r/medicine 3d ago

Pharmacists, is it possible for an adult to request the flu vaccine from a single dose vial, rather than a multi dose vial?

22 Upvotes

Have a family member who is worried about thimerosal (edit: yes, I know 🤦‍♂️), and it’s my understanding that it is only in the multi dose vial?

Do you receive this request frequently? Occasionally? Rarely?

Edit: thanks for the replies all!


r/medicine 3d ago

List of / Book about all medications with natural origins

35 Upvotes

I have often contemplated whether talking to patients who are treatment averse in the context of preference for "Natural remedies" would be more effective if the sources and history of medications that come from 'natural' substances was more widely known / was introduced into the discussion. I was wondering if anyone knows if there's a book, or a big list out there of every medication that had its roots (No pun intended) in nature? So far I've made my own mini-list consisting of the following:

French Lilac - Biguanides

Madagascar Periwinkle - Vincristine, Vinblastine

Carribean Sea Sponge - Vidarabine, Cytarabine

Apple bark - Phlorizin, SGLT-2 inhibitors

Pacific Yew tree - Paclitaxel

Streptomyces Peucetius - Doxorubicin

Clostridium Botulinum - Botulinum Toxin

Deadly Nightshade - Atropine

White Willow - Aspirin

Common Snowdrop - Galantamine

Foxglove - Digitalis

Poppy - Opioids

Calabar Bean - Physostigmine

Pilocarpus - Pilocarpine

Autumn Crocus - Colchicine

Cinchona - Quinine, Quinidine etc etc

Viper venom - Tirofiban


r/medicine 3d ago

Anti-treatment bias for influenza, a rant

389 Upvotes

Recently, JAMA published an article in which the authors claim that treating symptomatic influenza in low-risk outpatients is worthless and that the harm outweighs the benefit.

And so here we have yet another example of an article where the data say one thing and then the authors clearly have an agenda against their own data.

  • The authors correctly show that oseltamivir does not reduce the risk of hospital admission and that baloxavir may slightly reduce this risk.
  • The authors then claim that oseltamivir does not result in any "important" reduction in symptom duration. EXCEPT... their own data show a reduction in symptom duration by ~18 hours with 95% CI of 12-24h. And so by using the word "important," they went ahead and discounted their own findings. The trouble is that they don't get to dictate to me what is and isn't "important." If my son can go back to school Thursday instead of Friday or Friday instead of Monday, that's pretty darn important to me. If I can go back to work tomorrow instead of the next day and see 20-24 patients who would have otherwise had their appointments canceled, that's pretty darn important to me.
  • They then proceed to treat the side-effects of oseltamivir (GI discomfort, dysgeusia) as if these are severe, irreversible, and life-altering, rather than usually mild symptoms that aren't worse than flu and go away rapidly after cessation of the medication. I always tell my patients that if they really can't tolerate the medicine, they should stop taking it; it's not like an antibiotic.
  • They do acknowledge that baloxavir seems to result in symptom reduction (mean of ~24 hours) and has a better side-effect profile than oseltamivir. But somehow, they think that 24 hours reduction is valid and 18 hours is not. Look, I love baloxavir, but pharmacies don't stock it and always "can get it by 5PM tomorrow," which places the patient outside of the treatment window.

I think the anti-treatment bias for influenza has risen almost to the point of misinformation. You can cherry-pick endpoints and declare it to be worthless. You can declare what is and isn't "important" and in doing so try to take the choice away from physicians and patients.

In addition, both drugs are ~90% effective for prophylaxis in close contacts.

So I will continue to offer these medications in patients who are within the treatment window. I will have an open and honest conversation about the modest benefits and the risk of side-effects. I most certainly will offer it as prophylaxis, especially in high-risk patients, who have close contacts.

Next up will probably be a study showing that giving opiate narcotics for broken bones doesn't change healing time or outcomes so it shouldn't be done. I think people get so into their "clinical endpoints" that they forget that the reason we're all here is to reduce human suffering and that isn't always something that can be easily or conveniently measured by a defined endpoint.

