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Albert Fuchs, MD

Articles, page 2

Drugs and prescribing

Does restricting Vicodin make sense?

16

To understand the Vicodin story we first have to understand how habit-forming medicines are currently prescribed in the U.S. The Drug Enforcement Agency divides potentially addictive substances into different schedules. Schedule II controlled substances are prescription medicines that have a…

To understand the Vicodin story we first have to understand how habit-forming medicines are currently prescribed in the U.S. The Drug Enforcement Agency divides potentially addictive substances into different schedules. Schedule II controlled substances are prescription medicines that have a high potential for abuse and severe dependence. They include all the opiate (narcotic) pain medicines, like morphine, oxycodone, and fentanyl. These medications must be prescribed on a paper …

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Does restricting Vicodin make sense?

Conditions and diseases

The gaps in our current care of critically ill patients

5

A sudden life-threatening illness is every family’s nightmare. A loved-one suddenly develops an overwhelming infection or is in a terrible accident. She is rushed to the intensive care unit (ICU) and is put on a ventilator (breathing machine). Many medications…

A sudden life-threatening illness is every family’s nightmare. A loved-one suddenly develops an overwhelming infection or is in a terrible accident. She is rushed to the intensive care unit (ICU) and is put on a ventilator (breathing machine). Many medications are started or she is rushed to surgery for her traumatic injuries.

To the family, the first day or two is a blur of life-saving treatments, painfully waiting for the next …

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The gaps in our current care of critically ill patients

Conditions and diseases

Estrogen in men: Masculinity isn’t a molecule

2

Testosterone is one of the most over-prescribed and poorly understood medications. It is prescribed to millions of men for myriad indications, many of them unproven. Athletes believe it will improve their muscle mass and strength. Older men look to it…

Testosterone is one of the most over-prescribed and poorly understood medications. It is prescribed to millions of men for myriad indications, many of them unproven. Athletes believe it will improve their muscle mass and strength. Older men look to it as an anti-aging remedy. Men with flagging libido hope it will restore their sex drive. Testosterone has developed a mythology of masculinity. This is very similar to the notions we …

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Estrogen in men: Masculinity isn’t a molecule

Conditions and diseases

George W. Bush’s angioplasty: Did he receive the best care?

40

Former president George W. Bush underwent an angioplasty recently, and the details sparked a public debate about the controversies of heart disease treatments. His spokesman stated that he underwent a routine physical exam and had no symptoms of heart disease.…

Former president George W. Bush underwent an angioplasty recently, and the details sparked a public debate about the controversies of heart disease treatments.

His spokesman stated that he underwent a routine physical exam and had no symptoms of heart disease. A stress test showed EKG changes and a CT angiogram found a blocked artery. He was transferred to another hospital and underwent an …

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George W. Bush’s angioplasty: Did he receive the best care?

Conditions and diseases

A low salt diet for high blood pressure: Where’s the evidence?

13

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?…

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 …

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A low salt diet for high blood pressure: Where’s the evidence?

Conditions and diseases

Suicide in baby boomers: Convince them that hope is not lost

Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that…

Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that he can’t imagine how things could ever get better, that he would be better off dead.

Unfortunately, suicide in the United States is increasingly common. An article in …

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Suicide in baby boomers: Convince them that hope is not lost

Physician voices

Ordering tests just to reassure patients doesn’t work

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Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren't even slightly suggestive of the disease the patient is…

Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren’t even slightly suggestive of the disease the patient is worried about, but the patient’s neighbor’s brother-in-law was just diagnosed with the same disease, and so the patient is pretty sure that …

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Ordering tests just to reassure patients doesn’t work

Drugs and prescribing

The real reason to be cautious about Z-Paks and azithromycin

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide. What’s the hubbub about? Azithromycin is…

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

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The real reason to be cautious about Z-Paks and azithromycin

Physician voices

Common criticisms of concierge medicine that deserve to be answered

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The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s…

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

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Common criticisms of concierge medicine that deserve to be answered

Physician voices

Do patients bond best with doctors who misinform them with optimism?

10

Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer…

Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer who survived and is no longer ill.

Chemotherapy is still occasionally used in such cases and sometimes can prolong life by a few months. Chemotherapy might also help temporarily alleviate some …

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Do patients bond best with doctors who misinform them with optimism?

Physician voices

Some patients need absolution, not medicine

11

My heart is blighted like grass, and withered, for I forget to eat my bread. –A patient’s prayer, Psalm 102 I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone’s life. More…

My heart is blighted like grass, and withered, for I forget to eat my bread.
–A patient’s prayer, Psalm 102

I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone’s life. More often, I just reassure them that they’re going to be ok. Or I give them advice about what they need to do to live healthier. But what I do has limits, and …

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Some patients need absolution, not medicine

Health policy

How will doctors handle the flood of newly insured patients?

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If you think health care is expensive now, wait until you see what it costs when it’s free. -P.J. O’Rourke I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free.…

If you think health care is expensive now, wait until you see what it costs when it’s free.
-P.J. O’Rourke

I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for …

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How will doctors handle the flood of newly insured patients?

Conditions and diseases

Overweight people have a weight thermostat that is turned up too high

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I’ve written many times that losing weight is the second hardest thing I ask my patients to do. (Breaking an addiction like smoking or alcoholism is the hardest.) The frustrating thing is how little we know about how to lose…

I’ve written many times that losing weight is the second hardest thing I ask my patients to do. (Breaking an addiction like smoking or alcoholism is the hardest.) The frustrating thing is how little we know about how to lose weight successfully. But we are learning more all the time about why losing weight is so difficult.

Much about dieting and weight loss is poorly understood, but let’s first lay out …

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Overweight people have a weight thermostat that is turned up too high

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