PulmCrit- Phenobarbital monotherapy for alcohol withdrawal: Reloaded

It has been said that alcoholics exist to teach physicians humility. These patients are quite complicated, often suffering from several problems simultaneously (e.g., withdrawal, nutritional deficiencies, trauma, infection, psychiatric problems). Arguably the most important task when treating alcohol withdrawal is exclusion of alternative or superimposed problems. Phenobarbital obviously cannot be expected to solve every problem that may exist in an alcoholic patient.

Phenobarbital does, however, appear to be a uniquely effective and safe treatment for alcohol withdrawal (including withdrawal seizures and delirium tremens). Several reasons for the superiority of phenobarbital are listed above. Preliminary evidence suggests that these do indeed translate into meaningful clinical benefit (e.g. faster recovery, fewer complications).

Read the entire post here.

Myths debunked: Physicians’ incomes are too high and they are the cause of rising health costs

The deeply respected and revered Pulitzer Prize-winning columnist, Mike Royko, who wrote for the Chicago Sun-Times and the Chicago Tribune is remembered as a no-nonsense, tough but fair and probing reporter. Politicians cringed at the very mention of his name, especially if he was doing a story on them. When asked about a poll critical of physician earnings in April of 1993, he did not mince any words – in typical Royko style. In a column entitled, “Doctors’ Pay Poll Reflects a Whiny and Stupid Society,” he addressed those who felt that physicians were being paid too much. “Maybe the poll questions should have been phrased this way,” he began: “How much should a person earn if he or she must, (a) get excellent grades and a fine educational foundation in high school in order to, (b) be accepted by a good college and spend four years taking courses heavy in math, physics, chemistry and other lab work and maintain a 3.5 average or better, and, (c) spend four more years in grinding study in medical school, with the 3rd and 4th years in clinical training, working 80 to 100 hours a week and, (d) put in another three to ten years of post-graduate training, depending on your specialty and, (e) maybe wind up $ 100,000 in debt (editor’s note-more than $166,000 today) and, (f) then work an average of 60 hours a week, with many family doctors putting in 70 hours or more until they retire or fall over?”

He closed with one other pertinent comment: “Let us talk about medical care and one of the biggest problems we have. That problem is you, my fellow Americans. Yes, you, eating too much and eating the wrong foods; many of you guzzling too much hooch; still puffing away; getting your daily exercise by lumbering from the fridge to the microwave to the couch; doing dope; filling the big-city emergency rooms with gunshot victims; engaging in unsafe sex and catching a deadly disease while blaming the world for not finding a cure. You and your habits, not the doctors, are the single biggest health problem in the country. If anything, it is amazing that the docs keep you alive as long as they do.” Harsh words perhaps, but he uttered them 24 years ago, and there is still some truth in them.

Emphasis mine.  I try not to get into this debate with anyone.  But when I do, I don’t lose.

Source article here.