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My first and most memorable experience with placebos occurred when I was a medical resident at University of Virginia. We were on the hematology ward, and often we admitted patients who had chronic pain syndromes, typically very young people addicted to narcotic drugs. One night my senior resident, a very cynical man who ultimately eschewed a medical career for something less humane, had enough of pain seeking patients. We admitted a “frequent flier”: a patient who came in often writhing in pain and seeking intravenous narcotics. My resident conspired with some equally cynical nurses and they concocted a plan. They brought the suffering patient into a room and closed the door. “We’re
This week the major media outlets published results of a JAMA Internal Medicine study linking proton pump inhibitor (PPI, medicines like Prilosec) use to chronic kidney disease (CKD). Not long ago a flawed study linked PPI use to heart attacks, utilizing exaggerated relative risk numbers and failing to establish a causal relationship between the drug and the outcome. Now a new study shows that people who use PPIs have a 20-50% higher risk of chronic kidney disease. Therefore we must ask: does PPI use really cause kidney disease, and if so, how serious is it? Without a doubt the use of PPIs is excessive among the American population. People take these drugs indefinitely for symptoms that
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