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Two Cheers for Medical Paternalism Print E-mail
Written by Bill Gardner | The Incidental Economist   
Friday, 04 September 2015 17:19

In the NEJM, Lisa Rosenbaum looks at communication between doctors and patients and, as she has before, suggests that real clinical practice is more complex than orthodox bioethics makes it out to be. Discussing cases, including her own, she asks

Might there, in fact, be such a thing in medicine as
Too Much Information?

a view which she attributes to our received understanding of informed consent.

Instead, Rosenbaum argues for a kind of paternalism, in which patients rest in a cognitive and emotional dependence on physicians. She's getting something right, but it's critical to get clear on what kind of paternalism we might accept.

Let's start with informed consent to treatment. Roughly, we have informed consent to medical treatment when a competent patient...

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Last Updated on Friday, 18 September 2015 16:32
If We Fight For It Print E-mail
Written by Jordan Grumet, MD   
Thursday, 03 September 2015 00:00

It occurred to me towards the end of our conversation that there was a large gaping hole. We had talked about physician burnout, career choices, and his current plans. He had drawn a map of his future. It originally shot like a straight arrow towards clinical medicine, but now veered precipitously. I took a moment to first clear my thoughts, and then my throat.

Medicine, I explained, is still as noble a profession as ever. Every day I dip my toes tentatively into the current that swirls around me. Often I am pulled violently into the depths. My body bumps and sways in the mass of humanity.

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Quality Improvement: 'Become Good At Cheating And You Never Need To Become Good At Anything Else' Print E-mail
Written by FHI's Week in Review   
Monday, 31 August 2015 00:00

David Himmelstein and Steffie Woolhandler in an August 27, 2015 HealthAffairsBlog post:
The Centers for Medicare and Medicaid Services (CMS) has trumpeted the recent drop in hospital readmissions among Medicare patients as a major advance for patient safety. But lost amidst the celebration is the fact that hospitals are increasingly "observing" patients (or treating returning patients in the emergency department) rather than "readmitting" them.

Read more in the current issue of FHI's Week in Review HERE>>

Last Updated on Wednesday, 02 September 2015 17:53
Avoiding a bad death requires preparation Print E-mail
Written by Dr. John M   
Tuesday, 18 August 2015 00:00

If there was a hashtag for sub-specialty healthcare and ICU medicine in the United States it would be:
A recent study led by Dr. Harlan Krumholz (Yale University) showed that we have become more efficient at keeping elders alive. This is not surprising. And it's good news in the sense that technology-if used wisely-can enhance both quality and quantity of life.
The key phrase above is...if used wisely.
The obvious fact remains: Human beings don't live forever. The same medical technology that can extend life can also prolong death.
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Last Updated on Wednesday, 19 August 2015 16:54
Can FDA tell a drug company to stop talking about research? Print E-mail
Written by Nicholas Bagley | The Incidental Economist   
Friday, 14 August 2015 18:05

A long-running dispute over the First Amendment flared up this past Friday, when a federal judge in New York told FDA that it couldn't prevent a drug manufacturer from discussing research supporting an off-label use of its drug.

The drug at issue is Vascepa, the active ingredient of which is an omega-3 fatty acid. It's similar to fish oil, so let's just call it "fishy oil." In 2012, FDA approved the fishy oil for use in people with very high triglyceride levels (above 500 mg/dL). Turns out that taking fishy oil reduced their triglyceride levels, which are associated with heart disease.

The manufacturer of the fishy oil, Amarin, thought that people who had persistently high, but not very high, triglyceride levels (between 200 and 499 mg/dL for those already on statins) might benefit, too. So, with FDA's blessing, Amarin came up with a study to see if they did. And it turns out their triglyceride levels also dropped.

The thing is, though, that the ultimate goal of the fishy oil isn't to reduce triglycerides. It's to prevent heart disease. And what if reducing triglycerides doesn't help with that, as some recent studies have suggested?

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Last Updated on Tuesday, 25 August 2015 17:40
Storytelling in Medicine: the Passion and the Peril Print E-mail
Written by Dr. Danielle Ofri   
Wednesday, 05 August 2015 00:00

Some years back, we admitted a middle-aged French woman with advanced lung cancer who was in acute respiratory distress. It was not clear from her x-ray whether this was from her cancer progressing or from severe pneumonia. Whichever the case, she needed to be intubated, and soon.
Before we could put the tube down her throat, however, she insisted on dictating her last will and testament. Between wispy gasps of breath, she told us who should get her linens and her artwork, and where exactly in Paris she wanted to be buried.

I scribbled this down as fast as I could as the anesthesiologist hovered over us, endotracheal tube in hand.
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The Layman's Diagnosis Print E-mail
Written by Dr. Jordan Grumet   
Friday, 31 July 2015 00:00

Jim almost convinced me. The burning in his chest, after all, could have just been gastroesophageal reflux. He assured me that the sensation was nothing new; that he got it from time to time after a large meal and took Tums. I couldn't, however, ignore that it seemed to worsen with activity... 
...Jim and I argued over the EKG. He wanted to take his prescription and go home. No hospitalization, no blood tests, no diagnostic studies. I grabbed his shoulder, and did my best to convince him to reconsider. He slowly turned back toward the exam room. A few minutes later, I gulped as I looked down at the electrocardiogram. He was having a heart attack.

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Last Updated on Saturday, 01 August 2015 16:10
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