Confused by mammogram guidelines?

October is Breast Cancer Awareness Month, so I can’t let it pass without commenting on the American Cancer Society’s (ACS) recently updated screening mammogram guidelines.

Before, the ACS recommended annual mammograms starting at age 40.

Now they recommend annual mammograms for ages 45 to 54, with screening mammograms done every other year after age 55.

But, they add, women should still have the choice to start screening at age 40 and have yearly mammograms thereafter.

The confusion arises not only because the ACS is a bit wishy washy on its guidelines, but because the American College of Obstetricians and Gynecologists … Continue reading

The overuse of antidepressants

I know so many people taking antidepressants. And they talk about it quite openly, with me and with each other.

“What are you taking? Zoloft? Oh, I tried that but didn’t like it. Celexa works better for me.”

I’m sure none of these people went to his or her (mostly her) doctor and got a prescription for no reason whatsoever. But it’s pretty hard to deny that antidepressant use in this country has skyrocketed over the last two decades, which begs the question: Is everyone really that depressed?

No. A recent study in The Journal of Clinical Psychology looked at Continue reading

Patients need “Choosing Wisely”

I’ve written several posts about Choosing Wisely, an initiative launched in 2012 by the American Board of Internal Medicine (ABIM) with the mission of decreasing the use of unnecessary health care.

Overuse of diagnostic tests, screening tests, surgeries and drugs is rampant in our health care culture, and it’s costing billions of dollars every year, not to mention that some patients are actually harmed by overtreatment.

It’s a noble goal, but the burden is on the consumer—the patient—to read and use Choosing Wisely’s lists of  inappropriate treatments because a recent analysis shows that physicians are not paying enough attention … Continue reading

Is it wise to remove wisdom teeth?

I participate in a world-wide group of health care providers that exchanges information about the high costs of health care and overtreatment in our respective countries. (It’s not just an American problem!)

One provider recently shared for our consideration a paper that stated too many third molars (aka wisdom teeth) were being unnecessarily removed in the US.

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion.

In addition, more than 11 million patient days of “standard discomfort or disability”—pain, swelling, bruising, and

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Overuse of antipsychotics in teenagers

I read a disturbing bit of news a couple of weeks ago: Antipsychotic use rising among teens and young adults.

A growing number of teens and young adults are being prescribed antipsychotics, a new study suggests.

In particular, it appears they’re being used to treat attention deficit and hyperactivity disorder (ADHD) – a condition for which the powerful drugs are not approved.

The study mentioned was recently published in the medical journal JAMA Psychiatry.

Antipsychotics include such heavily-marketed drugs as Abilify (aripiprazole), Risperdal (risperidone), Seroquel (quetiapine) and Zyprexa (olanzapine).

Related posts:

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Cover your a** health care

“Cover-your-ass health care” or “save-my-ass medicine” are terms used to describe all the extra diagnostic tests (blood tests, CT scans, MRIs, etc.) ordered by physicians to rule out possible (but unlikely) life-threatening conditions.

Such as going to the emergency department with a headache and getting a CT scan to rule out an aneurysm or a brain tumor.

Or, as in this video example, being worked up for a heart attack when the most likely diagnosis is a simple case of heartburn. (Warning: video contains some bad language!)

The ER physician in the video is certainly … Continue reading

Nexium (esomeprazole) and heart attack risk

nexium esomeprazoleLast month a medical journal published a study out of Stanford that links the use of Nexium (esomeprazole) and other proton pump inhibitors (PPIs) with an increased risk of heart attack.

This is another study that used “big data”—the information from thousands (if not millions) of patients’ electronic health records—to identify risks from drugs and other medical treatments.

Nexium, or “the Purple Pill”, is widely prescribed to treat heartburn and gastroesophogeal reflux disease (GERD). Other commonly used PPIs include Prevacid (lansoprazole) and Prilosec (omeprazole). These drugs are also readily available over-the-counter, and are heavily marketed to the general population.… Continue reading

Too much vitamin B12

Last weekend my husband participated in a golf tournament. It was sponsored by Costco, and each player received a swag bag of Costco merchandise.

When he got home, my husband and I took a look at his “gifts.” I couldn’t help but laugh.

