January 4th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Policy, True Stories
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It has been proven than there is tremendous variation in the practice of medicine across the United States. The Dartmouth data (Wennberg et al) has documented the differences in how medical resources are used and how different physicians practice medicine, depending upon where they live. The Dartmouth studies are mainly focused on cost and outcomes and make the case that improved quality is often inversely related to the cost of care. More (expensive) care is not necessarily better care.
Now that I am recovering from a total joint replacement, I am amazed to see the differences in how physicians, doing the same surgery, treat the patient. Total knee replacement (TKA) is one of the most common orthopedic procedures done today. Despite this, the patient cannot expect the same post op care. Read more »
*This blog post was originally published at EverythingHealth*
December 21st, 2009 by Toni Brayer, M.D. in Better Health Network, Health Tips
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Just when you thought it was safe…now there is another article in the NewYorkTimes about the pharmaceutical industry pushing hormones for post menopausal women. It is a long and somewhat “shocking” article about how women have been sold a bill of goods regarding estrogen and progesterone after menopause and Wyeth Pharmaceutical paying multimillion dollar claims for women who took hormones and developed breast cancer.
Let me say…don’t believe everything you read. As readers of EverythingHealth know, I am not a shill for big Pharma and have written critiques of their corporate tactics many times. But when it comes to Estrogen replacement it isn’t just doctors and Pharma pushing drugs on unsuspecting women.
The link between breast cancer and endometrial cancer and estrogen (ERT) has been open dialog for decades. The pharmaceutical companies have had it listed in their marketing literature and good physicians make it part of the risk/benefit discussion. I have never felt pushed to prescribe ERT when it was not indicated and good evidence remains about the benefits of female hormones for bone strength and symptom control. Patients should know that for every 10,000 women who take estrogen, 8 more cases of breast cancer are seen. Other factors influence breast cancer like smoking, radiation (excessive chest X-rays, cat scans or mammograms), alcohol etc etc etc. Read more »
*This blog post was originally published at EverythingHealth*
December 14th, 2009 by Toni Brayer, M.D. in Better Health Network, Opinion
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Most doctors have a closet in their office filled with various pharmaceutical samples. The pharmaceutical industry has had “drug reps” or account reps or pharmaceutical sales staff making the rounds on doctors offices in every city and town across the United States for decades. The industry spent $33.5 billion promoting drugs and sending reps to doctors offices with samples in 2004. That is a lot of samples!
Most of us thought we were doing the right thing for our patients when we accepted drug samples. I was able to give patients a month (or more) free to make sure it worked and that they tolerated it. Other patients had no insurance and I supplied them with all of their medication for free from my sample closet. I had a good relationship with the rep and they kept my office stocked with the medication my patients needed. It seemed like a win-win for everyone. Read more »
*This blog post was originally published at EverythingHealth*
December 7th, 2009 by Toni Brayer, M.D. in Better Health Network, Health Tips
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After a holiday weekend of movie-going and eating that popcorn that smells so good in the theater, it was a shock to read the report from the Center for Science in the Public Interest that shows just how bad theater popcorn is. The researchers studied medium size popcorn from three large movie chains; Regal Entertainment Group, AMC and Cinemark.
The analysis showed that a Regal medium popcorn contains 1,200 calories and 60 grams of saturated fat. AMC popcorn was a “smaller” medium and contained 590 calories and 33 grams of saturated fat. This was before adding the butter topping. Cinemark wasn’t much better at 760 calories but it only had 3 grams of saturated fat.
Kudos to Cinemark for popping their corn in canola oil with less saturated fat. The other chains use heart unhealthy coconut oil, which is about 90% saturated fat. Lard is 40% saturated!
The study showed that a $12 medium popcorn and soda combination at a Regal movie would be the equivalent of three McDonald’s Quarter Pounders with 12 pats of butter. Read more »
*This blog post was originally published at EverythingHealth*
November 29th, 2009 by Toni Brayer, M.D. in Better Health Network, Opinion
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The movement for physicians to say “I’m sorry” when things go wrong in patient care has been under debate for the past few years. In the past, physicians were advised to never admit to a problem or to apologize for clinical errors with the thought that it would lead to more lawsuits. Saying “I’m sorry” might be taken by a lawyer as an admission of guilt and malpractice. Attorneys advised, “Say nothing” but that left patients with unanswered questions and often the feeling that the doctor just didn’t care.
Numerous studies have shown that patients want physicians to disclose harmful errors and they want information about what happened, why it happened and if something has been done to keep it from happening again. There has been a gap between what patients want and what actually occurs. Read more »
*This blog post was originally published at EverythingHealth*
It has been proven than there is tremendous variation in the practice of medicine across the United States. The Dartmouth data (Wennberg et al) has documented the differences in how medical resources are used and how different physicians practice medicine, depending upon where they live. The Dartmouth studies are mainly focused on cost and outcomes and make the case that improved quality is often inversely related to the cost of care. More (expensive) care is not necessarily better care.
