Group items tagged

Treatment Options in Treatment-Resistant Depression, by Jennifer Gotto, MD, and Mark H. Rapaport, MD

By Niloofar Afari, PhD and Dedra Buchwald, MD.

"Lancet 2010: There is a U-shaped relationship between glycated hemoglobin (HbA1c) levels and mortality in people with diabetes, say researchers, meaning that intensive glucose-lowering therapy could be as harmful as uncontrolled hyperglycemia.\n\nWriting in The Lancet, Craig Currie and team (Cardiff University, UK) conclude that if their findings are confirmed, then diabetes guidelines may need to be revised to include a lower as well as an upper HbA1c threshold.\n\nCurrie's team used the UK General Practice Research Database from November 1986 to November 2008 to obtain data on two cohorts of patients aged 50 years and older with Type 2 diabetes.\n\nThe patients comprised 27,965 individuals whose treatment had been intensified from oral monotherapy to combination therapy with oral blood-glucose lowering agents, and 20,005 who had changed to insulin-containing regimens."

Medicine has increased the ranks of the elderly. Can it make old age any easier? The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible, and the retention of enough function for active engagement in the world. Most doctors treat disease, and figure that the rest will take care of itself. And if it doesn't-if a patient is becoming infirm and heading toward a nursing home-well, that isn't really a medical problem, is it?

In every industrialized nation, the movement to reform health care has begun with stories about cruelty. The Canadians had stories like the 1946 Toronto Globe and Mail report of a woman in labor who was refused help by three successive physicians, apparently because of her inability to pay. In Australia, a 1954 letter published in the Sydney Morning Herald sought help for a young woman who had lung disease. She couldn't afford to refill her oxygen tank, and had been forced to ration her intake "to a point where she is on the borderline of death." In Britain, George Bernard Shaw was at a London hospital visiting an eminent physician when an assistant came in to report that a sick man had arrived requesting treatment. "Is he worth it?" the physician asked. It was the normality of the question that shocked Shaw and prompted his scathing and influential 1906 play, "The Doctor's Dilemma." The British health system, he charged, was "a conspiracy to exploit popular credulity and human suffering."

ffect of coenzyme Q10, riboflavin and niacin in tamoxifen-treated postmenopausal breast cancer patients with special reference to lipids and lipoproteins

Can health care organizations and physicians be incented to deliver the highest quality, safest, most reliable, most patient-centric care at the lowest possible cost without Atul Gawande reading the findings of the Dartmouth Atlas into the Congressional Record? I think they can, if they have a strong hospitalist program.

My "argument" against this guy's lazy, reactionary blog post is at the very bottom of the page, dated April 12, 2009. I think it's the longest comment he's received so far, too. Just look for a verbose passage. That's my rant against his reactionary, unsupported claims against NDs.