The new breast cancer screening guidelines announced November 16th by the U.S Preventive Services Task Force have sparked widespread anger and confusion. The debate centers on the relative risks and benefits of various methods of trying to pick up breast cancer at an early stage. All current techniques, including mammography, MRI, ultrasound, and breast exam, can reveal abnormalities that end up being benign. These so-called “false positives” often lead to expensive, anxiety-producing, and invasive testing such as biopsy and fine-needle aspiration. The big question is: What screening tests are “worth it” and how do we define “worth it?” Read more »
For those of you following the surprising healthcare reform bill mandate of Christian Science prayer as a medical treatment to be payed for by your taxes… I have good news. That was stricken from the merged legislation.
The bad news is that there is currently even more worrisome language in the S.3950 bill. Senator Tom Harkin has introduced language that would essentially require ineffective medical treatment systems like homeopathy to be paid for by government programs, and give people without legitimate medical training the right to become primary care physicians who would establish a “medical home” for patients. Read more »
I was having an interesting Twitter chat with online friends (Liz Cohen @elizcohencnn, Dr. Chuk Onyeije @chukwumaonyeije; Dr. David Gorski @gorskon; Dr. Marya Zilberberg @murzee; Sherry Reynolds @cascadia; and @speakhealth) about the mammogram debate. They asked me “where I drew the line” on paying for expensive screening tests that may save lives but require unnecessary surgery for countless others. My opinion takes into account human nature and political savvy rather than pure science and statistics on this one.
To me, the bottom line is that the mammogram is a sloppy screening test. It’s expensive, there are lots of false positives and unnecessary surgeries, yet it saves occasional lives (which is dramatic and meaningful). We have to appreciate that women have come to accept the risks/benefits of this test, and have been told for a long time that they should begin screening at age 40.
It’s not emotionally or politically possible to reverse course on this recommendation until a better choice is available. You can trade the mammogram for a better test, but you can’t trade it for doing nothing. The amount of drama associated with the perception of having something potentially life-saving taken away is just not worth the cost savings. It may be a reasonable value judgment based on the data, but it’s not politically feasible so we should mentally take it off the table. Read more »
Last week someone posted on Twitter that they had swallowed a plastic toothpick. What to do? So they turned to the hive for help. “What should I do?” I thought as I read my Twitter feed. I was paralyzed in a way. I wanted to share my experience with hundreds of patients had swallowed pins, toothpicks and other pointy things. I specialize in just this sort of thing. But short of a random comment about gastric emptying, I kept to myself. Why? Because once I lend a hand I’m all in.
The simple offer of patient-specific advice constitutes a relationship in the eyes of the law.Once involved, I potentially share responsibility in whatever happens to someone.Crazy but true.It’s just a matter of time before slip-and-fall lawyers hold physicians accountable for helping out in the social sphere.
Doctors aren’t the only ones wearing targets. Read more »
*This blog post was originally published at 33 Charts*
This article by Dr. Daniel Man (full reference below) is well worth the time spent reading it. Telltale signs of facelift procedures can include tightening across the lower face, visible scars, a distorted hairline, and the “pixie ear” deformity. Dr. Man looks at the causes of the ear deformity and ways to prevent it. (photo credit)
Dr. Man has provided a pdf file of the article on his website, so you don’t have access to the Aesthetic Surgery Journal to read the article.
Between January 2005 and November 2007, the author performed facelifts on 106 patients using a technique that included autologous fat injections to improve facial volume, hidden incisions in and around the ear, and absorbable bidirectional barbed sutures. Patient charts and photographs were reviewed retrospectively. Read more »
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