In 2002 pro baseball manager Billy Beane accomplished the impossible. He took the Oakland Athletics, a low-budget team comprised of unknown baseball players to the playoffs. The story’s magic is that he was able to compete with the Goliaths of the baseball world – the New York Yankees - with only a fraction of the budget. The idea is simple - draft players who are statistically successful in their respective ...

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The Joint Commission of Hospital Accreditation requires hospitals to ask the patient for their level of pain, just subjectively. They require we use a 10-point scale, from 0 for no pain to 10 being the worst pain ever. I knew instinctively that this was a bad thing and would lead to more narcotic addiction, as it did eventually. But in our patients, the pain scores went down as we detoxified patients ...

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Sometimes, old ideas and time-tested treatments remain the best. Newer doesn’t always mean better. Except in the case of one of our oldest antihistamines, tried-and-true Benadryl. It is time for that old drug to be retired, sent off to pasture, and never used again. Goodbye, Benadryl. Fare thee well, adieu, and don’t let the door hit you on the way out. Benadryl (diphenhydramine) was introduced in 1946. The top single that ...

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Imagine a looming global crisis that threatens the health of countless people, confounding scientists and governments with its sheer magnitude and complexity and growing at a pace that will quickly exceed our ability to reverse course. Sounds a little like climate change, right? The existential threat I'm referring to in this case is microscopic: antibiotic-resistant bacteria and fungi. In a way, antibiotic resistance is the climate change of medicine. It has potentially lethal ...

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At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their ...

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"Boxed warnings" or "black boxes" are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks. The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes "confuse" and "unnecessarily alarm" patients). So it was no surprise that when the
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Antibiotics are ubiquitous in today’s society. Prescriptions for these bacterial killers have become so prevalent that a wonder drug cure phenomenon for any illness has become the cultural norm. The evidence is overwhelming that antibiotics are far too overprescribed for viral illnesses. They are 100 percent ineffective against viruses. And the number of inappropriate antibiotics prescribed has been increasing for decades, as high as 30 percent in one study. For years, ...

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Although I have never been a big fan of modeling studies, viewing their appropriate role as hypothesis-generating rather than clinical decision-supporting, a study published in the Annals of Internal Medicine deserves kudos for trying to do what neither the American College of Cardiology/American Heart Association nor the U.S. Preventive Services Task Force did in their respective guidelines on primary prevention of cardiovascular disease for adults ...

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In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% ...

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It is a fluke of the news cycle that if we don't hear a product warning frequently, we can "forgive" that product and think it has somehow become safe. While no one would "forgive" cigarettes, lead in drinking water or mercury in tuna, the public has definitely softened on the danger of hormone replacement therapy (HRT) for menopause. So it is noteworthy that a recently released ...

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