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Having a sick child is never easy. But if your child has to be sick, hope for something mechanical: a broken bone, a gash that needs stitches—something that can be physically mended. Failing that, wish for something commonplace. Chickenpox, a bladder infection, bronchitis. Doctors can manage these things with their eyes closed. If pushed, consider the merits of illnesses that are at least well understood—illnesses that can be definitively diagnosed and have generally agreed-upon courses of treatment. What you least want is something obscure, something not yet well characterized—and least of all, something both obscure and pertaining to the mind.
Diabetes-related peripheral arterial disease is rapidly overtaking trauma as the leading cause of amputation, a trend made all the more horrifying by the racial disparity in amputations and the way in which lack of access to quality primary care converts treatable PAD into amputations.
The Cut [NYMag] speaks to seven doctors who practiced on the cusp of Roe. Many are still practicing. [more inside]
Today, respected medical medical journal Annals of Internal Medicine published a short, anonymous account called "Our Family Secrets" of two different sexual assaults (or, in the journal's words, situations with "overtones" of sexual assault) by surgeons on their unconscious patients. (trigger warning for sexual assault and misogyny) [more inside]
"House calls, which accounted for 40% of all doctor visits in 1930, dwindled to less than 1% by 1980 as physicians found it far more efficient to see 20 or 30 patients a day in an office than just a handful in their homes. But in-home care is starting to be seen as cost-efficient again—particularly for the most expensive patients." [SLWSJ]
In memoriam: Dr. Michael Davidson, cardiac surgeon, killed while doing a job he loved. A reflection on bad outcomes versus mistakes and taking risks versus playing it safe.
It's easy to break a patient like Rogelio—Mexican and poor and chronically ill—down to his potassium level and to make medical decisions according to a number. But that's only part of the story of how the undocumented ill are cared for here in Houston. Within this city's history—a history that includes segregation during the 1960s, a large immigrant population, strong economic growth over the past half century, not to mention the world's largest medical center—is the story of how Houston sought local solutions to provide compassionate care to its indigent and undocumented, the latter of which, some might say, have helped the city grow.Dr. Ricardo Nuila reports from the emergency room at Houston's Ben Taub Hospital, where Harris County's undocumented ill can avail themselves of some of the country's best health care: Taking Care of Our Own. [more inside]
Since 2006, Alice Proujansky has photographed childbirths around the world for a project entitled 'Birth Culture.' Her intent is to highlight 'the universal aspects of childbirth, elements that are culturally-specific and the struggle to provide women with safe, respectful maternity care.' Images: Photographer's site. NYTimes Gallery. Agnostica. Slate. Some photos may be NSFW.
A timeline of diseases and vaccines [warning: graphic photo of cutaneous diphtheria at year 1975]. Categories are: diphtheria, measles, polio, smallpox, yellow fever, and 'others'. You can select one keyword to view only that subject's timeline. From the History of Vaccines website (about page | FAQ). Similar timelines at the same site for pioneers, science and society, and there's an En Español timeline, too. [more inside]
"If an NHS trust proposed today that it was going to introduce Viagra sales reps into men's genitourinary wards, or reps for walking aids to orthopaedic wards, the very least you'd expect would be some stout resistance. It is a measure of the strength of the association between "motherhood" and "buying stuff" that the presence of commercial representatives on maternity wards has been tolerated for so long."[more inside]
On Breaking One's Neck. Dr. Arnold Relman, former Editor in Chief of the New England Journal of Medicine, gives a first-hand account of a catastrophic accident, intensive care, and rehabilitation--as a patient. I am a senior physician with over six decades of experience who has observed his share of critical illness--but only from the doctor's perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.
In the Shadows. The healthcare and human rights challenges of the LGBT populations of Malawi -- where homosexuality is outlawed. Via
The Rising Cost of Cancer Drugs: "New drugs could extend cancer patients’ lives—by days. At a cost of thousands and thousands of dollars. Prompting some doctors to refuse to use them."
