There is no better place to watch science in action than in the world of medicine. It was discovered in the 1930s that blood, in the presence of a certain streptococcus bacteria, did not clot. The agent formed by the bacteria was isolated and eventually called streptokinase, the first "clot-buster." Through the decades, pharmaceutical companies created other similar drugs, but the overall use was still fairly infrequent. The early heart ...

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“Please don't tell my family,” Mary (identifying information changed) immediately asked me after I disclosed the results of her lymph node biopsy and diagnosis of metastatic non-small cell lung cancer. At the time, I was a first-year oncology fellow. Initially, I thought it was a normal reaction (an example of my lack of experience). I respected her wishes and only disclosed to her family that she had metastatic cancer. I ...

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I pause for a moment and close my eyes -- to center myself in this country, where I am today.   I am about to walk through the door and tell the parents what my assessment has shown. I nod to the interpreter waiting behind me and knock firmly before entering the room.  You see, I am the bringer of news, the bringer of new, unwanted knowledge that validates their fears, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old woman is evaluated for recently worsening joint symptoms. She has a 13-year history of Crohn disease characterized by four to six stools daily and mild crampy abdominal pain. She also has a 1-year history of arthritis. She currently has pain in the left knee, right ankle, and ...

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A man in his fifties is wheeled into the emergency department on a gurney hoping he’ll still be around to cheer from the sidelines at his daughter’s next soccer game. A little girl on the pediatric floor upstairs simply hopes her tummy stops hurting. A woman in the clinic explains her puzzling symptoms and hopes that this is the specialist who will finally be able to ascertain why she hasn’t ...

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Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects movement, resulting most notably in tremor, slow movement, stiffness and balance issues. While Parkinson’s patients benefit from medicine that can alleviate some of these symptoms, there are no available treatments to slow, halt or reverse the progressive destruction of dopamine-producing brain cells and abnormal clumping of alpha synuclein, an otherwise normal brain protein. The disease affects roughly 10 million people ...

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Some children present to me with complex problems or multiple problems that fail to resolve after the typical interventions. I recall a child with severe abdominal pain. He had tried numerous medicines and had had scopes and studies galore. It had reached the point where he was being scheduled for exploratory surgery to try and see the cause of his pain. I lost track of his case when I rotated elsewhere ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 79-year-old man is evaluated for a 2-month history of progressively worsening headaches, nausea, visual disturbance, and difficulty speaking. He also has hypertension and gastroesophageal reflux disease. Medications are lisinopril and omeprazole. On physical examination, vital signs are normal. Right oculomotor nerve (cranial nerve III) and bilateral abducens nerve (cranial ...

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Parents often ask me about snacks for their children once they are eating table food. Should they even give them snacks? If so, what kinds are good for them, and how often? In general, after age one I recommend three kid-size meals and 1 to 2 snacks to help them get their daily nutritional requirements. Try not to stress or obsess at each feeding about them eating all that you ...

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As a sports medicine orthopaedic surgeon, I often see patients with complaints at their elbow. One of the more common diagnoses is tennis elbow, otherwise known as lateral epicondylitis. Surprisingly, most of my patients with this condition don’t even play tennis! Many types of repetitive arm movement can lead to tennis elbow. It all has to do with the tendons in our arms. Tendons are the structures that hold muscle to ...

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