Category Archives: NEJM

Osmolality and Brain Injury

Tweet The August 23rd issue of the New England Journal of Medicine has a review article about the treatment of raised intracranial pressure. A patient with head trauma is the index case. Patients who are known to have increased intracranial pressure or more commonly thought to have it are typically treated with agents that increase…


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Unreasonable Health Insurance Premiums

Tweet New York Times columnist and Nobel prize winner in economics Paul Krugman is famous for his dedication to fiscal stimulus as an escape from our current economic woes. No matter how much money the government pumps into the economy he wants more if the result is not what is desired. Thus he is indulging…


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Hepatorenal Syndrome

Tweet The September 24th issue of the New England Journal of Medicine has an excellent review article by Ginès and Schrier on Renal Failure in Cirrhosis. It reviews the pathogenesis of the circulatory events by which severe liver disease compromises renal function. Surprisingly, the authors omit a key step in the pathophysiology of compensated cirrhosis….


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Screening for Prostate Cancer – Yet Again

Tweet It seems to be impossible to drive a stake through the heart of this issue. The current New England Journal of Medicine has two more studies and an editorial on the subject. One (Mortality Results from a Randomized Prostate-Cancer Screening Trial) concludes “that prostate-cancer screening provided no reduction in death rates at 7 years…


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Medicare's Payment of Physicians

Tweet Every year Congress goes through a Medicare ritual. The law as written requires about a 20% reduction in payments to doctors. Medicare’s rates are already low causing many physicians to refuse new Medicare patients who don’t have supplemental insurance.These physicians usually are the best in each locale; it’s the weakest that stay in the…


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Doctors Confirm 1st Law of Thermodynamics

Tweet A study just published in the New England Journal of Medicine concludes that reducing calories results in the same weight loss regardless of how the caloric reduction is realized. In other words a calorie lost from reducing fat, or carbohydrate, or protein has the same effect. “Reduced-calorie diets result in clinically meaningful weight loss…


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Exciting Times

Tweet That’s how Jonathan Gruber PhD a professor of economics at MIT views the domestic scene in the US today in a Perspective piece in the NEJM. What he’s excited about are the good prospects for the passage by the congress of universal health care coverage. Professor Gruber rejects the view that adding universal health…


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Medicine and Inconvenient Truths

Tweet Victor Fuchs, a long time deep thinker (no sarcasm intended) about medical economics has a perspective piece in the October 23 issue of the New England Journal of Medicine that presents three “inconvenient truths” about health care. His analysis is likely to represent that which will be applied to medical care over the next…


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Hypertension in the Very Old

Tweet Virtually all physicians treat their hypertensive patients who are 80 years old or more. The evidence for the effectiveness of this treatment in very old patients has up till now been lacking. The New England Journal of Medicine has published a paper, Treatment of Hypertension in Patients 80 Years of Age or Older, that…


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Medicine Undefined

Tweet The purpose of medicine is twofold. First to prolong life, ie to prevent premature death from disease. The second is to relieve pain and suffering from disease. To many medical “experts” it also appears to include the alleviation of just about anything that can cause distress of any sort. War, murder, crime, poverty are…


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