Neurologists debate . . .

. . . the growing trend of cosmetic neurology. One scenario:

"For instance, if pilots perform better in emergencies when they take donepezil (a drug typically used to treat dementia), should they be expected or required by their employer to take this medication?" Chatterjee said. "We need an explicit notion of what it means to be human and a clear sense of the evolving role of physicians."

Arms race

Massachusetts has the same number of MRIs as all of Canada, and there are no signs of slowing down:

Not surprising, the number of patients having MRIs is soaring, too; 487,700 scans in 2002, up more than 80 percent in four years, according to the most recent data from IMV Medical Information Division, an Illinois market-research company. Nationally, spending on diagnostic imaging is projected to grow to as much ...

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No surprise . . .

. . . that half of the Viagra pills sold on the internet are fake.

Grand rounds

Today marks the debut of Grand Rounds, a weekly summary of the best from the medical blogs. Blogborygmi is hosting this week's edition. Visit and spread the word!

Empowerment

This article suggests that the price-comparison tool on the Medicare web site will have Medicare beneficiaries questioning their doctors about their prescriptions:

The discovery that a competing brand-name drug or generic substitute is significantly less costly will likely convince some beneficiaries to ask their physicians about the appropriateness of a switch, Health and Human Services Secretary Tommy Thompson said at a briefing.

"Nobody compares prices better than our seniors," ...

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Another comparison

Nothing new here, but another article from AMNews comparing the Bush and Kerry health plans.

Battle-lines . . .

. . . are drawing closer. Not only in Florida, but also in three other states:

Rivaling Bush vs. Kerry for bitterness, doctors and trial lawyers are squaring off this fall in an unprecedented four-state struggle over limiting malpractice awards. The volatile issue is in voters' hands and each side is desperate to win, spending millions of dollars to make their cases and portray the other side as ...

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Studies are continuing to quickly and accurately diagnose chest pain in the ER. I was recently having a discussion where the topic of serum myoglobin came up as a routine part of the cardiac enzyme panel at some institutions.

The hospitals that I work at typically only include the CK, CK-MB and troponin I as markers for cardiac injury - I was less familiar with ...

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A common scenario that comes up in the GI forum that I moderate is the subject of acalculous biliary pain (ABP - gallbladder pain in the absence of gallstones). The NY Times has an interesting case of this today, where it was diagnosed by repeating the HIDA scan with CCK stimulation. It is a common recommendation that those with a low gallbladder ejection fraction benefit from a cholecystectomy:

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More black and white. Tort reform works (from PointofLaw):

The Medical Assurance Co. of Mississippi, which provides medical malpractice insurance to about 60 percent of the doctors in the state, will not raise base premium rates in 2005.

Insurance Commissioner [and Democrat] George Dale said Friday that the decision shows that "those people who said that tort reform would not work and actively fought any civil ...

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Taking exception

A commenter responds to what I wrote about the Boston Herald story on ER care yesterday:

Not surprising is that most healthcare workers always side with the hospital. Why is that? What if that had been your family member that had been refused treatment and ended on a vent at a different hospital? Would your loyalties still be with the hospital? Blaming the victims is not the way to ...

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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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