This is a trash study and the title implying that this is an AHA statement is misleading. It was a data dredge associational study with minimal controlling for other covariates / risk factors for heart failure. The implication that melatonin has a causal relationship with CHF based on this alone is a pretty big jump.
It's complicated. Physicians can own imaging equipment, for example, but they can't require you to use it for the radiology tests that they order. There are weird carve-outs for in-office ancillary services (e.g. you're an orthopedic surgeon who uses x-rays in your office, which is common and arguably necessary).
There's also rules regarding things like percentage ownership of physician owned facilities and the percentage of referrals to that equipment that come from the physician owners.
Urine drug screens in an in-office "lab" are another big source of revenue for certain specialties that involve referring patients to your own tests, or doing your own pathology on biopsies as a dermatologist or whatever. My understanding is that most of those things, and many like them, are not Stark law violations.
Excellent article in Bloomberg on this subject: https://www.bloomberg.com/news/features/2024-07-24/is-the-nu... (non-paywall'd link: https://archive.ph/03f4u) -- not the standard r/noctor drivel, but a well-researched and sources cited article exploring this phenomenon. Not discussed in the article is the phenomenon of more unnecessary testing with less trained providers doing the ordering which has downstream effects of cost and overdiagnosis.
I agree with a lot of the critiques of our healthcare system and as an emergency department doctor share them, but I doubt LLMs or NPs are going to fix our system. I also have a lot of concerns about broader societal trends in looking for pathologies / diagnoses in ourselves to justify or validate not feeling "well", repeatedly asking for more and more tests or self-identifying with a nebulous diagnosis and then incorporating that into identity as one who is perpetually sick. Particularly with younger generation, this is a really big issue and I don't see it getting better.
You need to have the sugar because it is required to transport sodium across the cell membrane in the intestine. Without the sugar you will not absorb the salt, which is what helps maintain hydration and electrolyte balance. This discovery has possibly saved roughly as many lives as antibiotics.
Yes but it is the cause of many gastric ulcers and is undertested for at least in my community. Where I can easily do the test in the ER, I diagnose and treat many people with previously-unexplained epigastric abdominal pain syndromes.
