I want to ration your health care. Well, I don't want to do it personally, and not to you specifically. And that's the problem. Policies on the individual and societal levels feel very different. We are not culturally prepared for "rational" rationing. We're happy to do it irrationally; if you don't have insurance, you're probably not going to get proton beam therapy for your prostate cancer. Someone might be willing ...

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Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws ...

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I have a 5% chance of having a heart attack in the next 10 years.  That’s not so high, but it’s higher than I want it.  Most of that risk is due to my cholesterol and my age.  I can’t do anything about the latter, but the former is under my complete control.  Cholesterol medications can improve my cholesterol significantly.  So can proper diet and exercise.  That’s not true of everyone; ...

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The HIV pandemic in the US has developed a stable appearance over the last few years, and that appearance is notably non-white and non-wealthy.  When the pandemic was discovered nearly thirty years ago, it was---in the US---primarily a disease of gay men.  In Africa, the disease is everyone's.  Women make up significantly more than half of HIV cases in Africa, and tens of thousands of children are infected during ...

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Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules. They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants.  Omega-3′s are currently very popular, but the evidence for their usefulness isn’t so clear.   A recent study failed to show any benefit in preventing dementia.   A new study out ...

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When I go to the doctor for my yearly physical (OK, not quite yearly, but…) he puts me through the ringer.  He asks me dozens of questions, follows up with more questions, and does a (thorough!) physical exam.  Then he takes some blood, and sometimes runs some other tests.  The big question is "why"?  What are ...

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In my opinion, people are often too embarrassed to see their doctor about sexually transmitted infections (STIs)—in my opinion. “In my opinion” is one of the most dangerous phrases in science.  But when in comes to attitudes toward STIs, the data are scarce. STI’s are very much a “behavior”-based disease, so knowing what attitudes prevail can help us design effective prevention strategies.  Attitudes toward HIV have been ...

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First, this piece is not a how-to guide for getting into medical school. But I use this ploy for good, and not for evil.  Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education.  A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and ...

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Vitamin D is a fascinating molecule with a fascinating story. Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health.  These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri.  Other vitamin deficiencies were found ...

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The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is. A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients.  This is both true and overly simplistic. First, we must review what “placebo” is. ...

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