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New Theories About A Link Between Uterine Environment And Autism Raise Questions Without Answers

Two news events got people talking recently.  One was that Casey was deemed not guilty of killing little daughter Caylee ( “O.J. all over again”, I heard repeatedly).  I must admit I was rather surprised….

The second was the results of two new studies that were published in the Archives of General Psychiatry.  One of them stated that environmental factors during pregnancy might contribute as much as genetics in the development of autism spectrum disorders.  The 2nd study conducted by Kaiser Permanente Northern California found a 3 times higher risk of autism if the mother took antidepressants in the first trimester of pregnancy.

With the incidence of autism disorders increasing over time to the current range of 3-6 per 1,000 births, these studies are of interest to millions of parents and professionals.  Autism affects boys at a rate of three times more than girls,  and is usually detected by the age of 3.   The cause has been maddeningly unknown.

While genes certainly play a part (as they do in most every disorder) other theories and assertions have been disproven.  It certainly does not have anything to do with “poor mothering” or “lack of maternal bonding”.  Those theories did more harm than bloodletting in the 19th century!  The link between autism and vaccines has been thoroughly debunked.  If you believe in science and research, you must believe that vaccines are not the cause and finally leave that one in the dust. Read more »

*This blog post was originally published at EverythingHealth*

Goodbye Marcus Welby, Hello Hospital Employee MD

Close your eyes and think of a doctor.  Do you see a Marcus Welby type? A middle aged, smiling and friendly gentleman who makes house calls?   Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you?  If that is what you envision, either you haven’t been to the doctor lately or you are in a concierge practice where you pay a large upfront fee for this type of practice.  Whether you live in a big city or a rural community, small practices are dissolving as fast as Alka Selzer.  Hospitals and health systems are recruiting the physicians, buying their assets (unfortunately not worth much) and running the offices.

Doctors are leaving small practices and going into the protection of larger groups and corporations because of economic changes that have made it harder and harder for small practices  to survive.  The need for Read more »

*This blog post was originally published at EverythingHealth*

Primary Care Is Undervalued: What Should Be Done?

An article by Brian Klepper and Paul Fischer at Health Affairs has me all fired up. Finally these two health experts are calling it like it is. The Wall Street Journal, New York Times and EverythingHealth have written before about the way primary care is undervalued and underpayed in this country and how it is harming the health and economics of the United States.

A secretive, specialist-dominated panel within the American Medical Association called the RUC has been valuing medical services for decades. They divvy up billions of Medicare and Medicaid dollars and all insurance payers base their reimbursement on these values also. The result has been gross overpayment of procedures and medical specialists and underpayment of doctors who practice primary care in internal medicine, family medicine and pediatrics). These payment inequities have led us to a shortage of these doctors and medical costs skyrocket as a result. As Uwe E. Reinhardt says, “Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians.”

Klepper, Fischer and author Kathleen Behan make a bold suggestion. Let’s quit complaining about the RUC and their flawed methodologies. Let’s quit admiring the problem of financial conflicts of interest and the primary care labor shortage. It’s time for the primary care specialty societies, Read more »

*This blog post was originally published at ACP Internist*

Vitamin D For COPD: Why That Won’t Be Enough

I am frequently extolling the health benefits of Vitamin D because almost weekly there is a new study that correlates high vitamin D levels with reducing some disease.  The latest is from the American Journal of Respiratory and Critical Care Medicine and research shows that high doses of vitamin D supplementation improved respiratory muscle strength in patients with Chronic Obstructive Pulmonary Disease (COPD).  The patients that did not receive supplemental vitamin D had blood levels of 22.8 compared to 53.8 in the supplemented group.  The patients who were supplemented had improved respiratory function, strength and less shortness of breath.  It certainly didn’t cure or reverse COPD but the improvement was an encouraging trend in this terrible chronic disease.

In reading about this it got me thinking about COPD and the fact that it is one of the most common reasons for hospitalization and disability in the United States. It is a progressive disease that affects the alveoli (small air sacs that exchange oxygen) and small bronchioles of the lungs.  These airways and air sacs lose their elastic quality and become thick and inflamed.  Mucus forms and patients become progressively short of breath and eventually need supplemental oxygen just to breathe.  COPD is the fourth leading cause of death in the United States.

Did you know that most COPD is caused by Read more »

*This blog post was originally published at EverythingHealth*

Should Physicians Wear White Coats?

The Doctor’s white coat has been a symbol of the profession for decades.  In the 1800’s and up through the early 20th Century, doctors wore street clothes while performing surgery…rolling up their sleeves and plunging dirty hands into patient’s bodies.  They often were dressed in formal black, like the clergy to reflect the solemn nature of their role.  (And seeing a doctor was solemn indeed as it often led to death)

A 1889 photograph from the Mass General Hospital shows surgeons in short sleeved white coats over their street clothes and in the early 20th Century the concept of cleanliness and antisepsis was starting to take hold in American medicine.  Both doctors and nurses started donning white garb as a symbol of purity.  The white coat took on more and more symbolic meaning and the “White Coat Ceremony”, where medical students are allowed to don the formal long white coat,  has even been a right of passage with graduation from Medical School.

For the past few years, the American Medical Association and other medical societies have debated if it is time for the white coat to be retired.   Read more »

*This blog post was originally published at EverythingHealth*

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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