BITTERSWEET MEDICINE

Cetaphil Skin Cleanser For Head Lice

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I was delighted to find this benign treatment for head lice on a blog titled Well at The New York Times.  This is legit and published in the journal Pediatrics.  The protocol explained in the article gives a cure rate over 3 weeks of 95%, exceeding that of more toxic treatments like Malathion.  I look forward to giving it a try in the right situation.

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March 24th, 2010 at 9:51 am

Overrated Medications Series: No.1 Weight Loss Medications

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This is the first in my series on overrated medications.  I am not trying for a definitive ranking of these medications, but rather I am simply trying to show my readers some of the most hyped and overrated drugs on the market.  It will help people make better decisions, avoid waste and improve their health. Read the rest of this entry »

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March 21st, 2010 at 9:49 am

Posted in Family Medicine

ACCORD BP Study Shows Best Guesses by Experts Wrong

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The Action to Control Cardiovascular Risk in Diabetics (ACCORD) study shows that intensive blood pressure control with a target of 120 mmHg is of no benefit in reducing fatal and nonfatal cardiovascular events.  Results were released at the American College of Cardiology’s Scientific Sessions in Atlanta Georgia and published online in the New England Journal of Medicine.  These results conflict with the advice given to physicians in the JNC 7 guidelines recommending a systolic BP below 130 in type 2 diabetics. Read the rest of this entry »

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March 15th, 2010 at 9:47 am

Posted in Blood Pressure

Coumadin and Tooth Extractions

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On several occasions dentists have asked that I stop patient’s Coumadin prior to dental extractions.  I have always complied with this request.  However, a cardiologist told one of my patients this was not necessary.  I decided to investigate this and found it true.   Read the rest of this entry »

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March 11th, 2010 at 9:42 am

Posted in Coumadin

Mammogram Screening: Why Physicians Should Review USPSTF Guidelines with Patients

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mammo_breast_cancer1.jpg-w=300&h=219For years now, I have routinely referred my female patients of age 40 years and older for mammograms.  I have actually known for some time that evidence of benefit was weak.  But, like most physicians, ordering the mammograms was habit and my patients expected it.  When the US Preventative Services Task Force (USPSTF) released their recommendations against routine screening for women under 50 years of age in November 2009 I decided to look into the evidence a bit. The Cochrane Reviews cover it well and here is an excerpt: Read the rest of this entry »

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March 8th, 2010 at 9:32 am

What We Really Know About Crestor: The JUPITER and some Other Trials

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C Reactive Protein

C Reactive Protein

I yawn every time I hear a Big Pharma rep tell me what a breakthrough their drug is.  It’s like news about vitamins and just as often its too good to be true.  New drugs are almost  always “me too” drugs: cost a lot, do little more than their predecessors.  Approved August 12, 2003, Crestor is the latest of the class of drugs known as statins.  These drugs lower cholesterol by decreasing synthesis of cholesterol by the liver.  So, let us take a look at Crestor, the latest, supposedly greatest, cholesterol drug. Read the rest of this entry »

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March 5th, 2010 at 10:22 am

Posted in Crestor

Medicare Physician Reimbursement Declines 21% March 1, 2010

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President Lyndon Johnson signed The Social Security Act of 1965 into law on July 30, 1965.  President Harry S. Truman was the first beneficiary.  Detractors of the plan warned it would become prohibitively expensive and accused President Johnson of hiding the true costs.  Just as it does today, the government in 1965 underestimated the costs of their programs.  How much?  Well, in 1965 the government projected Medicare spending on hospital care would be $9 billion in 1990.  They were off by a factor of 7 and actual costs in 1990 were $66 billion.   Medicare is in deep financial doo-doo.  The medicare program has somewhere between $50 and $100 trillion in unfunded liability.   Let’s put this in perspective; the entire federal budget for 2010 is $3.55 trillion.   Or let’s put it another way.  If you made $50,000 a year, but were in debt $1.4 million, you would be in a similar situation as the government.   And don’t forget, that’s just Medicare.  Social Security is another pile of unfunded liability. Read the rest of this entry »

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March 2nd, 2010 at 10:20 am

Posted in Family Medicine

Pay For Performance, Clinical Guidelines and the Death of Family Medicine

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When I was a resident in family medicine evidence based medicine was just getting started.  Expert panels were publishing guidelines for treating various medical conditions.  Some physicians found the idea insulting.  “Cookbook” medicine they called it.  But it was hard to argue with the idea.  Most physicians, especially generalists like myself, simply cannot cover enough ground reading medical journals to stay current.  Guidelines were the answer.  They summarized the best evidence and provided algorithms (decision trees) for treating patients.  Of course, if circumstances dictated otherwise, the guideline could be modified or ignored. Read the rest of this entry »

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February 24th, 2010 at 10:18 am