Recent quotes:

Everything You Know About Obesity Is Wrong - The Huffington Post

The problem starts in medical school, where, according to a 2015 survey, students receive an average of just 19 hours of nutrition education over four years of instruction—five hours fewer than they got in 2006. Then the trouble compounds once doctors get into daily practice. Primary care physicians only get 15 minutes for each appointment, barely enough time to ask patients what they ate today, much less during all the years leading up to it. And a more empathic approach to treatment simply doesn’t pay: While procedures like blood tests and CT scans command reimbursement rates from hundreds to thousands of dollars, doctors receive as little as $24 to provide a session of diet and nutrition counseling.

Everything You Know About Obesity Is Wrong - The Huffington Post

Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

Take a vacation -- it could prolong your life -- ScienceDaily

Participants were randomised into a control group (610 men) or an intervention group (612 men) for five years. The intervention group received oral and written advice every four months to do aerobic physical activity, eat a healthy diet, achieve a healthy weight, and stop smoking. When health advice alone was not effective, men in the intervention group also received drugs recommended at that time to lower blood pressure (beta-blockers and diuretics) and lipids (clofibrate and probucol). Men in the control group received usual healthcare and were not seen by the investigators. As previously reported, the risk of cardiovascular disease was reduced by 46% in the intervention group compared to the control group by the end of the trial. However, at the 15-year follow-up in 1989 there had been more deaths in the intervention group than in the control group. The analysis presented today extended the mortality follow-up to 40 years (2014) using national death registers and examined previously unreported baseline data on amounts of work, sleep, and vacation. The researchers found that the death rate was consistently higher in the intervention group compared to the control group until 2004. Death rates were the same in both groups between 2004 and 2014.

Wait, just a second, is your doctor listening? -- ScienceDaily

On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors. Also, only one in three doctors provides their patients with adequate opportunity to describe their situation. The pressure to rush consultations affects specialists more than primary care doctors says Naykky Singh Ospina of the University of Florida, Gainesville and the Mayo Clinic in the US. She led research that investigated the clinical encounters between doctors and their patients, how the conversation between them starts, and whether patients are able to set the agenda.

What doctors wear really does matter, study finds: Survey of more than 4,000 patients isn't just about fashion -- patient satisfaction may be affected -- ScienceDaily

When asked directly what they thought their own doctors should wear, 44 percent said the formal attire with white coat, and 26 percent said scrubs with a white coat. When asked what they would prefer surgeons and emergency physicians wear, scrubs alone got 34 percent of the vote, followed by scrubs with a white coat with 23 percent.

Pharmaceutical Advertising Down But Not Out - News - News Releases - 2013

The pharmaceutical industry has pulled back on marketing to physicians and consumers, yet some enduring patterns persist. According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, advertising peaked in 2004, with industry promotion to physicians declining nearly 25 percent by 2010, to $27.7 billion or 9 percent of sales.  Similar declines were seen in direct-to-consumer advertising, which remains concentrated among a small number of products. The number of products promoted to providers peaked at over 3,000 in 2004, and declined by approximately 20 percent by 2010. Despite these changes, there was little change in the split of marketing between primary care physicians and specialists, and the proportion of all promotion taking place in physicians’ offices also remains unchanged. Free samples and physician detailing accounted for over 70 percent of promotional expenditures in 2010, with the remainder comprised by consumer advertising as well as physician marketing through journal ads, e-promotion and sponsored conferences and meetings. The results are featured in the February 2013 issue of the open-access journal PLOS ONE.

Research Center Tied to Drug Company - The New York Times

tors. In a November 1999 e-mail message, John Bruins, a Johnson & Johnson marketing executive, begs his supervisors to approve a $3,000 check to Dr. Biederman as payment for a lecture he gave at the University of Connecticut. “Dr. Biederman is not someone to jerk around,” Mr. Bruins wrote. “He is a very proud national figure in child psych and has a very short fuse.” Mr. Bruins wrote that Dr. Biederman was furious after Johnson & Johnson rejected a request that Dr. Biederman had made for a $280,000 research grant. “I have never seen someone so angry,” Mr. Bruins wrote. “Since that time, our business became non-existant (sic) within his area of control.” Mr. Bruins concluded that unless Dr. Biederman received a check soon, “I am truly afraid of the consequences.”

Drug Maker Told Studies Would Aid It, Papers Say - The New York Times

In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard. “Full professor,” he answered. “What’s after that?” asked a lawyer, Fletch Trammell. “God,” Dr. Biederman responded. “Did you say God?” Mr. Trammell asked. “Yeah,” Dr. Biederman said.

