db's Medical Rants

This list represents my arbitrary ranking of the top ten stories covered which I covered this year. Factors which I used to develop the ranking concern the health of patients and the medical community. Limiting and ranking the list proved much more difficult than I first thought. Readers will disagree [...]

The surgery your doctor shouldn’t perform
A growing body of medical literature suggests that only highly trained vascular surgeons should, in the majority of cases, be allowed to perform the surgery. Because it requires the surgeon to close down a section of the aorta — akin to replacing a fuel hose in a plane [...]

Worried Pain Doctors Decry Prosecutions
In recent years, similar charges of illegally prescribing prescription narcotics, criminal conspiracy, racketeering and even murder have been brought in dozens of states against scores of doctors who treat chronic pain with prescription narcotics. At least two have been imprisoned, one committed suicide, several are awaiting sentencing, many [...]

Bush Administration to Ban Ephedra I have ranted extensively about ephedra – just go and search for multiple rants (22).
Ephedra, also known as Ma huang, Chinese Ephedra and epitonin, poses health hazards ranging from high blood pressure, irregular heartbeat, nerve damage, injury, insomnia, tremors and headaches to seizures, heart attack, stroke and death, [...]

Just go read it. You will be amazed. Or you might not be. The Milky Way of Doing Business by Katie Allison Granju
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Sometimes I feel like a broken record. I rant about the working conditions for physicians. I rail about the bureaucracy which now increasingly surrounds medicine. Mostly I complain about a reimbursement system which makes no sense. The outcome of this and other problems is a growing physician shortage. Physician [...]

Does bureaucracy drive you crazy? Most physicians rail against bureaucracy. I found this page with great quotes about bureaucracy. First a couple of gems:

Bureaucracy is the art of making the possible impossible. He who has trusted where he ought not will surely mistrust where he ought not.
–Marie von Ebner-Eschenbach
The only [...]

The Science of Naming Drugs (Sorry, ‘Z’ Is Already Taken)
It has often been noted that drug makers have favorite letters, and that they run the gamut from X to Z. Think Nexium, Clarinex, Celebrex, Xanax, Zyban and Zithromax. But why are these letters so popular? “Some letters look better in print, make [...]

I started thinking recently about the major impact medical stories of 2003. This is a work in progress, and I need your help. This rant will just list (in no particular order) stories which captivated me and the commenters this year. I plan to consider them all week, and elicit your opinions. [...]

As we start to digest the monstrous Medicare bill, we find the good, bad and the ugly. HSAa are in the good category. Robert Prather has championed this idea on his excellent blog for the past year at least. He addresses the issue once again with reference to the bill – Maybe [...]

A surgeon on lap versus open appendectomy
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They work better than traditional appendectomy. Less invasive appendix surgery means faster recovery
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Stampede of Diabetes as U.S. Races to Obesity
Many people seem to think they don’t have to worry about a preventable disease that does not, at the outset at least, have serious consequences and that can be treated. One such disease was long called adult-onset diabetes. There are two things wrong here: first, [...]

I posted 3 rants on Neurontin in May and July – The whistle blower and Warner-Lambert, The Neurontin story, and More on Neurontin. These rants received many comments from angry users (who blame many side effects on these drugs. One of my guiding principles is to carefully look at the data rather than anecdotes. [...]

There’s a Blurry Line Between Rx and O.T.C.
The decision to sell a drug by prescription, experts say, may involve factors that have nothing to do with science or patient safety. Marketing and financial considerations, politics, doctors’ concerns and consumer psychology all may play a role. “Unequivocally, there is no bright line,” said [...]

Most influenza does not need a physician visit. This article makes clear the signs that should lead to physician care. U.S. Offers Advice on When to Seek Flu Care
But for some, influenza can be life-threatening. Among warning signs that should bring immediate notification to a doctor are rapid or difficult breathing and [...]

Often I have seen David Sackett introduce himself at medical meetings. He generally uses the pseudonym – Kilgore Trout. Of all my heroes (and yes he is clearly one of my heroes) he has the best sense of humor. This piece from the BMJ uses humor in hopes of making us think [...]

Richard Smith, editor at the BMJ, recently spoke to a group of new medical students. He asked many physicians for advice. His remarks appear in today’s BMJ – Thoughts for new medical students at a new medical school While these thoughts are originally meant for new medical students, I would argue that [...]

I ranted earlier this week on the new atrial fibrillation guidelines. Medscape does an excellent job of developing selected articles for in depth coverage. Here is the link for those who want to learn more about this issue – ACP/AAFP Issues Guidelines for Management of Atrial Fibrillation
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Virtually all men eventually develop benign prostatic hypertrophy (BPH). Our goals of therapy are twofold, improve quality of life and prevent surgery. Today’s NEJM has an important article – summarized in this story – Drug Combo Can Fight Enlarged Prostate
The two drugs in the study, doxazosin and finasteride, are now widely [...]

The American College of Physicians and the American Academy of Family Physicians have jointly released new guidelines for atrial fibrillation management. I am providing the link for those who have access to the Annals of Internal Medicine and for my own future use – Management of Newly Detected Atrial Fibrillation: A Clinical Practice Guideline [...]

My previous rants on medical marijuana are just a search away. This particular story deserves wider coverage. Federal appeals court OKs medical marijuana in some cases
A federal appeals court ruled Tuesday that a congressional act outlawing marijuana may not apply to sick people with a doctor’s recommendation in states that have [...]

Infectious disease experts worry about antibiotic resistance. Generally they err on the side of underusing antibiotics. The National Health Service in Great Britain now wonders whether this movement leads to difficulties. UK considers antibiotic policy

A big rise in pneumonia deaths may be linked to a clampdown on the use of antibiotics for [...]

We were sitting in clinic yesterday afternoon with some residents. One had a documented exposure to influenza. He had taken the vaccine last month but was trying to decide whether or not to take Tamiflu as prophylaxis. Our opinion was that given the imperfect coverage of this vaccine this year, we would [...]

Our colleague, Robert Prather at Insults Unpunished, has long championed health savings accounts. The new Medicare bill encourages them – Medicare reform opens up health savings accounts to all
Regardless of HSAs’ ultimate popularity, the important thing is a new market option has been added, said Loussedes. The American Medical Association shares [...]