MKSAP: 30-year-old woman with HIV infection
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated in follow-up after being recently diagnosed with HIV infection. She is asymptomatic. Medical history is unremarkable, and she takes no medications; she has not yet started antiretroviral therapy. She received all scheduled childhood immunizations.
On physical examination, vital signs are normal. She has shotty cervical lymphadenopathy, but the examination is otherwise unremarkable.
Laboratory studies:
Absolute CD4 cell count
461/µL
HIV viral load
44,874 copies/mL
Hepatiti...
Source: Kevin, M.D. - Medical Weblog - August 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Infectious Disease Source Type: blogs
Which of these patients should get a liver transplant?
People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a candidate toward the head of the line? Age? Medical diagnoses? Insurance coverage? Employment status? Worth to society? Criminal record?
Consider the following six hypothetical examples of pat...
Source: Kevin, M.D. - Medical Weblog - July 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Conditions Gastroenterology Source Type: blogs
The Most Expensive Drugs in America: Interview with GoodRx Co-Founder/Co-CEO Doug Hirsch
United States healthcare policy is currently in the spotlight as the Trump administration seeks to weaken Obamacare with actions such as the Tax Cuts and Jobs Act, which removes the individual mandate that required individuals to carry health insurance. Another focus of the current administration’s plan is to lower drug prices with strategies like preventing brand-name drug manufacturers from blocking the entry of cheaper generics and creating incentives for cheaper drugs. While the results of this strategy have yet to play out, they do beg the question, how expensive are medications in the United States?
For that an...
Source: Medgadget - June 27, 2018 Category: Medical Devices Authors: Michael Batista Tags: Exclusive Medicine Net News Public Health Society Source Type: blogs
Fight Aging! Newsletter, June 11th 2018
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - June 10, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
An Interview with Jim Mellon, and Update on Juvenescence
This interview with Jim Mellon opens with an update on some of the recent investment activities of Juvenescence, founded last year in order to participate in the enormous market opportunity afforded by the development of the first working rejuvenation therapies. It is in Mellon's self-interest to help educate the world about the size of this market, and draw in other, larger entities that will help to carry his portfolio companies to the finish line. So he is doing just that, and in doing so benefits us all. His advocacy will help all fronts in fundraising for research and development in this field.
That advocacy co...
Source: Fight Aging! - June 4, 2018 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
A physician makes the case for some routine labs
Many medical organizations have recently been promoting focused and individualized lab testing for routine screening or when pursuing a diagnosis. Research has shown that the “shotgun” approach to lab testing usually leads to further invasive testing which has not been proven to significantly alter morbidity or mortality.
Additionally, tests rely on pre-test probabilities and can have false-positive or negative results and even lead to adverse events from the follow-up testing. In response to this, medical organizations have created many resources to help educate and guide physicians from over-testing. The American Col...
Source: Kevin, M.D. - Medical Weblog - May 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/shmuel-golfeyz" rel="tag" > Shmuel Golfeyz, MD < /a > Tags: Conditions Gastroenterology Hospital-Based Medicine Primary Care Source Type: blogs
Is " Curing Patients " a Good Business Model for Pharma?
An interesting point was made in a recent article that the stock market may"punish" companies likeGilead Sciences which has developed a drug called Harvoni to cure hepatitis C. The supposed reason for the punishment is that the prospects for drug profits will diminish as its highly effective use continues (see:Goldman Sachs report:"Is curing patients a sustainable business model?"). Below is an excerpt from the article:In Goldman Sachs's April 10 report,"The Genome Revolution," its analysts ponder the rise of biotech companies who believe they will develop"one-shot" cures f...
Source: Lab Soft News - April 17, 2018 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Cost of Healthcare Genomic Testing Healthcare Business Medical Consumerism Medical Ethics Medical Research Pharmaceutical Industry Public Health Source Type: blogs
Are hepatits C drugs too expensive? Analyzing the pros and cons.
The last few years have been marked by public outcry over the costs of novel prescription drugs, such as the hepatitis C medication sofosbuvir (brand name Sovaldi), which are highly efficacious but extremely expensive.
On the one hand, sofosbuvir produces cure rates of >90%, a figure that seemed unthinkable a few decades ago. On the other, it is priced at approximately $1000 per pill ($60,000–$90,000 for a treatment course), making it unaffordable for many patients. This price tag has spurred physician and advocacy groups to call for price lowering so that more patients can benefit. In turn, the drug manufacturer ha...