The model is not the reality

Doctors loved Kübler-Ross’s five stages. The stages gave doctors the capacity to diagnose their dying patients, to target their questions and categorize the evidence: if the patient wasn’t depressed, then maybe she was in denial. The stages provided guidance on what to say in impossible circumstances. She had, unwittingly, provided doctors with a system for discussing death like a medical process. Her collaborator, Kessler, told me that on more than one occasion, a medical colleague would stop by while he and Kübler-Ross were writing to seek help with a diagnosis. “They’d be like, ‘Elisabeth, what stage are they in?’ And she would say, ‘It’s not about the stages! It’s about meeting them where they are!’” She found it laughable how some doctors had the gall to hold an essential organ in their hand but had no capacity for ambiguity.

Doctors in denial about death, their own powerlessness

Medical students were invited to attend the seminars, but for a long time, none did. “The physicians have been the most reluctant in joining us in this work,” Kübler-Ross noted in On Death and Dying. “It may take both courage and humility to sit in a seminar which is attended not only by the nurses, students, and social workers with whom they usually work, but in which they are also exposed to the possibility of hearing a frank opinion about the role they play in the reality or fantasy of their patients.” American doctors were so preoccupied with avoiding death that they avoided any discussion of it. “I observed the desperate need of the hospital staff to deny the existence of terminally ill patients on their ward.” This was typical for the medical profession at the time. In the early 1970s, years after Kübler-Ross began her research, only about 10 percent of doctors told their patients when they had a terminal condition; until 1980, the American Medical Association considered it a doctor’s right not to tell their patients if they had an incurable disease. At Kübler-Ross’s hospital, most doctors would inform the patient’s family of a fatal diagnosis and allow them to decide what to share with the patient.

Newfound 'organ' had been missed by standard method for visualizing anatomy -- ScienceDaily

The researchers say that no one saw these spaces before because of the medical field's dependence on the examination of fixed tissue on microscope slides, believed to offer the most accurate view of biological reality. Scientists prepare tissue this examination by treating it with chemicals, slicing it thinly, and dying it to highlight key features. The "fixing" process makes vivid details of cells and structures, but drains away any fluid. The current research team found that the removal of fluid as slides are made causes the connective protein meshwork surrounding once fluid-filled compartments to pancake, like the floors of a collapsed building.

Study reveals lack of self-awareness among doctors when prescribing opioids: Emergency department physicians underestimated how often they prescribed opioids, but prescriptions decreased after they saw their actual data -- ScienceDaily

Some 65 percent of those surveyed prescribed more opioids that they thought they did. Michael and his team found participants discharged 119,428 patients and wrote 75,203 prescriptions, of which 15,124 (or about 20 percent) were for opioids over the course of the 12-month study. The researchers then monitored the doctors after they were shown their actual prescription rates. "Everyone showed an overall decrease in prescribing opioids," Michael said. "After seeing their real data, the people with inaccurate self-perceptions, on average, had 2.1 fewer opioid prescriptions per 100 patients six months later and 2.2 percent fewer prescriptions per 100 patients at 12 months."

The Illusions of Psychiatry | by Marcia Angell | The New York Review of Books

Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.5

Patients react better when doctors imply uncertainty, rather than state it directly -- ScienceDaily

Diagnostic uncertainty is widespread in clinical practice and physician guidelines generally recommend that doctors explain the degree of uncertainty associated with their diagnosis. However, how exactly doctors should communicate uncertainty is a matter of debate. This communication can lower visit satisfaction, decrease adherence to doctor instructions, lessen trust, and decrease confidence in the doctor. The researchers here surveyed parents of pediatric patients who hypothetically received a diagnosis with an element of uncertainty. The uncertainty in the diagnosis was communicated in one of three ways; either with an explicit expression of uncertainty (such as "I'm not sure which disease this is"), an implicit expression of uncertainty using broad differential diagnoses (such as "it could be this disease or this other disease"), or another implicit expression of uncertainty (such as "it is most likely this disease"). Researchers found that explicit expressions of uncertainty were associated with lower perceived technical competence of the doctor, less trust and confidence, and a less willingness to adhere to doctors' advice. "Misdiagnosis is common in medical practice and to enable improvements, uncertainty of diagnosis is something both doctors and patients will need to embrace" said Hardeep Singh, MD, MPH, senior author and researcher at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety and Baylor College of Medicine. "Our study provides a foundation for future development of evidence-based guidance on how doctors can best communicate diagnostic uncertainty to patients to improve diagnosis and care outcomes."

