In early January a friend mentioned that his New Year’s resolution was to beat his chronic depression once and for all. Over the years he had tried a medicine chest’s worth of antidepressants, but none had really helped in any enduring way, and when the side effects became so unpleasant that he stopped taking them, the withdrawal symptoms (cramps, dizziness, headaches) were torture. Did I know of any research that might help him decide whether a new antidepressant his doctor recommended might finally lift his chronic darkness at noon?

The moral dilemma was this: oh, yes, I knew of 20-plus years of research on antidepressants, from the old tricyclics to the newer selective serotonin reuptake inhibitors (SSRIs) that target serotonin (Zoloft, Paxil, and the granddaddy of them all, Prozac, as well as their generic descendants) to even newer ones that also target norepinephrine (Effexor, Wellbutrin). The research had shown that antidepressants help about three quarters of people with depression who take them, a consistent finding that serves as the basis for the oft-repeated mantra “There is no question that the safety and efficacy of antidepressants rest on solid scientific evidence,” as psychiatry professor Richard Friedman of Weill Cornell Medical College recently wrote in The New York Times. But ever since a seminal study in 1998, whose findings were reinforced by landmark research in The Journal of the American Medical Association last month, that evidence has come with a big asterisk. Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.

Begley, “The Depressing News About Antidepressants” (via newsweek)

And again, please read The Truth About Drug Companies

Drug companies understand that most drugs help 1/3 of people, don’t do anything for 1/3 of people, and harm 1/3 of people. But the cost and time required to get FDA approval means that drug companies can’t afford to find the 33% of people for whom a drug will work very, very well. That would cut their potential market, and potential revenue, by 66%. So they treat everyone the same. The future of the pharmaceutical industry is genetically matching super low cost generics up with the perfect people for whom that 5 cent pill works like magic.

Whole Foods Puts Its Mouth Where the Money Is

Whole Foods CEO John Mackey, who recently published a controversial op-ed on health care, announced that the company will soon offer higher store discounts for healthier employees. The company will consider blood pressure, cholesterol, smoking status, and body mass index (BMI) in determining the discount level. “Our intention for all of these lifestyle programs is that they are empowering and fun for Team Members who enjoy a challenge,” Mackey wrote in a letter to employees. “In offering the higher discounts to Team Members who choose to participate, we take nothing away from Team Members who choose not to do so…”

Whole Foods Puts Its Mouth Where the Money Is

New patients— Are you prepared for your visit? What does your physician want to know ? What should you ask?


Physicians are under pressure to see patients in a timely,  effective, and efficient manner. Take a little time, organize your thoughts, come prepared and your visit could be much more productive.

What to bring:

  • Pad and pen… you will likely receive recommendations and many patients forget them as soon as they leave the office.
  • A list of your medical problems
  • A list of your medications
  • A list of your prior surgeries
  • A copy of pertinent studies (MRI, X-ray, etc)
  • A copy of pertinent medical records (valuable for second opinions).

Dress appropriately.  The physician will need to see the area of concern.

Organize your thoughts:  A new orthopedic history will include…

  • When did the problem start?
  • What were you doing?
  • Have you started taking any new medications?
  • Have you changed your exercise program?
  • What makes the pain worse?
  • What makes the pain better?
  • Do you have pain at night?
  • Does it awaken you?
  • Any numbness, tingling or weakness?
  • Any morning stiffness?
  • Pain getting up from a seated position?
  • Pain walking on hills?
  • Shoulder patients consider what motion causes your symptoms.
  • Do you have any mechanical symptoms (catching, locking, clicking, etc)?
  • Do you have any instability (does the joint feel loose)?
  • Do you have any swelling?
  • How does the pain affect your quality of life?
  • What have you tried so far to obtain relief (physical therapy, injections, medications, exercise, etc)?

After the exam and discussion of the findings, your doctor will likely present you with alternatives….some thoughts you should have.

  • What are the possible diagnoses?
  • Is further testing necessary (If the test will not change the plan of care, then it is possible that you do not require further tests)?
  • Is an MRI or expensive imaging necessary (many times it is not)?
  • What are the non-surgical, surgical alternatives available to treat my condition?
  • What are the possible risks, side effects of the treatment?
  • What will happen if I choose not to have surgery?
  • What does the literature or research recommend (many physicians still practice based on anecdotal experience [which might be appropriate, depending on the situation])

Specific considerations for surgical patients.

  • What are reasonably forseeable risks of the surgical procedure?
  • What are the realistic goals of the procedure (relief of pain, functional improvement, etc)?
  • What is my “expected recovery time (recovery means different things to different people… be VERY CLEAR about your goals)
  • When can I use my arm/leg?
  • When can I l use my arm/leg for activities of daily living?
  • When can I use my arm/leg against resistance (lifting objects or putting weight on your leg)?
  • When can I drive?
  • Do you know what I do for a living? When can I return to work?

Hopefully this will help you on your next visit….

of course you understand that this does not constitute medical advice and you should only use this as a guide to improve your preparation for a visit to an orthopedic surgeon or any physician for that matter.

Women, the best freaking firewall in the world!


One human cell contains 75MB genetic information.
One sperm contains a half of that; that is 37.5MB.
One ml of semen contains 100 million sperms.
In average, ejaculation lasts for 5 sec and contains 2.25 ml semen.
This means that the throughput of a man’s member is equal to (37.5MB x 100,000,000 x 2.25)/5 = 1 687 500 000 000 000 byte/second = 1,6875 Тerabyte/sec

    This means that the female eggcell withstands this DDoS attack at 1,5 terabyte per second, and only lets through one(!) data package, thereby being the best freaking hardware firewall in the world!

    The downside of it is that this only small data package that it lets through, hangs the system for the whole of 9 months!

    Women, the best freaking firewall in the world!