Category Archives: Healthcare

FDA Asks, Gets Answers, Pain Patients not Involved

FDA Asks, Gets Answers on Reducing Opioid Epidemic – Pain Medicine News – Oct 2017 – Kenneth Bender

The prevalence and consequences of opioid use disorder can be reduced without preventing patients with pain from receiving necessary opioid analgesics, according to a consensus report from the National Academies of Sciences, Engineering, and Medicine requested by the FDA.

Perhaps it can be, but it certainly is not.

Once again, the fate of pain patients is being decided by people who don’t understand the cruel waste of a life devastated by chronic pain.   Continue reading

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Medical Taylorism: Industrialization of Medicine

Medical Taylorism – NEJM – Jan 2017

This “Perspective” from the prestigious New England Journal of Medicine laments the industrialization of medicine, the application of standardization and manufacturing efficiencies to the practice of healing.

Frederick Taylor, a son of Philadelphia aristocrats who lived at the turn of the last century, became known as the “father of scientific management” — the original “efficiency expert.”

He believed that the components of every job could and should be scientifically studied, measured, timed, and standardized to maximize efficiency and profit.   Continue reading

Rest and Ice may Delay Healing

Rest ice compression elevation | Rice Therapy and Price Therapy – Caring Medical

For many athletes a doctor’s recommendation of the RICE protocol for healing their sports related soft tissue issue injury was seen as the gold standard of care.

However, this treatment is now under criticism from a surprising source, the doctor who created the RICE treatment guidelines, Gabe Mirkin, MD.

In a recent article on his own website, Dr. Mirkin admits that both ice and rest (key components of RICE) may delay healing.   Continue reading

Request a Meeting on Drugs from FDA

I just found this interesting government web page, indicating that you can simply request a meeting with the FDA’s “Center of Medical Products and Tobacco” (an odd pairing) by filling out a short form online.

Meetings between stakeholders and the FDA’s Center for Drug Evaluation and Research (CDER) promote effective two-way communication to improve drug development and safety.

To submit your request for a meeting on drug-related topics, please click the Request a Meeting on Drugs button below and download the meeting request form to your desktop.   Continue reading

Do medical experts really know best?

Do medical experts really know best? – Stephen C. Schimpff, MD and Harry Oken, MD | KevinMD | November 30, 2017

“In the beginner’s mind there are many possibilities,
but in the expert’s view, there are few.”

Shunryu Suzuki was writing about Zen beginners and masters, but this concept applies to the practice of medicine as well. Experienced physicians are slow to accept a new paradigm, while medical students and new physicians are more open.

Sometimes, what we “know” to be true is not.   Continue reading

Epigenetics, cellular memory, and gene regulation

Epigenetics, cellular memory and gene regulation: Current Biology – July 2016

The field described as ‘epigenetics’ has captured the imagination of scientists and the lay public. 

However, when describing these scientific advances as ‘epigenetic’, we encounter the problem that this term means different things to different people, starting within the scientific community and amplified in the popular press.

To help researchers understand some of the misconceptions in the field and to communicate the science accurately to each other and the lay audience, here we review the basis for many of the assumptions made about what are currently referred to as epigenetic processes.  Continue reading

Evidence for Health Decision Making — Beyond RCTs

Evidence for Health Decision Making — Beyond Randomized, Controlled Trials — NEJM

A core principle of good public health practice is to base all policy decisions on the highest-quality scientific data, openly and objectively derived.

Although randomized, controlled trials (RCTs) have long been presumed to be the ideal source for data on the effects of treatment, other methods of obtaining evidence for decisive action are receiving increased interest, prompting new approaches to leverage the strengths and overcome the limitations of different data sources.   Continue reading

Moral Choices for Today’s Physician

Moral Choices for Today’s Physician | Humanities | JAMA | The JAMA Network – Donald M. Berwick, MD, MPP

The current generation of physicians is the most challenged by moral choices in perhaps a century. Those choices come in three tiers: personal, organizational, and societal.

This is the moral choice in its simplest, purest, most elemental form. To tell the truth, or not, when “not” is perhaps in your short-term self-interest.

A second form of choice comes in equal silence and has to do with one’s self-image as a physician. It is the choice between being a hero and being a citizen. Continue reading

What We Mean by Evidence-Based Medicine

What We Mean When We Say Evidence-Based Medicine – The New York Times– Dec. 27, 2017 – By Aaron E. Carroll

In medicine, the term “evidence-based” causes more arguments than you might expect. The mission of “evidence-based medicine” is surprisingly recent.

Before its arrival, much of medicine was based on clinical experience. Doctors tried to figure out what worked by trial and error, and they passed their knowledge along to those who trained under them.

Considering the current proliferation of guidelines for all kinds of medical care, perhaps the old method wasn’t so bad…   Continue reading

Research: Lab Mice not like Wild Mice not like Humans

The comparative immunology of wild and laboratory mice, Mus musculus domesticus : Nature Communications – May 2017

We often forget that much health research is performed on what is supposed to be a functionally equivalent species: the lab mouse.

This article details the differences found between immune systems that are exposed to “real life” versus those isolated in a lab. I believe this might also apply to humans who grow up too sheltered from the environment.

Wild mice are immunologically different from laboratory mice. Continue reading