One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes. Each time she visited the office, I would recommend that we start multiple medications to control these conditions, and every time she would politely decline. Her previous physicians had left frustrated notes in her chart littered with terms such as "non-compliant," "against medical advice" and expressing wonderment why ...

Read more...

by Todd Neale Levels of tobacco-related nitrosamines -- known carcinogens produced when curing tobacco -- are higher in popular brands of American cigarettes compared with those from other countries, potentially leading to more cases of lung cancer, researchers found. The study of 126 smokers in four countries found that exposure to one carcinogen -- 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) -- was highest among those from the U.S. compared with smokers from England, Canada, and Australia, ...

Read more...

by Charles Bankhead Heroin addicts had almost a threefold increase in negative urine specimens when treated with supervised heroin injection rather than with oral methadone, data from a British study showed. Overall, 72% of patients had negative specimens at least 50% of the time compared with 27% of patients assigned to oral methadone, according to the report published in the May 29 issue of The Lancet. Treatment with injectable heroin almost doubled the ...

Read more...

by Charles Bankhead Hot-flash frequency and severity declined by 50% in postmenopausal women treated for six weeks with the antidepressant citalopram, according to data from a placebo-controlled, randomized clinical trial. The trial, conducted among 254 women with frequent hot flashes (at least 14 hot flashes a week for a month or longer), found that the lowest of three citalopram doses was as effective as the highest for dousing hot flashes, but the ...

Read more...

Why do dentists prescribe antibiotic prophylaxis so often? Because they can. Why am I dissing my dental colleagues? Because I can. Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals: • Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold • ...

Read more...

The FDA released a Drug Safety Communication warning about a possible risk of increased fractures with acid blocking medications called proton pump inhibitors or PPIs. PPIs have been a major advance in medical science. Prior to these and earlier medications, the treatment for severe gastroesophageal reflux disease (GERD) was major surgery. PPIs are now commonly prescribed for GERD and less serious heart burn, many are generic, and some are now sold ...

Read more...

by John Gever Worries that cramming multiple vaccinations into the first months of life slows brain development have no basis in fact, researchers said. There was no evidence of neurodevelopmental delays or deficits associated with on-time vaccination in an intensively studied cohort of more than 1,000 children, according to Michael J. Smith, MD, and Charles R. Woods, MD, of the University of Louisville, in the June issue of Pediatrics. "These data may reassure ...

Read more...

Patients requiring controlled substances to manage their pain have always been controversial to treat. Every time the subject is broached on this blog, the comments inevitably becomes a contentious discussion of "drug seeking behavior" versus treating legitimate pain. It's a problem that doctors nationwide grapple with every day, and is addressed in a recent essay from the New York Times. Michael Kahn is a Boston psychiatrist, who recently asked residents how they ...

Read more...

Good health is only affordable—for the majority of the population—if it is covered by insurance. An excellent case in point is the vaccine for shingles (herpes zoster). Shingles is the revisiting of the chicken pox virus. The virus lives in the body since the first episode of shingles as a child, and then flares up during later adulthood to give shingles. Shingles is rarely life-threatening, but it is immensely painful and debilitating, ...

Read more...

I’ve recently posted about the insane costs of health care, and about how defensive medicine is a big contributor. Prescription drugs are another huge cost, accounting for about 11% of the 2 trillion spent each year on health care in The United States. And it turns out that the marketplace for prescriptions is also rife with bizarre sources of waste and sneakery. First, some good news: prescription medications are ...

Read more...