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, […]
Herman Pontzer and colleagues published a landmark study of energy expenditure in people from a very physically active hunter-gatherer group, the Hadza of Tanzania. These important findings have been central to how I think about diet and obesity. Here is what they found: Hadza hunter gatherers spend about the same […]
Interferon is an innate immune molecule with an important antiviral function that provides a first line of defense against infection. Interferons are found across the tree of life, existing in all tetrapods and most fishes. It is thought that interferon evolved first in jawed fishes, about 400 million years ago. […]
I spent some time this week looking back at our year of pandemic and considering the question of how evolutionary medicine can help guide treatment in the emergency department. My first reaction to this question was: “of course evolutionary medicine is useful during every step of the patient encounter.” It […]
I cannot think of a time in my life when newspaper headlines overlapped quite as much with the scientific enterprise of evolutionary medicine. Here is an example, from Bloomberg: “British doctors who spent 102 days treating a cancer survivor for Covid-19 documented how the virus mutated after the man was […]
I listened recently to a podcast conversation between physicians David Katz and Zubin Damania on the ZDoggMD podcast and a few things caught my attention. First, and relevant to this blog, Katz referred to the evolutionary biology of disease a few times during the podcast. Here is Katz on obesity: […]
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