August 7th, 2011 by DrWes in Opinion
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This morning in the Chicago Tribune’s business section appeared an article entitled “Just What the Doctor Ordered” that included an interview with Dr. Howard Bauchner, the new editor for the Journal of the American Medical Association (JAMA). He plans to pursue a strategy of “intelligent innovation” for the journal:
…looking for ways to get information to doctors and consumers through several new platforms, such as social media, video and other forms. “If you look at TED or Big Think, they have been experimenting with video clips,” Bauchner said. “I could imagine having some of our authors do video clips where they speak about the meaning of their research for eight or 10 minutes, and then that’s easily linked to a smart phone.”
He also wants shorter on-line version of articles that condense the topic to 500 words from the typical 2,500- to 3,000-word articles not too dissimilar, I suppose, to the abstract.
Which leads to the inevitable end result: Read more »
*This blog post was originally published at Dr. Wes*
August 2nd, 2011 by DrWes in Opinion
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It’s the hardest thing in the world for a doctor to do.
After all, doctors are do-ers. That is how they have managed to achieve their degrees: hard work, discipline, perseverence. Who else would be willing to memorize all those organic chemistry equations long enough to vomit them back on paper? Who else would tolerate long nights and weekends on a constant basis? But they do it because it’s the right thing to do. They do it because someone has to. People don’t get sick nine to five. They get sick at 2 am. And so, by it’s very nature over the years, medical education becomes a sort of natural selection: only the strong survive.
Historically, doctors endure the system because they know that there are rewards for this hard work personally, professionally, socially, and financially. So throughout their training, doctors learn to perfect the art of doing. That’s what people come to expect. Oh my God, doctor, he’s choking: do something! He’s turning blue: do something! But he fainted, doctor! Do something!
One of the best parts of medical school is learning the answers to these mysteries of medicine and how to fix them. In the past, this gave doctors an aura of deity: they could be trusted to fix just about any ailment that befell man. It was awesome. With time, a sense of invincibility and omnipotence set in.
And like flies to a flame, we bought it. Lock. Stock. Barrel.
In fact, Read more »
*This blog post was originally published at Dr. Wes*
July 21st, 2011 by DrWes in Opinion, Research
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To ensure rational and responsible dissemination of this new
technology (transcatheter aortic valve replacement [TAVR]), government,
industry and medicine will need to work in harmony.”
– David R. Holmes, Jr., MD, FACC
President, American College of Cardiology
Today, Edwards Lifesciences’ will request pre-market approval of its SAPIEN Transcatheter Heart Valve from the FDA’s Circulatory Systems Devices Panel of the Medical Devices Advisory Committee. And for the first time, the groundwork for our complicated new era of health care rationing will be exposed.
To win an expensive technology on behalf of patients these days, there will have to be “harmony” between doctors and their professional organizations and government regulators. If not, patients lose.
At issue is a transformative technology – another milestone forwarding medical innovation on behalf of some of our oldest and sickest patients: those with critical aortic stenosis who are too sick to undergo open heart surgery. Aortic stenosis tends to be a disease of the elderly that carries at least a 2-year 50% mortality when accompanied by a weakened heart muscle. Yet thanks to the wonders of careful engineering and some daring researchers that paired their expertise and lessons learned from a variety of disciples (cardiothoracic and peripheral vascular surgery, cardiology, and even cardiac electrophysiology), technigues and technology have combined to offer a percutaneous option for aortic valve replacement.
Everyone involved in this research (and even those who have watched from afar) knows this therapy works. Most believe in the long run, it will prove to be a safer option than open heart surgery in these patients.
But that’s about where the harmony ends. Read more »
*This blog post was originally published at Dr. Wes*
July 14th, 2011 by DrWes in Health Policy, Opinion
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* Bzzzzzaaaaapp *
Suddenly, the light went out. There was complete and utter darkness. Then, about 3 seconds later, the lights returned. My computer with its flat screen poised before me, remained dark. I hesitated a moment, then pushed the power button. Within a few more moments, the computer restarted. All seemed intact.
But what if it wasn’t?
Today with our myriad of computer systems, electronic medical records, e-mail messages, paging systems, digital xray machines, blood chemistry analyzers, automated blood pressure cuffs, etc., etc., etc., what would happen if we had no power or functional electronic medical record, just for a week?
Could our health system function?
We have entered the era when our medical students and residents have never entered a written order and “flagged it.” Our unit secretaries wouldn’t have a clue how to take off an order from a “flagged” chart. How would we order a stat portable chest xray without a computer? And what about our written notes. Would they include the date and time in the lefthand column, or would that be forgotten in our hurry to write our manual progress notes? Would our digital phone systems work? How about our pagers? Doctors can no longer find manual blood pressure cuffs on our wards since hospitals have moved to automated blood pressure cuffs that upload their readings into the electronic medical record automatically. Have our nurses and medical assistants lost the art of taking a manual blood pressure? Read more »
*This blog post was originally published at Dr. Wes*
July 8th, 2011 by DrWes in Health Policy, Opinion
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It was another headline busting study this week: Pfizer Drug Tied to Heart Risks – a provocative title no doubt fed to the media from the publisher: the Canadian Medical Association Journal. The study was yet another meta-analysis that culled the world’s literature in an attempt to determine if a trend could be found that might implicate Chantix as a causative agent for and increased incidence of heart disease in smokers.
On its surface, the study sounds authoratative, analyzing “14-double-blind randomized controlled trials involving 8216 participants” ranging in duration from “7 to 52 weeks.”
Never mind that 57% (25) of adverse events were weighted from one study and that none of the 14 studies had odds ratios that did not cross the unity line.
Despite this, the lead author concluded:
Despite the limitations of our analysis, our findings have potential regulatory and clinical implications.
Sorry, this is not correct. There are no clinical implications of this trial. Like all metanalyses, meta-anaylses simply cannot determine cause and effect. (Note to main stream media: are you folks listening?!?)
That being said, there’s another concern I have Read more »
*This blog post was originally published at Dr. Wes*
