It’s Wednesday at 3:27 p.m.
I was just in the kitchen cutting potatoes for a belated birthday dinner which, ironically, will be happening very early this evening. I noticed a missed text on my phone and decided to call back, as was requested. It was from a member of “a network of licensed physicians” as they are looking for Massachusetts physicians credentialed to certify for medical cannabis. I am one of …
Like many scary health scenarios where patients seek some modicum of influence, the COVID-19 pandemic has led to patient demand for “immune-boosting” dietary supplements. Toilet paper wasn’t the only essential item being limited by stores; bottles of zinc and vitamin C flew off the shelves as consumers stocked up. The role of vitamin D in COVID-19 has been conflated and deflated depending on …
It was September 11, 2001. My dad had cheated on my mom again, the building that I worked in at that time had received an anonymous tip that we were a potential target for the terrorist attacks, and my mom, who needed a reprieve from my dad’s crap, was vacationing in Florida and was worried for me and my well-being. Plus, my dad was threatening to kill himself, and I …
Family lore recalls that my grandfather, succumbing to stomach cancer in the mid-1960s, “died addicted to morphine.” Decades before the AIDS crisis sparked the hospice and palliative care movements, the confluences of pain, dependence, and addiction were confused and regrettably moralized. Since then, the science has excelled, but our clinical understanding of how pain and addiction intertwine remains limited by stigma, assumptions, and the separation of the underlying science …
Do you know what it’s like to sit in a meeting and learn that something you hold close as a fundamental principle is probably not as fundamentally true as you thought?
That’s the way I felt earlier this week while attending a meeting on the quality of pharmaceuticals, sponsored by the Food and Drug Administration and Duke University’s Margolis Center for Health Policy.
The meeting—a Read more…
Just this week, the administration asked the U.S. Supreme Court to reverse a lower court ruling allowing women to receive telemedicine abortion services and pills delivered by mail during the COVID-19 pandemic. If Trump wins, millions of women across the U.S. risk losing this essential health care.
I met one such woman in my clinic a few months ago. She was a teenager, and she was tearfully anxious. She …
An excerpt from Medical Marijuana: A Clinical Handbook.
Imagine two patients sitting in the waiting area of a clinic. The first is a man in his sunset years who has recently begun treatment for stage 2 lung cancer. His treatment involves the use of chemotherapy, which has …
President Trump recently signed two executive orders directly related to prescription drug prices in the U.S.
One order would allow the “reimportation” of prescription drugs from Canada. This longstanding idea would allow U.S. pharmacies and drug wholesalers the ability to pay generally much lower prices for their prescription drugs by getting them from Canadian suppliers who benefit from government management of the system. Many consumers have been buying direct from Canadian …
Click through North Dakota’s Division of Medical Marijuana website, past the addresses of every cannabis dispensary in the state, into the presentations and annual reports, and you’ll eventually come to a 32-slide presentation about the state’s medical marijuana program. You’ll see the 26 diseases that can be treated with marijuana, a colorful flowchart showing the types of available marijuana, and a …
When I was in Sweden, I heard this phrase several times: “There is no such thing as bad weather, just bad preparation.” They said this when we asked them what they did with their children in dead of winter. The proud parents made it very clear that no matter what the weather, when it is time to go outside for recess at school, or to get out of the house …
Much controversy surrounds whether or not hydroxychloroquine is effective in preventing or treating infection with COVID-19. While much of the data so far suggests that hydroxychloroquine is not effective at treating COVID-19, and perhaps that it might even be harmful, multiple clinical trials focusing both on prevention and treatment are ongoing. The controversy around …
Gilead’s $1,000-a-pill antiviral remdesivir is no wonder drug. We knew this when it failed for hepatitis, the disease it was created for. And then when it failed for Ebola. And then again, when it failed for COVID-19.
But like a bolt, in late April, a breakthrough: in a second trial for COVID-19 patients, remdesivir sped time to recovery—proof of benefit, Read more…
On April 29th Anthony Fauci announced the National Institute of Allergy and Infectious Diseases, an institute he runs, had completed a study of the antiviral remdesivir for COVID-19. The drug reduced time to recovery from 15 to 11 days, he said, a breakthrough proving “a drug can block this virus.” Now people are clamoring for $1,000-a-pill remdesivir.
While the results were preliminary, unpublished, and unconfirmed by …
This time of COVID-19 has brought us to a scenario of scale and scope that most had never planned for. Whether you are at a small practice or a large one, you are likely looking for ways to rapidly evolve your business and patient care processes to survive this global pandemic.
Many physician practices are trying to do more with less in terms of how and where they are spending their …
My patient was a young man who wanted to be placed back on buprenorphine. He had started using again. He often missed appointments, did not pick up phone calls. So when I saw him in the room, I masked my surprise. “What makes you want to start today?” I asked. “I live with my grandma,” he said. He could not keep leaving the house for heroin.
Of the many …
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 …
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 …
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 …
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 …
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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