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On not moving and other dangerous sports
I finally finished reading the many journals piled up on my dining room table, which have been shunted to other flat surfaces for projects or the visits of friends. I didn't read them all well, but I...
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South Sudan trip: take 4
I have just returned from Old Fangak, Jonglei State, South Sudan after my fourth trip. I seem to have earned a welcome there for teaching bedside ultrasound to anyone who will learn and doing...
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Drug costs and copays
Drug costs in the US are higher than in in any other industrialized country in the world. Our cost for an insulin glargine (long acting insulin) pen is $76.80 and in Canada, so very few miles away, it...
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Comparing the US with other high income countries: how do we pay so much for...
Healthcare costs in the US are significantly greater than in any other developed country and for this we have a shorter life expectancy than they. We also develop cutting edge technologies and miracle...
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How the best of care can be terrible without bedside ultrasound
I just read a "Clinical Problem Solving" case from the New England Journal of Medicine (NEJM). It was entitled Stream of Consciousness and it told the story of a 65 year old man who was a patient at...
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A monoclonal antibody to prevent migraine!
This last week a monoclonal antibody injection for migraine was released, with fanfare and great hopes of becoming a commercial success. Amgen developed Aimovig (erenumab) and published its findings in...
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How did American healthcare get so expensive? Perhaps it was Ronald Reagan's...
The New York Times has pointed out a very interesting coincidence. It was during the presidency of Ronald Reagan that health costs and outcomes began to diverge from the rest of high income countries...
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Dang. Just have to rant about some really expensive drugs: Lucemyra, Trelegy...
The price of new drugs just seems to go up. I've stopped being excited about innovative pharmaceuticals that target various hard to treat diseases and conditions, simply because they cost so horribly...
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Overachievers on a plane
"If there is a physician on the plane, please press your call light!"The vast majority of doctors who have flown on airplanes have heard this, and most of us are willing, if not entirely eager, to...
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Lewy body dementia and a farewell to my father
When I finished my training I was taught that the vast majority of dementia was Alzheimer's disease, with occasional cases of multi-infarct dementia as well as odd syndromes such as Kreutzfeld-Jacob...
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Doing Global Health--not always the same as doing good
When I went to medical school over 30 years ago I dreamed of working in exotic places, plagued with poverty, where nothing was familiar and where I could be of use. It sounded deeply gratifying. I...
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Oral or intravenous antibiotics for bone and heart valve infections?
Antibiotics are a miracle, killing the bacteria that might otherwise kill us. They are also dangerous, with side effects that can be fatal as well as merely annoying. They kill good bacteria as well as...
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Poop wars and the commercialization of fecal transplant
The New York Times is interested in fecal transplant. This is the euphemistic term for taking feces, poop, crap, sh*t, bowel contents from one person and putting it into another person. There are...
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Removing the heart from health care: an experiment
I delight in learning my patients' stories and giving them exactly what they need when I take care of them in the hospital. Who they are and what is the best approach to their problem is the primary...
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Humongous healthcare salary disparity is not OK
In 1980 I worked as a nurse's aid for a summer. It was a great job, in its way. I had no training and I worked nights in a nursing home. This meant that I rounded pretty much all night long, helping...
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Now what?
I gave my 3 month notice about 4 months ago now. It was clear that the rural hospitalist program in which I worked was not going to continue to be my happy place. (Corporate medicine, hospital...
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Climate change and global warming: what can a doctor do?
The Problem (which sounds pretty bad)Climate change. Global warming. The greenhouse effect. Devastating wildfires, dangerous air quality. Catastrophic weather events and mass human migration. It all...
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Poor people know how to spend money: a novel way to provide aid to developing...
I just read an article that documents the far reaching positive economic impact of giving people money. It's well written and looks at context and details so perhaps you should just read it instead of...
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The Transformation of Medical Education
Yesterday I read an article by Ezekial Emanuel, a professor and former adviser to President Obama on health care policy. Dr. Emanuel is a very nuanced thinker and had some great ideas around the time...
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Covid 19--How the novel coronavirus will change everything
Not yet facing the emotionally draining horror of working to take care of people in a system that is overwhelmed, I am full of ideas. I am fascinated with the way the response to this global pandemic...
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