I recently attended a cardiology conference where a speaker proudly presented a case of shared decision-making.  It involved a young female athlete who had survived a cardiac arrest and was diagnosed as having an anomaly in her heart conduction system, putting her at risk for arrhythmia during exercise. She had received an implantable cardioverter-defibrillator, and the decision in question had to do with whether she could resume sports activities or not.  ...

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In a matter of less than a decade, “shared decision-making” (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere.  Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been ...

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Here’s the typical story we come across every day: Jack was overweight and had a terrible cardio-metabolic profile. Jack changed his diet: He eliminated X, Y, Z and added more A, B, and C. He’s now lost 30 pounds, and he feels fantastic. His numbers are also perfect: His HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range. Todd was overweight and had ...

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Kenan Malik writes in the New York Times in support of Charlie Gard’s parents, presenting a secular, utilitarian argument for the continuation of the child’s treatment. In the article, Malik draws attention to a contradiction between the State’s position regarding Gard and its position regarding the wishes of a patient with a terminal neurological condition who wishes for assisted suicide. The practice of withdrawal of care is often invoked in the ...

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On the surface, the news from America about health care seems rather grim: cost and dissatisfaction keep rising, reforms are stalling, and, for some, even life expectancy may be declining.  If that wasn’t bad enough, President Trump issued a tweet on March 25 predicting that “Obamacare will explode.” For a small but growing number of doctors and patients, however, the future is surprisingly hopeful. The nascent direct care movement is made up ...

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Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment. Medscape recently featured a video interview of Timothy Quill, the palliative-care specialist and long-term assisted suicide activist. He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS). Several points ...

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In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on. I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the ...

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Transparency -- or its absence -- continues to fascinate health care analysts and health care economists.  A study published in the Annals of Internal Medicine addresses the effects of public reporting of hospital mortality rates on outcomes.  Its senior author, Dr. Ashish Jha, offered his perspective on the study results and on the topic. According to the study investigators, mandatory public reporting of hospital mortality is not improving outcomes.  The result of their analysis surprised them ...

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Whenever I have the opportunity to suggest that good medicine is based on friendship, I usually get a nod of approval mixed with a quizzical look.  What’s that supposed to mean? At a recent meeting of an editorial board on which I serve,  the reaction to my suggestion was more forceful and perhaps more honest.  The topic of the day concerned patient education, and how hard it can be to move patients to do things ...

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I feel that I have been spending way too much time as a “chronicler of the decline,” to use von Mises' phrase.  The secular trend in health care (literally spanning the last 100 years) is one of increasing centralization, consolidation, and reduced choice.  Nevertheless, there are some promising developments that give me hope for a better future. Here are five notable trends, in no particular order: 1. Direct patient care. Direct care encompasses all ...

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The shaming campaign that followed the news of two generic drug prices somersaulting into the stratosphere after being acquired by private companies is not too surprising.  The idea that a drug that cost $13.50 one day can cost $750 the next, seemingly on the whim of greedy Wall Street investors and pharma start-ups, is fodder for the outrage machine. But what the outrage machine does not realize is the ...

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pnhp-long-setweisbartversion-52-638 In contrast to the expected shortage of tens of thousands of physicians, there appears to be an abundance of health care administrators, at least judging by graph above. The originators of the graph -- economists and physician-activists at Physicians for a National Health Program (PNHP) -- invoke the administrative bloat as reason to promote a single payer system.  With a single ...

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shutterstock_116371780 The war on medical error was officially launched in 1999, when the Institute of Medicine (IOM) published its landmark report To Err is Human, alleging that up to 98,000 yearly deaths in US hospitals were due to human missteps. Despite significant ambiguities in the definition of a medical error, numerous militias known as patient safety organizations ...

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shutterstock_164925521 I keep getting served a Facebook ad from the American Association of Medical Colleges imploring me to ask politicians to fund residency training for medical school graduates.  The link leads to a webpage with neat graphics and a series of well-designed cartoons dramatizing an ominous shortage of 90,000 doctors expected to occur by 2025. Now, the notion of “doctor shortage” by itself is meaningless. ...

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When a terminally ill but mentally competent patient wishes to die, should a physician be allowed to bring about such wish? The California legislature is considering that question, and physicians will soon be asked to weigh in on it. Until recently, so-called “physician-assisted dying” (PAD) garnered little support among doctors. Currently, however, enthusiasm in its favor is growing. What are the reasons given to justify this emerging practice? Do they ...

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Last year, Dean Dupuy, 46, an engineer at Apple, suddenly died of a heart attack while playing hockey. He experienced no warning symptoms and, with a healthy, active lifestyle, did not fit the profile of someone at risk. Too late to save him, Dupuy’s wife Victoria discovered that early coronary disease can be identified by simple CT scans. She recently launched a nonprofit organization, No More Broken Hearts, in San Jose ...

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It is a rare occasion nowadays when academic journals treat us to an editorial debate of some substance.  The staff at the Journal of the American College of Cardiology can be applauded for publishing last summer two articles representing fundamentally opposed viewpoints on the best strategy to avoid cardiovascular illness.  Amusingly, both claimed in the title of their piece the distinction of promoting a "rational approach" for the reduction ...

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The New York Times recently published an opinion editorial entitled "Squandering Medicare’s Money"in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend "a fortune each year on procedures that have no proven benefit." To support her contention, Redberg cites several studies which indicate that many routinely performed tests and treatments ...

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