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FDA and Herbal Medicine - Caveat Emptor!

Many of my patients are taking herbal supplements, or so they think.  This herbal and health supplements industry likely is envied by traditional pharmaceutical companies.  The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA).  Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known or a new medicine is proved safer and superior.  While it’s not quite a crapshoot, there is a strong element of chance at play here. Roll the Dice with the FDA? Herbs and the supplements that are saturating our airwaves escape FDA scrutiny.  They will only draw governmental fire if they are deemed to be dangerous.  They are required to use certain language in their promotional materials that differs from traditional FDA approved prescription medicines.  Take a look at this example: Fosamax:  The FDA has approved this for the treatment and prevention of osteoporosis Glucosam

Medicine is an Art and Science

Medicine is an art, not a science.  We’ve all heard that maxim before, but what does it actually mean for living, breathing patients? Physicians rely upon knowledge and experience when we advise patients.   We try to stay current on relevant medical studies to guide us, knowing that the latest medical ‘breakthrough’ may be debunked in a few years.  Seasoned physicians resist the temptation to abruptly change their medical advice based on a single study, even if published in a prestigious journal. Knowledge and experience are important, but judgment trumps them both, in my view.   The best clinicians are those who consistently exercise excellent medical judgment. A knowledgeable physician may be able to recite a dozen explanations for your high calcium level. An experienced doctor can expertly perform a colonoscopy having mastered the technique. A physician with a high level of medical judgment knows that surgery is wrong for a particular patient, even though medical t

Money Back Guarantee on Medical Care?

How many times each week do we hear the phrase, 'if you're not completely satisfied, we'll refund the purchase price - no questions asked." This is more often a marketing ploy than a true money-back guarantee.  I have a sense that trying to obtain a promised refund on an item that dissatisfied us is about as easy and carefree as changing an airline ticket reservation or reaching a live human when our home internet service is down.   So, when the weight loss pills don't really melt the pounds off, don't be shocked if the check isn't in the mail when you mail back the placebo pills to a post office box several states away.  And, of course, you won't recover the shipping and handling costs. Send Stuff to P.O Box in Southeast Asia Photo Credit This is my opportunity to ask for help from my erudite readership.  What exactly is shipping and handling?  Doesn't postage already cover the 'shipping'?  $8.95 seems pricey for a 'han

The Doctor-Patient Relationship, Is There an App for That?

I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace.  I realize this is ho hum to the under 35 crowd.  Soon, there won’t be any paper checks as the entire transaction will occur electronically.  As a member of the over 35 crowd (plus 20 years), I am wowed by this process.  I remember being astonished when my kids told me how they performed this same process months ago.   It’s the same amazement I experience when I first read about a new piece of technology called a ‘fax machine’. You mean you slide a document into a machine and an exact copy emerges elsewhere? In my younger days, depositing a check into a bank account meant waiting in line with my bank book in hand waiting for a living, breathing human to count and record my allowance and snow shoveling earnings.   The bank that my kids use has no physical offices.  It is entirely in the Twilight Zone. Medicine will not be left behind here.  The manner in

Rolling Stone Magazine Rolls the Truth

  Recently, I was with a group of good friends whom I have known for 20 years.  They are a spirited group of unabashed liberals.  I doubt any of them have ever voted for a Republican, or ever would.  Of course, we have a secret ballot in this country so we never know for sure.  Publicly, at least, they profess unwavering fealty to the Democratic Party. I regard myself as a political independent, although I tend to vote Republican.  However, when I am amid this group of left-leaners, they look to me for the ‘far right’ view on the issues of the day.  Yes, we have different views on the proper role of government and the judiciary, but I don’t look to Ted Cruz or Sarah Palin for political inspiration. During our conversation, the recent Rolling Stone journalistic debacle that detailed an alleged rape at University of Virginia came up.  Immediately, the prevailing liberal talking point was offered up to the group, expecting acclamation.   “This Rolling Stone retraction is

Ready for the Silent Treatment?

When moved to do so, I wander off the medical commentary pedestal to share thoughts with readers.  This is one of those occasions.   I had a singular experience last weekend that impacted me. Most of us can agree that there is a paucity of silence in our world.  There is noise and static everywhere filling our time and space with cacophony.  Television news shows have become performances where we watch panels of pundits who appear as clucking hens.  Try to find a coffee shop that isn’t blaring music.  Even sports games on television have every nanosecond filled with barkings from commentators.  Can’t we just enjoy the play? Last Sunday, I went to a Quaker Meeting House for the first time, accompanied by my daughter Ariella, representing our family.  There was no speaker, ushers, music or program of events.  The room was set up with chairs in each half that faced each other.  Folks took their seats and remained quiet.  At first, I was disquieted by the quiet, impatient for some

What's the Cause of Chronic Abdominal Pain?

I see patients with abdominal pain every day.  Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable.   I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion.  With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal distress.   I wish it were the case. Some Cases Defy Sleuthing The majority of cases of chronic abdominal pain that I – and every gastroenterologist – see will not be explained by a concrete diagnosis.   Sure, I’ve seen my share of sick gall bladders, stomach ulcers, diverticulitis, bowel obstructions, appendicitis and abdominal infections, but these represent a minority of my afflicted patients.  Patients with acute abdominal pain are more likely to receive a specific diagnosis, such as those listed above.  However, patients who have abdominal