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Preventive Health In HD: A Video Just For Men

Check out this darkly humorous advertising campaign from the U.S. Department of Health and Human Services. How do you convince men to go to the doctor and get the preventive healthcare that’s known to save lives?  You make it all about television. Men + HD TV = “Yes.” This video is funny on so many levels.

*This blog post was originally published at The Happy Hospitalist*

Overtreatment: When Less Is More In Medicine

The Associated Press recent article “Overtreated: More medical care isn’t always better” reiterated a commonly known fact which is not understood by the public. This problem of doing more and yet getting little in return is a common issue which plagues the U.S. healthcare system and was illustrated quite convincingly by Shannon Brownlee’s book. Americans get more procedures, interventions, imaging, and tests but aren’t any healthier.

In fact they are often worse off. Too many unnecessary back surgeries. Too many antibiotics for viral infections, which aren’t at all impacted by these anti-bacterial therapies. Too many heart stents which typically are best used when someone is actually having a heart attack. Research shows that those that are treated with medications do just as well. As all patients with cardiac stents know, they also need to be on the same medications as well.

Eliminating unnecessary treatments is a good thing, particularly when it is based on science. Read more »

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

Cancer Pathology: Are Lab Tests Always Right?

The Wall Street Journal’s Health Blog says that cancer lab tests “aren’t always right.” They report on reports issued by two professional societies that point out that as many as 20% of a certain kind of test are inaccurate. According to the Health Blog the problem is the tests “aren’t black and white, and rely on a pathologist’s judgment.”

Now, judgment is a critical factor in most everything in medicine, but perhaps nowhere else are the consequences of incorrect judgment so serious as in pathology. As Dr. William Osler famously observed: “As is your pathology, so goes your clinical practice.” But how widespread is this problem? Read more »

*This blog post was originally published at See First Blog*

Dr. LaPook’s Colonoscopy: Screening Tests Save Lives

Last night, President Obama made a pitch for preventive care in his address to a joint session of Congress on health care:

“And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.”

As a doctor who has held the hands of patients dying from totally preventable illnesses, I couldn’t agree more. The largest number of deaths in the United States are caused by two preventable causes – tobacco smoking and
high blood pressure – killing an estimated 467,000 and 395,000 people respectively in 2005. The list goes on and on, including obesity, physical inactivity, and poor diet.

When I was working in the emergency room as a medical resident, it was heartbreaking to see a patient with poor routine medical care roll into the emergency room with a devastating stroke that could have easily been averted with regular office visits and blood pressure medication – both relatively inexpensive compared to the cost of caring for the stricken patient.

We’re not preventing enough deaths by the types of cancer screening tests mentioned by President Obama. One reason is the technology is still not good enough. We need to develop better screening tests that pick up problems early but don’t lead to an unacceptable number of unnecessary biopsies, procedures, and further tests. And
not enough patients are screened. Only about about 60 percent of women get mammograms and about 50 percent of men and women get routine colonoscopies.

Lack of insurance coverage is certainly a big reason why some patients don’t undergo screening. Another reason is patient fear and misunderstanding. In order to educate the public about the risks of colon cancer and the benefits of screening exams, Katie Couric underwent a colonoscopy on national television in March, 2000. Three years later, researchers at the University of Michigan found that colonoscopy rates jumped by 20 percent across the country following Katie’s procedure, calling the rise the
“Katie Couric Effect.”

It’s almost 10 years later and we’re still not screening enough patients. Although the death rate from colon cancer has dropped in recent years – likely mostly because of screening efforts – colorectal cancer still strikes almost 150,000 Americans every year and kills about 50,000.

As a gastroenterologist, I have seen patients’ lives saved by the removal of polyps and early cancers found by colonoscopy. I have also taken care of patients whose colon cancers were found too late to save them. Over the years, I must have heard every excuse for ducking a colonoscopy. The top four (and my answers):

  • I have no symptoms (most colon cancers start small and have no symptoms until they grow larger.)
  • I have no family history of colon cancer (that’s true in about 70 percent of patients with colon cancer.)
  • I’m afraid it will hurt (that’s why we use sedation and, if needed, anesthesia.)
  • I can’t do the prep (we’ll figure out a way to clean out your colon that you can tolerate.
  • And even if you have a tough night, it sure beats chemotherapy.)For this week’s CBS Doc Dot Com, I follow Katie’s lead and undergo a colonoscopy with cameras rolling in an attempt to remind people that a screening colonoscopy can save your life. I had the benefit of a house call the night before by my office nurse, Debbie Fitzpatrick, who held the video camera and offered advice and encouragement as I had a taste of my own medicine: the colon cleanout solution. The colonoscopy was performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

    For more information about the Jay Monahan Center,click here.

  • For more information about screening for colon cancer, click here.To watch my colonoscopy, click below:


    Watch CBSNews Videos Online

  • Why Cancer Is Difficult To Detect


    I sat with non-medical friends last night and the discussion turned to “health”, as it often does. One guy related the terrible story of a woman who went to her doctor with a certain pain which turned out to be cancer that had spread and she died within a week. The inevitable question; “How do you detect early cancer, so you can catch it and cure it?”

    The answer I gave was less than satisfactory for my friends. In fact, they were a bit incredulous with the answer.

    All cancer is genetic, in that it is caused by genes that change. Only a few types are inherited. Most cancers come from random mutations that develop in body cells during one’s lifetime – either as a mistake when cells are going through cell division or in response to injuries from environmental agents such as radiation or chemicals.

    Different types of cancer show up differently in the body. We have screening tests for some types of cancer. We can detect early breast cancer with mammography. We detect early colon cancer with colonoscopy and hemocult stool tests. We do screening for cervical cancer with pap smears. Early prostate cancer can be detected with PSA, but it is not very specific. Skin cancers can be found early with visualization and biopsy.

    What about brain cancer, testicular cancer, leukemia, sarcoma, lung cancer, ovarian cancer and a number of other less common malignancies? We have no screening tests for these diseases. Perhaps we will discover some gene test or imaging test or breath test in the future, but right now, a person would need to have symptoms that would point to the disease.

    This is a scary thought for people…especially those who try to live healthy lives.

    It is the randomness of life that has always made us feel vulnerable to things we cannot control.

    *This blog post was originally published at EverythingHealth*

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