The CVS tobacco decision is no small thing — Keep the chips and soda please
Yesterday, CVS Caremark announced that its 7600 stores will stop selling tobacco products. Company leadership said that selling tobacco is not consistent with being a health company. This decision, which takes effect in October 2014, will result in 2 billion less revenue.
I am no business person, (though, as an observer of humans, I follow business news), but giving up 2 billion dollars in revenue seems like a bold and courageous move. Forbes journalist Matt Herper explains the business aspects. He teaches us that CVS’ model is changing. Not only are pharmacies like CVS turning into health care delivery portals, with...
Source: Dr John M - February 6, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
A Super Week in Biology: This could change everything about the practice of Medicine.
Editor’s note: What follows is a guest post. Michael Zhang is an MD-PhD student studying at the University of Louisville School of Medicine. He is one of my go-to experts on matters of cell biology and stem cells. (His bio is below.)
As you may have heard, this week brought striking news in the field of stem cell biology. Researchers from Boston and Japan published two papers in the prestigious journal Nature in which they describe new and easy ways to transform mouse cells back into stem cells. (NPR coverage here.) Make no mistake, this is not mundane science news. This is big.
I follow cell biology because I belie...
Source: Dr John M - February 2, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
100 is the new 80…If you are good to yourself (and lucky)
“There has been a change in your prescription,” said the eye doctor, a wise and bald man, who could have been mistaken for an economics professor at Princeton.
“It’s improved?” the 30 year-old cardiologist asked. Better, improved, always the reflex for athletic cardiologists.
“Doctor…you have been to the pinnacle and passed it. Your eyes, like the rest of your body, are on the downward side.”
Damn aging. The creases, the sags, the morning kinks, and the children on bikes who ride away from you as if they are on a motorbike.
Then there is Frenchman Robert Marchand.
The phrase ...
Source: Dr John M - February 1, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
ICD and Pacemaker deactivation: It is neither physician-assisted suicide nor euthanasia
The purpose of this post is to clarify important issues about cardiac devices as they relate to deactivation. As I wrote yesterday, Paula Span of the NY Times covered this important issue earlier this week. Her coverage came about because of this Mayo Clinic paper published in JAMA-IM, which showed most patients with cardiac devices approach end of life without proper preparation.
The first two questions to clarify are: What is a cardiac device and what does it mean to deactivate it? When we say “cardiac device” we are referring to either an Internal Cardiac Defibrillator (ICD) or a pacemaker. There are many im...
Source: Dr John M - January 31, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
ICD deactivation in the NY Times — with a quote from a blogger
The news came via a direct message on Twitter. “You got a plug in the NY times. Congrats.” (Thanks Dr. Jay Schloss.)
Paula Span, author of the NY Times’ The New Old Age Blog, reported today on the issue of cardiac device deactivation in patients who are approaching end of life.
The role I had in the piece stems from the editorial I co-authored with University of Colorado Professor Dr. Dan Matlock in the Journal of the American Medical Association-Internal Medicine.
I think this is my first mention in the Times. It’s especially nifty because end-of-life care is such an important topic.
Yes, car...
Source: Dr John M - January 30, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
When doctors meet with hospital administrators…
The meeting was remarkable. It’s not normal to get nine cardiologists to sit down with this many important hospital people. There was a CEO and CFO, two vice presidents, and a ‘consultant,’ a man who sported a nice suit but said no words. We gathered to discuss major issues in healthcare, things like budgets, pro forma estimates, physician recruitment, declining reimbursement, and yes, the electrophysiology situation.
It goes without saying that I can’t offer details. I can, however, share four big-picture things:
First…This stuff is really hard. Healthcare delivery I mean. It’s hard on peop...
Source: Dr John M - January 29, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
In the treatment of pain, OPIOID helps caregivers weather the regulatory storm
What follows is a guest post. James Patrick Murphy, MD, MMM is board-certified in Pain, Addiction, and Anesthesiology. He is President of The Greater Louisville Medical Society and the Course Director for OPIOID — Optimal Prescribing Is Our Inherent Duty.
Dr Murphy, a friend, writes on the matter of optimal prescribing of pain therapy. It’s a timely and important topic. As a bike racer, I have experienced the anguish of pain. From a patient perspective, the problem with pain is not just that it hurts, but also, that it’s hard to see the end of suffering. Thankfully, I have been lucky to have had compassio...
Source: Dr John M - January 27, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
The danger of grading doctors…
It goes without saying that caregivers are not interchangeable. Quality matters. What else is there other than our health?
