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Why the American People want Miracles over Science

May 29, 2011

First, a bit of old business. A friend asked me if the Medicare benefits and taxes figures I quoted last weak were adjusted for net present value. The dollar amounts quoted were in 2010 dollars adjusting for inflation, so yes, they were adjusted for net present value. The link to the...
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The Ryan Plan

May 22, 2011

It’s been interesting watching the political maneuvering since Newt Gingrich criticized the plan to reduce the federal budget deficit proposed by the House Budget Committee Chair Paul Ryan of Wisconsin. After receiving push back from fellow Republicans, Gingrich spent the week backpedaling from his earlier remarks. Many pundits have recognized Ryan...
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Processes versus Outcomes in the VA system

May 15, 2011

When the quality improvement movement first started in medicine, I was all for it. The principle that you can’t fix what you can’t measure resonated with me. I felt that individual physicians and systems should be accountable to the people paying the freight and our patients. Doubt should have started creeping...
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Raising Young Family Physicians

May 8, 2011

Happy Mother’s Day to all the moms. In honor of this day, let’s talk about raising young family physicians. Though the match in family medicine for residency slots was a little better this year than last year, it is still miles from where it needs to be. Only a little over...
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How Dr. Oz Increases Healthcare Costs — Example 2, Multi-ologist Recommendations

May 1, 2011

My local newspaper prints the You Docs column 3 days a week and I’ve been reading it for over two years. I can’t say I’ve read every column in that time, but I can say most of them. There is a clear pattern to their writing and thinking. In the column...
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The Stupid Insurance Companies Continue to Undermine Primary Care

April 23, 2011

A colleague in private practice, Dr. S of Plano, TX, sent me the following note he gave me permission to share: Since the beginning of 2011, we’ve observed a disturbing trend among our patients’ new insurance plans. At least two major payors (Aetna and Cigna) are now offering $0 or reduced...
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How Much to Prevent a Blood Clot?

April 17, 2011

A study in the New England Journal of Medicine several months ago presented findings on a new medicine to prevent a deep vein thrombosis, which is a blood clot in one of the larger veins of the leg. These clots are usually more of an annoyance than dangerous, though the worst...
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Where Should You Go When You Get Sick?

April 10, 2011

An article in Health Affairs documented well what all of us know in front-line medicine: patients who don’t feel well go the emergeny room. The study looked at data from a national survey and found that a minority of patients see their primary physicians (42%) for first-contact care, with visits to...
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Medicare Just Increased the National Debt

April 3, 2011

This means your children and grandchildren are now saddled with even more of the financial burden of the excesses of this generation. It came as no surprise that Medicare approved the  new prostate cancer drug Provenge. It had to. The laws governing Medicare say it has to cover all therapies that...
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We Need Another Mammogram Study

March 27, 2011

There have been 10 controlled trials of mammograms and not all of them were randomized controlled trials. We need another. Treatment for breast cancer has improved since the advent of mammography. Drugs like tamoxifen and trastuzumab have improved survival in selected patients (though trastuzumab costs a fortune, but it actually helps)....
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