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: Carroll K, Mesman J, McLeod H, Boughey J, Keeney G, Habermann E Abstract Utilising frozen section technologies, Mayo Clinic has one of the lowest reoperation rates for breast lumpectomy in the United States. The research reported on sought to understand the successful teamwork between the Breast Surgery Team and the Frozen Section Laboratory at Mayo Clinic. Researchers worked collaboratively with healthcare staff from breast surgery and the frozen section pathology laboratory to identify communication styles and strategies that contribute to the timely and accurate intraoperative evaluation of breast cance...
Source: Journal of Interprofessional Care - Category: Health Management Tags: J Interprof Care Source Type: research
ConclusionsNIV showed a significant protective effect for intubation in immunosuppressed patients (cancer and transplants) and in patients with APE/CAP. However, the benefits of NIV for other etiologies are not clear and more trials are needed to prove these effects.
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
ConclusionsThis study shows that reduction of CTRP3 concentrations is likely to bring a concomitant increase in risk of diabetes in obese and normal body weight young adults. Decrease in CTRP3 concentration may have an essential role in the pathophysiology of metabolic disorders concomitant to obesity.
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research
A new study shows a drug targeting the immune system could help women with an aggressive type of breast cancer. The results were announced at a conference in Europe and could change the way women are treated. Dr. Jon LaPook reports.
Source: Health News: CBSNews.com - Category: Consumer Health News Source Type: news
Publication date: Available online 19 October 2018Source: Pharmacology &TherapeuticsAuthor(s): Ryuji Yamaguchi, Lydia Lartigue, Guy PerkinsAbstractRegulation of both the extrinsic and the mitochondria-dependent intrinsic apoptotic pathways plays a key role in the development of the hematopoietic system, for sustaining cell survival during generation of various cell types, in eliminating cells with dual identities such as CD4/CD8 double-positive cells1,2, for sustaining cells during the rapid clonal expansion phase3, as well as eliminating cells during the contraction phase4. The anti-apoptotic protein Mcl-1 is necessar...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 19 October 2018Source: Pharmacology &TherapeuticsAuthor(s): André Moraes Nicola, Patrícia Albuquerque, Hugo Costa Paes, Larissa Fernandes, Fabricio F. Costa, Erika Seki Kioshima, Ana Karina Rodrigues Abadio, Anamélia Lorenzetti Bocca, Maria Sueli FelipeAbstractThe need for better antifungal therapy is commonly accepted in view of the high mortality rates associated with systemic infections, the low number of available antifungal classes, their associated toxicity and the increasing number of infections caused by strains with natural or acquired resistance. The urg...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 19 October 2018Source: Pharmacology &TherapeuticsAuthor(s): A.D. Dobrian, M.A. Morris, D.A. Taylor-Fishwick, T.R. Holman, Y. Imai, R.G. Mirmira, J.L. NadlerAbstract12-lipoxygenase (12-LOX) is one of several enzyme isoforms responsible for the metabolism of arachidonic acid and other poly-unsaturated fatty acids to both pro- and anti-inflammatory lipid mediators. Mounting evidence has shown that 12-LOX plays a critical role in the modulation of inflammation at multiple checkpoints during diabetes development. Due to this, interventions to limit pro-inflammatory 12-LOX metabolites eithe...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 19 October 2018Source: Pharmacology &TherapeuticsAuthor(s): Joseph T. Madak, Armand Bankhead, Christine R. Cuthbertson, Hollis D. Showalter, Nouri NeamatiAbstractIdentified as a hallmark of cancer, metabolic reprogramming allows cancer cells to rapidly proliferate, resist chemotherapies, invade, metastasize, and survive a nutrient-deprived microenvironment. Rapidly growing cells depend on sufficient concentrations of nucleotides to sustain proliferation. One enzyme essential for the de novo biosynthesis of pyrimidine-based nucleotides is dihydroorotate dehydrogenase (DHODH), a known t...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 19 October 2018Source: Pharmacology &TherapeuticsAuthor(s): Xiangjin Zheng, Wan Li, Liwen Ren, Jinyi Liu, Xiaocong Pang, Xiuping Chen, De Kang, Jinhua Wang, Guanhua DuAbstractSphingolipid metabolites, such as ceramide, sphingosine and sphingosine-1-phosphate (S1P), play many important roles in cellular activities. Ceramide and sphingosine inhibit cell proliferation and induce cell apoptosis while S1P has the opposite effect. Maintaining a metabolic balance of sphingolipids is essential for growth and development of cells. Sphingosine kinase (SPHK) is an important regulator for keeping...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
ConclusionLack of drug efficacy, inappropriate drug adherence and patient knowledge were the major TRPs identified via delivering the MMR service to post-stroke patients. The identified TRPs highlights the importance of the MMR service, and supports planning future strategies aimed at decreasing the incidence of strokes.
Source: Saudi Pharmaceutical Journal - Category: Drugs & Pharmacology Source Type: research
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