A Primer on Radiation Exposure

Japan's Nuclear Plants: Nuclear plant malfunctions raise concerns regarding the health of individuals and of the community at large, both locally and globally.

• Observation: For those interested in more background information with which to respond to questions regarding mass exposure to potentially toxic radiation, refer to a primer published last year in Radiology (Radiology 2010;254:660-77).

Robotic Prostatectomy: A new multicenter study indicated that to achieve professional standards of competence (tumor tissue margins), a surgeon would have to have performed nearly 1,600 robotic prostatectomies. Most surgeons perform fewer than 100 such procedures a year (Internal Medicine News, online Feb. 16, 2011).

• Observation: Sixteen hundred operations to achieve competency? Really? ... Really? This adds to the fog regarding prostate cancer and its effective management. 

Reducing Federal Spending: The nonpartisan Congressional Budget Office has issued a report on strategies to reduce the federal budget deficit. It has wide-ranging recommendations that include many that pertain to health care. Among the more interesting ideas:

-Reduction in funding from the National Institutes of Health.

-Tort reform.

-Reduction and consolidation of support for Graduate Medical Education.

-Eliminate special status of critical access hospitals.

-More cost sharing for TRICARE, skilled nursing services, home health.

- Vouchers for federal employees to purchase health insurance.

-Public plans in health insurance exchanges.Block grants to support Medicaid long-term care.

• Observation: This document includes brief, very readable explanations of the rationale and impact of these budgetary suggestions. It implies that residents might receive lower salaries, and therefore bear more of the costs of their ongoing training. The recommendations for tort reform were refreshing, targeted, and will be seen as very welcome by the medical community. Many other cuts are recommended as judicious and designed to stimulate better priority setting and efficiencies in health care markets and research enterprises. It also outlines areas in which increased copays by patients and families could alter decision making and restructure service delivery. Overall, these suggestions were more thoughtful than frightening and worthy of a look by those who want to sense where budget realities might be taking us in the not-too-distant future.

Cardiac Screening: Consumer reports has posted on its website an age- and sex-adjusted guide regarding the value of cardiac screening tests to aid consumers and health professions. 

• Observation: The recommendations are conservative and clearly presented. Perhaps it can help busy clinicians convince patients who think that more testing will help them live longer to focus instead on maintaining a healthy lifestyle. It’s clearly an easier route than trying to explain Bayesian logic!

--William E. Golden, M.D.

Dr. Golden is professor of medicine and public health at the University of Arkansas for Medical Sciences where he served as director of the division of general internal medicine for nearly 20 years. He is currently the Medical Director, Arkansas Medicaid Enterprise at the Arkansas Department of Human Services.