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Welcome to DOCTOR PUNDIT. Awesome!

Originating from Saint Paul, MN, DOCTOR PUNDIT is about the intersection between healthcare policy, science, politics, and all surrounding points and issues.

Although the entire scope of healthcare delivery and policy is much too encompassing for just one blogger to cover, I’ll try my best. Enjoy! From time to time, you’ll also see other items of interest that probably have nothing to do with health policy in the least. Try and keep an open mind. :)

Proprietor & Editor — Michael Douglas, MD, MBA




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The Morning News



  • July 19, 2014 11:16 am

    "What kind of value do these types of rankings and reports add to patient care, or do these lists obscure and add noise to an already-difficult-to-navigate physician-patient relationship?"

    — Sanjay Gupta, MD, asked this question in an online forum, concerning hospital rankings. My take? It does lower the signal to noise ratio, but not much. Hospitals and integrated healthcare systems are continuing to message more effectively in an increasingly crowded marketplace. I think that more systems realize the increasing savviness of healthcare consumers. These rankings are a reflection of the effort to engage them. —MD

  • July 19, 2014 9:54 am

    Erratum, fixed

    To all who have emailed or asked, I fixed the sidebar links that corresponded to the CONTACT and Tumblr FOLLOW buttons. It’s all a go! Thanks! —MD

  • July 19, 2014 9:33 am

    Prominent HIV researcher, many other activists among those killed on downed airliner

    Much has been said concerning the political ramifications in the ongoing crisis in Ukraine. Perhaps as equally disturbing as the current political circumstances are the inevitable stories coming out from those who are affected most significantly — the families and friends of those passengers killed in the downed Malaysian airliner, an act we now know was caused by a direct surface-to-air missile strike.

    Perhaps the most poignant tributes have come from those who knew the HIV/AIDS researchers killed on the flight. In all, some 100 researchers and activists were among the dead. They were headed to Australia for a conference. News of this particular faction of victims has hit many very strongly.

    "What if the cure for AIDS was on that plane? Really? We don’t know,"HIV researcher Trevor Stratton told the Australian Broadcasting Corporation.

    As the AIDS community begins to mourn some of its leading luminaries who died on Flight MH17, it remains resolute in its mission to honor on their work. The 20th International AIDS Conference, the event to which the esteemed activists were headed via a connecting flight, is continuing its scheduled programming, according to the organization website.

    Experts are also confident that the AIDS community, though deeply affected, will move forward in a stronger way than before.

    Perhaps the highest profile death — that of pioneer Joep Lange, who played a critical role in antiretroviral therapy trials and in the prevention of mother-to-child transmission of HIV, has been among the most devastating stories. Lange began researching the epidemic more than 30 years ago and had worked at the WHO, heading clinical research and drug development in the mid-1990s. Dr. Lange was also a major advocate of affordable drugs for AIDS patients in poor countries. | LINK

  • July 18, 2014 9:06 am

    Mayo researchers link protein and its pathology to degenerative dementia

    Just days after the news broke that Mayo was deemed America’s top hospital comes news that researchers there have linked an abnormal brain protein as a possible Alzheimer disease precursor.

    The protein, known as TDP-43, is normally found in the brain. But what Mayo researchers found is that when it becomes abnormal — chemically different and bunched up — a patient is more likely to show symptoms of Alzheimer’s, explained Dr. Keith Josephs, who headed the research team’s four-year study.

    Of course, we’re years away from a cure. But, one discovery of this nature, well, practically any discovery along this vein, only adds to the armamentarium researchers have in battling this debilitating disease. in 2104, we are light years ahead of where we were just 20 years ago in our understanding of this disease process. Discovery of this protein, naturally, does not mean this is a cause, but it does provide context from which more targeted research can occur. Excellent news.

  • July 15, 2014 6:26 am

    "The physician a patient sees can influence their treatment fate. Physicians play an important role in whether or not men with low-risk prostate cancer are managed with observation or treatment."

    Dr. Karen Hoffman on how a patient’s fate is literally in the hands of a physician who can either elect to treat aggressively or simply watch and wait. The principle of informed consent could not be more applicable in the typical physician-patient dyad. 


  • July 14, 2014 11:39 pm

    Who is at fault for current deadlock in fixing VA healthcare delivery disaster?

    GOP lip service on fixing the VA wrongs? A House-Senate committee has the task of writing the bill that will detail the delivery of primary healthcare from private providers in the wake of countless patient appointment delays in the VA ambulatory care delivery model. Both parties have come out in favor for such an intervention to the crisis, but this conference committee has been slow on the uptake (in spite of lowered cost estimates).

    CQ Roll Call’ s Ellyn Ferguson reports that CBO has reduced its estimate by 15 percent to $38 billion per year, down from $50 billion, but Republicans are still keen on spending offsets while Democrats are urging a non-offset emergency designation for the bill.

    Offsetting new spending with cuts in other programs is a continuous congressional battle on all major health care legislation.

