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The Heart Beat

with James Beckerman, MD, FACC

Heart disease can be prevented! Your personal choices have a big impact on your risk of heart attacks and strokes. Dr. James Beckerman is here to provide insights into how making small, livable lifestyle changes can have a real impact on your heart health.


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Thursday, August 16, 2012


By James Beckerman, MD, FACC

Man with Smartphone

We just got back from Honduras.

Sort of a different type of summer vacation. Howler monkeys, sand fleas, and the occasional hurricane made for an exciting off-the-grid experience for me and my family — particularly my two little boys.

Whenever I travel, I try to imagine what life would be like if I had been born under different circumstances — in a different culture or country with different access to health care. Honduras is one of the poorest countries in the Western Hemisphere, with greater than 50% of its population below the poverty line. Sanitation and clean water are constant problems. Few people have access to preventive or interventional medical care. There are an estimated 157 physicians per 100,000 people. I see that many doctors in our hospital cafeteria every day.

But one thing that I did notice was that people do carry cell phones. And from what I could tell, many of them are smart phones that can be used to go online. I feel like there are some opportunities here. While providing health care in developing countries seems insurmountable — we are having trouble getting the job done here at home — prevention can begin with education. And education can be provided easily online, with videos, articles tailored to culture and schooling, and links to what resources might be available.

While I do expect that this is already happening on some level in countries like Honduras by their own leadership, I also see an opportunity for us to share what we already have. It’s just a question of helping people understand that it’s available.

Nearly 1.2 million people in Honduras already use Facebook to keep in touch with friends. It would be amazing if websites like WebMD and others that provide content and community could partner with existing social networking sites to reach more people and make a positive difference — for free.

Because it turns out that you’re never really off the grid.

I’d love to hear what you think — please add your comments below. Ultreya!

Photo: Stockbyte

Posted by: James Beckerman, MD, FACC at 11:17 am

Thursday, June 28, 2012

Big Gulps + Big Medicine = Big Government?

By James Beckerman, MD, FACC


Last month Mayor Michael Bloomberg re-ignited a national debate about the role of government in regulating what the private individual can do — or drink. His new policy restricting the sale of jumbo sodas responds to frustration that nutrition education has had limited success in promoting healthy intake and more exercise. We have learned through research that limiting choices and creating obstacles to less healthy behaviors (thereby making healthy behaviors more convenient) can steer behaviors in a direction that may turn the tide, however slowly.

Supporters of Mr. Bloomberg herald his decision as brave and many believe his policy is the first of many to domino across the nation as health care costs skyrocket and true health reform (regardless of the recent SCOTUS decision) is nowhere in sight. If we instill policies that make it easier for people to become healthier, they might argue, then everybody wins!

But based upon the controversy surrounding his announcement, many think that the typical American won’t win. Some suggest that thirsty individuals will gladly pay for another medium-sized drink to sate their sweet tooth, and some believe that the law unfairly targets lower-income individuals. Others point to the limited effectiveness of menu labeling and other regulatory measures as a sign that it just won’t work.

Which brings us to regulation. Probably the greatest frustration that people have with Mr. Bloomberg’s plan is that it presents yet another example of Big Government intruding into the lives of ordinary citizens, limiting choices and free will in the form of a 32-ounce Big Gulp.

How dare an organization over which we have limited day-to-day control meddle in our dietary affairs?

These points are fair, but also need to be interpreted in proper context. First, the government provides health care to a booming number of citizens, including lower-income individuals who may be disproportionately impacted by this legislation as well as older individuals who have the highest rates of heart disease, diabetes, and health care costs. Promoting health, even through regulation, can be consistent with providing health care. Second, and perhaps more importantly, regulation is not a new thing.  A regulation is a principle designed to control behavior. It’s just a euphemism for manipulation…and it’s happening all around you.

Have you ever wondered how high fat, high sugar, high salt, and highly processed foods are so cheap? And why soda bottles got so big in the first place? Through a clever combination of government subsidies, lax rules regarding marketing to youths, and extensive research into our palates without consideration for our paunches, the beverage industry has manipulated us into buying its products and consuming more than we need. It has facilitated unhealthy behaviors and — by reducing cost per calorie as compared to healthier options — Big Beverage has created obstacles to eating real, unprocessed food.

