Clinical Pearls, 23-Jan-1998. People are walking less and less. A report this week in the British Medical Journal estimated that people are walking 22% less today than they did in 1972. The greatest decline in walking was among 5 to 15 year olds. Thought to be primarily responsible for this decline is the rising use of the automobile. The report estimated that one fourth of all car trips are less than 2 miles. Also, since 1975 the percent of children travelling to school by car has increased from 12% to 23% in 1994. No amount of money devoted to medical care will make up for the decline in activity by our youth.

This week the Lancet reports on a patient with intractable hiccups that apparently was cured by smoking marijuana.

Recommended reading this week is Don't Sweat the Small Stuff...and it's all Small Stuff by Richard Carlson.

Now for the pearls of the week...

About 1 in 20 Americans have asthma, with about 1 in 10 children suffering from it; the good news it that a SINGLE daily dose of inhaled steroids can control symptoms (I.e. 4 puffs once a day is as effective as 1 puff 4 times a day). J Allergy Clin Immunol 1997 100:0771.

The combination of aspirin and coumadin (mean INR 1.47, mean dose 4 mg/d) was successful in preventing a heart attack in 5,085 men. Treating 1,000 men with aspirin OR warfarin a year would save 3 deaths; if both used for a year, 5 deaths avoided. Lancet 1998 351:0233.

The International Study of Infarct Survival (isis 3) concluded that contrary to earlier reports, sex has a minimal effect upon outcome after a heart attack. Age and other confounding factors are much, much more important. NEJM 1998 338:0008.

It is advocated the the use of bisphosphonates for the treatment of osteoporosis be restricted to 80 year olds with at least one spinal compression fracture and also a low bone mineral density. Arch Intern Med 1997 157:2617.

Treating chronic anal fissures with botulinum toxin was found to be more effective than saline injections in this study of 30 patients. Maria G … NEJM 1998 338:0217.

Aspirin is as effective as cholesterol lowering medications in the primary prevention of a myocardial infarction. Lancet 1998 351(9098).

HMGcoA reductase inhibitors are useful in the primary prevention of stroke. Bucher HC … Ann Intern Med 1998 128(2).

In Kentucky, 60% of medicaid patients with an upper respiratory infection were given antibiotics although only an estimated 6% actually needed them. The cost savings for unnecessary antibiotic prescriptions in Kentucy is $1.62 million dollars a year. Mainous AG … Arch Fam Med 1998 007:0045.