Category Archives: First Comments

The pricing of generic medications for uninsured patients is irrational and counter-intuitive. Because of this, the uninsured patient can pay far too much for a generic drug. One might expect that the price of a generic medication to be “low”, … Continue reading →

Lithium induced subclinical hypothyroidism Definition: elevated TSH (thyroid stimulating hormone) in a lithium treated patient, with normal T4 and T3 Prevalence: 6-52% in 11 reports (UptoDate Lithium and the Thyroid, accessed 3.8.2015), average 20-30% Odds ratio for hypothyroidism on lithium: … Continue reading →

Lithium, hypercalcemia (increased serum calcium), and hyperparathyroidism or What to do when you’re stable on lithium and your calcium level is high? Lithium therapy increases the prevalence of hypercalcemia and hyperparathyroidism (http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.13081057): 1. 10% absolute risk in 730 lithium-treated patients … Continue reading →

This superb summary of ADHD is likely to be of interest to several different types of reader. First, the physician who wants a brief (the entire book, including index, is 125 pages) overview; second, the therapist whose patients have ADHD … Continue reading →

I’ve been impressed by James D. Watson, the co-discoverer of DNA, ever since I read his  account of the discovery of the structure of DNA,  The Double Helix  and used his Molecular Biology of the Gene to study biology as … Continue reading →

I’ve had too many discussions with patients about exercise that go like this: Doctor: How much are you exercising? Patient: I’m not. Too busy. To avoid this stalemate, I think it’s helpful to think about what we mean by exercise. … Continue reading →

I first became aware of the CURES program a few years ago, after a  psychiatrist left a voicemail warning  me that patient X, to whom I had been prescribing a controlled substance,   was receiving the same drug not only from … Continue reading →