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Are we winning yet?

From the New York Times (4/15/2007): Despite all of the cancer in the news and the fundamental fear of what has been called The Dread Disease, cancer is still second to heart disease in the mortality statistics. In addition, cancer death rates (different from cancer incidence or prevalence data) have been declining for a while. The full report was published about 6 months ago, and reported in an NCI press release.

Running With the Big Dogs

Science - April 5, 2007

This is the cover of the April 5th issue of Science which refers to a fascinating article on the finding that polymorphisms in one gene, insulin-like growth factor 1 (IGF1) appears to be responsible for most of the variation in size that one sees in dogs. I had no idea that domestic dogs have the most diversity in body size than any other terrestrial vertebrate. Link to full paper here

Did they realize the subtext?

From the New York Times (4/3/2007) article on Atul Gawande, MD. Dr. Gawande does mostly thyroid surgeries, and so it is pretty funny (to me) that while waiting for biopsy results he’s playing a game of hangman (you know, where the rope goes around the neck and if you lose your man dies) on the patient’s drapes with a skin marker.

As I’ve been saying …

Mind and Brain

From “Brain Injury Said to Affect Moral Choices” (NYT), a graphic demonstrating a possible neuroanatomical site for pathways involved in human morality. This story is based on a paper recently published in Nature. This is a timely topic given the recent emphasis on brain injuries in soldiers returning from the chaos in Iraq.

What we also have here is a loss of trust.

Why patients think that doctors supposedly overtreat.

Clearly there is a disconnect between doctors and patients, and an erosion of trust. The 45% of patients who think that doctors are adding on tests to increase their revenues clearly have never heard the two words “utilization review” or “economic credentialing”. Of note, the 45% who think that doctors overtreat “to meet patients’ demands” think that it’s the other 45% who are making the demands.

What we have here … is a failure to communicate.

What patients do when they don’t agree with their doctor’s recommendations

Harris Interactive/WSJ Survey (3/15/07): More than half (52%) of adults have chosen to question or forego recommended care because they felt it was unnecessary or too aggressive. Notice how “ask your doctor to explain their thinking/actions/reasons” is not one of the listed answers.

The other side of the sword

Secondary malignancies in ALL survivors

From Hijiya et al., JAMA 2007: Chemotherapy for acute lymphoblastic leukemia is good. Very good. But it’s a two-edged sword. One side creates long-term cancer survivors. The other creates secondary malignancies in cancer survivors.

It’s not the fire that’ll get you …

Firefighter cardiac mortality data

From Kales et al., NEJM 2007: Cardiovascular events cause 45% of the on-duty deaths that occur in firefighters, compared to 22% of the on-duty deaths in police officers, 11% of the on-duty deaths in EMS workers, and 15% of the on-duty deaths in all otehr jobs. Hmm. EMS workers seem to do better. Could be because they’re always within arms reach of one of these.

One of my two billable procedures

Bone Marrow Biopsy

Well, since I’m a fellow, I don’t bill for them yet. The other procedure, of course, is a lumbar puncture.