Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Prometheus Labs Takes Steps Toward Applied Precision Medicine

If you want a glimpse at a company putting precision medicine into practice look no further than Prometheus Labs.  They make diagnostic products for personalized care in digestive disease and oncology.  I use their products to diagnose and target therapy in children with inflammatory bowel diseases (crohn’s disease and ulcerative colitis).

IBD offers a nice place to see the evolution of precision diagnostics:

Early biomarker testing.  Initially we had ASCA and pANCA antibodies to discern crohn’s and ulcerative colitis.

Advanced biomarker testing. Read more »

*This blog post was originally published at 33 Charts*

Pediatric Physician Joins Collaborative Network And Sees Improvement In His Work

I never thought I’d change the way I practice medicine.  But I recently enrolled as a provider in the Improved Care Now (ICN) collaborative network and I’m already working differently.

ICN is an alliance of gastroenterologists and patients working in a new model of pediatric inflammatory bowel disease care based on the analysis of thousands of doctor–patient visits as well as the latest studies and treatments.  Doctors and patients apply this information, experiences are tracked in an open registry, the results are then shared and refined to improve care.  I can see what I’m doing well and where I’m falling short relative to other clinics and pediatric gastroenterologists.

ICN is under the direction of Dr. Richard Colletti of the University of Vermont.  ICN is supported by the Chronic Collaborative Care Network (C3N), the brainchild of Cincinnati Children’s qualitymeisters, Peter Margolis and Michael Seid.  I flew to Cincinnati earlier this week to catch up on C3N and what appears to be a first step into medicine’s future.  More on the specifics later.  But suffice it to say that I’m stoked about where this is all headed.

A couple of thoughts after enrolling my first few patients: Read more »

*This blog post was originally published at 33 Charts*

Does Accutane Cause Inflammatory Bowel Disease? The Evidence Is Weak

At home the kids’ current TV show of choice is How I Met Your Mother, supplanting Scrubs as the veg out show in the evening. Both shows are always on a cable channel somewhere and are often broadcast late at night. Late night commercials can be curious, and as I work on projects, I watch the shows and commercials out of the corner of my eye.

Law firms trolling for business seem common. If you or a family member has had a serious stroke, heart attack or death from Avandia, call now. The non-serious deaths? I suppose do not bother. One ad in particular caught my eye: anyone who developed ulcerative colitis or Crohn’s disease (collectively referred to inflammatory bowel disease, or IBD) after using Accutane, call now. Millions have been awarded.

My eye may have been caught because of my new progressive lenses, but I will admit to an interest in inflammatory bowel disease, having had ulcerative colitis for years until I took the steel cure. It also piqued my interest as these were three conditions among which I could not seen any connections. Accutane, ulcerative colitis, and Crohn’s. One of these is not like the other. Read more »

*This blog post was originally published at Science-Based Medicine*

Inflammatory Bowel Disease Puts Patients At Risk For Some Skin Cancers

I stumbled across this review article (first full reference below) earlier this week.

Skin cancer is the most common form of cancer in the United States.  Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems (such as inflammatory bowel disease patients on immunosuppressive therapy).

According to the National Cancer Institute (NCI), in there were more than one million new cases of nonmelanoma skin cancers (NMSC) in the United States in 2010.  There were less than 1,000 NMSC deaths during the same time.

NMSC includes  squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).   Both occur more frequently on sunlight-exposed areas such as the head and neck. BCC is far more common than SCC and accounts for approximately 75% of all NMSC. 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…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »