The Deans of Johns Hopkins and Miami discuss ACO’s

By Steven Greer, MD

Dean Miller of Johns Hopkins and Dean Goldschmidt of Miami discuss accountable care organizations, or ACO’s. The new ACA healthcare law will mandate academic medical centers to form new groups of doctors and Read more »

Steven Greer MD: A discussion with Bill O’Reilly about radiation risks

A discussion with Bill O’Reilly about radiation risks from the Fukushima nuclear meltdowns and the fallout hitting the U.S. and entire globe.

Updated: February 28, 2012

A report on the handling of the Fukushima nuclear plant crisis confirmed what Dr. Greer first said last year: that the government and TEPCO were lying to the public and downplaying the risk, while also being incompetent in handling the meltdowns.

NEJM letter casts doubt on original Gawande checklist paper

June 11, 2014- By Steven E. Greer, MD

When the recent Canadian studied published in the NEJM failed to show any benefit from the WHO surgical checklist championed by Atul Gawande, The Healthcare Channel pointed out that the original Gawande paper was possibly the problem. It was designed poorly, and collected data from non-U.S. countries with little oversight.

Now, in the current online NEJM, letters to the editor are coming in. One writer echoes our concerns about the original Gawande paper. Read more »

Matthews Chacko, MD: Renal denervation to treat HTN

December 29, 2010

Many medical devices cause a far greater clinical impact than pharmaceutical therapies such as statins and chemotherapies. For example, ICDs have a dramatic life-saving capability, but for only a small portion of the patients receiving an ICD. Likewise, coronary stents improvement survival in patients with acute MI, but merely alleviate angina in most other patients.

A new device, unknown to most doctors, currently being investigated in Australia, Europe, and South America, could confer the most dramatic clinical benefit to the largest group of patients in the history of medical devices. That device is the Ardian renal artery/nerve ablation catheter to treat essential hypertension, recently acquired by Medtronic.

Medications to treat high blood pressure deliver tens of billions in revenue to the pharmaceutical companies, yet the magnitude of effect is just a few millimeters of mercury reduction in hypertension. In a small, but well designed, trial of the Ardian device, improvements in blood pressure of the magnitude of 30 mmHg were seen in almost all patients. If these data hold up, and safety concerns do not arise, this device would turn the hypertension market upside down, to the dismay of Big Pharma. Total medical costs could be reduced as well if damage to the kidneys, eyes, and hearts of millions of patients are avoided.

Matthews Chacko, MD, Director of Peripheral Vascular Intervention at Johns Hopkins, discusses this device, the data in The Lancet, and his thoughts on safety and efficacy.

Double arm transplantation

Gerald Brandacher, MD, Scientific Director of the  Composite Tissue Allotransplantation (Reconstructive Transplant) Program at Johns Hopkins discusses the first double arm transplant.

A Bridge Too Far: Patient classifications for LVAD reimbursement

September 16, 2013- By Ashish Shah, MD, Cardiac transplant surgeon, The Johns Hopkins Medical Center

Left ventricular assist devices (LVADs) arose from the ashes of the total artificial heart era. The idea of a permanent mechanical solution was abandoned in the 80’s after very public cases involving the Jarvik 7 total artificial heart. However, a few teams utilized the same technology to temporize critically ill patients until a donor heart was available. This effectively “bridged” them to heart transplant.

Throgh the 90’s, attention turned to univentricular support rather than total replacement.  These LVADs serve to bridge the patient until they are well enough to be listed for heart transplant: bridge to transplant (BTT). After the publication of the REMATCH trial in 2001, a new class of LVAD patients were defined. Destination therapy (DT) represents the idea that a patient is actually not a candidate for transplant. The LVAD is the final therapy.

The BTT patients typically look like good heart transplant candidates but have run out of time or have reversible end organ dysfunction like renal insufficiency, malnutrition, or pulmonary hypertension that need the support period to improve their post transplant outcome. The DT patients on the other hand, may be older with a greater burden of extra cardiac organ dysfunction.

Over the last decade, Read more »

See one. Do one. Harm one? by Peter Pronovost, MD, PhD

July 11, 2012 By Peter Pronovost, MD PhD

I recently cared for Ms. K, an elderly black woman who had been sitting in the intensive care unit for more than a month. She was, frail, weak and intermittently delirious, with a hopeful smile. She had a big problem: She had undergone an esophagectomy at an outside hospital and suffered a horrible complication, leading her to be transferred to The Johns Hopkins Hospital. Ms. K had a large hole in her posterior trachea, far too large to directly fix, extending from her vocal cords to where her trachea splits into right and left bronchus. She had a trachea tube so she can breathe, and her esophagus was tied off high in her throat so oral secretions containing bacteria did not fall through the hole and infect her heart and lungs. It is unclear if she will survive, and the costs of her medical care will be in the millions.

Ms K’s complication is tragic—and largely preventable. For the type of surgery Read more »

Julie Freischlag, MD: The new 80-hour work week surgery residency

The Surgeon-in-Chief of Johns Hopkins Hospital, Dr. Julie Freischlag, discusses how they adapted the surgery residency training from ultra-long abusive work hours down to the mandated 80-hour maximums.

Johns Hopkins survey of public views on gun policies

Colleen Barry, PhD, of the Johns Hopkins Bloomberg School of Public health discusses her NEJM article that was a study of the public views on various gun control policies being proposed. Most of them are very popular, even among gun owning NRA members.

Related stories:

Reliable gun violence statistics

ABC’s This Week discusses the Connecticut school massacre

The Connecticut shooter was influenced by violent video games

Long-term outcomes for AAA repair

Frank Lederle, MD, discusses the NEJM paper he authored that studied long-term outcomes of endovascular repair of abdominal aortic aneurysms versus open surgical repair. This study adds to the body of evidence because of the long-term nature, use of more modern devices, and use of more reliable North American patient cohort data.