ALL

I don’t remember her name anymore. She was 8 years old: blonde, pretty, smiling politely. I remember her parents, older than most, looking concerned. She looked too healthy to be the source of their concern, but as I moved close to her, I could see the petechiae on her cheeks. In three weeks, she was […]

One Drug Interaction

The unveiling of Drug Interactions from The Medical Letter® reminded me of the profound effects of a single drug interaction that occurred in the emergency room of New York Hospital in 1984. Libby Zion was an 18-year-old college student who came to the hospital seeking treatment for a flu-like illness. She had been taking the […]

O Canada!

The current issue of The Medical Letter (May 22, 2017) leads off with a contentious topic: drug prices. I could think of a lot of good reasons for not publishing an article on this subject: not our usual thing, more questions than answers, everyone in the world has already written about this, etc. But many […]

The USPSTF and Vision Screening in Older Adults

In 2009, the Affordable Care Act required Medicare and private insurance plans to cover, without a copay, preventive services given grades of A (high certainty of substantial net benefit) or B (high certainty of moderate net benefit, or moderate certainty of moderate to substantial net benefit) by the US Preventive Services Task Force (USPSTF). The […]

Treating Influenza

The CDC recently announced that the influenza vaccine has been 48% effective this year in preventing influenza illness. Presumably, it has been even less effective in subgroups like the elderly, the immunosuppressed, and those with chronic heart, kidney, or liver disease. The CDC recommends antiviral treatment for documented, or even suspected, influenza illness in these […]

Vaccine Resistance

The New York Times has reported that an antivaccine crusader may soon lead a government commission on vaccine safety. The commission is expected to focus particularly on the long discredited link between vaccines and autism, which originated in a study of 12 children that was published in The Lancet in 1998. The article was retracted […]

NSAIDS

Patients tend to underestimate both the effectiveness and the toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs). For acute pain, single full doses of NSAIDs are more effective than acetaminophen, and some have shown an equal or greater analgesic effect compared to oral opioids combined with acetaminophen, or even injected opioids.  However, there is a price to […]