Generic Drugs
Lately I have found treating Glaucoma to be very frustrating. More and more of our drugs are being pushed as generics, yet they are clearly not equivalent drugs. Every drug company has numerous studies showing the subtleties of ophthalmic drug formulation, from preservatives to suspension size, that have dramatic effects on the effectiveness of drugs via the topical ophthalmic delivery route. Yet when we petition to have a more effective drug approved for our patients, we are asked on a case by case basis to 'prove' that the generic is not effective. Excuse me? How about we have the generic manufacture 'prove' that it is? How exactly do I 'prove' the drug was ineffective in clinical practice? To further muddy the water, numerous manufactures are making the same drug with differing formulations, and patients receive these different bottles at random.
Someone needs to find out!
Thursday, March 15, 2012
Wednesday, May 25, 2011
Sunshine
I am one of those 'Nuts' that thinks sunshine is good for you. I also think there is more to it than just vitamin D, but that is for another post.
I cannot help but notice in my twenty plus years of practice that nearly all of my Breast Cancer patients have what I would call an unhealthy pallor. There is a trend among women to avoid the sun, wear sunscreens in nearly all cosmetics and if they go to a Tanning Bed they go to the ones with only UVA which prevent the formation of any significant Vitamin D. Newer studies have suggested that Vitamin D is protective against cancer. That research is encouraging but cannot be the whole story.
Someone needs to find out.
I cannot help but notice in my twenty plus years of practice that nearly all of my Breast Cancer patients have what I would call an unhealthy pallor. There is a trend among women to avoid the sun, wear sunscreens in nearly all cosmetics and if they go to a Tanning Bed they go to the ones with only UVA which prevent the formation of any significant Vitamin D. Newer studies have suggested that Vitamin D is protective against cancer. That research is encouraging but cannot be the whole story.
Someone needs to find out.
Tuesday, April 26, 2011
Smart Bugs
As I listened to a fellow practitioner explain to a patient how a fever is beneficial, I remembered that I did not personally ascribe to that theory. Why? Let me explain using two examples.
First, ever notice how it is that when you have a dripping sinus, it eventually turns into a sore throat? If you are lucky you then progress into bronchitis and occasionally pneumonia. Why? Because most of these organisms are non-motile, they have to 'ride the wave' to move throughout the body. It is to their benefit to have the capacity to stimulate those secretions, yet the accepted theory is that the secretions are part of the bodies plan to rid themselves of the offending organism. It would also explain why so many infections don't seem to be especially virulent unless the nasal region is first inoculated.
Continue along those lines to fevers. Everyone knows how weak you become when you have a fever. Perhaps the change in temperature is to lower the viral replication potential as theorized. But maybe the virus stimulates an abnormal body temperature to impair the body's immune response potential.
I know two things for sure. Ibuprofen IS a miracle drug. And drying up sinuses DOES work.
Somebody needs to find out.
Wednesday, April 20, 2011
Left side Right side
Ok, I have an admission to make. No research whatsoever was done for this particular post. Namely because it was an observation in passing that might be of interest to someone, but not particularly to me!
Twelve years ago, when my daughter was small, my wife expressed relief that she showed no left handed tendencies. When I wondered aloud why it mattered, my Chinese wife explained that in the Orient, there was a stigma attached to left handedness. She told about how her mother spent hours taking things out of her siblings left hands and placing them in their right hands. Did it work? Apparently so.
I remember in Medical school years ago, diagrams of right and left side functions that were different in Asians from other groups. Perhaps the study subjects self identified as right handed, indeed never knew any different, when actually they were left handed from birth?
Twelve years ago, when my daughter was small, my wife expressed relief that she showed no left handed tendencies. When I wondered aloud why it mattered, my Chinese wife explained that in the Orient, there was a stigma attached to left handedness. She told about how her mother spent hours taking things out of her siblings left hands and placing them in their right hands. Did it work? Apparently so.
I remember in Medical school years ago, diagrams of right and left side functions that were different in Asians from other groups. Perhaps the study subjects self identified as right handed, indeed never knew any different, when actually they were left handed from birth?
Thursday, April 14, 2011
Glaucoma
I spend an enormous amount of my professional time treating glaucoma. When I graduated, a senior private practice doctor asked me if they had taught me anything about a connection between cardiac health and glaucoma. I admitted they had not. But I promised to research it. A year later, our office had started a project to contact every patient that had never returned for a follow-up of any type, and inquire about why they had chosen not to return. Much to my shock, many of the people I had identified as a glaucoma suspect, did not return for follow-up for one very important reason.
They had died.
Fast forward 20 years. A study recently published in Arch of Ophth concluded that patients who were placed on a glaucoma medication experienced a 74% improvement in mortality. Wow.
I have observed that young patients who present with high IOP commonly have multiple bypass surgery within a couple of years. When I have such a patient, I send them for a full cardiac workup. But since they do not meet typical screening criteria, the referral is not taken seriously. We know that in a heart attack, enzymes, which we use as markers, are released and detectable in the blood stream. Perhaps when the heart is under stress, the same or other factors are released that influence IOP? Someone needs to find out.
They had died.
Fast forward 20 years. A study recently published in Arch of Ophth concluded that patients who were placed on a glaucoma medication experienced a 74% improvement in mortality. Wow.
I have observed that young patients who present with high IOP commonly have multiple bypass surgery within a couple of years. When I have such a patient, I send them for a full cardiac workup. But since they do not meet typical screening criteria, the referral is not taken seriously. We know that in a heart attack, enzymes, which we use as markers, are released and detectable in the blood stream. Perhaps when the heart is under stress, the same or other factors are released that influence IOP? Someone needs to find out.
