January 19th, 2011 by GarySchwitzer in Better Health Network, Opinion
Tags: Accurate Diagnosis, Becoming A Patient, Blood Test, Cancer Diagnosis, Cancer Diagnosis Tool, Cancer Epidemic, Cancer Screening, Complications of Screening Tests, Dartmouth, Disease Pathology, Dr. Gil Welch, Gary Schwitzer, HealthNewsReview.org, JAMA, Journal of the American Medical Association, Oncology, Overdiagnosis, Overtreatment, Prostate Cancer Surgery, Prostate Specific Antigen, PSA Screening, Public Health, Risk of Complications, Single Cancer Cell, Unnecesary Medical Complications, Urinary Incontinence, Urology
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That’s the question Dartmouth’s Dr. Gil Welch asks in a column on the CNN website. He reflects on [recent] news about a test in development that might find a single cancer cell among a billion healthy ones — as so many news stories framed it. Welch analyzes:
“But it’s not that simple. The test could just as easily start a cancer epidemic.
…
Most assume there are no downsides to looking for things to be wrong. But the truth is that early diagnosis is a double-edged sword. While it has the potential to help some, it always has a hidden side-effect: overdiagnosis, the detection of abnormalities that are not destined to ever bother people in their lifetime.
Becoming a patient unnecessarily has real human costs. There’s the anxiety of being told you are somehow not healthy. There’s the problem that getting a diagnosis may affect your ability to get health insurance. There are the headaches of renewing prescriptions, scheduling appointments and keeping them. Finally, there are the physical harms of treatments that cannot help (because there is nothing to fix): drug side-effects, surgical complications and even death. Not to mention it can bankrupt you.
Americans don’t need more diagnoses, they need the right diagnoses.
I don’t know whether this test will help some patients. It might, but it will take years to figure that out. Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
January 19th, 2011 by BobDoherty in Better Health Network, Health Policy
Tags: ACP Advocate, ACR, American College Of Physicians, American College of Radiology, Bob Doherty, Diagnostic Imaging, Diagnostic Tests, Health Affairs, Healthcare Costs, Healthcare Policy, Imaging Facilities, Imaging Studies, Imaging Tests, In-Office Labs, In-Office Medical Services, In-Office X-Ray, Investor-Physicians, Medical Imaging, Medicare, Physician Referral, Self-Referral, Unnecessary Referrals
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Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue — a practice called “self-referral” — unless the facility is located in their own practice. This exemption exists to allow patients with access to a laboratory test, X-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less inconvenience and speeder diagnosis and treatment — what could be wrong with that?
Much, say the critics, if it leads to overutilization and higher costs and doesn’t really represent a convenience to patients. This is the gist of two studies by staff employed by the American College of Radiology, published in the December issue of Health Affairs.
One study analyzes Medicare claims data and concludes that patients aren’t really getting “one-stop-shopping” convenience when their physician refers them to an imaging facility that qualifies for the “in-office” exemption.
“Specifically, same-day imaging was the exception, other than for the most straightforward types of X-rays. Overall, less than one-fourth of imaging other than these types of X-rays was accompanied by a same-day office visit. The fraction for high-tech imaging was even lower — approximately 15 percent.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
January 19th, 2011 by Elaine Schattner, M.D. in Better Health Network, Research
Tags: Advanced Cell Technology, Anemia, Artificial Cells, Blood Disorders, Cell Research, Cha University, Chapel Hill, Dr. Elaine Schattner, Harvard Medical School, Hematology, Human Blood Supply, Human Embryonic Stem Cells, Medical Lessons, Megakaryocytes, Nature Journal, Platelets, PNAS, PRINT Technology, Proceedings of the National Academy of Sciences, RBCs, Red Blood Cells, Seoul, Stem Cell and Regenerative Medicine International, Synthetic Blood, University of Illinois, University of North Carolina
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There’s hematology news, times two (at least):
1. Progress in developing synthetic red blood cells
A University of North Carolina-Chapel Hill research group has created hydrogel particles that mimic the size, shape and flexibility of red blood cells (RBCs). The researchers used PRINT® (Particle Replication in Non-wetting Templates) technology to generate the fake RBCs, which are said to have a relatively long half-life. The findings were reported on-line yesterday in the Proceedings of the National Academy of Sciences (PNAS) (abstract available, subscription required for full text). According to a PR-ish but interesting post on Futurity, a website put forth by a consortium of major research universities, tests of the particles’ ability to perform functions such as transporting oxygen or carrying therapeutic drugs have not yet been conducted.
