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Hypertension: New (Joint National Committee 8) Recommendations for Treatment
Doctoring is a practice based in science, but at its best, attempts to treat whole complex humans to achieve goals such as health and happiness which have no good scientific definition. Good doctors...
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Smoking: A half century of knowing we should quit
In 1950 Ernst Wynder MD and colleagues began to produce convincing data that cigarette smoking caused lung cancer. Over the ensuing many years evidence has arisen linking cigarette smoking to many...
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Ultrasound in South Sudan: what might it be good for?
Last month I spent 2 weeks in a small hospital in South Sudan and probably did about 100 bedside ultrasounds. The whole experience was very moving, and encompassed so much more than doing ultrasound,...
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Paul Lee--a Washington healthcare lobbyist talks about why it's all good
A few nights ago I attended a dinner and lecture at the local dining venue where they served huge hunks of prime rib and sauteed snow peas from some far away place where it's Spring, and chocolate...
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Sick patients with chronic diseases and the wisdom of Dr. Bernard Lown
I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very...
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Mammograms don't help--and the dog that didn't bark in the night
In the short story "Silver Blaze" by Sir Arthur Conan Doyle, Sherlock Holmes remarks that it was very curious that when a race horse disappeared and its trainer appeared to have been murdered, the dog...
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Requiem for ABC David.
When I first learned to take care of patients in the hospital, as a third year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would...
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The Hospital Dependent Patient--some people will be in and out of the...
This week the New England Journal of Medicine published an article by David Reuben MD and Mary Tinetti MD, both academic gerontologists, about patients who are unable to stay out of the hospital. The...
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Critical Access Hospitals--the 96 hour rule and other ridiculous and self...
My home hospital is small. In a town of just over 20,000 people, this hospital has 25 beds and is designated "critical access" by Medicare because it is felt to be necessary to the health care of the...
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Tranexamic acid--why you may be less likely to bleed to death in Britain than...
The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid...
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Principles of Critical Care Medicine for Non-Intensive Care Specialists:...
I just got back from Boston where I visited friends and went to a really good and useful Harvard Medical school continuing medical education course. Harvard is one of the few institutions that I have...
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Mammograms are not as awesome as we said they were: Damage control articles...
A few weeks ago I wrote a blog which addressed a newly released study of the effectiveness of mammograms. This article, in the the British Medical Journal, looked at women who were followed over a 25...
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America's New Guidelines for Cholesterol Lowering Drugs: What do European...
In November of last year the American Heart Association released new recommendations on who should be taking "statins" (drugs like lipitor/atorvastatin), the most common medicines we use to control...
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Pocket Ultrasound Machines: "Why doesn't everyone have one of these?"
For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November of 2011 I first...
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E-Cigarettes and the FDA: Where should we stand?
People have smoked tobacco for centuries, possibly thousands of years, and cigarettes were first machine made in France in the 1880's. In the US, smoking peaked in the year 1965 when 50% of men and 33%...
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What is this VA scandal about?
I've been hearing about the VA (Veterans Health Administration) scandal recently. A traipse through the high quality media coverage available on the internet has brought me up to date. Apparently in...
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Why does American health care cost so much? The New York Times says it's...
A friend sent me a link to a New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American healthcare is so expensive...
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Ezetimibe (Zetia): why are we still prescribing what appears to be a useless...
A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over 1.8 billion, is the cholesterol lowering drug ezetimibe, brand...
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They do make an ultrasound probe that plugs into a USB port!
"They should make an ultrasound probe that plugs into your laptop. It could just hook into a USB port."Ultrasound technology has become progressively more accessible to doctors who aren't radiologists....
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Schistosomiasis in Tanzania--a prologue
I am in the African Republic of Tanzania. This year I have again accompanied a group of medical students from University of California at Irvine who will be teaching bedside ultrasound to clinical...
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