The surprising way patients get drugs Tom is diabetic, asthmatic, and broke. He’s back for a checkup. “I take my metformin every morning with my grits,” he says, “but I don’t need no refill. I just got me some metformin XR.” “How did you get extended release? They’re super expensive.” “Well, my neighbor runs a tattoo shop. We live behind her store. Her doc switched her up to insulin, so ...

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When I was in medical school, our nutrition researchers taught us that vitamins didn't do much good and only made expensive urine (where the water soluble ones end up).  We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc.  But the evidence that healthy people should take vitamins was marginal at best. Is our search for immortality the reason that we turn to the pill or potion?  Do ...

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The CDC’s report on the overuse of antibiotics raises concerns that the infectious disease community has been aware of for decades. Unfortunately, systemic action to address these concerns is hindered by misperceptions about antibiotic therapy: that it is safe, inexpensive, easy to prescribe, and that early administration is the best approach. At first blush, antibiotic therapy appears to be safe. But there can be dangerous complications to its use. Clostridium difficile, an ...

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The discovery of antibiotics is one of the most significant medical achievements of the 20th century. In the 1920s Alexander Fleming pioneered the discovery and use of penicillin, winning the Nobel Prize in Physiology and Medicine for his work. Other pioneers built upon his success and scientific research to pave the way for even more antibiotic development. The ability to fight infections has ultimately resulted in longer life spans and ...

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It was like watching the news footage of shoppers trampling each other to get through the doors of a Filene's Basement sale or witnessing people standing outside all night for the new iPhone even though it isn't a sale and it will be made in mass production for months or years to come.  I am talking about seeing people line up in the dark of pre-dawn to get their fingers ...

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The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid before arriving at the hospital because it reduces death from bleeding. "What's that?" I said. I kind of barely remembered hearing this medication's name associated with the treatment of a rare disease, but not treatment of trauma. So I was guessing ...

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What an amazing time to be a champion of new health care delivery models.  Three megatrends are driving change at a pace that I only wished for 20 years ago. Back then, I first had the insight that care could be improved, in some instances, if we separate doctor and patient in time and space. The first trend is provider reimbursement reform.For provider organizations going at risk with their payers, these are nerve-wracking ...

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The evening news is filled with fatal car crashes and shootings. But drug overdoses kill nearly 40,000 people a year, accounting for more deaths than vehicular accidents or homicides. Drug overdoses are on the rise in America, fueled largely by prescription meds. Reversing the course of this epidemic will require some dramatic changes. The facts Drug overdose rates climbed more than 100 percent between 1990 and 2012. But what most people don’t recognize ...

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Opioids are a family of pain medications chemically related to opium and heroin. They include morphine, fentanyl, codeine, hydromorphone and others. Opioids have unique properties that make them both indispensable for pain management and extremely dangerous. Unlike virtually any other family of medications, opioids have no maximum effective dose. If any dose, no matter how high, is ineffective at controlling pain, a higher dose can give more pain relief. Most other ...

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On February 18, 2014 the Food and Drug Administration indicated their consideration to allow pharmaceutical companies to shorten the list of possible side effects seen by millions everyday and night in pharmaceutical ads and commercials. In recent years, citizens -- patients and consumers -- have been bombarded with numerous and lengthy televised commercials in which pharmaceutical companies push their medicinal wares. It's called "direct-to-consumer" advertising (DTC). Such DTC efforts work for detergents, ...

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