How dare an organization over which we have limited day-to-day control meddle in our dietary affairs?

But it doesn’t end there. Our health care system (which is partially propped up by our government) is at a loss for how to improve health outcomes, so organizations like the American Heart Association, the American College of Cardiology, and Canada’s PartipACTION promote healthy behaviors through advocacy, education, and outreach. But it costs a lot of money to make television commercials, run exercise programs, and print pamphlets. Wouldn’t it be great if corporate donations helped to support these lofty goals?

Welcome back to the tent, Big Beverage. Our thirst for your sodas is only exceeded by our thirst for your profits. Corporations that create and promote unhealthy products are some of the greatest donors, supporters, sponsors, and partners of our health organizations. It’s altruism with a bottom line. And as a result, Big Medicine ends up having egg on its face. Or at least some sugary carbonated water.

I understand the skepticism surrounding Mr. Bloomberg’s policy, but I’m struck even more by the extent to which corporations have manipulated — and even regulated — our tastes, our cravings, and our pocketbooks. The proposed policy is a response, but the initial outrage might be directed elsewhere.

Big. Gulp.

Photo: Polka Dot

Posted by: James Beckerman, MD, FACC at 10:55 am

Monday, June 4, 2012

Happy CPR/AED Awareness Week!

By James Beckerman, MD, FACC


In December 2007, Congress designated the first week of June as a time for education and advocacy about sudden cardiac arrest. Nearly 400,000 out-of-hospital cardiac arrests occur every year, and 88% of them occur inside the home.  But while CPR can double or triple the chance of surviving sudden cardiac arrest, only about a third of victims receive CPR. So if someone in every household learned CPR this week, we would save some lives.

People are often surprised to learn that the American Heart Association and the American Red Cross now support “hands-only” CPR, which does not involve mouth-to-mouth resuscitation. You can learn everything you need to know at As the school year is coming to an end, it’s also a good time to find out whether your children’s schools have AED’s available and accessible.  Prompt use of a defibrillator provides the best opportunity to help someone suffering from a cardiac arrest.

And while you’re getting inspired to save a life, you might also want to check out a community of heart disease survivors who are fighting their heart disease head on. Iron Heart Racing is (from their website) a community of “everyday athletes on a mission. It’s quite simple: Compete in endurance races across the globe while raising awareness for healthy heart living and congenital heart disease.”  I think they have the potential to do for the community of people living with heart disease what Livestrong has done for cancer awareness and research.

But read further and you’ll realize that in addition to sponsoring running events and raising money for cardiac charities, the Iron Heart Foundation is also taking things to the next level – the Iron level – by creating a documentary about eight “cardiathletes” who have all undergone heart surgery, and are now taking on an Ironman Triathlon. Their hope is to raise awareness about heart disease and try to convince people living with it that, in many cases, they can still dream big under proper medical supervision. As a cardiologist, I see the benefits of cardiac rehabilitation in people who have undergone surgery, but I’m also curious to learn more about these extreme athletes and their journeys, as well as the doctors who are helping them to be hopefully safe along the way.

Check out the preview for Flat Line to Finish Line and let me know what you think.  I know I will definitely be watching. All 140 miles…

Photo: iStockphoto

Posted by: James Beckerman, MD, FACC at 11:48 am

Thursday, May 31, 2012

Heart Healthy at Any Age

By James Beckerman, MD, FACC

Heart Healthy Kid

I just got back from a whirlwind 24-hour trip to Phoenix, Arizona, where I joined an incredible volunteer committee in supporting the American Heart Association in its efforts to raise money for research, education, and advocacy to help fight and prevent heart disease.

We heard from a variety of speakers at the AHA’s mid-year planning meeting, and I was impressed to learn that Phoenix has been raising money for the AHA for 53 years with their annual Heart Ball — they pioneered what is now a nationwide tradition in dozens of cities. Throw in a fashion show, a raffled shopping spree at Neiman-Marcus (no, I didn’t win), and my first time cutting vegetables on television, and it made for a busy, fun day.

And a hot one — it was 107 degrees — and for this Oregonian, that meant air conditioning in a big way. So I was thrilled that we capped off our day with a visit to the Halle Heart Children’s Museum. This one-of-a-kind interactive exhibit is housed adjacent to the offices of the American Heart Association and provides visitors with a fun, educational, and even inspiring tour of the cardiovascular system with lots of creative ways for young people (and older!) to learn more about how to be heart healthy.

