Doctors Adapting and Trying to Survive

Close your eyes and think of a doctor.  Do you see a Marcus Welby type? A middle aged, smiling and friendly gentleman who makes house calls?   Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you?  If that is what you envision, either you haven't been to the doctor lately or you are in a concierge practice where you pay a large upfront

Food Reward: a Dominant Factor in Obesity, Part VII

Now that I've explained the importance of food reward to obesity, and you're tired of reading about it, it's time to share my ideas on how to prevent and perhaps reverse fat gain.  First, I want to point out that although food reward is important, it's not the only factor.  Heritable factors (genetics and epigenetics), developmental factors (uterine environment, childhood diet), lifestyle factors (exercise, sleep, stress) and dietary factors besides reward also play a role.  That's why I called this series "a dominant factor in obesity", rather than "the dominant factor in obesity".
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Tennis at San Quentin

Many people can't understand why a law abiding citizen like me would go to San Quentin Prison and play tennis with the inmates.  I've written on this before and it is a fascinating look at life we don't usually get to witness.  Today was another San Quentin tennis day where I got to play some good, friendly tennis as well as hear some stories of redemption.

I spent a good deal of time talking

Drug Cessation and Weight Gain

Commenter "mem", who has been practicing healthcare for 30+ years, made an interesting remark that I think is relevant to this discussion:

Recovering substance dependent people often put on lots of weight and it is not uncommon for them to become obese or morbidly obese.

This relates to the question that commenter "Gunther Gatherer" and I have been pondering in the comments: can stimulating reward pathways through non-food stimuli influence body fatness?  

It's clear that smoking cigarettes, taking cocaine and certain other pleasure drugs suppress appetite and can prevent weight gain.  These drugs all activate dopamine-dependent reward centers, which is why they're addictive.  Cocaine in particular directly inhibits dopamine clearance from the synapse (neuron-neuron junction), increasing its availability for signaling.
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Rob a Bank to Get Health Care

Just when you think things can't get any nuttier with American health care, here comes the strange and sad case of James Richard Verone.  Mr. Verone, age 59, was laid off from his job of 17 years as a Coca Cola deliveryman.  He went through his savings and  took a part-time position as a convenience store clerk but he had no health insurance.   He had a back ache from lifting and bending and pain

Pterygium

 
This 45 year old man came to his doctor about a triangular shape growth in the inside corner of both eyes.  It had been present for a long time but seemed to be increasing.  There was no pain, no discharge and no visual problem.  The internal eye exam was normal.  What is the diagnosis?
These common conjunctival growths are called a pterygium (pronounced "teryjium").  We don't know what causes

Stop Unnecessary Medicare Tests

We are in a time when  Medicare is bankrupt and the GOP wants to privatize it and make seniors go to the open market to get insurance. Even the idea that we would dismantle this important social benefit is shocking yet everyone knows we have to bring costs under control.  So now we find that hundreds of hospitals (and radiologists)  in the United States are performing unnecessary CT scans on both