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Showing posts from December, 2009

questioning everything: CT scans and cancer, coffee and diabetes

Computerized tomography, otherwise known as CT or Cat scanning, has imaged 70% of non-elderly adults in the last 3 years. The use of this technology has been steadily rising, and we now perform a total of over 19,500 CT scans per day in the US.CT scans use a computer to organize x-ray data in such a way as to produce pictures that resemble cross sections of the human body, complete with bones, brains and soft tissues, tumors and blood vessels. The pictures are truly marvelous and have revolutionized the way we diagnose disease, allowing us to know many things about the insides of a person without actually cutting them open. We can see if a tumor is present, has spread, if an aneurysm is bursting or if the excruciating pain in a person's belly and back is a kidney stone or pancreatitis. We can tell if a victim of trauma is bleeding internally or if a mysterious fever is caused by a well hidden abscess.In December's issue of the Archives of Internal Medicine, researchers from th…

mammogram screening, take 2

I finally read through the 3 articles in the Annals of Internal Medicine that addressed the new recommendations from the US Preventive Services Task Force (USPSTF) about the recommendations for mammogram screening and breast exams. These have led to angry reactions, mostly based on lack of information and lack of understanding of the science behind the recommendations.First of all, the USPSTF is far from the only organization to weigh in on screening recommendations. There are organizations such as the American Cancer Society, the American College of Obstetrics and Gynecology and various other official groups from various branches of medicine. The USPSTF is, however, the most evidence based of the groups, the least financially motivated, and the most conservative.The recommendations of the USPSTF are categorized according to how sure they are that they are right, and changes come after long discussion and detailed evaluation of the research and the opinions of other organizations. I…

missing the safety net

What if you graduated from high school, left home, got a job delivering pizza, and were critically injured in a motor vehicle accident?

What if you had a part time job at a big company, a house, a family and got cancer?

What if you lost your job and your 8 year old daughter got appendicitis?

In the United States there are systems that act as safety nets for situations such as these, but they are not self sufficient and are severely strained in their ability to provide services with the progressive loss in adequate insurance coverage, the floundering economy and the increasingly outrageous costs of various forms of medical care.

If you were the first guy, ejected from your Geo Metro when you were t-boned at an intersection by a drunk driver, you would be taken to an emergency room at any hospital, transported to a trauma center if necessary, and treated until you were on the mend by that hospital. If you were eligible for medicaid or medicare due to the severity of your disability the hosp…

How the conference on affordable health care went

There were nearly 30 people there, at a not much more than 40 bed hospital. This is unprecedented for a not-required noon meeting. There was food, but it wasn’t very good, so they were there for the content (or maybe they though the food would be better.)The radiologist talked about appropriate use of technology and reducing unnecessary testing. Primary care docs talked about ways to make the computerized medical record systems give information about costs. The pharmacist talked about how to find out good information about drug costs, and we discussed ways to educate docs in the hospital on alternatives to the most expensive medications. We discussed other methods for reducing pharmacy costs which will also have other health benefits (changing medications given by vein to ones given by mouth, for instance.) The hospital CEO was willing to commit to putting into practice a system that would promote cost transparency for providers and patients. We talked about shifting responsibilities…