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Do I Have a Food Allergy?

You might think that gastroenterologists like me are conversant with food allergies.   You would be wrong.   Here is a second misunderstanding you likely harbor.   Most individuals who believe or suspect that they are suffering from a food allergy have no allergic condition at all.   A true allergic reaction involves the firing off of one’s immune system in response to an external stimulant resulting in a rash, wheezing and other characteristic allergic responses.   Poison ivy, for example, is an allergic reaction.   Nausea resulting from an antibiotic is not an allergic reaction.   Physicians, of course, appreciate this distinction.   This is why when you tell us you are ‘allergic’ to a medication, we will ask you specifically what the reaction was.   In my experience, most of these ‘allergic reactions’ are routine non-allergic side effects.   Often enough, a patient will claim to have a penicillin allergy, for example, but has no clue what the reaction might have been.  
Recent posts

What Drives Medical Overutilization?

There are many forces driving utilization in health care.  Patients come to doctors for explanations and relief. They relate symptoms that will likely lead to diagnostic testing.  For example, if you tell your physician that you have a burning sensation when you urinate, it is likely that you will be asked to surrender an aliquot of your urine for analysis.  If you enter your doctor’s office with some difficulty breathing, fever and a cough, I’ll wager that there’s a chest x-ray just around the corner.  These diagnostic tests are appropriate. When does utilization morph into overutilization?   I don’t know where the threshold between them lies.   Moreover, doctors disagree amongst ourselves on what constitutes an unnecessary medical test. Doctors agree that there is too much testing and prescribing going on, but they tend to point their fingers toward their colleagues rather than toward themselves.   Think of politicians here.   It’s common for a congressman to criticize another cong

Surge pricing for Colonoscopies?

Euphemisms are omnipresent.  Recently, I learned a human resources term called rightsizing.  This sanitized version sounds a little softer than employee layoffs, but they mean the same thing.  In the near term, New York City will implement congestion pricing when new Yorkers who drive through Manhattan’s central business district will be forking over 15 bucks for this privilege, $36 if you’re a large truck.  These fee amounts will vary depending upon the time of day traveled.  I suppose the marketing folks felt that the term congestion pricing was more palatable than driver shakedown .  Just a year ago, I railed against another form of customer extortion known euphemistically as a resort fee, when guests' money is essentially confiscated each day that they could have used to purchase goods or services they didn’t need or want.  Here’s the resort fee link but make sure you’ve taken your blood pressure medicine before clicking. Recently, Wendy’s, the fast-food establishment, anno

New Blood Test Detects Colon Cancer - Will Colonoscopy Survive?

Over the past several decades, I’ve earned a good portion of my living performing colonoscopies – tens of thousands of them.  And risking a charge of heresy, I’ll say out loud that patients deserve a better colon cancer screening experience.  Progress is just around the corner.  Here’s a list of negative aspects of the colonoscopy experience.  I’ve got some street cred here.  Although I am usually on the operator end of the scope, I’ve also personally experienced the light at the end of the tunnel. Pre-test anxiety over the outcome. Ingesting liquid dynamite – often in the middle of the night -  and praying for a complete cleanse. Time away from work. D-day!  Enjoy IV needle placement, repetitive interviews, posh medical garments and the dignity of a public airing of high-amplitude flatus. The procedure has risks of complications, albeit at a low rate of occurrence. Driver must be present. Post-test anxiety over pending biopsy results. High aggregate cost including fees from the phys

Artificial Intelligence in Medicine - Caveat Doctor!

Artificial intelligence (AI) has arrived and will permeate every aspect of our society.  It will touch all of us in our work, in the arts, in entertainment, in our government, and in our culture.  As with all technology, it will deliver us both blessings and curses.  We have been sharply warned of its potential destructive capability even by advocates of this technology.  Will governments, industry, and the public agree on proper guardrails and restraint or will the tiger simply be let out of the cage?  I worry that the strategy will be Ready! Fire! Aim! , instead of adopting thoughtful and prudent measures to keep us safe.  Indeed, I’ve offered some sober thoughts on this issue to my readers in a prior post . My medical journals are now riddled with studies on various medical uses of AI portending an unimaginable future in the medical profession. A few paragraphs further down in this post, I will ask my readers a philosophical question regarding AI and I invite a dialogue.   Until

Do I Have a Rare Disease?

 There’s an adage known to every medical student, intern, resident, and practicing physician. When you hear hoofbeats behind you, don't expect to see a zebra. This quote has been paraphrased into several iterations, but the quote is credited to Dr. Thomas Woodward in 1940.   Dr. Woodward, a wise medical professor and Nobel Prize nominee, offered his advice to medical interns.   The aphorism has timeless value. The point is for physicians to exhaust common explanations when confronting medical clues before broadening the exercise to contemplate rare potential diagnoses.    It is more likely that hoofbeats are made by a common horse than a more exotic hoofed beast.   Get it? Let me offer a brilliant quote.   Common things occur commonly.   If a patient sees his physician to evaluate a fever, it’s unlikely that the doctor will entertain malaria as a diagnostic consideration, even though fever is a hallmark of malaria.   Seasoned clinicians will widen their diagnostic view when

Are Probiotics Safe and Effective?

Recently, I stated that probiotics are marketed and sold free from the strict scrutiny of Food and Drug Administration  (FDA) oversight that our prescription drugs routinely undergo.  And this is just how these companies want it.  Trust me, if probiotics had to endure the same vetting process that actual drugs go through, most of them would be snuffed out along the way. Here’s a simplified glimpse of how the system works. Yo ho, hey hey, keep away from the FDA! Many probiotics are classified by the FDA as dietary supplements, rather than drugs.   Indeed, it is this classification that allows the industry to thrive.   The FDA regulates supplements much more leniently than they do conventional prescription drugs that must endure years of intensive vetting and successive clinical trials.  The drug approval process is so rigorous that most drug candidates will not reach the finish line.  The FDA maintains high standards for safety and efficacy.  However, b ecause probiotics are not drugs