Cardiologists are causing patients to get cancer. It’s true. Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever. As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual. And cardiologists routinely subject patients with normal coronary arteries ...

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Cardiovascular disease -- including coronary atherosclerosis and cerebrovascular disease -- remains the number one cause of mortality in the United States. One out of three people in this country will die of cardiovascular causes.  Although I can’t say that the other top causes of mortality are particularly attractive -- cancer, chronic lung disease, accidents and dementia -- premature cardiovascular death can certainly be very devastating and it makes sense to do ...

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How should patients determine the quality of their doctor? This is an interesting question that has now reached mainstream media status as evidenced by a Wall Street Journal article by Laura Landro, a very accomplished veteran health care reporter. With the best and brightest going in to medicine, the requirement for more rigorous training than anywhere else in the world by (some might say) "exceptional, world class" medical educators and longstanding ongoing mandated continuing medical ...

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Would you tell me, please, which way I ought to go from here? That depends a good deal on where you want to get to. I don't much care where – Then it doesn't matter which way you go. - Lewis Carroll In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials. An instructive case is in the ...

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“I used to be strong, I wrestled the bull,” Sumner Ball said, “but now I can’t even wrestle the rooster.” On the far side of eighty-years-old, he looked lively and trim, and his weathered face hinted at a smile as his blue eyes peered straight into mine. “I think these cholesterol pills are hurting my muscles,” he declared. “I don’t think they’re good for me.” “Is it your back?” I scanned through his last ...

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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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Should we follow a Mediterranean diet? We’ve known for quite some time that weight loss can reduce the risk of developing insulin resistance and type 2 diabetes. However, a healthy diet alone (without weight loss) may also help to reduce risk. In a recent Spanish study (published in the Annals of Internal Medicine), 3,541 men and women ages 55-80 at risk for diabetes were followed for ...

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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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From MedPage Today:

  1. Striking a Nerve: Bad Odor to This Fish Oil Study. A new analysis of fish oil and brain health "adds to the growing literature" connecting the two, its authors write -- but possibly less than any of the previous studies.
  2. HRT May Protect New Joints. Women who had total knee or hip replacements were significantly less likely to have implant failure ...

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I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect -- I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines. Late last year, I ...

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