    What is it about “the more things change, the more they….”? Well, in this case, offsets would probably have to come from some other Veterans’ social program the GOP wants to delay making public as long as possible. Democrats should be asking what the real delay is in getting this bill off the ground and out of committee — you can read it here [PDF].

  • July 14, 2014 1:21 pm

    CMS to begin implementing payment penalties tied to patient outcomes

    A North Carolina academic hospital will be docked a percentage of Medicare reimbursements because of complications related to untoward patient outcomes. With respect to preventable (poor) outcomes, iatrogenic infections remain the area in which most preventive and systemic modalities can be put into place to increase performance metrics. Sounds easy for an acute hospital to plan for such avoidable issues, right? Think again.

    A quarter of the nation’s hospitals — those with the worst rates — will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761.


    Even infections that are waning are not decreasing fast enough to meet targets set by the government. Meanwhile new strains of antibiotic-resistant bacteria are making infections much harder to cure.

    Currently, approximately 13 percent of hospital admissions — according to the feds — ultimately contract an iatrogenic infection. Although this is still a relatively “common” figure that easily identifiable, the problem many teaching hospitals have with making inroads into this number has more to do with the population that is served — large publicly owned tertiary care institutions serving many impoverished patients with low health literacy — than with simply identifying the source of these infections. The bigger issue here is — what does this say about the institutions: are teaching hospitals now suddenly harming patients more than other institutions (with seemingly fewer resources on the surface), simply because the federal government says they are? Or, are these hospitals facing certain penalties year after year because they simply cannot avoid certain patient demographics?


  • July 13, 2014 8:27 am

    Tech creep slowly invades cardiac disease research

    When it comes to matters of regeneration after cell damage, cardiac muscle is a dead end — at least that was what we were/are taught in physiology classes in medical school. After ischemic damage to the cardiac muscle (the most specialized muscle in the body) occurs, the effect on the function of the heart becomes cumulative. Not taking steps to protect the other functioning areas of the heart could result in permanent failure and death due to factors that exacerbate the ill-functioning muscle.

    Could there be a role for stem cell tech in reversing this process? Well, in the media, I suppose anything is possible. 

    [The investigator] led one of the earlier stem cell trials, using cells taken by biopsy from the patient’s own heart. The cells were multiplied in a laboratory for two to three weeks and then reinfused through a catheter. At the time … it was thought that the stem cells themselves turned into new heart muscle and blood vessels.


    Like re-charging a battery, the infusion of new cells seems to trigger the body to produce new tissue: new muscle and blood cells.

    "The cells will only be there a few weeks before they’re immunologically rejected, but during that time they do their magic, and their magic stays behind long after the cells are gone," explains [the investigator].

    Research toward this end is certainly laudable, but the nation’s #1 killer is an infinitely tentacled beast, with multiple avenues of vulnerability. Preventive medicine is a disparagingly underfunded, underresearched area that would serve the public well (along with the increase in primary care physicians to implement such care) and is as ripe for study innovation as stem cell research. | LINK

  • July 13, 2014 1:35 am
    radiologysigns:A Codman triangle is a type of periosteal reaction seen with aggressive bone lesions. Due to rapid growth of the lesion, only the edge of the raised periosteum has time to ossify creating the triangular appearance. It is seen particularly with osteosarcoma  and Ewing sarcoma but can be seen with other aggressive lesions too. This was an osteosarcoma.Board question … —MD View high resolution


    A Codman triangle is a type of periosteal reaction seen with aggressive bone lesions. Due to rapid growth of the lesion, only the edge of the raised periosteum has time to ossify creating the triangular appearance. It is seen particularly with osteosarcoma and Ewing sarcoma but can be seen with other aggressive lesions too. This was an osteosarcoma.

    Board question …


  • July 12, 2014 12:07 pm

    New York state med student takes on Dr. Oz

    A rather bold and enterprising move by a medical student in New York is taking shape, and it’s all about protecting the impact of medicine as a discipline and science. Many are already familiar with the row that noted pseudoscientist physician Mehmet Oz caused when testifying recently before a senate subcommittee on the dubious claims he’s made in the media concerning questionable and certain non-evidence based medical treatments. Well, this med student isn’t letting things rest with a half-baked mea culpa from the Oprah acolyte.

    Organized medicine has an interest in protecting physicians as a profession. They want to maintain the prestige, trust, and income that physicians have historically received in the US. In order to protect the profession as a whole, organized medicine sometimes has to protect individual doctors, even if they are not acting in the best interest of patients. The AMA may fear that undermining Dr. Oz could undermine overall trust in doctors.

    The student’s inspiration came from an elderly patient who eschewed the student’s pleas for her to continue to use standard-of-care treatments for her chronic conditions (diabetes, coronary disease) in favor of Dr. Oz’s green coffee bean extracts. 

    The movement in medicine has been toward evidence-based medicine because physicians had done things by their gut and belief for hundreds of years. Most physicians would agree it’s only through the scientific process and evidence that we were able to make huge differences in medical care. It’s insulting to talk about important medical issues and drugs as if it they were a matter of belief. It degrades all that work that has been done.