From the miniature golf course that takes you through a blocked artery to a grocery store fully stocked with rubber (but heart healthy!) foods to a film where kids teach kids how to save a life, this manageable but comprehensive museum would easily fill an afternoon.

But the best part? The American Heart Association lets public school groups in for free. Second graders and fifth graders visit the Halle Heart Children’s Museum every day as part of an ongoing science enrichment curriculum in cooperation with local public schools, and the AHA foots the bill. At a time when we are hearing consistently bad news about school budgets, this is a refreshing positive footnote from the community.

As we put our heads together to develop a comprehensive strategy around curbing the tide of childhood obesity, we are also learning that around half of these young people are already exhibiting risk factors for future heart disease, like elevated blood pressure, abnormal cholesterol, and elevated blood sugar. It should be no surprise, but it’s still sobering. A study by the Centers for Disease Control in the medical journal Pediatrics also recently noted that upwards of 37% of normal-weight kids carry a risk factor as well. This suggests that not only should we be targeting obesity, which is a visible suggestion of possibly increased cardiac risk, but we need to be proactive about educating kids (and their parents) and steering them toward their pediatricians for regular visits to consider these risk factors before they blossom. In a world fueled by digital content, where health strategists are understandably geared toward meeting kids where they tend to live — on cell phones and computer screens — there is something refreshing about an educational tool which you can touch, hear, and see…in real life.

And the air conditioning works great too.

Photo: iStockphoto

Posted by: James Beckerman, MD, FACC at 9:46 am

Tuesday, May 8, 2012

The Force of the Quantified Self

By James Beckerman, MD, FACC


In my last post, I talked about the Dark Side of the Quantified Self — the possibility that becoming too focused on one’s own personal data may begin to diminish our individual real-life experiences and interactions. Mindfulness can be mind numbing if taken to an uncomfortable level. But for every Dark Side, I’m told, there has to be a Force for good. And in the case of the Quantified Self, I see the greatest potential for health improvement in the quiet collection of data that happens without our constant attention.

But don’t get rid of your pedometer quite yet. Pedometers, food diaries, and scales are definitely associated with positive changes in behavior, so we do recommend them as external triggers when we have trouble motivating ourselves on our own. But collecting data under the radar (with consent of course) and communicating it to the right people could potentially offer even more than a health course correction — it could save your life. I think that this is the future of the Quantified Self.

The AliveCor ECG device is an example of cool ideas to come. It’s simple and beautiful — an iPhone case that fits neatly on your phone. You gently press the phone to your chest and the phone automatically begins to record an electrocardiogram tracing which includes information about your heart rate and rhythm. It can even potentially diagnose a heart attack. The data could be sent automatically to a cardiologist who examines your heart’s data and can contact you with any concerns. I recently debuted the device on television and people are already asking when they will be available for sale. This simplicity of data collection, transfer, and health care provider response should be our goal.

So what’s the next step? Because ideally we wouldn’t need to find our iPhone when we develop an abnormal heart rhythm or a heart attack. Someone else would know about it and would be able to help us. Wouldn’t it be great to record this data on an ongoing basis and feed it to a databank which can analyze it and direct us to appropriate health interventions? Enter, a new platform that will help combine innovative sensors and your mobile phone to upload and track heart data — hopefully for millions of people. Researchers will have access to data to understand our hearts better, and clinicians will be able to give you a call if your heartbeat is irregular, too fast or too slow, or if there are signs of a heart attack. It’s amazing, and it’s really happening.

Would you want to upload your personal health data? Or does it sound too much like Big Doctor looking over your shoulder? It’s true — with big data comes great responsibility… So may the Force be with us.

Photo: Hemera

Posted by: James Beckerman, MD, FACC at 9:52 am

Tuesday, April 10, 2012

The Dark Side of the Quantified Self

By James Beckerman, MD, FACC


I admit it: I have a dysfunctional relationship with my running watch.

You may already have your own — or a similar device accessory that logs your calories, miles, steps, stairs, sleep, sitting, or even altitude. This year we’ve experienced an incredible increase in the ability and affordability of wearable technology that serves to quantify us, but it’s not a new phenomenon.

