Should the patient really get the drug?

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

Is insulin life-saving for type 2 diabetics?

There are two diseases that share the name “diabetes mellitus”. This is unfortunate, because the diseases have very little in common, except for the fact that both are associated with high levels of glucose in the blood stream. Type 1 diabetes is an auto-immune disease, in which the immune system destroys the insulin producing cells that reside in the pancreas. Type 1 diabetics quickly die … Read more

Why medicine is broken, with Seamus O’Mahony

Seamus O’Mahony is an Irish physician who’s written a trilogy of books that explore the varied ways in which modern medicine is broken. The first book, “The way we die now”, discusses how the movement of death in to hospitals in the modern era and a culture of denial around mortality has resulted in horrendous overtreatment of dying patients up until the very moment … Read more

Does covid cause brain damage?

The latest in the long succession of attempts at maximizing people’s fear of covid is the claim that it causes brain damage. And not just in those who have spent time in the ICU, in everyone, even if all they had was a mild cold. The claim is currently doing the rounds on social media (apparently alarmist propaganda only counts as misinformation if it’s going … Read more