Sam burst into the office, a two-year-old wild bundle of energy. Squealing with delight -- or was it distress; it was hard to tell -- he ran from toy to toy not looking at me or his mother, Jane. He was unable to engage with anything. Jane had brought him to see me in my pediatric practice because, “he hits me, has explosive tantrums, and I can’t take him anywhere.” ...

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shutterstock_111707921 America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you. To combat our opioidification the
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The first test tube baby was born July 25th, 1978 in the north of England.  Louise Brown was called the “baby of the century” by some and a “moral abomination” by others.  It wasn’t Brown who critics accused of being immoral, of course.  She was just a blameless infant.  Instead, it was her doctors who came under fire for their new fertility treatment—in vitro fertilization (or IVF).  Roman Catholic theologians ...

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I’ve always had nagging doubts about filling out death certificates. An excellent article in American Medical News explores the “inexactitude” of the custom. Doctors are never taught how to fill out the documents. The article quotes Randy Hanzlick, MD, chief medical examiner for Fulton County, GA:

Training is a big problem. There are very few medical schools that teach it,” he said. “For many physicians, the first time they see it ...

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Radiolab recently aired a show called “The Bitter End” that discusses the end-of-life care preferences of physicians and non-physicians. Physicians are much more likely to decline “heroic” measures, such as CPR, mechanical ventilation, feeding tubes, etc. This comes as a surprise to the hosts and, presumably, to other non-physicians. It’s a good show. I recommend it. (Full disclosure: I like Radiolab.) In the show, Ken Murray argues that physicians ...

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The failure of doctors to talk to their patients about end of life decisions perplexes me.  This gap in vital communication results in poor care, uncontrolled pain, futile treatment and death in hospital or nursing home, where no patient wants to be.  Certainly, for oncologists, every patient they see is concerned about dying and by not opening the topic it leaves each isolated. I have generally taught my students that this ...

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"Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying" argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post. "Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their ...

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downton abbey If you have not yet seen the fourth episode of the third season of Downton Abbey and wish to be surprised by it, read no further. And if you aren't watching PBS's addictive costume drama currently set in 1920--and, seriously, why aren't you?--read on anyway. This is about medicine, then vs. now. First, to recap the medically relevant aspects of the ...

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Let’s talk a little about health accountability.  Two news items have provoked the following rant: why is it always someone else’s responsibility? The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller.  Such a drug would be a gold-mine for that pharma company because it could ...

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shutterstock_93793456 Young children are naturally petulant, noisy, and self-centered. We’re all born with ourselves in the center of the universe, an impression reinforced by parents who must cater constantly to their young babies. But babies become toddlers, and toddlers become children. Sometime during this transition, parents have to teach their children that they are part of a family. For a family to function ...

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