Tag Archives | health-care

How to Determine If a Clinical Practice Guideline is Trustworthy

An interesting article titled “How to Decide Whether a Clinical Practice Guideline Is Trustworthy,” written by David F. Ransohoff, MD Michael Pignone, MD, MPH, and Harold C. Sox, MD appears in JAMA, January 9, 2013,Vol 309, No. 2, pp. 139 -140. The article mentions how many controversies have arose recently over cancer screening guidelines. The article mentions how in 2008 Congress gave the Institute of Medicine (IOM) of the National Academies with developing standards for objective, scientifically valid, and consistent approaches to developing practice guidelines. Well as I mentioned in this blog post Tips to Prevent Medical Errors – AHRQ Congress actually gave the Agency for Health Care Policy and Research (AHCPR) in 1989 evidence-based, clinical-practice guidelines. However, the medical device industry and several doctors organizations opposed this as it was threatening to limit their profits and found a sympathetic ear with the Republican Controlled House Majority who crippled the budget of AHCPR and turned it into AHRQ. The authors state “The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. Therefore, the first requirement for earning trust is a rigorous process for assembling, evaluating, and summarizing the evidence. […]

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Anti Affordable Care Act (Anti ObamaCare) Ads with Uncle Sam

In the United States, with the ObamaCare exchanges set to go live on Tuesday and the looming government shutdown also set for Tuesday, I wanted to draw your attention to some recent ads you may have missed. Now I came across these ads watching Real time with Bill Maher last week, where Bill plays one of the ads on his program and discusses it. The videos are designed to deter young people from signing up for the ObamaCare exchanges and do so by featuring a young man and a young woman about to undergo prostate and pelvic exams. The ads are from from Generation Opportunity, a Virginia-based group with ties to the Koch brothers. I have embedded the two ads below and they both show two young college age students who have their first doctors appointment using the new ObamaCare exchanges. In both videos before the pelvic or prostate exams are to be performed, the doctor leaves, and then a sinister looking Uncle Sam emerges. For a more detailed analysis of the videos I suggest the article titled Anti-ObamaCare ads show menacing Uncle Sam giving prostate exams by Elise Viebick on September 19, 2013 on the Hill located over at  http://thehill.com/blogs/healthwatch/health-reform-implementation/323319-disturbing-anti-obamacare-ads-place-uncle-sam-in-exam-room […]

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How does the U.S. Health Care System Differ From Other OECD Countries

An interesting article written by Victor R. Fuchs titled “How and Why US Health Care Differs From That in Other OECD Countries” appears in JAMA, January 2, 2013,Vol 309, No. 1, pp. 33-34.  The article attempts to discuss the difference between the U.S. Healthcare system and other countries in the  Organization for Economic Co-operation and Development (OECD). One way they differ is that the healthcare expenditures in the U.S. are twice as high. A second way they differ is that the share of expenditures funded by the U.S. government is lower. Most OECD countries have a tax-supported system healthcare system that is able to have lower administrative costs and is able to negotiate costs more aggressively with drug companies and physicians. Thirdly, there are differences in care with the U.S. being more technology intensive such as with MRIs. The author then argues some reasons for the differences. He says that in the U.S. individuals appear more distrustful of government, and that this has a deeply historic cause. Of course the author points out that Medicare and Medicaid are an exemption to this. I find this argument hard to believe. For example, many Americans put money in a private bank, yet […]

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Senate Report Calls for Removing Deceptive Corporate Dentistry Entities From Medicaid

Previously I have written an article titled Fraud and Abuse in Medicaid Clinics where a discussion was made that currently dentists have large amounts of debt when they graduate from school. This leads to them having to face potentially hard and difficult choices to pay their bills as they essentially become indentured servants. Recently Senators Charles Grassley (R-IA) and Max Baucus (D-MT) published a 1517 page report in June 2013, titled “JOINT STAFF REPORT ON THE CORPORATE PRACTICE OF DENTISTRY IN THE MEDICAID PROGRAM.” This report is a very large PDF file (143 MB) and is available for download over at http://www.finance.senate.gov/library/prints/.  Don’t be intimidated by the size of the report though as it really is a bit over 30 pages with the rest of the 1400+ pages serving as an appendix. Hence, it is very readable. The report talks about dental management companies that in some cases own dental clinics and have complete control over operation which includes clinical care provided by dentists. Some states have specific requirements which only allow a licensed dentist to own a clinic. However, the report discusses how some dental management companies have deceptive ownership structures which may hide from state authorities that the […]

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Looking at Evidence Supporting Dental Procedures from Cochrane Systematic Reviews

An interesting article titled “Is the Evidence Supporting Dental Procedures Strong? A Survey of Cochrane Systematic Reviews in Oral Health” by Clovis Mariano Faggion Jr. appears in J Evid Base Dent Pract, vol. 12, pp. 131-134, 2012. The article sets out to explore Cochrane systematic reviews and whether or not they provide useful information for use in dentistry. The author set out to look at the quality of evidence for Cochrane systematic reviews published in dentistry. The evidence was considered inadequate when authors described weak or insufficient evidence or when no studies were selected for the review. A total of 120 systematic reviews were looked at for 20 topics. The author did have some creative interpretation to assess the reviews. He states: “The full text of articles was, however, scrutinized to assess the risk of bias of included primary studies; methodological issues, such as allocation concealment and blinding, were usually not reported or were performed in a part of the primary studies sample. Some can argue that using stricter criteria would probably categorize almost all systematic reviews as providers of inadequate evidence. In other words, for some reviews, the attitude when scoring evidence as adequate was optimistic.” The author states: “Over […]

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