Saw Palmetto Does Not Help for Prostate Enlargement

Some of my patients ask me if I "believe in" Eastern, or holistic, or homeopathic medication. The truth is I don't "believe in" any kind of medicine. I need to be convinced. I'm not a Western medicine chauvinist; I'm an evidence-based medicine chauvinist. If there is a good study that supports that a medication is safe and effective I'll use it. I won't ask if it comes from the East or West, or if it's natural or artificial, or if it's a tablet or a crushed leaf. I just want the evidence. Tha...
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Fighting Jet Lag

Many of my patients are frequent business travelers. Travel presents its own set of health challenges, from the risk of prolonged immobility in small airline seats, to the risk of acquiring respiratory infections on a plane. One painful consequence of travel that we've all experienced is jet lag. Especially when crossing several time zones, jet lag can make the first day or two at your destination very unproductive. In last Saturday's Los Angeles Times business section, James Gilden has a very ...
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Critically Ill Patients Do Better in Large Hospitals

An interesting study in the July 6 issue of The New England Journal of Medicine confirms what many physicians and patients have suspected: experience leads to quality. The study looked at over 20,000 patients with respiratory failure (inadequate or stopped breathing) in 37 different hospitals. The patients all required mechanical ventilation, meaning they were connected to a machine (a ventilator) that a...
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The Surgeon General’s Report on Secondhand Smoke

U.S. Surgeon General Richard Carmona released today a major review of the scientific evidence on secondhand smoke: The Health Consequences of Involuntary Exposure to Tobacco Smoke. This subject was last reviewed by the Surgeon General's office twenty years ago, under Dr. C. Everett Koop. The comprehensive study examined the link between secondhand smoke and a large number of diseases to determine if th...
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The Effects of Coffee and Napping on Nighttime Highway Driving

This issue of Annals of Internal Medicine has the most relevant medical study I've read in a long time. We've all been in the scary situation of driving late at night while sleepy and struggling to stay awake. This study asked the important question: Does drinking coffee or taking a nap improve driving late at night? The study design involved having volunteer drivers each take 90 minute drives on differ...
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Increased Weight is Associated with Heartburn

Gastroesophageal reflux disease (GERD), in which acid from the stomach rises into the esophagus causing heartburn, is a very common and uncomfortable problem. A connection between GERD and increased weight has long been suspected. This recent study in The New England Journal of Medicine makes a fascinating connection between being overweight and having symptoms of GERD in women. The study looked at o...
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Many Americans Unaware They Have Diabetes

A new study from the National Institutes of Health (NIH) and Centers for Disease Control highlights how common type II diabetes is among American adults. The study is summarized in this NIH news release. 6.5% of American adults have diabetes. Even more alarming is that a third of them don't know they have it. Type II diabetes has serious potential consequences, and its high prevalence makes it a common cause of disabi...
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Gastric Banding is a Reasonable Treatment Option for Obesity

Obesity is a serious problem in America and in my practice. Obesity predisposes to type II diabetes, high blood pressure, and high cholesterol. It also increases stress on joints and worsens arthritis. Nevertheless, losing weight for most patients is very difficult. Dietary modification and exercise have been the most proven weight loss techniques, but many patients can not adhere to a strict exercise and diet regimen. More recently, surgical treatments for weight loss have offered an alternati...
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Homocysteine: A Risk Factor Worth Ignoring

Last month's New England Journal of Medicine has a great lesson about how we should think about risk factors. It's been long known that homocysteine is a risk factor for heart disease. That means that, when looking at large numbers of people, those with high levels of homocysteine have more heart attacks on average than those with low levels. Too frequently, we confuse a risk factor with a cause, and we jump to the conclusion that homocysteine causes heart attack. A risk factor, howeve...
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