A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist.  I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus. I expected a benign explanation for her swallowing issue.   She was relatively young and not particularly ill.  She had seen my partner years in the past for a similar complaint, which he ...

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There’s nothing like discrimination -- true or imagined -- to keep our airwaves humming. Recently, Indiana and then Arkansas were media fodder for laws that were proposed to protect religious freedom. Yes, I know the other side of the argument, that these religious freedom protections were veiled attempts to discriminate against the LGBT community. Both states raced to revise their original laws, although the laws' backers deny any discriminatory intent ...

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shutterstock_154685816 I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city.  They are a world class medical institution whose reputation is largely derived from its cardiovascular department.   Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as ...

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"Safety first" is a mantra of today's hovering parents.  It's the default explanation that a parent invokes when an edict has been issued that cannot be challenged or reversed. "Mommy, can I please have a water pistol?" "I'm sorry, honey.  You know how Daddy and I feel about guns.  This is a safety issue.  Now go and practice your violin and afterwards help yourself to some kale chips." The safety concept has crept ...

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Many of my patients are taking herbal supplements, or so they think.  This herbal and health supplements industry likely is envied by traditional pharmaceutical companies.  The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA).  Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer ...

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How many times each week do we hear the phrase, "If you're not completely satisfied, we'll refund the purchase price -- no questions asked." This is more often a marketing ploy than a true money-back guarantee.  I have a sense that trying to obtain a promised refund on an item that dissatisfied us is about as easy and carefree as changing an airline ticket reservation or reaching a live human when ...

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I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace.  I realize this is ho hum to the under 35 crowd.  Soon, there won’t be any paper checks as the entire transaction will occur electronically.  As a member of the over 35 crowd (plus 20 years), I am wowed by this process.  I remember being astonished when my kids ...

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I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal ...

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Most of us reject the rational argument that better medical quality costs more money.   Conversely, I have argued that spending less money could improve medical outcomes.  Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy.  Not a day passes that I don’t confront excessive and unnecessary medical care -- some of it mine -- being foisted on patients. At one point in my career, I would ...

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shutterstock_155857724 We’ve all heard or used the phrase, "Leave it to the professionals." It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car ...

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