“I used to be strong, I wrestled the bull,” Sumner Ball said, “but now I can’t even wrestle the rooster.”
On the far side of eighty-years-old, he looked lively and trim, and his weathered face hinted at a smile as his blue eyes peered straight into mine.
“I think these cholesterol pills are hurting my muscles,” he declared. “I don’t think they’re good for me.”
“Is it your back?”
I scanned through his last …
When something natural does indeed work
Overheard in the gym:
“Yeah, but I heard that ____ can be dangerous.”
“Oh, they wouldn’t let us buy it if it was.”
Lately, the public’s faith in the safety of prescription and over-the-counter drugs has been making me uneasy. Advances in drug development mean that many of us truly can live better lives through their wise use. But are we adequately guided and protected by a) regulators, b) our clinicians, c) a …
Patients need to take an active role in their medications
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
When doctors don’t have access to medications that are necessary to successfully perform procedures, patient safety is at risk. Over the past several years, drug shortages have significantly impacted the health care industry, making it not only difficult for physicians to do their jobs, but for …
Drug shortages can jeopardize patient safety
No one can deny that medical students today face an increasingly competitive environment with a strong focus on board scores and class grades as strong requirements for entrance into competitive specialties. Mirroring the trends in both primary and secondary school, a standardized test has become the yardstick by which all physicians-in-training are compared.
The most recent survey reported by the National Resident Matching Program, showed that scores on Step 1 of …
Intellectual doping: Stimulant abuse in medical students
Recently, I treated a young patient with diabetes in the hospital. Throughout her young life she had struggled with glucose control, and on this day her struggle left her in a state of diabetic ketoacidosis (DKA). DKA is a life-threatening condition that diabetics often face when their body is unable to uptake enough glucose, leading to utilization of fat and consequential build up of acidic ketones, which cause blood levels …
Pizza or insulin: What does our society value more?
We guard the privacy of patients in my hospital zealously — we take care of a lot of celebrities since we’re right in the shadow of Beverly Hills. And of course we live in terror of HIPAA violations, those federally mandated HHS rules that protect individually identifiable health care information and could bring down “civil money penalties” upon us if we don’t keep our patients’ medical records strictly confidential.
But for …
Flu vaccination by government mandate: A violation of HIPAA
About a year ago, I was surprised to find out from my daughter that hookah pens were all the rage among the high school crowd.
If you are, like I was, among the uninitiated, this is a device of roughly cigarette proportions that contains a battery, a tiny vaporizer, something to vaporize, and a button to make it go.
Most commonly that “something” is propylene glycol and nicotine. Press a button and …
Are e-cigarettes creating new generation of smokers?
First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment. Risk is an interesting word, because risk is about populations; it loses the individual.
And it seems that statin treatment has taken on a bit of stigma — something we’re used to in psychiatry — now you can eat your cake and have low cholesterol, …
Another take on the statin issue: Can lifestyle changes kill?
I rather doubt you need me to bring the roiling statin debate to your attention, given its prominence in scientific circles and mass media alike. In essence, a new set of guidelines for the use of lipid-lowering drugs to prevent heart disease was issued with considerable fanfare and then set off a firestorm of controversy. The old approach relied heavily on levels of LDL cholesterol, while the new approach relies on …
The statin debate ignores the signal of lifestyle as medicine
We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs).
The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency. This is in addition …
Proton pump inhibitors and B12 deficiency: What to do now
Let’s say you were inventing a new flea powder, called Flea-B-Gone. To test it and manufacture it, you’d need a whole mess of fleas. As everyone knows, kangaroo fleas are hardy and docile, so you open up a kangaroo farm to grow your fleas. You treat the kangaroos well, and other than itchiness, they don’t have much to complain about as you scrape off their fleas to make your Flea-B-Gone. …
Anti-vaccine propagandists and the rogues’ gallery of misinformation
As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.
One patient even complained, “My new health care plan tripled in price, and now, it is …
Dear lawmakers: Why aren’t doctors involved in health care reform?
A version of column was published in USA Today on November 20, 2013.
I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin. When I saw him months later for follow-up, he admitted that he didn’t fill the prescription.
“I took red yeast rice capsules instead,” he said.
When I asked him why, he told me that he was wary of statins’ long list of side effects …
Herbal supplements may be natural, but that doesn’t mean they’re safe
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New guidelines from the American College of Cardiology and the American Heart Association on the assessment of cardiovascular risk and the manipulation of cholesterol levels to mitigate that risk have certainly been in the news. The guidelines appropriately use high quality evidence to abandon old untested or unproven paradigms such as treatment to LDL targets and manipulation of non-HDL cholesterol as a secondary goal. In many ways, the new guidelines …
Cholesterol management with patients requires shared decisions
I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease.
Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest.
Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was …
Speakers need to explicitly state financial relationships
There has been much discussion recently, by journalists and health professionals, on the new guidelines for the treatment of blood cholesterol put forward by the American Heart Association (AHA) and the American College of Cardiology (ACC). Critics have raised concerns the revised guidelines will increase the number of healthy people who take statin drugs by 70 percent, that treatment thresholds are too low and that some guideline writers have links …
The new cholesterol guidelines: Emphasize patient preference
Ever get confused over the names of medicines?
I do.
There’s Zantac and Xanax. Zanaflex and Zaleplon.
But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike.
Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical …
Standardize drug names and reduce the risk of medication errors
The American Heart Association, in collaboration with the American College of Cardiology, recently released recommendations that should change the way we prescribe medications called statins, including drugs like Lipitor and Crestor and their generics, atorvastatin and rosuvastatin.
The headlines say stuff like, “More Americans may be Eligible to Receive Cholesterol Lowering Drugs!”
I am a bit skeptical of news about statin therapy because Lipitor, before it went generic, was responsible for over …
Digging deeper into the new cholesterol guidelines
It was a huge relief to Carol Thompson in 2011 when her breast cancer drug Femara (letrozole) went off patent and became available in a generic version. With a high deductible in her private insurance plan, Thompson was forking over $450 for a month’s supply of the life-saving drug. After the generic hit the market she was thrilled to find letrozole available for just $11 a month at Costco. But …
Generic drugs play a central role in reining in health care spending
Well, this isn’t good news.
The CDC has compiled an extensive report of the top US health risks from infections. Called “Threat Report 2013,” their evaluation shows that the three most worrisome risks have all been created by our own indiscriminate overuse of antibiotics. The biggest baddies:
Carbapenem-resistant Enterobacteriaceae. The carbenapenem antibiotics were first developed in the 1970s and grew into wide use in the late 1980s. They had been the biggest, baddest …
Stopping the threat of drug resistant bacteria
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