November 12, 2018

Vitamin D for the masses? Nope

Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo, another example of how theory guided practice before the scientific research was done.

November 4, 2018

Statin Interaction Reference

Your EMR, Epocrates, Lexicomp and your local pharmacy may give you four different opinions on which drugs interact (and how much) with each other.

A week or so ago I did a physical on a patient on simvastatin with chronic gout. My EMR flagged a major interaction between simvastatin and colchicine. Epocrates had something bad to say about the combination of any statin I tried with colchicine. I decided to stew about it for a while.

Today I asked Dr. Google, and he served up what I wished I had heard about it when it was first published: An AHA statement about more than a dozen statin Drug-Drug interactions.

It turns out rosuvastatin has only one pathway for interaction with colchicine while simvastatin and atorvastatin have two, making rosuvastatin “reasonable”.


Thanks, AHA, and thanks, Dr. Google!

“Coadministration of colchicine and rosuvastatin, fluvastatin, lovastatin, pitavastatin, and pravastatin is reasonable when clinically indicated. Dose reductions may be considered for atorvastatin, simvastatin, and lovastatin, given the potential for interactions mediated by both CYP3A4 and permeability glycoprotein (P-gp) pathways.”

October 28, 2018

Small practice, less doctor burnout?

“Just 13.5 percent of providers who work in SIPs reported being burnt out, according to a study published in the Journal of the American Board of Family Medicine, titled “Correlates of Burnout in Small Independent Primary Care Practices in an Urban Setting.” The survey’s respondents included 204 physicians and 31 nurse practitioners or physician assistants.

The survey used a one-item variant of the Maslach Burnout Inventory. Earlier results, such as the December 2015 Mayo Clinic Proceedings study, found that 54.4 percent of 6,880 physicians reported at least one symptom of burnout.”

October 28, 2018

Cold, Wind, Darkness Kill

Fellow Swedes prove cold, wind, darkness and low pressure cause more heart attacks. So I moved to the northern coast of Maine……

October 26, 2018

BBC News: New ‘Trojan horse’ antibiotic promising

Bacteria crave iron. Our bodies try to keep iron from them. This antibiotic is bound to iron and bacteria gobble it up, only to be killed.

New ‘Trojan horse’ antibiotic promising_104034475_gettyimages-162534536.jpgIt uses a clever trick to sneak inside bacteria in order to kill the bugs.
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October 21, 2018

Doxycycline and Tooth Staining | CDC

  • Doxycycline is the most effective antibiotic for the treatment of suspected rickettsial infections, including Rocky Mountain spotted fever (RMSF).Misperceptions about the use of doxycycline for children prevent kids from getting lifesaving treatment.
  • Delay in treatment of rickettsial diseases may lead to severe illness or death. Children are five times more likely than adults to die from RMSF.
  • Misperceptions about the use of doxycycline for children prevent kids from getting lifesaving treatment.
  • Doctors often avoid prescribing doxycycline to young children because of a warning that tooth staining may occur when used in children less than 8 years old.
  • In a new study, experts at the CDC and Indian Health Service (IHS) found that short courses of the antibiotic doxycycline can be used in children without causing tooth staining or weakening of tooth enamel.

October 8, 2018

British Doctors Also Suffer

My latest post on A Country Doctor Writes is about a simple, yet radical fix to the crazymaking situation most American primary care physicians find themselves in:

“A better day for medical providers:

1) Encounter Productivity Achieved

2) Charts done on time

3) Inboxes Cleared.

Those are the three basic tasks of a medical provider, yet most medical organizations only schedule providers for one of them, the patient visits, and somehow expect that by pure magic, superhuman willpower or personal sacrifice, the other two things will get done, and continually act surprised when that doesn’t happen.”

The BMJ writes on the same theme, and there is even a British conference on “The Wounded Healer”:

“Rates of mental illness, emotional exhaustion, and anxiety are increasing among health professionals.23 The causes are generally the same across the world and include a lack of time with patients, loss of continuity, erosion of amenities such as on-call rooms and doctors’ messes, shift systems that undermine traditional peer and senior support, unrealistic public expectations of medicine, the industrialisation of healthcare turning it into a production line, a growing burden of administrative tasks, and being expected to deliver more with fewer resources.”

“Doctors increasingly work within a culture of litigation and blame, carrying the full burden of accountability despite a loss of authority and autonomy.”

“The BMJ champions the wellbeing of doctors. To coincide with the tenth annual conference of the Practitioner Health Programme, the wounded healer, on 4 and 5 October, we have curated an online collection of articles published in the past few years (”

What’s this world coming to, when the people who are supposed to be healing the sick are themselves sick from the way their work is structured, organized and mandated?

September 20, 2018

Obesity, Doctors and the Food Industry

In my inbox today there was a graphic from NEJM Catalyst indicating that individual doctors are a whole lot more responsible for addressing the obesity epidemic than private companies.

More than General Mills, Ocean Spray, Coke and Pepsi???

September 17, 2018

When I grow up, I’ll be a worse GP | Pulse Today

Swedish and British humor are fairly similar. That’s why I always enjoyed British sitcoms, back when I lived in Sweden and on PBS when I had a TV (stopped when they went digital, ten or fifteen years ago).

This entertaining piece was on the British GP website Pulse:

“At the age of 37, I contrive to look like a sensible professional to those who don’t know me. But I am not. I cannot adult. I don’t know if I’ll ever be able to. And the more I meet people older than me, the more I realise they are no more wise or together than I am, but are simply bemused adolescents trapped in the body of a grown-up.

I may never master adulting. But do you know what? I am proud. I am proud I frequently make stupid mistakes and laugh at them, and I choose my friends because they do the same. I think I am a more human and relatable GP for it.”

September 16, 2018

Air Pollution, Blood Pressure and Heart Attacks

Fine particle air pollution is associated with increased cardiovascular morbidity. Air purifier use causes measurable, rapid decrease in blood pressure in urban US elderly populations according to an article in JAMA Internal Medicine:

Effect of Portable Air Filtration Systems on Personal Exposure to Fine Particulate Matter and Blood Pressure Among Residents in a Low-Income Senior Facility –