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Did Merck circumvent its duty to warn on 'Fosamax fractures'? Print E-mail
Written by Suzanne Robotti | STAT First Opinion   
Tuesday, 18 December 2018 18:39
How would you feel if you were harmed by a medicine you took as prescribed and then learned that the drug company wasn't liable - even though it knew about the risk and didn't tell you or your doctor? This is exactly what has happened in the case of Fosamax (alendronate), a drug used to treat bone-thinning osteoporosis and osteopenia. After it was approved by the Food and Drug Administration and women across the country began taking the drug, the FDA and its maker, Merck, started receiving reports about spontaneous fractures of the thigh bone among women taking the drug. These fractures, dubbed "Fosamax fractures," happen with no warning and usually require surgery. Although they are a rare side effect of the drug, millions of women have taken the drug. While the true number of Fosamax fractures isn't known, about 500 women have sued Merck for failing to warn them about the risk of this painful and possibly debilitating side effect. These lawsuits are at the heart of a case, Merck, Sharp & Dohme Corp. v. Doris Albrecht, et al., that will be argued before the U.S. Supreme Court on Jan. 7, 2019.
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Last Updated on Tuesday, 18 December 2018 18:43
Money will be lost in health care. This is true no matter how we describe it. Print E-mail
Written by Edwin Leap, MD | KevinMD   
Tuesday, 04 December 2018 17:33
Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime? I mean, we're  constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced "left without being seen" scores are connected to the money we make. Medicine now is far less about the wonder of the body, the ravages of disease, the delight of the diagnosis and the thrill of healing. Medicine, now, is clicks and time-stamps, clipboards and strategies, through-put, input, out-put, put-out, burned out.

Last Updated on Tuesday, 04 December 2018 17:53
Are Vertical Desks Overrated? Print E-mail
Written by Aaron Carroll, MD, MS | The Incidental Economist   
Friday, 23 November 2018 14:08
We know that physical activity is good for us, and that being sedentary is not. Some have extrapolated this to mean that sitting, in general, is something to be avoided, even at work. Perhaps as a result, standing desks have become trendy and are promoted by some health officials as well as  some countries. Research, however, suggests that warnings about sitting at work are overblown, and that standing desks are overrated as a way to improve health.
Dr. David Rempel, a professor of medicine at the University of California, San Francisco, who has  written on this issue, said, "Well-meaning safety professionals and some office furniture manufacturers are pushing sit-stand workstations as a way of improving cardiovascular health - but there is no scientific evidence to support this recommendation."

Last Updated on Friday, 23 November 2018 14:15
Patient Satisfaction: Who is Rating the Ratings? Print E-mail
Written by Skeptical Scalpel via KevinMD   
Wednesday, 07 November 2018 00:00
Everything is being rated these days. But who is rating the ratings? As a public service, I have been blogging about the shortcomings of various rating systems since 2010. Two recent papers on this topic are worthy of review.

In a randomized controlled study, investigators from the University Hospital of M√ľnster, Germany found that medical students who were provided cookies during academic course sessions rated the experience significantly higher than students who did not receive cookies....

<Meanwhile> A research letter from the Cleveland Clinic published in JAMA Internal Medicine looked at over 8,400 patient encounters for respiratory tract infections involving 85 telemedicine doctors and found 66% resulted in an antibiotic being prescribed. The estimated prevalence of bacterial acute respiratory tract infections in outpatients is low. A substantial number of the antibiotics prescribed by telemedicine physicians were probably unnecessary. Physicians received 5-star ratings from 91% of patients who were prescribed antibiotics and 86% of those who received a non-antibiotic drug prescription. When no drugs were prescribed, 72% of patients gave 5-star ratings, a significant difference.

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Last Updated on Friday, 09 November 2018 14:14
Female Physicians and the Fiberglass Ceiling Print E-mail
Written by Torie Sepah, MD | KevinMD   
Friday, 28 September 2018 12:35
A male physician - one who sits on multiple committees at a large hospital in Dallas - was recently quoted in the Dallas Medical Journal, that female physicians earn less, and they "choose to or they simply don't want to be rushed." Adding, "most of the time, their priority is something else ... family, social, whatever." I should be astounded that a colleague, in 2018, who appears to be about my age, would think so concretely, let alone state it publicly as though he's commenting on a breed of dogs ( "... the female Yorkies tend to shy away from true terrier traits, they are not as hard-working").

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Last Updated on Friday, 28 September 2018 12:45
Growing Up with Women in Emergency Medicine Print E-mail
Written by Kathleen Stephanos, MD | KevinMD   
Tuesday, 07 August 2018 17:22
I come by many things in my life naturally - my stubbornness, my red hair and my career. I am very fortunate. Unlike many, I am the daughter of a female emergency physician. This is something I never really considered while growing up. Yes, my mom was a doctor. Did she save lives? I guess so. She didn't spend  much time talking about life outside of the home and she was still present for many holidays, birthdays, etc. All I knew was that someday I too would be a doctor. When I refused to set foot in the ED (where she worked and I had visited many times), she simply brought the supplies home to repair my lacerated chin. When I had a fever and abdominal pain, I recall the look in her eyes when she recognized my appendicitis. But, that was life in our home. She did not bat an eye when we injured ourselves because she'd seen worse.
After attending an all-female high school, she went on to join the first class at Loyola College of Maryland (now Loyola University) to allow women, attended University of Maryland for medical school and ultimately became board certified in Emergency Medicine (which was not an available residency when she trained).
Last Updated on Tuesday, 07 August 2018 17:24
What if a Study Showed Opioids Weren't Usually Needed? Print E-mail
Written by Aaron Carroll, MD, MS   
Thursday, 26 July 2018 00:00
Promising health studies often don't pan out in reality. The reasons are many. Research participants are usually different from general patients; their treatment  doesn't match real-world practice; researchers can devote resources not available in most physician offices. Moreover, most studies, even the gold standard of randomized controlled trials, focus squarely on causality. They are set up to see if a treatment will work in optimal conditions, what scientists call efficacy. They're "explanatory."
Last Updated on Friday, 27 July 2018 16:10
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