Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person disease: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false ...

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Toxoplasma gondii is a parasite that causes opportunistic infection in helpless people. It may have met its match. The cost of treating toxoplasmosis, a rare but extant infection, just shot up exponentially. Drug-resistant strain, you ask? Have physicians in infectious disease gone mercenary, you wonder? No. A change in ownership. Daraprim (pyrimethamine) is a nifty drug that kills parasites. It’s been around for eons. I still recall its name from my ...

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A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70  percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing.  The study has limitations. Finland is not just a land of the
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shutterstock_287266676 When report cards of performance became available, cardiac surgeons in New York and Pennsylvania avoided high risk patients. Could something similar happen, nationally, after the forthcoming revolution in transparency inspired by ProPublica’s data release? Take two fictional orthopedic surgeons, Cherry Picker, MD and Morbidity Hunter, MD. Cherry Picker lives in the Upper East Side of New York. His patients give ...

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shutterstock_90934610 I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience -- MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched ...

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shutterstock_145545640 Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules. But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind. “U.S. radiologists think that Indian radiologists are ...

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shutterstock_222192721 There’s a simple way to define value. Ask why we exist. Imaging exists because clinicians are uncomfortable with uncertainty. Imaging exists because emergency physicians feel that being 98 percent correct about the absence of pulmonary embolism is not good enough. Radiologists exist because imaging is not an assay on a Western blot with a 100 percent accuracy. Radiologists exist because information is ...

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shutterstock_118491940 I used to be a surgical resident in the U.K. One day, I was a little dispirited during a brutal call, and my senior resident asked, “Do you love surgery?” “I like surgery,” I replied. “If you don’t love surgery, love it unconditionally I mean -- like loving your child -- you will be unhappy.” He warned. I really liked surgery. I like radiology. ...

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Following the recession, the Obama administration sought shovel-ready projects. One unlikely shovel-wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 percent of the stimulus towards digitizing medical records. Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between ...

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1408738840000-Dr-Oz-Headshot-2 If I could invite four people for dinner, alive or dead, they would be Mark Twain, William Shackleton, Christopher Hitchens and Homer Simpson (Bart’s dad). If Mehmet Oz turned up with a bag of Garcinia cambogia, I would excuse myself. Few things drive me to the abyss more reliably than the banality of status updates on Facebook and the monotony of health ...

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To his credit, Mark Cuban, engaged on Twitter in response to my post.

Mark, I’m sorry I had to leave Twitter abruptly. My wife threatened to kill me and then divorce me -- in that order -- if I didn’t get off Twitter instantly and get the groceries.

However, I caught the tail end of the Tweets. I’ll do my best to respond.

1. “Why is this contingency ...

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o-MARK-CUBAN-facebook Businessman and maverick, Mark Cuban recently opined, “If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘ He further opined that this must be done to “create your own personal health profile and history. It ...

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shutterstock_186812807 Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the president, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after ...

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EverythingIsAwesome Recently, I was asked to fill a questionnaire during check-out at a hotel in India. I was very pleased with my stay, so I agreed to provide feedback. It is worth pointing out that if I was only mildly satisfied I would not have agreed. If I was disappointed with my stay, I would have filled the form more enthusiastically. When I ...

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An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort ...

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Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long. Surgeon and writer, Atul Gawande, explores the medicalization of aging and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and say enough ...

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shutterstock_97190261 In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough. There is little doubt that APCs ...

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In defiance of dire predictions, children haven’t been sent to workhouses and women haven’t been chained to utensils after the GOP gained strength in the House and the Senate. And Vivek Murthy, the unabashed Obamaphile, was finally confirmed surgeon general. To be honest, I always thought the controversy surrounding Murthy’s nomination because of his stance on gun control was rather daft. Stopping doctors from pontificating over guns, such as the docs ...

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In the giddy days after the passage of ACA, I was chatting with a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; "Healthcare post-Obamacare" or "Radiology in the new era." Talks warning us that we were exiting the ...

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I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks. Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero. Stupidity, though, was ...

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