More than half the population of small, rural Madras, Oregon (population: ~6059) and its surrounding community is served by one clinic: Madras Medical. At the beginning of 2006, the clinic's doctors and nurses decided to ban pharmaceutical reps from visiting their practice. No more free lunches. No more free drug samples. No more gifts. And yet.... "It's made us better doctors." (Via) [more inside]
How to Charge $546 for Six Liters of Saltwater - a brief story of the humble bag of saline solution given intravenously at ERs and hospitals, and how one unit of it can be marked up from 86 cents to $91 when given to patients
John Green: "Why Are Americans Health Care Costs So High?" A quick, handy little overview of common misconceptions on the US healthcare system. (SLYT)
Because of nationwide shortages, Washington hospitals are rationing, hoarding, and bartering critical nutrients premature babies and other patients need to survive. Doctors are reporting conditions normally seen only in developing countries, and there have been deaths. How could this be allowed to happen?[more inside]
"India's supreme court has ruled against Swiss drug giant Novartis in a landmark case that activists say will protect access to cheap generic drugs in developing nations." [more inside]
Bitter Pill: Why Medical Bills Are Killing Us. Summary: Inside the Cover Story. Related video: The Exorbitant Prices of Health Care [more inside]
Two-year-old Emma wanted to play with blocks, but a condition called arthrogryposis meant she couldn't move her arms. So researchers at a Delaware hospital 3D printed a durable custom exoskeleton with the tiny, lightweight parts she needed.
In less than an hour, the Supreme Court will hand down its final judgment in what has become one of the most crucial legal battles of our time: the constitutionality of President Obama's landmark health care reform law. The product of a strict party line vote following a
year century of debate, disinformation, and tense legislative wrangling, the Affordable Care Act would (among other popular reforms) require all Americans to buy insurance coverage by 2014, broadening the risk pool for the benefit of those with pre-existing conditions.
The fate of this "individual mandate," bitterly opposed by Republicans despite its similarity to past plans touted by conservatives (including presidential contender Mitt Romney) is the central question facing the justices today. If the conservative majority takes the dramatic step of striking down the mandate, the law will be toothless, and in danger of wholesale reversal, rendering millions uninsured, dealing a crippling blow to the president's re-election hopes, and possibly endangering the federal regulatory state.
But despite the pessimism of bettors, some believe the Court will demur, wary of damaging its already-fragile reputation with another partisan 5-4 decision. But those who know don't talk, and those who talk don't know. Watch the SCOTUSblog liveblog for updates, Q&A, and analysis as the truth finally comes out shortly after 10 a.m. EST.
Choosing Wisely encourages physicians and patients to discuss whether certain medical tests and procedures are unnecessary, especially those that can cause harm. The site offers nine lists of Five Things Physicians and Patients Should Question about the most appropriate care for a patient, including lists for cardiology and oncology. [more inside]
This morning marked day two of marathon proceedings in what's likely the most momentous and politically-charged Supreme Court case since Bush v. Gore: the effort to strike down President Obama's landmark health care reform law. While yesterday was a sleepy affair of obscure technical debate, today's hearings targeted the heart of the law -- the individual mandate that requires most Americans to purchase insurance by 2014. With lower courts delivering a split decision before today, administration lawyers held some hope that at least one conservative justice could be persuaded to uphold the provision, which amortizes the risk that makes universal coverage possible. But after a day of deeply skeptical questioning by swing justice Anthony Kennedy and his fellow conservatives [transcript - audio], the mandate looks to be in grave trouble, with CNN legal analyst Jeffrey Toobin going as far as calling the day "a train wreck" for the administration. But it's far from a done deal, with a third day of hearings tomorrow and a final decision not expected until June.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.How Doctors Die.
Hesperian is a non-profit publisher of books and newsletters for community-based health care, mostly aimed at the third world. Their first book, Where There Is No Doctor, A Village Health Handbook, has been translated into 88 languages and is one of the most widely used training and work manuals for community health care in the world. They have now made 20 of their publications available for free download, many of which can now also be browsed online through their website using an "Ebrary" in-browser interface. [more inside]
The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need. - Atul Gawande’s commencement address at Harvard Medical School.
