The other day I went to my local Costco. As I entered the queue of over-laden carts, emblematic of the excesses of globalized consumerism, I passed an enormous display of over-the-counter Kirkland-brand Omeprazole stacked high in eye-catching purple and pink packaging. Omeprazole was made over the counter in 2003 but […]
There is conflict brewing in your guts. This conflict plays out between your genome and the multiplicity of microbial genomes in the microbiota. As Herald Brüssow and others have pointed out, the conflict zone is mostly in your upper gut, above your colon. The large intestine, or colon, is relatively […]
This entry is (mostly) a repost, but I think the topic is interesting and timely. Why is it that many if not most people think evolution is unimportant in health and wellness? I obviously think the opposite is true, but many folks still need convincing. I came across an essay […]
In 1987 Louis Ignarro published a paper in the Proceedings of the National Academy of Science that was the culmination of years of work trying to identify a molecule known before then only by its function – Endothelium-derived relaxing factor, or EDRF. As the name implies this was a substance […]
For those who clicked on the previous post and expected to read more on the shrinking Surviving Sepsis guideline, this follow up post is for you. the Surviving Sepsis Campaign is predicated on the idea that sepsis is a medical emergency and demands an immediate muscular response. From the current […]
The New England Journal of Medicine published an important trial today that aimed to answer the question: how much fluids should we give to patients with septic shock? Before we get into that result, let’s revisit the reasons we give fluids in the first place: to normalize low blood pressure, […]
“Doctor – Your Sepsis Patients Have Scurvy,” asserted Paul Marik MD in a Critical Care Editorial. Marik, who at the time was a respected critical care physician at Eastern Virginia Medical School in Norfolk, Virginia, supported his scurvy claim by noting that patients with sepsis suffer a “severe total body […]
Updated! The promise and power of science is that it produces results better than superstition, anecdote, and intuition. Vaccines, antibiotics, and insulin are powerful examples of those results. However, success can sometimes lead to the phenomenon of overshoot. Overshoot is when treatments miss the mark, and cause more harm than […]
In my specialty of emergency medicine, it seems we have an insatiable need for information about our patients. Many of our patients are speedily attached to the EKG machine, placed on continuous cardiac monitoring, pulse oximetry, and then phlebotomy – the routine bloodletting we do in the service of laboratory […]
Medicine is conservative, favoring stability over change. We breathe a sigh of relief when a patient’s vital signs are stable. We worry about labile (changing) emotions, mood, or blood pressure. We have an inordinate fondness for homeostasis; we grow concerned when we detect outliers or departures from “normal” homeostasis. However, […]
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