Melatonin supplements are increasingly popular, but the evidence is weak and mixed. Will taking a melatonin supplement put you to sleep?I don’t understand how Facebook’s algorithms work; but I wonder if they have gotten the false impression that I suffer from insomnia, since I have recently been bombarded with information… read more "Melatonin"
Don’t Ice Sprains
Ankle sprains are common; as a family physician I treated a lot of them. My most memorable ankle sprain patient was a young woman I saw during my residency training. Doctors had diagnosed a sprain. They gave her crutches and told her not to try to bear weight on the… read more "Don’t Ice Sprains"
Osteopenia: When Does Decreased Bone Density Become a Disease Requiring Treatment?
Osteoporosis is routinely treated with bisphosphonates to prevent fractures. A new study suggests that osteopenia should be treated too. But questions remain. Bisphosphonate drugs have been shown to increase bone density and prevent fractures in postmenopausal women with osteoporosis (remember Sally Field in those ads for Boniva?) but what about… read more "Osteopenia: When Does Decreased Bone Density Become a Disease Requiring Treatment?"
Should Evidence-Based Medicine Be Replaced By Interpersonal Medicine?
An opinion piece in the New England Journal of Medicine complains about the limitations of evidence-based medicine (EBM) and recommends a new approach they call “interpersonal medicine.” In my opinion, good clinical medicine is already interpersonal medicine; there is no need for something new. The 22 November 2018 issue of The New England… read more "Should Evidence-Based Medicine Be Replaced By Interpersonal Medicine?"
New Blood Pressure Guidelines: Why Are Previously Normal BPs Now Classified as High Blood Pressure?
Under the new blood pressure guidelines, more people are classified as having high blood pressure; but the treatment emphasis is on lifestyle changes, not medications. The American Heart Association and the American College of Cardiology recently released new guidelines for the diagnosis and treatment of high blood pressure. The highlights are reported here.… read more "New Blood Pressure Guidelines: Why Are Previously Normal BPs Now Classified as High Blood Pressure?"
Vaginal Birth After C-Section: How Safe Is It?
Doctors used to insist “once a C-section, always a C-section.” Today it is standard practice to allow vaginal births after C-section (VBAC) for appropriately selected patients. The American Congress of Obstetricians and Gynecologists (ACOG) has issued a Practice Bulletin to guide obstetricians in determining which patients are appropriate candidates for VBAC. We… read more "Vaginal Birth After C-Section: How Safe Is It?"
Who’s Crazy Now? DSM-5 and the Classification of Mental Disorders
What does it mean to be crazy? We use the word loosely. In casual conversation we might say “He’s crazy” or “That’s insane!” but that doesn’t mean we really think the person is certifiable. Sometimes all it means is “He doesn’t agree with me.” What does it take to be… read more "Who’s Crazy Now? DSM-5 and the Classification of Mental Disorders"