Category Archives: Medicine

Random Thoughts on Addiction, the Stock Market, and Gerbils on a Wheel

Tweet Having changed the definition of sex, gender, marriage, pronouns, speech, health, victory, defeat, money, bullying, poverty, success, dress, fake news, children, and height, I thought a few ruminations on smoking, addiction, and whatever free association could bring to mind might fill a few paragraphs. On Friday July 28 the FDA announced a comprehensive regulatory…


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Don’t Look Back

Tweet The most poorly managed institution in modern western society is the hospital. I say this after half a century of steady exposure to hospitals of all sorts. I was a student, resident, fellow, staff member, section chief, department chair, chief of staff, and even a patient. Inertia at all levels was unconquerable. Newton’s first…


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The Charlie Gard Case

Tweet By now almost everyone has heard of the the Charlie Gard case. The issue at its core is much simpler than any of the accounts that I have read of the plight of this child and his family. Medically the case is straightforward. The child suffers from a rare metabolic defect that has destroyed…


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The Opioid Epidemic

Tweet There seems to be no end of mischief that the government can do when it plunges into the quicksand of American medicine. Let’s consider the opioid epidemic. It appears that deaths from opioid overdose have sharply increased in this country.  Let’s also grant that this surge in deaths is exactly the way it’s portrayed…


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More Uncertainty about Cholesterol and Cardiovascular Disease

Tweet Cholesterol and lipid metabolism used to simple. There was good (HDL) cholesterol and bad (LDL) cholesterol. Eat a diet low in cholesterol and fat and your blood vessels will be as open as a new straw. On the basis of very little solid scientific information a litany of assumptions was issued by both the…


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Statin Therapy in the Elderly and Quality vs Cost

Tweet The JAMA published a study online which examines the Effect of Statin Treatment vs Usual Care on Primary CV Prevention Among Older Adults. The full paper is below as a pdf file. I’ve written about the overuse of this type of cholesterol lowering drugs in the primary prevention of cardiovascular disease several  times. Primary…


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Gene Therapy for Sickle Cell Disease

Tweet Sickle Cell Disease is a disorder of hemoglobin production secondary to an alteration in the hemoglobin gene on chromosome 11.  Specifically, there is a single amino acid substitution in “adult” β A -globin (Glu6Val) stemming from a single base substitution (A→T) in the first exon of the human β A -globin gene. The abnormal…


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Salt Intake in Chronic Kidney Diease

Tweet How much salt people should eat continues to be a murky issue. A paper in the February 2017 issue of the American Journal of Kidney Diseases examines the issue of salt (actually sodium) intake on the prevention of cardiovascular disease in patients with chronic kidney diseases (CKD) stages 2-4. It is a commentary on…


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Thoughts on The Affordable Care Act

Tweet As everybody above ambient temperature knows, the US Congress is about to repeal and replace the Affordable Care Act. The repeal part is easy. What to replace it with is much harder. As someone who’s spent more than half a century taking care of patients and teaching others how to do the same, I’d…


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Celecoxib and Cardiovascular Disease

Tweet The New England Journal of Medicine has a paper in its current issue (Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis) that examines the safety of the COX-2 inhibitor celecoxib, best known under its brand name Celebrex, though now available in a generic formulation. This drug is the only COX-2 inhibitor available in…


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