Asthma
I have been thinking about Asthma a fair amount lately. When I was a child 40 years ago, I was one of only a few students in a large suburban school who had asthma. Now, you can go to a soccer game and nearly the entire team has to stop for a medication break!
When I was a child, they blamed second hand smoke. My mother was made to feel terribly guilty that she had caused my asthma. Cigarette smoking has dramatically decreased while asthma has dramatically increased. Then all the experts pointed to air pollution. Not only has air pollution improved, but more importantly, think about when asthma symptoms are worse and when are they better? For me (and now both my children), symptoms are worse in the winter and better in the summer. Hmmmm. The opposite of air pollution trends. At least outdoor air pollution.
Another observation. A physician friend of mine recommended we try my daughter on a steroid inhaler practically from her first episode. That was an 'off label' use. Guess what? Rarely does she need more than two doses in the same day to clear her asthma, often for weeks at a time. Works even better on myself and my younger son who rarely need more than one 'puff'. Hmmmmm. That is an odd treatment for the 'infectious agent' theory.
The latest theory currently in vogue is that we keep our kids too clean and the immune system is looking for something to do. Ok. Maybe. Blame it on Mom again. But to me the steroid proves that in many cases, we are dealing with a low level inflammation caused by a relatively brief exposure to an inflammatory cause. Perhaps the winter/summer paradox is caused by something the children inhale mostly at school during the school year? Like the so called 'sick building' syndrome. Perhaps a disinfectant that has become ubiquitous in public buildings over the decades? Perhaps one also used at home in typically smaller quantities, enough to make a connection with 'too clean a home'? As studies go, this could be initially as easy as a challenge test. Think ammonia, chlorine, and a host of newer ones. Somebody needs to find out.
When I was a child, they blamed second hand smoke. My mother was made to feel terribly guilty that she had caused my asthma. Cigarette smoking has dramatically decreased while asthma has dramatically increased. Then all the experts pointed to air pollution. Not only has air pollution improved, but more importantly, think about when asthma symptoms are worse and when are they better? For me (and now both my children), symptoms are worse in the winter and better in the summer. Hmmmm. The opposite of air pollution trends. At least outdoor air pollution.
Another observation. A physician friend of mine recommended we try my daughter on a steroid inhaler practically from her first episode. That was an 'off label' use. Guess what? Rarely does she need more than two doses in the same day to clear her asthma, often for weeks at a time. Works even better on myself and my younger son who rarely need more than one 'puff'. Hmmmmm. That is an odd treatment for the 'infectious agent' theory.
The latest theory currently in vogue is that we keep our kids too clean and the immune system is looking for something to do. Ok. Maybe. Blame it on Mom again. But to me the steroid proves that in many cases, we are dealing with a low level inflammation caused by a relatively brief exposure to an inflammatory cause. Perhaps the winter/summer paradox is caused by something the children inhale mostly at school during the school year? Like the so called 'sick building' syndrome. Perhaps a disinfectant that has become ubiquitous in public buildings over the decades? Perhaps one also used at home in typically smaller quantities, enough to make a connection with 'too clean a home'? As studies go, this could be initially as easy as a challenge test. Think ammonia, chlorine, and a host of newer ones. Somebody needs to find out.
Welcome
Welcome to my new Blog!
I have been practicing for over twenty years. Like many doctors, I continually have ideas that result from observations and hours of thought as to why things may be the way we observe. Yet I am often in the wrong field or have insufficient time to carry the ideas further.
About ten years ago, I came up with the idea of an on-line magazine that doctors from all healthcare professions could contribute to. A magazine of ideas. Brainstorming if you will. A place where anyone in the medical field needing a research topic could come to for inspiration. In short, a way to connect possibly brilliant ideas, with brilliant research!
At the last large research seminar that I attended at UAB, I was surprised to see the level of secrecy that surrounded every presentation. I remember one of the event monitors banishing a presenter from the stage because they were not there to share anything. They were there only to tell everyone how close they were to a scientific breakthrough which would reward them with breathtaking amounts of money. Now I am a realist, and money is what people invest in research and money is what they expect to get out. All I ask is that if you take something from this site that proves valuable, at least give the contributing author credit for the idea.
Without a doubt, the internet has raised the educational level of most people. Nonetheless, there is value to a formal education. I do not intend to publish all ideas submitted on this blog. If you have credentials, please so state. I will leave it to my own judgement as to which ideas have merit. Without doubt, that is not fair. But as I tell my children, 'fair' is where they show cows and horses! I ask that you do not let that deter you and I will always give proper credit to those who submit.
I have been practicing for over twenty years. Like many doctors, I continually have ideas that result from observations and hours of thought as to why things may be the way we observe. Yet I am often in the wrong field or have insufficient time to carry the ideas further.
About ten years ago, I came up with the idea of an on-line magazine that doctors from all healthcare professions could contribute to. A magazine of ideas. Brainstorming if you will. A place where anyone in the medical field needing a research topic could come to for inspiration. In short, a way to connect possibly brilliant ideas, with brilliant research!
At the last large research seminar that I attended at UAB, I was surprised to see the level of secrecy that surrounded every presentation. I remember one of the event monitors banishing a presenter from the stage because they were not there to share anything. They were there only to tell everyone how close they were to a scientific breakthrough which would reward them with breathtaking amounts of money. Now I am a realist, and money is what people invest in research and money is what they expect to get out. All I ask is that if you take something from this site that proves valuable, at least give the contributing author credit for the idea.
Without a doubt, the internet has raised the educational level of most people. Nonetheless, there is value to a formal education. I do not intend to publish all ideas submitted on this blog. If you have credentials, please so state. I will leave it to my own judgement as to which ideas have merit. Without doubt, that is not fair. But as I tell my children, 'fair' is where they show cows and horses! I ask that you do not let that deter you and I will always give proper credit to those who submit.
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