January 29th, 2011 by KevinMD in Health Policy, Opinion
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I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.”
So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.
Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed:
Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t think many will propose more than a 25 percent bonus. It’s also possible that the benchmarks which define success were too low and therefore didn’t improve outcomes. There’s no scientific reason to think that the recommendations weren’t appropriate, however. More likely, it’s what I’ve said before. Changing physician behavior is hard.
So if money can’t motivate doctors, what’s next? Physicians aren’t going to like what Dr. Carroll has to say. Read more »
*This blog post was originally published at KevinMD.com*
January 29th, 2011 by Peggy Polaneczky, M.D. in Opinion, Research
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Here’s yet another study showing that abortion does NOT lead to future psychiatric problems. From The New York Times:
The New England Journal of Medicine has taken on one of the pillar arguments in the abortion debate, asking whether having the procedure increases a woman’s risk of mental-health problems and concluding that it doesn’t. In fact, researchers found, having a baby brings a far higher risk.
The study, by Danish scientists (and financed in part by the Susan Thompson Buffett Foundation, which supports research on abortion rights), is the most extensive of its kind to date. It studied 365,550 Danish women who had an abortion or gave birth for the first time between 1995 and 2007. Of those, 84,620 terminated their pregnancies and 280,930 gave birth.
In the year after an abortion, 15.2 out of 1,000 sought psychiatric help (defined as admission to a hospital or clinic), which was essentially the same as the rate of that group (14.6 per 1,000) in the nine months before the abortion. In contrast, among women who went on to give birth, the rate at which they sought treatment increased to 6.7 per 1,000 after delivery from 3.9 per 1,000 before.
Why do first-time mothers have a lower overall rate of mental illness both before and after pregnancy than those who choose termination? The researchers suggest that those who have abortions are more likely to have emotional problems in the first place. Compared with the group who give birth, those who have abortions are also statistically more likely to be struggling economically, and to have a higher rate of unintended pregnancies.
And why do first-time mothers seem to nearly double their risk in the year after giving birth? That is likely to have something to do with the hormonal changes, decreased sleep, and increased stress of parenting, which women who terminate do not experience.
Can we please talk about something else? Like maybe how to help these young women with the issues and unmet contraceptive needs that led to unplanned pregnancy in the first place?
*This blog post was originally published at The Blog That Ate Manhattan*
January 28th, 2011 by Berci in Quackery Exposed, Research
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Luc Montagnier received the 2008 Nobel Prize for his discovery of the human immunodeficiency virus (HIV), but now he’s come up with a more-than-strange theory. He thinks DNA can teleport from one tube to another via electromagnetic signals. Is this the so-called “Nobel disease?”
French virologist Luc Montagnier stunned his colleagues at a prestigious international conference when he presented a new method for detecting viral infections that bore close parallels to the basic tenets of homeopathy.
Although fellow Nobel prize winners — who view homeopathy as quackery — were left openly shaking their heads, Montagnier’s comments were rapidly embraced by homeopaths eager for greater credibility.
Montagnier told the conference last week that solutions containing the DNA of pathogenic bacteria and viruses, including HIV, “could emit low frequency radio waves” that induced surrounding water molecules to become arranged into “nanostructures.” These water molecules, he said, could also emit radio waves.
He suggested water could retain such properties even after the original solutions were massively diluted, to the point where the original DNA had effectively vanished. In this way, he suggested, water could retain the “memory” of substances with which it had been in contact — and doctors could use the emissions to detect disease.
*This blog post was originally published at ScienceRoll*
January 28th, 2011 by Paul Auerbach, M.D. in Health Tips, Research
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This is a guest post by Dr. Jeremy Windsor.
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Steroids and Acute Mountain Sickness
In recent years, many attempts have been made to identify safe and effective medications to prevent acute mountain sickness (AMS). Acetazolamide (Diamox), currently the “drug of choice” for this purpose, is not perfect and occasionally causes objectionable side effects. Dexamethasone (Decadron), a powerful steroid medication, has become increasingly popular for prevention and treatment in certain circles. While there is ample evidence to suggest that dexamethasone is effective, a recent case report highlights that this drug is not without risk.
In the latest issue of the journal Wilderness & Environmental Medicine [WEM 21(4):345-348, 2010] in an article entitled “Complications of steroid use on Mt. Everest,” Bishnu Subedi and colleagues working for the Himalayan Rescue Association (HRA) described the case of a 27 year-old man who was prescribed a course of three drugs, including dexamethasone, intended to support him during his attempt to climb Mt. Everest. After more than three weeks of taking the medications, the mountaineer noticed the appearance of a rash and decided to stop taking them. Rather than wait for the rash to subside, he chose to continue his acclimatization program and ascend to Camp 3 at 7010m altitude. The patient arrived exhausted and confused; onlookers quickly recognized that something was seriously wrong and so a rescue party was organized to help him back to safety. Read more »
This post, Drug Safety In Preventing Acute Mountain Sickness, was originally published on
Healthine.com by Paul Auerbach, M.D..
January 28th, 2011 by DrWes in Better Health Network, Opinion
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You know it’s bad when the attending surgeon has to write this at the beginning of his operative note:
“I certify that the services for which payment is claimed were medically necessary and that no qualified resident was available to perform the services.”
So there you have it.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
