Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology. Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then? Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science. Molecular testing of the actual ...

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Promoting patient safety, preventing medical error, preventing physician error, preventing errors in diagnosis, preventing nurse error, preventing surgical error, preventing communication error, preventing health illiteracy error, preventing errors from language barriers, preventing laboratory error, preventing computer error, preventing patient mix-ups, preventing right and left side of body mix-ups, preventing mistakes, since mistakes are the stepping stones to failure. Recognizing human frailty, recognizing physician humanity, recognizing system fallibility, owning up to problems, ...

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Who is your favorite addict? I guess we have to talk about addiction as a preface to that question. Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh Day Adventists, and the like. All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction. Most people who become addicted to one drug often ...

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There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone. In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more. Then, in the 1970s, 80s, 90s, ...

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Most humans, even those who are educated, can read and write, and have studied some science, seem to have a hard time comprehending unpleasant future realities, absent personal experience. Some say that people learn most from their own mistakes. If true, that makes widespread prevention of anticipated calamities very difficult. And I am not only talking about people who are deeply into religion and superstition, and those who send politicians who proudly ...

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Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes. The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, ...

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All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies. Why? Because they are the only games in town, and both security and safety are top Maslow imperatives. The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a ...

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A law is a rule of conduct or action formally recognized as binding and enforced by a controlling authority. Law enforcement broadly refers to any system by which some members of society act in an organized manner to promote adherence to the law by discovering and punishing persons who violate the rules governing that society. The purposes of punishment for crimes include: 1. Punishment will stop them from committing further crimes. 2. Punishment ...

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Healthy, wealthy and wise. Or is it wise, wealthy, and healthy, or perhaps healthy, wise, and wealthy, or even wealthy, wise and healthy? Which came first, the chicken or the egg? Is there cause and effect? The question matters a lot because, these days, we are constantly talking about bona fide disparities in health -- by gender, race, ethnicity, geography, age, status of citizenship, and type or absence of insurance. But, ...

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"I gave at the office." I am an American taxpayer just like most of you, the audience. My tax dollars, and yours, fund the great majority of health-related research in the United States, mostly through the National Institutes of Health. Thus, I, and you, the taxpayers, own the results of that NIH funded research. We paid for it. Then, why, for goodness sake, do I, the owner, or my physician, another owner, have ...

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I don't know how many of you readers are old enough to remember the frequent use of open chest cardiac massage, first successfully performed in 1901. It began as a way to resuscitate suddenly dead people, assuming that their hearts had arrested or fibrillated. The surgeon would open the chest between ribs 5 and 6 and rhythmically squeeze the heart to move the blood and re-establish life. Sometimes it worked; usually ...

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I grew up in the American Deep South, in Lower Alabama, with Jim Crow and Old Crow, where fire-breathing preachers, Harper Lee, Truman Capote, and I all knew that one may never kill a mockingbird. And in that day and place, the "War on Drugs" was actively waged county by county. The drug was alcohol and the method of war was called "local option." Every several years, the Baptists and the ...

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It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future. The inexorable upward trend line is unsustainable. In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health. They were:

  1. Use intensive medical therapy instead of coronary artery bypass grafts and invasive ...

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How can you determine whether you are in a "developed" or a "developing" country? We used to call these latter "un- or underdeveloped" or "3rd world" countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic. If one objectively examines all 20 dozen or so of the world's countries, a geographer would divide them into either north or south of the Equator. And if, ...

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The next time I receive medical care, I want to know how much it will cost before I agree that it will be done -- and that includes no matter who pays the bill. And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody. You say it is beyond your control to know? I say, insist. Rise up, ...

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Imagine an America with no health insurance companies. What do health insurance companies do? They take as much money as possible from people who want health insurance coverage. They pay out as little money as possible -- so-called medical loss -- to settle claims from creditors for health services and products that have been delivered. They keep as much money as possible for the incomes of their executives and other employees, and to ...

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Doctor, do you know a lot about human nutrition? You said "yes?" Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson's infamous quote "you lie" is applicable. American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don't know or care much about a topic, it often gets short shrift. I ...

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Autopsies establish truth, detect change, provide hard data, instruct learners, and promote justice. Yet, they seem poorly valued in modern America except in many TV crime shows like "CSI." Dr. Donna Hoyert of the CDC, in August 2011, profiled the dramatic changes in American autopsy rates, noting that while forensic autopsies remain common, hospital autopsies for patients with diseases, especially in the elderly, have almost disappeared. In evaluating ...

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Are you a recovering alcoholic? Be honest. How about a recovering nicotine addict, or recovering from an addiction to some illegal drug, or maybe addiction to gambling, or sex, or football, or even your computer screen, or Angry Birds? I have worked in the addiction field most of my professional life. For me, addiction to a chemical includes physical and mental dependence, tolerance, withdrawal, and, of course, drug seeking behavior, despite recognized ...

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There seems to be a deep, even innate, need on the part of many young men to actually, or vicariously, strike out at other people to cause pain and injury while striving to dominate. In 1996, I wrote an editorial entitled "Blunt Force Violence in America" describing "a modern continuum from street fights to barroom brawls to domestic child, spousal, and elder abuse, to ultimate fighting to extreme fighting, to ...

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