David Juurlink

Internal Medicine, Clinical Pharmacology/Toxicology and drug safety research @Sunnybrook and @UofTMedicine. Inexplicably fortunate husband.

[David Juurlink @DavidJuurlink]

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.

[The New Yorker @NewYorker]

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. https://t.co/JvWEg3hUpZ

[Josh Farkas MD 💊 @PulmCrit]

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.

[David Juurlink @DavidJuurlink]

@MarcusVPinto @MicieliA_MD FWIW I’ve seen a few cases of GBS in which reflexes were preserved at presentation, only to be absent a few days later.

[David Juurlink @DavidJuurlink]

For the love of god please stop withholding ceftriaxone in patients with anaphylaxis to penicillin

[Josh Farkas MD 💊 @PulmCrit]

IMHO everyone in this thread is wrong.

PCN isn’t cross-allergic with ceftriaxone.

If someone is allergic to PCN and CTX is the best antibiotic for them, then just give the CTX! Simple.

(Yes, even anaphylaxis to PCN)

You even have guidelines to back you up now.

[David Juurlink @DavidJuurlink]

@pdlonghorn In this case yes, multimodal is the way to go. The thing to stop is mindless dose escalation.

[David Juurlink @DavidJuurlink]

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.

[David Juurlink @DavidJuurlink]

New patient: “Internal medicine? Like House?”

Me: “Yes but minus the personality disorder and Vicodin addiction.”

[David Juurlink @DavidJuurlink]

As a general rule, do not take the big aspirin. The little aspirin works just fine.

[Dr Charlie Ward @DrcharlieWardQ]

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.”

[David Juurlink @DavidJuurlink]

@ClementLeeMD Any mention of tramadol?

[David Juurlink @DavidJuurlink]

Among people using illicit fentanyl, we estimate an *average* daily dose equivalent to ~9000 milligrams of morphine.

Led by @MorganGodvin w/ @ChelseaLShover and @JosephRFriedman

https://t.co/6lXwr1eI90

[Todd C. Lee @DrToddLee]

@PulmCrit The truth is we should not use oseltamivir and we have wasted decades in getting RCT evidence in hospitalized patients

[David Juurlink @DavidJuurlink]

Just amazing to watch deaths from cervical cancer plummet as HPV vaccination coverage increases
https://t.co/4nJhaaaSD7

[David Juurlink @DavidJuurlink]

@DrToddLee Tell me you have a forthcoming NEJM publication without telling me you have a forthcoming NEJM publication

[David Juurlink @DavidJuurlink]

@kidney_boy 💯

[David Juurlink @DavidJuurlink]

I don’t know who needs to hear this but dehydration and volume depletion aren’t the same thing.

[David Juurlink @DavidJuurlink]

@bryan_johnson @MartinShkreli When a drug appears to reduce multiple major adverse outcomes by 25-35%, there’s a good chance the treated group is fundamentally healthier than the untreated group

[Adam Feuerstein ✡️ @adamfeuerstein]

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 @DavidJuurlink]

That bupropion overdose who looks totally fine? They’re about to become very, very sick.

[David Juurlink @DavidJuurlink]

In any cohort of medical students, one will, by definition, be the least knowledgeable

[Pitt Crave @PittCrave]

Noah Wyle compares his medical knowledge to that of a third year

[Ethan J. Weiss @ethanjweiss]

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 https://t.co/a52WwDQ2Ju

[Neil Renic @NC_Renic]

Need the Pope to release an encyclical against Teams calls