Our grandparents used to tell us, "if it ain't broke, don't fix it". Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain't broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or ...

Read more...

When do tests improve mortality? This is a question well worth asking, particularly as we argue about the merits of mammography screening. The USPSTF has really stirred up the hornet's nest with this one, and the politicians cannot help but get on their populist pulpit, ignoring the facts completely. But the question remains, do screening or diagnostic tests that are more sensitive save lives? We all hear that mortality from many diseases ...

Read more...

I believe in the peak oil theory. Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to ...

Read more...

Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession's existence, there is a grassroots effort afoot to upgrade the name, and presumably ...

Read more...

Now, as you know, I am a big fan of epidemiology. I do not believe that a randomized controlled trial is the be-all-and-end-all in evidence generation, and a well done observational study can add to our reservoir of knowledge much more efficiently. Of course, I, as many others, acknowledge certain limitations of epidemiologic design. However, many of them can be overcome with careful design and analysis. I have to confess, though, ...

Read more...

Remember the trial a couple of years ago that showed that group support participation was associated with prolonged survival among women with metastatic breast cancer? I've thought a lot about that over the years. Isn't it interesting that something as simple as a supportive environment can make a difference in what researchers consider to be the hardest endpoint there is: survival? In our dualistic view of the human organism, we think ...

Read more...

A recent story from the UK reported a school child who developed diarrhea and tested positive for C difficile. The alarming thing is that there did not seem to be any explicit risk factors for this. The appalling thing is the mis-information by the story that, "children rarely become ill with C diff, which normally strikes elderly people in hospital." This is how things used to be, before the BI/NAP1/027 bug ...

Read more...

The recent uproar over the new screening mammography recommendations got me thinking about a lot of stuff. One of the lessons cited by some journalists and pundits is on how potentially volatile information should be presented to the public. The USPSTF was excoriated by critics not only for what it said, but how it said it. While the objections over the former can be dismissed as ravings of loud and ...

Read more...

The costs of healthcare have been rising exponentially, but people's incomes have not. Despite the biggest economic expansion over the last 50 years, and despite astronomic rise in our productivity, the real wages for the bottom 80% of all earners have not increased one iota since 1975. This means that, while the costs for all products and services have grown at the pace of inflation or more rapidly (as in ...

Read more...

When we talk about efficiency in the business world, we are basically talking about getting as much profit as possible. This profit is wrung out of the system by reducing production costs to the maximum extent possible and by charging the top price that the market allows. Some of the ways in which the US companies have increased their efficiencies over the last 30 years are, 1) by moving manufacturing to ...

Read more...

Most Popular