Weight loss is one of the most common recommendations that doctors make.  How do we know if a patient should lose weight?  We usually use the Body Mass Index (BMI) which is a way to compare a patient’s weight to her height.  (For all you math geeks, it’s the weight in kilograms divided by the height in meters squared.  For all you physicists, I know the units make no sense.)  A BMI of 18.5 to 25 i...

You may not yet have heard of the bacterium Clostridium difficile (C. dif.), but in the next few years it will likely become a household name, as well known as Staph and Strep.  C. dif. causes a severe infection of the colon leading to severe diarrhea.  It frequently results as a consequence of antibiotic use.  Antibiotics can kill the normal intestinal...

Aspirin has long been known to prevent strokes and heart attacks in patients with a previous stroke or heart attack.  But aspirin has potentially serious side-effects.  Aspirin can cause stomach ulcers, and it inhibits blood clotting raising the risk of life-threatening bleeding. If we knew in advance that a patient was going to be in a car accident or have a bleeding stomach ulcer, we would disc...

Treatments for depression are difficult to study.  First, depression is a condition that can improve without treatment.  So any treatment must be compared to placebo to see if the treatment is responsible for the improvement or if the depression improved on its own.  Also, depression can not be measured objectively.  There is no objective test like an X ray or a blood test that can diagnose depres...

Short work weeks make for short posts, doubly so when virtually all the health-related news is about the healthcare bill in Congress. So I’ll end the year with two unrelated bits of good news. The first is that the H1N1 flu pandemic is mostly behind us. The peak numbers of people getting sick both nationally and in California was about two months ago, with decreasing numbers ever since. As pre...

Mercury in high doses is known to be toxic.  So if you were thinking about breaking your glass thermometer and drinking the contents on a lark, I beg you to reconsider.  This has raised concern about possible harm from eating seafood since many species of seafood are known to contain trace amounts of mercury.  Much hand-wringing has ensued.  Should we shun salmon?  Avoid albacore? The most recent...

Every primary care physician occasionally encounters questions similar to the following. “I just found some of my blood pressure medicines.  The container fell behind the couch a year ago.  The expiration date was last month.  Can I still use them?” or “I know you just prescribed amoxicillin for my sore throat, but I just found some amoxicillin in my cupboard that I bought during the Nixon admi...

One of the first outpatient problems a primary care trainee learns to manage is sore throat.  The current algorithm is fairly simple.  Most sore throats are caused by viruses and will not improve with antibiotics.  Symptomatic medication for pain and fever is the best we can offer.  But a significant minority of sore throats is caused by a bacterium called group A β-hemolytic streptococcus.  These...

I’m grateful to all the readers of my weekly posts for all the stories you’ve pointed me to and all your valuable feedback.  Thanks for reading. I’m grateful to my partners Dr. Rubencio Quintana and Dr. Dorothy Lowe for making our office a happy and intellectually stimulating place to work. I’m grateful to Jaymes, Nancy and Jill for helping us take great care of our patients.  I couldn’t dream o...

This week the US Preventive Services Task Force (USPSTF) revised their recommendations for screening mammograms.  Their recommendations have ignited much controversy and have weakened the credibility of a formerly objective scientific body. This post is longer than usual.  It deals with an important subject in some detail.  For the readers who like to delve into the details and see the data, set ...