Paging Dr. Gupta: The Anti-Vaccine Crowd is Calling

Should Dr. Gupta stimulate conversation around a controversial topic (vaccinations), or should he share what he knows (or should know) about the data?

The heated commentary sure increases hits.

Medicare Will Pay for "Heart Scans"! WTF?

You've got to be fucking kidding me.

Medicare has agreed to pay for heart imaging studies?

What the fuck?

Let's not pay for things for which there is clear evidence (or at least not pay adequately for them), and let's pay for cardiac imaging, for which there has been no clear impact on morbidity and mortality.

It looks like the American College of Cardiology and the American College of Radiology (along with a number of pseudo-organizations, such as the Society of Cardiovascular Computed Tomography) are our heroes here.

Of course, the rest of us know that they're behind this because it leads to more interventional cardiology procedures. One can never do enough stenting, you know...

In the meantime CVT surgeons are getting screwed, despite the fact that they've got a superior intervention....and the folks that are behind aggressive medical management are REALLY screwed.

This decision so perfectly demonstrates why complete anarchy is necessary to reform our health system. The whole fucking thing needs to be blown up:

• Incentives are skewed to benefit the high-tech proceduralists, independent of evidence.
• The average person is brainwashed to believe that they need these things.
• People get things that they don't need, and they get hurt.
• The system pays for the complications.
• There's little money left for the physicians that do the work to lower costs and improve outcomes for the system.
• Medicare's decision here leads to unnecessary testing and intervention, and thus more intervention without benefit.

How can it be possible to have true health care reform without saying 'no' to some things???

Healthy, Nurtured Kids Lead to Less Crime

Great posts from Health Beat:

Part I and Part II.

Here's the deal. Keep kids physically and mentally healthy, and they're less likely to commit crimes as adults.

"I'm Not Fat, I'm Just Big-Boned"

Guess what?

Cut down on TV and computer use, and your "big-boned" kids will magically be right-sized.

McCain Believes Vaccines Cause Autism! WTF??

And by the way, he thinks the world is flat too.

Vaccines absolutely do not cause autism, you frickin' moron!

More Expensive Pills Work Better, Right?

This MIT study suggests that a placebo at $2.50 per pill relieves pain better than one priced at $0.10 per pill.

Incidentally, it looks like the same is true for wine--the same wine priced more expensively tastes better.

My ass hurts just thinking about the larger macroeconomic consequences of this conclusion.

Good luck explaining cost effectiveness to these folks.

Why Winter is Flu Season

Even docs wonder about the reasons why flu season takes place in the winter.

Personally, I think there are a number of reasons. This recent study adds to the list.

Cool stuff.

(Think M&M's.)

Dumb Ass Thinks We Shouldn't Vaccinate Against Influenza

The problem with the mainstream media is that it's so fucking biased.

I'm glad people are reading. I'm pissed off as hell that the media is feeding information that leads people to make bad choices.

Health Punk spanks someone on ABC's reader comments.

Who Needs Evidence? There's Money to be Made!

Look at this irresponsible campaign recommending that people demand a CT scan.

Bullshit, bullshit, bullshit.

It's enough that this racks up waste and cost in the system. In fact this does actually does harm!

Shame on the oncologists that support this...but then again, since when is oncology evidence-based? There's money to be made!

Flu Shots and Autism? Dumb Asses.

People are so frickin' stupid sometimes.

The CDC recommends flu shots for all kids now.

This story says that parents disagree.

The reasons are bullshit, by the way. Let me clear this up:

• Vaccination does not cause autism (and "Dr. Bryan Jepsen" can't be a real physician--nor an autism expert--base on his suggestion--quackery in mainstream media).
• The vaccination isn't just about protecting kids (the pediatrician interviewed doesn't seem to get this fact either)--it's about preventing it from spreading to the high-risk groups (the elderly, those with chronic diseases, the immunocompromised, etc.) for whom it really is deadly on a wide-scale basis. A great example of selfishness ("it's all about me") in our society.

Suckered by the "Popes of Cardiology"--LDL is Bullshit?

Have we been suckered by the "Popes of Cardiology" (who have also made a bundle of cash in the process)?

Could it really be true that LDL cholesterol is bullshit? That LDL values should be ignored?

I just read two kick-ass posts from Maggie Mahar at Health Beat.

Check out The Cholesterol Con Part I and Part II.

I Love to Menstruate, Don't You?

Check out Annuale, the new oral contraceptive that allows for once-a-year menstruation.

Homeopathy is a Fraud...Like Cures Like? WTF?!!

Homeopathy can't cure HIV.

It's a shame that insufficient access to legitimate care is leading people in Africa to seek care from homeopathy.

It's criminal, deceitful, and downright sinister.

