Raining on the Ice Bucket Parade

Amyotrophic lateral sclerosis (ALS, sometimes called Lou Gehrig’s disease) is a truly horrible illness. It is a progressive fatal neurodegenerative disorder that leads to worsening muscle weakness. Weakness in the limbs initially makes handwriting sloppy and makes it hard to button clothes and eventually causes paralysis. Patients also develop weakness in the muscles that control swallowing and speech, eventually requiring them to use feeding tubes and computer text-to-speech software. Ev...

Suicide Contagion in the Age of Social Media


In every life we have some trouble When you worry you make it double Don’t worry. Be happy.

It will soon pass, whatever it is. Don’t worry. Be happy. -- Bobby McFerrin

Much has already been written in reaction to Robin Williams’s untimely death, about his incandescent talent, his prolific career, his decency and kindness, his addiction and his mental illness. His death robbed his fans of many more years of his genius and...

On Medicine and Absolution

… or Reflections on Yom Kippur

“My heart is blighted like grass, and withered, for I forget to eat my bread.” -- A patient’s prayer, Psalm 102

[None of the anecdotes in this post are descriptions of any specific patient. They are amalgams of many patients. Specific details have been distorted or invented to preserve anonymity.] I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone’s life. More often, I just reassur...

Learning from Massachusetts

In 2006 Massachusetts passed sweeping health care reform which provided for insurance coverage for nearly all of its residents. In 2010 the Affordable Care Act (ACA) was passed at the federal level which will enact very similar reforms nationally. While the US Senate was debating the...

Eat Right for Your Belt Size, Not Your Blood Type

Every couple of months I get asked this same question. “Doc, what’s my blood type?” I load my “why you don’t need to know your blood type” speech from my cerebrum and press replay, trying to add a little spontaneous variation for authenticity. “Actually, I’ve never checked it.” “I thought you check everything.” “Nobody checks everything. There are thousands of different available blood tests. Most of them would be completely useless to you.” “Well doc, could you check my blood type?” “I’m...

News Nincompoops Narrate Nuclear Nonsense

Images from Japan continue to sadden and shock us. Over 12,000 are confirmed dead or missing due to the earthquake and tsunami, and that number will likely rise. Hundreds of thousands have been displaced from their homes. I’m having a hard time finding recent numbers on those without water and electricity, but all the stories state that this continues to be a major problem. The magnitude of what has already been lost, not to mention the serious challenges that remain to get food and water to eve...

Rational Rationing

The healthcare reform debate has generated much heat but very little light.  (And it’s also getting a lot of coverage, so there’s very little else to report about this week.) I wrote a couple of months ago my opinion of two simple (but unpopular) steps that would make high-quality healthcare affordable to virtually everyone: abolishing the employer tax deduction for health insurance, and slowly phasing out Medicare.  The entire national debate is going in the opposite direction, with one party ...