  • OptiFiber Natural Fiber Supplement
  • Body & Soul My Vision Health Eye Vitamins
  • Natrol Fast Dissolve Melatonin
  • Focus Factor Brain Health Supplement
  • Testosterone Support For Men Supplement
  • Slice of Life Energy Boost Gummy Vitamins With B12
  • ZipFizz Healthy Energy Drink Mix With Vitamin B12
  • Oh, and some golf balls and tees

The organizers of that tournament knew their … Continue reading

Cancer doctor’s fraud sends him to prison

A few weeks ago I wrote a post about Dr. Farid Fata, the Michigan oncologist who has been on trial for bilking millions of dollars out of Medicare and other insurance companies.

Worse than the fraud is that he actually falsely diagnosed patients with cancer and/or treated them unnecessarily with expensive, harmful chemotherapy drugs.

The good news is that he has been sentenced to 45 years in a federal prison.

U.S. District Judge Paul Borman this week heard stories of brittle bones and fried organs as patients chillingly described the effects of excessive chemotherapy at the hands of Dr. Farid

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Palliative care and hospice

hospice and palliative careFor the last few months, my family has been dealing with the reality that my 93-year-old father’s health is failing. Following a health crisis that resulted in his being hospitalized and no longer able to make decisions himself, my mother and siblings all agreed that he would not want any heroic, life-extending treatments.

He survived that hospitalization, however, and is now living in a memory care home. He is receiving excellent (and very expensive) around-the-clock care.

When he was discharged from the hospital, I made it known to everyone involved—his primary care doctor, the visiting home health nurse, and his … Continue reading

A horrific story of cancer treatment fraud

July 14—an update to this story: Cancer doctor’s fraud sends him to prison 

I read a news story out of Michigan yesterday that almost made me literally sick:

Whistle-blower: How doctor uncovered nightmare; Oncologist’s discovery leads to the downfall of a cancer treatment empire

[Dr. Farid] Fata’s Michigan Hematology and Oncology Inc. (MHO) was the state’s largest private cancer practice in 2013, with clinics in seven cities, its own pharmacy and diagnostic center, and 1,700 patients, virtually all of them assigned to Fata, the tireless physician. Those who needed proof of Fata’s dedication could look to the doctor’s work ethic

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A routine urinalysis is unnecessary

This week the National Kidney Foundation (NKF) started a public health campaign called “Everybody Pees.”

The highlight is a short video featuring a catchy song and colorful South Park-esque kidneys peeing in all sorts of places—parks, swimming pools, on top of a car, etc.

OK, it’s cute, kind of. But here’s my problem with this video (other than the it’s a cartoon more appropriate for six-year-olds): a routine urinalysis is NOT recommended to screen for kidney disease.

But that’s what the song seems to tell us to do:

The smartest place to pee

Is at

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What nurses know (and you don’t)

nursesThere is a new book I can’t wait to read: The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital by Alexandra Robbins.

The author wrote a preview of the book for Politico this week.

If you want to know what’s really happening in a medical building, don’t ask a doctor. Instead, turn to the best-informed, hardest-working and savviest professionals in health care: Nurses.

Many nurses call their profession—3.5 million strong in the United States and more than 20 million worldwide—a “secret club.” In the years I spent going behind the scenes in hospitals, I

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Atul Gawande – Overtreament, “Overkill”

A friend of mine who is an avid reader of both The New Yorker and my blog sent me the following link: Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

The author is Atul Gawande, MD, one of my favorite surgeon/writers. It’s a long article, but if you are interested in saving money on your health care (and possibly saving your health), I encourage you to take time to read it.

I have posted many times about America’s obsession with overtreatment—too many tests, too many specialists, too many … Continue reading

Chaparral – When herbs turn deadly

I ran into an old acquaintance a few days ago. As we got caught up, he asked “Do you remember Michael?”

“Yes,” I replied. “But I haven’t seen him in years. How is he?”

“He’s dead.”

“Wow, what happened?” I inquired. Michael was relatively young, in his forties. I thought perhaps an accident or a heart attack or cancer.

“Chaparral poisoning. It destroyed his liver.” Huh.

I had never heard of chaparral, but as soon as I’d finished chatting with my friend, I googled it.

Chaparral (aka larrea) is a shrub native to the southwest. It’s also known as the … Continue reading