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Administration Censors Statements On Controversial Scientific Issues

A New York Times Magazine story published on the newspaper’s website on Wednesday details the complicated history of screening for prostate cancer in the U.S. and revisits the related story of the U.S. Preventive Services Task Force meeting that was abruptly cancelled for political reasons on November 1, 2010, the day before the midterm Congressional elections. I was interviewed several times for this story, starting shortly after my resignation from my position at the Agency for Healthcare Research and Quality, where for 4 years I had supported the USPSTF’s scientific activities on a wide range of topics.

I commend science journalists Shannon Brownlee and Jeanne Lenzer for their tireless reporting efforts and dogged persistence in pursuing the real reason for the meeting’s cancellation, despite repeated and vigorous denials of senior government officials. Former USPSTF Chairman Ned Calonge confirms in the Times story that politics played a role: “In November 2010, just before midterm elections, the task force was again set to review its [prostate screening] recommendation when Calonge canceled the meeting. He says that word leaked out that if the November meeting was held, it could jeopardize the task force’s financing.” It’s true that several members of Congress had threatened to cut off funding for the Task Force after it recommended against routine mammography for women in their 40s. To the best of my knowledge, however, the order to cancel the meeting came directly from the White House, not Congress. And according to my superiors at the time, Dr. Calonge had no choice in the matter. Read more »

*This blog post was originally published at Common Sense Family Doctor*

Chocolate’s Effect On Your Health: The Good, The Bad, And The Ugly

Eating a lot of chocolate was associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared eating less, researchers reported. But, people are trending toward record obesity by the year 2030, which is a cardiometabolic risk in its own right.

Chocolate Melting by peter pearson via Flickr and a Creative Commons license

Willie Wonka’s factory wasn’t the only risky place for those with a sweet tooth.

In the first study, to evaluate the association of chocolate with the risk of developing cardiometabolic disorders, researchers performed a meta-analysis of randomized trials, six cohort and one cross-sectional, which reported the association between chocolate and the risk of cardiovascular disease (coronary heart disease and stroke), diabetes, and metabolic syndrome for about 114,000 people.

Because the studies reported chocolate consumption differently, researchers Read more »

*This blog post was originally published at ACP Internist*

Exaggerated Claims Can Be Found In Respected Medical Journals

e-Patients who want to collaborate with their physicians, and be responsible for their medical decisions, need to clearly understand what constitutes good evidence. It’s not always easy.

Now Richard Smith, a 25 year editor of the British Medical Journal, has written another piece for the BMJ blog, citing a JAMA study showing “that of the 49 most highly cited papers on medical interventions published in high profile journals between 1990 and 2004 a quarter of the randomised trials and five of six non-randomised studies had been contradicted or found to be exaggerated by 2005.”

What’s an e-patient to do?? Especially when we “patients who google” are so often sneered at by physicians who rely on these same journals.

Well, we need to educate ourselves, and learn to speak calmly, confidently and understandingly to anyone who doesn’t understand – just as we expect clinicians to do with us.:–) In short, we need to Read more »

*This blog post was originally published at*

It’s Time To Tango: Impatient With Progress On Patient-Physician Partnership

The other day I came across this photo of a couple clasping each other in a dramatic tango on the cover of an old medical journal – a special issue from 1999 that was focused entirely on doctor-patient partnership. The tone and subjects of the articles, letters and editorials were identical to those written today on the topic: “It’s time for the paternalism of the relationship between doctors and patients to be transformed into a partnership;” “There are benefits to this change and dangers to maintaining the status quo;” “Some doctors and patients resist the change and some embrace it: Why?”

Two questions struck me as I impatiently scanned the articles from 12 years ago: First, why are these articles about doctor-patient partnership still so relevant? And second, why did the editor choose this cover image?

I’ve been mulling over these questions for a couple days, and I think an answer to the second question sheds light on the first. Here are some thoughts about the relationship between patients and doctors (and nurse practitioners and other clinicians) evoked by that image of the two elegant people dancing together:

It takes two to tangoEver seen one guy doing the tango? Nope. Whatever he’s doing out there on the dance floor, that’s not tango. Without both dancers, there is no tango. The reason my doctor and I come together is our shared purpose of curing my illness or easing my pain. We bring different skills, perspectives and needs to this interaction. When in a partnership, I describe my symptoms and recount my history. I talk about my values and priorities. I say what I am able and willing to do for myself and what I am not.  My doctor has knowledge about my disease and experience treating it in people like me; she explains risks and tradeoffs of different approaches and tailors her use of drugs, devices, and procedures to meet my needs and my preferences. Both of us recognize that without the active commitment of the other we can’t reach our shared goal: To help me live as well as I can for as long as I can.

Each dancer adjusts to his or her partnerIn tango, each partner has different moves; the lead shifts subtly and constantly between them throughout the dance. In a partnership, when I am really ill, I delegate more decisions to my physicians; when I am well we freely go back and forth, discussing treatment options and making plans. Read more »

*This blog post was originally published at CFAH PPF Blog*

When Money Isn’t Everything To Doctors

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to, ponders the options. First he comments on why the performance incentives in the NHS failed:

Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t think many will propose more than a 25 percent bonus. It’s also possible that the benchmarks which define success were too low and therefore didn’t improve outcomes. There’s no scientific reason to think that the recommendations weren’t appropriate, however. More likely, it’s what I’ve said before. Changing physician behavior is hard.

So if money can’t motivate doctors, what’s next? Physicians aren’t going to like what Dr. Carroll has to say. Read more »

*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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