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Showing posts from May, 2023

Memorial Day 2023 - Freedom is not Free

I have never served in the armed forces, but I have enormous respect for our veterans and for those  who serve now.  My father served for 39 months during World War II.  Fortunately, he was not placed in harm's way.  During that era, nearly every young male served joining together in an existential conflict between good and evil.  This experience bound the entire nation together in a shared purpose with shared sacrifice.   Our nation so desperately needs an experience that will transcend our divisions to unite us as Americans.  Is there a moonshot out there that we could all rally behind?   Is there a leader in sight who can bring us together?  What if we could agree on our country's top 3 goals and then join forces to achieve them? Hey wait, I have an idea.  What if a deadly pandemic swept across the nation that could have the potential of causing over a million fatalities?  Facing this common enemy, we would surely become united against a deadly foe that was striking wildly w

Lessons from the Pandemic - Did We Strike the Right Balance?

We all have taken lessons from the pandemic. There were many things we got right, particularly the development and administration of safe and effective vaccines.  There was also much we got wrong including inaccurate and contradictory information from government agencies and keeping kids out of school long after the data supported a return to in person learning.  And while I am not a public health expert, I still wonder about the wisdom of having imposed restrictions and mitigating measures on all of us rather than focus more narrowly on at risk folks.  I realize that this is a controversial issue as there was the fear that low-risk individuals could transmit the virus to a vulnerable recipient.  The mortality and morbidity in elderly infected people were quite different from that of younger and sturdier individuals.  Public health experts argued that we needed a broad brush to protect more people. Coronavirus Caused Illness, Death, Anger and Division Protecting public health should

Is Anesthesia for Colonoscopy Safe?

Sometimes, we read about a study result that is widely publicized, yet we are reluctant to accept its absurd conclusions.   I’m sure there are studies buried somewhere that conclude that seat belts and bicycle helmets are dangerous and that cigarettes prolong life.   If such studies do exist, they would face mountains of contrary scientific evidence.  In other examples, a medical study’s conclusions may be false or misleading because the data are improperly or inadequately interpreted.   Consider this hypothetical study.  One hundred patients with rheumatoid arthritis (RA) patients and 100 control patients are questioned about their exercise habits.  Ten percent of RA patients exercise regularly in comparison to 40% of the control group.   The authors than conclude that exercise might protect against the development of RA.  There are many scientific reasons why this conclusion is erroneous including the probability that RA patients don’t exercise as much because they have arthritis. 

Is There a Safe Blood Thinner?

For those who can’t stand the sight of blood, I would advise against pursuing a career in gastroenterology.   We confront blood more often and more directly than nearly every other medical practitioner.   One of the most common reasons we are called to see hospitalized patients is to evaluate internal bleeding that originates somewhere within the alimentary canal.   It is then our task to identify the exact site of leakage and to caulk the leak, if possible.   As even a casual TV watcher knows that blood thinning medications are ubiquitous.    In the olden days, there was Coumadin (aka warfarin), which is still in use today.   It is a rather clumsy drug that requires frequent monitoring and dosage adjustments.   At times, and for no apparent reason, a Coumadin user’s blood will become thinner than desired and internal bleeding may result.   More recently, new generations of blood thinners have emerged giving physicians many new ways to thin their patients’ blood.   These newer agen