Medications Are Not the First Choice of Treatment for Low Back Pain

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Low back pain is very common. The vast majority of people reading this sentence have had low back pain at some time in their lives. It is one of the most common reasons for physician visits in the U.S. and results in an estimated $100 billion in annual costs. Given the very high prevalence of low back pain, you would think that we would already have noninvasive treatments that are proven to be safe and effective. You’d be wrong. Recently the American College of Physicians (ACP) reviewed e...
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Weighing the Risks of Celebrex

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Non-steroidal anti-inflammatory medicines (NSAIDs) have been around since the 1960s. They include ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren) and over a dozen others. NSAIDs are used to treat pain, decrease fever, and decrease inflammation. They are prescribed over 100 million times annually in the US. Naproxen and ibuprofen are also available over the counter. NSAIDs were a boon compared to the medications that were available before them. They ar...
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Prolonged Antibiotics Don’t Help in Lyme Disease

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Lyme disease is a bacterial illness transmitted by tick bites. It is treated with antibiotics, and most guidelines suggest a two to four week course of treatment. Most patients’ symptoms resolve at that point, but 10 to 20% of patients continue to have fatigue, joint and muscle pain, sleep problems, and difficulty concentrating. These patients can be quite debilitated and no specific effective treatment has been found for them. A patient advocacy group has recommended treatment with antib...
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Why You Might Want More Blood Pressure Medicine

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We’ve known for over a generation that using medications to lower high blood pressure can decrease the risk of strokes, heart attacks, and kidney failure. National guidelines have recommended using medications to get the systolic blood pressure (the higher blood pressure number) below 140. So for my whole career a systolic in the 130s would lead to me pat the patient on the back and declare victory, while a systolic in the 140s would lead me to increase a dose of a medication or stress to th...
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Best Treatment for Chronic Insomnia is Cognitive Behavioral Therapy

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I'm having trouble trying to sleep I'm counting sheep but running out As time ticks by… And still I try… -- Brain Stew by Green Day from the album Insomniac

Sleep that knits up the raveled sleave of care, The death of each day’s life, sore labor’s bath, Balm of hurt minds, great nature’s second course, Chief nourisher in life’s feast. -- Shakespeare, Macbeth

Chronic insomnia affects 5% to 15% of Americans. It is far ...
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A Small Step Towards An Artificial Pancreas

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Patients with type 1 diabetes (T1D) are forced to spend much of their time obsessing about their blood sugar and insulin doses. The state of the art in treatment of T1D is an insulin pump that delivers insulin and a continuous glucose monitor that displays the glucose level and sounds alarms for values that are too low or too high. (See here for a refresher on the differences between type 1 and type 2 diabetes.) Currently, p...
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The Anti-Medication Bias

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[The patient interactions in this post are amalgams of hundreds of patient encounters over my career. They are not accurate depictions of any encounter with any single patient.] “I don't like taking medicines.” All physicians hear some form of this opinion very frequently. Even more frequently, patients don't state this view outright but rely on it to completely subvert their doctor’s plans. When I was new to practice such an utterance would shock and confuse me. “I don't want to...
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Nearing a Cure for Hepatitis C

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In the contest to get a creative name, few pathogens have done worse than hepatitis C. In the 1970s there were two known viruses that caused hepatitis – liver inflammation. You might have already guessed that these two viruses were called hepatitis A and hepatitis B. It was known at that time that people sometimes developed hepatitis after blood transfusions and that the majority of those patients tested negative for hepatitis A and B. A new pathogen was hypothesized and called non-A-non-B h...
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There Has Never Been a Better Time to Have Diabetes

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The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus. For an explanation of the differences between these two very different diseases see the first half of this post.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leadin...
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