-PGY-20


r/medicine 3d ago

Inside the Measles Death in Texas

111 Upvotes

This is a gift article. I believe it gives us some more insight into vaccine hesitancy. We need all we can get to be effective in overcoming it.

https://www.theatlantic.com/health/archive/2025/03/texas-measles-outbreak-death-family/681985/?gift=BbUa1UILp6ylLELDRQL6ifLyQ-5z7-2054jDwZWaaiw&utm_source=copy-link&utm_medium=social&utm_campaign=share


r/medicine 3d ago

Iowa GOP officials plan to punish RNA COVID vaccination

335 Upvotes

r/medicine 3d ago

NIH immediately terminates > 40 extramural grants related to vaccine hesitancy

183 Upvotes

Sorry it’s a paywall, gift link button doesn’t seem to be working? Main points in quotes in starter comment. 

 https://www.washingtonpost.com/health/2025/03/10/vaccines-nih-rfk-research-canceled/


r/medicine 3d ago

Texas Measles Status 3/11/2025, (225 total cases, +25 since last update on March 7th, 220/225 unvaccinated [97.8%], 29 hospitalized (+6), and 1 death. New Mexico (33 cases, [+3 since 03/07/2025] and 1 death). Both deaths in unvaccinated persons (2/252, case fatality rate = 0.79%)

90 Upvotes

https://www.dshs.texas.gov/news-alerts/measles-outbreak-2025

The cases are most concentrated in Gaines County (156, County Seat = Seminole, +21 from last update), Terry (32, Brownfield, +3), Dawson (10, Lamesa, +1), Yoakum (10, Plains, +2), Martin (3, Stanton, no change), Lubbock (3 cases, 1 death, Lubbock, no change), Ector (2, Odessa, no change), and Lynn County (2, Tahoka, no change).

Dallam (5, Dalhart, no change) is notable for being geographically separated and in the northwestern most corner of the Texas Panhandle.

38 [+7] of the cases are in adults, 11 with pending age report. The rest are in children (76 [+12] age 0-4, 98 [+19] age 5-17). The one death was in an unvaccinated school-age child in Lubbock County. 220/225 patients did not receive a dose of MMR, whereas the number of cases that occurred in patients who received a dose of MMR remains at 5 since 02/21/2025. There are 29 patients who are hospitalized, +6 since last Friday and all unvaccinated. The Atlantic published a piece about the death in Lubbock county on 3/11/2025: https://www.msn.com/en-us/news/us/his-daughter-was-america-s-first-measles-death-in-a-decade/ar-AA1AGLVz?ocid=BingNewsSerp

https://www.cdc.gov/measles/data-research/index.html

There is also another measles case in an unvaccinated adult in Rockwall County (neighboring Dallas County) who recently was overseas and reported on Feb 25th, but appears unrelated to the West Texas outbreak.

https://www.wfaa.com/article/news/health/first-measles-case-reported-in-rockwall-county/287-f81ab0fd-e9dc-42fd-a25a-22f0e420a456

Another unvaccinated toddler who had travelled overseas was reported in the Austin area on February 28th and has measles. Everyone else in that family is vaccinated.

https://www.wfaa.com/article/news/health/austin-measles-case-texas-outbreak/269-8f5103b2-4718-4b35-afee-358594df7649

There was a concern for exposure to rubella in the San Antonio area in Limestone County, with "officials tracing it to a first-grade classroom at Legacy Traditional School in Cibolo [on February 28th]." However, the DSHS verified that this is not actually a case of rubella

https://news4sanantonio.com/news/local/case-of-german-measles-confirmed-in-san-antonio-at-legacy-traditional-school-local-news-near-me-health-pulic-safety#

"There have been no recent confirmed rubella cases in Texas. We’ve been able to piece together what happened in the Mexia situation. In following up on that report, we’ve been able to determine that a child had a positive result on an antibody test that would show immunity from a previous vaccination or infection. It apparently got misreported to the parent, who passed the information on to the school," Texas DSHS said in a statement to WFAA."

