LanceArmstrongOprahinterview According to George Orwell, "serious sport has nothing to do with fair play. It is bound up with hatred, with jealousy, with boastfulness, with disregard for all rules, and with sadistic pleasure in witnessing violence: in other words it is war minus the shooting." Ok ... sounds pretty much like the Super Bowl, but the Tour de France? Lance Armstrong? Ergogenic aids? Cancer ...

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It's really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis. As is not unusual in Greek mythology, Coronis meets a violent death, but the infant Aesculapius is saved. He is raised by a wise centaur, becomes skilled in healing arts, and succeeds in ...

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Legend tells of an Athenian named Pheidippides who, in 490 B.C., ran from the battlefield at Marathon to Athens, telling of the victory over the Persians. Proclaiming the news that Athens would be spared pillage and fire, the Athenian dropped dead. The story is a myth. But the marathon, like most things worth doing, does offer both risks and rewards. Because it gives a chance to go beyond usual boundaries, with ...

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POLST stands for "Physician Orders for Life-Sustaining Treatment". It is a next generation replacement for an Advanced Directive and DNR ("Do Not Resuscitate") order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting. The ...

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Hard choices and healthcare reform are here.  Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama. Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA.  He is an outspoken advocate for the single-payer system, admires Britain’s National ...

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Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes. This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial ...

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Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. "Socrates," she stated, "was a really old Greek guy who went around giving people good advice. They poisoned him." But here goes: We do not need government intervention to improve our health, and, by extension, the quality of our lots in life. This essay ...

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The bioethics community has been working on defining the concept of medically futile care for more than a quarter of a century, yet the debate continues. The way in which the current notion of medical futility becomes folded into the proposed healthcare reform bills is at a critical point. Sophisticated medical technology that is at once life-saving, life-prolonging as well as death-prolonging has created populations which, in the past, would have ...

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Originally posted in MedPage Today She is 11, a fifth grader, as prepubescent as nature allows, and utterly terrified. She hasn't eaten normally for nearly a month, her mother reports. She sleeps poorly, reports nightmares, and cleans her hands so obsessively that she is literally bleeding raw. Her fifth grade peer group typically does not guard its language nor govern its remarks, ...

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