Changing the culture of American Medicine — Start by removing hubris

This may be the most important post I have ever published. I’m going to tell you about a study that should change the entire way doctors approach patients, and how patients should think of prescribed treatments. These findings should begin a culture change in American medicine. Background: I used to think Medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat. That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at the white board to explain, I often find myself pausing for a moment to think: Is this really the right course? Does the evidence support doing it this way? Do I know the science, or is it “just the way things are done?” I have the same problem in the hospital—perhaps worse, as there, dogma permeates most of what we do. What keeps popping into my head is the hubris of Medicine. As I grow older, the excessive pride and confidence of the medical establishment becomes more obvious. Why didn’t I see it before? In many cases, medical and surgical treatments that were once thought to be beneficial turn out to be not so. Often, these therapies were backed by expert guidelines and taught to young students as law. Think of that for a moment. We do things to people; we monitor, we medicate, and we e...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs

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Authors: van Dalfsen JH, Markus CR Abstract The short (S) allele of a functional polymorphism (5-HTTLPR) within the promoter region of the serotonin transporter gene (SLC6A4) is found to predispose the risk for stress-related affective disorders relative to the long (L) allele. Evidence suggests that elevated stress reactivity of the hypothalamic-pituitary-adrenal (HPA) axis might underlie this association although there is little understanding about the origin of inconsistent findings. Since inadequate sleep is commonly known to promote HPA stress reactivity, it might well play an important modulating role. The pr...
Source: Stress - Category: Research Tags: Stress Source Type: research
Conclusion-The results could help the researchers to investigate the possible role of the environmental electromagnetic fields on the promotion of diabetes disease. PMID: 29792541 [PubMed - as supplied by publisher]
Source: International Journal of Radiation Biology - Category: Radiology Tags: Int J Radiat Biol Source Type: research
CONCLUSION: GoC conversations may be facilitated by enabling oncologists to conduct these conversations despite difficult circumstances and emotional reactions by activating patients and family via increased health literacy and by advancing palliative-informed practice environments. PMID: 29790421 [PubMed - as supplied by publisher]
Source: Journal of Palliative Care - Category: Palliative Care Tags: J Palliat Care Source Type: research
Henry J. Kaiser Family Foundation. 05/25/2018 This issue brief examines what has changed in the larger international Ebola response landscape since 2014, and the current status of the U.S. Government engagement, including comparing the U.S. response now to a similar point in the trajectory of the 2014 outbreak. It details how the Democratic Republic of the Congo has experience with Ebola outbreaks, the World Health Organization has addressed important shortcomings, and an effective Ebola vaccine is available and being used. (Text)
Source: Disaster Lit: Resource Guide for Disaster Medicine and Public Health - Category: International Medicine & Public Health Authors: Source Type: news
Authors: Lipiecki J, Brunel P, Morice MC, Roguelov C, Walsh SJ, Richardt G, Eerdmans P, Zambahari R, Berland J, Copt S, Stoll HP, Urban P Abstract AIMS: The LEADERS FREE trial has demonstrated that a polymer-free Biolimus A9-coated stent (BA9-DCS) is superior to a bare metal stent (BMS) for high bleeding risk (HBR) patients when treated with one month of dual antiplatelet therapy (DAPT). This analysis aimed to determine the impact of PCI procedure complexity on the two-year results. METHODS AND RESULTS: Six hundred and sixty-seven (667) patients enrolled in the LEADERS FREE (BA9-DCS 346, BMS 321) underwent a co...
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
CONCLUSIONS: This is the first study providing clinical evidence on the use of PF-BES in all-comer patients irrespective of HBR status. Our findings suggest that PF-BES has a favorable safety and efficacy profile in a real world clinical setting. Further investigation in randomised clinical trials against new-generation DES is warranted. PMID: 29784631 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
The World Cancer Research Fund (WCRF) has bad news for lovers of bacon and booze: Eliminating processed meats and alcohol from your diet may help reduce your risk of developing cancer. The third report from the WCRF’s Continuous Update Project, an ongoing effort to inform consumers about lifestyle habits that may be related to cancer, provides numerous recommendations for people looking to minimize their risk of getting cancer. But two, in particular, are likely to cause a stir for many Americans. First, the WCRF recommends significantly or totally cutting back on processed meats including bacon, salami, hot dogs and...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized Cancer healthytime onetime Source Type: news
DIABETES type 2 symptoms include unexplained weight loss, tiredness and frequently needing the toilet. If you develop the condition it is important to take steps to control your blood sugar levels, as failing to do so can cause further life threatening problems. These are seven problems you can develop due to the condition.
Source: Daily Express - Health - Category: Consumer Health News Source Type: news
Contributors : Duhen Thomas ; Montler Ryan ; Weinberg AndrewSeries Type : Expression profiling by arrayOrganism : Homo sapiensIdentifying tumor antigen-specific T cells from cancer patients has been a goal of tumor immunologists for several decades. Co-expression of CD103 and CD39 on CD8 TIL highly enriches for tumor-reactive T cells. CD39+CD103+ CD8 TIL have a distinct TCR repertoire compared to other CD8 TIL subsets and are clonally expanded within the tumor.They are highly enriched for tumor antigen recognition and efficiently killed autologous tumor cells. Patients with head and neck cancer whose CD8 TIL contained a hi...
Source: GEO: Gene Expression Omnibus - Category: Genetics & Stem Cells Tags: Expression profiling by array Homo sapiens Source Type: research
Our weekly DiabetesMine advice column explores reasons why people with diabetes sometimes get low blood sugar even when they dose insulin just right.
Source: Diabetes Mine - Category: Endocrinology Authors: Source Type: blogs
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