Understanding Select Conditions and Illnesses

What is a Heart Murmur?

What is a Hernia?

What is a Testicular Varicocele?

Allergies And Upper Respiratory Symptoms

Generic Medications



Updates January 20, 2014

The Poor Health Insurance Companies

It’s hard for me to read this article for a few reasons.  I guess I am glad that the for-profit, contributing-little-if-anything-to-the-health-of-our-nation health insurance industry has found a voice.  I am more offended that I went to college with this guy.  A college which was very diverse, but I felt that one thing that united all of us was our commitment to fairness and justice in the world, or at least the world we can influence.  Regardless of any problems that the Affordable Care Act faces, President Obama should be proud that it is referred to as Obama Care.  His legacy will be to ensure that citizens of our country enjoy the rights that those of every other developed countries have had for decades.  If Humana goes bankrupt, hooray.  Perhaps we’ll get one step closer to insurance reform or even a single payor system.


Updates July 1, 2012

Let’s (not) get Physicals

This article is misguided in several ways. A physical exam is not a few blood tests. It involves establishing and fostering a relationship with a primary care physician. To say that people should not get physicals because PSA screening has been shown to not be cost-effective is not only potentially wrong (depending on price tag one puts on a year of life) but also misguided. The patients with a testicular mass, prediabetes, leukemia, obesity, drug dependence or other health concerns that get diagnosed and treated because of a routine physical certainly derive some benefit. If one in twenty physical exams makes someone lose 10 pounds, quit smoking, start treating undiagnosed high blood pressure, or make any number of small changes that a physical exam often provokes, there is certainly some cost benefit. Being able to call see one’s primary care physician who knows your history because of routine visits keeps people out of emergency rooms. And in a country where at least 25% of health care expenditures are spent in people’s last year of life (often because they did not address end-of-life issues with a primary care doctor ahead of time), is spending the pittance that we currently spend on primary care and preventive medicine the biggest issue we face?


Updates February 9, 2012

I’m trying to update this section with the handful of articles about health and medicine that I found particularly interesting on a monthly basis. Here are a few that I hope you’ll enjoy:

EHR Templates: Time Saver or Patient Safety Risk?

Interesting article on electronic health records.

Why Early Detection Is the Best Way to Beat Cancer

This article from Wired really turned my thoughts about cancer research upside down. We’ve made huge strides in understanding what cancer is and how it emerges and evolves, but little of that knowledge has translated into treatments that increase cure rates significantly. The few screening tests we have for early detection are pretty blunt instruments, but when they catch an early stage cancer, the cancer is nearly always curable. This article suggests that we focus more on honing the methods for early detection. It would be cheaper, more quickly attainable, and probably save a lot more lives.

The Score

Why are there so many more C-sections these days. It’s complicated. Atul Gawande does a brilliant job of explaining the many reasons for why C-sections are out-scoring natural childbirth at such an alarmingly quick pace.

Every Patient Tells a Story

I really enjoyed this book by Dr. Lisa Sanders, whose byline is often seen in the New York Times health and science sections. The book is a little all over the map, which I personally found one of its endearing qualities, but infinitely readable and truly thought-provoking. The link is to a review of the book I found in a neurology medical journal, an interesting perspective for sure.


Updates January 30, 2012

There are a few things that I have been meaning to post on this page for a long time. Hopefully some of these things are of interest.

MRI Overuse

A thorough physical examination for musculoskeletal injuries is nearly always enough to diagnosis the problem, but physicians still routinely order MRIs. This article shows how MRIs can find abnormalities that may not be contributing to patients’ pain, and how they can often befuddle rather than clarify the situation when patients have fairly straightforward complaints


So many patients suffer from anxiety, and so few of them are willing to try anti-depressant drugs. I’m the last person to push psychotropic medications, but when one’s life is being hijacked by unmanageable anxiety, I feel that they’re worth a try. One is not making a lifelong commitment or admitting a personal failure, and she/he may actually rediscover the person they once were. This essay says it so well.

Morality Pill

This opinion piece really reinforces the ideas in the above article.

Attention Deficit Medication

Every adult on psycho-stimulant medication for attention deficit disorder needs to read this article.


New Stuff – August 20, 2011

I realize it’s been a long time since I put anything new here. I hope that anyone who is perseverant enough to reach this part of my site will find these new bits at least somewhat interesting.

Shared Medical Decision Making

This is my goal as a physician. I truly want people to understand what I do; how I evaluate their health, how I formulate diagnoses about potential illnesses, why I order additional testing or referrals to specialists to strengthen these diagnoses, and with what evidence I recommend various options for treatment. If less than half of my patients can’t answer basic questions about their medical issues, then I have failed them as a physician. If any of my patients have questions that they feel I don’t have time to answer or that I would think the answers are so obvious that they’re embarrassed to ask, then I may as well retire. I also understand that sometimes people want me to tell them what I would do personally if I were in their situation, and I do, being careful to point out my biases and personal situation, but shared decision making leads to better outcomes precisely because the solutions that this approach lead to are a collaborative effort, and when one has ownership of a solution it’s bound to be more successful.

