In the News: Advances in treating Alzheimer’s disease

New studies have been showing some exciting results that hold promise for the effective treatment of Alzheimer’s dementia. One such study showed that infusion of an investigational drug cleared amyloid plaques—the tangled clumps of protein found in the neurons of Alzheimer’s patients—by stimulating the immune system. The study wasn’t powered to show if it had an effect on the symptoms of Alzheimer’s but larger studies are sure to follow. Read More→

A Patient Asks: “How do you know if an infection is bacterial or viral?”

The question: When you have an upper respiratory infection, how can you tell if it’s bacterial and you need antibiotics or it’s viral and antibiotics won’t help?

The science: Statistics show that by far the majority of infections in the respiratory tract (sinuses, nose, throat, lungs) are viral. Bacteria are responsible for sinusitis, for example, in only 0.5-2% of all cases. Bacteria (specifically strep infections) are responsible for pharyngitis (sore throats) in only 5-15% of cases. Rarer bacteria are responsible in less than 5% of cases. Viral infections account for sore throats in 80% of cases. Bacterial infections are responsible for bronchitis in only 1-5% of cases. Read More→

Letter to a Widow

I remember when I first read the pathology report on my patient, Mr. Jackson (not his real name), my stomach flip-flopped.  “Adenocarcinoma of the pancreas” it said. A week later, a CT scan revealed the cancer had already spread to his liver. Two months after that, following six rounds of chemotherapy, around-the-clock morphine for pain, a deep vein thrombosis, and pneumococcal pneumonia, he was dead. Read More→

An Alternative to Willpower for Losing Weight


A common belief, even among doctors, is that almost no one succeeds in losing weight in the long term. And for almost two decades, I’ve counted myself among the skeptics, being able to tally on the fingers of one hand the number of my patients who’ve managed to do it—literally less than five out of multiple hundreds, if not a few thousand.

When I stumbled across the ideas put forth in the slow-carb diet though (“slow” in contrast to “low” because one cheat day a week is allowed), I became excited—and not just for my patients. Read More→

Why Executives Don’t Need Executive Health

Traditional Executive Health programs designed for business executives take advantage of the widespread belief that more medicine is better medicine. That is, if a test is available to detect disease, it should be done. For this reason, such programs typically offer a full day of testing designed to detect hidden disease at an early (and therefore theoretically curable) stage and assess the risk for future disease. Read More→

A Patient Asks: “What’s better for back pain, heat or cold?”

lower-backThe question: When you strain your back, which should you apply, heat or cold?

The science: One study reviewed the literature and concluded: “The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and subacute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.”

Caveats: When you strain your back, pain may emanate from more than one source. There is the pain that comes from the structure that’s actually been injured, frequently a structure buried far below the skin, out of the reach of either heat or cold. Then there is often the pain from accompanying muscle spasm. These muscles are located superficially and therefore are easily within the reach of heat and cold. Thus, it’s this latter pain that heat or cold has a chance to affect.

My recommendation: Muscle spasm, in general, is made worse by cold and improved by heat. Thus, though I have the occasional patient who tells me that applying cold to a back injury improves pain, in general I always recommend heat to reduce the pain of muscle spasm. The best way to apply heat is through water, either in a hot shower or with a hot washcloth. Heating pads are good, too. I usually recommend applying heat for 20 minutes at a time throughout the day. I warn against sleeping with a heating pad on because of the risk of burning the skin.


In the News: The Microbiome and Obesity

colonScientists have become increasingly interested in how bacteria living in our large intestines influence our health. There are, in fact, more bacteria in our large intestines than there are cells in our bodies. Many diseases have been known for some time to relate to shifts in what’s called the microbiome, or regular population of gut bacteria. Clostridium difficile colitis, for example, occurs when antibiotics reduce the population of “good” bacteria in the microbiome and enable a “bad” bacteria, clostridium difficile, to multiply to the point where it causes disease. Observational studies have begun to show links between certain microbiomes and other diseases including asthma and certain autoimmune diseases. It seems each person’s microbiome is like a fingerprint in that it’s unique to each individual. Read More→

How and Why to Get Good Sleep

sleepingAll animals sleep, strongly suggesting that the act of sleeping has some evolutionary benefit. Human beings spend approximately 1/3 of their lives—about 8 hours per night—sleeping. The true purpose of sleep, however, is poorly understood. Whether it’s for restoration, energy conservation, memory consolidation, or all three, sleep is more than just something we do at the end of the day. It’s one of the most important requirements for optimal health, and we must defend our ability to do it rigorously. Read More→

Too Much Care

hospital bedsNot long ago, one of my elderly patients (who gave me permission to tell this story) began requiring blood transfusions for a condition known as ischemic colitis. Usually it occurs because there are blockages present in the arteries that supply blood to the colon and, starved of blood, the inner lining of the colon becomes inflamed. But her arteries, it turns out, are normal. So we term her ischemic colitis microscopic because we consider the blockages to be in the tiny arterioles. Unfortunately, in her, it’s entirely unclear why these tiny arterioles should be blocked at all. But at whatever level the blockage of blood flow occurs, the predominant symptom is the same: continuous bleeding from the colon. Read More→

In the News: Prilosec and Dementia


A recent study garnered a lot of attention in the popular press about the association between the use of acid suppressants like Prilosec and the risk of dementia. Here’s one such article:

The study was observational, however, meaning because of its design the most it can tell us is that there’s a possible association between chronic Prilosec use and dementia. It can’t tell us that drugs like Prilosec cause these problems. Though the relative increase was large (40%) the absolute increase in risk is dependent on the absolute baseline risk, which was only moderate. Further, in observational studies, it’s difficult to control for all variables that could influence the results. For these reasons, I think it’s too early to stop drugs like Prilosec in patients for whom they’re helpful.