Still No Evidence that Organic Food is Healthier

“It’s not what you don’t know that hurts you, it’s what you know that isn't so.” -- attributed variously to Mark Twain and to Will Rogers

Many popular ideas are popular not because they're right but because of a widespread failure of skepticism. For example, in the 1970s the idea that wide lapels really make you look great was widely adopted without rigorous testing. Organic food has grown to a $26 billion industry in the last couple of decades largely on publ...
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Preventing Falls in Older Patients

Falls are the most common cause of injury in adults 65 years or older. About one third of adults in that age group fall at least once per year, and 5% to 10% of those falls result in a broken bone, a laceration, or a head injury. Injuries sustained due to falls can cause a permanent decrease in mobility...
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CT Scans Not Very Helpful in Diagnosing Heart Attacks

Obstetrician 1: Get the EEG, the BP monitor, and the AVV. Obstetrician 2: And get the machine that goes 'ping!'. Obstetrician 1: And get the most expensive machine - in case the administrator comes. -- From Monty Python’s movie “The Meaning of Life”

Heart attacks remain the number one cause of death for men and women in the U.S. Heart attacks typically feel like squeezing or pressure in the center of the chest that lasts longer than a few minutes. More

Many with Prostate Cancer Do Not Benefit From Surgery

My regular readers know that prostate cancer has been a controversial topic recently. The controversy centers around our ignorance of whether treating early prostate cancer helps patients, and by extension, whether early diagnosis is helpful. In May I wrote about the US Preventive Services Task Force’s new recommendation against screening men for prostate cancer with PSA blood testing, finding that the benefits of such scree...
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Are You Afraid to Talk to Me?

A couple of generations ago medical culture was aloof and authoritarian. Doctors did not give advice to patients, they gave orders. Patients were expected to follow those orders. Questions might have been tolerated, but patient requests for explanations or suggestions for a different approach were considered very unusual. I thought this paternalistic model of doctoring ended long before I was trained. I was trained to think of the patient’s autonomy as the core of the patient-doctor relationshi...
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Without a Randomized Study Your Results May Vary

A family of osteoporosis medications called bisphosphonates (which include Fosamax, Actonel, and others) is known to cause irritation of the esophagus. These medications have been prescribed millions of times. There are a few reports of patients developing cancer of the esophagus while taking these medicines. Obviously, many more people who develop esophageal cancer have never taken bisphosphonates. So how can we tell if bisphosphonates increase the risk of esophageal cancer? A More

Weight-Loss Surgery More Effective for Diabetes than Medication

About 20 million Americans currently have type 2 diabetes, three times more than in 1980. Diabetes is a major risk factor for stroke and heart attack, is the leading cause of new cases of blindness, and is the largest cause of the need for dialysis. Diabetes is also usually progressive, meaning that on the same medications and on the same diet and exercise regimen, the blood sugar of a patient with diabetes will slowly increase, necessitating constantly increasing amounts of medications. So des...
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