One catch phrase in health care reform is cost-effectiveness.  To paraphrase, this label means that a medical treatment is worth the price.  For example, influenza vaccine, or flu shot, is effective in reducing the risk of influenza infection.  If the price of each vaccine were $1,000, it would still be medically effective, but it would no longer be cost-effective considering that over 100 million Americans need the vaccine. Society could not ...

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Physicians, whether practicing medicine or not, should not be involved in clinical research. They should never be consulted on development of new drugs and medical devices. Doctors should not invent new treatments, and should never supervise clinical trials. They should not travel to or speak at conferences either, and they should banish all entrepreneurial notions out of their heads. If they insist on engaging in these activities, they should do ...

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Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads -- often sooner than we should have -- and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He ...

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As we head into health insurance enrollment season, which opens in November, consumers/patients will face yet another challenge in selecting the best health plan. Sorting through policies was tough already, but now insurers are making it even harder by changing the way they will cover generic drugs. It used to be that opting for generics was a snap. Health plans usually offered three or four tiers of drugs -- one for ...

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Prevent the overdose of OTC pain medications Recently in the emergency room, I saw a 35-year-old patient -- we’ll call her Jane -- who was vomiting blood. The source of the vomiting turned out to be a bleeding ulcer caused by unintentionally overdosing on ibuprofen. Jane was in pain -- she was taking prescription ibuprofen for her chronic knee pain -- but she was also taking over-the-counter (OTC) ...

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I received my new thinner bigger iPhone.  Within a few days, news reports highlighted how new iPhone 6 owners accidentally bent the latest Apple iteration of the modern smartphone. A blogger bent an iPhone 6 Plus with his bare hands. This story, the subsequent fallout, and response has learnings for doctors and health care on the challenges facing the vaccination “debate.” The best launch in iPhone history with roughly 10 million smartphones shipped ...

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There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating ...

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Since 1996, 21 states have approved the legalization of marijuana for medical use. More recently, Washington and Colorado have legalized the use of recreational marijuana, with California and Oregon not far behind. The health risks associated with marijuana have been well documented in a number of studies, but these are secondary to the much greater mortality risk associated with an increased prevalence of the drug: driving under the influence. As is ...

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Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks. Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ ...

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