New NY State Law on Information for Women Undergoing Mastectomy

The reality is that many women, particularly poor women without newspapers or internet access in their homes, don’t know about any of this. They don’t know their insurance covers pretty much all of these options, by law. Now they will, or should as of Jan 1, 2011. Good. The other curiosity is that …

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Doctors Not Using Email Like It’s 2010

There’s been a recent barrage of med-blog posts on the unhappy relationship between doctors and electronic communications. The first, a mainly reasonable rant by Dr. Wes* dated August 7, When The Doctor’s Always In, considers email in the context of unbounded pressure on physicians to avail themselves to their patients 24/7. That piece triggered at […]

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Back to Basics – But Which Ones?

A front-page story on the Humanities and Medicine Program at the Mount Sinai School of Medicine, here in Manhattan, recently added to the discussion on what it takes to become a doctor in 2010. The school runs a special track for non-science majors who apply relatively early in their undergraduate years. Mount Sinai doesn’t require […]

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Living Like It’s Shark Week!

Today is the start of this year’s Shark Week on the Discovery Channel. Dialog from NBC’s 30 Rock, Season 1, Episode 4 “Jack the Writer” (2006)*: Tracy Jordan: But I want you to know something… You and me, it’s not gonna be a one-way street. Cos I don’t believe in one-way streets. Not between people, and not […]

Posted in cancer survival, from the author, Life, Life as a Doctor, Life as a Patient, Patient Autonomy, TVTagged , , , , , Leave a Comment on Living Like It’s Shark Week!

Staying Healthy in Hot Summer Travel

Hiking, or even just walking, in the hot summer heat to see ancient ruins, national monuments or spectacular vistas can sap the energy of healthy people. For someone who’s got a health issue – like chronic lung disease, reduced heart function or anemia – or anyone who’s pregnant, elderly or just frail, summer travel can knock you out in the wrong sort of way….Don’t plan

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Avoiding Blood Clots During Long-Distance Travel

A few years ago my family took a trip to China. Even before we arrived, I learned something about an unfamiliar health care culture. What I observed en route was that many of the older passengers on that long flight to Beijing were getting up from their seats and stretching. Not just once, but regularly […]

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On Sergey’s Search (for a Cure for Parkinson’s Disease)

…This goes well beyond a new approach to finding a cure for Parkinson’s disease.

This story, largely based in genomics and computational advances, reflects the power of the human mind, how the gifted son of two mathematicians who fell into a particular medical situation, can use his brains, intellectual and financial resources, and creativity, to at least try to make a difference.

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Mind over Matter? Don’t Kid Yourself (on Stress and BC)

I learned of a new study implicating stress in reduced breast cancer survival by Twitter. A line in my feed alerted me that CNN’s health blog, “Paging Dr. Gupta,” broke embargo on the soon-to-be-published paper in the journal Clinical Cancer Research. The story – that women who undergo a stress relief program live longer after […]

Posted in Breast Cancer, cancer survival, clinical trials, Essential Lessons, Medical News, Oncology (cancer), Pseudoscience, Psychiatry, Women's HealthTagged , , , , , , , , , 3 Comments on Mind over Matter? Don’t Kid Yourself (on Stress and BC)

About Those Skipped Heart Test Results

Harlem Hospital Center stands just three miles or so north of my home. I know the place from the outside glancing in, as you might upon exiting from the subway station just paces from its open doors. The structure seems like one chamber of its neighborhood’s heart; within a few long blocks’ radii you’ll find rhythms generated in the Abyssinian Baptist Church; readings at the Schomburg Center and artery-clogging cuisine at the West 135th Street IHOP.

So I was saddened to hear about the missed heart studies. Or should I say unmissed? No one noticed when nearly 4,000 cardiac tests went unchecked at the Harlem center,

Posted in Cardiology, Communication, health care costs, health care delivery, Ideas, Life in NYC, Medical News, Patient Autonomy, Under the RadarTagged , , , , , , , 2 Comments on About Those Skipped Heart Test Results

DNA Comes Home, or Maybe Not

Earlier this month employees at most of 7500 Walgreens pharmacies geared up to stock a new item on their shelves: a saliva sampler for personal genetic testing. On May 11, officials at Pathway Genomics, a San Diego-based biotech firm, announced they’d sell over-the-counter spit kits for around $25 through an arrangement with the retailer. A curious consumer could follow the simple package instructions and send their stuff in a plastic tube, provided in a handy box with pre-paid postage, for DNA analysis.

Posted in Diagnosis, Empowered Patient, Future of Medicine, Genetics, Medical Education, Medical News, ScienceTagged , , , , , , , 2 Comments on DNA Comes Home, or Maybe Not

Why Blog on OncotypeDx and BC Pathology?

I can’t even begin to think of how much money this might save, besides sparing so many women from the messy business of infusions, temporary or semi-permanent IV catheters, prophylactic or sometimes urgent antibiotics, Neulasta injections, anti-nausea drugs, cardiac tests and then some occasional deaths in treatment from infection, bleeding or, later on, from late effects on the heart or not-so-rare secondary malignancies like leukemia. And hairpieces; we could see a dramatic decline in women with scarves and wigs.

