February 24, 2017

Deep brain stimulation for refractory anorexia nervosa: The Lancet Psychiatry

Anorexia Nervosa, a disease I first saw treated with behavioral therapy in medical school on the OB/GYN ward at Uppsala Akademiska Hospital, appears to respond to Deep Brain Stimulation.


February 14, 2017

Back Pain? No Drugs!

The American College of Physicians has issued their new guidelines on how to treat low back pain without sciatica. No more “pain is the fifth vital sign”, and no more opioids.


February 13, 2017

The Root of Physician Disengagement

Richard Gunderman is a wise and prolific writer, radiologist and professor of many disciplines. He writes eloquently in NEJM Catalyst:

What Is Medicine For?

The core problem, then, isn’t managerial. It isn’t even ethical. It’s ontological, pertaining to the most fundamental question of all: what in medicine is most real?

Recent efforts to convert medicine from a relationship-centered profession to an efficiency-focused production process have shifted the focus of attention……describing…a health care culture seriously out of step with what matters most in patient care. This imbalance inevitably erodes the engagement of health professionals.


October 6, 2016

Is Infertility Hereditary?

I have, in my entire life, made up only one joke worthy of standup comedy. It is perhaps similar to Stephen Wright’s “I live on a one-way, dead end street”.

It goes “Is infertility hereditary?”

Of course, there is some serious thought behind it. More serious than I thought, it turns out:


Sons born with fertility treatment ‘inherit problems’

Boys born to fathers who needed help conceiving grow up to have poorer sperm quality than peers conceived without help, a study has found.


April 23, 2016

Top 100

A Country Doctor Writes is one of the top 100 healthcare blogs on eVisit’s 2016 list. They write:

This blog is a great read from a small-town doctor who’s been practicing on the same families for generations. The posts feature “progress notes,” highlighting interesting and unusual cases, along with touching stories of being the doctor for such a close-knit community.

Top 100 Healthcare Blogs: 2016 Edition

January 31, 2016

Expert Advice, But Not in Spelling

Here’s a headline from this week’s Medical Economics. The article points out that our office notes are scrutinized for lazy documentation cliches that don’t reflect the amount or complexity of work to justify our charges.

What’s that expression about throwing rocks from a glass house?


January 23, 2016

Single Dose Propranolol and Reexposure to Phobia or PTSD Triggers Brings Cure

After one round of treatment, the arachnophobes held the spiders in their bare hands.


December 20, 2015

When Hospital Paperwork Crowds Out Hospital Care

A FRIEND was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10.
She mumbled, “4 to 5.” The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend’s pain.


September 18, 2015

Fish Oil May Have More Benefits for the Inuit than for Westerners

I have heard many people advocate eating local foods, and avoiding things from far away. Human metabolism, some say, isn’t the same everywhere. Now there is new evidence that whale blubber may be better for the Inuit than for westerners.

In the 1970s, Danish researchers studying Inuit metabolism proposed that omega-3 fatty acids found in fish were protective. Those conclusions eventually led to the recommendation that Westerners eat more fish to help prevent heart disease and sent tens of millions scrambling for fish oil pills.

Today, at least 10 percent of Americans regularly take fish oil supplements. But recent trials have failed to confirm that the pills prevent heart attacks or stroke. And now the story has an intriguing new twist.

A study published on Thursday in the journal Science reported that the ancestors of the Inuit evolved unique genetic adaptations for metabolizing omega-3s and other fatty acids. Those gene variants had drastic effects on Inuit’s bodies, reducing their heights and weights.

Rasmus Nielsen, a geneticist at the University of California, Berkeley, and an author of the new study, said that the discovery raised questions about whether omega-3 fats really were protective for everyone, despite decades of health advice. “The same diet may have different effects on different people,” he said.


September 18, 2015

Value Based Care: Whose Values?

The Journal of the American Medical Association is taking a stand for elderly and disabled patients in today’s online issue:

“As Medicare moves to implement value-based payment initiatives tied only to current quality measures, the values of large populations of disabled and frail persons, whose care is the most costly and most concentrated in Medicare, are at high risk for being seriously neglected. These people will receive the medications and treatments that would be mostly correct if they were healthier, but their actual priorities will be neither noticed nor met. If the United States intends to pay on the basis of value, it is essential to ask patients what they value, and then deliver on those priorities.”