I’m in an email group that is all in agreement that the U.S. healthcare system is exorbitantly expensive and needs reform. We come from wildly different backgrounds. The variety of perspectives is wonderful. However, a claim of some of the contributors is that aggressive medical therapy of cardiovascular disease (CVD) chronic...
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The topic today is some of the older diabetes treatments. I’ll cover some of the newer agents–jardiance, ozempic, trulicity, and so on–next month. The cost-effectiveness literature covers individual drugs and overall goals such as “intensive glucose control” or “goal of normoglycemia.” Before I get into the details, I will try to...
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Since diabetes was the disease that started me on this journey, I’ll get into it now. I’ll break this huge issue into smaller posts. Since I went into great detail about the methods of the literature with the hypertension post, I’ll keep these shorter. Screening for and preventing diabetes does not...
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I’ve complained before about the uselessness of traditional industrial QI/Metrics in primary care. There is now more proof in the literature. The National Health and Nutrition Examination Survey (NHANES) is the annual comprehensive assessment of American health. They enroll about 10,000 people each study year and ask them a thousand questions,...
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The best primary care-based research comes out of Europe, where countries have medical research budgets that actually fund primary care research. The U.S. has no equivalent funder. Therefore, American family physicians must often look overseas for answers to their daily clinical questions. Does screening for diabetes make any difference? A recent study...
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A major study was just published in Lancet that addressed the issue of whether or not diabetes screening in primary care improves major health outcomes. This was a 10-year randomized controlled trial!! In other words, this study is the granddaddy of them all in terms of the rigor of its methods....
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The GIMeC (Government Industrial Medical Coalition) ignorance fairy has been busy lately, flying around waving her crooked wand at the unsuspecting public. The claim this time is that efforts to prevent diabetes save money. Two articles making this claim were published at nearly the same time. The first was an article...
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Most chronic diseases don’t have an easily definable beginning point. Children’s personalities vary widely from quiet and focused to rambunctious and distractible. At what point do we say they have ADHD? There is an association between higher blood pressures and higher stroke and heart attack rates across a wide spectrum of...
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All of us want to live long healthy lives, but what if the lives aren’t really healthy? A study in the Journal of Gerontology concluded that our increasing national life expectancy – which is still low compared to the rest of the developed world – has not increased lately. More disturbing...
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I received one of those politely worded letters from a major insurance company recently informing me of how it thought I was doing caring for one of my patients. It includes warm language such as “We value our relationship with you,” though their medical director who signed this letter has never...
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