Monthly Archives: February 2014

Price Check! Genital Herpes. How Much is Nursing Time Worth?

It is worthwhile to check drug prices now and then (once a quarter seems about right) to see what is happening in the pharmaceutical world.  When you do this, you will find some drugs that have inexplicably shot up in price.  One recent example was doxycycline, which went from around ten cents a tablet to over two dollars a tablet in a couple of months.

On the other hand, drugs that we think of as expensive in the back of our minds sometimes are no longer expensive.  Olanzapine (Zyprexa) is now cheaper than haloperidol.  Risperidone is cheaper still.

And sometimes, a drug that is a bit more expensive than its alternative is still the most cost-effective treatment based on “the hassle factor,” meaning frequency of dosing, ease of administration, potential for diversion–that sort of thing. Drugs prescribed for outbreaks of genital herpes are like that, in my opinion.  Valacyclovir can be more cost-effective than acyclovir for the treatment of recurrent genital herpes.herpes1 Continue reading

A Quick Spin Around Dizziness–a guest post by Dr. Bill Wright

Dr. Bill Wright

Dr. Bill Wright

My good friend Dr. Bill Wright guest-wrote this post about dizziness.  He is the author of Maximum Insecurity: A Doctor in the Supermax, which you should read if you have not!  Thanks, Dr. Wright!  –Jeff Keller

“Can’t you understand? I’m just dizzy!”

Do these words make you want to head for the clinic exit? If so, you’ll find a lot of company trying to get through the door. Many physicians hate to see dizzy patients because they can’t easily get their heads around the complaint. They can’t see, hear, feel, smell, or touch it, so it’s hard to know where to start. Help is on the way. Continue reading

Introducing C.F.O.A.M. (and Other Changes)

It is June, 2012 at a pub in Dublin, Ireland. During a break in an international Emergency Medicine conference, and over a pint of Guinness stout (what else?), several doctors were discussing how much medical information was freely available online. Everyone in attendance agreed that the way that medical information is shared has changed radically in the last 30 years—from a few choice textbooks on the office bookshelf and subscriptions to a few medical journals to the availability of most textbooks and journals instantly, online. Not only that, but instant messaging services like Twitter make it possible to get medical help from experts almost instantly—even if the expert is on the other side of the world! In fact, the main problem now is harnessing the incredible potential of the internet to improve medical knowledge and decision-making. Where are the really good reservoirs of medical information online? How can we more easily communicate with our colleagues and friends when we need help with a vexing case?19970122 Continue reading