Running time: 20 min. In some diseases there are two diagnoses to make: the clinical diagnosis and the diagnosis of what the patient’s treatment preference is. The first is hard enough to make, and the widening choice of treatment choices complicates the second. Welcome to the task of “preference diagnosis,” which can lead to [...]
A chat with clinician-essayist Cameron Page, whose essay “They Paved Paradise and Put Up a Parking Lot” appears in this month’s Health Affairs. Our conversation explores the connections in medicine that link outside the clinic walls, with stops along the way at William Carlos Williams, Richard Seltzer, the Yankees, and more. We get around [...]
Dr. Peter Bach is the first author on a new JAMA analysis of the benefits and harms of using low-dose CT screening for lung cancer. The American College of Chest Physicians and the American Society of Clinical Oncology requested the systematic review to assist them in drawing up a clinical guideline. Join us in [...]
Dr. Arnold Relman, longtime observer of the U.S. healthcare system and editor emeritus of the New England Journal of Medicine, proposes two major reforms: First, private insurance companies should leave the healthcare field, and second, physicians should organize into multispecialty practices. His proposals, just published in BMJ, grow out of his alarmed observation — [...]
Heart failure brings problems associated with hypercoagulation, such as stroke and sudden death. An international study followed some 2300 patients with heart failure (ejection fractions of 35% or less) and in stable sinus rhythm for a mean of 3.5 years, randomizing them to treatment with either warfarin or aspirin. The two treatment groups showed [...]
About half of adolescents with type 2 diabetes fail treatment with metformin alone within a few years. Things go somewhat better with metformin plus an intensive lifestyle intervention, and better still with the addition of rosiglitazone to metformin — however even the addition of the second drug leads to treatment failure about 40% of [...]
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