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February 2016

A look at the thyroid gland

This HND piece starts with the basics, and details typical symptoms of both hypo-and hyper- thyroidism. While classic blood tests have long been available to elucidate proper thyroid function, a growing number of people are exposing serious flaws in the conventional wisdom.

One of these is Dana Trentini, who has her own quite tragic story of being misdiagnosed as "normal." Yet one more example of mindless addiction to "normal" blood titers, by an internal medicine community that clearly should know better by now.

Read the complete article.

An unethical clinical trial, a leading journal, and the sketchy motives of NGOs

This HND piece is a follow-up to an earlier story describing how three healthcare-related non-governmental organizations (NGOs) are conspiring to undo hard-fought improvements in work rules, pertaining to surgical resident physicians. The NGOs in question are the American Board of Surgery, the American College of Surgeons, and the Accreditation Council for Graduate Medical Education (ACGME).

Now, the research—such as it is—supporting more hours for the residents, has been published in no less than the New England Journal of Medicine.

Mark well that this is a double travesty, in that the research itself clearly violates long-established ethics guidelines, and it being published in NEJM violates the Journal's longstanding policies on accepting manuscripts from human subjects research. In short, this is failure beyond failure, only it doesn't seem to matter. Inasmuch as NEJM surely has no shortage of submissions, it is simply mind-boggling that they would fast-track such crapola.

God knows why the academic surgeon from Northwestern heading up the study would waste his time with this egregious nonsense, or why the editorial board of the Journal has turned into a bunch of feckless Kool-Aid drinkers.

Read the complete article.

Bridging the great dental divide—cost-effectively

This HND piece is a follow-up to an earlier article, which examined the problem of getting much-needed dental care to lower income Americans.

Yes, Medicaid does provide for this, in theory, but delivering the care in reality is another matter altogether. That's where Dental Management Service Organizations (DMSOs) and Dental Service Organizations (DSOs) come into play.

A recently released study suggests that the DSOs (as they are usually called) help a lot. This particular study focuses on Kool Smiles, which accepts Medicaid at all of its offices. The findings are striking, and show that better care is getting to more people—for fewer dollars.

Read the complete article.

A look at hypertension

This HND piece gives you the skinny on high blood pressure, including the nasty things it can cause. However, as with so many physiological parameters that can be easily measured, the acceptable numbers keep dropping—to sell more drugs.

And, unlike other easily measured parameters, medical science has no idea what causes hypertension, in most cases. When it occurs in oldsters, we can talk about loss of flexibility in the blood vessels, but...if such a state is a normal part of aging, what is inherently "wrong" with that? Most older folks' hair turns white, but no one says that's unhealthy, per se.

Certainly, if a 20-year-old has the typical BP of a 65-year-old, it might be cause for concern, but then, how many physiological signs are the same in these two vastly different cohorts?

Read the complete article.

Updates on electronic health records and tainted endoscopes

This HND piece brings you current on EHRs and those troublesome endoscopes.

As to the pretty much unmitigated disaster that is the EHR push, some good news is that the "Meaningful Use" debacle is about to come to an end. I think some of the public unraveling is because the powers-that-be can't keep it a secret that essentially everyone—except the vendors and the Federal overlords—hate EHRs. We will continue watching this issue.

As far as the scopes and Senator Murray, it only took two days after her report was released that Olympus—owning around 85 percent of the affected scope market—announced its "Urgent medical device removal and corrective action." Only, don't breathe easy just yet. A lot of ground has to be covered before this mess is truly cleaned up.

Read the complete article.

The trouble with Scalia

The late Supreme Court Justice Antonin Scalia is being praised as a conservative icon, brilliant writer, and all around great guy. Also included in the obituaries are descriptions of his friendship with his fellow justice Ruth Bader Ginsburg. This relationship went well beyond mere collegiality. In fact, they saw each other socially quite frequently, partied together, and took vacations together.

During a joint appearance with the woman he also has called his “best buddy” on the bench, Scalia said, “Why don’t you call us the odd couple?”

“What’s not to like?” Scalia joked at an event hosted by the Smithsonian Associates. “Except her views on the law, of course.”

So, here’s the problem: These two justices disagreed on virtually everything, from abortion and gun control, to gay marriage, capital punishment, and Obamacare. He was a devout Catholic, and she is a secular Jew. Surely, one can be cordial and professional with a person who holds opposite positions on essentially every major political, social, and cultural issue—but why go out of your way to hang out with such an individual?

What would Scalia have to suppress to preferentially spend lots of time with Ginsburg? Would YOU choose to socialize with someone who disagrees with you on so much, even if you both might like the same classical music?

And, then it came to me. For all his brilliant opinions, and all of his conservative bona fides, Antonin Scalia must have viewed being a Supreme Court justice as his day job, and whatever passion he put into his writings was strictly vocational. What incredible emotional detachment! (If that’s what it really was.)

You hear all the time about doctors and homicide detectives who “don’t get emotionally involved” with the death and destruction around them. However, nine times out of ten, that is just pure bravado. And for that amazing one out of ten, he doesn’t get emotionally involved because he can’t. He’s seen too much, and he is now but an empty shell.

We wonder then, was Scalia truly able to separate work from his personal life, or was he actually an empty shell, posing as a happy Renaissance Man? Where did he hide the passion for his legal theories after hours?