All Blog Posts (1,644)

My Colleague and pedicatiric oncologist Dr Curt Civin and I wrote the folowing Op Ed which appeared December 7, 2011 in the Baltimore Sun.

Hospitals nationwide are experiencing shortages of critical generic intravenous drugs. We believe a fundamental reason for this national shortage is government price controls. With these limits there is little incentive to invest…

Our children (and grandchildren) are the future and we are responsible for their growth and development. As responsible parties, we are clearly failing. 

That is my interpretation of the report issued a few days ago by the Centers for Disease Control (CDC) as part of the National Health and Nutrition Examination Survey on seven criteria known to the associate with ideal cardiovascular health. They are defined, briefly, as 1) a diet with…

Americans are aging – fast. And that means more chronic illnesses like arthritis, heart failure and cancer. It also means more falls, more osteoporotic fractures, poorer hearing and vision and myriad other problems we equate with aging. It also means some older folks become “frail,” irrespective of chronologic age.

You know a person is frail when you see him or her – instinctively you will think a person is “frail” if they are “skinny,” weak, tired, inactive and slow. But…

I toured a major medical center recently to get a look at the robots in the pharmacy and to understand how the electronic medical record worked there. I was particularly interested in the new robot that made up “injectables,” the fluid bags filled with medications to be given intravenously, such as antibiotics. There was also a robot that selects pills and tablets based on bar code technology. A third robot actually delivers the medication to the individual nursing units, a little “R2D2.”…

Melanoma is the most virulent form of skin cancer with a rapidly rising incidence due to prior sun exposure. About 40,000 men and 30,000 women per year in the USA develop melanoma. In addition to sun exposure, there are independent genetic risk factors such as a variation in the “red hair” gene that increases in frequency the further one’s ancestral home is north of Africa.  …

Colleagues,

Consistently, one of the most interesting medical technology meetings of the year - MMVR, Medicine Meets Virtual Reality - this year returning to its historic home in beautiful Newport Beach, California. 

I can attest from personal experience, a wonderful venue...

ENJOY!

CC

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The Next Step In The Creation Of The Open Source System

Arlington, Virginia – OSEHRA, the Open Source Electronic Health Record Agent, a notfor-

profit foundation facilitating EHR (Electronic Health Record) improvements through open

source development, announced today the launch of its Code Repository and Software Quality

Certification Process. The establishment of the repository and certification process is a

significant step in…

In an earlier post I described the problem of excessive and inappropriate drug prescribing when a patient with multiple chronic illnesses did not have good care coordination by a single primary care physician. In this post I will relate the story of a lady who had an excellent primary care physician but the communication system broke down when she went elsewhere for a single visit. In her case the problem was the recommendation of an inappropriate medical technology for her chronic…

This is the fourth post in a series on care coordination; this time focusing on other examples of team-based care.  Patients with diabetes not only have to deal with the diabetes itself and its management, such as insulin and drugs, but they have to deal with nutrition, weight and exercise.  They need to cope with potential side effects of the diabetes, such as damage to their eyes or kidneys or the blood vessels running into the lower legs that can lead to ulcerations, infections and even…

This is the third post in a series on care coordination and the importance of the electronic medical record to effect that coordination.

Medical images such as CT scans, MRI and pathology specimens are largely all digitized today so they can be transmitted to any location in an instant.  This means that the most experienced physician at a distant institution can be called upon to review, say, a mammogram that has raised questions for the initial local reviewers or for a…

Today is national mesothelioma awareness day which is fitting because so few know what mesothelioma is or its impact on its victims. Mesotheliomas are rare tumors caused predominantly by exposure to asbestos. This cancer is hard to diagnose early and harder still to treat effectively but there are advances coming and multi-disciplinary care along with good palliative care can markedly improve overall treatment.

They mostly occur on the lung lining (pleura) but can…

Medical care is organized to treat acute conditions but the need today is to prevent, diagnose and treat chronic illnesses. Unfortunately, we are sorely lacking in a good chronic care management system. this will be the first in a series of six posts on this issue.

Our medical care system has developed over decades and even centuries around diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gives an antibiotic for…

Banks might not need as much convincing that challenge questions based on shared secrets aren’t safe since the FFIEC’s updated guidelines came out saying as such, but there are other industries – like healthcare and ecommerce, that still need to take heed.

Case in point:

A California man who…

Adhering to a moderate yet healthy lifestyle can reduce the risk of sudden cardiac death by about 90% according to a new study. It is well known that high blood pressure, high cholesterol, and diabetes correlate with coronary artery disease. Life style factors do as well – a combination of a Mediterranean style diet, moderate regular exercise, appropriate weight  and non smoking all correlate with less coronary artery disease, less stroke, less high blood pressure, less diabetes, less…

I really don’t want to brag too much or seem too over the top we have changed the world of identity authentication.  Really.  We did.

How? By launching ExpectID Enterprise, a brand new knowledge based authentication (KBA) product that solves many of the problems associated with those ridiculously frustrating and hard to remember shared secret questions we all know…

It was just 30 years ago in June 1981 when the first cases of what came to be known as Acquired Immune Deficiency Syndrome (AIDS) were published by the Centers for Disease Control (CDC) in its Morbidity and Mortality Weekly Report (MMWR.) These were men who had a wasting illness and died of unusual infections, ones of the types seen mostly in “immunocompromised hosts.” These were infections with which I was very familiar in my work treating and preventing infections in aggressively treated…

It is often difficult to appreciate that improving the care of patients can actually reduce the costs of care. Last year Dr H Brody wrote in the New England Journal of Medicine (vol 362, p283-5) about “Medicine’s ethical responsibility for health care reform – the top five list.”  In essence he challenged physicians to be first to find ways to rationally reduce health care costs by identifying the top five tests or treatments in any given specialty or subspecialty that could be markedly…

Drug companies can use genomics to create targeted drugs like imatinib (Gleevec) and trastuzumab (Herceptin.) Physicians can then use the results of genomic studies to guide prescribing. As discussed in prior posts, a person with Philadelphia chromosome-positive (i.e., having the BCR-ABL translocation with its aberrant tyrosine kinase) chronic myelocytic leukemia will likely respond to Gleevec. And a woman whose breast cancer shows high levels of the Her2neu receptor will likely respond to…