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Concierge Medicine Is Here and Growing!!

An increasing number of primary care physicians are downsizing to a concierge medical practice (also termed “retainer-based medicine”). In a concierge medical practice, the physician limits the number of patients in his practice and offers exclusive services for an annual fee. The patient pays a surcharge for increased access and additional services from their physician.1 […]

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Joseph S. Alpert, MD

Polypharmacy in Elderly Patients: The March Goes On and On

Polypharmacy is a major public health problem in the United States and abroad. Although there is no standard definition of polypharmacy, I see and recognize it every day in the outpatient and inpatient environment. A typical example that I saw yesterday was an 84-year-old man admitted to our internal medicine service for worsening heart failure. […]

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Dr. Joseph S. Alpert

Will Physicians Stop Performing Physical Examinations?

In the 21st century, debate continues concerning the value of the physical examination.1, 2, 3, 4 That such a hallowed and respected ritual of clinical medicine should even be questioned is the result of the remarkable advances during the last 50 years in imaging technology and laboratory medicine. When I was a student and resident in the late 1960s […]

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Dr. Joseph S. Alpert

Can a Toothpaste Reduce Heart Attacks and Strokes?

My father was a busy and successful dentist in New Haven, Connecticut. One of my earliest memories is of sitting in one of his dental chairs and having my teeth inspected and cleaned. Many years later when I was about to start medical school, my father told me that in his practice, patients with poor […]

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Joseph S. Alpert

Statins and Diabetes: Wider Utilization Is Needed in Treatment and Prevention

  In this issue of The American Journal of Medicine, Hennekens et al1 address many cogent methodologic issues concerning whether there is a valid statistical association between statins and the development of diabetes. While they conclude that the current totality of evidence is insufficient to confirm a valid association, if such an association were present, the most plausible […]

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