(Homeopathy can't cure anything, by the way. It's all bullshit designed to milk money out of people when they are most desperate by relying on the placebo effect. Fuck them, and fuck everything they stand for, the unethical bastards).

Tying Pharma Rep Income to Outcomes?

Could it actually happen that pharmaceutical rep income will one day be tied to patient outcomes or health status within a territory?

Arrgh! Fuck the RUC!

More on this bitch of an organization from Kevin, M.D.

Read the full piece on the RUC in Family Practice Management here.

Do you think 5 caths (assuming they are actually necessary) should be equal to 80 99214's?

More Cardiac Arrest Deaths at Night & Weekends

You are 18% less likely to survive a cardiac arrest in a hospital if it occurs on a night or a weekend. Huh.

I'll make sure I don't.

Got Weed? ACP Statement on Medical Marijuana

The ACP made a pretty strong statement regarding its position on medical marijuana, and debunked a number of myths and misperceptions at the same time.

Happy Ending to OHRP Checklist Story

The "....ragtag band of committed clinicians and other quality improvers..." has made a difference in changing policy in the OHRP regarding the use of checklists....says Bob Wachter.


Blog on.

Raise hell.

Do something.

AMA Banned from Hearings: I Don't Care

Here's the deal.  The AMA has been banned from the hearings dealing with the impending 10.1% Medicare cuts will happen or not.  Apparently, they've just pissed people off.

I don't care.  I've always felt the AMA sucks ass, and that it could never adequately represent me and my colleagues.  In fact, if they were involved in these hearings, I still believe that they more strongly represent subspecialists.  

The AAFP and ACP got it covered, among a number of other good organizations.

With that said, I really hope they can achieve a complete formula fix instead of another patch. 

God help everyone on Medicare if they don't.

Does Preventive Care Save Money?

OK, the perspectives piece "Does Preventive Care Save Money? Health Economics and the Presidential Candidates" does raise an interesting question. 

In this case, the authors have raised the question based on the hypothesis that the statements and claims being made presidential candidates are perhaps a bit too broad.

Maybe.  I actually think this was a pretty crappy article overall...I get the point.  But it really trashes prevention in the areas where there are huge savings (brushing over the economic impact of some high-impact USPTF recommendations).  I also think it doesn't go far enough in telling the hard truth for docs and the public:

• Not all "screening tests" currently in use meet the criteria for ideal screening tests.  
• Screening tests should be use appropriately.  The authors say that "...screening costs will exceed the savings from avoided treatment in cases in which only a very small fraction of the population would have become ill in the absence of preventive measures."  Well, then, this doesn't quite meet the criteria for the ideal screening test.  The 80-year-old man doesn't need a PSA, and his wife doesn't need a pap smear.  Similarly, people shouldn't be ordering CA-125 tests for women to screen for ovarian cancer.  Strap on some balls, and tell your patient they don't need the tests.
• The public tends to think we have the ability to detect anything early and cheat death if it's caught early.  As a society, we need to get a grip on our mortality, and on what is and is not possible.
  
• The concierge physical market isn't doing any favors here.  Lots of high-cost tests without proven outcomes set the expectations for all patients that they need these things when, in fact, they may actually cause harm
  
• People need to be clear on the definitions of primary care and prevention.  Yes, prevention is part of what we do.  But it's not just prevention of heart disease, it's also prevention of the avoidable ER visit or hospitalization.  Access to primary care is clearly tied to reductions in these areas.
  
• Everyone is dancing around the fact that we'll have to ration resources more.  No, Mr. Johnson, you can't get a fucking MRI for your back given your symptoms.  And no, you can't fucking sue me for saying so.  (OK, so the candidates are just trying to get into office right now...but someone's got to be saying it!)

The authors actually provide some misleading information.  Although they didn't list the 279 preventive measures that they refer to, the authors do present some of the measures used in their tables.  The quality of some of the studies used for the analysis is really shoddy.  Take the "high" versus "low" intensity smoking relapse-prevention programs, for example.  The high intensity program sent 7 mailings to patients, while the low intensity approach sent one single booklet.  First of all, neither approach works that well!  If it were to be compared to a more effective approach (regular access with a primary care physician, support groups, etc.), I wonder if the results would be different.

And screening for medium chain acyl-coenzyme A dehydrogenase deficiency in newborns?  Since when is that a useful screening test worthy (in terms of ideal screening test criteria) of application to all patients?  I think the real issue here is that when it comes to babies, people have a real hard time rationing care (not to mention the medico-legal pressures).

It's not a horrible article.  It raises a point.  But don't fucking dance around the issues.  This is a perspectives piece, and some leeway is allowed.  We're not doing the public any service by sugar-coating the real issues.