I was working side-by-side with a Kenyan ENT doctor at his hospital in Eldoret, Kenya. My wife, Kathi, and I were part of a team of head and neck surgeons organized by Indiana University spending two weeks working with Kenyan ENT surgeons to help them build confidence to perform operations independently. In rapid sequence, we were seeing dozens of patients who had signed up to be examined and hoping to ...

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Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online. A patient came to see me last week for a check up and requested a prescription for birth control pills.  She’d used them in the past without problems. I wrote the script and sent her on her ...

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She asked me, “Is it okay to laugh?” My patient Linda, who was only 12 weeks pregnant, had just had a chorionic villus sampling, or CVS. During this procedure, a small piece of placenta (chorionic villi) is removed via a long, thin needle inserted into the woman’s uterus, and then the sample is sent to a laboratory for genetic analysis. My patient fell into the category of advanced maternal age, and ...

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Weight is not a behavior, and weight is not a choice. Nobody wakes up and decides what to weigh today. In an age when healthy and unhealthy behaviors are increasingly subject to incentives and disincentives, respectively, this is all too easily forgotten. Of course, weight is largely the byproduct of behaviors and choices, namely what and how much we eat, and what and how much we do: calories in and calories ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for a 3-week history of painful muscle spasms and twisting movements in the neck and trunk. She says that her neck feels as if it is being pulled backward. She also reports general restlessness and an inability to keep still. Her medical history is notable for asthma, ...

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Interpreting studies is a dicey thing. Often I find what might be statistically significant translated into headlines that might not really get at the nuance of the study or the results. Take these three for example:

  1. "Pine bark extract improves severe perimenopausal symptoms"
  2. "Two weeks of antibiotic therapy relieves IBS (irritable bowel syndrome)"
  3. "Study: 'Female viagra flibanserin' works"
The first line of the last article: "Need a boost to your sex life. The magic could be in ...

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For years internationalists have being trying to make the argument to ordinary Americans that foreign policy matters -- that we must contend with complex issues overseas like countering terrorism while also focusing resources and energies on economic issues at home. We have posed it as a trade-off. We are making the foreign affairs case the wrong way.  Rather than argue the positive merits of trade or the negative repercussions of unchecked ...

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Readers know that I am skeptical over the efficacy of complementary and alternative medicine. This is not merely a demonstration of my inborn skepticism, but doubt based on the fact the so much of their claims are untested, unproven and refuted. I don’t regard the above comment as controversial. It is factual. I’ll let readers decide if it is but another example of the arrogance of conventional physicians who worship on ...

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Clinical medical research -- finding out which treatments help and which ones don’t (or even make the situation worse) -- is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is ...

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recent blog comes to the conclusion that non-vaccinating parents believe their pediatrician “would have to be staggeringly incompetent, negligent or malicious to keep administering (vaccines).”  Using this as the premise, this pediatrician goes on to say that these patients should be dismissed from our practices. First off, these parents don’t think we’re the enemy.  The reason they bring their kids to see us ...

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