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William Cayley: Numerical minimal change disease

14 Oct, 16 | by BMJ

bill_cayley_2What difference makes a difference?

We often encourage patients to make small behavioral changes, in the hope that even one step in the right direction is at least small progress. However, when it comes to medical care, and testing in particular, I think we forget that some changes are not really changes at all.

As we continue to think collectively about overdiagnosis, we also need to look at the impact of “minimal change disease.” more…

Jeanne Lenzer: Clinton and Trump on healthcare

27 Sep, 16 | by BMJ

jeanne_lenzerThe Presidential Debate That Wasn’t

The 90 minute presidential debate between Hillary Clinton and Donald Trump ended last night without a single word about healthcare. Yet two-thirds of voters said “the future of Medicare and access and affordability of healthcare are top priorities for the candidates to be talking about during the 2016 presidential campaign.” [1] more…

Catherine Hough-Telford: How have pediatricians’ experiences of vaccine delays and refusals changed?

26 Sep, 16 | by BMJ

catherine-hough-telfordIt’s unbelievable that one of the most remarkable innovations of our time—one that has prevented millions of deaths—has come under so much fire by a cacophony of misinformed voices in recent years. As the saying goes, vaccines have become a victim of their own success.

The relative rarity of vaccine preventable diseases in the US, compounded by misinformation, bad science, and unsubstantiated claims from anti-vaccine groups—which have been amplified by the media as “controversy”—have created mistrust, fear, and ill placed concerns about vaccines. This has caused some parents to be hesitant about vaccinating their children. more…

William Cayley: What is your story?

21 Sep, 16 | by BMJ

bill_cayley_2Much has been written in recent years about “narrative medicine” or “narrative based medicine,” and there has even been discussion of how to integrate “narrative” and “evidence based” medicine in both journal articles and books.

Most of this work (very helpfully) focuses on the narratives of patients: who they are as people, how their sufferings affect them, how they create or find meaning, etc. These are all important considerations, but what about our narratives of our work as physicians or healthcare professionals? In what story context do we see our work? more…

Jeanne Lenzer: Donald Trump on Dr Oz—the greatest non-evidence based show on earth

16 Sep, 16 | by BMJ

jeanne_lenzerLate night comics will love Donald Trump’s latest act of showmanship: the neatly choreographed moment when he pulled out his “medical record” from his jacket pocket on The Dr Oz Show last night.

The show and this big reveal garnered plenty of headlines: now everyone knows that Mr Trump is overweight, verging on obese; that he thinks that waving his hands during his speeches is exercise; and that he asks his aides not to tell fast food servers that they are purchasing for Trump lest they doctor the food. And he takes low dose aspirin and a statin. more…

William Cayley: Systems wisdom

16 Sep, 16 | by BMJ

bill_cayley_2In a recent BMJ blog Steve Ruffenach made some excellent points on the importance of balancing “accept” and “except” in approaching “Tech” in medicine.

However, as we continue to feel the pressure of realizing “meaningful use” of electronic medical records (often with attendant requirements for documentation, reporting, and ad-nauseam clicks of different buttons in each patient’s chart), I’ve been intrigued by growing evidence suggesting we need rather to focus on “wise use.”

Some seem to feel that the more systems (usually supported by “tech”) that we implement in medicine more…

William Cayley: Where is our faith?

1 Sep, 16 | by BMJ

bill_cayley_2One of my favorite radio pundits is EJ Dionne, so I was intrigued to read in my morning paper his opinion piece, asking “where are our faith leaders?” In short, he argues that in today’s society discussions about religion have mainly been subsumed under political discussion of issues about which religious people care (or are about which they are thought to care).

Thus, he argues, “Religion is talked about a lot, but mostly superficially”—and the result is that we have a lot of political debate, and perhaps even a lot of politicians, seeming to tell the religious what to think more…

Elizabeth Loder: Should orange be the new black for price-gouging pharma execs?

31 Aug, 16 | by BMJ


One thing’s for sure: Heather Bresch, the CEO of Mylan Pharmaceuticals, looks good in orange. She’s the subject of a recent New York Times article that opens by declaring “America has a new pharmaceutical villain.” (Martin Shkreli, former CEO of Turing Pharmaceuticals who raised the price of an essential toxoplasmosis drug by 5000%, is the old villain, of course.) The piece describes the public outcry in the US over enormous price rises for the company’s life-saving EpiPen® product. It details the many company activities, overseen by Bresch, which made those increases possible. It’s a sordid, unedifying tale. Bresch is pictured alongside the Times article wearing a stylish orange dress. Judging by the tone of some of the article, it makes you wonder if instead she should be wearing an orange prison jumpsuit? more…

William Cayley: Happy to be healthy

3 Aug, 16 | by BMJ

bill_cayley_2Drawing on a variety of demonstrated correlations between happiness (or “wellbeing”) and health, John Appleby recently argued that “improving individual, and hence national, wellbeing might best be achieved through improving people’s health.” While I appreciate any suggestion of policies or interventions that might boost health, I also think it worth considering whether the argument may actually work the other way round.

Does health produce happiness? Or does happiness produce health? The data documenting a relationship between happiness and health are dramatic, yet only document correlation—not causation. This leaves me wondering, which is the chicken, and which the proverbial egg? more…

Suzanne Gordon: Encouraging all members of a medical team to speak up

12 Jul, 16 | by BMJ


The oval, mahogany table dominates the center of the large conference room. A number of chairs circle the table and dot the perimeter of the room. Every week, a group of high level hospital administrators, physician leaders, and leaders of other professional and occupational disciplines—physical therapy, social work, clinical directors of nursing, housekeeping, etc—gather in this room to discuss hospital function. They call themselves a “team” and the gathering a “team meeting.” more…

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