Do you remember when we talked last year about the purpose of preventive medicine?  Then you remember that the point of blood pressure medicine isn't to lower blood pressure, it's to prevent strokes and heart attacks. There are now many blood pressure medicines that have been proven to prevent strokes and heart attacks and have trac...

The New England Journal of Medicine and the Massachusetts Medical Society released a video this week of a panel discussion on U.S. health policy.  I thought it was a fascinating and intelligent discussion by representatives of all the stakeholders in the debate.  The discussion covers many topics critical to American healthcare, including the dwindling numbers of primary care physicians, ...

Coronary angioplasty is a technical marvel.  A thin tube is threaded from an artery in the groin to the heart.  Through this tube a tiny balloon is threaded into a narrowed coronary artery.  The balloon is inflated to open the artery, and then a stent (a metal mesh tube) is placed in the newly open artery to keep it open.  About a million coronary angioplasties are done in the United States annual...

Two years ago I wrote about the controversy of routine screening for prostate cancer.  Screening for prostate cancer is usually done with a blood test called PSA.  But whether diagnosing prostate cancer early helps patients is still unknown, and there are many serious complications that result from prostate cancer treatment.  That's why in many cases of prostate cancer watchful waiting is a reason...

I usually write about an item in this week's news or in the recent medical literature.  Forgive me from straying from that path this week to share some personal reflections. For sedentary patients there is an enormous psychological barrier to exercise.  All primary care doctors face that barrier daily.  We encourage, cajole, practically shove our patients to become more physically active.  The va...

When I was a resident (over ten years ago!) we were taught that there was no evidence that breast self-examination saved lives.  A new review puts another nail in the coffin of breast self-examination.  This week the Cochrane Review published a re-analysis of a review of the scientific studies on breast examination.  The conclusion: women who perform breast self-examination undergo more breast bio...

This week the Food and Drug Administration (FDA) requested a new warning on a family of antibiotics called fluoroquinolones.  This family includes ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox) and others.  The warning has to do with the increased risk of tendonitis and tendon rupture due to these antibiotics. This information is not new.  The increased risk has been known ...

"Summertime, And the livin' is easy" -- George Gershwin

Summer is here, and especially in Southern California, that means opportunities to enjoy lots of outdoor activities including fun days at the beach and in the pool.  Unfortunately that also means more accidental drowning.  In 2005 there were 3,582 drowning fatalities in the United States, a quarter of them in kids 14 and ...

Dementia is not a single disease.  Dementia is a family of diseases that cause progressive memory loss, usually in older patients.  The most common cause of dementia is Alzheimer's disease.  Dementia is progressive, and while some treatments exist, their efficacy is only modest.  In addition to memory loss, patients frequently suffer personality and behavior changes. Dementia is common, affecting...

This week, a large national survey of physicians' use of electronic health records (EHRs) was published in the New England Journal of Medicine.  The results generated a lot of attention in the general media. The good news is that physicians with EHRs are largely very satisfied with them and believe that EHRs improve patient care.  The bad news is that nationally only 4% of doctors use EH...