In 1964 the Surgeon General issued a report on smoking, summarizing the scientific evidence demonstrating the health risks of tobacco use. Scientifically, nothing in that report was new. It was a review of what was already known. But it had a profound societal effect by publicizing a health risk that had been until then largely ignored. Education, health policy, and the advice of many individual doctors were transformed. This week the Surgeon General released More
“To die: to sleep; No more; and by a sleep to say we end The heart-ache and the thousand natural shocks That flesh is heir to, 'tis a consummation Devoutly to be wish'd.” -- Hamlet, ShakespeareThe California End of Life Options Act became effective in June. Before we can understand what the new law permits and how it might change the care of dying patients, we have to understand a little about end of life care prior to this development. Suffering and...
It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Yet prior to the Affordable Care Act, healthcare was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009 I wrote a series of four posts explaining how the healthcare marketplace reached su...More
When I meet a new patient, I’m frequently astounded by the healthcare he has received. I’ve met patients with absolutely no cardiac symptoms who have been receiving EKGs every six months for years. I’ve had patients brag to me about their annual executive physicals in which myriad tests including treadmill stress tests and chest X rays were ...More
To understand this week’s story we first have to understand how habit-forming medicines are currently prescribed in the U.S. The Drug Enforcement Agency divides potentially addictive substances into different schedules. Schedule II controlled substances are prescription medicines that have a high potential for abuse and severe dependence. They include all the opiate (narcotic) pain medicines, like morphine, oxycodone, and fentanyl. These medications must be prescribed on a paper prescription...More