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Treatment-Resistant Depression: New Insights

Only one-third of people with major depression achieve remission after trying one antidepressant. When the first medication doesn’t adequately relieve symptoms, next step options include taking a new drug along with the first, or switching to another drug. With time and persistence, nearly seven in 10 adults with major depression eventually find a treatment that works.

Of course, that also means that the remaining one-third of people with major depression cannot achieve remission even after trying multiple options. Experts are hunting for ways to understand the cause of persistent symptoms. In recent years, one theory in particular has gained traction: that many people with hard-to-treat major depression actually suffer from bipolar disorder. However, a paper published online this week in the Archives of General Psychiatry suggests otherwise — and the findings provide new insights into the nature of treatment-resistant depression. Read more »

*This blog post was originally published at Harvard Health Blog*

Why Doctors Should Be Less Like Chuck Yeager And More Like Captain Sullenberger

A recent medical error of a wrong-site surgery that occurred in one of the country’s best hospitals, Massachusetts General, reminded me why doctors need to be less like Chuck Yeager and more like Captain Sullenberger.

Growing up, I always wanted to be a fighter pilot, years before the movie “Top Gun” became a part of the American lexicon. My hero was World War II pilot Chuck Yeager, who later became one of the country’s premier test pilots flying experimental jet and rocket propelled planes in a time when they were dangerous, unpredictable, and unreliable.

Much like the astronauts in the movie “The Right Stuff,” Yeager and his colleagues literally flew by the seat of their pants, made it up as they went along, and never really knew if their maiden flight in a new aircraft might be their last. They were cowboys in the sky wrangling and taming the heavens.

Fast forward to January 2009, when shortly after takeoff, a one-in-a-million chance, a double-bird strike completely disabled a US Airways jetliner. Captain Chesley Sullenberger, with the help of his co-pilot Jeff Skiles, ditches the aircraft in the Hudson River in under four minutes even as the nation surely expected a tragedy. But not on that day. Not with that pilot. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

When Doctors Make Mistakes: About Humanness And Perfection

The best part of doctoring is its humanness. Machines can’t do it — not even Apple products.

But that’s the worst part, too. Since humans practice medicine, there will be “medical errors.” And when doctors err, people — not spreadsheets or profits — are hurt. That’s the rub. Like any endeavor, the greater the reward the greater the risk.  Those cards were put on the table in medical school.

“Don’t want mistakes? Don’t do anything. Don’t make any decisions. Don’t do any procedures. Then, there will be no errors,”  the grey-haired, Swiss-born cardiac surgeon counseled me many years ago after an imperfect ablation.

The headline was about a doctor’s error. It was a doozy. But for me, the story belies the headline. A Boston Globe reporter called a surgeon’s public admission of performing a wrong operation “an unusual display of openness.” I would call it something else: Breathtaking. Unprecedented. Courageous. Read more »

*This blog post was originally published at Dr John M*

New York Times: Lou Gehrig May Not Have Had Lou Gehrig’s Disease?

This was one time when the headline was okay, but the story that followed had our heads spinning. “Study Says Brain Trauma Can Mimic Lou Gehrig’s Disease” is a story that was troubling on a number of fronts. It reported on a study which at the time had not yet been published suggesting that some “athletes and soldiers given a diagnosis of amyotrophic lateral sclerosis…might have been catalyzed by injuries only now becoming understood: concussions and other brain trauma.”

To be clear — and please don’t anyone miss or miscontrue this point — this is an important and fascinating area of research. But the story did not exhibit the best of health/medical/science journalism:

1. It was based on a study of 3 people. (The ALS Association says there are up to 30,000 people in the U.S. living with ALS.)

2. It stated, “Lou Gehrig might not have had Lou Gehrig’s disease.” (No evidence for this was provided. He also may not have been a great left-handed hitter. That may have been an optical illusion.)

3. It said this could “perhaps lead toward new pathways for a cure.” (After a suggestive finding in just three people?)

4. The story later says, “The finding’s relevance to Gehrig is less clear.” (Hedging already after a bold earlier statement in the story.)

5. But just a few paragraphs later, the story says, “The new finding…suggests that Gehrig might not have had (ALS).” (Head spinning yet?) Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

An Artificial Pancreas For Type 1 Diabetes

Researchers at Massachusetts General Hospital and Boston University have reported that an “artificial pancreas” has worked in 11 patients enrolled in a study sponsored by the Juvenile Diabetes Research Foundation (JDRF). The device consists of insulin pumps, glucose sensors, and a laptop with regulatory software. Read more »

*This blog post was originally published at Medgadget*

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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