by Tony Cusano | Nov 11, 2018 | Public
This harrowing five-part story adapted from ‘The Digital Doctor’ by Robert Wachter describes a near disaster due to a medication error augmented by a high-quality hospital’s Electronic Health Record. It starkly reveals the risks of medical care in the digital age. Too much system noise and overwhelmed caregivers make even routine decisions and tasks take on a high level of risk.
Vigilance is required at every turn. If you feel that you are overwhelmed managing a hospital episode for yourself or a loved one, or in keeping track of the complex facts of your medical care, we can help.
by Tony Cusano | Sep 20, 2018 | Public
This very well written review of scientific issues regarding complementary and alternative medicine reminds us of the challenges in making good medical decisions when medical science is incomplete.
The author points to one study of an asthma remedy that improved breathing symptoms without changing lung function. That could lead to fatal consequences,
Yet, as author Andrew Solomon says In this wise and humorous story of how exorcism can cure depression, “for depression, if I can stand on my head and jump up and down three times and feel better, that works.”
Conditions that involve less pathology than symptomatology are perfect for traditional remedies. But seemingly harmless remedies that relieve symptoms without improving the underlying pathology can be very dangerous.
We encourage you to take charge of your health care. We also advise rigorous evaluation of the benefits, risks, alternatives and unknowns of any treatment, whether the science behind it is rigorous, or weak.
We can help you find information or sort out the information you have.
Call for a free consultation.
by Tony Cusano | Sep 17, 2018 | Public
A large and rigorous study to look an the question of whether aspirin makes sense for older people to prevent cardiovascular events raises serious questions about its benefits and risks.
The study showed more risk than benefit, and found more death from cancer in those using aspirin. This raises great concern that previous positive studies were statistical flukes.
Unfortunately, The way medical statistics are used by medical scientists leads to most medical studies turning out to be wrong.
This is another spectacular example of why you should make a careful and collaborative evaluation of the benefits, risks, alternatives and unknowns of every medical decision.
The use of single chemicals to alter the human body, Even those found in natural sources like willow bark and other traditional medicinal plants which contain the main ingredient of aspirin, has some merit, but may make little sense for many people.
If you want to learn more about how to evaluate medical studies, or to collaborate with your doctor better to make good medical decisions, we can help.
Call is for a free consultation.
by Tony Cusano | Sep 9, 2018 | Public
Many people have developed type 2 Diabetes Mellitus (the kind that does not usually need insulin). The best treatment for it is weight loss through diet and exercise. The mainstays of drug treatment over the past decade or so have been Metformin to improve insulin efficiency in the body, and one form or another of sulfonylurea medications that increase insulin output by the pancreas. These treatments are variable in their success, though the variability is largely due to dietary indiscretion and inadequate exercise.
A few new types of medications have come along, and all successfully reduce blood sugars. Two of the new classes seem to prevent cardiac events that are so common in diabetes, although the true extent of the benefit to risk rations has not been fully elucidated.
The problem with these new medications is that they have only been on the market for a few years, so lots of unknowns still exist. A new warning from the FDA emphasizes one of those that has been recently uncovered by its post marketing surveys (what I like to call the phase 5 safety trial).
I cannot emphasize enough how significant this risk is. Although not common, the severity is so high that no one should take the medication unless they absolutely need to, and all the alternatives have been considered.
This new warning about a very heavily promoted medication that seems great but has only marginal benefit over older medications while carrying significant risks and unknowns serves as another reminder that it is critical to take charge of your own care by collaborating with your doctor on important medical decisions.
We can help you collaborate better. Contact us for a free consultation.
by Tony Cusano | Aug 26, 2018 | Public
As a practicing physician educator and health system administrator this Story about brusque care blindly following controversial guidelines without shared decisions deeply saddens me.
The behavior of many of the caregivers described is clearly not compassionate, or even professional. Additionally, the underlying culture of blindly following guideline-driven care using important but incomplete and controversial medical science is a devastating indictment of the vocation that I entered. Doctors are healers and life-givers first, and healing or life-giving involves practices much deeper than simply using technology only partially tested in small groups regardless of its effects on the individual encountered in an exam room.
If your physician or their assistants are not listening to you or your specific needs, as in this story of being rushed through an exam and having symptoms that appear after complex medical therapy ignored, take charge of your care by asserting your concerns until they are addressed.
And insist on learning the benefits, risks, alternatives and unknowns of any treatment plan your doctor has. Asserting your right to hear them and having your doctor explain them aloud may help your doctor to realize that the plan that simply follows the guidelines may not be the best plan for you or your family member.
The evidence from the SPRINT trial that was used to create the blood pressure guidelines in this story is flawed and controversial because the study did not contain enough subjects to be scientifically certain (even though it was considered statistically certain, a vastly different and deficient kind of certainty). And as some of the doctors in the article discuss, even reasonable guidelines are meant to be applied individually, not uniformly.
If your doctor can’t or won’t explain the full details of how the guidelines they’re applying to you were created, they may not be making the best decision for you, and they’re definitely not engaging your collaboration by allowing you to apply your own needs and values to share in the decision.
We can help you understand guidelines, and collaborate better with your doctors. Call for a free consultation to learn more.
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