Low back pain is very common. The vast majority of people reading this sentence have had low back pain at some time in their lives. It is one of the most common reasons for physician visits in the U.S. and results in an estimated $100 billion in annual costs. Given the very high prevalence of low back pain, you would think that we would already have noninvasive treatments that are proven to be...

My longtime readers know that I love to inform you about ways that Mother Nature tries to hurt us. Since it’s winter, norovirus deserves our attention as it wreaks its seasonal havoc and occasionally closes down schools. Norovirus causes inflammation of the stomach and intestines. It’s commonly referred to as a “stomach virus” or “stomach flu”. (But it’s not related to the influenza virus. ...

Non-steroidal anti-inflammatory medicines (NSAIDs) have been around since the 1960s. They include ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren) and over a dozen others. NSAIDs are used to treat pain, decrease fever, and decrease inflammation. They are prescribed over 100 million times annually in the US. Naproxen and ibuprofen are also available over the...

In 1964 the Surgeon General issued a report on smoking, summarizing the scientific evidence demonstrating the health risks of tobacco use. Scientifically, nothing in that report was new. It was a review of what was already known. But it had a profound societal effect by publicizing a health risk that had been until then largely ignored. Education, health policy, and the advice of many individu...

“To die: to sleep; No more; and by a sleep to say we end The heart-ache and the thousand natural shocks That flesh is heir to, 'tis a consummation Devoutly to be wish'd.” -- Hamlet, Shakespeare

The California End of Life Options Act became effective in June. Before we can understand what the new law permits and how it might change the care of dying patient...

Every year I write a post in the late summer letting you know that flu season is approaching and to get a flu shot. I try to keep my posts informative and evidence-based, but I don’t have anything new to tell you about that. Actually, I do have one bit of news. Some of you may have heard of FluMist, the flu vaccine given by nasal spray. It’s especially popular with children and with patient...

Which animal has killed more people than any other? Sharks? Sharks are terrifying, right? Nah. They’re not even in the top ten people-killers. They kill about 10 people per year worldwide. Lions? They do a little better with about 100 deaths per year. Snakes are in third place, killing about 50,000 annually.

The aortic valve is the valve that allows blood out of the heart into the aorta, but not back. As people get older it’s not uncommon for the aortic valve to accumulate calcium deposits, stiffen, and not open as widely. This condition is called aortic stenosis. As the aortic valve narrows, it impairs the blood flow through it. Patients can develop heart failure, lightheadedness, chest pain, and...

Lyme disease is a bacterial illness transmitted by tick bites. It is treated with antibiotics, and most guidelines suggest a two to four week course of treatment. Most patients’ symptoms resolve at that point, but 10 to 20% of patients continue to have fatigue, joint and muscle pain, sleep problems, and difficulty concentrating. These patients can be quite debilitated and no specific effective...

“The waiting is the hardest part.” -- Tom Petty

Over 100 million doctor visits in the US each year result in a prescription for antibiotics. Over a third of those visits are for respiratory infections. A large fraction of the antibiotics prescribed yield absolutely no benefit to the patient. The issue is much more severe than just unnecessary spending on ineff...