Human Papilomavirus: The Latest Celebrity Pathogen

Recently human papilomavirus (HPV) has been making a lot of news.  The story involves big business, cancer, government policy, and sex.  I'm surprised HBO hasn't made a series about it. HPV is a sexually transmitted virus that causes genital warts, cervical cancer, and has recently been associated with oral cancers.  Merck recently released Gardasil, a vaccine that protects against the strains of HPV that cause most (but not all) of the cas...
More

Computer Aided Mammography Interpretation Not Ready for Prime Time

Most of my patients know that I'm a big fan of technology.  From electronic medical records to viewing diagnostic images over the web, I love finding tools that help me take better care of patients.  A study in this week's New England Journal of Medicine is an important cautionary tale that reminds us that new technologies should always be tested rigorously. The study examined the use of a technology ca...
More

Preventive Care Recommendations at Your Fingertips

Preventive medicine is a rapidly growing field.  Testing that detects diseases in early stages, treatments that prevent diseases before they occur, and behaviors that make diseases less likely all hold the promise to keep us healthy and let us live longer.  Unfortunately the field is also increasingly marred by tests and services that are recommended to patients without any scientific evidence that they work, or worse, despite much evidence that they are useless. That's why I've long been a dis...
More

CDC Advisory Committee Recommends Vaccine to Prevent Shingles

Six weeks ago I wrote about Zostavax, a vaccine that prevents shingles.  At that time I suggested waiting to see if the CDC was going to recommend it.  Last week the CDC Advisory Committee on Immunization Practices (ACIP) recommended that all adults over 60 who have had chicken pox receive the vaccine.  The press release about the ACIP's recommendation is ...
More

An Interaction between Aspirin and Ibuprofen

About a month ago the FDA released a warning about an interaction between very commonly used medications:  aspirin and ibuprofen. Many patients have been instructed to take low dose aspirin (81 mg daily) for heart attack or stroke prevention.  Aspirin prevents heart attacks and strokes by binding to an enzyme in platelets called cyclooxegenase (COX) and preventing its normal function.  COX is essential for...
More

The CDC Recommends Routine HIV Screening for All Teens and Adults

Last week the Centers for Disease Control and Prevention released new recommendations for all physicians for HIV testing.  The new recommendations were generated in response to the fact that of the approximately 1 million Americans infected with HIV, about one quarter have not been tested and are unaware of their infection.  These patients can not take advantage of the many therapies available for HIV infect...
More

A Vaccine to Prevent Shingles

Zostavax, a vaccine to prevent shingles, has recently been approved by the FDA and reviewed by The Medical Letter. Shingles (also called herpes zoster) is a very painful illness involving blisters that occur in a stripe-like pattern on one side of the body.  Shingles can only happen in people who have had chicken pox.  The virus that causes chicken pox, varicella zoster virus (VZV), stays in the in sensory nerve cells of the infect...
More

Will Primary Care Survive?

Last week's New England Journal of Medicine features an important article by Dr. Thomas Bodenheimer, Primary Care -- Will it Survive?  I encourage all of you to read it. Dr. Bodenheimer starkly presents the looming crisis in primary care.  Patients are waiting increasingly long for shorter appointments, frequently do not understand their doctor's instructions, and are increasingly dissatisfied.  Primary ca...
More