Longer looks: Rushed medicine; Exercising your way to a smarter brain

Apr 20 2012

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

Newsweek: The Doctor Will See You--If You're Quick
Something in the world of medicine is seriously amiss. Unhappy patients gripe about their doctors' brusque manner and give them bad marks on surveys and consumer websites like HealthGrades and Angie's List. They tell tales of being rushed out of the office by harried doctors who miss crucial diagnoses, never look up from their computers during an exam, make errors in prescriptions, and just plain don't listen to their patients. ... And things don't seem much better from the other side of the stethoscope. In a recent survey by Consumer Reports, 70 percent of doctors reported that since they began practicing medicine, the bond with their patients has eroded (Shannon Brownlee, 4/16).

The New York Times Magazine: How Exercise Could Lead To A Better Brain
For more than a decade, neuroscientists and physiologists have been gathering evidence of the beneficial relationship between exercise and brainpower. But the newest findings make it clear that this isn't just a relationship; it is the relationship. Using sophisticated technologies to examine the workings of individual neurons -; and the makeup of brain matter itself -; scientists in just the past few months have discovered that exercise appears to build a brain that resists physical shrinkage and enhance cognitive flexibility. Exercise, the latest neuroscience suggests, does more to bolster thinking than thinking does (Gretchen Reynolds, 4/18).

The Economist: Up In Smoke
The raids on (Richard Lee's) properties are only the most telegenic instances of a much wider federal crackdown (on marijuana) that has taken states and counties by surprise. Dispensaries, and even landlords of dispensary-operators, all over California, Colorado and Montana have been getting menacing letters. Many have closed shop. ... The question is why the federal government is doing this. On the one hand there is a federal law, the Controlled Substances Act, which recognises no exception for medical marijuana and thus considers all use and trade of it criminal. But on the other hand the Obama administration originally signalled that it would not deliberately clash with the states about weed. … The overall effect has been to confuse everybody and leave matters entirely at the discretion of individual prosecutors (4/14).

The Atlantic: Using Social Media To Prevent Suicide
College students and adolescents now congregate in online social networks just as much as they do in dormitory common rooms. So organizations like the National Suicide Prevention LifeLine seek to be present in these environments. The LifeLine recently developed a Facebook chat add-on that enables users to report updates to Facebook that they feel are indicative of suicidal behavior. These then trigger a connection to a trained counselor. The service functions in ostensibly the same manner as the LifeLine's telephone service, which took its first call in January of 2005. There are two ways of accessing the chat -- either by clicking on the user's post or by reporting it to the Facebook Help Center. The user is then contacted by a crisis center via email, encouraging them to either call the help line or click on a link to start an online chat with a counselor(Anna Codreo-Rado, 4/18).

The New Yorker: T-Cell Army
In the last hundred years, progress in the treatment of cancer has come mostly from radiation and chemotherapy. Previously fatal blood-cell cancers, such as childhood leukemia and Hodgkin's disease, are now curable. But solid tumors, which grow in the lungs, the colon, and the breast, have stubbornly resisted treatment once they spread beyond their initial site. … Targeted therapies, which are designed to disarm these mutations, are now at the forefront of care. The first successful targeted therapy was Gleevec, which caused rapid remissions in chronic myelogenous leukemia, with few and mild side effects. … But now patients who did not respond to available therapies have shown dramatic and unexpected responses to a new series of treatments that unleash the immune system (Jerome Groopman, 4/23).

MedPage Today: Why Patients Should Be Paid For Good Health
Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis.  Many articles, both pro and con, have been written regarding P4P.  I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals.  I also believe that the establishment of performance guidelines will lead to the mechanization of medical care as physicians and hospital administrators will learn what they need to do to "perform" and practice guideline-based medicine as opposed to providing personalized care. Recently, I have reassessed my P4P stance and believe that a system that pays patients for performance could work.  Yes. "patient pay for performance (PP4P)" would be a good thing (Stewart Segal, April 2012).