From the day I began as a doctor, the absence of a legitimate meritocracy has been a source of inflammation. In 1996, when I started private practice, referrals depended too much on old-boy networks. In 2014, the situation is worse. Now, referrals depend almost exclusively on who employs whom. I could be a wizard of catheter ablation, but referring doctors who are employed by competing systems will not send me patients. They might sneak their mother in, but their patients go to the electrophysiologist ...
Source: Dr John M - January 24, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Doctors play an important role in improving US healthcare woes
Elisabeth Rosenthal, a reporter with the New York Times, is doing American doctors a favor. Her series, Paying Till it Hurts, is forcing us to face our role in the US healthcare problem. That’s a good thing, because, as it goes in the practice of Medicine, the first step to achieving good outcomes is identifying the problems.
Ms. Rosenthal’s most recent piece, Patients’ Costs Skyrocket; Specialists’ Incomes Soar, published today on the front page of the Sunday Times, aimed its scalpel on the lucrative specialty of Dermatology. But one mustn’t focus too much on the skin, there are ample areas of healthcare in ...
Source: Dr John M - January 19, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
New post up on Cardiology Medscape: Lessons learned from the failure of Renal denervation for high blood pressure
Most people come by it honestly. They eat too much, move too little, skimp on sleep, take on too much stress and then succumb to buying larger clothes. The word we use in medicine is insidious.
High blood pressure (hypertension – HTN) is one of the leading cardiovascular problems of this time. Some have called treating HTN the holy grail of medicine. Think about why this may be. The human heart contracts 100,000 times per day. Each beat delivers a pressure load to the thousands of arteries in the body. Over days, weeks, months, years and decades, small elevations of high pressure can have devastating wear and tear ef...
Source: Dr John M - January 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Dear Senator/Representative — US healthcare needs more knowledge
If you had to write a one page memo to a Senator/Representative detailing the one thing they could do to improve US healthcare, what would it be?
For me, it’s improving the wastefulness of our system. Here is my attempt at a memo:
Comparative Effectiveness Research is a win-win: Knowledge always is.
US healthcare is too big and too wasteful. Inefficiency is the conflict that needs resolution. Dare I say there is too much fat in our system?
As an experienced physician, I believe the main cause of inefficiency is a deficit in knowledge. When we don’t know something, we are often scared. Fear and ignorance pushes the...
Source: Dr John M - January 13, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Clicked back in…Holiday reading and thoughts on medical writing
Hey everyone…
Welcome to 2014. I’m back from holiday. I like to say ‘holiday’ rather than ‘vacation.’ It sounds more Euro. Plus, if one truly seeks word precision, saying holiday when describing time in Key West works. Everything about that place is celebratory and festive.
Let’s talk about reading and writing.
First, I’m not going to do a top-ten DrJohnM posts of 2013. WordPress sends you a tidy email of your most popular posts. I didn’t look at it. I do enough self-promotion as it is. It feels funny re-posting stuff that is already out there.
Second, I have to tell yo...
Source: Dr John M - January 8, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
A Christmas message: Wright’s Law — Physics and Love
This fella is a Physics teacher in Louisville.
We see him at quick recall matches. Who knew he was so extraordinary.
A former student made the video, which Vimeo picked as a Top-ten for 2013. It’s a perfect post for Christmas.
Love teachers.
After doing some research, I learned Mr Wright was featured in the NY Times last December.
JMM
Related posts:
Heart-healthy Christmas Wishes
Merry Christmas
Love the wisdom of physician colleagues (Source: Dr John M)
Source: Dr John M - December 25, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Two gifts and a consolation prize
President Obama has a few good ideas.
He wants Americans to discuss healthcare this holiday season. That’s actually a really good idea.
This blog aims to do some good in the area of medicine and health. What follows are two incredibly important essays. The consolation prize is an excerpt from my recent Top Ten post. I chose this particular excerpt because in my view the most impactful cardiology study of 2013 involved two prominent themes of this blog–arrhythmia and the power of lifestyle choices.
On over-treatment and the collective inability to give peace a chance:
Dr. Rob Lamberts is a primary care doctor, a...
Source: Dr John M - December 24, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
2013: Year-end summary of top cardiology stories
When the editors of Medscape asked me to write a Top Ten article on the best Cardiology stories in 2013, I jumped at the chance. I spent a lot of time thinking about Cardiology this year. I was invested.
Plus, 2013 was a year for pivoting–big time pivoting. What made news in 2013 was not new drugs or devices, but new approaches to heart disease. Entire paradigms changed. The rock of dogma was cracked. The verb need, as in Mr Jones needs this pill or procedure, began its decline.
And the disruption is only beginning.
For instance, a patient with heart disease who was already on a statin drug asked me yesterday: “...
Source: Dr John M - December 21, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
