The Medical Letter is a biweekly publication which publishes the most unbiased reviews of medications. It is not supported by advertising and prides itself in giving objective evidence-based information. I think it’s ...

Niacin has been getting some bad press recently. A brief retrospective of Niacin’s rise to prominence will help us understand its recent fall from favor. Niacin is also known as vitamin B3 or nicotinic acid, a molecule that we need in tiny quantities in our food. As far back as the 1950s it was known that niacin in higher doses reduces blood levels of cholesterol. At that time our understanding o...

For each new morning with its light, For rest and shelter of the night, For health and food, For love and friends, For everything Thy goodness sends

Thanksgiving By Ralph Waldo Emerson

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Everyone hates stress, and for good reason. Stress makes us miserable. Perhaps for that reason, stress is blamed for virtually every disease for which the cause is still unknown. Later, when we discover the true cause, we find that it is unrelated to stress. We thought stress causes stomach ulcers before discovering the bacterium that is the true culprit. We thought stress caused heart attacks bef...

Irritable bowel syndrome (IBS) is a chronic condition marked by abdominal pain, bloating, and alternating constipation and diarrhea. There is no specific test for IBS and other more serious diseases like celiac disease and inflammatory bowel disease can cause similar symptoms. The good news is that when a doctor has ruled out these more serious diseases and diagnosed IBS the patient can be assured...

One of the implicit themes we were taught in medical school is that an understanding of the basic science of a disease informs and guides treatment of patients. The general philosophy that we absorbed was that an understanding of the molecular or cellular defects in a disease would explain the abnormal organ physiology which would explain the patient’s abnormal signs and symptoms. This understandi...

It’s been a disappointing month for proponents of screening. You remember what screening is? Screening is testing someone for a disease who does not have any signs or symptoms of that disease....

Lots of my patients take vitamin supplements. I don’t recommend them. My patients don’t ask me about it, they just tell me. In the absence of a specific vitamin deficiency or medical condition, there is absolutely no evidence that any vitamin improves any health outcome. I’ve always assumed that vitamins are generally ineffective, but harmless. Some patients are very eager to feel like they’re d...

Every year in the US over 200,000 men are newly diagnosed with prostate cancer, and every year 30,000 men die of the disease. With a problem this common that kills so many, you would think that aggressive testing of healthy men is certain to save lives. Whether screening for prostate cancer has any benefits has always been controversial. By the way, screening means testing for a disease i...