Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their ...

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The following deceptive advertisement appeared in my church's bulletin yesterday:

Life Line Screening, the nation's leading provider of preventive health screenings, will offer their affordable, non-invasive, painless health screenings [in the church cafeteria] on April 9th. Five screenings will be offered that scan for potential health problems related to: blocked arteries, which is a leading cause of stroke; abdominal aortic aneurysms, which can lead to a ruptured aorta; hardening of the ...

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One of the ugliest incidents in my career occurred during my faculty development fellowship year, when I spent two days each week seeing patients at several federally qualified community health centers in inner city Washington, DC. Midway through the year, I was transferred from a health center that served an African-American population to one serving a mostly Spanish-speaking clientele. Nearly all of the permanent Read more...

As a family physician, I've found that patients' individual health beliefs often play a big role in important decisions such as starting a new medication or undergoing an invasive test or procedure. Some patients were more willing to endure potentially risky procedures in order to learn their diagnosis quicker, for example, while others preferred "watchful waiting," or monitoring symptoms that were unlikely to be a sign of anything serious. Unfortunately, in ...

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Mr. B, the patient who first stirred my interest in family medicine, was a spry former World War Two fighter pilot who came to the ER complaining of an irregular heart beat. I remember him regaling me with stories about the Battle of Britain while his wife dutifully stood by his side in the chaos of the crowded emergency room at a private hospital affiliated with my medical school. It was ...

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There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables. As anyone who has ever ...

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Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice. This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has ...

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You've probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn't make sense. Why is it so important for me to arrive on time when, in reality, I won't be called back until half an hour (or more) later? What's the point of waiting for another 20 minutes in a chilly examining room for the doctor ...

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One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes. Each time she visited the office, I would recommend that we start multiple medications to control these conditions, and every time she would politely decline. Her previous physicians had left frustrated notes in her chart littered with terms such as "non-compliant," "against medical advice" and expressing wonderment why ...

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Pharmaceutical companies and their shareholders are always looking for the next "blockbuster" drug, the label given to a drug that generates more than $1 billion of revenue per year. Blockbuster drugs don't necessarily have to save many (or any) lives - slick marketing more than compensates for marginal improvements in treatment efficacy -- but they do need to target conditions that are common enough that millions of patients will buy them. ...

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