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Latest Posts

Considering A Non-Fatal Patient’s Quality Of Life

Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?

The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.

I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »

*This blog post was originally published at Musings of a Dinosaur*

Wanda Sykes Diagnosed With DCIS And Opts For A Double Mastectomy

When Wanda Skyes, 47, had a bilateral breast reduction in February, the pathology returned with DCIS present in the left breast specimen.  Recently the comedian appeared on  “The Ellen DeGeneres Show” and during the interview revealed her breast cancer diagnosis and her decision to have a double mastectomy.

Sykes continued, “It wasn’t until after the reduction that in the lab work, the pathology, that they found that I had DCIS [ductal carcinoma in situ] in my left breast. I was very, very lucky because DCIS is basically stage-zero cancer. So I was very lucky.”

But, she added, “Cancer is still cancer. I had the choice of, ‘You can go back every three months and get it checked. Have a mammogram, MRI every three months just to see what it’s doing.’ But, I’m not good at keeping on top of stuff. I’m sure I’m overdue for an oil change and a teeth cleaning already.”

Because she has a history of breast cancer on her mother’s side of the family, Sykes explained she opted to have a bilateral mastectomy.

“I had both breasts removed, because now I have zero chance of having breast cancer,” she said. “It sounds scary up front, but what do you want? Do you want to wait and not be as fortunate when it comes back and it’s too late?”

The American Cancer Society Read more »

*This blog post was originally published at Suture for a Living*

Medical News Stories: Beware Of Insufficient Evidence

After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a “simple blood test that could save women’s lives.”

Readers – and maybe especially TV viewers – beware whenever you hear a story about “a simple blood test.”

And this is a good case in point.

Brian Williams led into the story stating:

“Two of three women who die suddenly of cardiac heart disease have no previous symptoms which is all the more reason women may want to ask their doctors about a blood test that can be a lifesaver.”

Then NBC News chief medical editor Dr. Nancy Snyderman said:

“It’s not a new test, it’s not an experimental test but nonetheless it’s a test not a lot of people know about and that’s a problem because this simple blood test could save your life.”

The test in question is Read more »

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

Culinary Metaphor Used To Understand Gene-Environment Interactions

a pie cut in almost half with the smaller piece labeled Environmental and the larger piece labeled GeneticA recent article in the Archives of General Psychiatry by Hallmayer et al. discussed the role of genetic and environmental factors in autism and autism spectrum disorders (ASD).  The study was a heritability analysis of 192 pairs of twins, which attributed 37 percent of the variation in risk of autism to genetic factors and 55 percent to shared environmental factors.  The authors contrasted their findings with those of previous studies, which had given genetics a much higher share (up to 90%).

Rather than contradicting previous research, the new results provide more evidence that autism, like many other common diseases, results from both genetic and environmental factors.  The way that these elements – often called “nature and nurture” – influence health outcomes has been discussed for decades but is often misunderstood, even among scientists.

Disease Causation is Not as Easy as… Pie Read more »

*This blog post was originally published at Genomics and Health Impact Blog*

Mammogram Frequency Should Be Dependent On More Than A Woman’s Age

I read the LA Times article by Shari Roan, Study urges more individual mammogram guidelines, with interest.  As Roan notes, guidelines to date have mainly focused on a woman’s age and not her other risks factors.

The American Cancer Society recommends that healthy women undergo screening mammograms every one to two years beginning at age 40 regardless of risk factors. In 2009, the U.S. Preventive Services Task Force recommended a different schedule which urged the inclusion of an individual’s personal risks:  screening for women ages 40 to 49 should be based on individual risk factors and women ages 50 to 74 should be screened every two years.

Monday, a paper was published in the Annals of Internal Medicine (full reference below) which argues for a more personalized approach to screening mammograms.

The study by Dr. Steven R. Cummings, senior author and senior researcher at the California Pacific Medical Center Research Institute, and colleagues was based on a computer model comparing the lifetime costs and health benefits for women who got mammograms every year, every two years, every three to four years or never. Read more »

*This blog post was originally published at Suture for a Living*

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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