Use crowdsourcing to develop clinical trialsAt my hospital, we are committed to offering a lot of clinical trials in the community. But it’s hard -- nationally, only about 3% of patients with cancer participate in clinical trials. Even at some academic centers, it may be below 10%. With less research funding available, we need to find new ways to make it easier and cheaper ...

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Twitter -- its functions, benefits, risks and limitations -- has figured prominently in the heated discussion about Emma and Bill Keller's respective editorials in The Guardian (since deleted, though the archived version is still available) and the New York Times about the Twitter feed of Lisa Bonchek Adams. I have followed Lisa for a long time and greatly admire her thoughtful, highly personal tweets about the ups and downs ...

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Where I come from, when most people refer to the Good Book, they are referring to the Bible.  This is not true for my father, because to him, the Good Books are something else entirely. He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of ...

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A large woman, she has soiled herself.  With practiced motion, Bob rolls his wife onto her side. Yellow diarrhea has leaked out of the diaper, soaking the nightgown and sheets, finding its way into each fold, crease, and flaw.  The room fills with odor, but the winter house remains dark; outside wind blows down the empty street. It is 2:00am and Bob is cleaning shit.  Only 90 minutes asleep, he ...

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From MedPage Today:

  1. Adrenal Masses May Carry Heart Risk. Patients with adrenal incidentalomas may have worse cardiovascular outcomes if their tumors secrete even low levels of cortisol.
  2. TAVI Increases Use of Valve Surgery, Too. Despite concerns to the contrary, the introduction of transcatheter aortic valve implantation (TAVI) into everyday practice has not decreased the number of patients undergoing surgical valve replacement.
  3. Obama ...

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Skin cancers are never truly benignI spent 4 hours on New Year's Eve sitting in the surgeon's chair getting a skin cancer taken off my nose. Nothing about the experience fits the "benign" label so many professionals, including yours truly, have used:  routine; easy to treat; nothing to worry about.  Friends, after this experience, which left me looking like a tall, white-haired Rudolph the ...

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From MedPage Today:

  1. SGR Repeal Cost Now Pegged at $121 Billion. The most recent congressional proposal to repeal Medicare's sustainable growth rate (SGR) payment formula would cost $121.1 billion over 10 years if enacted.
  2. Preoperative RT May Up Survival in Mesothelioma. A preoperative accelerated high-dose radiation therapy protocol for advanced mesothelioma has led to a 3-year survival more than twice what would have been ...

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An advantage astrologers have over genetic testing is that the prediction of astrologers are personally verifiable. An astrologer once emphatically stated that I had no chance of a career in international cricket or Bollywood. So far both claims have turned out to be remarkably accurate. How does one personally verify a “12.5%” increased chance of lung cancer, the sort of number the vendor for genetic testing 23andMe produces? If one develops ...

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I was recently readmitted to the hospital for my second round of chemotherapy. I’m doing a regimen called Hyper-CVAD, which involves four rounds of two alternating cycles of treatment, for a total of eight rounds of chemo. For my first cycle I got cyclophosphamide, doxyrubicin, and vincristine, along with an intrathecal injection of a drug whose name I’ve since forgotten. This round I’m getting intravenous methotrexate and cytarabine and TWO (insert frowny ...

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When counseling patients and families about end-of-life care, I try to focus on a simple, clear standard.  Knowing that events are overwhelming and complex, I say,  “Look at each treatment, each action and each moment and ask; How does it improve quality of life?”  My goal is to reduce the choices during a chaotic time of life to the simple goal of comfort. For example, most families are very concerned about ...

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