Harvard Medical School is planning a medical campus in the United Arab Emirates. Some interesting points:

. . . there are enormous hurdles to fostering US-style health care in a region where medicine is so spotty that the 100 million Persian Gulf residents spend $25 billion a year getting treatment elsewhere, according to Dubai Healthcare City officials. Many medical school students enroll straight out of high school and ...

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Here is a nice article from the Boston Globe that investigates some of the issues of importing medications from Canada.

As a follow-up to what I wrote last week, it seems like the new Medicare cards are slow to take off. And why not? On one hand, you have a dizzying, confusing array of Medicare cards - on the other, you have Canada, which gives you better savings. The choice seems pretty clear. It confounds me how the government can so poorly implement a simple ...

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Here's a nice joke from the BMJ:

For those of you who watch what you eat and drink, and worry about heart disease, here is the truth"”according to a joke currently doing the rounds. The Japanese eat very little fat, while people in Mexico eat lots. Both groups suffer fewer heart attacks than the British or Americans. Africans drink very little red wine, while the Italians drink large ...

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In the article, Why do doctors use treatments that do not work?, several interesting points were made. It is making a case that we need to continually rely on the evidence, and less on empiricism. This is why it is so frustrating when I hear stories where EBM is tossed around like a "dirty word" and when physicians are making treatment decisions that are evidence-bereft.


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IBS is one of the more frustrating diseases to treat. Increased fiber intake, antispasmodic agents, and Zelnorm (for constipation predominant disease) are among the treament choices. However, in many cases, these treatments aren't enough and many patients unfortunately remain symptommatic. In the GI forum that I moderate, there are many who report refractory IBS symptoms.

Today comes a study from the American ...

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We all know that one reason for rising health costs is that newer technologies are more expensive. For one small example, consider the evolution from sigmoidoscopies to colonoscopies. The medical director Patient Care writes that sigmoidoscopies have virtually ceased once colonoscopies became a covered benefit under both Medicare and private insurance. Consider the charge for a sigmoidoscopy is several hundred dollars compared to over $3000 for a ...

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Inevitable

It was only a matter of time that this would happen.

AP:
A businessman has sued the promoters of the Atkins Diet, saying the low-carb, high-fat meal plan clogged his arteries and nearly killed him.

Scutmonkey comics

I got a good laugh from Michelle Au's scutmonkey comics. Very funny, very true. I particularly like the 12 types of med students.

Medpundit and DB has chimed in on the mainstream coverage of the deficiencies of PSA screening for prostate cancer that was discussed here on Tuesday and Wednesday.

Medpundit writes:
Beware of organizations made up of hospitals and urologists who call for lower thresholds for treatment. They have much to gain from the increased number of biopsies such lower thresholds would produce. Unfortunately, it's far from clear ...

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The FDA approved rifaximin, a non-absorbed antibiotic that remains within the body's gastrointestinal system, for traveller's diarrhea. This is in contrast to most other antibiotics which are spread throughout the body. Cipro or Bactrim are medications that are currently used.

A review article has suggested that this therapy may become the treatment of choice once routinely available.

We're always told that a sincere apology after a medical error reduces the risk of an impending lawsuit. Here is a story of that theory in practice.

The mainstream press has caught wind of the NEJM study that was discussed here yesterday. Here are some quotes from the article:

. . . "This study adds to information that perhaps the PSA threshold may be dropped to 2.5 or so," said Gomella, the Philadelphia urologist. "The number 4 may not be the, quote, normal that we look at anymore."

. . . Some ...

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In today's environment where drug companies are being monitored closely (take TAP's recent lawsuit in the Boston area for instance) for physician kickbacks for prescribing drugs, comes this story from Italy:

A two-year investigation by the financial brigade found that the Italian subsidiary of Glaxo had mounted an illegal incentives scheme involving 4,713 people, including 4,440 doctors.

Glaxo clearly wasn't subtle in their efforts to influence physicians:


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In the May 27th issue of the NEJM, a study was released that concluded that biopsy-detected prostate cancer was not rare among men with PSA levels of 4 or less. Prostate cancer was diagnosed in 15 percent of cases in the group with PSAs of less than 4, and of those cases, 15 percent were high grade.

This begs the question - should the threshold ...

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Hiccups

Medpundit wrote about hiccups today. It reminded me about one of my patients who had protracted hiccups for 5 years - you could only imagine how frustrating this was. He was a 70-yo male who started having hiccups after surgery. Multiple medications were not successful: PPIs, H2 blockers, Thorazine, Reglan, Compazine, Neurontin and Dilantin were given without success. Endless GI and neurology consults were not ...

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AMNews compared two Medicare discount cards with Drugstore.com and a Canadian mail-order pharmacy. As you can see, the discounts still aren't enough. There is also pretty wide variability between the two Medicare cards:

Medication / Card 1 / Card 2 / Drugstore.com / Canada

Celebrex $105.64 / $162.87 / $76.99 / $38.69
Lipitor $60.85 / $66.82 / $62.99 / $49.85
Nexium $109.39 / ...

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From the Archives of Internal Medicine, comes a study that suggests that the majority (82 percent) of osteoporotic and hip fractures occured in women with T-scores greater than 2.5 (i.e. at osteopenic, not osteoporotic levels). This suggests that treatment at an earlier stage (i.e. with T-scores between 1 and 2.5) may be considered.

Remember that the USPSTF recommends that women aged 65 and older be screened routinely ...

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Toxic neckties?

This story caught my eye - guess I'll think about dry-cleaning my ties from now on:

A small study of neckties worn by doctors at a Queens hospital found almost half the 42 ties tested harbored microorganisms that can cause illness.

Of the 42 physician neckties sampled, 20 contained one or more microorganisms known to cause disease, including 12 that carried Staphylococcus aureus, five a gram negative ...

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A recent study concluded that "about one in 10 people suffer weekly from [restless legs] syndrome that causes leg discomfort and leads to sleeplessness, and few are properly diagnosed by their physicians." I've certainly diagnosed my fair share of this, but only after having a high enough index of suspicion. More information can be found on this patient information page.

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