In Search of a Good Doctor

This New York Times article mentions many of the things I say on my website about board certification, etc. I guess I just want you to know that the folks at the Times seem to agree with me.

Overuse of Statin (Cholesterol-lowering) Drugs May be Preventive Medicine Gone Awry

This article is a fair and balanced report about the use of these medications for patients who have high cholesterol but have not had a heart attack or stroke. This is termed primary prevention, preventing a issue from happening in the first place. Secondary prevention refers to preventing the same problem from occurring again. If one has had a heart attack or stroke, and you take statins to prevent another event, that is secondary prevention, for which statins have been shown to be exceptionally effective. People with other cardiovascular risk factors like family history, smoking, or obesity can probably benefit from statins for primary prevention. This article and especially the comments after it are a bit inflammatory, but I think provide a firm basis for not drinking the stain/cholesterol Kool-Aid without a grain of salt.


General Health Websites

Up to Date for Patients

This is the patient-oriented version of a web resource that I and most of my colleagues use daily. Each article on this website is written by an expert in the field and refers to published research about the topic. There is usually little need to go any further for balanced and accurate medical information

The Body

For HIV-positive folks and those interested in learning more about HIV, this is the source. A great mix of medical, social, legal, and psychological information about HIV/AIDS.



Vitamin D Myth

Every doctor seems to be testing people’s vitamin D level. I personally have never thought it that important, and truly doubt that there are many people truly suffering from vitamin D deficiencies.

The Vitamin Myth – Reader’s Digest

I know, Reader’s Digest. It’s a well-written and well-researched article that doesn’t make any claims that aren’t backed up by solid medical science, unlike the supplement industry.

What Makes People Gay – The Boston Globe

If anyone out there still thinks it’s a lifestyle choice, this scientifically astute article will quickly disabuse them of that notion.

Lung Cancer Patients Who Quit Smoking Double Their Survival Chances

Without question, quitting smoking is the single best thing a smoker can do to improve his or her health. Sometimes people think that the damage has already been done, but it’s never too late, and regardless of when one quits, there’s always a benefit.

City Endorses New Policy for Treatment of H.I.V.

There has been a lot of study regarding starting people with HIV on medications earlier than was before thought appropriate. This article discusses how the city of San Francisco has taken these studies to heart.

Does Your Language Shape How You Think?

While not necessarily health-related, this article talks about fascinating ideas in evolving neuroscience. The fact that it was the most forwarded article on the NY Times website speaks to the science geek in all of us.

A New View on Inflammation

This article about inflammation is a bit old, but what it has to say about the role of inflammation in so many chronic diseases, like heart disease, cancer, and auto-immune disorders, is still very relevant. I feel that this is the first article that makes this emerging science accessible to the general public

Medical Errors Continue to Kill Patients

Yet another article that reinforces the idea that having a primary care doctor is incredibly important.


HIV Articles

Life Expectancy Continues to Rise for HIVers on Treatment, Huge Study Finds

There are many studies that use various mathematical models and other techniques to predict the average life expectancy of people newly infected with HIV. They all fairly consistently conclude that while HIV infection probably will shorten life span, the reduction is less than 10 years and decreasing consistently over time. Given the pace of medical advances, the impact of HIV on life expectancy will almost certainly become even less.

City Endorses New Policy for Treatment of H.I.V.

There has been a lot of study regarding starting people with HIV on medications earlier than was before thought appropriate. This article discusses how the city of San Francisco has taken these studies to heart.

HIV Vaccine Advance

This article does a very good job of explaining the very complex science behind the recent advance in HIV vaccine development.


Study The recent trend in starting patients with HIV on anti-retroviral medications was strongly influenced by the NA-ACCORD study. The following article does a good job of explaining this very large and complicated study.

HIV drug proves to be effective in preventing HIV.

This study has taken years. It’s not so clear what the implications are for Americans at moderate or even high risk for contracting HIV. Should we focus on drugs to prevent HIV infection, or should we continue to pursue efforts to change behaviors in people who are at high risk for HIV infection? This is an important study that answers some of these questions.


Other Disease-Related Articles

Orthostatic Hypotension and non-Pharmacologic Methods of its Treatment

Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint. While more serious cases of orthostatic hypotension sometimes need treatment with medication, life style changes and some simple home remedies can successfully treat most cases. Most of these techniques can be found in this article

The American Heart Associations Stance on High Blood Pressure

So often patients are reluctant to start medication to lower their blood pressure, feeling somehow that the side effects of medication outweigh their potential benefits. This page on the American Heart Association explains the risk of untreated blood pressure very well.


