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Category: topical debates

opinions and musings on topical subjects. let’s clear the air

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Why Your Doctor Is Either Depressed or Retiring

Why Your Doctor Is Either Depressed or Retiring

Why Your Doctor Is Burned Out or Retiring There is a growing litany of acronyms and alphabet soup organizations and algorithms that are designed to confuse, obfuscate and subordinate physician discretionary thinking. Funneling physician thinking into more pre-defined and standardized patterns. With the notion that these patterns are always superior, more efficient and accurate.  More than traditional physician discretionary thought, observation and formulation of diagnosis and treatment plans. This dizzying array is one of the many reasons why virtually every…

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Statins: A Critical Appraisal

Statins: A Critical Appraisal

You can find a number of well written books with articulate statistical analyses over the years questioning the results of statin therapy.   What is the true value and efficacy of statins (HMG-CoA reductase inhibitors) in treating and preventing heart disease?   The statistics can be overwhelming.   What is the real risk benefit ratio? Lipids and the Emergence of Statin Therapy Lipid research actually started sometime in the early 1920’s.   It gained more momentum in the 1950’s with John Gofman at the…

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Let’s Revolutionize Prostate Cancer

Let’s Revolutionize Prostate Cancer

A New Approach to Prostate Cancer It is time.  We need to rationally approach prostate cancer with new tools.  Imaging first — biopsy last. In 2004 Dr. Thomas Stamey, Chief of Urology at Stanford, published a seminal article, heralding the end of the PSA era.  He was known as the “the father of the PSA.”  This was not greeted with great applause.  He concluded that PSA testing was not an accurate measure of prostate cancer.  In subsequent years, he has…

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Health Care: The Day After

Health Care: The Day After

The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it. — Michael Moore

Health Reform: PostMortem Coda

Health Reform: PostMortem Coda

My take on why we saw the thrilla in … Massachusetts: From Inside Washington, Nina Totenberg encapsulated it best.   The economy and job prospects dwarf all other issues. If we had 5 percent unemployment, he probably would have gotten the plan through.  But you can’t refocus people’s attention on an aspirational goal for a society — I think it’s very difficult to do that — when people are hurting so much in the immediate sense and businesses are going down…

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Trying to Please Everyone and No One – part 2

Trying to Please Everyone and No One – part 2

Where is this train wreck headed?  Wending its way through the various Senate and House subcommittees, the health care reform debate of 2009 is approaching a crescendo.    What do we have to show?   The question I posed in a previous post still has yet to be answered – just what is the problem?  Is the problem greater access?  Is the problem escalating insurance premiums?  Is the problem stratospheric and ruinous hospitalization bills?  Is the problem rapidly declining quality of care? …

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Healthcare Focus: Quality or Quantity

Healthcare Focus: Quality or Quantity

What is the message?    What do you want? The World Health Organization definition of health has not changed since 1949.  We were asked this the first day of medical school.  No one answered correctly: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Political strategists play with focus groups to achieve Machiavellian goals.  Issues can be framed positively or negatively.  In a recent series of  soundbites with Republican and…

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Political Health Endgame: You Deserve Better Solutions

Political Health Endgame: You Deserve Better Solutions

Post-war Britain, and Londoners in particular, had suffered mightily after two years of punishing aerial bombardment.  The East End of London had been reduced to rubble. Winston Churchill, arguably the greatest leader and politician of the 20th century, was turned out of office.  A new day dawned.  Anuerin Nye Bevin, a “firebrand” Socialist, was determined to remake the British health care system.  On July 5, 1948 he became the first Minister of Health.   Out of his uncompromising efforts was born…

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change the metaphor

change the metaphor

Joseph Campbell first offered this sage aphorism: “If you want to change the world, you have to change the metaphor.” – Joseph Campbell The president subtly changed the metaphor this morning in a major financial address.  Instead of the phrase health care reform he used the phrase health insurance reform.  Ah , now we are framing the right debate. Was this metaphorical or strategic? We have argued for months now that this is not about health care reform.  Want real…

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… Waiting for Merlin

… Waiting for Merlin

And now we wait for the speech of a lifetime.  The make or break — defining speech.  We wish this unreal set of expectations on no one. Medicare for all? Let me renew this debate with trilogy of  blogs over the next week.    First with a set of charts and diagrams laying the foundation for the daunting statistics that face us. First consider this simple chart plotting the inexorable rise in yearly total health care expenditures from 1960 to 2016 …

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