Most physicians are increasingly forced to grapple with the problem of shortages in generic drugs. These are drugs for which the patent has expired and any company can make them. Certainly for those of us in the PICU it is a chronic problem because the majority of drugs we use are injectable medications that have been generic for many years. Hardly a week goes by I don’t receive a notification …
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An innovative approach to fix the generic drug shortage
Vaccines have been hailed by virtually all medical experts, as well as medical historians, as the among the greatest triumphs of public health to occur in the past two centuries. Yet since Jenner first proposed vaccination for smallpox using the vaccinia, or cowpox, virus there have been both skeptics of its effectiveness and people who thought it was dangerous. That is, they had the risk/benefit ratio of vaccination exactly backwards, …
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Has the anti-vaccine movement affected vaccination rates?
A recent article and accompanying commentary in the journal Pediatrics describe what we currently know about children who have died from influenza over the past decade or more. The Centers for Disease Control (CDC) has collected information about this since the 2003-2004 influenza season. In that first report, there were 153 deaths. Since then there have been at least 100 influenza deaths annually among children. Several characteristics have not changed. …
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Influenza in children: reducing the death rate
We’ve known for some time the prevalence of obesity is growing among Americans — not just adults, but children, too. Obesity is associated with a long list of medical problems, including heart and other vascular diseases, diabetes, and joint problems. It is encouraging that recently the seemingly inexorable growth of pediatric obesity prevalence seems to have reached a plateau. But we still have a future problem looming for population health as …
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Childhood obesity is a grave threat to our nation’s health
I majored in history of religion in college and have always had an interest in the places various twists and turns of theology can lead people. One relatively recent wrinkle is what has been loosely termed “prosperity gospel” or “prosperity theology.” It’s built upon the basic notion good things happen to good people, and bad things happen to bad people. Of course, that’s a foundational viewpoint of much of Christianity in the …
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How religion helped this physician in the PICU
Most experienced pediatric intensivists, myself included, have encountered situations in which we, the doctors, believe continuing to support a child is unethical because it is not saving the life but prolonging the dying; whereas the child’s parents believe the opposite — that it is unethical to withdraw life support because all life is sacred, no matter the circumstances. Sometimes these situations arise because poor communication causes families to distrust the …
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Withdrawal of care in the PICU: What happens if there is disagreement?
Humans evolved with the constant force of the earth’s gravity. This is relevant to several of our organs, but the brain’s anatomy makes it especially important. The brain floats in spinal fluid encased inside the closed box of the skull. Gravity would be expected to affect the details of that. Indeed, studies of people who spent prolonged periods of time in bed in a head down position indicate this abnormal …
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What happens to our brains in space?
In theory, of course, it’s a great idea for people to give their opinions and rate their experiences with any goods or services they buy. The notion goes back long before the Internet with publications like Consumer Reports, which is now itself online. Sites such as Angie’s List are very popular and can give you testimonials about providers of everything from home renovations to car repair to daycare. So it’s not surprising several …
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Online physician reviews: A physician does a study on himself
It’s fall in the PICU, and we just saw our first severe case of respiratory syncytial virus (RSV) of the season. RSV is by far the most common cause of bronchiolitis in infants. To scientists, RSV is a fascinating virus with several unique properties. One of these is its behavior in the population. When it’s present, RSV is everywhere. Then it suddenly vanishes. There are exceptions to everything in medicine …
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Respiratory syncytial virus: Are we making any progress?
As the kids say, it’s complicated. Practicing physicians are seeing an ever increasing list of protocols and pathways coming their way. These arrive in several forms — order sets for medications, guidelines in how to proceed for various conditions, when to do this, when to do that, and when not to do either one. They generally are the product of various committees trying to synthesize what these days we call …
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A physician’s mixed feelings about clinical pathways
I occasionally dip my toe into the constant Internet flame wars over the generous term “vaccine skepticism,” and the less generous “vaccine denial.”
If you’re looking to see one of these quickly, Twitter always has some ongoing vaccine fireworks. The character limit of Twitter tends to compress the exchanges into hurled invectives, only occasionally punctuated by futile pleas for calm. Many quickly devolve into exchanges between posters of what they believe to …
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A physician wades into the swamp of vaccine denial
For many centuries medical practice was a black art. What physicians did was based upon theories of how the body worked that turned out to be fanciful at best, dangerous at worst. The late nineteenth century brought breakthroughs in the biological sciences, such as the identification of bacteria and new understandings of physiology, which increasingly placed medical practice on a scientific basis. That process has continued over the past 150 years, …
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The promise and pitfalls of evidence-based medicine
A fairly recent article in the Journal of Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students. It is sobering because it describes the potential harm that can come from it — harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything.
“Overdiagnosis” is the term the authors …
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Overdiagnosis harms kids. Here’s how to avoid it.
We do many things in medicine to patients that are either not helpful or have the potential to harm. If you take the long view of medical history, this should not be surprising. After all less than a century ago, physicians were still giving toxic mercury compounds to people in the form of calomel. And a century before that, physicians were bleeding people because they thought that was a good …
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Let’s stop therapies that hurt kids
Sometimes an interesting thing happens on patient rounds. Rounds are a traditional exercise in hospitals going back at least a century. In the old days, this meant the physician going from patient to patient. He (it was nearly always he back then) went over the patient’s progress with the bedside nurse, examined the patient, reviewed pertinent test results, made an assessment, decided on a plan for the day, and gave …
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A game of broken telephone in the hospital
Asthma is a complex, chronic lung problem that now affects nearly 10 percent of all children. Both the incidence of new cases and the prevalence of ongoing cases in the pediatric population have been rising steadily for years, although there are hints these increases may have leveled off.
A wealth of research suggests a huge part of asthma causation comes from the environment the child lives in, things like air quality and exposure to various …
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What can the Amish teach us about asthma in children?
