Category Archives: Medicine

Benzodiazepines, the Elderly, and Good Clinical Judgement

Tweet There has been a steady campaign to convince primary care physicians to stop prescribing long term benzodiazepine treatment to elderly patients. The intense declaratory nature of these admonitions suggests an almost emotional commitment to these recommendations.  The argument against their use includes a loss of effect after as brief a period as 4 weeks,…


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ACE Inhibitors and Lung Cancer

Tweet A recent paper in the British Medical Journal reported that treatment with angiotensin converting enzyme (ACE) inhibitors was associated with an increased incidence of lung cancer. As scores of millions of patients take these drugs for the treatment of hypertension and related disorders, the study naturally attracted a lot of attention from the lay…


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Addiction and Disease

Tweet Drug addiction has received extraordinary attention over recent years to the point where politicians have become interested in the problem. This is a sure sign that a real problem will be the subject of a lot of muddle headed thinking. For the past three decades or so addiction has been held to be a…


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Prophylactic Aspirin in Healthy Elderly Adults

Tweet Three studies, published online on Sept 16, 2018 by the New England Journal of Medicine, examine the effect  of prophylactic aspirin in healthy elderly patients. The subjects received 100 mg of aspirin daily or a placebo for five years. Trial participants were community-dwelling men and women from Australia and the United States who were 70 years…


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The Hard Bargain – Book Review

Tweet Richard Tucker (1913-75) was the greatest operatic tenor America has so far produced. He had three sons. David (b 1941) was the second child and the only one who aspired to take up his father’s profession. He ended up in medicine as an ophthalmologist. The Hard Bargain is his account of how he went…


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No Time For Patients – ICD 11 and the Banality of Evil

Tweet Talk to your doctor and ask about how much time is spent on the 21st century’s version of paperwork. Also ask about the sense of satisfaction he gets from spending more time in front of a computer than he does interacting with his patients. Having just been confronted with with ICD 10, which contained…


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The First Medical Harvey Award

Tweet The MHA is named for Harvey Kurtzman (no relation) the  founder and first editor of Mad magazine. This award is not to be confused with the Harvey Awards for achievements in comic books. It (the MHA) is given to the authors of any paper in the scientific literature (not including the Journal of Irreproducible…


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CMS – Proposed New Physician Fee Schedule

Tweet If you think health care is expensive now, wait until you see what it costs when it’s free PJ O’Rourke CMS (the federal agency that runs Medicare and Medicaid) is proposing a new physician fee schedule. The three page article that summarizes the proposed changes is hard for my ossified brain to decode, so…


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Type 1 Diabetes Mellitus and an Artificial Pancreas

Tweet Clinical endocrinology can be defined in one sentence. It is the study of diseases that are characterized by too much or too little of a hormone or by over or under responsiveness to a hormone. That’s it. The rest is detail. Type 1 diabetes is due to the lack of insulin secondary to autoimmune…


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Folic Acid and Psychosis

Tweet The Journal of the American Medical Association has a paper thus far only published online – Association of Prenatal Exposure to Population-Wide Folic Acid Fortification With Altered Cerebral Cortex Maturation in Youths – that is both interesting and a big stretch. Government mandated folic acid fortification of enriched grain products has been in force…


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