Recently, the U.S. House of Representatives passed the 21st Century Cures, known simply as the Cures Act. This is thought to be the largest and most powerful health care-related law since the passage of the Affordable Care Act during Obama’s first term. The Cures Act provides for a large increase in funds for boosting biomedical research and also takes aim at speeding up drug and medical device approvals through the ...

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The blood thinner heparin is not a 21st-century cure. It was discovered 100 years ago by a scientist looking for something else entirely, and is one of the oldest drugs still in regular use. After my daughter was diagnosed with a potentially fatal blood disorder, heparin played a key daily role in her treatment. We’d wash our hands meticulously, lay out gloves and antiseptic wipes, saline flushes for the access lines ...

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Current reports from the International Narcotics Control Board (INCB) suggest that the United States is second on the list of countries with the highest per capita consumption of opiates.  Data from 2014 quotes U.S. use of opiates at 700 mg per capita per year. The only country that has a higher per capita use is Canada at 967 mg per capita both in ME (morphine equivalents). This suggests that in ...

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I spent one year working full-time as a pharmacy technician at a high-volume community pharmacy prior to entering medical school. Besides learning the intricacies of billing and the dispensing process, I was granted personal access into a world nearly all patients, but few providers are aware of.  At the time my job was just that: a job. There were fun perks like counting pills in multiples of five and visualizing ...

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A couple of years ago, I inherited a patient who was on both a patch for the powerful painkiller fentanyl and a high dose of oxycodone four times daily — and she didn't have cancer. I had 15 minutes with that patient to get her medical history, review her medications, assess her current complaints, and decide whether or not to continue her opioid prescriptions. I had no paper records and a ...

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When you hear people say, “I don’t want to vaccinate my kid. Why would I give them autism?” It’s hard not to get upset and meet your patients with some judgment. John and Carly were middle-class Americans that had a lot of misconceptions about vaccines — mostly from the media. They loved their two-year-old daughter Leslie and wanted the best for her. They didn’t understand that we wanted the same thing. ...

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If you’re going to indulge in anticipatory medicine, it is best to anticipate those at highest risk. An elegant study by Wald et al in the NEJM shows how precision primary prevention can be done. The researchers screened toddlers, who presented routinely to their general practitioners for vaccinations, for an uncommon, but not rare, familial predisposition to high cholesterol known as heterozygous familial hypercholesterolemia (FH), in which premature ...

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The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle.  If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately.  This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically.  Was it something ...

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On November 8, voters in California, Maine, Massachusetts and Nevada approved ballot measures to legalize recreational cannabis. It is now legal in a total of eight states. And this creates potential problems for road safety. How do we determine who’s impaired and who’s not? The effects of alcohol vary based on a person’s size and weight, metabolism rate, related food intake and the type and amount of beverage consumed. Even so, ...

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I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — ...

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