What’s my advice to my overweight patients? Eat less and exercise more. I give this advice every day, but following this advice is much harder than giving it. Overweight people frequently struggle with diet and exercise for years, sometimes successfully, sometimes regaining their previously lost weight.
And as we become more overweight as a nation, obesity is no longer just a problem for adults. Over 5 million adolescents are estimated to be obese in the US, which predicts bad things for th...
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Twelve Years Later, the Truth about Vaccines and Autism
Ideas have consequences. False ideas, especially popular false ideas, can cause harm. For example, the very popular false idea “corduroy pants and wide lapels are far out, man” made an entire nation ugly for about a decade. And some false ideas do even more harm than that.
In 1998 the British medical journal The Lancet published a paper authored by Dr. Andrew Wakefield that claimed to link autism to the vaccine against measles, mumps and rubella (MMR). The study looked at 12 children (that’...
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Normal Weight Obesity: Why Losing Weight Is Not Always the Answer
Weight loss is one of the most common recommendations that doctors make. How do we know if a patient should lose weight? We usually use the Body Mass Index (BMI) which is a way to compare a patient’s weight to her height. (For all you math geeks, it’s the weight in kilograms divided by the height in meters squared. For all you physicists, I know the units make no sense.) A BMI of 18.5 to 25 is considered normal. A BMI of 25 to 30 is considered overweight, and over 30 is considered obese. ...
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A New Treatment for Clostridium difficile
You may not yet have heard of the bacterium Clostridium difficile (C. dif.), but in the next few years it will likely become a household name, as well known as Staph and Strep. C. dif. causes a severe infection of the colon leading to severe diarrhea. It frequently results as a consequence of antibiotic use. Antibiotics can kill the normal intestinal bacteria and allow harmful bacteria like C. dif. to proliferate.
Decades ago, C. dif....
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To Clot or to Bleed?
Aspirin has long been known to prevent strokes and heart attacks in patients with a previous stroke or heart attack. But aspirin has potentially serious side-effects. Aspirin can cause stomach ulcers, and it inhibits blood clotting raising the risk of life-threatening bleeding.
If we knew in advance that a patient was going to be in a car accident or have a bleeding stomach ulcer, we would discontinue the aspirin a week before the event and minimize the bleeding risk. (This is exactly what w...
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Antidepressants for Mild Depression May Not Help Much
Treatments for depression are difficult to study. First, depression is a condition that can improve without treatment. So any treatment must be compared to placebo to see if the treatment is responsible for the improvement or if the depression improved on its own. Also, depression can not be measured objectively. There is no objective test like an X ray or a blood test that can diagnose depression. (At least not yet. As our understanding of brain function improves, such a test is certainly...
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End of Year Cheer
Short work weeks make for short posts, doubly so when virtually all the health-related news is about the healthcare bill in Congress. So I’ll end the year with two unrelated bits of good news.
The first is that the H1N1 flu pandemic is mostly behind us. The peak numbers of people getting sick both nationally and in California was about two months ago, with decreasing numbers ever since. As predicted by yours truly in April, the world did not end (though a bunch of my patients were plenty mis...
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Mollified about Mercury (or Calm about Catfish)
Mercury in high doses is known to be toxic. So if you were thinking about breaking your glass thermometer and drinking the contents on a lark, I beg you to reconsider. This has raised concern about possible harm from eating seafood since many species of seafood are known to contain trace amounts of mercury. Much hand-wringing has ensued. Should we shun salmon? Avoid albacore?
The most recent issue of The Medical Letter, a publication I frequently cite, summarizes the scientific literature ...
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Expired Medications (or Medicines From The Mesozoic)
Every primary care physician occasionally encounters questions similar to the following.
“I just found some of my blood pressure medicines. The container fell behind the couch a year ago. The expiration date was last month. Can I still use them?”
or
“I know you just prescribed amoxicillin for my sore throat, but I just found some amoxicillin in my cupboard that I bought during the Nixon administration. Can I take that?”
The bigger question is, what happens to medications after they expir...
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Lemierre Syndrome: Rethinking Pharyngitis in Young Adults
One of the first outpatient problems a primary care trainee learns to manage is sore throat. The current algorithm is fairly simple. Most sore throats are caused by viruses and will not improve with antibiotics. Symptomatic medication for pain and fever is the best we can offer. But a significant minority of sore throats is caused by a bacterium called group A β-hemolytic streptococcus. These cases are more commonly known as “strep throat”. In strep throat antibiotics shorten the duration ...
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