Cheers

I don't often give the mainstream media many kudos when reporting medical news, but I'm happy to see MSNBC highlighting the appropriate context of a screening MRI for breast cancer. The story even made the MSNBC home page. Echoing what was written here, MSNBC reports:

If you're not at high risk for breast cancer, make sure you get a yearly mammogram. But at this point, MRI is not ...

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The hidden cost of medications

From the Archives of Internal Medicine, comes this story:

About one-third of chronically ill adults who underuse medications because of the costs associated with buying the drugs, never tell their health care practitioners . . .

The underuse of essential medications, including cholesterol-lowering medications, heart medications, asthma medications and antipsychotics, has been associated with increased emergency department visits, nursing home admissions, acute psychiatric hospitalizations, and a decrease in self-reported ...

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Screening for breast cancer

In a good news/bad news kind of article, it suggested that most women are receiving their mammograms by the age of 40, but aren't following-up as suggested:

A new study finds most women now follow the recommendation to receive their first screening mammogram at age 40, but there is widespread failure to return promptly for subsequent exams and several sub-populations of women still are not being screened by the ...

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Mainstream

Some journalism blogs, like Micro Persuasion and Jim Grisanzio, have picked up last week's profile in the Telegraph. Jim expresses one of the major reasons why this blog exists:

The information the docs were offering was complex and many times serious. Trivializing it could have profound implications. It needed more time to be explained and understood than the 60 second special report on the news with dramatic music and ...

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I just completed another shift in the emergency room (which I do about once per month), and it continually amazes me the amount of non-emergent cases that comes through - but that's for another rant.

So I'm reading that the family of John Ritter is suing the hospital for misdiagnosing his ascending aortic aneurysm. Galen certainly has some tough words for this. I'll reserve opinion since I'm ...

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Hostages in the ER

In a reminder that an emergency room can be dangerous place, this story reveals how desperate some patients are to continue their prescription drug abuse:

A man apparently distraught at not being able to see a doctor immediately held two hostages for 20 minutes at Frisbie Memorial Hospital Wednesday. . .

"They were able to get a doctor to respond to the emergency room," Officer Mike Allen said. ...

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With media focus on Bill Clinton's impending bypass surgery, the INTERHEART study that I briefly alluded to recently has received an early-release from the Lancet.

Some observations:
1) Smoking and a poor cholesterol ratio accounts for the majority of risk.
2) Psychosocial factors ("stress") plays a significant role.
3) The cholesterol ratio they used was the ApoB/ApoA1 ratio. What does this mean? From UptoDate:

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The final word on South Shore ER

Today the Massachusetts Department of Public Health came down with its decision on South Shore hospital, just south of Boston. I have written about the situation previously and followed up here.

The Department of Public Health report, released yesterday, ends review of a dozen complaints about the pace of care in South Shore's emergency room since last year. It found that emergency room staff at the ...

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Galen has bluntly chimed in on the study comparing exercise stress testing and calcium scores from electron beam computed tomography (EBCT) that the lay press has been reporting.

As we brace ourselves for patients demanding EBCT, let's consider the data and recommendations. Again, UptoDate comes in handy:

Coronary calcification detected by EBCT is found in individuals who have significant angiographic CHD, with a sensitivity ranging from ...

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Exercise stress testing

The lay press is all over this study, blaring out this headline: Stress Test May Miss Early Heart Disease. Here were the participants in the study:

Most were men over 45 or women over 55, smokers, people with high cholesterol or high blood pressure, diabetes or a close relative with early heart disease, they reported in this week's issue of the Journal of the American College of Cardiology.


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Winning Gmail entry #4

It's been awhile since I've received any submissions for my remaining Gmail invites. I still have 3 more left. Send me any entertaining, medically-related story or article, and I'll give a Gmail invite to what I find interesting. I give preference to entries that are well-written.

This morning, I received this story from someone who works with the developmentally disabled. An eye-opener to say the ...

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A thoughtful response to my piece on good business vs good medicine. The commenter argues that the fundamental problem is our dependence on the insurance system. Consequently, our health-care system is slanted against good medicine. It is the insurance companies that forces good business on our medical practice, and the physicians are unwitting pawns. Take a read:

The assumption is that somehow good business and good ...

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This story is getting a lot of play here. Here are the basics:

In short, the unsupervised pharmacy technician, in her second week on the job, wrongly added insulin to an undisclosed number of intravenous nutrient bags prescribed to sick infants.

The feeding bags contained no indication of insulin on their labels. They apparently were not checked by the pharmacist before delivery to the neonatal intensive ...

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Seems like practices who have a liability surcharge may become increasingly common:

Physicians gathered at the AMA Annual Meeting last month explored a variety of options for immediate relief for a profession besieged by increasingly unaffordable medical liability insurance premiums.

The hottest topic of discussion: liability surcharges. The idea is that physicians would tack a charge onto patients' bills to help offset their insurance payment. Low Medicare ...

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Statins and cancer

So the big story today is how statins can ward off cancer. This is a classic case of media hype of questionable data that was discussed last week. In this case, the data is observational and can hardly be used for any recommendations. Even the article itself recognizes this (of course, not in the title):

However, researchers seem unanimous in saying the evidence is still ...

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Here's something interesting I came across from Internal Medicine News Online. It discusses whether the media overplays and overpublicizes clinical studies. Some excerpts:

. . . most studies cannot stand alone. "Rarely is a study conclusive enough or broad enough to establish public policy or direct individual action by itself," . . .

. . . Although they might be suitable for journal publication, very few ...

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Cover the uninsured week

Although the United States spends more on health care than any other industrialized country (the United States spent $4,887 per capita on health care in 2001, compared to $2,792 in Canada, $2,513 in Australia and $1,992 in Britain) - totalling more than 1.4 trillion dollars, there continues to be a sizable portion without health insurance. This is simply unacceptable. Next week is "Cover the unisured week" to ...

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