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Talk Is Cheap, Unless It’s Talk Therapy

Gardiner Harris had a [recent] article in the New York Times called “Talk Doesn’t Pay So Psychiatrists Turn to Drug Therapy.” The article is a twist on an old Shrink Rap topic, “Why your Shrink Doesn’t Take Your Insurance.” Only in this article the shrink does take your insurance, he just doesn’t talk to you.

With his life and second marriage falling apart, a man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Dr. Levin sees 40 patients a day. And he’ss 68 years old. This guy is amazing. There’s no way I could see 40 patients a day for even one day. He’s worried about his retirement, but I wouldn’t make it to retirement at that pace. (Should we make a bet on whether Dr. Levin has a blog?)

The article has a whimsical, oh-but-for-the-good-old-days tone. In-and-out psychiatry based on prescribing medications for psychiatric disorders is bad, but the article doesn’t say why. In the vignettes, the patients get better and they like the psychiatrist. Maybe medications work and psychotherapy was overemphasized in the days of old? The patients don’t complain of being short-changed, and if Dr. Levin can get 40 patients a day better for — your guess is as good as mine, but let’s say — $60 a pop, and they only have to come every one to three months, and there’s a shortage of psychiatrists, then what’s the problem? Why in the world would anyone pay to have regular psychotherapy sessions? Read more »

*This blog post was originally published at Shrink Rap*

Lying: A Way Of Life In The Medical Profession

In his last post, DrRich analyzed whether the young Wisconsin doctors who stood out on street corners proudly offering fake “sick excuses” to protesting teachers were engaging in an act of civil disobedience. DrRich respectfully kept an open mind on this question, but after careful deliberation concluded that it is very unlikely that their actions constituted classic civil disobedience as espoused by Thoreau or Gandhi.

Instead, these doctors were, in a professional capacity, lying. They did not lie in any truly malicious way, however. They lied because they have been trained to believe in a higher cause than mere professional ethics, namely, the cause of social justice. They lied in full confidence that telling lies to advance such a noble cause is a natural duty of the medical profession. They never expected to be criticized for it (except perhaps by Rush Limbaugh and sundry teabaggers and the like), and they almost certainly will be stunned into indignant incoherence if they end up actually receiving the full punishments their actions allow.

But what really interests DrRich is the near-perfect silence we have seen from the mainstream news media regarding this sad episode. While it’s easy to find stories about the phony sick excuses all over Fox News and conservative websites, major outlets like the New York Times, Washington Post, CNN, CBS and NBC — sources one might expect to express at least some sympathy for these doctors and their work to advance a just cause – have reported next to nothing about it. When a left-leaning mainstream outlet does report on the episode (for instance, this article appearing in the Atlantic), rather than expressing any support for the Wisconsin doctors, they express at least mild dismay. It seems plain to DrRich that the mainstream media wish the whole thing hadn’t happened, and that perhaps their silence might help it go away as soon as possible.

So here we’ve got a small cadre of youthful and idealistic physicians, behaving in a manner entirely consistent with what they’ve just learned during their medical training, and not only are they facing formal investigations and potential punishment, but also the very people and organizations whom they were surely counting on for support have retreated into an embarrassed silence, or worse, criticism. What gives? Read more »

*This blog post was originally published at The Covert Rationing Blog*

Prevention Magazine Pushes Non-Evidence-Based Heart Screening

Prev. mag pullout.jpgThe February issue of Prevention magazine has an article entitled “Surprising Faces of Heart Attack” profiling “three women (who) didn’t think they were at high risk. Their stories are proof that you could be in danger without even knowing it.” No, their stories are not proof of that.

The story is about three women in their 40s. The story varyingly states that the three should have had the following screening tests:

– Advanced cholesterol test, carotid intimal medial thickness test ( CIMT)
– Advanced cholesterol test and stress echocardiography
– Cardiac calcium scoring and CIMT

 There’s an accompanying piece: ”7 Tests You’re Not Having That Could Save Your Life.”

Harry Demonaco photo.jpgI asked one of our medical editors, Harold Demonaco, director of the Innovation Support Center at the Massachusetts General Hospital, to review the two pieces. As his day-job title suggests, he deals with review of the evidence for new and emerging healthcare technologies. He wrote: 

The section “7 Tests you are not having that could save your life” states: “If you have not had these cutting edge screenings, put this magazine down and call your doctor. Now.”

Wow. While much of the information is correct, it is the context that is disturbing. Suggesting that these tests are essential in everyone is a bit over the top. Some of the information provided for each test is basically correct. However in some cases the recommendations go well beyond national guidelines.

The major issue here is the tacit assumption that tests are infallible, without any downsides and are always a good thing. That is simply not the case. So who should get these tests? Read more »

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

Warning Labels For Health Journalism

I’ve seen the very clever journalism warning labels pictured and offered on Many good friends and contacts wrote me about this, some urging to produce its own — and we may. Of the many great labels offered, this one is perhaps my favorite:


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

The Male Menopause Story: Journalists All Over The Map

An article on the Knight Science Journalism Tracker comments on German media coverage of the “Is there male menopause?” question. An excerpt:

One study, but very different types of headlines: “‘Male Menopause’ discovered” and “Men have no Menopause.” Both types of headlines are based on one study published in the New England Journal of Medicine, which analyzed 3219 European males between 40 and 79. Blood samples provided testosterone levels and questionnaires (!) asked about the “general, sexual, physical, and psychological health.”

What the scientists found was nothing more and nothing less than a correlation between a low testosterone level and three clinical symptoms (“decreased frequency of morning erection, decreased frequency of sexual thoughts, and erectile dysfunction”). So, one could call it an age-related testosterone deficiency, affecting only a minority (about 2%) of elderly men.

But one shouldn’t name it “andropause” or “male menopause” — and the scientists themselves did NOT use the term in the whole article — because this term immediately suggests a relation to menopause, which is a completely different and natural developmental phenomenon for every woman above the age of 50. Read more »

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

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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