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Health and Human Services announces push to end fee-for-service payments for...
On January 26, 2015, the department of Health and Human Services (HHS) reported plans for a sustained effort to end "fee for service" in medical care. Fee for service is a model of payment we are all...
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Vaccinations, measles outbreak and reasonable and civil discourse
Lately there has been an outbreak of measles, a vaccine preventable disease, along with an outbreak of people yelling at each other. There have been angry exchanges between people who would like all...
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Nursing homes: what are we paying for and what are the alternatives?
The US population is getting older. There are about 9 million Americans who are over the age of 80 and about half of them need some kind of help in the activities of daily life. About 1.3 million...
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Chronic obstructive pulmonary disease (COPD) exacerbations and respiratory...
We're having a curtailed winter and early spring here in the inland northwest, or so it seems. We could still get a snowstorm or two, but the crocuses are blooming and the redwing blackbirds are...
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Practical Emergency Airway Management--human factors in response to medical...
Physicians need to complete about 50 hours of some kind of continuing medical education (CME) every year. The ideal kind of class is one that we actually attend in person, with teachers who are expert...
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American Board of Internal Medicine Maintenance of Certification firestorm:...
About 2 years ago I finished the process of recertifying for the American Board of Internal Medicine. I had last done this in 1990 and had a time unlimited certification, but had heard that...
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Crazy idea: take blood pressure like the pros, and teach patients to meditate.
I recently read a discussion by 3 hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat "resistant hypertension." Resistant hypertension is blood pressure that...
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Preventive Medicine: on being a "bad patient" (Readers beware: this is the...
I am, or will be, a "bad patient." The "good patient" accepts advice gracefully. The "bad patient" may not be a bad person, but does not play the part of the patient well. The word patient comes from...
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Reducing variability in healthcare delivery--maybe not such a great idea
I just got back from the annual meeting of the American College of Physicians, an organization of internal medicine physicians with about 140,000 members. In the annual meetings organizational things...
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Doctors of tomorrow: please forgive us for thinking that it was a great idea...
Lately I've had the opportunity to work in an outpatient clinic where the regular doctor is out sick for a prolonged period of time. It is a breathtakingly beautiful little community, with green hills...
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More on the epidemic of prescription opiate use and abuse
Facts (from the Centers for Disease Control Health report, 2013) :The consumption of opioid pain medications (like morphine, hydrocodone an oxycodone) increased 300% between 1999 and 2010.The death...
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Actinic Keratoses and Carac (fluorouracil) cream: why is this so expensive?
First, a disclaimer: I don't know why Carac (0.5% flourouracil cream) is so expensive. I will speculate, though, at the very end of this blog.Sun and the skin: what happensIf a person reaches a certain...
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Ultrasound in Tanzania--the gift that keeps giving
Another great trip! I have gotten to go with University of California at Irvine medical students to Tanzania for three years as their supervising MD. They do all of the work, pretty much, preparing...
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Drug company funded research in the New England Journal of Medicine: this...
Today I thought I'd read the New England Journal of Medicine (NEJM) and learn something deeply meaningful. I usually love the New England Journal (Wikipedia says it is "among the most prestigious...
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Another rant about how drug companies are not acting for the common good
A few weeks ago I was feeling angry and disappointed when I noticed that many of the articles I was reading in my favorite medical journal were funded by companies who made the products those articles...
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Medicare Part D--the insurance plan to cover medication for seniors: has it...
In 2003 the Medicare Modernization Act added a prescription drug plan to the benefits available to seniors and disabled adults. The act did a few other things, including introducing health savings...
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Marketing medicine and the treatment of high blood pressure
I just read a disturbing article about a recently completed study on treating high blood pressure. The SPRINT (systolic blood pressure intervention) trial was conducted at around 100 locations in the...
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Medical bills: why are these completely inscrutable and full of mistakes?
Within the last two days I received a bill for my glasses and read a post by a friend ranting about medical billing mistakes. This is a huge problem that is so common that it could be considered the...
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Repatha and Praluent: VERY expensive drugs to lower cholesterol which may not...
In July of 2015 the US Food and Drug Administration (FDA) approved an injectable monoclonal antibody alirocumab (Praluent) which lowers the LDL or "bad cholesterol". The drug is produced by Regeneron,...
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How can we start coming up with new therapies that actually save money?
In the United States, biomedical research, including basic science and clinical studies, is paid for mainly by companies that expect to make money off of new discoveries. The government, through the...
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