Dear alternative medicine, Hi, it's HD again. You may remember me from the last time we entered the squared circle, "Endocrinology vs. Naturopathy: Steel Cage Death Match." I had hoped that you might internalize a couple of the lessons I tried to teach you: "Know your assay" and "know your pre-test probability" — but, shocker, it didn't happen. You regrouped, and you've come back more formidable than ...

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How would you like to double your chances of winning the lottery? Just buy two tickets! Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment? Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk. For example, I just ...

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There are some sad truths about being an aging male. Your muscle mass usually declines. You start feeling tired more easily. And there’s a good chance either you start losing interest in sex or start experiencing a decline in sexual performance. Here’s another truth: Your testosterone level probably ain’t what it used to be. Which raises a question: Would testosterone supplementation restore some of your youthful vitality? That is certainly what manufactures ...

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As the calendar turns to early October, I’m reminded that this is the 6th anniversary of Steve Jobs’ death. At the time of his death, I was a medical student and my wife had just completed six months of chemotherapy. I was surprised to learn that Jobs had died from complications of cancer and shocked to discover that he had initially refused conventional cancer treatment in favor ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning. On physical examination, temperature ...

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asco-logo I see these couples quite often: the man has been prescribed androgen deprivation therapy and his partner is distressed. He no longer has erections, although for some that had been a problem for years. But even then, they tell me, he at least tried occasionally. Now there is nothing. No hugs, no kisses, no hand holding, no touch. The partners are ...

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When Hurricane Harvey swept through Texas, devastating millions of people, I was lucky to be in an area of Houston where the flooding did nothing more than confine me to my apartment for a few days. It hurt to see so many people suffering after reading the news and social media posts about people losing their homes, many of their belongings, and in some cases, their lives. As the flooding ...

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The writing's on the wall. The last few decades have seen two groups of people: One group that is “dying longer,” yes some might call it living long but not healthy. (As a physician, I call it dying longer). These are folks who are disabled, obese or emaciated and depressed or demented, with multiple medical issues spending a quarter of their life in the medical system, and the last decade of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, ...

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I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped ...

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