Going to the doctor starts as a disconcerting experience: Getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for. How far does this special relationship ...

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A doctor in our area was recently indicted for allegedly running a “pill mill”. According to local news reports, patients were recruited to come in and ask for narcotics and the doctor received massive cash payments to write the prescriptions. After the guy was nabbed, his patients (the real ones and the others) spread out in the community looking for new doctors to take care of them (or to write ...

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“He’s dead, Jim.” So here’s my beef. At the recent Forbes Healthcare Summit  there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, ...

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How drugs are promoted isnt a freedom of speech issue I learned of a disturbing decision from the Court of Appeals for the Second Circuit. In an insane ruling, two of judges determined that a drug rep promoting “off-label” uses for a drug was exercising his freedom of speech. Let’s stroll to the back of a typical doctor’s office to see how this plays out. Of all the ways pharmaceutical companies ...

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Over at his blog Gene Expression, Razib Khan expressed his disgust with the paternalism of the medical profession. His disgust was not misplaced, but he did bypass some of the subtleties. Razib, a respected science blogger, ran smack into a frightening piece in Time. In it, doctors discuss whether and how much genetic information should be given to parents about their kids. The doctors featured evaluated a ...

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“This note was produced using [mega-brand] medical dictation software. While every effort has been made to insure accuracy, errors may still exist.” Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce an accurate record? A lot of them.  Dictations are easy to read if you are willing to confound legibility and accuracy.  Dictation software is relatively cheap, and with the continued profusion ...

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In the ongoing battle to gain from our society’s scientific illiteracy, Dr. Oz has nocked another arrow. This time, he as the cure for all fatigue. I hope he’s got this right because this is one of the most common and most difficult problems to treat. Fatigue is a tough one. Everyone has experienced fatigue at some point, and as a physician, part of my job is to figure ...

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I want to ration your health care. Well, I don't want to do it personally, and not to you specifically. And that's the problem. Policies on the individual and societal levels feel very different. We are not culturally prepared for "rational" rationing. We're happy to do it irrationally; if you don't have insurance, you're probably not going to get proton beam therapy for your prostate cancer. Someone might be willing ...

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Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws ...

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I have a 5% chance of having a heart attack in the next 10 years.  That’s not so high, but it’s higher than I want it.  Most of that risk is due to my cholesterol and my age.  I can’t do anything about the latter, but the former is under my complete control.  Cholesterol medications can improve my cholesterol significantly.  So can proper diet and exercise.  That’s not true of ...

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