Posted in Breast Cancer, cancer treatment, Communication, Diagnosis, Empowered Patient, health care costs, Informed Consent, Pathology, Patient AutonomyTagged , , , , , , , , 2 Comments on Why Blog on OncotypeDx and BC Pathology?

More News, and Considerations, on OncotypeDx

This week I’ve been reading about new developments in breast cancer (BC) pathology. At one level, progress is remarkable. In the 20 years since I began my oncology fellowship, BC science has advanced to the point that doctors can distinguish among cancer subtypes and, in principle, stratify cases according to patterns of genes expressed within […]

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The Checklist and Future Culture of Medicine

…Poka-yoke, a Japanese term for rendering a repetitive process mistake-proof, is familiar to some business students and corporate executives. This concept, that simple strategies can reduce errors during very complex processes, is not the kind of thing most doctors pick up in med school. Rather, it remains foreign.

Posted in Future of Medicine, health care costs, health care delivery, Life as a Doctor, Medical Education, Policy, Public HealthTagged , , , , , , , , 6 Comments on The Checklist and Future Culture of Medicine

A Routine Visit

Yesterday I visited my internist. I had no particular complaint. My back hurt no more than usual. The numbness in my left foot was neither better nor worse than it was last month. I wasn’t suffering from vertigo or abdominal pain. I went because I had an appointment to see her, nothing more.

Until just a few years ago, I rarely

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When ‘No’ Turns Positive in Medical Care and Education

The medical word of the month is a most definite “no.”

The word is featured, explicitly and/or conceptually, in recent opinions published in two of the world’s most established media platforms – the New York Times and the New England Journal of Medicine. Their combined message relates to a point I’ve made here and elsewhere, that if doctors would or could take the time to provide full and unbiased information to their patients, people might choose less care of their own good sense and free will.

Let’s start with David Leonhardt’s April 7 column, “In Medicine, The Power of No.” In this excellent essay…

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Ten Ways to Better Our Health

(in the Style of a Magazine Cover)

If patients knew more:

1. they’d understand more of what doctors say;

2. they’d ask better questions;

3. they’d be more autonomous;

4. they’d make better decisions (ones they’re comfortable with, long-term);

5. they’d spend less money on care they don’t want or need.

If doctors knew more…

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9 + 1 Ways to Reduce Health Care Costs

Recently in the Times’ “Patient Money” column, Lesley Alderman shared nine physicians’ views on how we might reduce our country’s health care mega-bill.

Here, I’ll review those comments, add my two cents to each, and then offer my suggestion (#10, last but not least!) regarding how I think we might reduce health medical costs in North America without compromising the quality of care doctors might provide.

The “answers” from…

Posted in Communication, Future of Medicine, health care costs, health care delivery, Ideas, Medical Education, Patient-Doctor Relationship, Policy, Public HealthTagged , , , , , , Leave a Comment on 9 + 1 Ways to Reduce Health Care Costs

A Small Study Offers Insight On Breast Cancer Patients’ Capacity and Eagerness to Participate in Medical Decisions

Last week the journal Cancer published a small but noteworthy report on women’s experiences with a relatively new breast cancer decision tool called Oncotype DX. This lab-based technology, which has not received FDA approval, takes a piece of a woman’s tumor and, by measuring expression of 21 genes within, estimates the likelihood, or risk, that her tumor will recur.

As things stand, women who receive a breast cancer diagnosis face difficult decisions…

Posted in Breast Cancer, cancer survival, Communication, Diagnosis, Empowered Patient, Informed Consent, Oncology (cancer), Pathology, Patient Autonomy, Patient-Doctor Relationship, Statistics, Under the RadarTagged , , , , , , , , , , 5 Comments on A Small Study Offers Insight On Breast Cancer Patients’ Capacity and Eagerness to Participate in Medical Decisions

MedlinePlus, A Public Resource

MedlinePlus, a virtual superstore of medical information, is one of the most frequented health-related websites worldwide. The site, co-sponsored by the National Library of Medicine and the National Institutes of Health, is comprehensive and, with some exceptions (see below) relatively free of commercial bias. I find it a useful starting point for almost any health-related search…

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Today’s Press on Targeted Therapy for Cancer

Today the NY Times printed the third part of Amy Harmon’s excellent feature on the ups and downs and promise of some clinical trials for cancer. The focus is on a new drug, PLX4032, some people with melanoma who chose to try this experimental agent, and the oncologists who prescribed it to them.

What I like about this story is that, besides offering some insight on the drug itself, it balances the patients’ and doctors’ perspectives; it explains why some people might elect to take a new medication in an early-stage clinical trial and why some physicians push for these protocols because they think it’s best for their patients.

And it provides a window into the world of academic medicine, where doctors’ collaborate among themselves and sometimes with corporations.

Here’s some of what I learned:

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