Source: Kevin, M.D. - Medical Weblog - April 5, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/joshua-liao" rel="tag" > Joshua Liao, MD < /a > Tags: Conditions Gastroenterology Source Type: blogs
MKSAP: 57-year-old man with chronic hepatitis C infection
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is evaluated during a routine examination. His medical history is notable for chronic hepatitis C infection with cirrhosis, which was diagnosed 3 years ago. He undergoes surveillance ultrasound for hepatocellular carcinoma every 6 months.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/82 mm Hg, pulse rate is 65/min, and respiration rate is 18/min; BMI is 22. Muscle wasting and scleral icterus are noted. There is no flank dullness and no asterixis.
Ultrasound ...
Source: Kevin, M.D. - Medical Weblog - March 31, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Oncology/Hematology Source Type: blogs
Knowing when to screen … and when to quit
Follow me on Twitter @RobShmerling
Let us sing the praises of good medical screening tests.
These are the tests that can detect medical problems before they become untreatable and before they cause complications or even death. Even better are those screening tests that detect “predisease” — abnormalities that aren’t dangerous on their own but can lead to problems later.
According to the US Preventive Services Task Force, relatively few screening tests are considered good enough to routinely recommend for adults, including
mammography for breast cancer (women)
Pap smear for cervical cancer (women)
bone density test...
Source: Harvard Health Blog - March 1, 2018 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Cancer Health Prevention Screening Source Type: blogs
It’s in the Urine
"I just put a young woman in her mid-30s back in room 9," the triage nurse said. I made a mental note that that was the GYN room. The nurse continued, "She feels bad, fatigued, and just not right in her stomach." The obvious question flew from my mouth. "Is she pregnant?""I have the urine, but the quality controls are being run now, so it will be a few minutes."I glanced at the EMR before heading back to the room: normal vitals, no fever, no medications, a couple of kids, no surgeries, last period three weeks before. Not much there to go on, but I could see her while waitin...
Source: Lions and Tigers and Bears - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Precision Medicine and Public Health (from Precision Medicine and the Reinvention of Human Disease)
Excerpted fromPrecision Medicine and the Reinvention of Human DiseaseDespite having the most advanced healthcare technology on the planet, life expectancy in the United States is not particularly high. Citizens from most of the European countries and the highly industrialized Asian countries enjoy longer life expectancies than the United States. According to the World Health Organization, the United States ranks 31st among nations, trailing behind Greece, Chile, and Costa Rica, and barely edging out Cuba [42]. Similar rankings are reported by the US Central Intelligence Agency [43]. These findings lead us to infer that acc...
Source: Specified Life - February 6, 2018 Category: Information Technology Tags: cancer cancer vaccines precision medicine prevention public health Source Type: blogs
This physician won ’t practice parachute-based medicine
I try my best to practice evidence-based medicine on a daily basis. When I know that the test or intervention that I am recommending for my patient is based on expert opinion rather than reliable data on patient-oriented outcomes that matter, I invariably make a point of saying so. It has been my position for several years that despite the impressive effectiveness of newer antiviral medications for hepatitis C at producing a sustained virologic response (SVR), there are still not enough data to be certain that SVR always represents a “cure,” and therefore not enough data to warrant age cohort-based screen...
Source: Kevin, M.D. - Medical Weblog - January 29, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/kenneth-lin" rel="tag" > Kenneth Lin, MD < /a > Tags: Physician Cardiology Source Type: blogs
The flu is here — and so is a new advisory from the CDC
In conclusion…
Maybe this year’s flu season will be milder than expected. But I wouldn’t count on it. I’ve had the flu and it’s not pleasant. Do what you can to lessen your risk. It’s worth the effort.
The post The flu is here — and so is a new advisory from the CDC appeared first on Harvard Health Blog. (Source: Harvard Health Blog)
Source: Harvard Health Blog - January 10, 2018 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Cold and Flu Infectious diseases Source Type: blogs
How 2016 Drug Spending Stacks Up
We have written many times about the way growth in drug spending has significantly been below the growth rate of overall national healthcare spending, despite the media spotlight on the issue.
Total nominal United States health care spending increased at a rate of 4.3% and reached $3.3 trillion in 2016. Per capita spending on health care also increased by $354, totaling $10,348. Health spending growth did decelerate in 2016, however, following faster growth in 2014 and 2015 associated with coverage expansions under the Affordable Care Act and strong retail prescription drug spending growth.
In 2016 the slowdown was broad...
Source: Policy and Medicine - January 4, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