>50% medical journal editors get money from drug companies

The authors investigated 52 influential U.S.-based journals in 26 physician specialties. In 2014, approximately half the editors of these journals received payments from pharmaceutical or medical device companies. These payments were disclosed by the applicable companies in the U.S.-based Open Payments database a federally run program that requires industry to report information about financial relationships to physicians. These payments were made to the editors personally, rather than for research funding, and were characterized in various ways, including honorariums, patent royalties, food and beverage, travel expenses, and consulting fees. The highest payments went to editors from endocrinology journals, followed by cardiology, gastroenterology, rheumatology and urology. The authors found that, on the whole, journal editors who are also physicians received higher payments from the pharmaceutical and medical device industries than physicians in their same specialty who are not journal editors.

Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon

Access rapidly becomes an addict's top priority, he notes, and self-medicating physicians will do everything in their power to ensure it continues. "They're often described as the best workers in the hospital," he says. "They'll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They'll sign up for extra call and show up for rounds they don't have to do." Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.

Stimulant Use Exceptionally High Among Medical Students

Of 148 medical students, 145 (98%) responded to the survey. The results revealed that 20% of students reported lifetime use of stimulants, with 15% reporting stimulant use during medical school. Compared with Asian students, white students had a 9-fold increase in odds for stimulant use (P = .001). The investigators note that the sample size was not large enough to reliably compare prevalence of stimulant use in black and Hispanic medical students. The researchers report that 13 students (9%) reported a diagnosis of ADHD and had an odds ratio of 37 for stimulant use in medical school compared with those without an ADHD diagnosis (P < .001). The study also revealed that, of those who had taken stimulants, 83% used them specifically to boost cognitive performance, including improving focus while studying and staying awake longer while on clinical duty. There were no differences in stimulant use by age, marital status, or academic achievement. "Indeed, those with high standardized test scores had an almost identical use prevalence compared with those with lower test scores," the investigators report. The majority (83%) of students who reported using stimulants used them specifically to improve cognitive performance.

My Stimulant Use in Med School: The Good, The Bad, The Victory » in-Training, the online magazine for medical students

ADD medications are generally marketed to “unleash the potential of the student,” which is accurate. In my case, I could finally barrel through those lecture notes without stopping five times to look at some shiny thing in order to earn a slightly below average grade on an exam (I’d stop only 2 times, instead). Indeed, there is evidence to suggest that high-functioning students do not benefit from stimulant use the way lower-functioning students do. Of course, “high” and “low” functioning takes on a whole new meaning when we’re now splicing up classes of some of the highest achieving students from their colleges, but this is part of the issue in saying “ADD versus ‘normal.’” It’s really “ADD versus your potential.” The ability to synthesize complex ideas in my head had never been the issue, even through college (i.e. my intellect on its own was plenty strong). My ability to utilize this abstract synthetic ability was the issue, thus the obvious utility of Focalin.

The Heroism of Incremental Care - The New Yorker

Rose told me, “I think the hardest transition from residency, where we are essentially trained in inpatient medicine, to my practice as a primary-care physician was feeling comfortable with waiting. As an outpatient doctor, you don’t have constant data or the security of in-house surveillance. But most of the time people will get better on their own, without intervention or extensive workup. And, if they don’t get better, then usually more clues to the diagnosis will emerge, and the steps will be clearer. For me, as a relatively new primary-care physician, the biggest struggle is trusting that patients will call if they are getting worse.” And they do, she said, because they know her and they know the clinic. “Being able to tolerate the anxiety that accompanies taking care of people who are sick but not dangerously ill is not a skill I was expecting to need when I decided to become a doctor, but it is one of the ones I have worked hardest to develop.”

