Black and white

Tort reform = lower malpractice rates:

Texas' largest medical liability insurance provider said Monday it will cut its rates by 5 percent starting in January.
No tort reform = soaring malpractice rates:
Physicians in a northwest Maryland county plan to halt non-emergency surgeries for at least two weeks to protest a 33 percent increase in malpractice insurance premiums.

Take your medication

Following up what I wrote about patients not taking their medication, comes this retrospective study. It concludes that diabetics who do not adhere to their oral antihyperglycemic medication have more than twice the risk of hospitalization. More concerning was the percentage of patients who did not take medication for potentially serious conditions (diabetes, hypertension, and an elevated cholesterol):

The proportion of enrollees who were nonadherent to ...

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The insider

An executive at Pfizer speaks out and supports drug importation:

A vice president of marketing at Pfizer Inc., Rost has broken ranks and is publicly accusing drug companies of employing misleading and immoral tactics in their effort to stop the importation of low-cost prescription medicine from Canada.
Medical News Today has a nice article that summarizes many of the press quotes from this story.

Even if drug imporation is ...

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Galen links to a recent NEJM article saying that health care ranks as the fourth most important issue in this year's presidential election:

Although health care ranks higher in importance among voters than most other domestic issues, it is only fourth in importance in deciding their vote for president. The health care issues of greatest concern are the affordability of health care and health care insurance. Health care issues ...

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On the front page

"ER Nearly Killed Me". This was today's front page story on the increasingly tabloid-like Boston Herald. Again, the media takes the easy way out, choosing a lazy, shock-value headline instead of highlighting the real problem of ER overcrowding.

On Terri’s law

Chris Rangel has posted an excellent recap of the discussion surrounding Terri's Law, which the Florida Supreme Court struck down yesterday. This is certainly a thorough debate on a controversial issue.

Balanced view

The Washington Post takes a balanced view on both the Bush and Kerry plans for health care. It also gets to the root of increasing health care costs:

To be serious would require admitting that the basic problem does not lie with insurance companies, trial lawyers, hospitals or any of the usual suspects. It lies with public opinion. We Americans want the impossible. We want our health care system ...

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Not that simple

Medrants notes that improving wait times to see GPs in the UK cannot be solved by such a simple solution:

Simple bureaucratic solutions like the 48 hour rule established in the NHS are doomed to fail, because the rules remove judgment from the decision making process. Bureaucracy often fails because it substitutes rules for reasoning.

I'm proud to be part of the top health plan in the country:

The national organization that ranks health insurers said it has chosen Harvard Pilgrim Health Care as the top health plan in the country, based on several quality measures and a survey of its members.

The National Committee for Quality Assurance, a nonprofit group based in Washington, D.C., runs a voluntary accreditation program for health plans ...

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I had a small amount of input in an article on the effects of over-the-counter (OTC) painkiller overuse in today's Nashua Telegraph:

Over-the-counter pain killers are killing more than pain: they have been linked with more than 16,000 deaths and 103,000 hospitalizations a year in this country . . .

"They're not benign, especially now that what was prescription medicine is now over the counter," said internal medicine physician ...

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The inaugural Grand Rounds

Blogborygmi is organizing the first Grand Rounds to be posted next Tuesday, 9/28. Read more about it, and find out how you can contribute.

No surprise here

After many instances of media misinterpretation of cancer screening, comes this poignant study.

Morphine in hospice care

An article in Cancer suggests that too little morphine is used in hospice care. As was discussed previously, alleviation of pain and maximizing comfort is paramount in hospice situations. Interestingly, those who were given larger doses of morphine lived longer.

"New Blood Test Advised for Diabetes Patients". Quite a headline. This is the media's interpretation of an article in this week's Annals of Internal Medicine. This "new" test is in fact, the hemoglobin A1c - which is a standard test in monitoring diabetes control. The title should have been "A new use for an old test".

The study suggests that cardiovascular (CV) disease ...

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An interesting study in this week's NEJM on discussing death with children who are terminally ill. The conclusion:

Parents who sense that their child is aware of his or her imminent death more often later regret not having talked with their child than do parents who do not sense this awareness in their child; overall, no parent in this cohort later regretted having talked with his or her ...

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An excellent debate . . .

. . . on malpractice reform at PointofLaw. Ironically, we find a physician supporting Kerry, and a lawyer arguing for Bush.

. . . of antibiotic overuse: educate. Almost 1/3 of those surveyed believed a cold or flu should be treated with an antibiotic.

Hospitalists

Medpundit writes about giving in to the hospitalist temptation. Let me say, hospital medicine is a completely different world from primary-care medicine. If you stay away from it, that knowledge will slowly dissipate. It's like not exercising a muscle - after awhile, it will atrophy and weaken. That's partly why I enjoy the occasional hospital and ER shifts - keeping these skills sharp is important ...

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The eyes . . .

. . . have it (via Psych Central).

B-natriuretic peptide

One of the more helpful tests that I've used recently in the past few years or so is the B-natriuretic peptide (BNP). It recently came up in a story I was reading.

I was reminded of how useful the test was during a recent emergency room shift. In those presenting with shortness of breath, one has to decide whether the cause is the lungs (pneumonia, COPD, ...

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