Madame Laurent came to my office one day last year with bloodshot eyes and a two-day headache. She’s well known in our clinic – kind to all the staff and always smiling even when she’s in pain. Despite a stroke a few years ago, she is mentally sharp, often able to read what I want to say before I can say it – an impressive feat considering that she only ...

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If you’re going to indulge in anticipatory medicine, it is best to anticipate those at highest risk. An elegant study by Wald et al in the NEJM shows how precision primary prevention can be done. The researchers screened toddlers, who presented routinely to their general practitioners for vaccinations, for an uncommon, but not rare, familial predisposition to high cholesterol known as heterozygous familial hypercholesterolemia (FH), in which premature ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a routine examination. He has no symptoms. Medical history is significant for a bicuspid aortic valve. He is not taking any medications. On physical examination, he is afebrile, blood pressure is 130/70 mm Hg, pulse rate is 56/min, and respiration rate is 15/min. Cardiac examination reveals ...

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Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions -- maybe ask a few questions -- and move on. For some of those patients, the medications are more than a one-off; they are intended to be taken indefinitely. One of the most common of these medications is a statin. Imagine you exercise four ...

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Kevin Thomas is a cardiac electrophysiologist at Duke University Hospital.  Watch his journey.  Courtesy of Black Men In White Coats and Diverse Medicine.

A friend asked me recently about statins. He takes a statin for primary prevention but is concerned that he has muscle pain and weakness as a side effect. So he posed the question: “How important is the statin?” The Washington Post had this recent article: "Who should take statins? A vicious debate over cholesterol drugs."

But while nearly all experts agree that statins are beneficial for people at a substantial ...

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“Beep,” went the machine. I left a message and hung up. My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year. I was leaving a message on his behalf. You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of lifestyle modification for his diabetes but has not yet started antihypertensive therapy. He is currently taking no medications. On physical examination, blood pressure is 148/92 mm Hg, and ...

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It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo -- a rebel, a free thinker, a rocker of the establishment -- the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin. On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate ...

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