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Who Should Get the Liver Transplant? Print E-mail
Written by MD Whistleblower   
Tuesday, 15 May 2018 17:24

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver  transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a candidate toward the head of the line? Age? Medical diagnoses? Insurance coverage? Employment status? Worth to society? Criminal record?

Consider the following 6 hypothetical examples of patients who need a liver transplant to survive. How would you rank them? Would those toward the bottom of your list agree with your determination?
Preventing CTE is a no brainer Print E-mail
Written by FHI's Week in Review   
Monday, 07 May 2018 16:23

Chris Nyte, DO, a former nose guard, reminds us of the horrors of chronic traumatic encephalopathy (CTE) in a May 4, 2018 KevinMD post. Clinical findings associated with CTE include memory loss, depression, anxiety, violent behavior, mood disorders and heightened suicidality, the author informs us. It tends to progress with time and can lead to dementia according to a recent study. And the fact that CTE is a direct result of blows to the head such as those suffered by athletes competing in contact sports, especially football, is no longer in doubt.

Read more in the current issue of Week in Review>>
A Call for Cost Transparency Print E-mail
Written by FHI's Week in Review   
Monday, 23 April 2018 16:33

Mukul Mehra, MD, in an April 20, 2018 KevinMD post, insists doctors need and want cost transparency. "Physicians are the building blocks of value-based care, yet the cumulative human and financial costs of our decisions are mostly hidden from us," he states.

Read more in the current issue of Week in Review>>

Last Updated on Monday, 21 May 2018 17:27
Why I Now Treat Hepatitis C Patients Print E-mail
Written by MD Whistleblower   
Tuesday, 17 April 2018 18:29

In a prior post, I shared my heretofore reluctance to prescribe medications to my Hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself - or my patients - to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another specialist who had a different view on the value of HCV treatment.

I do believe that there is a medical industrial complex that is flowing across the country like hot steaming lava. While I have evolved in many ways professionally over the years, I have remained steadfast that less medical care generally results in better outcomes. 

There was an astonishing development in HCV treatment that caused me to reevaluate my calculus.

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Last Updated on Tuesday, 17 April 2018 18:31
Take 2 Broccoli and Call Me in the Morning Print E-mail
Written by The Fit Physician via KevinMD   
Friday, 13 April 2018 16:09

We live in a pill-popping society. The first line treatment for many of the medical problems that walk through our doors is a medication. Have heartburn?  Forget about avoiding the foods that cause your symptoms - just take a pill.  New diagnosis of diabetes?  We give lip service to lifestyle modifications and then start patients on Metformin. Hypertension? Diuretics, ACE inhibitors, ARBs, beta blockers - take your pick, and I guess make the obligatory mention of weight loss.

I fully realize that there is a time and a place for medication. There are varied medical problems that can only be treated with medication, and there have been many life-changing discoveries on the pharmaceutical front. Heck, humanity owes a large part of our prolonged life expectancy to pills that we pop to treat chronic disease. I am not here to poo-poo taking pills.

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Sure, cancer mutates, but it has other ways to resist treatment Print E-mail
Written by Fabian V. Filipp | The Conversation   
Tuesday, 10 April 2018 16:35

Because of advances in drug design and precision medicine, researchers have been able to target certain molecules within a cell at the root of a particular disease and to develop specific therapies to undo their damages. Today, precision targeting combines therapy decisions with molecular insights to offer hope after a life-changing cancer diagnosis.

But there's a dark side to cancer-killing drugs designed to match distinct cancer mutations like a key into a lock. Some cancers that initially respond to targeted chemotherapy become treatment-resistant - and the drug itself may not be the culprit.

New research helps explain how therapy-resistant cancers arise, findings with important implications for the future of cancer therapy. It shows how hidden, subtle layers of regulation - epigenetics - control the activity of genes to produce drug-resistant surviving cells.

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Last Updated on Thursday, 10 May 2018 09:36
Sink the Two Canoe Argument Print E-mail
Written by Gary Kaplan, MD & C. Craig Blackmore, MD | NEJM   
Thursday, 29 March 2018 00:00

Physicians have defended the status quo in healthcare based on the fear of straddling both fee-for-service and value-based payment models. Two executives at Virginia Mason Health Care System believe that strategy is no longer valid.

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Last Updated on Friday, 30 March 2018 16:33
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