I recently gave a lecture to 70 primary care physicians here in Stockholm, titled “should the patient really get the drug?”. The lecture seemed to generate quite a bit of cognitive dissonance among some in the audience, based on the somewhat aggressive discussion that followed the lecture, which suggests to me that much of what I was saying was stuff they had literally never been … Read more
Bisphosphonates: pros and cons
Bisphosphonates are one of the most commonly prescribed drug classes. Their intended purpose is to strengthen bones, and thereby prevent fractures. They are primarily prescribed to postmenopausal women with evidence of bone thinning, either because a bone scan has shown that they have a weak skeleton, or because they’ve experienced a fracture from relatively low energy trauma. Examples of drugs in this class are alendronate, … Read more
What defines a good drug?
Most people will naturally assume that when a doctor prescribes them a drug, it’s because the doctor thinks they will receive a meaningful benefit from it. Most people have never heard the term NNT, which stands for Number Needed to Treat, or to put it another way, the number of people who need to take a drug for one person to see a noticeable benefit. … Read more
Why sleeping pills are a bad idea
I hate sleeping pills. I really hate them. The negative emotional response I get when I see them in a patient’s chart is much stronger than what I feel when I see pretty much any other drug. In particular, there is one class of sleeping pill that I really hate, and that is the weirdly named “nonbenzodiazepine”, which is basically a benzodiazepine (a highly addictive … Read more
Why our food is killing us, with Dr. Robert Lustig
Robert Lustig is an American physician and researcher who has written extensively about how our modern food environment is poisoning us. His 2012 book “Fat Chance” was a New York Times bestseller. He recently came out with a new book, “Metabolical”, in which he lays out in detail the science of how and why modern processed foods destroy our health. He also explains why the … Read more
Why we get fat, with David Raubenheimer and Stephen Simpson
David Raubenheimer and Stephen Simpson are biologists who have dedicated their careers to trying to understand how animals decide how much to eat and what to eat. They started with insects, and then moved on to small mammals, and ended up looking at humans, and they’ve chronicled their research in their book “Eat like the animals”.
What they’ve discovered is that most animals, including … Read more