or, Malaria Makes a Bad Souvenir
or, I Went on Safari and all I Got Was Hepatitis A
We Americans take for granted much of what keeps us healthy. We expect our food and water to be uncontaminated. We expect the neighbor’s dog to have had all his shots. We expect that if we get sick we will receive prompt and excellent care. Then, when we travel to the developing world, we forget that none of our expectations apply. We plan our itinerary, our meals, even our web access, but we forget to plan...
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Screening for Prostate Cancer May Harm More than Help
About 20 years ago a blood test called prostate specific antigen (PSA) was developed with the hope that it would help in the diagnosis of prostate cancer. Since then, countless healthy men have been tested for prostate cancer with a PSA and a digital rectal exam despite the fact that there has never been convincing evidence that diagnosing prostate cancer saves lives.
The reason for the controversy about prostate cancer screening is that prostate cancer is a very slowly growing cancer which us...
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The Challenge of Sobriety
Three weeks ago I wrote about the difficulty of quitting smoking. This week I’m writing about an even harder habit to break – problem drinking.
Our understanding of alcohol use and abuse is evolving. Alcoholism or alcohol abuse is defined as continued alcohol drinking despite negative consequences, whether those negative consequences are to one’s work, relationships or health. Alcohol abuse happens to different people at different quantities of drinking, so the amount of drinking was never t...
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Everyone March to Your Colonoscopy
I don’t know about you, but whenever I think of March, the first thought that springs to mind is National Colorectal Cancer Awareness Month.
Patients frequently ask me to be tested for whichever cancer they are particularly anxious about. “Is there a test to make sure I don’t have early ovarian cancer?” “Pancreatic cancer?” “Lymphoma?” I have to explain that for healthy people without any symptoms, there is no test that has been proven to find these malignancies early or save lives by findi...
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Mind if I Don’t Smoke?
Quitting smoking is probably the hardest thing I ask my patients to do. (Losing weight is probably the second hardest.) Smoking is a profound addiction. Smoking feels good, and countless smokers have told me the calming pleasure they get from a cigarette.
Despite the health risks and financial costs associated with smoking, medications aimed at helping smokers quit have been only modestly successful. A very helpful article in Monday’s Los Angeles Times reviews the medications avail...
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Would You Like Some Salmonella With That?
Our modern hyper-efficient means of producing, processing and distributing food has made hunger virtually extinct in the developed world. (In fact obesity is a much more pressing problem.) But our modern food production network is revealing an increasingly dangerous cost. Because food from any one farm or any one plant is frequently distributed nationally or even internationally, contamination with a foodborne infection can sicken thousands before the source is identified.
Two years ago Esc...
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The Flu: Good News, Bad News
The good news about this flu season is that so far, both nationally and in California, it has been a mild one, with a relatively small number of people infected. The weekly trends are still increasing, so the worst is still ahead of us.
The bad news is that one of the major strains of the flu virus this season is resistant to Tamiflu, the most frequently prescribed and safest anti-flu medicine. In response, the CDC has issued an Interim Antiviral Guidance statement, which recommends which ant...
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Got Safety?
My bachelor’s degree is in engineering. (I hear all of you thinking “Ah! No wonder he’s such a geek.” But I was a geek long before that.) In engineering, safety is an entire field of study with formal ways to account for and measure errors, plan for system failures, and quantify the likelihood of adverse outcomes.
Until the last several years, medicine had a very different culture. Traditionally giving a lot of latitude to physician judgment and autonomy, hospitals had few systems in place...
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Resolutions for a Healthy 2009
Many people use the occasion of the New Year to reflect on the last year and make specific goals for the next. Resolutions can be very helpful motivators if they are specific, realistic and written down. Just as people make goals for their careers and their relationships, resolutions for your health are a smart way to work for achievable targets in the health-related struggles you face.
So I encourage you this week to write down your health resolutions for 2009. Obviously, what progress is a...
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Crestor Prevents Heart Attacks and Strokes in Patients with Normal Cholesterol and High CRP
“If you think health care is expensive now, wait until you see what it costs when it’s free.” -- P.J. O’Rourke I’ve written several times about the proven benefits of a family of cholesterol-lowering medicines called statins. Statins include the medications Crestor, Zocor, Lipitor, Mevacor, Pravachol and others. The group has a solid base of evidence showing that they prevent strokes and heart attacks in patients with high cholesterol and in patients who have had...