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When ‘No’ Turns Positive in Medical Care and Education

Elaine Schattner M.D.

The medical word of the month is a most definite “no.”

The word is featured, explicitly and/or conceptually, in recent opinions published in two of the world’s most established media platforms – the New York Times and the New England Journal of Medicine. Their combined message relates to a point I’ve made here and elsewhere, that if doctors would or could take the time to provide full and unbiased information to their patients, people might choose less care of their own good sense and free will.

Let’s start with David Leonhardt’s April 7 column, “In Medicine, The Power of No.” In this excellent essay…

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Ten Ways to Better Our Health

Elaine Schattner, MD

(in the Style of a Magazine Cover)

If patients knew more:

1. they’d understand more of what doctors say;

2. they’d ask better questions;

3. they’d be more autonomous;

4. they’d make better decisions (ones they’re comfortable with, long-term);

5. they’d spend less money on care they don’t want or need.

If doctors knew more…

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9 + 1 Ways to Reduce Health Care Costs

Elaine Schattner M.D.

Recently in the Times’ “Patient Money” column, Lesley Alderman shared nine physicians’ views on how we might reduce our country’s health care mega-bill.

Here, I’ll review those comments, add my two cents to each, and then offer my suggestion (#10, last but not least!) regarding how I think we might reduce health medical costs in North America without compromising the quality of care doctors might provide.

The “answers” from…

Posted in Communication, Future of Medicine, health care costs, health care delivery, Ideas, Medical Education, Patient-Doctor Relationship, Policy, Public HealthTagged , , , , , , Leave a Comment on 9 + 1 Ways to Reduce Health Care Costs

An Ordinary Day

Elaine Schattner M.D.

If there’s one obvious thing I didn’t learn until I was well into my forties it’s this:

Don’t let a day go by without doing something you feel good about.

This message is not unusual, cryptic or even interesting. It’s simple, really so trite you could find it in most any “how having cancer changed my life” book available in bookstores and on-line.

Why say it again? Everyone knows we should relax and enjoy sunny weekend days like this.

Because it’s a reminder to myself, as much as for some readers and maybe a few fledgling doctors out there. One of my…

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Another Erroneous Report on Breast Cancer Screening by Mammography

Elaine Schattner M.D.

What the authors tried to do was analyze trends in breast cancer mortality in relation to mammography’s availability in distinct regions of Denmark over several decades. Using Poisson regression, a form of statistical analysis, they looked for a correlation and found none. They concluded that they couldn’t detect a benefit of screening mammograms among Danish women who might benefit (see below).

Here’s what I think are the two most serious flaws in this observational study:

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Peter Sings Colonoscopy

Elaine Schattner, MD

Am I pro- or con- colonoscopy for routine screening, you might wonder. Well, that depends.

Am I pro- or con- famous singers and other celebrities extolling the benefits of particular medical interventions? Well, that depends, too.

But I’m sure I prefer “Puff the Magic Dragon.” Also “Leaving on a Jet Plane” fills me with imperfect memories of 6th grade.

Posted in cancer awareness, Communication, Music, Oncology (cancer), Wednesday Web SightingTagged , , , , , , , , 1 Comment on Peter Sings Colonoscopy

A Small Study Offers Insight On Breast Cancer Patients’ Capacity and Eagerness to Participate in Medical Decisions

Elaine Schattner M.D.

Last week the journal Cancer published a small but noteworthy report on women’s experiences with a relatively new breast cancer decision tool called Oncotype DX. This lab-based technology, which has not received FDA approval, takes a piece of a woman’s tumor and, by measuring expression of 21 genes within, estimates the likelihood, or risk, that her tumor will recur.

As things stand, women who receive a breast cancer diagnosis face difficult decisions…

Posted in Breast Cancer, cancer survival, Communication, Diagnosis, Empowered Patient, Informed Consent, Oncology (cancer), Pathology, Patient Autonomy, Patient-Doctor Relationship, Statistics, Under the RadarTagged , , , , , , , , , , 5 Comments on A Small Study Offers Insight On Breast Cancer Patients’ Capacity and Eagerness to Participate in Medical Decisions

Considering Targeted Therapies For Cancer

Elaine Schattner M.D.

I first heard about STI-571 (Gleevec, a targeted cancer therapy) from a cab driver in New Orleans in 1999. “Some of the doctors told me there’s a new cure for leukemia,” he mentioned.

We were stuck in traffic somewhere between the airport and the now-unforgettable convention center. His prior fare, a group of physicians in town for the American Society of Hematology’s annual meeting, spoke highly of a promising new treatment. It seemed as if he wanted my opinion, to know if it were true. Indeed, Dr. Brian Druker gave a landmark plenary presentation on the effectiveness of STI-571 in patients with chronic myelogenous leukemia (CML) at the conference. I was aware of the study findings.

“Yes,” I said. “There is a new drug for leukemia.”

Since then, oncologists’ enthusiasm for targeted therapies – medications designed to fight cancer directly and specifically – has largely held. But the public’s enthusiasm is less apparent. Perhaps that’s because many people are unaware of these new drugs’ potential, or they’re put off by their hefty price tags.

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The High Cost of Food-Borne Illness, and Some Steps To Avoid These in Your Home

Elaine Schattner M.D.

A new report from the “Make our Food Safe” project, based at Georgetown University, makes clear that food-borne illnesses – from bacteria, parasites and a few viruses – are ever-present and costly.

The study, authored by Robert Scharff and funded by the Pew Charitable Trusts, finds that food-borne illnesses tally nearly $152 billion per year. This huge sum includes some subjectively-measured expenses like pain, suffering and missed work. Even without those, the toll registers above $100 billion – it’s a big sum, either way.

The main culprits are

Posted in Homemaking, Infectious Disease, Medical NewsTagged , , , , , , , 1 Comment on The High Cost of Food-Borne Illness, and Some Steps To Avoid These in Your Home

MedlinePlus, A Public Resource

Elaine Schattner M.D.

MedlinePlus, a virtual superstore of medical information, is one of the most frequented health-related websites worldwide. The site, co-sponsored by the National Library of Medicine and the National Institutes of Health, is comprehensive and, with some exceptions (see below) relatively free of commercial bias. I find it a useful starting point for almost any health-related search…

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