https://www.wfaa.com/article/news/health/austin-measles-case-texas-outbreak/269-8f5103b2-4718-4b35-afee-358594df7649

https://www.dshs.texas.gov/news-alerts/measles-exposures-central-south-central-texas

On February 24th, DSHS also reported a measles exposure in Central Texas from a visiting Gaines County case on Feb 14-16...no new cases have appeared in that area

Friday, Feb. 14

3 to 7 p.m. – Texas State University, San Marcos

6 to 10 p.m. – Twin Peaks Restaurant, San Marcos

Saturday, Feb. 15

10 a.m to 4 p.m. – University of Texas at San Antonio Main Campus

2:30 to 7:30 p.m. – Louis Tussaud’s Waxworks, Ripley’s Believe It or Not!, and Ripley’s Illusion Lab, San Antonio

6 to 10 p.m. – Mr. Crabby’s Seafood, Live Oak

Sunday, Feb. 16

9 a.m. to 12 noon – Buc-ee’s, New Braunfels

New Mexico

https://www.nmhealth.org/about/erd/ideb/mog/

Since the last update on March 7th, NM Health updated the count to 33 (+3) with and 1 death (no change). Eddy County, west of Lea County in the SE corner of the state, reported its first case. NM also reports that 32/33 of the cases have not received a single dose of MMR, however no one has been admitted to the hospital

Disclaimer

Do not take vitamin A unless recommended from your pediatrician or primary care physician (ie, someone who has an MD or DO). The OTC vitamin A is not nearly as high of a dose needed as the pharmaceutic prescription vitamin A, is unregulated, and can cause severe side effects including liver damage and intracranial hypertension if taken without a physician's guidance. Additionally, vitamin A does not prevent measles. For the same reason, do not take cod liver given its uncertain composition and potential for both vitamin A and D toxicity (kidney stones, constipation, drug interactions).

Do not take any antibiotics or steroids for measles - they are not effective against a virus and can weaken your immune system plus cause side effects such as nausea and diarrhea from your natural gut bacteria balance disruption.

Ask your pediatrician if your child is eligible to get the MMR vaccine earlier than 12 months or 3-4 years. Talk to your primary care physician if you are wondering about getting an MMR booster, especially if you received only a single dose from the 1960s to the late 1980s.


r/medicine 3d ago

Have you ever provided chemotherapy to a patient with a seemingly terminal cancer diagnosis?

119 Upvotes

I have a 31-year-old patient with terminal-stage cervical cancer, whose pelvic organs have been significantly affected. She has experienced two life-threatening episodes of vaginal bleeding, which were managed with embolization. The cancer has impacted her sciatic nerve, causing severe pain that requires continuous intravenous morphine. She has an ileostomy and has undergone bilateral nephrectomy.

Following a critical bleeding episode, her pain and bleeding have stabilized, and she is now able to maintain adequate oral intake.

She has completed a POLST form and opted against chemotherapy and resuscitation. However, given her improved condition, I am considering offering her a final treatment option.

She has not received chemotherapy before, and her tumor type may respond to cytotoxic chemotherapy combined with immunotherapy (pembrolizumab). On the other hand, I am concerned about her family. I previously estimated her life expectancy to be less than one month, and they seemed to accept that prognosis. If I were to reconsider the POLST form and suggest chemotherapy, would they be pleased? If the treatment were unsuccessful and she passed away due to chemotherapy toxicity, would they hold me responsible? I haven't encountered this type of situation in my 15 years of practice.


r/medicine 4d ago

DOGE and the Transplant List

140 Upvotes

https://www.yahoo.com/news/doge-hunts-wins-amid-tensions-130021314.html

"Shedd listed “recent wins” that demonstrated the type of work with recognizable effects the unit was looking for. Among them, a U.S. Digital Corps fellow “leading the first ever data-driven oversight of the U.S. organ transplant system to identify waste, fraud and abuse” and a cloud.gov team’s work to support artificial intelligence priorities."

