To paraphrase General MacArthur, old doctors never retire, they just fade away. Despite having greater than average financial resources and more burdensome than average work load, many doctors seem to have a hard time knowing when it is time to call it quits. I know doctors who continue to practice into their 70s and 80s. Some continue to work until the day they die. Why is this? I think that some ...

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A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia. This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined ...

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Top stories in health and medicine, July 3, 2014From MedPage Today:

  1. Proposal To Add 'Copper' Plans to Marketplace Raises Concerns. If you offer it, will they come? Insurers and some U.S. senators have proposed offering cheaper, skimpier "copper" plans on the health insurance marketplaces to encourage uninsured stragglers to buy.
  2. Childhood Malnutrition May Raise HTN Risk. Young adults who survived ...

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Should doctors be paid overtime for taking call? Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call. Granted. However, these awful events are part of ...

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Top stories in health and medicine, June 30, 2014From MedPage Today:

  1. FDA Finally OKs Inhaled Insulin. After several denials, the FDA announced Friday that it had approved inhaled insulin (Afrezza) to be used for improving glycemic control in adult patients with diabetes.
  2. ADHD Meds Tied to Cardio Risk. Danish children taking stimulant drugs for attention deficit-hyperactivity disorder (ADHD) had roughly ...

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I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. A recent piece in JAMA and the editorial that 
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Top stories in health and medicine, June 27, 2014From MedPage Today:

  1. Shortage of Saline Has Hospitals on Edge. Hospitals across the country are struggling to deal with a shortage of one of their essential medical supplies. Manufacturers are rationing saline -- a product used all over the hospital to clean wounds, mix medications, and treat dehydration. Now drug companies say they won't ...

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It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look. The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered ...

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Top stories in health and medicine, June 26, 2014From MedPage Today:

  1. Drug Discounts Have Pharma Crying Foul. In 1992, the federal government told drug manufacturers they had to give steep discounts to hospitals that treat a large percentage of poor patients.
  2. Quitting Snus After MI May Lower Death Risk. Stopping the use of smokeless tobacco after a myocardial infarction (MI) ...

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This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient's arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is ...

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