The Tyranny of Health Then and Now
November 17th 2010When we hear the words "tyranny of health" these days, it's usually a reference to the tyranny of a government imposing unwanted health care on its citizens. It brings to mind images of protesters carrying signs that denounce the "socialism" of Obamacare.
Disseminated Histoplasmosis in a Woman With History of Polymyositis and Possible Dermatomyositis
November 10th 2010For 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills, and nonproductive cough. She complained of rash, joint pain, and progressive immobility because of severe muscle weakness. For the past 6 years, she had been taking prednisone (60 mg/d), hydroxychloroquine (200 mg bid), and tramadol (100 mg q6h prn for pain).
Middle-Aged Man With Wedge-Shaped Growths in Both Eyes
November 10th 2010A 45-year-old man of Hispanic ancestry presents for evaluation of what he describes as a "growth in both eyes." This growth has been present for some time; however, it has recently become more prominent. The patient has had mild redness and irritation in both eyes, but he denies any change in vision.
An Example of Futile Spending: Preventive Screening at End of Life
November 5th 2010Looking at contemporary medicine’s complex landscape, especially in regard to soaring costs, can make practitioners dizzy. For example, if primary care physicians were asked whether it is cost-efficient and reasonable to screen with prostate-specific antigen (PSA) measurement for early-stage prostate cancer in men with terminal pancreatic cancer or to perform colonoscopy for early diagnosis of colon cancer in women with stage IV lung cancer, the answer would be a quick and uniform no. Unfortunately, a recent publication suggests that in the real world the answer has been yes, as disturbing and wasteful as that may be.