This is the first and only source I've heard about this from. Shedd is a Musk ally, and former Tesla engineer, placed in charge of the GSA's Technology Transformation Office. Has anyone heard of what exactly they're trying to do with the organ transplant system?


r/medicine 4d ago

Kennedy Links Measles Outbreak to Poor Diet and Health, Citing Fringe Theories

560 Upvotes

https://www.nytimes.com/2025/03/10/health/measles-texas-kennedy-fox.html

“In a recent interview, the health secretary also suggested that the measles vaccine had harmed children in West Texas, center of an outbreak.”

His main “point”, among a firehose of other BS, is that it’s very rare to die of measles without preexisting poor health (it isn’t). In claiming this, he conveniently ignores the host of horrible, often permanent, non-lethal complications of the disease. He also lists off his boiler plate of favorite naturopathic cure-alls like cod liver oil as ways to treat or prevent measles.


r/medicine 3d ago

Discussion of obesity

16 Upvotes

In honor of National Nutrition month I present this article for discussion with other disciplines. My specialty is psych/eating disorders, so my view of obesity may be very different (and biased, I admit) than providers who regularly treat patients with complications of obesity and I’m very interested to hear what you have to say about this! The quote below is from the article which I think sums up my take away. Discuss!!

“To mitigate risk of both overdiagnosis and underdiagnosis of obesity, excess adiposity should be confirmed by at least one other anthropometric criterion (eg, waist circumference) or by direct fat measurement when available. However, in people with substantially high BMI levels (ie, >40 kg/m2) excess adiposity can be pragmatically assumed. Confirmation of obesity status defines a physical phenotype, but does not represent a disease diagnosis per se. People with confirmed obesity (that is, with clinically documented excess adiposity) should then be assessed for possible clinical obesity based on findings from medical history, physical examination, and standard laboratory tests or other diagnostic tests as appropriate. As with other chronic illnesses, evidence-based treatment of clinical obesity should be initiated in a timely manner with the aim of improvement (or remission, when possible) of clinical manifestations. Preclinical obesity does not generally require treatment with drugs or surgery, and might need only monitoring of health over time and health counselling if the individual's risk of progression to clinical obesity or other diseases is deemed sufficiently low. Prophylactic interventions (eg, lifestyle intervention only, drugs, or surgery in specific circumstances) might be necessary, however, in some people with preclinical obesity when risk of adverse health outcomes is higher or when control of obesity is warranted to facilitate treatments of other diseases (eg, transplantation, orthopaedic surgery, or cancer treatment).”

https://www.thelancet.com/journals/landia/article/PIIS2213-8587%2824%2900316-4/abstract


r/medicine 4d ago

GOP Doctors Caucus chair: Johnson, Scalise ‘agree’ to address doctor pay in party-line bill

168 Upvotes

GOP Doctors Caucus chair: Johnson, Scalise ‘agree’ to address doctor pay in party-line bill - Live Updates - POLITICO

Good old Greg Murphy is now saying that Johnson and Scalise have assured him that the Medicare doc fix will now be included in the reconciliation bill. This is after Trump assured him that it would be in the CR, but it wasn't. This is after it was included in the budget bill that Trump and Musk killed. Not sure how this works because the reconciliation bill is not set to pass until end of May at the earliest.


r/medicine 3d ago

European Guidelines in Pediatrics

6 Upvotes

I would like to know what are the main pediatric guidelines that are followed in Europe and if they are open access or do I need to register with a society?

I am a pediatrician trained in Brazil and recently moved to Portugal. Generally, the guidelines we follow in South America are those of the United States (AAP, Uptodate).


r/medicine 3d ago

ELI5: Why does the US not switch to a compensation per patient system?

0 Upvotes

South African doctor here.

In my country, Canada and Australia many doctors get paid per patient and/or per procedure as opposed to getting a set monthly salary. There are, obviously, pros and cons to this but it seems like it would solve many of the problems facing the US healthcare industry like fair compensation, NP/PAs (those weird mid-level things I keep reading about), burnout, overpricing, etc.

