Live Long and Prosper

“I hope I die before I get old” -- The Who My Generation Composed in 1965 by Pete Townshend, currently 65 years old

The good news is that people are living longer all the time.  This trend has been happening as long as records have been kept and shows no sign of stopping.  Better hygiene and sanitation, safer living environments, and antibiotics have nearly eradicated death in childhood and early adulthood.  As progress continues battlin...

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California’s Whooping Cough Epidemic

Pertussis or whooping cough is a bacterial respiratory disease marked by a runny nose for a week or two followed by a severe persistent cough.  In adults it rarely causes severe illness, and usually resolves even without treatment, but in infants the disease can be life-threatening. California is currently experiencing a whooping cough epidemic.  Over 4,000 cases have been reported this year, the most since 1955.  Nine have died, all babies.  Three quarters of the patients that required hospita...
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Salmonella Sunny Side Up

This summer a Salmonella outbreak traced to contaminated eggs has sickened over 1,000 people and led to the recall of over 500 million eggs. Eggs are particularly susceptible to Salmonella contamination.  The outsides of egg shells can be contaminated by bacteria if they come into contact with chicken droppings or with dirt.  That’s why you should discard cracked or dirty eggs.  The shell itself is fairly resistant to bacteria, but if the chicken is infected with Salmonell...
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Admitting Our Mistakes

I’ve written before about how the error rate in the practice of medicine is far greater than that in other industries.  I’m not talking about when doctors make a difficult decision that in retrospect was wrong; I’m talking about just plain mistakes, such as when one medication is ordered but another is dispensed or when the dose dispensed is 10 times greater than what was what was intended because of an extra zero was written in the order.  We are finally looking to fields such as aviation to le...
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Time for Flu Shots

Summertime, and the livin’ is uneasy Stocks are slumpin’ Unemployment is high

(with apologies to George Gershwin)

Reminders of the end of summer are upon us.  Kids are returning to school.  Rain covers are thrown over backyard grills.  Flu vaccines are arriving in doctor offices.

This season’s influenza vaccine is here.  It contains the flu strains most likely to reach North America this fall includ...
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Rethinking Calcium Supplements

This week I discovered how painful it can be to change a habit.  Not because it means admitting I was doing the wrong thing, but because it means analyzing how feeble my reasons were for the habit in the first place. Ever since I started practice I’ve been recommending calcium supplements to post-menopausal women.  Why?  Mostly out of habit.  There’s not a shred of evidence that calcium supplements prevent fractures, but some suggestion that they may help bone density.  But what’s the harm?  Ca...
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Doctors to Deal with Distracted Drivers

Doctors are expected not just to diagnose and treat diseases but to prevent disease by counseling patients about behaviors that expose them to risk.  We are expected to ask patients about smoking, alcohol use, high-risk sexual behavior, failure to use seatbelts and dancing on windowsills.  We are expected to counsel our patients to refrain from behaviors that may lead to injury or disease. “Mrs. Jones, I’m very worried about the fact that you grease your stairs with motor oil.  I advise that yo...
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Carotid Artery Stenting Almost Ready for Prime Time

Three months ago I wrote about carotid artery narrowing, which is one of a number of causes of stroke.  There are currently two alternative treatments for severe carotid artery narrowing:  surgery, called endarterectomy, to open the artery, and a newer procedure called carotid artery stenting.  (Read my previous post, link below, for some background about these procedures and their role in stroke prevention.) Thus far, carotid artery stenting has not been shown to be as safe as endarterectomy. ...
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Zostavax is Safe, Effective, and Not Free

Varicella zoster virus (VZV) is the virus that causes chicken pox, usually a relatively minor childhood illness.  Unlike other viruses that are cleared from our bodies after infection, VZV stays in our sensory nerve cells forever.  Over the subsequent decades our immunity to VZV wanes.  When our immunity falls too low, VZV can reactivate and cause shingles.  Shingles is a painful blistering rash along the distribution of one sensory nerve.  The rash resolves in a few weeks, but in some older pat...
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Vitamin C and Vitamin E Do Not Prevent Eclampsia

A friend of mine recently asked me “Is regular soda or diet soda better for you?” I tried to probe for details.  “Are you talking about calories?  Obviously, if you’re watching your weight or restricting carbohydrates, you should have the diet soda.” “No, I don’t mean the calories.” “Oh, you mean the concern that the citric acid might leach calcium out of your body?” “No.  I just mean overall, are they good or bad for you?” This precipitated an important revelation that had been percolating...
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