Heart Stents Don’t Decrease Chest Pain

A stent in a coronary artery. Image credit: WikiJournal of Medicine

“The first principle is that you must not fool yourself – and you are the easiest person to fool.” -- Richard Feynman

This month brought more bad news for coronary artery stents. To understand how far coronary stents have fallen, we have to understand what we’ve been using them for. But first I should explain that coronary stents are life-saving treatments during a heart attack. That has been well established and is not changed by anything in this post. T...

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

Photo credit: Vimeo (labeled for reuse)
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...

Weighing the Risks of Celebrex

Ibuprofen tablets
Photo credit: Wikimedia / public domain
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...

Less Invasive Method of Replacing Aortic Valves

The Hufnagel Heart Valve developed in the 1950s.
Credit: National Museum of Health and Medicine / Wikipedia
The aortic valve is the valve that allows blood out of the heart into the aorta, but not back. As people get older it’s not uncommon for the aortic valve to accumulate calcium deposits, stiffen, and not open as widely. This condition is called aortic stenosis. As the aortic valve narrows, it impairs the blood flow through it. Patients can develop heart failure, lightheadedness, chest pain, and fainting. There are no effective medications for aortic stenosis. Until several years ago the only ...

Prolonged Antibiotics Don’t Help in Lyme Disease

erythema migrains
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...

Should You Get Antibiotics for that Upper Respiratory Infection?

Credit: Wikimedia Commons

“The waiting is the hardest part.” -- Tom Petty

Over 100 million doctor visits in the US each year result in a prescription for antibiotics. Over a third of those visits are for respiratory infections. A large fraction of the antibiotics prescribed yield absolutely no benefit to the patient. The issue is much more severe than just unnecessary spending on ineffective medication. As I’ve written before, antibiotic overuse is a major cause of More

Why You Might Want More Blood Pressure Medicine

A patient's blood pressure being taken
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...

Best Treatment for Chronic Insomnia is Cognitive Behavioral Therapy


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 ...

Consuming Peanuts in Infancy Can Help Prevent Peanut Allergies

Food allergies are commonly misunderstood, so please bear with me while I first explain what food allergies are and are not. Various foods can cause all sorts of unpleasant effects. Most of these are not allergies. Allergies are only reactions caused by a specific antibody (called IgE) that results in hives, trouble breathing, or a life-threatening condition called anaphylaxis. So, if yogurt gives you diarrhea, that’s not an allergy. It might be lactose intolerance. If coffee gives you palpi...