Faculty Bibliography

Many, if not most, of the author's New York City patients suffer from acid reflux disease. The introduction of proton pump inhibitors (PPIs) in the late 1980s changed everything. PPIs stand as a triumph of pharmaceutical research, and it seems that it has been underreported just how good they are. Overall, PPIs are a wonderful arrow to have in the medical quiver and have changed the course of esophageal, stomach and duodenal disease

Less than 100 mg/dL -- optimal; 100 to 129 mg/dL -- near optimal; 130 to 159 mg/dL -- borderline high; 160 to 189 mg/dL -- high; 190 mg/dL and above -- very high. Many practicing cardiologists and lipid experts say these target numbers are far too high, and shoot for LDL cholesterols of 70 or 80 even in patients who lack known heart disease. I suggested a high-speed CT scan of the chest for calcium scoring, evidence of calcified coronary plaques. I would also order an ultrasound of her carotid arteries (in the neck), which would provide easy evidence of the kind of plaques that correlate with plaques in the coronary arteries of the heart

There is a new help-you-sleep kid on the block -- Lunesta. Like its older cousins, Ambien and Sonata, Lunesta is a hypnotic sleep drug that is not addictive and does not require larger and larger doses. Ambien and Sonata revolutionized the treatment of insomnia because they can be taken without fear of physical dependence, though they may be somewhat habit forming. Lunesta may have an advantage for people who have trouble maintaining sleep, because it has a six-hour half-life. Two other sleeping pills are in late-stage clinical trials

In the fall of 2005, the purchase of hand sanitizers was up almost tenfold. I'm sure this is a response to the fear of getting bird flu -- a way to reassure yourself that you are doing something to protect yourself. I would never discourage hand cleansing, but keep in mind that any quick remedy for bird flu fears also reinforces the notion that bird flu is almost here, when there is no evidence to support this. The same is true for avoiding poultry. It may make some people feel safer for a brief moment, but it also reinforces the misconception that our poultry supply is at risk. The chances of an infected human bringing bird flu to the United States on a plane are practically nonexistent, simply because there are so few cases of human bird flu. But even if someone brought bird flu here, it would not spread because there is no human-to-human transmission with bird flu in its current state. It is very unlikely that a live bird will pass bird flu to North America, though bird smugglers do exist and Pacific flyway birds can occasionally make it across Siberia to Alaska. It is far more likely that some chilled or frozen poultry containing H5N1 will arrive here, mislabeled or smuggled from Asia. In that case, the virus would be destroyed as soon as the poultry was cooked, and the virus would not be transmitted to humans or other animals

Ten years ago I assumed the care of a woman with advanced pancreatic cancer that had spread to her spine. She was a well- known writer, and we quickly became friends. I would travel to her apartment and visit her for hours there, something I'd rarely done before and haven't done since. She had a close group of friends who visited her constantly, and an Irish nursing agency that cared for her impeccably around the clock. At first her cancer wasn't causing her pain, though it paralyzed her below the waist and bound her to her bed and wheelchair. Still, she enjoyed the visits, mine and everyone else's, until the fateful day when the cancer spread to her bones and began what was clearly an escalating pain. I dialed up the morphine to compensate, until the day came when the amount of morphine necessary clearly hastened her death. I was able to predict roughly the time she would die, and her friends said their goodbyes. I used morphine in the name of relieving suffering, not as a murder weapon. No one who knew her seemed upset by the trade-off, a tortured life for a peaceful death, and all thanked me for my care at the end

Last year a study in the journal Cancer Epidemiology, Biomarkers & Prevention looked at 7,000 current and former smokers and found a marked reduction in cancer occurrence and mortality in those who exercised regularly and vigorously, even among current smokers. For example, there was a 25 percent reduction in cancer deaths in the 54- to 62-year-old smokers who followed a workout program compared to those who did not exercise. The study is among several that shows exercise has a positive effect even in heavy smokers. The study looked at 43,000 people from the 1970s through 2002 and found that those who smoked very little (one to four cigarettes daily) had poor health outcomes. These light smokers were three times more likely to die of heart disease than nonsmokers; heavy smokers were four times more likely. Light smokers also had significantly higher death rates over the 30 year period -- 1.5 times higher generally -- than those who had never smoked. Going from zero to four cigarettes per day showed by far the greatest correlation in the study between smoking and associated death rates. In fact, it wasn't until cigarette consumption increased to 25 cigarettes per day that the corresponding death rate from all causes reached three times normal. Certainly, a subset of patients has been so devastated by smoking that any exertion may present a strain too great for a severely damaged heart or lungs. Any smokers considering beginning an exercise program must consult with their physicians first. But for most smokers it seems clear that regular exercise initiates a healthy cycle that is likely to improve, and perhaps extend, their lives

Quinolones are great drugs, but like all great drugs, they should be used judiciously. All drugs have side effects, and this family of antibiotics is no exception, causing occasional diarrhea, insomnia, tremors and restlessness. Quinolones have traditionally established themselves as gram-negative drugs for the urinary tract. But further quinolones were developed, including Levaquin and Avelox, that not only treated atypical lung infections but also showed better activity against garden-variety pneumococcus. Criticism against quinolones has obscured a safe, versatile and extremely useful category of drugs