The earliest studies of pedometers demonstrated years ago that the mindfulness afforded by documentation tends to increase our overall activity levels. Fast forward to GPS locators, sophisticated accelerometers, and Bluetooth, which make it possible to develop surprisingly accurate algorithms that monitor where you go and what you are doing — with the goal of having you do more.

The next generation of gadgets will be able to dig even deeper, measuring your heart rhythm, blood pressure, blood sugar, and kidney function. Diabetics will be able to maintain their sugars at safer levels and triathletes will know when they should have their next energy drink. The quantified self is expanding rapidly.

But when does mindfulness actually become mind-numbing?

I had a chance to experience this first-hand a few weeks ago. For unclear reasons, my running watch stopped connecting with the USB port on my computer. I was unable to upload my runs for a few weeks. And in the world of connectivity, this means only one thing: my runs never happened. Because one thing I’ve learned about the quantified self is that if you can’t document it, then you can’t prove you did it. And if you can’t prove you did it, then those early mornings on the treadmill are somewhere in the ether — but unfortunately not in the Cloud.

It bothered me that I even cared. But I recognize this phenomenon as The Dark Side of the Quantified Self — there is a tendency to become so dependent on the secondary gain experienced by documenting our activities that our experience of the activity itself is tied to its documentation.

If you don’t believe me, then check your Facebook account. You and your friends are posting updates, photos, links, and check-ins. Why? Because you really care if the kid who used to pick on you in high school reads some random Jezebel blog post, watches the ukulele duet of Zooey Deschanel and Joseph Gordon-Levitt, knows that you’re killing time at the Gas N’ Sip, and sifts through the fifty photos you posted from dinner last night? Nope. It’s because with status updates, there are “likes.” There are comments. There are shares. It’s because we are, unfortunately, judging our own tastes, experiences, and even (gulp) the cuteness of our kids based on whether our questionably curated group of friends thinks that they are as awesome as we do.

As we use similar technology to quantify ourselves, let’s be careful that we don’t fall into the same traps. Quantity doesn’t always mean quality, especially when it comes to the self.

Even as an early adopter of Facebook and Twitter, and especially as an advocate of mindfulness as a technique to improve health outcomes, I realize our collective tendency to lose the joy of a tasty meal in the hurry to input calories, or to mistake gamification for a true runner’s high.

Sometimes I just want to enjoy the moment for what it really is, not for its “significance” in defining who I supposedly am. I’m reminded of the observation by Socrates that the unexamined life is not worth living. Maybe so. But I’d still give him one heck of a deal on a slightly used running watch.

Photo: iStockphoto

Posted by: James Beckerman, MD, FACC at 7:42 pm

Thursday, April 5, 2012

The Full Story

By James Beckerman, MD, FACC


Today, our obsession with celebrity combined with a 24-hour news cycle afforded by the internet and cable television make any tragic event seem worthy of further investigation. Like many people, I hear about the deaths of celebrities and feel empty. And curious. Because much in the same way that we are fascinated by the road that people take to achieve success, we are similarly captivated by the choices people make that lead to tragedy. We can learn from people’s good choices, and conversely we can learn from others’ mistakes.

For instance, smoking cigarettes may lead to chronic lung disease, which can be treated with steroids, which may impact the immune system, which can increase the risk of pneumonia. Chronic breathing problems may limit our ability to exercise. Steroids may worsen diabetes. In our effort to simplify a final moment, we uncover people’s inherent complexity.

For Whitney Houston, it was no different. Her autopsy report identified a 60% blockage in her right coronary artery and no evidence of a blood clot in the vessel or a heart attack. Toxicology testing showed cocaine, benzoylecgonine, cocaethylene, marijuana, alprazolam (Xanax), cyclobenzaprine (Flexeril), and diphenhydramine (Benadryl) in her system.

Substance abuse, and cocaine in particular, carry significant risk of the development of heart disease. Cocaine can impact the heart in three ways. The first is that the increased heart rate and high sympathetic tone can increase the risk of developing a cardiomyopathy. This is characterized by reduction in heart function and can be associated with symptoms of congestive heart failure like shortness of breath, fatigue, and swelling in the legs and ankles. Cardiomyopathies can also be associated with abnormal or dangerous heart rhythms.