FDA study -- stimulant triggered psychosis, violence sometimes doesn't resolve

FDA Review ADHD Drugs Induce-Psychosis, Mania, Homicide, Suicide http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210B-Index.htm DATE: March 3, 2006 TO: Thomas Laughren, M.D., Director Division of Psychiatric Products (DPP), FDAOffice of Counter-Terrorism and Pediatric Drug Development (OCTAP) Memorandum. FROM: Kate Gelperin, M.D., M.P.H., Medical Epidemiologist Kate Phelan, R.Ph., Safety Evaluator The DDRE ADHD Psychiatric Review Team Office of Drug Safety (ODS) 1 EXECUTIVE SUMMARY / INTRODUCTION A BPCA (Best Pharmaceuticals for Children Act) review of methylphenidate products, prompted by Concerta pediatric exclusivity requirements, identified psychiatric adverse events as a possible concern. The review found some psychiatric adverse events mentioned in labeling, but a need for improved clarity was identified. The Pediatric Advisory Committee1 agreed at the June 2005 meeting at which the methylphenidate reviews were discussed, that the issue of psychiatric adverse events with all drugs indicated to treat ADHD should be examined with the goal of better characterizing these events so that drug labeling could be updated and made consistent between products. Thus, DDRE embarked on reviews of postmarketing and clinical trial reports of psychiatric adverse events associated with drugs used to treat ADHD. This document presents the results of the review of postmarketing reports. A companion document2, from Dr. Andrew Mosholder, presents the results of the review of clinical trial reports.  Information pertaining to selected psychiatric adverse event reports received since January 1, 2000 was requested from the manufacturers of products approved or with pending applications for the treatment of ADHD. Sponsors were asked to provide information regarding four broad categories of psychiatric adverse events: 1) signs and/or symptoms of psychosis or mania; 2) suicidal ideation and behavior; 3) aggression and violent behavior; and, 4) miscellaneous serious adverse psychiatric events. In addition, searches of the FDA AERS safety database were conducted covering the same time period, and the identified cases were assessed by a DDRE Review Team. Duplicates, and reports which were considered to be of poor quality or highly unlikely to be related to the drug of interest were excluded from this analysis.  Cases received from Sponsors, as well as those identified from the FDA AERS safety database, were systematically reviewed and analyzed to assess the probability of adverse drug reactions and to describe characteristics or risk factors observed in these reports. This review focuses on postmarketing safety data from the first three search categories. The miscellaneous category was considered to be beyond the scope of this current analysis due to the large volume of data for review. The most important finding of this review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors, at usual doses of any of the drugs currently used to treat ADHD. Current approved labeling for drug treatments of ADHD does not clearly address the risk of drug induced signs or symptoms of psychosis or mania (such as hallucinations) in patients without identifiable risk factors, and occurring at usual dosages. In addition, current labeling does not clearly state the importance of stopping drug therapy in any patient who develops hallucinations, or other signs or symptoms of psychosis or mania, during drug treatment of ADHD. We recommend that these issues be addressed.  A substantial proportion of psychosis-related cases were reported to occur in children age ten years or less, a population in which hallucinations are not common. The occurrence of such symptoms in young children may be particularly traumatic and undesirable, both to the child and the parents. The predominance in young children of hallucinations, both visual and tactile, involving insects, snakes and worms is striking, and deserves further evaluation. Positive rechallenge (i.e., recurrence of symptoms when drug is re-introduced) is considered a hallmark for causality assessment of adverse events. Cases of psychosisrelated events which included a positive rechallenge were identified in this review for each of the drugs included in this analysis.  In many patients, the events resolved after stopping the drug. In the FDA AERS review, resolution of the events after stopping the drug was reported in 58% of amphetamine /dextroamphetamine cases, 60% of modafinil cases, 33% of atomoxetine cases, and 48% of methylphenidate cases. (Note: Outcome of the psychiatric adverse events was not reported in 21% of amphetamine / dextroamphetamine cases, 9% of modafinil cases, 41% of atomoxetine cases, and 30% of methylphenidate cases.) For drugs currently approved for ADHD treatment, no risk factors were identified which could account for the majority of reports of psychosis-related events. For instance, drug abuse was reported in fewer than 3% of overall cases from the FDA AERS analysis of psychosis-related events. Also of note, in the overwhelming majority of cases (roughly 90% overall), the patient had no prior history of a similar condition. Numerous postmarketing reports of aggression or violent behavior during drug therapy of ADHD have been received, most of which were classified as non-serious, although approximately 20% of cases overall were considered life-threatening or required hospital admission.

What patients say and what doctors document: Comparison of medical record to self-report of eye symptoms shows wide variation -- ScienceDaily

Symptom reporting drove the inconsistencies between surveys and medical records, the study found. The top discordant issue: glare. Of patients reporting concern about glare on their surveys, 91 percent didn't have it on their medical record. Eye redness was second-most common (80 percent had no medical record mention), followed by eye pain (74.4 percent). Blurry vision was only the symptom to tilt the scales -- with more instances of inclusion in medical records than in questionnaires.