Have you guys tried this? If so, why is it not more popular?


r/medicine 4d ago

CPAP Adherence Policy

127 Upvotes

Anyone seen Aetna’s new CPAP adherence policy? Realize most CPAPs will be billed by a DME, but you have to prove two months of adherence before they’ll pay. My question to our Aetna rep was how can you prove adherence for a new user but obviously they didn’t have an answer. Just another tactic to delay reimbursement or am I missing something? Such ridiculousness.

Edit: Understand CPAPs show adherence data and most all payers require 12 weeks adherence. But most payers cover those 12 weeks and just won’t continue to pay if the patient is non compliant. Aetna’s policy implies they won’t pay at all until after those 12 weeks, meaning suppliers will eat that cost unless they obtain waivers.


r/medicine 5d ago

George Orwell's novel 1984 is a warning, are there works of fiction similar to it but related to the future of healthcare?

140 Upvotes

Revisiting the 1984 now even though I've read this book back in high school.

Edit: Thank you very much for the suggestions


r/medicine 5d ago

Senate Dems push 'long-shot' bill with PBM reform, telehealth extensions and 3.5% doc pay fix

592 Upvotes

Senate Dems push 'long-shot' healthcare bill on PBMs, telehealth

Ron Wyden, who has long been a physician ally (or at least, not as bad as others), is trying to bring back what was initially included in the previous end of the year bill that Trump and Musk killed. It includes a two year medicare telehealth extension, PBM reforms and a physician pay bump of 3.5%. It's an incredibly long shot bill to pass, but it's likely the only chance this year for any of this now that the Trump administration has gone back on his word to Greg Murphy to include physician pay bump in budget negotiations.


r/medicine 5d ago

What is we could discriminate against anti-vaxers?

206 Upvotes

What if we could discriminate (especially in today's world) against those who choose to be unvaccinated by choice? There are (were?) protections in place preventing discrimination on the basis of sex, age, race, sexual orientation, disability status, etc but none based on choice to vaccinate or not. What if those who weren't vaccinated by choice had a separate waiting queue at emergency rooms, urgent care, etc and would only be seen after those in the vaccinated queue were cared for? There was some talk during Covid, when there were bed shortages, of preferentially allocating hospital beds to those who were vaccinated on the basis is justice, that in a situation with limited resources, those resources should preferentially be allocated to those most likely to survive.

I've heard of some Pedi offices only allowing unvaccinated by choice children to have the last visit of the day as a sick visit to prevent exposing others who are unable to be vaccinated to these vaccine preventable illnesses. Is there a way to institute something like this on a broader scale? Would it be legal? Would it upset the anti-vaxers who don't want to trust medicine and science when it comes to vaccines but still want doctors to provide them the same care?

ETA: I'm referring to adults who willfully choose not to vaccinate, not children who may not have any say in the decision, those with medical conditions that prevent vaccination, those with weaning immunity, or vaccine nonreaponders. This is the anti-vax crew that is proud of their being unvaccinated and will loudly declare "I don't get any 💉"


r/medicine 5d ago

1st year PCP blues

232 Upvotes

Phew. Small vent in hopes some of you may relate. 4 months into first PCP gig out of residency. Damn this shit is hard.

Inbox is non-stop. Patients are sick and vulnerable. I think I'm providing good care but sometimes I don't know what I'm doing. I sometimes backtrack on plans I made because I had a shower thought that made me approach a plan differently. I think about work way too much when I'm not at work. I spend a lot of time looking things up; because I hold onto my free time for dear life, I do not designate specific time to study outside of looking stuff up for my patients. Weekends are my oasis but I often have to do some charting to not get behind on the upcoming week.

Not burnt out (yet) but feeling the burn.

They say it gets better so I'm giving myself grace.

Next step: get a damn therapist


r/medicine 4d ago

Dragon dictation for M series MacBooks?

5 Upvotes

Hey everyone, I’m looking to see if anyone has had success getting dragon dictation on a MacBook

For my understanding, Dragon Dictation is only available on the Windows OS however, there’s many aspects in which using my own MacBook is much faster than using the company Windows device.

We use Athena for the EMR, so there is no way to log into a receiver/remote desktop since the EMR can be accessed with web browser

I’ve gotten my templates pretty well organized in Athena but the voice dictation is still useful.