The second way that cocaine can impact the heart is by promoting early-onset coronary artery disease, though the mechanism is not well understood. While some younger women like Whitney Houston may develop coronary disease, it is not as common in the absence of other significant risk factors like diabetes, high blood pressure, or abnormal cholesterol. It is possible that cocaine use might have contributed to the 60% stenosis noted in her right coronary artery. Her autopsy would suggest that, despite having coronary artery disease, she did not have a heart attack. There was no evidence of a ruptured atherosclerotic plaque or a clot at the site of her blockage to suggest an abrupt closure of the vessel. Additionally, inspection of the heart itself did not indicate any obviously damaged muscle, although earlier in a heart attack this might be more difficult to detect.

Finally, the possibly most life-threatening cardiac manifestation of cocaine use is abnormal heart rhythms, or arrhythmias. Using cocaine increases the possibility of developing dangerous heart rhythms that arise from the ventricle — the lower chamber of the heart. These can be associated with drops in blood pressure, decreased oxygen supply to the brain, and, eventually, death. Even if not deadly, an abnormal heart rhythm can cause a person to faint, and fainting while in a bathtub is clearly a life-threatening event.

While we may never know what exactly happened in the hotel room that day, Whitney Houston’s autopsy report reads, “Death was due to drowning due to effects of atherosclerotic heart disease and cocaine use. No foul play is suspected. The mode of death is accident.” Simply put, a tragic ending to a complex life.

In the end, we are devoid of celebrity, or wealth, or struggles. We all die alone. And sadly, there is always more to our story.


Posted by: James Beckerman, MD, FACC at 10:45 pm

Friday, March 23, 2012

How to Save a Life…on Spring Break

By James Beckerman, MD, FACC


Millions of Americans will be traveling this week – some in search of sun, and others snow. And sadly, some people will experience injury or illness, or even worse. So this week I want to challenge you to do something that might save a life — maybe even yours — by joining other travelers to become an altruistic part of a crowdsourcing solution.

Crowdsourcing is a way people who don’t even know one another can solve problems together. Each individual can contribute to a solution by providing a small, unique part of the answer. All it takes is a smart phone and about a minute of your time.

The problem: Sudden cardiac arrest kills over 250,000 Americans every year; more than 95% of victims die before they reach the hospital. The definitive treatment for sudden cardiac arrest is defibrillation. But the risk of death or irreversible brain injury increases with every minute that passes before a bystander delivers that potentially lifesaving shock from an automated external defibrillator (AED). You might be able to access an AED quickly to help someone in a gym or school or in other familiar places. But what would you do if you were somewhere else? You’d call 911 and start CPR, but knowing where to find the nearest AED could significantly increase the likelihood of saving a life.

The solution: A group in the Netherlands has launched the website as well as free iPhone and Android AED4 U.S. applications. This service enables you to add the location of any AED you see through either the website or via the GPS locator in your phone. By adding an AED location, you can contribute to an evolving worldwide map of AED locations along with thousands of other people. And by keeping the app on your phone, you will be able to locate the nearest AED if you find yourself in the position of needing to save a life. Even if you never need it, someone else will.

It can take a minute to save a life.  Not a bad way to start off a vacation.

For more information about crowdsourcing your health, watch Lucien Engelen talk about this technology, and join Dr. Beckerman on Twitter @jamesbeckerman to continue the conversation.

Photo: iStockphoto

Posted by: James Beckerman, MD, FACC at 1:41 pm

Monday, March 19, 2012

Can Hipsters Save Healthcare? Lessons from SxSW

By James Beckerman, MD, FACC

Doctor Texting

“Go easy.”

The waiter raised his voice above the bluegrass band at the Salt Lick BBQ as he wished me a good time at Austin’s South by Southwest (SxSW) conference just a few days ago. An explosive marriage of music, film, and interactive (think tech/startups/social media) where strange bedfellows like Al Gore, Biz Stone, and Bruce Springsteen speak and perform before 30,000 fans wearing hipster glasses, personal WiFi hotspots, and ironic t-shirts.

Not your typical medical conference.

I sampled panels on digital health, social media and medicine, technology, and the arts. I made new friends from the WebMD family, and my Twitter feed became a human reality. Flying home from Austin to Portland, I found myself with three takeaways from South-by, and probably more to come.

