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Mike Merrill, MD
I'm a doctor (internal medicine).
Interests: Crossfit
Tae Kwon Do
Philosophy
Economics
Recent Activity
Save Black Lives from COVID in your community. Do what Buffalo did.
In March, black deaths from COVID in Buffalo were on track to being as bad as the rest of the USA. The black community is 15% of the population of the county, but was 36% of the deaths. Then Rev. Kinzer Pointer and his team started their public health program.... Continue reading
Posted Jun 28, 2020 at Dr. Mike Merrill
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I was right about deaths due to refusing Medicaid expansion, pretty much
In 2013, I quickly estimated that in Texas, not adopting the Medicaid expansion under Obamacare would mean 3,200 deaths per year. A more recent estimate puts that number at 750 deaths per year. So I was off by a factor of 4. Continue reading
Posted Nov 15, 2019 at Dr. Mike Merrill
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A letter to my grandchildren about climate change
I know climate change is terrifying to the youngest generations. Their eyes are not blinded by decades of experience and the expectation that old patterns will repeat. So the raw reality of a rapidly changing world, and the risk of the end of civilization, are evident and emotionally overwhelming. I'm... Continue reading
Posted Nov 14, 2019 at Dr. Mike Merrill
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Why are hospital prices so confusing?
A new law requires hospitals to post their prices online. The prices vary quite a bit. Why is this? The main reason, I think, is that in a hospital it is difficult to do cost accounting. "Cost accounting" is figuring out what it costs to do something inside an organization.... Continue reading
Posted Feb 8, 2019 at Dr. Mike Merrill
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Metrics are based on humanness
In healthcare, we understand that metrics have limits. So when we measure diabetes control, we know we're not seeing all of healthcare quality. It's only part of the picture. And we know that each number has a story behind it. For example, diabetes control in a disadvantaged population means something... Continue reading
Posted Jan 30, 2019 at Dr. Mike Merrill
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"Social determinants of health" are macroeconomic, not micro
There's a lot of work on "social determinants of health" that involves helping individual patients get the things they need: secure housing, food security, transportation. But the real message of the literature on social determinants is that factors larger than the individual - factors on a society level - affect... Continue reading
Posted Jan 16, 2019 at Dr. Mike Merrill
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Three cuban professors define socialism (short videos), and other notes from a visit to Havana
Posted Jan 6, 2019 at Dr. Mike Merrill
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This is $1 million of the drug Eyelea
Posted Dec 17, 2018 at Dr. Mike Merrill
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The PSA test sounds so innocent.
It's possible to hurt a patient with a lab test. It's an innocent enough thing to order, but the downstream effects may not be useful at all. The test is done, it leads to an inconclusive result, further testing is done, maybe a referral, and eventually a treatment occurs that... Continue reading
Posted Dec 14, 2018 at Dr. Mike Merrill
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Is coronary angiography overused in Western New York?
Coronary angiography is the "gold-standard" test for coronary disease. It's considered the final word on whether or not you have it. It involves threading a catheter to the arteries that supply the heart. A liquid that x-rays don't penetrate is injected into the blood, and so with an x-ray (really... Continue reading
Posted Nov 16, 2018 at Dr. Mike Merrill
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Screening tests may not make sense from the individual's perspective
Posted Nov 9, 2018 at Dr. Mike Merrill
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Yeah, I'm diabetic and my sugar gets low sometimes. No big deal, right?
Actually it can be a pretty big deal, especially if you are older and you've had diabetes for a while. Hypoglycemia causes anxiety, tremors and sweating. In more severe cases, you can get confused, lose consciousness, have a seizure, or even die. Think about driving and having all that sneak... Continue reading
Posted Nov 2, 2018 at Dr. Mike Merrill
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Better medical tests: "normal" becomes "disease"
Posted Oct 26, 2018 at Dr. Mike Merrill
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Over time, disease definitions are expanded. Is that good?
A great many things are labelled diseases nowadays. "Caffeine withdrawal" is a formal diagnosis, for example. But there are also examples of existing diagnoses getting expanded, such that more people are classified as unwell. Pre-diabetes and "mild cognitive impairment" (basically pre-dementia) would be examples. This all creates higher risk of... Continue reading
Posted Oct 19, 2018 at Dr. Mike Merrill
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Is it OK to say to your doctor, "I don't know what you're talking about"?
Many patients think they will get better care from doctors if they are nice. Some think it's better to be aggressive. Many just want to get away as soon as possible. Of the ones who try to be nice, there's a risk that they will not get what they need.... Continue reading
Posted Oct 12, 2018 at Dr. Mike Merrill
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Overdiagnosis is an error in prognosis
In overdiagnosis, a clinician identifies an abnormality that would never have hurt the patient, and treats it as an actionable pathology. You can never know who is overdiagnosed in real time; it only becomes apparent after the fact, while examining populations. In a way, the term "overdiagnosis" is misleading. It... Continue reading
Posted Oct 5, 2018 at Dr. Mike Merrill
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Lab tests before surgery: not always useful
Partly out of habit, physicians frequently order lab tests before surgery, to make sure everything is OK. But this is not always useful. The purpose of pre-operative testing is to figure out what risks there are, and to minimize those risks. If you are going through a low risk surgery,... Continue reading
Posted Sep 14, 2018 at Dr. Mike Merrill
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How do you explain overdiagnosis?
You can't know if an individual has been overdiagnosed. You only see it at the aggregate level. The decision point is the choice to seek a diagnosis. After that point, overdiagnosis can occur. By definition, overdiagnosis will not improve prognosis - it's not going to make you live longer or... Continue reading
Posted Sep 5, 2018 at Dr. Mike Merrill
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In overdiagnosis, harm looks like benefit
Posted Aug 27, 2018 at Dr. Mike Merrill
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Why do doctors order unnecessary imaging of the back?
Imaging for low back pain (LBP) is only recommended in certain situations. The Choosing Wisely campaign suggests avoiding imaging during the first six weeks in the absence of red flags, like weight loss, a history of cancer, recent trauma, osteoporosis or age greater than 50. And imaging for LBP is... Continue reading
Posted Aug 24, 2018 at Dr. Mike Merrill
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Avoid testicular self-exams
Posted Aug 24, 2018 at Dr. Mike Merrill
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Mammograms if you're 90?
Posted Aug 17, 2018 at Dr. Mike Merrill
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Fewer fingersticks for type 2 diabetics
Posted Aug 10, 2018 at Dr. Mike Merrill
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Choosing Wisely: with back pain, don't rush to an MRI
Someone out there may completely understand back pain, but I haven't met them, and it's not me. But there are things we do know. And one of them is that in most cases, an MRI is not useful. The low back is a weak spot in human anatomy because we... Continue reading
Posted Aug 3, 2018 at Dr. Mike Merrill
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Can't hear well? You're probably isolated and unhappy
Posted Sep 27, 2016 at Dr. Mike Merrill
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