Cardiovascular disease -- including coronary atherosclerosis and cerebrovascular disease -- remains the number one cause of mortality in the United States. One out of three people in this country will die of cardiovascular causes.  Although I can’t say that the other top causes of mortality are particularly attractive -- cancer, chronic lung disease, accidents and dementia -- premature cardiovascular death can certainly be very devastating and it makes sense to do ...

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Here’s an interesting clinical dilemma brought to my attention by another physician. She was asked to refill a prescription for a drug called domperidone to help a patient with lactation. Domperidone is not FDA approved in the United States for any indication. However, in Europe and in Canada it is approved as a promotility agent for patients with a condition called gastroparesis, which causes the stomach to empty very slowly and results in ...

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Recently a patient of mine brought in a bottle given to her by her acupuncturist. She had turned to acupuncture with my encouragement after traditional medicine fell short at addressing her chronic pain. Indeed, there is data to support the efficacy of acupuncture in the management of chronic pain. I was encouraged to hear that this treatment, often labeled as "alternative," seemed to be helping her substantially. However, my patient’s ...

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When should drivers retire from driving? When should drivers retire from driving? This question is always difficult to answer.  In our suburban car culture driving allows seniors to maintain their independence and prevents social isolation. However, at what point does it become unsafe for the elderly to drive and what are the risks? One month ago my fit and about 80-year-old in-laws were involved in a serious car accident. A young ...

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Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions.  A study published in the New England Journal of Medicine and discussed in the New York Times' Economix blog in 2012 looked at Medicare Part D expenditures and correlated them with drug prescribing patterns. The regions of the United States with the highest Medicare expenditures were those where ...

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For the past month I’ve been trying to formulate a blog that could capture my thoughts about mental illness and the prevention of violence. At this point my ideas are still not crystallized, but perhaps writing this will help. A few days before Christmas I received a phone call from a former patient’s mother.  She called while I was at the mall with my family doing some last minute shopping—I ...

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Over the past several decades medical costs in the United States have escalated rapidly, exceeding the pace of inflation and threatening bankrupt to Medicare.   As we heard in last week’s presidential debate, different solutions have been proposed on how to slow Medicare’s growth and reduce cost.  President Obama highlighted his administration’s success in tackling fraud and waste within the system. This strategy appears to be supported across party lines.  On ...

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How much should doctors reveal about themselves to patients? Whether or not “self-disclosure” is an effective communication strategy in the doctor-patient relationship has been debated.  In fact, some studies have demonstrated that doctors who talk about themselves more are rated more poorly by patients than those who are more private. This topic has been of interest to me and I have written about it in my blog:  Doctor, Patient, Friend:  Blurring the ...

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Recently a physician reporter for the New York Times, Elisabeth Rosenthal, argued in the cover article of the Sunday Review that routine physicals are in many ways pointless, and perhaps even dangerous. In the article, entitled “Let’s Not Get Physicals,” Dr. Rosenthal goes on to point out that many routine tests performed during physicals -- EKG’s, pap smears and blood work, are unnecessary. In my opinion, Dr. Rosenthal’s front page ...

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I was recently struck by two conversations that I had with acquaintances about recent experiences that they had had with their primary care physicians.  The first occurred at my local pool. A fellow swimmer asked me if I took new Medicare patients.  She bemoaned that she was abandoned -- her beloved physician of over 20 years had sent out a letter announcing that she would no longer accept Medicare patients. My ...

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