(image: Plioz.com) Ever cared for that patient with metastatic cancer in your ICU, intubated for acute respiratory failure and surrounded by a bewildered and stressed family who cope by emotionally blaming you, the intensivist, because “He just saw his oncologist last week, and he said everything was OK!”? Forcing you to begin painful end-of-life discussions [... read more]
Antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) made big bucks for Roche and GSK respectively during the H1N1 influenza pandemic: Roche reportedly sold about $3 billion of Tamiflu in 2009. Although sales have dropped off precipitously, the drugs are still recommended by CDC for serious cases of seasonal influenza. But do Relenza and Tamiflu even [... read more]
What happens when the “Rapid Response Team” is called for an acutely deteriorating patient, but there’s no ICU bed available to send her to? In Alberta, Canada, not much, apparently. Henry Stelfox, Brenda Hemmelgarn, and Braden Manns analyzed 3,494 consecutive patients with “Code MET (medical emergency team)” rapid-response activations in Calgary between 2007 and 2009. [... read more]
A large proportion of primary care doctors were easily fooled by numbers that seemed to support cancer screening, but were actually irrelevant. Just as bad, they ignored data supporting screening that would genuinely save lives, in a questionnaire simulation published in the March 6 Annals of Internal Medicine. 412 primary care docs were given surveys testing [... read more]
The Joint Commission (previously called “JCAHO”) launched its new “Tobacco Cessation Performance Measure Set” on January 1, 2012. Like most New Years’ resolutions, we all promptly ignored it. But it’s time to pay attention — your hospital might be. Wasn’t there already a smoking cessation performance measure? Yes, in 2004 hospitals were required to report the proportion [... read more]
This post was featured on KevinMD.com; an excerpt follows. “Full code” is the universal default status for patients who haven’t chosen otherwise. Yet I suspect most physicians believe this policy is wrong. We feel in our hearts we’re doing harm when we perform CPR on poor souls whose bodies are trying to naturally end their [... read more]
You might think you’re just writing a prescription and signing your name. But the innocent ink (or pixels) you leave behind in your daily routine turns into liquid gold for an entire industry that makes big profits from understanding and interpreting your behavior to pharmaceutical and insurance companies. As Lawrence Gostin points out in a [... read more]
“The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care,” writes Ezekiel Emanuel, Obama’s former health care advisor who’s now back at University of Pennsylvania in a big-thinker job spanning ethics, economics and medicine. In a JAMA essay with co-author Viktor Fuchs, they opine that [... read more]
This post was featured on KevinMD.com; an excerpt follows: An essay in JAMA by Vinay Prasad (Northwestern of Chicago), Adam Cifu (U. of Chicago) and John Ioannidis (Stanford) should be required reading for every medical student, resident, and to pass every board certification exam in any specialty. In my humble opinion. John Ioannidis became one [... read more]
Sleep docs don’t come off looking so hot in this recent NPR story, which paints some of them as opportunistic plunderers of the nation’s health care dollars, over-ordering expensive sleep studies to make a buck. As reporter Jenny Gold points out, the number of sleep studies performed in the U.S. has quadrupled over the past [... read more]
The National Lung Screening Trial (NSLT) showed a 20% reduction in death from lung cancer, but with a number needed to screen of 320 to prevent one death, a false-positive rate of 96% and each abnormal scan generating costs of ~$45,000, the risk / benefit / cost accounts are far from settled. Few insurers (e.g. [... read more]
Are you a hospital administrator, obsessed with improving “quality” and “performance” of your institution according to flawed, arbitrary criteria that lack a proven relationship to real-world outcomes, but are imposed by large governing and regulatory authorities who hold a sword of Damocles over your head threatening a crippling reduction of payments to your hospital at [... read more]
“Medical identity theft” — theft of your unique identifiers to perpetrate Medicare or insurance fraud — may be on the rise, according to the Federal Trade Commission. There were 12,000 cases of medical identity theft reported by patients or doctors between 2007-2009. A JAMA article by Shantanu Agrawal and Peter Budetti describes one hapless victim’s [... read more]
Apparently German doctors go on strike almost as often as American doctors buy BMWs. (Google “german doctors strike” and the stories go back for more than a decade.) They’ve just done it again, last week, to protest their low pay and up to 9 nights on call per month. According to Lancet, new doctors in Germany [... read more]
Legal eagle Kevin Outterson explains the latest twists in the saga of the FDA’s quest to get large, scary pictures on every cigarette package under its new regulatory muscle of the 2009 Obama-authorized Tobacco Control Act. R.J. Reynolds sued, and federal judge Richard Leon took their side in November 2011, deciding to apply the more [... read more]
Do you conduct original investigations in respiratory medicine? Are you tired of publishing your work in The New England Journal of Medicine, Science and Nature? Well, Lancet has been feeling left out. They’d like to publish your manuscript(s) in a September 2012 issue to coincide with the European Respiratory Society meeting. They’ve issued a call for [... read more]
My post featured on KevinMD: Obama health reform adviser Ezekiel Emanuel has been writing regularly in the lay and medical press to soften up physicians and the public for the coming of the mysterious accountable care organizations. But are rank-and-file docs buying the party line? Will physicians buy into ACOs? (KevinMD) http://www.kevinmd.com/blog/2012/02/physicians-buy-acos.html
The Cochrane Collaboration smells a rat around Pharma’s handling of its data on oseltamivir (Tamiflu) and zanamivir (Relenza). They’re taking the unusual step of publicly calling for Roche (Tamiflu) and GlaxoSmithKline (Relenza) to make available their data from the original clinical studies that led to approval of the two blockbuster drugs. They point out that [... read more]
One-third of smokers try to quit each year, but few stay quit. Even with varenicline (Chantix), the most effective smoking cessation aid to date, only 10% are abstinent at one year. Anne Joseph, Steven Fu, Dorothy Hatsukami et al wonder if that’s partly because our (fee-for-service-driven) intermittent-visit model of patient care and counseling leaves craving [... read more]
The Obama administration is about to mandate strict new reporting requirements that will, in effect, require that every gift to a doctor from a pharma or device company be recorded on a publicly accessible government website. This initiative was authorized in the federal health care law, but the details were unspecified and implementation delayed. Senators Charles Grassley [... read more]