HIV and ID Observations

April 26th, 2024

Hey, Insurance Companies and Pharmacies — Stop Messing Around with the Price of Cheap Generic Drugs

If you’re practicing medicine these days, you’ve likely experienced some version of this painfully annoying scenario. You prescribe a generic medication, one that’s inexpensive. Your patient goes to the pharmacy, and the pharmacist says that it requires a prior approval. They leave without getting their meds. Here’s a recent example from one of my patients (details […]

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April 8th, 2024

The Rise and Fall of Paxlovid

It’s been quite the ride for our “preferred” outpatient therapy for COVID-19, nirmatrelvir with ritonavir — much better known as Paxlovid, so allow me the license to use the licensed name. Let’s recap the astonishing success and now failure of this intervention (some dates approximate): December 2021, the FDA issued an Emergency Use Authorization for Paxlovid:  Action […]

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March 27th, 2024

Think Again Before Sending Your Patient Home on Intravenous Vancomycin

I took care of a patient many years ago with MRSA. The severity of the infection required a prolonged treatment course, and vancomycin was the default option. Cripes, it was the only option. He ultimately was discharged on home IV therapy, and as usual we had a plan to monitor his renal function and vancomycin […]

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February 20th, 2024

Variability in Consult Volume Is a Major Contributor to Trainee Stress — What’s the Solution?

Back when he was program director of our ID fellowship, Dr. David Hooper would give the applicants a description of our program. One of the key parts was his estimating the workload — in particular, the number of new consults per day. “We average three to four consults a day,” he said. “But there’s a high […]

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January 25th, 2024

Printed Medical Textbooks — Going, Going, but Not Quite Gone

Take a look at the things behind my desk at work: cute photos of family and dog a bunch of sentimental objects, gifts from grateful patients or colleagues a smattering of miscellaneous plaques and clocks pictures of our current (awesome) first-year ID fellows and other stuff a bunch of books, several of them many inches thick […]

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January 2nd, 2024

Reflections on Working in the Hospital During the Holidays

For the zillionth year in a row, I spent the Christmas holiday working in the hospital. For me, it’s not much of a sacrifice — we don’t celebrate Christmas, and my kids are long out of school so the strict limits on when we can take vacation are a thing of the past. But it […]

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October 31st, 2023

HIV Research Highlights from IDWeek 2023

Having already featured an important non-HIV clinical research study from IDWeek — the amazing ACORN trial — I turn now to a grab bag of HIV-related studies, a veritable Halloween treat bag full of them. (Note to self: What’s with that “Halloween treat bag” reference? Couldn’t you come up with a less awkward way to link […]

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October 17th, 2023

A Brilliant Strategy for Conducting Clinical Trials — The ACORN Study

The secret to doing a great clinical trial is quite simple. Here, I’ll share it with you: Come up with an important clinical question for which there’s true equipoise. Choose primary and secondary endpoints that people care about. Make the inclusion and exclusion criteria easy to understand and chosen so that they define a readily available […]

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October 8th, 2023

An October ID (and Non-ID) Link-o-Rama

For those venturing next week to IDWeek here in Boston, fall gives us our very best weather. Comfortable sunny days with brilliant blue skies, cool evenings, low humidity — great weather for exercising and sleeping. Usually you just need a light jacket. And now, after one of the rainiest Septembers on record (boo!), October has […]

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September 8th, 2023

Endless Recertification in Medicine — Some Thoughts About the Tests We Take

The tests issued by the American Board of Internal Medicine (ABIM) for credentialing physicians are much in the news again. There’s even a petition circulating to eliminate the Maintenance of Certification (MOC) process entirely, signed by nearly 20,000 physicians. I have a bunch of memories, thoughts, and feelings about ABIM and the tests they issue. They’re […]

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