Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Illness Care

Battling Cancer Beyond Everything

It is crazy to deny terminal patients access to possibly life-saving drugs for fear of offending the Statistics gods! Whether for-profit or not, insurance companies and the pharmaceutical industries are weighing in on experimental therapies; we have to be sure that reasonable  interventions are given a reasonable chance, and that reasonable costs can be factored in. Quoting my wife who is a two-time cancer survivor and advocate: "When people are... Read more Tags: soy, cancer, diet, contributing factor, cancer survival, breast cancer, terminal cancer, hope, life extension, life-saving drugs, indignity, human side Read more articles about: growths, cancers, neoplasms

Specialist Surfeit; Primary Care Paucity

It's schadenfreude (enjoyment obtained from the troubles of others).  That's where I find myself as I observe the surfeit of specialists juxtaposed to a dearth of primary care docs. As Dr. Pauline W. Chen said in "Where Have All the Doctors Gone?"—"I [don’t] envy Mr. Obama.... Any attempt to make health care more accessible will be doomed to failure without an adequate number of primary care physicians and a strong primary care system."... Read more Tags: specialist, primary care, medical school debt, training costs, FFS Read more articles about: primary care

A Few Fatigue Syndromes

Chronic Fatigue Syndrome Is Now, "Systemic Exertion Intolerance Disease (SEID) "The criteria for SEID[4] are supposed to be simpler than the Centers for Disease Control and Prevention (CDC) [1994 criteria set for Chronic Fatigue Syndrome[1]] and include substantial decline in functional activities for at least 6 months, postexertional fatigue, and nonrestorative sleep. The criteria require all three, and then at least one of the following:... Read more Tags: fatigue, exertion, endurance, low energy level, Fibromyalgia; PROMIS; Pain; Psychometrics, Chronic Fatigue Syndrome, Systemic Exertion Intolerance Disease, SEID, SHINE, energy, Osteogenesis imperfecta Read more articles about: musculoskeletal conditions

Autism and Autistic Behavior

Autism Spectrum Disorders (ASDs) Understanding diseases that affect development of the brain, e.g. autism and schizophrenia is challenging because of the complexity of such diseases and the difficulty of studying developmental processes in human tissues. First, Definitions: The following provides standardized criteria to help diagnose ASD; it is from the American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM... Read more Tags: autism spectrum disorder, ASD, autism, autistic, Pervasive Developmental Disorder, PDD, emotional reciprocity, social interaction, social communication, symbolic play, imaginative play, language delay Read more articles about: psycho-social issues

The Fiscal, Physical and Psyche Burden of Cancer

Speaking to the emotional, plus overt/hidden financial costs, cancer's the 2nd most expensive ailment in the U.S., after heart disease  Quote:  The estimated annual cost of $171 billion, two-thirds ($114 billion) are considered "out-of-pocket" costs [1]. Patients and their families are often surprised by the additional expenses that can be associated with cancer treatment, including the cost of transportation, childcare, restaurant meals, hotel... Read more Tags: bio-psycho-social, financial costs, direct costs, indirect costs, burden of illness Read more articles about: growths, cancers, neoplasms

Managed Care Mindset Results in a Coronary

Was newscaster, Tim Russert’s sudden death at age 58 from a heart attack preventable? After all, he was being monitored as he was being treated for asymptomatic coronary artery disease. Unfortunately, his doctors did not realize the extent of it.  Indeed, Russert had performed well on a stress test a few months prior to his demise; he was exercising and was careful about  what he was eating.  His cardiologist, Dr. Newman said that "even at a... Read more Tags: heart attack, prevention, secondary prevention, cardiac event, sudden death, hypertrophic cardiomyopathy, coronary artery disease, testing, screening, sports, syncope Read more articles about: heart

In Diabetes, More is Less

9 of 10 persons who have pre-diabetes are not aware it is causing damage. Thus, the "Centers for Disease Control and Prevention and the American Medical Association are calling on [physicians to increase] screening efforts and raise awareness about the risk factors for developing a full onset of the disease.” Congressional Quarterly (3/13/2015, Zanona, Subscription Publication) Furthermore, in kids, an English study reveals that using an insulin... Read more Tags: diabetes, pre-diabetes, over control, over-control, under control, under-control, outcome, benefit, hypoglycemia, tight glycemic control, conventional glycemic control, blood glucose, caloric intake, health care costs, Hospital, community health services Read more articles about: Illness Care

Asthma & COPD Management

In poorly controlled asthma or COPD in children or adults, what works best? Ans: Long-acting beta agonists (the ones with the warning*) are more effective than either monteleukast (Singulair) or doubled dosing inhaled corticosteroids. To put things into perspective, about 7 million U.S. children have asthma; the prevalence is more than doubling over the past 2 decades; this  group suffers 500,000 hospitalizations, 10.5 million physician-office... Read more Tags: asthma, reactive airway disease, COPD, COPD exacerbations, long-acting beta agonists, NIH, guideline, works best, Singulair, montelukast, inhaled corticosteroids, systemic corticosteroids, steroids, asthma-free days, poorly controlled asthmatic children Read more articles about: airway / breathing

Medical Community: Stop Your Whining!

A New York Times article portrays physicians' frustration stemming from having to deal with the underpayment of primary care. "There is no doubt that the system for providing medical care in the country is in need of major reformation, and that the system of training the providers of that care is in need of major transformation, but the medical community needs to get a grip on their whining." Remember, the primary care physician is an advocate... Read more Tags: primary care, payment, earnings, cost of care, the costs of care, spending, affordability, value Read more articles about: primary care

Are bones stronger after a fracture?

Take care of yourself!  Know that muscle, the bones and the brain, as you might expect, weaken when not used.  Also, there's the other side of the coin: it's a myth to say healed bones are stronger then they were before the injury! Factoid: Known as Wolff’s law, that concept is "the reason astronauts return with reduced bone density after floating in microgravity. And conversely, it explains why studies show that tennis players and fencers... Read more Tags: bone fracture, healing, injury, callus, mineralization Read more articles about: musculoskeletal conditions