Why EBM won’t fly in the United States

There is an interesting discussion going on at Blogborygmi. Nick applied the evidence-based Ottawa ankle rules in a situation, only to be overruled by his attending – “in our country, I can’t afford not to get an X-ray.” Discussion ensued in the comments, with arguments discussing whether EBM is merely a cost-containment strategy versus good medicine.

I would agree with the attending in this …

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Old dog, new tricks?

So I was having a discussion with a friendly drug rep about McNeil’s drug, Flexeril. Now, this is not a new medication, but the 5mg formulation is. The big selling point is similar amount of muscle relaxation with less sedation. What’s left out is that the regular 10mg of Flexeril is a generic medication, but 5mg is brand-name only, meaning it’s third tier on most health plans. …

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Lest we think that . . .

. . . frivolous lawsuits are an American-only phenomenon, fear not – it happens in Korea as well.

Talk about a free-market

Singapore is offering “medical tourism”, slashing rates of medical procedures to lure overseas patients. I guess that’s one way to increase revenue.

Back to basics

As we continue to get blitzed with happy-meal style medications like Azithromycin Z-paks and Tri-paks, Biaxin XL-paks, and Levaquin Leva-paks, consider the most recent review from NEJM on bacterial sinusitis. Some excerpts:

In an analysis of a large pharmaceutical database, 29,102 patients were identified with a billing diagnosis of acute sinusitis and a related prescription for an antimicrobial agent. Clinical success was defined as the absence of an …

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Not what Merck wants to hear . . .

I’m sure that they’re in damage control mode after reading about how Vioxx increases heart attack risk.

Patients taking Merck & Co. Inc.’s Vioxx arthritis drug had a 50 percent greater chance of heart attacks and sudden cardiac death than individuals using Pfizer Inc.’s rival Celebrex medicine, according to a large study financed by the U.S. Food and Drug Administration. . .

The study also found patients taking the …

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The black box of health care costs

Trent has written a dissenting opinion on the piece by Mr. Baker yesterday in the Boston Globe. He writes:

Consumers only want and seek the information if the benefits of such information exceed the costs of finding it. Part of the reason things stand as they do is that patients do not save from finding this pricing information. This is the fundamental problem with third-party payers, whether …

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Today’s op-ed in the Boston Globe . . .

. . . gives Charlie Baker’s opinion on disclosing health care costs to the public. He is the CEO of Harvard Pilgrim Health Care, an HMO in Massachusetts. I completely agree with his comments.

Another article . . .

. . . on physician blogs.

ER doc turned malpractice prosecutor

Fascinating interview with Bruce Fagel, a former ER physician who is now a malpractice attorney. He touches on which doctors he sues, the costs of litigation, and opinions on tort reform.

The growth and challenges of e-consultations

I am a pretty big supporter of e-health – that is educating and empowering patients to take control of their health using the internet. With this new resource, comes many dangers – especially in the form of incorrect medical information and misinterpretation of information. Two articles from the BMJ discusses the effectiveness and challenges of e-mail consultations.

Websites promoting anorexia

There’s a disturbing new trend – pro-anorexia websites. Sad, in more ways than one.

BKA = "Baloney amputation"

Maybe I shouldn’t laugh, since we also outsource our transcription to India. But, I couldn’t help but to chuckle at some of the transcription errors from outsourcing.

Open access

A good case for same-day appointments. Our practice currently uses this model (allowing several same-day urgent care visits per physician) with good success. Patients are happy with the improved access, and these slots invariably fill.

Check out . . .

. . . Carotids.com – “an irreverent look at the latest medical news. We as health professionals enjoy learning, discussing, and laughing at the latest news and research. Get your real research from your journals. Come here to laugh and chat about our wonderful professions.”

Some good stuff on this website and more than a few laughs. I’ve added it to my Blogroll.

More coronary artery disease screening and EBCT

Galen has bluntly chimed in on the study comparing exercise stress testing and calcium scores from electron beam computed tomography (EBCT) that the lay press has been reporting.

As we brace ourselves for patients demanding EBCT, let’s consider the data and recommendations. Again, UptoDate comes in handy:

Coronary calcification detected by EBCT is found in individuals who have significant angiographic CHD, with a sensitivity ranging from …

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Sound familiar?

Poor reimbursement rates for dealing with the indigent population, leading to a shortage of those who represent them. Another story on our broken health care system? No – apparently, the same thing is happening to lawyers.

Lawyers, welcome to our world.

Exercise stress testing

The lay press is all over this study, blaring out this headline: Stress Test May Miss Early Heart Disease. Here were the participants in the study:

Most were men over 45 or women over 55, smokers, people with high cholesterol or high blood pressure, diabetes or a close relative with early heart disease, they reported in this week’s issue of the Journal of the American College of Cardiology.


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A website . . .

. . . allowing those to comparison shop for prescription medication is proving to be quite popular in New York state.

Morning news rounds

I have an extra half-hour this morning before I see patients, so here are some interesting stories to start your day.

Despite tort reform, some physicians are leaving high-risk practice.

An article on people who steal physician identities.

I do some work at the VA, so I see first-hand many of the primary care physician shortages (6+ month wait in some cases). With a …

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