Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The ...

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What if I told you that your adolescent child could contract a disease that can never be cured, but only maintained? That it would be a lifelong struggle that could change their personality, compromise their potential and values, destroy their relationships and have a long-term detrimental effect on their overall and mental health? That this disease can even be fatal, when ineffectively maintained? What if I told you that the ...

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My experience trying to obtain the drug prescribed by my rheumatologist is a cautionary tale. This is not about whether the doctor ordered it, or how the specialty pharmacy (CVS) must wait for approval from the insurer before filling the prescription, but the fact the patient who resides and waits at the end of the line, me, is treated not as a person in need, but an expense. In my ...

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One night, a woman I’ll call Tonya got a compliment from a guy when she was out with her boyfriend. Tonya’s boyfriend cursed her because another man had complimented her. He said: “You give it to everybody, I want it too.” In anticipation of his physical abuse, she reasoned, “I could go off to Wonder World.” She then injected heroin, to be “in her own world,” she later told me. Tonya ...

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In recent years, it feels like we’ve been inundated by stories of greedy pharmaceutical companies jacking up the price of important generic medications. In 2015, “Pharma Bro” Martin Shkreli, recognized that no other generic companies were manufacturing Daraprim, a drug used to treat infections common among people with AIDS, from $13.50 a pill to $750, confident that no generic competitor was around to cut into his market 
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her ...

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What is CBD? Cannabidiol or CBD for short is made from either the marijuana plant that contains tetrahydrocannabinol (THC) or hemp which contains little to any THC. “Hemp-derived” means that the CBD generally contains less than 0.3% THC while “marijuana-derived” contains higher amounts of THC. It is THC — and not CBD — is the primary psychoactive or intoxicating component of marijuana. CBD can also be manufactured synthetically. CBD is routinely sold ...

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On a daily basis, patients of mine come in for office visits complaining of wear and tear injuries, as well as aches and pains, and their methods of dealing with chronic pain. As we all know, aging is a part of the normal life process. For instance, as we approach 70 years old, we typically lose three-quarters of our functioning kidney cells (nephrons) but do well with our limited reserve as ...

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I recently read an article -- "California Doctors Alarmed As State Links Their Opioid Prescriptions to Deaths" -- that infuriates and frightens me I'm furious that doctors are being persecuted for opioid prescriptions written years ago, and frightened that my doctor here in California may be pressured to stop prescribing them for my painful genetic disorder (Ehlers-Danlos). Twenty-six states have already implemented arbitrary restrictions on our ...

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I haven’t counted how many times this happens every month, but I find it annoying. I send a prescription for a drug (sometimes not even expensive) to the pharmacy and soon after, I get a fax asking me (or my medical assistant) to go online and print a prior authorization form to complete and fax to the insurer, or answer numerous qualifying questions on the screen, or (worst of all) 
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