of rising healthcare costs.More than 1,200 readers responded by answering: 24%, Increased insurance premiums; 22%, New technology; 22%, Malpractice costs; 12%, Drug costs; 3% Increased physician payment; Other -- 16%.I voted "Other." This survey, like most, misses the main point. It is the decisions of patients and physicians that are the principal drivers ...
Every patient deserves a death with dignity and without pain
Death is not the enemy. We all die.The enemies of patients and physicians are premature death, disease, disability, pain, human suffering.I believe that all people deserve a death with dignity and without pain. Palliative care is the right mode for as many as 80% of all Americans who will die of chronic progressive incurable diseases. Eighty percent of those state that they do not want to die in a hospital ...
Legalizing marijuana, an opinion from a former JAMA editor
While I was still the editor of JAMA, I was in Boston in January, 1997, to do my regular teaching at Harvard. I dropped in to see my friend Jerry Kassirer, the editor of the New England Journal of Medicine. Little did I know that Jerry was in the midst of a firestorm of protest for his just-published editorial called "Federal Foolishness and Marijuana." Jerry told me that he received ...
Medicare for all may be next for healthcare reform
In the Journal of the American Medical Association on May 15, 1991, in our first of many theme issues dedicated to "Caring for the uninsured and underinsured," I wrote: "An aura of inevitability is upon us. It is no longer acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured. We can solve this problem. We have the knowledge and the resources, ...
