Medicine

The Salinity Obsession

March 13, 2018

Many physicians and those charged with regulating the nation’s health have been obsessed with salt since Lot’s wife was transformed into a pillar of the stuff. On March 7, 2018 the JAMA published online a well performed study of sodium intake, the investigators used 24 hour urinary sodium excretion as a marker of intake, which documents […]

Prevention of Contrast-Associated Acute Kidney Injury

February 22, 2018

The infusion of iodinated contrast materials as an aid to a variety of imaging studies is associated with the development of acute renal failure (now typically called acute kidney injury). This nephropathy almost always occurs in predisposed patients. Risk factors include pre-existing kidney disease, advanced age (>75), diabetic nephropathy, and congestive heart failure. The common […]

Britain’s National Health Service Continues to Struggle

January 24, 2018

The UK’s NHS is experiencing another major problem. Patients ‘dying in hospital corridors’ is the headline of a BBC article describing “intolerable conditions” in the country’s government run hospitals. The system’s current problem is blamed on the flu and, of course, government underfunding. That the taxpayers’ funding of the NHS is at an all time […]

Robot Reaches Milestone, Passes Medical Licensing Exam

December 4, 2017

The following is from Becker’s Hospital Review – November 21, 201. It was bound to happen. Draw your own conclusions. An artificial intelligence-powered robot in China took the country’s medical licensing examinations and passed, becoming the first robot to do so, Futurism reports. The robot, Xiaoyi, not only passed the tests, but it did so with flying colors — […]

New Blood Pressure Guidelines – Think First

November 14, 2017

The press with an assist from the American College of Cardiology is trying to drive the American public crazier than it usually is. Here’s a quotation typical of those floating around the media: “Nearly half of Americans have high blood pressure under the new guidelines issued Monday by heart organizations and the medical community. The […]

The Gene – Book Review

November 12, 2017

That children share traits with their parents, grandparents, and siblings has been recognized since antiquity. How these traits were transmitted remained a mystery for more than two millennia. Unmasking this process has been the greatest scientific discovery since man discovered fire. Siddhartha Mukherjee has written a history of this entire process – The Gene: An […]

Medical Rationing in the UK

October 29, 2017

A sizable, but likely still a minority, of the population seems to think that the federal government should have sole responsibility for the funding and delivery of medical care in the US – ie, a single payer system. Many, if not, most people make up their minds about the provision of both medical care and […]

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

July 30, 2017

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 plan […]

Don’t Look Back

July 26, 2017

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 law […]

The Charlie Gard Case

July 7, 2017

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 all […]

The Opioid Epidemic

June 30, 2017

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 in […]

More Uncertainty about Cholesterol and Cardiovascular Disease

May 29, 2017

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 medical […]

Statin Therapy in the Elderly and Quality vs Cost

May 24, 2017

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 prevention […]

Gene Therapy for Sickle Cell Disease

March 4, 2017

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 nucleotide […]

Salt Intake in Chronic Kidney Diease

January 24, 2017

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 an […]