One recent news item in the world of pharma is the less-than-enthusiastic response of an FDA panel to Boehringer-Ingelheim’s experimental “sexual desire for women” pill, flibanserin. I believe the quest for a “female Viagra” (an inaccurate parallel, by the way) is fundamentally misguided. Here’s why. There’s a big difference between sexual function and sexual desire. Viagra does something that a pill can, in fact, do – impacts a physiological process. Erectile dysfunction is, ...

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by 911Doc, MD WNL is doctor shorthand for "within normal limits". Saves a bunch of time when checking the boxes on the physical exam. The temptation is to write "WNL" whenever possible, and, therefore, it often ends up meaning "We Never Looked". A homeless gentleman presented to my ER a few months ago. He had been hit in the head with a beer bottle. He had a suturable laceration to his scalp ...

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Summer has already begun, and LeeAnn has already had enough of mosquitoes. She wants to know, “Does taking Vitamin B1 really help keep mosquitoes from biting? How much is safe for children?” I remember a trip to the Florida Everglades as a child with school—surrounded by mosquitoes, alligators, and miles of swamp, our teachers told us that mosquitoes are a vital part of the food chain, and essential to the ecosystem. I ...

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by Timothy Dempsey One thing changes everything. While this may be a poor paraphrase of the cheesy slogan ESPN used for the recently finished World Cup, in my life this statement has revealed itself as a universal truth. For me, one book changed everything. It would lead me into research labs, on a trip to disease-riddled Gaborone, Botswana, and pique my interest into an epidemic whose global ...

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by Todd Neale Postmenopausal women of any age with a 10-year fracture risk equal to or greater than that of a 65-year-old woman and no other osteoporosis risk factors should be screened for the disease, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF). The 2002 USPSTF guidelines recommended routine screening only for women ages 65 and older, as well as women ages 60 to 64 with an increased ...

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It’s exceedingly uncommon for a healthy middle-aged man to walk into his doctor’s office and demand a colonoscopy. But even though he lacked a family history, Stanley Thornton, an African-American engineer who was then in his mid-40’s, wouldn’t take no for an answer. “I was concerned that African-Americans do get colorectal cancer earlier, and I said, ‘hey, let me lead by example,’” he said recently. “We argued about it for a ...

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by Charles W. Patterson, MD Is it possible that some do not understand that to promote Healthcare Savings Accounts is the most effective thing we could do to preserve traditional medical practice? In a true doctor-patient relationship only doctors and patients discuss the options agree to the treatments and handle the money. No third party touches any of these. If everyone had a HSA it would be just like the good old ...

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In January, I wrote a Do it Yourself presentation on meaningful use for folks to use with their Board and Senior leaders. Now that its August, there is a different kind of Do it Yourself document - a letter to your Board and Senior leaders outlining your plan and timeframe for certification, measurement of meaningful use, and collection of your stimulus funds. We cannot be completely certain about every detail, ...

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"Avoiding those twin traps of overtreatment and therapeutic nihilism" Recognize this phrase? It's from our Hippocratic Oath, the one I took, standing beside my newly assigned cadaver, in my second year of medical school. "What Broke My Father's Heart", recently in the New York Times Magazine, is an exquisitely painful story of medicine and our Oath gone awry in the United States. I urge you to read it. End-of-life care is a ...

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An except from The Empowered Patient. by Elizabeth Cohen, MPH Did you ever see the Seinfeld episode where Elaine gets into trouble at the doctor’s office? While she’s waiting in the examining room, she sneaks a peek at her chart and notices that it says she’s “difficult.” When the doctor comes in, he whips the chart out of her hands. DOCTOR: You shouldn’t be reading that. ELAINE: ...

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by John Gever So-called cyberbullies share many of the psychosocial features as their victims -- and in fact many bullies were also victims themselves, researchers from Finland said. A population-based cross-sectional study surveyed more than 2,000 seventh- and ninth-graders in two Finnish communities and found that cyberbullies had higher than average rates of self-perceived difficulties in life, headache, feeling unsafe at school, and perceiving teachers as uncaring, among other problems, reported Andre ...

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It has been 10 years since the landmark Institute of Medicine report "To Err is Human" uncovered disturbing deficiencies in the quality of our nation's medical care. Progress in correcting these deficiencies remains frustratingly slow, and it has become clear that achieving the quality and safety improvements we seek will require us to examine our approach to medical education. Although today's newly minted physicians are well prepared in the science of medicine ...

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by Brian Forrest, MD When I started a cash-only, direct-pay practice nine years ago, my reasons were simple: spend more time with my patients, provide better care, and live a better life. I was uncomfortable signing insurance contracts that limited my ability to care for my patients. I was unwilling to sign an employment contract that required me to see a patient every 7.5 minutes, or lose ...

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An excerpt from Laugh, Sing, and Eat Like a Pig. laughsingLast month Dave deBronkart, known on the internet as “e-Patient Dave,” released his first book, Laugh, Sing, and Eat Like a Pig: How an Empowered Patient Beat Stage IV Cancer (and what healthcare can learn from it) (www.LaughSingBook.com). It’s his personal cancer story – excerpts from the journal he kept ...

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One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala. He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school. One thing that stands out in my memory, to this day, from those two months is how ...

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Regina Holliday’s husband, Fred, age 39, died of cancer in June 2009 leaving his wife, and his two young, beautiful children behind.  During their journey through the healthcare system to try to get Fred the help he needed, too many hurdles were put in their way.  Their story makes you want to scream. Among the horrors of their journey was the fact that Fred was transferred ...

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by Michael Smith It's not just TV -- video games are also associated with an increased risk of attention problems in children, researchers said. A large study found that children who spent more than three hours in front of a computer or television screen -- whether playing video games or watching TV -- were significantly more likely to have attention problems, according to Edward Swing, MS, of Iowa State University in Ames, ...

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In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks.  That is, the re-admission of recently discharged hospitalized patients. They bring up good some good points, and point out that, until recently, hospitals really didn't have any incentive to reduce bouncebacks:

... hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum ...

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So, you've decided to move forward and get an EMR for your practice, but studies and reports of EMR implementation failures are adding to your anxiety levels. You've probably read scores of rules on how to go about the task -- some of them in this column. But today I want to share with you some important things you shouldn't do. Medical groups of all sizes and specialties across the country make ...

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by Walter van den Broek, MD, PhD Do Facebook and other social networking services damage the profession of physicians or the public trust in this profession? So far, no systematic research into this topic has been published. However several cases were presented in the media resulting in disciplinary measures. On social networking sites patients may learn information about their doctors that compromises the professional relationship. Threats to ...

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