Doctor, Test Me for Everything

“Doctor, I really want to stay healthy and I just got a big promotion/had a baby/had a grandchild, so I really don’t want to end up with some horrible illness. Please test me for everything.” Primary care doctors hear requests like this all the time. It’s an impossible request to fulfill because it assumes two premises that are usually false. It assumes that we have a test for all illnesses, and that being diagnosed early with a dreaded illness makes a difference. Monday’s NY Times published <...
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Tai Chi Improves Balance in Patients with Parkinson’s

Parkinson’s disease is a progressive neurologic disorder. Parkinson’s biggest initial impact is on how patients move. Patients have tremors and have difficulty initiating movement. They walk with short shuffling steps. Balance worsens and falls are common. Parkinson’s disease is treated with medications and rarely with brain surgery. Resistance-based exercise has been shown to slow the worsening of balance and strength in patients with Parkinson’s disease, but these exercises frequently requir...
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How Frequently Should You Have Your Bone Density Checked?

Breaking a bone is frequently a catastrophic injury for an older patient. A hip fracture or a vertebral fracture frequently leads to a permanent decrease in mobility which starts an inexorable decline in health and independence. For that reason, fracture prevention is a critical part of the care of older people. Osteoporosis, which is severely decreased bone density, is a major risk factor for fractures, especially in women over 65. Osteoporosis is also treatable, and there is good evidence tha...
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Don’t Put Unsterilized Tap Water Up Your Nose

I like introducing you periodically to some of the stranger and more dangerous germs out there. It’s a good reminder that nature isn’t just full of daisies and rainbows, and that the most lethal dangers we face are natural. This week’s news presents a terrific example. Meet Naegleria fowleri. Naegleria fowleri is an amoeba, a single celled parasite that lives in warm bodies of fresh water, like lakes and rivers. Its nickname is the brain-eating amoeba. Isn’t that nice? (My nic...
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Niacin Much Less Helpful in the Age of Statins

Niacin has been getting some bad press recently. A brief retrospective of Niacin’s rise to prominence will help us understand its recent fall from favor. Niacin is also known as vitamin B3 or nicotinic acid, a molecule that we need in tiny quantities in our food. As far back as the 1950s it was known that niacin in higher doses reduces blood levels of cholesterol. At that time our understanding of heart disease was in its infancy and there were few effective medications to treat or prevent card...
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Vitamin E Increases Risk of Prostate Cancer

Lots of my patients take vitamin supplements. I don’t recommend them. My patients don’t ask me about it, they just tell me. In the absence of a specific vitamin deficiency or medical condition, there is absolutely no evidence that any vitamin improves any health outcome. I’ve always assumed that vitamins are generally ineffective, but harmless. Some patients are very eager to feel like they’re doing everything they can to be healthy, and I usually decide not to say anything and instead save my...
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