Medicaid — the program that provides funding for adults, seniors (along with Medicare), children and people who are blind or disabled who can't pay for their own health care — is expensive. It is painfully expensive. The program, along with CHIP (the Children's Health Insurance Program), marketplace subsidies and Medicare is responsible for 25 percent of the federal budget. Total Medicaid costs in 2016 were ...

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I just read a Clinical Problem Solving case from the New England Journal of Medicine (NEJM). It was entitled "Stream of Consciousness"and it told the story of a 65-year-old man who was a patient at the Brigham and Women's Hospital of Harvard Medical School, arguably one of the finest medical institutions in the world. These cases are presented in single paragraphs to a clinical expert physician who then ...

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Drug costs in the U.S. are higher than in in any other industrialized country in the world. Our cost for an insulin glargine (long-acting insulin) pen is $76.80 and in Canada, so very few miles away, it costs $19.60. The latter price is reasonable. The former price can make the difference between being able to afford a life-saving drug and dying. It is illegal, however, for a U.S. citizen to ...

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I finally finished reading the many journals piled up on my dining room table, which have been shunted to other flat surfaces for projects or the visits of friends. I didn't read them all well, but I touched them all and read what interested me. The early October edition of the Annals of Internal Medicine particularly caught my eye. There were two major articles that looked at determinants of health in ...

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Estrogen is a miracle drug for many women who experience the drenching sweats, sexual dysfunction and frustrating brain betrayals associated with entering menopause. It comes in expensive patches, less expensive pills or injections, as well as vaginal creams or rings. It has gone in and out of favor with the medical community for decades. Estrogen is the main ingredient in most birth control pills and has been studied extensively in that ...

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In about 1990 we got our first computer. I say "we" because my husband and I shared a desktop which I used infrequently. I mostly used it for word processing, and the Internet was very young. At the turn of the millennium, my children were using computers, and they were limited to 1 hour of computer time a day, which was on a shared desktop. By 2001, I was communicating ...

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Physician burnout and physician suicide have been getting more attention in the last several years. Suicide among physicians is horribly tragic, and maybe moreso because of several factors. Suicide is the quintessentially most preventable fatal event. In order to prevent suicide, the person killing him or herself needs only not do it. To anyone who knows the victim/perpetrator, it seems that if only the right words had been spoken, the ...

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I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, ...

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"Annie, Annie, are you OK?" Many of us learned to resuscitate a person who has collapsed using Annie, the mannequin based on a death mask of a young woman who had drowned in the Seine in Paris in the 19th century. Bystander cardiopulmonary resuscitation (CPR) has become increasingly accepted and expected as the years have passed, and we have even begun to make affordable machines to deliver a life-saving shock (defibrillation) ...

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There is enthusiasm in politics about reducing regulation to stimulate creativity and economic growth. Maybe. But reduction in oversight of medication and medical devices by the Food and Drug Administration (FDA) will probably lead to a proliferation of expensive potions and gadgets that don't actually help. The New England Journal of Medicine published an article detailing the near miss associated with an injectable monoclonal antibody for Alzheimer's disease. ...

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