The Internet Medical Journal

The Internet Medical Journal
Primary Care Pearls

Tuesday, April 23, 2002

Fish Oil May Help Diabetics.
Daily supplementation with docosahexaenoic acid was shown to increase insulin sensitivity in overweight individuals susceptible to type II diabetes. Comment: This was a small study of only 12 overweight men and women. Nonetheless, an interesting finding. [ article ] posted by Thomas F. Heston, MD, FAAFP 01:47 GMT © medjournal.com

Hormone Replacement and Healthy Arteries.
This small study presented at the 2002 Experimental Biology conference suggests that exercise plus hormone replacement can significantly increase the elasticity of the arteries in women over 60 years old. Comment: elasticity of your arteries is important in the development of cardiovascular disease. This study indicates to me that exercise is vitally important. The role of hormone replacement is still controversial, but in this study it was helpful. The women had to engage in an exercise program consisting of a 40-minute walk 5 times a week. [ article ] posted by Thomas F. Heston, MD, FAAFP 01:42 GMT © medjournal.com

Early Life Critical to Lifetime Cancer Risk.
This study of 600,000 immigrants to Sweden found that their lifetime risk of cancer did not differ significantly from that of the country of origin. Comment: an interesting study that hypothesizes that the gestation period for cancer may be decades. The quality of this study appears to be good. The take home message is that parents need to do their best to optimize their children's diet and lifestyle (of course). For example, the eventual development of osteoporosis is highly dependent upon a person's peak bone mass, which in turn is highly dependent upon dietary calcium intake during adolescence. Of particular concern is the large increase in obesity among children over the last 20 years. What will this mean in terms of cancer and heart disease when these children enter their 50's and 60's? [ article ] posted by Thomas F. Heston, MD, FAAFP 01:33 GMT © medjournal.com

Monday, April 22, 2002

Sudden Infant Death: Possibly Related to Bacteria in Mattresses.
This study suggests changing mattresses may help prevent suddent infant death (SIDS). Bacteria that grow in mattresses where a baby has vomitted (burped up food) have been linked to SIDS. Foam mattresses, or mattresses that are old or previously used by another baby, are most likely to harbor these bacteria. Comment: based on these findings the use of a non-porous, new mattress for babies seems reasonable. We still don't know very much about how to prevent SIDS. It may be that in the future, more stingent recommendations on the baby's sleeping surface will be made. At this point, it seems reasonable to follow the recommendations of these researchers. [ article ] posted by Thomas F. Heston, MD, FAAFP 04:13 GMT © medjournal.com

Afternoon Coffee May Disrupt Sleep.
Comment: Here's a suprising study: drinking coffee in the afterrnoon can keep you awake into the night. So, (surprise!) coffee increases wakefulness. [ article ] posted by Thomas F. Heston, MD, FAAFP 04:01 GMT © medjournal.com

Angry Temperment Strongly Linked to Heart Disease.
In this study of 1055 men for an average of 36 years found that hot tempers predicted heart disease long before other risk factors such as diabetes and hypertension. These findings are corroborated by other studies linking type A behavior (high stress) with cardiovascular disease. Comment: the statistics in this study are weak, but suggestive that our intuition is right-- a hostile, angry, negative temperament is not good for your health. [ article ] posted by Thomas F. Heston, MD, FAAFP 03:53 GMT © medjournal.com

Exercise Reduces Blood Pressure: So What?.
This meta-analysis of 54 studies found that aerobic exercise reduces systolic blood pressure by 3.8 mm Hg on average, and diastolic BP by 2.58 mm. Comment: this is a classic case of statistics being irrelevant. Why do the authors of this study say that the diastolic pressure is reduced by "2.58" mm Hg? Is there any known difference between that and "2.57" ? This is pure nonsense. Clinically, it appears that the effect upon blood pressure is very minimal. The conclusion of this study should be that we know that exercise is good for you, but don't depend upon exercise to significantly lower your blood pressure. If you have hypertension, you will need to do something more than exercise in order to get your blood pressure down. [ article ] posted by Thomas F. Heston, MD, FAAFP 03:26 GMT © medjournal.com

Saturday, April 20, 2002

Smoking in Movies Increases Smoking in Life.
Smoking by leading actors in movies appears to increase the rate of smoking among children and teens. Comment: this is not surprising at all. The continued lack of responsibility by Hollywood with their constant mantra that movies imitate life, is shallow and irresponsible. Remember the propaganda movies in WWII? Those sure convinced millions of people that the Nazi movement was just. Television and movies have been shown repeatedly to cause behavior, not just "imitate life." For example, the large increase in homicides from firearms has been convincingly linked to the widespread introduction of the television set (and visual violence) into American homes. For more information scientific proof of this link, read Big World, Small Screen : The Role of Television in American Society by Aletha C. Huston et al and published by the University of Nebraska Press. [ article ] posted by Thomas F. Heston, MD, FAAFP 17:34 GMT © medjournal.com

Exercise Does Not Protect Smokers.
This study of 27087 Finnish male smokers from 50 to 69 years old, aerobic exercise did not protect against lung cancer. Comment: if you smoke, quitting should be your top health priority [article] posted by Thomas F. Heston, MD, FAAFP 16:36 GMT © medjournal.com

The Power of Laughter.
Parents who use humor to help diffuse conflicts raise children that are better able to regulate their own emotions. In a study of 139 adolescents and their parents, the use of lighthearted joking and absurd statements versus sarcasm during conflicts was studied. The parents that chose humor were more likely to raise resilient, socially competent children. The use of sarcasm had the opposite effect according to the findings presented at the Ninth Biennial Meeting of the Society for Research on Adolescence in New Orleans, Louisiana. [article] posted by Thomas F. Heston, MD, FAAFP 16:07 GMT © medjournal.com

