Prolonged immobility has long been known to increase the risk of blood clots forming in veins in the legs (the medical term for which is deep venous thrombosis). Blood clots in the legs can be quite painful and debilitating but they can also travel to the lungs which can be life threatening. So doctors use medicines or inflatable leg squeezing devices to prevent blood clots in hospitalized patients who are bed-bound. But there is a much more common time when we all are fairly immobilized – tr...
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The Healthcare Meltdown – Part I
How Insurance Works
For many families healthcare is increasingly expensive while simultaneously increasingly mediocre. A recent study in the American Journal of Medicine found that two thirds of bankruptcies were due in part to medical expenses, and surprisingly, over three quarters of the individuals going bankrupt had health insurance. There is no denying that the American healthcare marketplace is broken. The problem for many of us is that we don’t know enough hi...
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Angst about Acetaminophen
When many of us get a headache, a fever, or just suffer the aches and pains of physical exertion we don’t think twice about reaching for an over-the-counter pain reliever. Acetaminophen, which is the medicine in the well-known brand Tylenol, has long been considered the safest pain medication. Non-steroidal anti-inflammatory medications (NSAIDs) can cause stomach irritation and ulcers and can decrease kidney function. Opiates (morphine and its relatives) can cause drowsiness, constipation and...
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Torpedoing Primary Care
For the last few years the future of primary care has been looking bleak. Fewer and fewer medical students are choosing primary care careers, just as baby-boomers retire and will need more care. Primary care physicians meanwhile are retiring early or cutting back their practices at record numbers, worsening the coming shortage.
The current issue of the Annals of Internal Medicine publishes a perspective article by Dr. David Norenberg that heaps on the gloom. Describing himself as cl...
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Folic Acid: Fabulous for Fertile Females, Feckless for Fellows
Folic acid, a vitamin found naturally in green leafy vegetables and legumes, is essential for making the building blocks of DNA. And since copying DNA is an important part of what cells do before they divide, it’s critical for cell division. Developing fetuses have very rapidly dividing cells, so it’s not surprising that folic acid deficiency has been linked to birth defects, specifically brain and spinal cord abnormalities.
To prevent these birth defects, physicians for many...
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Vaccine Refusal: Turning Back Two Centuries of Progress
Vaccines have become a victim of their own success. In 1809 Massachusetts became the first state to pass a law requiring a vaccination – of smallpox – ushering a series of public health victories over a number of serious diseases. In the past 200 years smallpox has been eradicated, and measles, polio, rubella and tetanus have become so rare that they have disappeared from public consciousness.
The number of children who contract vaccine-preventable diseases today is tiny compared to the numbe...
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What We Don’t Know About Diabetes – Part 3
In the last year I’ve written about a major change in our understanding of diabetes treatment. The goals of treatment used to be to get blood glucose as close to normal non-diabetic levels as possible. That usually meant increasing medication doses or adding additional medications until the glycated hemoglobin was down to normal. (Glycated hemoglobin, or hemoglobin A1c, is a blood test that measures an average of blood glucose over the previous 3 months.) Targeting normal glycated hemoglobin...
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Pay for Performance: Peril for Patients
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 patients as they can, but not to treat them well.
There is now a major drive by policy makers for ...
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How to Break an Already Dysfunctional Marketplace
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 adoption of EHRs by physicians. Well, it turns out hospitals are no better. A study in this week’s
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Screening for Prostate Cancer May Harm More than Help
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 controversy about prostate cancer screening is that prostate cancer is a very slowly growing cancer which us...
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