Health Policy Articles

How the Health Care Overhaul Could Affect You

This article from the New York Times does a great job of simply but comprehensively explaining what the health care legislation means and how it will impact citizens


My Publications

Influenza Vaccination and False Positive HIV Results

This is an article that I co-authored about how when an individual gets vaccinated for influenza, there is a small chance that they will test positive for HIV for several weeks after the inoculation. I never anticipated the response that this article would precipitate. We never intended this publication to suggest that HIV was not the causative agent in AIDS, as many have suggested. I and my colleagues just wanted the public to be aware that influenza vaccination can confound HIV testing, and to suggest that clinicians utilize alternative types of HIV testing such as viral load measurement when dealing with a patient who has a positive antibody test after influenza vaccination.

CCR5 Antagonists in the Treatment of HIV-Infected Persons: Is Their Cancer Risk Increased, Decreased, or Unchanged?

While I was working at Pfizer, I published this somewhat esoteric article about cancer risk in HIV patients using drugs that block the CCR5 receptor.




I am occasionally asked about books or products that I would recommend.  Amazon carries pretty much every item one could imagine, so it’s a good resource for providing a web link to various products.  A handful of items are listed below.  Full disclosure here – I will make a percentage of the purchase price if you buy these items through Amazon, and that would be nice, but primarily this listing of products is intended to guide you towards books, devices, etc that I have vetted and in which I have confidence.  If you get them from the public library, borrow them from a friend, or find a better deal elsewhere, I’m very happy.




Home Blood Pressure Monitor

I am often asked about home blood pressure monitors. When people come to see me, their blood pressure is very often elevated. Usually when I repeat the reading at the end of the visit, it has gone down. Other times it remains high. It’s impossible to tell if someone has truly, consistently high blood pressure or just has elevated blood pressure in the office because being in a doc’s office make them anxious. There’s even a name for this phenomenon – “White Coat Syndrome.”
One way to make the distinction is 24 hour blood pressure monitoring, which I offer as service in the office. You wear a device that checks your blood pressure every 15-30 minutes for a 24-hour period, and that’s an excellent way of determining your true blood pressure, but home devices can be equally valuable. This is one of the better machines I have seen. If your upper arm (bicep) is bigger than 16 inches in circumference, this device is not for you. We can talk about better alternatives.



A common issue that patients ask me about is irregularity in their bowel movements. The best way to improve in that department is to eat more whole grains, fruits, and vegetables which contain indigestible matter (fiber) that your intestines cannot absorb and pass through your colon undigested, but help to move all the other things in your gastro-intestinal tract along. Taking 2-3 capsules of this supplement daily will help make your bowel movements much more regular, and there is good evidence that increasing your fiber intake can prevent diseases like diverticulosis and even colon cancer. This is not a vitamin. Nearly everyone who eats a reasonable diet does not need vitamin supplementation. This is something that does not get absorbed by your digestive tract and for which there is sound medical evidence for its efficacy.



I cannot tell you how many times patients come to see me with a cough, sore throat, abdominal pain, etc and when I ask them if they have had a fever they say, “I don’t know, I don’t have a thermometer.” When they’re in the office, they have usually taken tylenol or advil which will mask a fever. They may say that they have felt hot or had chills, which is helpful, but nowhere near as helpful as an actual measurement, or even better, multiple measurements of their temperature. There is no way of doing this without a thermometer. A thermometer is something everyone should own.




In Defense of Food

“Eat food. Mostly plants. Not too much,” so begins Michael Pollan’s book about nutrition, the industrial agricultural complex, the local food movement, and essentially how to eat. He’s not plugging a diet program, he’s not saying anything revolutionary (like drink lemonade with cayenne pepper and maple syrup to lose weight.) That he offers no easy solutions and states incontrovertible facts, make this book so valid. Even if it doesn’t change your eating habits, which would be hard to imagine, it’s an incredibly interesting read.


Authentic Happiness

I’m the last person to recommend a self-help book, but while I think most people can gain some insight that will improve their lives by reading this book, it would be a disservice to label this book self-help. Dr Seligman, the founder of the “Positive Psychology” movement, explains his idea – that traditional psychology focuses too much on mental illness and neglects the majority of people who aren’t suffering from mental illness but would like to lead happier lives – in a readable tome that is filled with sound scientific evidence, not merely opinions. While I doubt that you won’t learn something that will enrich your life from this one, even if it leaves you no happier than before reading it, it’s an incredibly interesting, paradigm-shifting work


Trick or Treatment

A few years ago I decided that I should know more about alternative medicine. Patients were asking me about my thoughts about chiropractic, homeopathy, herbal medicine and acupuncture, and I didn’t have much to say. Traditional medical education does not include much about these modalities. Honestly, I went into my research with a very open mind. But over and over, I found that for most of these therapies, there is no sound evidence for their efficacy. I read about a dozen books on the subject. This one I think does the best job of summing up, fairly and accurately, the existing data about alternative medicine.