I’ve written before of the perverse incentives created by the price-fixed healthcare insurance model which reimburses every doctor the same fee for each service provided, promoting quantity rather than quality.  Recently, policy makers and insurance companies have noticed this problem too (over 30 years after they caused it).  They are slowly realizing that they are paying doctors to treat as many...

or, Malaria Makes a Bad Souvenir or, I Went on Safari and all I Got Was Hepatitis A We Americans take for granted much of what keeps us healthy.  We expect our food and water to be uncontaminated.  We expect the neighbor’s dog to have had all his shots.  We expect that if we get sick we will receive prompt and excellent care.  Then, when we travel to the developing world, we forget that none of o...

I haven’t made it a secret in these posts that I’m a big fan of electronic health records (EHRs).  I think they improve patient care, and I think that paper medical charts will eventually go the way of the vinyl LP.  (For those of you born after 1980, I’m referring to an archaic music recording medium.  Yes, even more archaic than the CD.) I’ve also written before about the very slow rate of adop...

About 20 years ago a blood test called prostate specific antigen (PSA) was developed with the hope that it would help in the diagnosis of prostate cancer.  Since then, countless healthy men have been tested for prostate cancer with a PSA and a digital rectal exam despite the fact that there has never been convincing evidence that diagnosing prostate cancer saves lives. The reason for the controve...

Three weeks ago I wrote about the difficulty of quitting smoking.  This week I’m writing about an even harder habit to break – problem drinking. Our understanding of alcohol use and abuse is evolving.  Alcoholism or alcohol abuse is defined as continued alcohol drinking despite negative consequences, whether those negative consequences are to one’s work, relationships or health.  Alcohol abuse ha...

I don’t know about you, but whenever I think of March, the first thought that springs to mind is National Colorectal Cancer Awareness Month. Patients frequently ask me to be tested for whichever cancer they are particularly anxious about.  “Is there a test to make sure I don’t have early ovarian cancer?”  “Pancreatic cancer?”  “Lymphoma?”  I have to explain that for healthy people without any sym...

Few things captivate the public more than a new diet.  From Atkins to Ornish to the Mediterranean diet, each new theory attracts attention and true-believer adherents and generates lots of book sales and interviews on daytime TV.  People passionately argue about whether a diet low in carbohydrates or low in fat is best for weight loss.  But until now no large trial has ever been done to answer the...

Quitting smoking is probably the hardest thing I ask my patients to do.  (Losing weight is probably the second hardest.)  Smoking is a profound addiction.  Smoking feels good, and countless smokers have told me the calming pleasure they get from a cigarette. Despite the health risks and financial costs associated with smoking, medications aimed at helping smokers quit have been only modestly succ...

Our modern hyper-efficient means of producing, processing and distributing food has made hunger virtually extinct in the developed world. (In fact obesity is a much more pressing problem.) But our modern food production network is revealing an increasingly dangerous cost. Because food from any one farm or any one plant is frequently distributed nationally or even internationally, contamination wit...

The good news about this flu season is that so far, both nationally and in California, it has been a mild one, with a relatively small number of people infected.  The weekly trends are still increasing, so the worst is still ahead of us. The bad news is that one of the major strains of the flu virus this season is resistant to Tamiflu, the most frequently prescribed and safest anti-flu medicine. ...