Few things captivate the public more than a new diet. From Atkins to Ornish to the Mediterranean diet, each new theory attracts attention and true-believer adherents and generates lots of book sales and interviews on daytime TV. People passionately argue about whether a diet low in carbohydrates or low in fat is best for weight loss. But until now no large trial has ever been done to answer the question.
This week’s New England Journal of Medicine published the largest study that di...
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Mind if I Don’t Smoke?
Quitting smoking is probably the hardest thing I ask my patients to do. (Losing weight is probably the second hardest.) Smoking is a profound addiction. Smoking feels good, and countless smokers have told me the calming pleasure they get from a cigarette.
Despite the health risks and financial costs associated with smoking, medications aimed at helping smokers quit have been only modestly successful. A very helpful article in Monday’s Los Angeles Times reviews the medications avail...
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Would You Like Some Salmonella With That?
Our modern hyper-efficient means of producing, processing and distributing food has made hunger virtually extinct in the developed world. (In fact obesity is a much more pressing problem.) But our modern food production network is revealing an increasingly dangerous cost. Because food from any one farm or any one plant is frequently distributed nationally or even internationally, contamination with a foodborne infection can sicken thousands before the source is identified.
Two years ago Esc...
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Can We Have Your Kidney?
For the hundreds of thousands of Americans whose kidneys have stopped functioning, there are two options: lifelong dialysis or kidney transplantation. Dialysis is time consuming, carries serious risks, and only partially replaces the functions of a healthy kidney. Patients live longer and have a much better quality of life after receiving a kidney transplant. The difficulty with transplantation is that donated organs are scarce and transplants are more likely to be successful with living dono...
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Got Safety?
My bachelor’s degree is in engineering. (I hear all of you thinking “Ah! No wonder he’s such a geek.” But I was a geek long before that.) In engineering, safety is an entire field of study with formal ways to account for and measure errors, plan for system failures, and quantify the likelihood of adverse outcomes.
Until the last several years, medicine had a very different culture. Traditionally giving a lot of latitude to physician judgment and autonomy, hospitals had few systems in place...
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So Long and Thanks for all the Swag
On January 1 the pharmaceutical industry started imposing on itself a ban against the branded gifts to doctors that have been a constant companion of pharmaceutical sales representatives. The Post-It notes, pens and coffee mugs bearing the brand names of various medications are gone. The paperweights and staplers and occasional plush toys with names of prescription antacids and antidepressants and blood pressure medicines will fade into extinction or become collectors’ items.
Last week’s ...
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Holiday Medical Myths
Every year the British Medical Journal has a Christmas issue devoted to more offbeat and lighthearted scientific studies. This year’s issue had an article reviewing holiday themed medical myths.
The article debunks the following myths:
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- that sugar increases children’s hyperactivity
- that suicides increase around the holidays
- that poinsettias are poisonous for you or your pets
- that you lose more heat from your head than any other part of your body<...
The Mendacity of Hope
Or: Just Give it to Me Straight, Doc
Any primary care physician from time to time has to give a patient bad news, sometimes terrible news. These conversations can be extremely difficult for the patient and his loved ones, but also for the doctor. When the patient is too sick to understand or participate in conversations about his prognosis and his treatment options, the terrible burden falls on his loved ones to have these conversations and make decisions on the patient’s behalf. When the ne...
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Lugubrious About LABAs
This week an FDA advisory panel reviewed the evidence on asthma medication and released recommendations about a class of inhaled medications that may be unsafe. Their conclusions drew much media attention.
The panel’s concern is the increasingly worrisome evidence about long-acting beta agonists (LABAs). LABAs are a family of inhaled medications including Serevent and Foradil which are frequently used to treat asthma. Studies have shown increased numbers of asthma exacerbations in patients t...
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Cyberchondria: How Dr. Google Can Make You Anxious
Almost everyone at some time becomes anxious about his health. Even people who can stay calm through a stock market crash can get worried about new or nagging symptoms. And while some anxiety about our health is perfectly normal, in some it can reach a level that interferes with day-to-day functioning and becomes incapacitating. Even when it’s not that bad, anxiety about health is frequently misguided. Your headache is thousands of times more likely to be due to muscle tension than a brain t...
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