This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use. Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to "prescribe" medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically indicated. My answer ...

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Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable. A decision has been made to put her in hospice -- which is a level of care more than an actual location. (Most hospice actually occurs at home.) The patient waxes in and out of consciousness, sometimes lucid, but mostly not. While no one is ready for her to die, this end-of-life ...

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Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce. The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really -- if you had it). This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for ...

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I recently told you of my admiration for Dr. Mona Hanna-Attisha, the Michigan pediatrician and epidemiologist whose strong research and advocacy was able to finally bring a shining light to the problem of lead in the water supply of Flint. Continuing with a theme, I now bring you the story of Dr. Adriana Melo of Campina Grande, Brazil. Dr. Melo is an OB-GYN who subspecializes in maternal-fetal medicine (MFM), the branch ...

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I have a new hero. Her name is Mona Hanna-Attisha, MD, MPH. Dr. Hanna-Attisha is a pediatrician in Flint, Michigan. She grew up in a suburb of Detroit. She graduated from the University of Michigan before attending medical school at Michigan State University. During her clinical years (the 3rd and 4th years of medical school), she spent many months at Hurley Medical Center in Flint, which serves as a clinical ...

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Quick: Which U.S. state has the highest rate of unintended pregnancy? I’ll reveal below, but I learned the answer and several other surprising facts in an interview with Mark Edwards, the co-founder of Upstream USA, a non-profit advocacy organization that provides technical assistance to health enterprises (medical practices, clinics, public health departments) in the use of long-acting, reversible contraceptives (known in the trade as LARC). LARC consists of two options:
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The big story recently is that the American Cancer Society issued an updated guideline recommending that women undergo mammography less frequently than before. This announcement was denounced on both “sides” of the perennial debate. Those in the “mammograms save lives” camp are outraged that a scientific society dedicated to cancer prevention and treatment would issue a proclamation that seems to run counter to the notion that “early detection saves lives.” Those in ...

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Ever heard of a doula? Doula is an ancient Greek word that translates as “woman who serves.” Specifically, it’s come to mean someone who serves as a birth attendant, a person trained in childbirth who acts in support of a birthing mother. A doula provides knowledge, comfort, and an extra pair of hands -- whether it’s to provide nourishment or massage, or help a mother find a comfortable position. As you may ...

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The Affordable Care Act. Obamacare. No matter what you call it, the law has two main goals: Insure more (all?) Americans, and in doing so, lower the aggregate costs of health care in the U.S. After year one of the Act’s main rollout, there is no doubt about the first goal: Millions more Americans now have health insurance. Many have purchased it on the exchanges, whether they are state-run (best example might ...

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Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks. Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ ...

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The New York Times had a front-page story about the growth of urgent care clinics nationwide. These are the places that are often referred to as “minor emergency rooms,” or “doc-in-a-box” outfits. Their value proposition is simple: You don’t need an appointment. The costs are “reasonable,” and much more transparent than usual medical care at a doctor’s office, emergency room, or hospital. Best of all: They can treat a majority of acute conditions and ...

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As a doctor, I’m trained to do many things: I listen. I ask. I examine, order, and test. And then I assess. I certainly try to treat. All too often, this includes prescribing. What frequently gets obscured in this paradigm is that, on many occasions, the listening part is enough. Take Gene, for instance. He’s a retired biochemist. When I met him for the first time as a patient, I took a ...

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More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field. First, ...

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In addition to providing coverage to millions of uninsured Americans, one of the key attributes of the Affordable Care Act (aka Obamacare) is reforming the way that we finance health care in the U.S. Since the rise of the health insurance industry (as a job benefit or under Medicare), we have operated under a system known as “fee-for-service,” in which every little nugget of health care provided (from an operation to ...

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Ever get confused over the names of medicines? I do. There’s Zantac and Xanax. Zanaflex and Zaleplon. But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike. Every drug has (at least) two names -- one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical ...

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The New York Times ran a fascinating piece about a dusty old medical experiment that was brought back to life recently after one of its perpetrators -- err, researchers, decided to come clean to a medical historian after having read the book The Immortal Life of Henrietta Lacks. The unnamed confessor was a surgical resident in the 1950s under Dr. Perry Hudson, the man in charge of the experiment. Dr. Hudson (a urologist, ...

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I was naive when I decided to enter medicine. My impressions then were that doctors always “did” stuff -- for patients, and to patients. We would do stuff to you (examinations, blood tests, scans, surgeries) in order to help you. A lot of time and education later, I’ve learned that that straightforward paradigm is far from the only way that doctors help people. In fact, following that mostly simple formula (you come to us, we do stuff to ...

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In case you missed it, former President George W. Bush had a stent placed in one of the arteries that feeds his heart. The 67-year-old came through the procedure with flying colors, we are told. Stents are tiny metal mesh tubes that get inserted into clogged arteries, essentially to prop them open. Bush, heretofore thought to be in excellent shape, seems an unlikely candidate for the procedure. We hear tale of him riding his ...

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An interesting conversation recently took place among residency program directors in my field of internal medicine. At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam. It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists. One is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical ...

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hipscrews Six months ago I posted a story about a demented 94-year-old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall. Her son wanted her to be made comfort care only, and avoid a trip to the operating room since she was likely within six ...

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