First Posted at Common Sense Family Doctor on 12/26/2013
The past year has been a productive one for me professionally. I became an Associate Professor at Georgetown, completed my Master of Public Health degree, made national television and radio appearances to discuss lung cancer screening on NBC News andNPR, and was appointed to a four-year term as a member of the American Academy of Family Physicians’ Commission on Health of the Public and Science. My most rewarding professional activity, however, continues to be writing for Common Sense Family Doctor. Below are links to and excerpts from the ten posts in 2013 that have received the most page views, with the top post viewed 6443 times to date.
1. PSA testing: excerpts from a roundtable discussion (January 5)
Even if people don’t follow the U.S. Preventive Services Task Force recommendations and discontinue prostate screening, I hope that we will have improved the quality of discussions patients are supposed to be having with their physicians about what their risk is, what outcomes they value, and what they are willing to endure to make sure that they don’t develop late stage prostate cancer.
2. Why don’t clinicians discuss cancer screening harms?(November 3)
More than 90 percent of primary care clinicians aren’t telling patients that there are downsides to undergoing routine mammograms, colonoscopies, and Pap smears. Why not? Is it because they aren’t familiar enough with the data to accurately describe these harms? Or is it because they fear that patients who receive information about cancer screening harms will choose to decline these tests?
With direct pay models, actual health care costs can be kept much lower and made much more affordable. Also, since direct pay models typically care for smaller patient panels, patients have more time with their primary care team to address the myriad of life issues that affect their health.
4. Concerns about calcium supplements (February 8)
Is it time to abandon routine calcium supplementation in healthy adults? If not, what additional evidence do we need?
5. Breast cancer and the Angelina Jolie effect (May 15)
Will the Angelina Jolie effect turn out to be a spike in the rates of women being tested for the mutations in their BRCA genes? If so, it’s likely that many more women will be harmed than helped. BRCA mutations are rare, affecting 2 to 3 per 1000 women. The vast majority of women who develop breast cancer do not carry these mutations and will not benefit from testing.
For lower-risk patients, for whom the potential lifesaving benefits of CT scans are very small, the downsides of the screening test become considerably more important. Screening tests have harms just like any other medical procedure, and it’s important for your doctor to thoroughly review those harms with you if you are considering screening.
The Institute of Medicine has identified low levels of health literacy as a major obstacle to ensuring optimal health and quality of care. But how can physicians expect our patients to make informed decisions regarding screening tests when large numbers of us are functionally illiterate regarding basic screening concepts?
Yes, robots and smartphones can and will play vital roles in the future of medicine. But if we really want sick patients to have the best chance to get better – and healthy patients to avoid getting sick in the first place – then we should do everything in our power to support low-tech and high-touch interventions too.
9. Unintended consequences of “pregnancy prevention” (February 5)
Defining pregnancy as a disease to be prevented is not just a matter of semantics. An overly interventionist approach to pregnancy is largely responsible for the current U.S. rate of one in 3 babies being born by Cesarean section, and predictions that it may soon approach 50 percent.
10. $10 billion per year to train the wrong physicians (June 18)
Where physician production is concerned, you get what you pay for. Medicare pays a disproportionate amount of its nearly $10 billion per year in subsidies to institutions that produce mostly subspecialists, at the expense of training sorely needed family physicians and other generalists whose presence has been shown time and again to deliver better health outcomes.
Very best wishes for a happy and healthy 2014!