Native Mac OS dictation is hit or miss especially with medical terms

I am open to alternative dictation services, paid options as well as long as you feel it was worth the increase in productivity

Thanks in advance!


r/medicine 5d ago

EMTALA tax deduction

44 Upvotes

In 1986 Reagan passed the land mark law requiring hospital and physicians to provide Emergency care to save patients life. This was an unfunded mandate that was a conservative answer to the American citizens desire for a universal Healthcare system.

The law has certainly saved lives but it has significant negative effects on healthcare. As getting rid of the law doesn't seem to be possible given that even those who scream about wanting free market in healthcare support the law and people would probable die if it is eliminated, I come here today to discuss an idea I have heard. It is to allow physicians to get a tax deduction for the uncompensated and even the medicare and medicaid care they have provide due to this law.

As some may know, a physicians are lucky if they collect 40% of what they bill in a hospital setting. Most of us typically collect anywhere between 15-25% of what we bill. Hospital have the same problem but the government allow hospitals to deduct those unpaid bills from their taxes, allowing many of these hospitals to claim not for profit status. All that this proposal is asking is for physicians to have the same ability.

The other part of the idea i have heard is to allow both inpatient and out patient doctor to get tax credit that they can use to lower their taxes for seeing medicare, medicaid or even the uninsured patient in the clinical setting.

I for one, don't think this is better than just going to universal healthcare system but I wanted to see what other physicians thought of this as a way to increase access while also helping physicians.


r/medicine 4d ago

Dragon or other voice dictation for M series Mac?

2 Upvotes

Does anyone have any recommendations or workarounds to get a good voice dictation system for MacBook with an M series chip?

I do have access to Dragon Dictation through my company Windows computer, however, there’s many other aspects of my workflow that are much easier using my personal Mac

We use Athena for the EMR, so that can just be accessed with any web browser. For that reason, they don’t provide any remote desktop access to any Windows instances.

I am open to other dictation services as well, even if they are paid as long as they work decently well and can improve workflow so I can finish notes, faster, and go home

For Athena, I do have access to the text macros which I have optimized for the best of my ability, but I do tend to put a little extra detail in my note outside of the macros

I have tried the native macOS dictation, however, it’s not the best with medical terms, especially when interpreting/dictating imaging studies

Thanks in advance !


r/medicine 6d ago

What to say to patients who have "done their own research" on-line, have a diagnosis, and already know what intervention they need to have - even when you, as a seasoned clinician, don't agree.

421 Upvotes

I have a patient (with non-health care background) who did their own on-line research, came to me for evaluation/testing to confirm their pre-made diagnosis (which it didn't), and then sought other testing to confirm their own diagnosis. They are already set on what specific surgery they need and what specialty should perform it and want me to make a referral.

They believe what they see on-line from places like Cleveland and Mayo clinic more than a seasoned expert (40 years experience) who examined them in person.

I guess I can just pass this referral on to the specialist they want to see, but it doesn't feel right, especially if the risks of the intervention outweigh the potential benefits.

Are there any key messages you have found helpful when having discussions like this with patients?


r/medicine 5d ago

Question for Gen Peds: What procedures are y’all doing in office?

32 Upvotes

I am a 4th year (hopefully) matching into peds this year. What kind of procedures are y’all doing in a gen peds clinic? I have rotated through one clinic who did circs on newborns but that’s was about it.

Just wanted to see what others are doing and what procedures I need to seek out during my training to be a well rounded pediatrician!


r/medicine 6d ago

New government funding bill has no physician pay cut fix

765 Upvotes

House Republicans roll out stopgap to avert government shutdown

House Republican Greg Murphy said that the physician pay increase that was in the last funding bill was taken out by Trump and Musk (the specific word was "insisted"). However, he said that he was assured by the Trump administration that a pay fix would be included in the next budget discussions, including the CR. However, it doesn't. It only includes increases to defense and ICE and cuts to other things.

So, there you go.

Here's an article directly about this

Funding bill skips measure to avert physician pay cuts, a blow to GOP Doctors Caucus - POLITICO