August 10th, 2011 by AnneHansonMD in Opinion
Tags: Discipline, Inmate, Involuntary Treatment, Monks, Prison, Protection, Psychiatry, Psychology, Reformation, Religious Awakening, Religious Ceremonies, Seclusion, Segregation Cell, Solitary Confinement, Voluntary, Vow Of Silence
No Comments »
I’ve always been struck by the similarity between solitary confinement inmates and monks. Historically, monks were kept under the vow of silence. They could only leave their cells to attend religious services. The only visitors they were allowed tohave were their religious advisors. (If any of you have seen the movie Into Great Silence you’ll know what I’m talking about.) The idea of the modern penitentiary came from this ‘penitence’ process: put someone in a room by himself, give him religious guidance while he’s there and he’ll reflect, repent and reform. This was how prisons were run in the Nineteenth Century too: prisoners were kept under the rule of silence and they could only come out of their cells for religious services or for work. No one ever alleged that monks became psychotic because of this though.
Then there’s the psychiatric seclusion room. Again, a bare cell with a bed or a mattress, no visitors, no clothes except a hospital gown. There is no ‘vow of silence’ or ‘rule of silence’ though.
So what makes the difference between the prison segregation cell, the monk’s cell and the psychiatric seclusion room? Read more »
*This blog post was originally published at Shrink Rap*
August 10th, 2011 by AndrewSchorr in Opinion, Research
Tags: Cancer Care, Cancer Research, Dr. Ron Levy, Fight Against Cancer, Hematologist-oncologist, Individualized Therapy, Lung Cancer, melanoma, National Cancer Institute, Oncology, Online Database, Personalized Medicine, Richard Nixon, Stanford, Technology, University of Washington, War On Cancer
No Comments »
You have heard it countless times, “The War on Cancer.” President Nixon announced it. The National Cancer Institute has spearheaded what TV and radio commercials always talk about as “the fight against cancer.” Singular. But we really need to start thinking about it as a plural. Wars on cancer. Fights against cancer. Taking it one step further, we need to see each person’s fight as an individual battle. Not just individualized to the patient’s spirit or age or sense of hope, but individualized to his or her particular biology, matched up with the specific cancer and available treatments. That is the nature of “personalized medicine” applied to cancer. We’ve been talking about it for a few years around here, but what’s exciting now is that even more super smart people in the cancer scientific community are devoting themselves to it.
I met two people like that today near the research labs at the University of Washington in Seattle. Without giving too much away (they’ve got big plans), these two hematologist-oncologists, with many advanced degrees between them and decades of experience, are trying to build something really big that could lengthen lives and save many too.
What they’re trying to do is Read more »
*This blog post was originally published at Andrew's Blog*
August 10th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
Tags: Cancer Treatment, Cost, Cost-Benefit Analysis, Cost-effectiveness, Medications, melanoma, Money, New York Times, Price, Prostate Cancer, Proven Preventive Medical Screening Test, Routine Vaccinations
2 Comments »
The concept of cost-effectiveness in medicine is elastic. One’s view on this issue depends upon who is paying the cost. Of course, this is true in all spheres of life. When you’re in a fine restaurant, you order differently when the meal will be charged to someone else. Under these circumstances, the foie gras appetizer and the jumbo shrimp cocktail are no longer luxuries, but are considered as essential amino acids that are necessary to maintain life.
In the marketplace, except in the medical universe, goods and services are priced according to what the market will bear. If an item is priced too high, then the seller will have fewer sales and a bloated inventory. Consumers will not pay absurd prices for common items, regardless of supernatural claims of quality.
- Would you pay $100 for an ice cream sundae that boasted it was the best in the world?
- Would you pay $1000 for a tennis racket that promised performance beyond your ability?
- Would you pay $500 for a box of paper clips that never lose their tension? Read more »
*This blog post was originally published at MD Whistleblower*
August 9th, 2011 by RamonaBatesMD in Opinion, Research
Tags: Abdominal Pain, Advil, Aleve, Arthritis, Celebrex, Drug Effectiveness, Drugs, Gastrointestinal Side Effects, Hand, Medicine, NSAID, Rheumatology, Side Effects, Swelling, Tylenol, Ulcers, Zantac
No Comments »
Recently I gave in and went to see a rheumatologist after more than 3 months of intense morning stiffness and swelling of my hands (especially around the PIPs and MCPs) and wrists which improved during the day but never went away. It had gotten to the point where I could no longer open small lid jars (decreased strength), do my push-ups or pull ups (pain and limited wrist motion), and OTC products (Tylenol, Advil, etc) weren’t working. I can’t take Aleve due to the severe esophagitis it induces. I didn’t want to write a prescription for my self-diagnosed (without) lab arthritis.
BTW, all the lab work came back negative with the exception of a slightly elevated sed rate and very weakly positive ANA. The rheumatologist was impressed with the swelling, pain, and stiffness and was as surprised as I by the normal lab work. He thinks (and I agree) that I am in the early presentation of rheumatoid arthritis. He wrote a prescription for Celebrex and told me to continue with the Zantac I was already taking (thanks to the Aleve). The Celebrex is helping.
So I was happy to see this article (full reference below) come across by twitter feed. H/T to @marcuspainmd: Useful review of NSAIDs effects & side effects for arthritis pain: Read more »
*This blog post was originally published at Suture for a Living*
August 9th, 2011 by Elaine Schattner, M.D. in Opinion, Research
Tags: B. Hillner, Bending the Cost Curve in Cancer Care, Cancer Treatment, End Of Life, Honesty, Hospice, NEJM, New England Journal of Medicine, Oncology, Palliative Care, Realistic Discussions, Research, T. Smith
No Comments »
We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”
In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough –
The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.
They review published findings on the topic: Read more »
*This blog post was originally published at Medical Lessons*