Obstetricians and gynecologists are meeting the increased demand for cosmetic vaginal surgery (NSFW)
Progesterone caproate injections have been used to reduce the likelihood of premature births in at-risk pregnant women for years. Up until now, the drug was custom-compounded by wholesale and specialist pharmacies, legally, but without federal approval. These injections cost between $5 and $15 a dose and were regularly reimbursed by insurance companies and Medicaid. Last month, the FDA announced their approval of a commercially produced version of the compound, to be marketed under the brand name Makena by a company called KV Pharmaceuticals. No stranger to controversy and trouble, KV barely survived a rash round of layoffs and wrongful termination lawsuits. Their former chief executive now faces criminal charges surrounding the company's failure to notify the FDA that they were producing oversized morphine tablets. (He could also do for a shave, it appears.) Now, KV has announced that the new drug will be available at a cost of $1,500 per dose, bringing the total pregnancy term cost of treatment to $25,000-$30,000, from its former cost of $250-$300, a 100-fold increase—but it gets worse... [more inside]
The Hot Spotters examines the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them. — by Atul Gawande [more inside]
Although the Stupak amendment was defeated, women in the new high risk pools will be denied coverage for abortion. The "clarification" from the administration comes in the wake of a scuffle over Pennsylvania's plan to provide abortion coverage. Hopefully, building criticism will have an effect.
Dirty Medicine — How medical supply behemoths stick it to the little guy, making America’s health care system more dangerous and expensive. [more inside]
What US Health Care Needs Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. (via)
Atul Gawande offers a way for health care to be improved through experimentation and pilot programs, much as agriculture was in 20th century
The Deadly Cost of Swooping In to Save a Life (single-page version): Deregulation and America's health care system combine to make medical helicopters increasingly dangerous.
How American Health Care Killed My Father After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem. (via mr) [more inside]
A simple question shows how complex the issue is. Chris at "Cynical C" asks his fellow citizens where they get thier health care (insurance) from and the incredible diversity of the current options and situations is immediately apparent. Quite spontaneously (but surely not unexpectedly), the question of "How much does it cost you?" becomes an essential part of the answers. Outsiders opine and tell stories and commiserate. [more inside]
The Cost Conundrum: What a Texas town can teach us about health care. Via Musings of a Distractible Mind.
Search for an Rx - We asked Johns Hopkins administrators, physicians, and researchers about the health of a system Americans rely on to keep them healthy. Afterall, an ounce of prevention... [more inside]
What's wrong with primary care in the US? With a new survey suggesting that nearly half of all primary care physicians would leave medicine if they had a viable alternative, and with American medical schools not generating nearly enough new doctors going into primary care, in this, their first issue to hit doctors' desks since the election, the New England Journal of Medicine has devoted their entire editorial section to exploring yet another challenge that threatens the stability of the US health care system. Video of the roundtable discussion. Individual essays, at times touching, at times hopeful, from various primary care perspectives in the US and Britain. [more inside]
Two years since Massachusetts instituted major statewide healthcare reform, the statistics are coming in. 340,000 residents, roughly half the state's previously uninsured, are now insured. The state says that 95% of its population is now covered, based on Department of Revenue estimates. However, a large portion of them are enrolled through state-subsidized insurance programs, and those program's rate of enrollment have far outpaced estimates. This has led lawmakers to forsee a budget shortfall. Premiums and co-pays are going up, cigarette taxes have increased, and a cost control proposal is making its way through the legislature. Assessments have been all over the map.
An analysis of the medical care provided to the family of Homer J. Simpson from the Canadian Medical Association Journal.
Sick Around the World, the newest documentary piece produced by PBS's Frontline asks: "Can the U.S. learn anything from the rest of the world about how to run a health care system?" Having previously shared a Pulitzer Prize with The New York Times, and produced such quality programs as Bush's War, this should be well worth a mere hour of your time.
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