Internal Medicine, Clinical Pharmacology/Toxicology and drug safety research @Sunnybrook and @UofTMedicine. Inexplicably fortunate husband.
Toronto
Joined January 2012
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I’ve spent 15 years challenging a flawed explanation for an infant’s death. Credit to @NewYorker for patient investigative journalism that corrected the record when institutions did not.
A paper by a renowned toxicologist argued for the first case of opioid overdose by breast milk in history. But in the years that followed, researchers began to suspect that the science was bunk. newyorkermag.visitlink.me/AU…
David Juurlink retweeted
My 2 cents on research during medical school & residency:
Research success is easy to metric (20 articles!!) and communicate on the CV in a highly visible way.
Mastering clinical medicine is nearly impossible to metric or report accurately on a CV.
The inevitable result = students & trainees are pushed to focus on research (at the cost of spending less time learning clinical medicine).
This is a major problem. For most trainees and students, skimping on clinical knowledge while mastering the dark art of publishing scientific articles won't serve them well in the long run.
Dr. Glaucomaflecken continues his fight against med student research (see link). I don't think we necessarily have to ban research, although that would be an improvement. We just need program directors to recognize that ranking by research pubs is bad for our profession. It causes early burnout among trainees and cheapens the value of research. Spread the word about the downsides of research rankings. There are lots of excellent program directors who will respond to this message the more it gets out. facebook.com/share/r/1EcmykH…
For the love of god please stop withholding ceftriaxone in patients with anaphylaxis to penicillin
An all-too-common medicolegal nightmare:
- Patient admitted with severe pain
- Appropriately given opioids
- Pain persists -> more opioids
- Pain persists -> more opioids
- Pain persists -> more opioids
- Found VSA 4:00 a.m.
"If what you're doing isn't working, stop doing it." xitter.cf/DavidJuurlink/status/1…
Loeb's Rules of Medicine:
1. If what you're doing is working, keep doing it
2. If what you're doing isn't working, stop doing it
3. If you don't know what you're doing, do nothing
4. Never make the treatment worse than the disease
Robert F. Loeb 1895-1973 #TipsForNewDocs
New patient: “Internal medicine? Like House?”
Me: “Yes but minus the personality disorder and Vicodin addiction.”
As a general rule, do not take the big aspirin. The little aspirin works just fine.
BREAKING 🚨 Reporter: “We saw the bruising on your hand. Are you okay?”
President Trump: “I’m very good. I clipped it on the table. So I put a little—what do they call it—cream on it. But I clipped it. I would say take aspirin if you like your heart, but don’t take aspirin if you don’t want to have a little bruising.”
“I take the big aspirin. And when you take the big aspirin, they tell you that you bruise. The doctors said, ‘You don’t have to take that, sir. You’'re very healthy.’ I said, ‘I’m not taking any chances.’ That’s one of the side effectseffects. of taking aspirin.”
Among people using illicit fentanyl, we estimate an *average* daily dose equivalent to ~9000 milligrams of morphine.
Led by @MorganGodvin w/ @ChelseaLShover and @JosephRFriedman
sciencedirect.com/science/ar…
David Juurlink retweeted
The truth is we should not use oseltamivir and we have wasted decades in getting RCT evidence in hospitalized patients
Just amazing to watch deaths from cervical cancer plummet as HPV vaccination coverage increases
thelancet.com/journals/lance…
David Juurlink retweeted
The right-to-try movement has a dark side that few of its supporters discuss:
Patients with incurable, fatal diseases and their families convinced to seek out unapproved, ineffective medicines by manipulative fraudsters touting misleading medical claims and falsified data.
You see these tragic stories play out on X and it's heartbreaking to watch. And AI slop has only worsened the problem.
David Juurlink retweeted
As a non-oncologist, i feel quite comfortable jumping on the bandwagon here. I can count the number of times I've seen unsolvable problems in medicine get solved in my lifetime. No, this is not a cure, but there has been no greater challenge than pancreatic cancer. Nothing worked. Now this...
These results are simply spectacular
Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer | New England Journal of Medicine nejm.org/doi/full/10.1056/NE…
David Juurlink retweeted
.@RichardLehman1 has died - a kind & humble, but witty & wise physician-communicator. He pinned this message on his X page: “Final reflection for today: the essence of professionalism is to know what you are doing, and to care about the effect of everything you do.” RIP, Richard
It's an unfortunate fact of pharmacology that some of the easiest medications to prescribe are also some of the hardest for patients to stop.