1.      Location. Location. Location. In the past five years, we have experienced a surge of connectivity through Facebook, Twitter, and now Pinterest. But at this year’s SxSW, the buzz was all about Intro and Highlight — apps that use your social media profiles and leverage your smart phone’s GPS to introduce you to people around you before you have even met them. It’s too soon to say how this might impact healthcare, but I’m confident it will, especially as people are becoming more comfortable sharing their own health information (check out the new Facebook health feature or our WebMD communities if you don’t believe me). What would it be like if you knew that the person next to you on the bus had breast cancer too — and beat it? Or that the shopper in front of you in the grocery line is a neurologist searching for an Alzheimer’s cure and could share a research protocol with you that could change your mother’s life? This technology has only been available for weeks. Just wait.

2.      People respond to positives. One of my favorite sessions was a slightly less “medical” workshop led by actor Jeffrey Tambor from the show Arrested Development. He shared a directing “secret” used by all the greats from Kubrick to Scorsese: You get people to do their best by encouraging them. Doctors should pay attention. Our messaging as health care providers has become more punitive and less constructive. Patients can feel bullied sometimes, or made to feel guilty rather than inspired. We need to set our patients up to succeed without creating an inappropriate health ideal that sets them up to fail.

3.      Be careful. I capped off the conference by attending a session called Surviving Technology. A cautionary tale in our pressured momentum toward ultimate connectivity, the speaker argued that we need to recognize that we can’t sacrifice quantity of associations for quality. No matter how cool the app, how many “friends” we think we have, or how much data we will ultimately share, nothing will replace a hug, a handshake, or looking someone in the eye. Don’t get me wrong — I strongly believe in the power of tech to improve our health — but I’m also proud to support the idea that the purest form of care will always happen at the bedside. In our efforts to leverage technology, we can never forget that are patients are people, not profiles.

So as the barbecue settles in our collective stomachs, and Sixth Street takes a breather until next spring, I leave Austin with a fresh perspective on continuing medical education:

Be present.

Be nice.

And go easy.

How do you see the future of technology and healthcare? Leave your comments and join Dr. Beckerman on Twitter @jamesbeckerman to continue the conversation.


Posted by: James Beckerman, MD, FACC at 1:42 pm

Monday, February 27, 2012

Is Qnexa the Next Statin?

By James Beckerman, MD, FACC

New Prescription

You are sitting in your doctor’s office, and after reviewing your laboratory tests, you hear what hundreds of millions have already been told:

“I think you should take a statin.”

So what’s your response? While some people are open to taking a cholesterol medication, others are not. So when I recommend a statin, I explain why. I describe the data that supports the use of statins to reduce the risk of heart attacks and strokes in higher risk individuals. I discuss what I perceive to be a benefit in lower risk people with significantly abnormal lipids. I mention the anti-inflammatory, anti-oxidant, and anti-clotting characteristics of statins which likely contribute to their benefit above and beyond their impact on your cholesterol levels. And despite some valid concerns regarding side effects, I also note that statins are likely the best studied medication in all of pharmaco-history. In the end, some take the prescription home, and others decide,

“I think I’ll work harder on diet and exercise.”

So fast forward to a world where Qnexa has been approved by the Food and Drug Administration — its expert panel gave it a thumbs up last week, so keep your eyes open for the television commercials any day now. Qnexa is a combination of phentermine and topiramate — an amphetamine and an anti-seizure medication with potential risks including elevated heart rate, fatigue, nausea, and increased risk of cleft deformities in children of pregnant women taking the drug. It was previously rejected because of concerns about these side effects and unknown longer term effects. But it will likely be approved because it is associated with loss of about 10% of total body weight. As with other obesity medications, the weight comes back if you stop the drug.

So there you sit in your doctor’s office, and after reviewing your weight and cardiovascular risk factors, you may soon hear what hundreds of millions will likely be told:

“I think you should take Qnexa.”

So what’s your response? Will you express concern about a medical therapy that was previously rejected because of safety concerns just two years ago? Will you wait for long-term data about its impact on blood pressure and stroke? Will you ask how it works, and wonder why a seizure medication is being used to help people lose weight? Will you take the prescription home, or will you decide,

“I think I’ll work harder on diet and exercise.”

I’ll be interested in your reaction. But if you go for the Qnexa, there might be a prescription for a statin waiting for you at the pharmacy too…

Posted by: James Beckerman, MD, FACC at 2:52 pm

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