Paleopathology

From the New York Times article "Unearthing Prehistoric Tumors, and Debate":

Often thought of as a modern disease, cancer has always been with us. Where scientists disagree is on how much it has been amplified by the sweet and bitter fruits of civilization. Over the decades archaeologists have made about 200 possible cancer sightings dating to prehistoric times. But considering the difficulties of extracting statistics from old bones, is that a little or a lot?
...
As scientists continue to investigate, there may be comfort in knowing that cancer is not entirely civilization’s fault. In the normal course of life a creature’s cells must be constantly dividing — millions of times a second. Sometimes something will go wrong.

Click here to access the NYT article...interesting stuff.

Fantastic Voyage?...Google's The Body Browser

Google "Body Browser" to access.  I haven't looked at it yet but it might be a good patient education tool.

Rethinking the placebo effect

From the Plos One article "Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome":

Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent.

Click here to access this interesting article.

November/December 2010 Issue of The ACCME Report now online

Included in this issue is the executive summary of the ACCME Board of Directors meeting, held November 18 – 19, 2010.  Click here to access the newsletter.

To stent or not to stent or if I could turn back time...

From the New York Times article "Doctor Faces Suits Over Cardiac Stents":

The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei in February after a series of articles in The Baltimore Sun said that Dr. Midei at St. Joseph Medical Center, in Towson, Md., had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance.

The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

Click here to access the NYT article.

Patty Cake Cats

Blogs and nepotism

Yep, definitely nepotism, but I wanted to let "my world" know about the new blog started by my nephew Erik's wife, Meadow.  Both Erik and Meadow are art teachers at Watts Atelier in the beach community of Encinitas, California -- both also freelance.  Meadow actually makes the period costumes for her paintings...her first blog posting is about how she is making a regency bonnet for a client...click here to check it out!.  Click here to see some of her paintings.  And, if you're missing Halloween, check out Erik's blog and his website (not for the faint of heart!).  Yes, I suppose my posting these links on my blog will be considered a "conflict of interest"...no resolution needed, however.

Nov/Dec issue of Medical Meetings magazine now online

This issue contains an article on team-based continuing education!  Check it out by clicking here.

NPs as independent PCPs...has the future just arrived?

From the FierceHealthcare article:

CareFirst BlueCross BlueShield (CareFirst) today announced that, effective immediately, it will permit nurse practitioners (NPs) to participate in its health care provider networks as independent primary care providers. Previously, CareFirst permitted NPs to participate in its networks, but they were only permitted to practice independently of physicians in certain medically underserved areas with limited access to primary care physicians.

Click here to access the article.

NAAMECC transforms into NAMEC

The North American Association of Medical Education and Communication Companies (NAAMECC) recently changed its name to the National Association of Medical Education Companies (NAMEC).  Click here to access their website.

Academic Medicine Supplement - Free!

September 2010 - Volume 85 - Supplement, A Snapshot of Medical Student Education in the United States and Canada: Reports from 128 Schools

Happy Halloween!

Erik, you've hardly changed at all! 

A lost art?

From the New York Times article "Physician Revives a Dying Art: The Physical":

He is out to save the physical exam because it seems to be wasting away, he says, in an era of CT, ultrasound, M.R.I., countless lab tests and doctor visits that whip by like speed dates. Who has not felt slighted by a stethoscope applied through the shirt, or a millisecond peek into the throat?

Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.

Medical schools in the United States have let the exam slide, Dr. Verghese says, noting that over time he has encountered more and more interns and residents who do not know how to test a patient’s reflexes or palpate a spleen.

Click here to access the NYT article.  As my stepfather, who was a large animal veterinarian, always taught me...H&P, H&P, H&P!

October issue of Health Affairs now online

This issue is packed with a number of articles on health reform and comparative effectiveness research.  Click here to access the TOC (sub. req.).

Health care fraud?

From the New York Times article "Side Effects May Include Lawsuits":

FOR decades, antipsychotic drugs were a niche product. Today, they’re the top-selling class of pharmaceuticals in America, generating annual revenue of about $14.6 billion and surpassing sales of even blockbusters like heart-protective statins.
...
Anointed with names like Abilify and Geodon, the drugs were given to a broad swath of patients, from preschoolers to octogenarians. Today, more than a half-million youths take antipsychotic drugs, and fully one-quarter of nursing-home residents have used them. Yet recent government warnings say the drugs may be fatal to some older patients and have unknown effects on children.
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Such marketing, according to analysts and court documents, included payments, gifts, meals and trips for doctors, biased studies, ghostwritten medical journal articles, promotional conference appearances, and payments for postgraduate medical education that encourages a pro-drug outlook among doctors. All of these are tools that federal investigators say companies have used to exaggerate benefits, play down risks and promote off-label uses, meaning those the F.D.A. hasn’t approved.
...
Over the next year, the government is adding at least 15 prosecutors and 100 investigators to pursue health care fraud.

Click here to access the NYT article.

To mammogram or not to mammogram?

From the New York Times article "Mammograms' Value in Cancer Fight at Issue":

Starting in their 40s or 50s, most women in this country faithfully get a mammogram every year, as recommended by health officials. But the study suggests that the decision about whether to have the screening test may now be a close call.
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Previous studies of mammograms, done decades ago, found they reduced the breast cancer death rate by 15 to 25 percent, a meaningful amount. But that was when treatment was much less effective.
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The study, published Thursday in The New England Journal of Medicine, looked at what happened in Norway before and after 1996, when the country began rolling out mammograms for women ages 50 to 69 along with special breast cancer teams to treat all women with breast cancer.

Click here to access the NYT article. Click here to access the NEJM article.

September 2010 Issue of the ACCME Report now available

Click here to access.

AMA PRA Booklet 2010 now available

Click here to check it out.

NCHS data on prescription drug use

Key findings from this report:

• Over the last 10 years, the percentage of Americans who took at least one prescription drug in the past month increased from 44% to 48%. The use of two or more drugs increased from 25% to 31%. The use of five or more drugs increased from 6% to 11%.
• In 2007–2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month.
• Those who were without a regular place for health care, health insurance, or prescription drug benefit had less prescription drug use compared with those who had these benefits.
• The most commonly used types of drugs included: asthma medicines for children, central nervous system stimulants for adolescents, antidepressants for middle-aged adults, and cholesterol lowering drugs for older Americans.

Click here to access the report. Click here to access Pharmalot's take on this report.

Board certification and quality of care

From the ABMS news release:

A new study on the quality of physician care provides evidence of the benefit of specialty board certification and suggests the necessity of continuous professional development programs, such as the American Board of Medical Specialties Maintenance of Certification® (ABMS MOC®) program.
...
The study also found two other important quality distinctions relevant to the general population of physicians in the United States:

•Specialty board certification was associated with lower mortality and shorter stays.
•Physician performance declined over time, with mortality rates and length of stays increasing with the number of years since graduation from medical school. The study was authored by John Norcini, CEO of Foundation for Advancement of International Medical Education and Research, a Philadelphia-based not-for-profit.

Click here to access the ABMS news release. Click here to access the Health Affairs article published on the aforementioned study (subscription required).