Healthcare journalist Peggy Girshman writes her own eulogy

I’ve been a fan of Peggy Girshman’s science and healthcare writing for a long time, so it was with great sadness that I read about her death in March at the young age of 61.

But in tribute to her award-winning journalism career, which included long stints at both NPR and Kaiser Health News, she actually wrote her own eulogy!

She wanted to share a few simple lessons she had learned from her years on the job of reporting healthcare-related stories. Because they resonate with my own view that we need more health and less medicine, I wanted … Continue reading

“End of the Line” for medical guidelines

Knowledge is king

That’s the take home message from Professor (of pharmacy) James McCormack’s latest parody video, End of the Line, which takes a whack at healthcare’s increasingly pervasive and rigid medical guidelines.

 

If followed to the letter, these guidelines (often based on research funded by drug companies) would have everyone diagnosed with a disease and taking one or more medications. Medical guidelines may be great for the drug business, but not so much for individualized, patient-centric care and shared decision-making.

Chronic disease state guidelines (blood pressure/lipids/glucose/bone density) do not provide clinicians with

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Be informed – Shared decision-making

Shared decision-making makes better informed patients, and better informed patients use less health care.

…as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids.

Which lowers health care costs.

…a 2012 study…showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months.

[It’s] estimated that implementing shared decision making for just 11 procedures would

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Tips to cut back on medications

cut back on medicationsI don’t think anyone would be surprised to know that Americans are popping more pills than ever.

About 60% take at least one prescription medication. Even more take daily dietary supplements, herbal remedies or other over-the-counter drugs.

And the more drugs you take, the higher the risk of dangerous drug interactions.

A new study published this month in JAMA reports that close to 88% of older Americans over the age of 62 take at least one drug. Of those, the report estimates, 15% are at high risk of suffering from a major drug-drug interaction.

I read Dr. Richard Lehman’s response Continue reading

Electronic health records and medical mistakes

I just read a funny-not-funny post on the health care blog KevinMD: This doctor orders pregnancy tests on men. You’re probably doing it too

The author, a physician, laments that his hospital’s electronic health records system (EHR or EMR) makes it way too easy to make mistakes, such as ordering pregnancy tests on male patients.

Now this may sound funny to you, and I know the nurses love to read me the riot act when I do it, but truthfully this is no laughing matter.

As easy as it is to order a pregnancy test on a man, it is

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Vitamin D doesn’t help knee arthritis

A few years ago vitamin D was being touted as the latest and greatest miracle supplement. Low vitamin D levels were linked to all kinds of conditions—autoimmune diseases, heart disease, chronic pain, osteoporosis, some cancers, and more—so doctors started prescribing high-dose supplements.

Or people just bought vitamin D supplements at the store and dosed themselves. Sometimes way over the recommended upper limit of 4,000 IU/day.

Multiple research studies, however, have found little help from vitamin D supplements in treating or preventing most of these conditions.

Most recently is a well-done study out of Australia, published in last week’s Journal of Continue reading

Nexium and increased dementia risk

nexiumI’ve previously posted that Nexium and similar acid-reducing drugs, the PPIs (proton pump inhibitors), have been linked to an increased risk of heart attack .

Now, a new study has confirmed a connection between PPIs and dementia.

The patients receiving regular PPI medication…had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication…

The avoidance of PPI medication may prevent the development of dementia.

The study specifically looked at PPI use in patients age 75 and older, who are frequently taking several prescription medications.

This is an important study, because as the health news Continue reading

Decreasing the overuse of antibiotics

Finally some good news!

I’ve posted many times about the problems of over prescribing antibiotics. Not only does it increase health care costs, but patients are at risk of side effects from the antibiotics, and overuse of antibiotics leads to drug-resistant bacteria—a big concern for everybody.

Many times the patient insists on an antibiotic and the doctor complies; sometimes doctors just over prescribe out of habit.

But I just looked at the results of a study that revealed a relatively easy way to encourage physicians to prescribe fewer antibiotics—and it works!

For 18 months, 248 clinicians from 47

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“It’s Just Life”

The United States isn’t the only country that is burdened with too much medicine (and subsequent out-of-control health care costs).

I belong to a network of health care professionals around the world who are having a dialogue about overscreening, overdiagnosis, overtreatment, and what to do about it.

A physician from Spain shared this amusing YouTube video, “Así es la Vida” (It’s Just Life):

The subtitles are in English, but I had to translate for myself the words on the “prescription” box of medicine given to each patient:

No little pill can solve the reality Continue reading

Be informed – PSA screening tests

PSA stands for Prostate-Specific Antigen. It’s a blood test used to screen for prostate cancer.

Doctors used to recommend an annual PSA test for men over 40. But now we know that the PSA is not a good screening tool. It results in a high number of false positives, and not all forms of prostate cancer need to be treated.

Too many men have received unpleasant, expensive treatment they didn’t need.

In an excellent YouTube video, Dr. Mike Evans explains more:

In 2012 the United States Preventive Services Task Force (USPSTF) recommended against Continue reading

Overuse of CT scans is dangerous and expensive

I read two articles yesterday that complemented each other:

In Kaiser Health News (KHN) Heavy Use Of CT Scans Raises Concerns About Patients’ Exposure To Radiation

And on KevinMD two radiologists posted The financial costs of treating CT-induced cancer

Each underscores the fact that CT scans are significantly overused in American healthcare.

Although CT scans are an essential diagnostic tool, the Food and Drug Administration reports that an estimated 30 to 50 percent of imaging tests are believed to be medically unnecessary.

Considering we spend tens of billions of dollars every year on diagnostic imaging, that’s a lot of wasted … Continue reading

Antidepressants and autism

Women who take common antidepressants while pregnant have a slightly higher risk of their children developing autism, or autism spectrum disorder (ASD).

This study was just released by JAMA Pediatrics.

Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.

SSRIs, or selective serotonin reuptake inhibitors, include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva) and Sertraline (Zoloft).

They are by far the … Continue reading

Antibiotics still overprescribed

antibioticsThe overuse of antibiotics continues to be a big problem in this country, and do you know who doctors blame? The patients.

That’s right. Doctors know that antibiotics don’t work against the common viruses that cause colds, flu, coughs and sore throats, but many admit they prescribe them anyway when patients ask for them.

In a five or ten minute office visit, doctors don’t feel they have time to explain the difference between a virus and a bacteria, and how overuse of antibiotics causes the very real problem of antibiotic resistance. So they do what’s easiest, fastest, and results in … Continue reading

Sad but true – CYA medicine works

A few months ago I posted about CYA—Cover Your Ass—medicine being one reason why too many diagnostic tests are ordered and health care costs are high.

CYA medicine is when the doctor or doctors are pretty sure what your problem is, but they order extra scans and x-rays and blood tests anyway because “failure to diagnose” is one of the leading causes of medical malpractice suits. They aren’t going to take any chances, and who can blame them?

Related story from KevinMD: This is why doctors practice cover your ass medicine

Besides, they don’t pay your resulting medical bill, so … Continue reading

Direct-to-consumer advertising

I was watching Game 5 of the World Series this weekend (go Royals!) and I couldn’t help but notice all the ads for prescription meds—Belsomra, Cialis, Lyrica, Cymbalta and Symbicort to name but a few.

Direct-to-consumer advertising has been legal since 1997. There is no doubt in my mind it has contributed to the over-prescribing of medications in this country, as well as our skyrocketing health care costs.

Anyway, watching all those commercials made me want to repost this hilarious video from Consumers Union: The Drugs I Need. 

Did you check out the fine print … Continue reading