Gabapentin and Pregabalin for Pain

An interesting recent article in JAMA Internal Medicine was critical of off-label use of gabapentin (Neurontin, and generics) and pregabalin (Lyrica) for treatment of pain,1 a subject The Medical Letter has reviewed with varying degrees of skepticism for many years.2-5 Goodman and Brett point out that both drugs were originally approved as anticonvulsants, but most […]

Epinephrine Injections for Anaphylaxis

In July of 2016, a 15-year-old girl travelling by plane from London to Nice died from an allergic reaction to sesame. She had eaten an artichoke, olive, and tapenade baguette that she had bought from a Pret A Manger store in the airport. The girl was aware of her allergy, but the sesame seeds that […]

Dietary Supplements: When Will They Ever Learn?

When we wrote about problems with dietary supplements in 2002, we concluded by saying that physicians should tell their patients that we really don’t know what’s in them. An article that recently appeared in JAMA Network Open1 tells us what’s in some of them, and it’s not good. The data in the new report comes […]

Opioids Again and Again

The CDC reported today that the opioid crisis is only getting worse: more ED visits, more deaths. More than from car accidents, more than from guns. Unbelievable, but we believe it and we are doing what we can to help. In the June 5th, 2017 issue of The Medical Letter, we published an article on […]

Alternatives to Hormonal Contraceptives

The results of a large Danish prospective cohort study (1.8 million women followed for an average of 10.9 years) published recently in The New England Journal of Medicine indicate that even low-estrogen oral contraceptives and progestin-only intrauterine devices are associated with an increased risk of breast cancer.  The risk was 20% higher in current or […]

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 […]

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 […]