Developing competent, artificial RBCs is a hematologist’s holy grail of sorts, because with that you might alleviate anemia without the risks of transfusion.
2. Progress in using human stem cells to generate lots of platelets
In an exciting paper published today in Cell Research, investigators stimulated human embryonic stem cells to become platelet-producing cells, called megakaryocytes. According to the article (open-text at Nature PG), the platelets were produced in abundance, appeared typical and clotted appropriately in response to stimuli in vitro. The researchers injected them into mice, used high-speed video microscopy for imaging, and demonstrated that the stem cell-derived human platelets contributed to clot formation in mice, in vivo (i.e., they seem to work). Read more »
*This blog post was originally published at Medical Lessons*
January 18th, 2011 by Michael Kirsch, M.D. in Better Health Network, Opinion
Tags: Dr. Michael Kirsch, Electronic Medical Record, EMR, General Medicine, MD Whistleblower, Medical Data, New Medical Technology, Point-and-Click Medicine, Shared Patient Information
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Whistleblower readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals.
In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position.
A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like nearly every hospital in Cleveland, is owned by one of the two towering medical behemoths. I’m not a businessman, but I have learned that when something owns you, it’s generally better for the owner than the ownee. This meeting was about the hospital’s upcoming EMR policy. Sometimes, these hospital meetings are ostensibly to seek physician input, but the true purpose is to inform the medical staff about decisions that have already been made.
In the coming months, this hospital will adopt a computerized ordering system for all patients. In theory, this would be a welcome advance. It would create a digital and permanent record of all physician orders that could be accessed by all medical personnel involved in the patients’ care. It would solve the perennial problem of inscrutable physician handwriting, including mine. Read more »
*This blog post was originally published at MD Whistleblower*
January 18th, 2011 by PJSkerrett in Better Health Network, Health Tips
Tags: Acute Coronary Syndrome, Blood Clot, Blood Flow, Blood Pressure, Cardiology, Chest Pain, Cold Weather, Harvard Health Blog, Harvard Health Publications, Harvard Heart Letter, Harvard Medical School, Harvard University, Heart Attack, Heart Health, Myocardial Infarction, Outdoor Safety, PJ Skerrett, Safe Shoveling, Shortness of Breath, Snow Shoveling, Winter Safety
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After shoveling the heavy, 18-inch layer of snow that fell overnight on my sidewalk and driveway, my back hurt, my left shoulder ached, and I was tired. Was my body warning me I was having a heart attack, or were these just the aftermath of a morning spent toiling with a shovel? Now that I’m of an AARP age, it’s a question I shouldn’t ignore.
Snow shoveling is a known trigger for heart attacks. Emergency rooms in the snowbelt gear up for extra cases when enough of the white stuff has fallen to force folks out of their homes armed with shovels or snow blowers.
What’s the connection? Many people who shovel snow rarely exercise. Picking up a shovel and moving hundreds of pounds of snow, particularly after doing nothing physical for several months, can put a big strain on the heart. Pushing a heavy snowblower can do the same thing. Cold weather is another contributor because it can boost blood pressure, interrupt blood flow to part of the heart, and make blood more likely to form clots.
When a clot forms inside a coronary artery (a vessel that nourishes the heart), it can completely block blood flow to part of the heart. Cut off from their supply of life-sustaining oxygen and nutrients, heart muscle cells begin to shut down, and then die. This is what doctors call a myocardial infarction or acute coronary syndrome. The rest of us call it a heart attack.
The so-called classic signs of a heart attack are a squeezing pain in the chest, shortness of breath, pain that radiates up to the left shoulder and down the left arm, or a cold sweat. Other signs that are equally common include jaw pain, lower back pain, unexplained fatigue or nausea, and anxiety. Read more »
*This blog post was originally published at Harvard Health Blog*