Excessive Lawsuits -> Higher Healthcare Costs.
Lawyers say that the rising number of class action lawsuits will make drug prices come down. The focus is on anti-competitive pricing practices. Comment: there is a need for balance in our society. Too many lawsuits simply result in increased costs and decreased availability of healthcare. Too many lawsuits even hurt the legal system (note the previous pearl on Alabama, where jury trials are being suspended). Too many lawsuits divert our money from scientific research into insurance companies and the legal system. The rising costs of malpractice insurance is a major reason that rural areas are getting less and less obstrical care, and a significant contributor to the increased overall cost of healthcare. Don't think for a minute that more lawsuits will force pharmaceutical companies to decrease their profits. They are going to simply raise prices in order to pay their higher insurance rates and legal bills. The US justice system is in terrible shape. It's time that we start limiting the number of lawyers admitted to the bar in this country (perhaps on a per capita basis). While not enough lawyers, and too few lawsuits can be bad, an excessive number (the situation we are now facing) is disasterous. [article] posted by Thomas F. Heston, MD, FAAFP 15:57 GMT © medjournal.com

Exercise Can Lower Risk of Death From Stroke.
Surprise! Yet another finding that exercise is good for you. This study of nearly 17000 men aged 40 to 87 found that the most fit had a 68% decreased risk of stroke. [Medicine & Science in Sports & Exercise 2002;34:592-595] posted by Thomas F. Heston, MD, FAAFP 15:18 GMT © medjournal.com

US Ranks 3rd in Global Child Prostitution.
An estimated 1 million children are forced into prostitution yearly, and the total number of prostituted as high as 10 million. Estimates are that there are 400,000 to 575,000 children exploited in India, 100,000 to 500,000 exploited in Brazil, and 300,000 in the US. In fourth place is Thailand and China with an estimated 200,000 children each. Comment: pedophilia in the US Catholic Church seems to be representative of the society as a whole, rather than an isolated problem. The solution? Read an earlier pearl on "disease mongering: sex." Our society's emphasis on sexual gratification needs to be toned down, and a greater emphasis placed on interpersonal relationships. [The Lancet 2002;359:1417-1421] posted by Thomas F. Heston, MD, FAAFP 15:08 GMT © medjournal.com

Balance Act: Drinking May Help Some Prevent a Stroke.
An alcoholic drink a day may help some people prevent a stroke, but more than one or two drinks daily has been shown to increase the risk. This well known finding was confirmed in a recent study of 5209 men and women participating in the Framingham Study. Comment: alchohol's effect upon stroke risk is thought to be due to its' effects upon blood clotting. Would an aspirin a day (or perhaps 400 IU of vitamin E) work just as well, while avoiding the negative side-effects of alcohol? [article] posted by Thomas F. Heston, MD, FAAFP 14:19 GMT © medjournal.com

Online Pharmacies Increasing.
The growth in online pharmacies is rapidly increasing. Readers of the Internet Medical Journal will note that my letter the the mainstream medical media fell on deaf ears a few years ago. My call to regulate online prescriptions was determined to be "not of sufficient interest to our readership" according to the editors of JAMA and NEJM. Pehaps now they will take note since the incomes of offline companies are now being affected. If you would like to join the Internet Medical Association's taskforce on setting standards for online medicine, please contact the association's president. [article] posted by Thomas F. Heston, MD, FAAFP 04:45 GMT © medjournal.com

Alabama Suspends Jury Trials for 5 months.
The United States' out of control legal system is causing serious problems in Alabama. On Friday, the state Supreme Court ordered a halt to all trials statewide because of a fiscal crisis. Maybe now the federal government will pass tort reform? Not likely as long as the Democrats control the US Senate. [article] posted by Thomas F. Heston, MD, FAAFP 04:27 GMT © medjournal.com

The Weaker Sex, Part 2.
The Lancet reported this week that couples were more likely to have a baby girl if either of the parents smoked heavily during the time around conception. Male sperm and embryos are known to be more fragile as compared to females. Thus, an increase the female/male birth ratio is thought to be and indication of worsening of the population's overall health. [article] posted by Thomas F. Heston, MD, FAAFP 03:31 GMT © medjournal.com

The Weaker Sex.
High ozone levels have been linked to a reduced ability of sperm to swim. This study, presented at a meeting of the Pacific Coast Reproductive Society, compared over 8500 sperm sample from donors in Los Angeles with 5574 samples from 35 men in Northern California. Higher ground levels of ozone were associated with a decreased motility in sperm. Comment: sperm are highly sensitive to changes in the environment, and this can affect birth rates, and the male/female birth ratio. [article] posted by Thomas F. Heston, MD, FAAFP 03:28 GMT © medjournal.com

Diluted Drugs.
US pharmacist Robert R. Courtney has acknowledged a long pattern of diluting down chemotherapy medications, possibly affecting 4200 patients. Comment: see the buyer beware pearl below. [article] posted by Thomas F. Heston, MD, FAAFP 03:17 GMT © medjournal.com

Friday, April 19, 2002

Experts Back Off From HRT Recommendations.
Experts are backing off recommendations for hormone replacement therapy. It's effects upon preventing heart disease are less clear than previously thought. Also, the effects upon osteoporosis is also not as definite as thought (bisphosphonates have more solid data). Clearly, the huge rush to promote hormone replacement therapy was premature. Comment: was the rush to recommend hormone replacement therapy for all post-menopausal women "disease mongering" by patient advocacy groups? (article) posted by Thomas F. Heston, MD, FAAFP 20:50 GMT © medjournal.com

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