health-care

Primary Care Doctors Moving to the Concierge Model

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So if you haven’t heard by now, many primary care physicians have been, as of recently moving to a “concierge model.” In fact, a primary care doctor I was seeing for a while decided to do this. When is the last time you have been to your primary care physician (pcp) as perhaps they have as well? Just go on pcp websites across the U.S. and you may see the trend. For example, a practicing physician Dr. Rob discusses how he is Dropping Out over on http://more-distractible.org/2012/09/08/dropping-out/. “I will be starting a solo practice that does not file insurance, instead taking a monthly “subscription” fee, which gives patients access to me.” In the post he discusses his top 3 frustrations with the current health care system too many patients, not getting paid properly for providing care, and non-patient issues such … Read more

Health Care Should Not Be Framed in the Personal Responsibility Narrative

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I read an interesting article by Micah L. Berman titled “From Health Care Reform to Public Health Reform” appearing in the Journal of Law, Medicine & Ethics (Fall 2011, pages 328-338). In the article Micah L. Berman discusses how the Affordable Care Act contains an “individualist/biomedical paradigm” which includes a number of provisions and programs which focus on public health but are in fact misaligned and at odds with public health research. He does this by first (A) arguing that in America there is a large cultural emphasis on personal responsibility which is shaped by powerful political, social, and psychological forces and second (B) that influential industries profit at the expense of public health. A) Micah states: “This paradigm focuses on what can be done by or to individual patients, and it leads to policies that seek to either (a) … Read more

Third Molars (aka Wisdom Teeth): Kandasamy vs White and Proffit

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Like usual there are often heated exchanges over the management of wisdom teeth (third molars). Back in November 2011, in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5)  there was an exchange regarding two previous articles that had appeared and consequent exchange (White RP Jr, Proffit WR. Evaluation and management of asymptomatic third molars: lack of symptoms does not equate to lack of pathology. Am J Orthod Dentofacial Orthop 2011;140:10-6; and Kandasamy S. Evaluation and management of asymptomatic third molars: watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 2011;140:11-7) The articles in question I am referring to here are “Third molars” by Raymond P. White, Jr, and William R. Proffit in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5, pages 600-601) and Author’s response by Sanjivan Kandasamy … Read more

Review of the Wisdom Behind Third Molar Extractions

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Back in 2009, an article titled  The wisdom behind third molar extractions” by “S Kandasamy and DJ Rinchuse appeared in the Australian Dental Journal (54. pages 284-292. 2009) I discussed some of the provocative comments in this article in the post Bringing About Healthcare Change. To reiterate he states “…in the 21st century, the routine removal of asymptomatic pathology- free third molars has become a dated practice that is rapidly running out of valid excuses, and it has no justification in contemporary dentistry and medicine.” Earlier this year an article titled “Patient Specific Variables are a Consideration in the Decision to Extract Asymptomatic Third Molars” by Katerine W. L. Vig appeared in the J Evid Base Dent Pract. (2012 12 pp. 92-94) The conclusion of this article is “The removal of third molars to avoid lower incisor crowding is not justified. … Read more

Scientific Integrity and the Commercial Speech Doctrine for Industry

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An interesting article by Joanna K. Sax titled “Protecting Scientific Integrity: The Commercial Speech Doctrine Applied to Industry Publications,” appeared in the American Journal of Law and Medicine in 2011 (vol. 37, pages 203-224). The article opens up by discussion how the economic reality of survival and profits may distort a company’s decision making process regarding full disclose on a particular drug. Dow Corning, which manufactured implants, withheld important data from long-term animal models which demonstrated adverse effects from breast implants and failed to conduct long-term studies. It was necessary for litigation in order to expose Dow’s failure to conduct the necessary studies. It was found that even though Dow denied liability they had evidence which demonstrated they had knowledge of the harmful effects of the breast implants and suppressed these findings. The author later mentions how the tobacco industry used propaganda in the 1960s … Read more