Category Archives: Medicine

When to Start Dialysis in Patients with Acute Kidney Injury

Tweet When to start renal replacement therapy in patients with AKI has been a serious and incompletely answered question for as long as dialysis has been available to treat it. The seriousness of this disorder derives from its frequency, associated mortality, and cost. The JAMA contains a new study, Effect of Early vs Delayed Initiation of…


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End Stage Kidney Disease: Costs and Treatment

Tweet About 1 million people  in the US have End Stage Renal Disease (ESRD). Treatment is divided roughly 70/30 between dialysis and kidney transplantation. The annual cost of the ESRD program, almost all of which is funded by Medicare, is more than $48 billion. It costs about $89,000 a year to care for a dialysis patient….


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Alcohol and Pregnancy

Tweet The CDC issued  a recommendation today that “Women of childbearing age should avoid alcohol unless they’re using contraception, federal health officials said Tuesday, in a move to reduce the number of babies born with fetal alcohol syndrome.” From a USA Today story which reported the advice as a new study. The CDC did not…


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British National Health Service Faces Financial Crisis

Tweet NHS faces biggest financial crisis ‘in a generation’ is the headline of an article published in The Telegraph. The NHS has a deficit of about £1 billion in just the first three months of its fiscal year. You can read the linked article to see the usual excuses offered when a government health program exceeds…


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Mortality and Ethnicity in the US

Tweet The overall mortality rate in the US is the highest in the developed world. But when you dig into the data the breakdown of the various American ethnic groups is very surprising. Last fall Anne Case and Angus Deaton published a paper in the Proceedings of the National Academy of Sciences, shortly before Deaton was…


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Death Panels and Futile Care

Tweet As the federal government becomes progressively more intertwined in the delivery and reimbursement of medical care, there are more discussions about ‘Death Panels’ and the denial of ‘futile’ care. Often, the two get conflated, but they are quite different. Commentators who clearly are well intentioned often get very confused when they talk about what…


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A Short Medical Update for the NFL

Tweet The Indianapolis Colts’ quarterback, Andrew Luck, has been sidelined with a traumatic lacerated kidney. When he will return is uncertain. The quotation below comes from an article about his injury. The Colts are handling Luck as carefully and cautiously as possible, and with good reason. Doctors know that Luck cannot risk elevating his heart…


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More Good Medicine From the Government

Tweet A couple of items. For about 25 years I’ve been saying and writing that routine PSA screening was a bad idea. For much of this time I was the sacrificial nay sayer at meetings devoted to the subject. You can read the several posts on this issue that I have written over the past 8 years….


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A Clinical Vignette About Medical Journals

Tweet A medical journal is supposed to be an unbiased and objective source of the latest and best medical information. Of course, since all journals (for now) are run by human beings the reality and the ideal are widely separated. Even so, you shouldn’t be able to tell the politics of the journal’s editor from its…


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Another Example of Unanticipated Consequences – New Medical Issues in Germany

Tweet The desire to do good is an innate human characteristic. Equally inborn, is the desire not to weigh the consequences of attempts to better the human condition. Common sense is obviously not very common. Germany: Migration Crisis Becomes Public Health Crisis is a detailed description of the medical problems resulting from Germany’s decision to…


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