Disease

High blood pressure, hypertension, is a pervasive health problem in the U.S. and globally. It consumes significant amounts of health dollars and is a co-morbidity or risk factor for many of the chronic diseases that ‘plague’ Western society. Given all the costs and concerns you think we could easily describe the natural history of the onset of hypertension, Because we tend to think in moments rather than longitudinally high blood pressure is defined as crossing some, arbitrary and often controversial threshold (the current guidelines are 130mmHg for the systolic, or upper number). A recent paper in JAMA provides insight into the dynamics of hypertension’s onset. It is not as cut and dried as our numerical threshold suggests.

In the static model, one day you are normal, the next...

As a vascular surgeon many of my patients had diabetes and in evaluating their surgical risk I was taught a rough rule of thumb:  the chronologic age of a patient with diabetes added to the duration of their diabetes was a good measure of their physiologic age, e.g., a 65-year-old with a 20 year history of diabetes was physiologically 85. A paper in The Lancet demonstrates the truth of that heuristic in Type 1 diabetes.

Type 1 diabetes represents a significant chronic disease of childhood and results in a lower life expectancy, primarily from cardiovascular disease. While Type 1 diabetes represents an autoimmune disease in which the insulin-producing cells of the pancreas are destroyed there is increasing evidence that it is not one monolithic process. Varying biomarkers suggest...

Gender disparity, the real and the “not really” is to be found everywhere. There is a growing body of research claiming that women and men physicians are better or worse than one another concerning the care they provide or the income they receive. A new study suggests that when women treat women for heart attacks, they have better survivals then when cared for by male physicians. It advances a literature that continues to be flawed and as a result should be considered with a large, large grain of salt.

In this study, the emergency department (ED) records for patients admitted to Florida hospitals was examined looking at survival. The researchers choose the ED because it is often first come, first served, with the most ill at the front of the line so that the physician caring for...

We've officially gone full circle. There was a time when people feared that artificial sweeteners caused cancer. (They don't.) Now, researchers claim that artificial sweeteners prevent cancer. Do they?

It's biologically plausible. Cancer cells undergo what is known as the Warburg effect. Typically, our body cells generate energy through a process known as aerobic respiration, but cancer cells ramp up fermentation, instead. Just like a muscle doing vigorous exercise, cancer gobbles up glucose (a sugar) and spits out lactic acid. Hypothetically, depriving a cancer cell of sugar could remove an important fuel source.

A team of researchers conducted a cohort study that examined the self-...

A new trial to assess the benefits and safety of stem cell transplantation for treatment-resistant Crohn’s disease has started. The researchers will use stem cells to “reboot” the immune system so that it is more responsive to existing drugs used to treat the disease.

Crohn’s disease is a long-term condition that results in inflammation of the lining of the digestive system. It affects as many as two people per 1,000 and is becoming more common.

People who have Crohn’s disease can suffer from diarrhea, abdominal pain, extreme tiredness and weight loss. Untreated, the disease has a significant impact on quality of life. Although Crohn’s disease can occur at any age, it usually manifests...

E. coli. Salmonella. Campylobacter. Norovirus. When somebody gets sick eating at a restaurant, these are often the culprits. But McDonald's has been hit by an outbreak of Cyclospora. I'm a PhD microbiologist -- who has taken two classes in medical microbiology -- and I'd never heard of that. What is it?

Though it sounds rather inconceivable, the truth is that we don't know much about Cyclospora. So, here's what we do know:

Unlike the aforementioned, which are bacteria or viruses, Cyclospora is a parasite. Like many other parasites, it has a...

As I've written before, drug companies, no matter how revolutionary a discovery they make, cannot control human behavior. Antiretroviral drugs, which decrease levels of HIV to such low levels that it cannot be transmitted have made unprotected sex "safe." But while it may keep you safe from HIV, this does not hold true for other sexually transmitted diseases (STDs). The decreased use of condoms resulted in a huge spike (1) in other sexually transmitted diseases, especially syphilis and gonorrhea

In a way, history is repeating because once again,...

Blood glucose is regulated by a network of organs inter-connected by nerves and chemical mediators some that we have identified, others we have not. Despite our increasing knowledge and belief that blood sugar is a dynamic response across a complex network, diagnostically we continue to rely on fasting blood sugars, a response to a glucose load or hemoglobin A1C.

The increasing incidence of diabetes has focused our attention on the “run-up” to a formal diagnosis, something that is termed pre-diabetes. The conceptualization of this “sub-clinical” dysregulation of glucose metabolism suggests that diabetes falls on some form of linear spectrum. While this is a conceptual improvement, it still does not incorporate the dynamics of a network of interactions. The requirement that...

We’re all well aware of the growing threat of superbugs. There are plenty warnings about how we encourage these antibiotic-resistant bacteria by either overusing antibiotics or not finishing a prescribed course of treatment. But while this has hopefully made people more cautious about misusing these drugs, few probably give it a second thought when it comes to their pets. As it turns out, this is going to have to quickly change.

It is well known that farm animals are an issue. Many of the antibiotics we give them are also used in humans, so superbugs on farms threaten us all. There are also problems with antibiotics getting into the water table because of farm run-off. The World Health Organization...

Bundled care, actually bundled payments refers to packaging hospitalization and the following 90 days of care into a single fee. CMS has successfully deployed these programs for knee and hip joint replacements generating significant savings which they share with the hospitals that have volunteered for the programs. A new study in the New England Journal of Medicine looks at bundled payments for medical conditions raising questions about how much we can generalize the results from surgical conditions.

The Study

The researchers obtained cost data on bundled payments to hospitals for five common medical conditions, heart failure, pneumonia, chronic obstructive pulmonary disease, sepsis and acute myocardial infarction. They utilized data for six month periods...