Conditions

The quality of CT and MRI scans vary, and how old machines can affect the treatment course

Medical imaging is one of the largest drivers of health care spending.

In a recent NY Times piece, Gina Kolata points to the fact 20 to 50 percent of scans ordered are not necessary. Indeed, as health reformers like to point out vis-a-vis the Dartmouth Atlas study, more care isn’t necessarily better.

In fact, it can lead to worse outcomes, as these scans can point to …

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Why do I need a rectal exam, and what can doctors find with the gloved finger?

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

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Does using Plavix with a proton pump inhibitor raise the risk of death in heart attack patients?

A recent, albeit retrospective, study suggests a correlation.

MedPage Today reports on a recent JAMA study that looked at patients who had an acute coronary syndrome. It found that those who took both a proton pump inhibitor (PPI), like omeprazole, Nexium or Protonix, with Plavix had a 25 percent increased risk of death or rehospitalization.

If true, that’s a pretty significant finding, especially since PPIs are …

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Having a stroke, and taking clot-busting drugs at home

How bad did this doctor want to avoid the emergency room?

Freakonomics’ blogger Steven Levitt recounts a story told by his physician-grandfather.

The 80-something year old started having symptoms consistent with a stroke. Instead of calling 911, or finding a way to an emergency room, he “called in a prescription to the drugstore around the corner for some clot-busting drugs and sent my grandmother to the …

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Are whites more likely to be screened for colon cancer?

According to a recent study looking at the Medicare population, the answer appears to be yes.

MedPage Today
reports a study showing that elderly white patients had colon cancer screening rates ranging from 39 to 47 percent, compared to 29 to 38 percent in blacks and 23 to 33 percent in Hispanics.

First off, all those rates are dismally low. There should be no reason that …

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Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief

CT, or “virtual”, colonoscopy is an emerging imaging test designed to screen for colon cancer.

However, the data supporting its efficacy is not conclusive, and despite several studies performed by radiologists, its accuracy does not yet match that of a traditional, endoscopic colonoscopy.

Recently, the USPSTF reviewed the evidence, and could not recommend virtual colonoscopy as an acceptable method to screen for colon cancer.

Justifiably, MedPage …

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Why implant more than one embryo per in vitro fertilization cycle?

The answer is cost.

Because the costly treatment isn’t often covered by insurance, doctors are sometimes pressured by patients to implant more than one embryo per cycle.

Since a single cycle can cost as much as $12,000, and those who aren’t successful often keep on trying, the cost of having a baby can reach into the hundreds of thousands of dollars.

As this reproductive endocrinologist recounts, …

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Should you be screened for oral cancer, and are companies profiting from the uncertainty?

Most dentists do a thorough visual mouth evaluation to screen for oral cancer.

Whether there is data to support this practice is in question, with few studies suggesting a mortality benefit. The recommendations themselves are extrapolated from studies looking at other cancers.

Like other diseases where there is a gray area surrounding the efficacy of screening, like ovarian, lung, or pancreatic cancer, companies are rushing in …

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Does masturbation really cause prostate cancer?

A small study garnered significant media attention last week, with headlines blaring an association between masturbation and prostate cancer.

Before anyone gets really worried, obstetrician-gynecologist Amy Tuteur takes a closer look at the data, and is not impressed.

The retrospective, case-control study actually didn’t reveal any significant initial findings, so the authors kept manipulating the variables until they saw a possible association.

Dr. Tuteur believes that …

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Why are black patients more likely to refuse lung cancer surgery?

Of those diagnosed with early stage lung cancer, 69 percent of black patients opted for surgery, compared to 83 percent of white patients.

MedPage Today reports the findings from a cohort study in the Archives of Surgery. All the patients had Medicare, making insurance a non-factor.

Possible reasons include different racial-based beliefs, including that blacks “were more likely to believe that surgery accelerated tumor …

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When ear piercings lead to keloid formation

A rare occurrence where a routine ear piercing goes horribly wrong.

Keloids are fibrous growths that uncommonly occur in cases of wound healing. They present predominantly in blacks, and any type of skin piercing can affect those predisposed to the disease.

The lesions can be severely disfiguring and painful, and often recur after treatment. The first-line therapy is injection of steroids into the keloid, with a 70 …

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Colonoscopy by primary care doctors, is it time to start joining the proceduralists?

As mid-level providers are starting to take over primary care, can generalist doctors start doing specialist procedures?

If they’re smart, they’ll try. Better to take advantage of a specialist-favoring physician payment system, rather than wait for things to change.

Colonoscopies are among the more lucrative of procedures, and signs are pointing to a shortage of gastroenterologists in the coming years to perform them.

MedPage Today

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It’s a beautiful day for cancer

Australia’s NSW Cancer Council goes rap to promote skin cancer awareness.

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Is the fee for service payment system affecting oncology practice and cancer patients?

Paying doctors to do more isn’t in a cancer patient’s best interest.

An oncologist pens a brutally frank letter discussing how the current fee for service system influences the decisions when administering chemotherapy.

Currently, up to 70 percent of a cancer doctor’s earnings come from the sale of chemotherapy drugs. There is a strong financial incentive from “doing more,” and doctors are not immune to this allure. …

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How accurate is a colonoscopy to screen for colon cancer?

Colonoscopies are considered the gold standard for colon cancer screening.

MedPage Today reports a recent study from the Annals of Internal Medicine, that suggests it’s much less accurate than initially thought. The problem was with detecting right-sided cancers, where “the test missed just about every cancer in the right side of the colon, where cancers are harder to detect but about 40 percent arise. And it also …

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Should prostate cancer screening stop after the age of 75?

The USPSTF recently advised against screening men older than age 75 for prostate cancer.

Is that recommendation sound? The NEJM has a nice perspective piece detailing the reasons why.

Some interesting points here.

First, efficacy for treatment in men aged 75 or older is questionable at best, as “18 radical prostatectomies would have to be performed to prevent a single death from prostate cancer over …

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Confusion surrounding prostate cancer screening

The USPSTF recently updated their cancer screening guidelines, recommending against prostate cancer screening in men older than 75.

Toni Brayer recaps the controversy surrounding the PSA test. With a Democratic-controlled government, a push is going to be made for a comparative effectiveness institute. There is a real possibility that the dogma of “more screening equals better medicine” will be challenged.

Patients are going to face the …

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Which cancer screening tests are really necessary?

Gary Schwitzer writes a nice piece on the hype surrounding cancer screening tests. Evidence-based guidelines from the USPSTF are often ignored by mainstream media, who write pieces glamorizing the latest, largely unproven, cancer screening modalities. Here are some reminders for journalists:

* Newer isn’t always better.
* More isn’t always better.
* Screening doesn’t make sense for everyone.
* Many screening tests do good; many …

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