A Twitter follower wrote me this: “Hospital making me use ‘safety scalpel’ w/retractable sheath. I’ve almost cut myself x 2. Do you know of any data about it?”
That got me interested because I like to question things. Was this going to be yet another rule without evidence?
I thought I would have to do an exhaustive search to see if anyone had ever …
Do safety scalpels reduce the risk of injury?
The New York Times ran a fascinating piece about a dusty old medical experiment that was brought back to life recently after one of its perpetrators — err, researchers, decided to come clean to a medical historian after having read the book The Immortal Life of Henrietta Lacks.
The unnamed confessor was a surgical resident in the 1950s under Dr. Perry Hudson, the man in charge of the experiment. Dr. Hudson (a urologist, …
Will PSA screening be an ethical tragedy in the future?
If you remember the 1950s you probably remember the terror of polio. Polio, short for poliomyelitis, is a disease caused by a virus which can cause severe inflammation of the spinal cord. Though most infected people have no symptoms, a small fraction of patients are left with permanent paralysis and deformities. The disease is sometimes fatal. In the US, the 1952 polio epidemic killed over 3,000 people and left over …
Lessons from the polio outbreak in Syria
Children who live with diabetes, like all children with chronic diseases, learn to grow up rather quickly. In order to survive, they must learn how to manage a disease with which most adults struggle. In particular, not only must children completely change their diet, but they also have to deal with checking blood sugars daily, time and dose insulin shots, all while trying to fit into a world where they …
How young eyes are devastated by diabetes
“I don’t even know what I have.”
Those were some of the first words that came out of the mouth of a 25-year-old Caucasian female at the county hospital. Amy, as I will hereby recall, presented with fever, malaise, chills, and sweats, supposedly from an unknown cause. She had recently come back from a trip to Africa with her boyfriend. Quite the exotic romantic getaway, but the only problem was that …
We are sheltered from global health diseases
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per day, last for approximately 60 seconds, and are associated with severe sweating, palpitations, and occasional nausea. She is awakened several times per night. She has tried herbal medications, …
MKSAP: 61-year-old woman with hot flushes
PG-13 movies now have more gun violence than R-rated ones.
I was in fourth grade when Red Dawn debuted as the first PG-13 rated movie back in 1985. At the time Red Dawn was released, it was considered one of the most violent films by The National Coalition on Television Violence, with a rate of 134 acts of violence per hour, or 2.23 per minute. And although not every PG-13 movie has …
Gun imagery in PG-13 movies is targeting our teens
Asthma is a common problem in children — nearly 10% now have it — and the number is increasing. Researchers are not sure of the reasons for this steady increase, but decreased air quality, lower activity levels among children, and an increase childhood obesity have all been implicated. Whatever the cause, it means that millions of American children take medicine for asthma. A significant number of these children end up in …
Asthma in children: A complete primer
In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more.
In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, …
The outrageous ER markup for a tetanus shot
“I’m so frustrated, Dr. Natasha. My 2-year-old son knows his letters and can count to 10, but he does not seem to know any colors. He just calls everything ‘blue’. Do you think he could be colorblind?”
Parents often come to my office with the concern that their child is unable to correctly identify colors, even when these children have an impressive …
How to teach your child colors
Acupuncture has become, for many women, an accepted part of their infertility journey. Several studies, including a meta-analysis of 24 studies published in the journal Fertility Sterility in 2012, indicated higher pregnancy rates among women who had undergone acupuncture as part of their treatment protocol compared with women who had no acupuncture or a sham procedure. Any improvement in outcomes is welcome considering the emotional and financial drain of each cycle.
However, there …
Does acupuncture help pregnancy rates in IVF?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 10-day history of malaise, right upper quadrant discomfort, and progressive jaundice. She has had no recent travel outside of the United States, does not drink alcohol, and has no recent ingestions of drugs, including acetaminophen or herbal remedies. Up until this time, she has …
MKSAP: 32-year-old woman with progressive jaundice
I am furious.
For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don’t do it at all.
The United States Preventive Services Task force reviewed the literature and …
A urologist’s hypocrisy on prostate cancer screening
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I think I am like many practicing physicians in my love-hate relationship with clinical practice guidelines.
On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice.
On the other …
A solution for clinical guideline overload
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning pituitary macroadenoma, followed 4 months later by radiation therapy because of residual tumor. She started taking hydrocortisone 14 months ago after adrenal insufficiency was diagnosed. The patient developed amenorrhea 1 …
MKSAP: 38-year-old woman with increasing fatigue and weight gain
Thermography uses heat sensitive infrared cameras to image the body and measure heat emission.
Solid tumors, even when they are tiny, have an increased blood flow and inflammation compared with non-cancerous tissue. Theoretically this could lead to a thermal gradient between a cancer and the surrounding non-cancerous tissues. Some animal studies indicate that thermography might detect heat differences between inflamed and non inflamed tissue and so it was postulated (initially back …
Thermography for breast cancer screening: Where is the evidence?
Kerry was only 28-years-old. He showed up in the ER one night complaining of upper abdominal pain which started suddenly that day. The emergency physician did the usual workup and found two things which led to an urgent call: a large intrabdominal mass and free intraperitoneal air.
The large mass was not necessarily an emergency, but free air, that is, air outside its usual place inside the bowel, almost always represents …
The remarkable resiliency of the human body
However you see the Reverend Al Sharpton, one thing is certain: you see less of him now. His Twitter pic tells you he is proud of his 167-pound weight loss. Good for him, he should be.
If you care about health, the disappearance of the Sharpton-of-old is worth mention. His story teaches us a lot, and, if one dares to look a little …
What we can learn about weight loss from Al Sharpton
The teenage girl was in my office for a routine physical. As we were talking about healthy dietary habits and routine exercise, she blurted it out: “I make good choices, Dr. Natasha, I’m not like those girls who just want a bigger thigh gap.”
“So, you guys are talking about thigh gaps now?” I asked with horrified curiosity.
“Yeah, mainly the girls in volleyball or cheer. I mean, they have to show their gaps. But, …
Focus on the thigh gap and the concern for eating disorders
I have represented a number of physicians who have been accused of “overprescribing.” Some of these were criminal investigations by local law enforcement authorities, such as a county sheriff’s office. Some were investigations by the Drug Enforcement Administration (DEA). Some were investigations by the state licensing agency (in this case, the Florida Department of Health).
In almost every one of these cases, either the DEA, the Department of Health or the …
A lawyer provides pain management tips for doctors
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