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Latest Posts

The Medical Arms Race Heats Up

I have written many times on this blog about one shining example of the medical arms race – the slow (some would say not so slow), steady, proliferation of huge and hugely expensive proton beam radiation facilities in medical centers in the US. I have written about how the proliferation never seems to occur in single units – rarely just one per town – but almost always two simultaneously – the medical arms race among health care institutions and providers at play.

The latest chapter is playing out in San Diego, as captured by HealthLeaders Media Online senior editor Cheryl Clark.

Excerpts:

“As members of the debt reduction “super committee” wrestle to slice $400 billion from Medicare over 10 years, I wonder what they might say about the $430 million proton beam center war now being waged a few miles from my home in San Diego.

This nearly half a billion dollar investment in proton therapy is a big part of Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Convincing The Public Of The Importance Of Evidence-Based Medicine

On October 4th, 2011, I delivered the Alex Drapos Memorial Lecture at Clark University as part of their ongoing President’s Lecture Series.  Here’s what Jim Keogh, Director of News and Editorial Services, reported about my talk:

Gruman said American health care treads a fine line between trying to serve the good of the many and the interests of the individual. But no one has yet figured out a cost-effective, yet humane, way to do both. She asserted that the skyrocketing expense of health care — expected to rise to $4.64 trillion by 2020 — isn’t reflected in the quality of treatment people receive.

“Should we be able to choose whatever medicine we want, even if there’s no evidence it’s effective?” ~ Jessie Gruman

“There is much ineffective, extra, inappropriate care being delivered,” Gruman said. As an example she cited Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Fighting To Keep Medicine Intuitive As Precision Medicine Takes Over

In The Innovator’s Prescription Clayton Christensen details how technology is disrupting health care.  He describes the provision of medical care as occurring on a spectrum ranging from intuitive medicine to precision medicine.  Intuitive medicine is care for conditions loosely diagnosed by symptoms and treated with therapies of unclear efficacy.  Precision medicine is the delivery of care for diseases that can be precisely diagnosed and with predictable, evidence-based treatments.  Intuitive medicine is almost entirely dependent upon clinical judgment.  Precision medicine not as much.  19th century medicine was intuitive; the 21st century will prove precise.

When we think about our role as doctors, we like to see ourselves as providers of intuitive medicine.  It’s how we were all trained – products of 20th century mentoring. And so we see of ourselves just as indispensable as we were 100 years ago.  But as medicine makes its march toward predictive care all of this will change.

There’s an endemic insecurity among the 21st century doctors: Read more »

*This blog post was originally published at 33 Charts*

Book Review: Food Truths, Food Lies

Food Truths, Food Lies, written by family physician Eric Marcotte, M.D., may be the most refreshingly evidence-based diet book of the decade. You will not find a single mention of super-foods, magical berries, or supplement “must-haves” in the entire book. What you will find is the cold, hard truth about why many Americans are overweight, and what it takes to become a healthy eater.

Marcotte writes for the average American – his simple language, matter-of-fact tone, and regular reminders of what the reader has learned, make for a quick and memorable read.  Although it’s clear that Marcotte has carefully distilled his dietary advice from the scientific literature, he refrains from burdening the reader with too many footnotes and references. Instead, he has created a kind of Cliff’s Notes of nutrition, having done the “heavy sifting” for us. What remains are the most basic principles underlying all healthy eating, such as:

*You can’t exercise your way to weight loss (i.e. you can’t outrun your own mouth – it’s much easier to eat more calories than you burn) Read more »

Anonymous Blogger Reviews The Lack Of Evidence For Robotic Surgery

The surgeon who blogs as Skeptical Scalpel writes that he (she?) is unable to contain him(her)self any longer and then lunges into a review of evidence (or lack thereof) for robotic surgery.

You may disagree with Skeptical Scalpel’s decision to be anonymous, but he/she explains:

Operating-Room.jpg“I’ve been a surgeon for almost 40 years and a surgical department chairman for over 23 of those years. During much of that time, conforming to the norms, rules and regulations of government agencies, accrediting bodies, hospitals, societies, and social convention was necessary for survival. I was always somewhat outspoken but in a controlled way most of the time. I now have a purely clinical surgery practice with no meetings, site visits or administrative hassles. I am free to speak my mind about medicine or anything else.”

On robotics, Skeptical Scalpel writes: Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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