A few years ago, while I was teaching in the hospital, a medical student presented the case of a man with coronary artery disease, diabetes, hypertension, and hyperlipidemia. When we entered the man’s room I was surprised that the student had omitted a certain fact from his presentation: the man weighed well over 400 pounds.
No one argues that diabetes and blocked coronary arteries are diseases. And nobody argues that obesity, …
“It don’t matter how many men you shot in Memphis,” the saying goes, “if your name is Sierra or Sequoia, you can’t sing the blues”. In a sense, this adage reworks an older, more bitter joke from the civil rights era, the one that begins “some of my best friends are …” and ends with “but you wouldn’t want your sister to marry one.” Both statements embody stigma, the social effects …
The stigma experienced by patients with psychiatric disorders
As I shopped for a new car last year, I realized that my priorities were considered odd by most car salesmen. The three most important characteristics I desired in a new car were good gas mileage, good crash safety, and relatively low concentrations of “new car smells.” The often celebrated (but particularly noxious) new car smell is actually a synthetic blend of respiratory irritants and potential carcinogens off-gassing from the …
Beware of that new car smell when shopping for a new car
There is a certain irony in the nearly immediate juxtaposition of the rare introduction of a new FDA-approved drug for weight loss (Belviq) to the marketplace and the recognition of obesity as a “disease” by the AMA. A line from the movie Jerry Maguire comes to mind: “You complete me!” Drugs need diseases; diseases need drugs.
And that’s part of what has me completely worried. The notion that obesity is a disease will inevitably invite a …
Obesity is much more like drowning than a disease
The fact that cunnilingus increases a man’s risk of developing oral cancer has been all over the Internet recently with Michael Douglas’ disclosure that he had an HPV-positive tumor.
To recap: some strains of human papilloma virus (HPV) are oncogenic, meaning they induce changes in a cell’s DNA that can lead to cancer. The same strains of HPV that are oncogenic in the genital tract for women, causing both cervical cancer …
How to reduce the risk of oral cancer
Sometimes it’s the simplest things that can make all the difference. Unfortunately, when it comes to informing patients with a new diagnosis of pulmonary fibrosis what to expect, things are anything but simple.
For years, pulmonologists have dreaded the moment when we inform patients of a diagnosis of pulmonary fibrosis. The discussion invariably involves informing them that this disease (which they have probably never heard of) may either kill them or …
Determining the prognosis of patients with pulmonary fibrosis
The more complex and high stakes a health care decision is, like with genetic testing and mastectomies, the more difficult it can be to find your way. There are no “right” answers, only guideposts to help you choose a path that is best for you.
Decision-making alone. When my kids went to camp in the fifth grade, they got to experience something called the Solo Hike. Counselors took them up into the …
Three tumors, two breasts, one very difficult decision
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted episodes of hand swelling, joint pain, blue color change of her fingers with cold exposure, and difficulty swallowing. She takes no medications.
On physical examination, temperature is 36.9 °C (98.4 °F), …
MKSAP: 38-year-old woman with fatigue and dyspnea on exertion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 26-year-old man is evaluated for a 3-day history of fever, lower abdominal pain, tenesmus, hematochezia, and watery diarrhea. Seven months ago, he underwent a cadaveric kidney transplantation. At the time of transplantation, the transplant donor was seropositive for cytomegalovirus, and the patient was seronegative for this virus. Current medications are tacrolimus, mycophenolate …
MKSAP: 26-year-old man with fever and lower abdominal pain
Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …
Should drug testing be considered screening tests?
Emily wrote in about an article about prenatal ultrasounds and autism: “I saw this on The Daily Beast today. Is the media trying to freak us expecting couples out or what? How big of a question is this in scientific circles or is this just sensational stuff? Sometimes I think there should be studies about how the internet causes anxiety disorders!”
A good question, and another post that I’m going to put …
Ultrasounds don’t cause autism
Repeated bumps to the head are bad for children. This sounds incredibly obvious, yet as a society, we don’t particularly act like we get it at all.
When the Bruins made it into the Stanley Cup finals, I thought about all the young hockey players who would be inspired to practice harder and play harder in the hope of one day doing the same. And I wondered: if they bumped their …
Youth sports should never knowingly risk brain damage
We know that people with high cholesterol have a higher risk for strokes and heart attacks than people with low cholesterol. So if a medicine lowers cholesterol it should also lower the frequency of strokes and heart attacks too. Right? Not necessarily.
Estrogen lowers cholesterol and doesn’t lower stroke or heart attack risk. We also know that people with high blood pressure have …
A low salt diet for high blood pressure: Where’s the evidence?
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Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.
About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. …
When does a teen girl need a pelvic exam?
In 2003, the Archives of Internal Medicine published an observational study assessing the impact of Katie Couric’s March 2000 Today Show colorectal cancer awareness campaign, including the well-known colonoscopy she underwent live on air. The data was compelling, showing a sizeable spike in colonoscopy rates across the U.S. of more than 20%, thanks to this very likeable, personable, and …
How Katie Couric continues to influence the colonoscopy debate
Over the course of a year, I have an alternating pattern of caffeinated coffee ingestion. As readers should know, I will not swallow Starbucks coffee as I do not think that I have sufficient stomach acid and other bodily defenses to successful prevail against this corrosive elixir. Of course, everything has a benefit if one is resourceful enough to discover it. For instance, I have found their coffee to be …
Anyone can fall prey to addiction and substance abuse
As with most things in life, romantic relationships are, for many of us, a double-edged sword: while most find it wonderful to love and be loved, developing intimate emotional ties to someone makes us emotionally vulnerable—vulnerable not only to being hurt by our partner’s opinions of and feelings toward us, but also vulnerable to being affected by our partner’s bad moods. If a colleague or a friend gets depressed, we’re …
What to do if your partner is in a bad mood
I recently celebrated my birthday with a 9-hour picnic and for the first time in my life I was aware that some of my friends were starting to wear large hats and sunscreen. In fact, one of my friends was asking me about tinting her windows to block out excess sun.
Finally we are all now realizing what our mothers have been telling us since day 1 and what was popularized …
This is why you should wear sunscreen
Rural America has a higher proportion of people who are at risk for mental health disorders and state offices of rural health have identified suicide, depression, anxiety disorders and lack of access to mental healthcare, as major rural health issues. A particularly sobering statistic is that suicide is the second leading cause of death in states with primarily rural populations. There is a shortage of mental health professionals practicing in rural areas …
How to enhance access to mental healthcare in rural America
Recently, the makers of the Oncotype DX prostate cancer test presented results of a large study demonstrating that their test can help men decide whether their prostate cancer carries a low enough risk of progression to forgo surgical or radiation therapy, two treatments that typically eradicate prostate cancers but also cause most men to experience impotence and incontinence.
Lacking such a test, many men have felt compelled to …
Should insurers pay for the Oncotype DX prostate cancer test?
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