Primary Care Pearls for the Week of April 14-20, 2002
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
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
Plug-in Air Fresheners Recalled.
The Glade brand Extra Outlet Scented Oil Air Fresheners SCJ079 have been recalled due to fire concerns. (article) posted by Thomas F. Heston, MD, FAAFP 20:45 GMT © medjournal.com
Lawyers Run Amuck in Australia.
The US isn't the only country with lawyer problems. In Australia, the medical malpractice insurance companies are facing huge shortfalls in cash due to (according to the insurance companies) the out of control medical indemnity situation. The government agrees, and is bailing out the largest insurer. The government has also planned a national summit meeting on medical indemnity for April 23, 2002. The out of control medical malpractice situation is similar to that facing the US: rural areas are facing growing shortages in medical care because physicians are unable to keep up with huge medical malpractice insurance rates.Comment: in some places in the US, malpractice insurance for rural obstetricians is $70,000 a year, which exceeds the income they are able to earn in low income, rural areas. This is a clear situation of having healthcare only for the rich, and possibly a reason for the large disparities in health care between the races. In the US, we regulate how many physicians there are, because too many physicians can be bad for the nation's health (see the disease mongering pearls below). Why don't we also regulate the number of lawyers admitted to the bar? Aren't too many lawyers also bad for the country? I once was posed this question: In the US, there are 100 lawyers for every scientist. In Japan, there are 100 scientists for every lawyer. Now, who do you think will win the technology race? (article) posted by Thomas F. Heston, MD, FAAFP 15:33 GMT © medjournal.com
Buyer Beware: Are Cheap Medications from Foreign Countries a Good Deal?.
I have lots of patients who think that buying their medications at the lowest price is always a good idea, even if it means buying them in a foreign country (e.g. Mexico). Well, buyers beware. A recent survey found that 8% of the medicines sold in Philippine pharmacies were fake, 60% of those sold in Cambodia fake (substituting a cheaper antibiotic for a more expensive but more effective one), and 38% of tablets sold in South East Asia fake. Comment: Also note the pharmacist in the US who diluted down cancer drugs in order to increase his profit. Herbal medications also are notorious for containing fake, and sometimes harmful ingredients. (article) posted by Thomas F. Heston, MD, FAAFP 15:10 GMT © medjournal.com
Mad Cow Disease Now in America?.
Health officials in Florida suspect that a 22 year old woman has mad cow disease, the incurable viral illness that slowly destroys your brain then kills you. There is no cure. Comment: it is funny but sad that the officials in Florida, after reporting this serious finding, state that there is no reason to suspect that cattle in the US have the disease. The stupidity of this statement is obvious given the huge problems experienced in Europe with mad cow disease. How about the health officials start imposing strict limits on antibiotic use by cattle farmers? This seems like the more reasonable solution, given proof that antibiotic resistance can move from animals to humans. Furthermore, antibiotic use by animal farmers in America is outrageously excessive. Why do the farmers give nearly all their animals antibiotics? Because the antibiotics make them healthier and grow better. How about we save the antibiotics for humans, so it will make us healthier and grow better? Too often, the government comes down on physicians, telling us incessantly to use fewer antibiotics. How about coming down on the farmers? How about reducing antibiotic resistance by decreasing usage among animals? Or is there a vested interest in promoting antibiotic resistance (in order to sell the newest, most expensive, most powerful antibiotics)? (article) posted by Thomas F. Heston, MD, FAAFP 14:35 GMT © medjournal.com
Disease Mongering: Death.
Death- which is not a disease but a natural part of life that affects everyone- faces over medicalization from both those wishing "death with dignity" and those who wish to use the full extent of technology to postpone death in all situations. This author addresses the issues physicians face in balancing technology with humanistic, compassionate, palliative care. Comment: The assisted-suicide movement in Oregon (USA) is typical disease mongering by turning death into something that physicians need to treat (i.e. bring about) medically. (article) posted by Thomas F. Heston, MD, FAAFP 07:30 GMT © medjournal.com
Disease Mongering: Psychiatry.
This author argues that the whole field of psychiatry has started to focus excessively on the use of medicines to treat mental disorders. Changing from the current biomedical model to a model that also include ethics and other social issues is recommended. Comment: remember Tipper Gore's focus on mental health during the Clinton/Gore administration? During that time, Americans were told that a full third of us currently had a mental disorder (primarily depression) and that the majority of us during our lifetime had mental health disease. This is typical disease mongering. (article) posted by Thomas F. Heston, MD, FAAFP 07:15 GMT © medjournal.com
Disease Mongering: Sex.
Medicalization of sex (disease mongering) takes many forms. In the past, certain forms of sexual behavior were categorized as "perversions" as opposed to "acceptable." Then, these "perversions" were viewed as treatable diseases. Now, according to these authors, our society has an obsession with sexual gratification. This opens the door for certain groups to push surgery or drugs designed to "improve" sexual pleasure. This over medicalization puts the biological side of sex above the social and interpersonal dynamics of relationships. (article) posted by Thomas F. Heston, MD, FAAFP 07:02 GMT © medjournal.com
Disease Mongering: Childbirth.
This article argues that childbirth has become over-medicalized. Too many interventions are being performed in most Western countries according to the authors. Although death from childbirth has greatly decreased due to interventions in high risk deliveries, there is a concern that low risk deliveries are being over medicalised ("disease mongering"). (article) posted by Thomas F. Heston, MD, FAAFP 06:56 GMT © medjournal.com
This editorial in the British Medical Journal argues that a lot of money can be made by telling healthy people they are sick. This medicalising of ordinary life is a frequent tactic of pharmaceutical companies in their direct-to-consumer advertising. Other groups guilty of disease mongering (telling healthy people they are sick, or that their mild conditions are serious) include doctors and patient advocacy groups. The solution? Replace corporate funded information with independent information. (article) posted by Thomas F. Heston, MD, FAAFP 06:49 GMT © medjournal.com
Flu Shot Helps Heart Patients.
This study of 300 Argentinian patients found that getting a flu shot greatly decreases the mortality rate among heart attack survivors and patients who have had a recent angioplasty. (article) posted by Thomas F. Heston, MD, FAAFP 06:39 GMT © medjournal.com
Poor Health in Russians to be Addressed.
Only one in three Russian children is born healthy, and up to 90% of teenagers suffer from at least one chronic disease. Russia's ministry of health just announced a nationwide campaign to conduct medical examinations of all children up to 18 years old. The completion date for this nationwide effort is December 15th, 2002. (article) posted by Thomas F. Heston, MD, FAAFP 06:36 GMT © medjournal.com
Take a Loved One to the Doctor Day.
September 24th is being billed as "take a loved one to the doctor day." The effort is to help narror the health disparities between Americans. Although the promoters are targeting black Americans, this promotion should also target men, a group that has shown to consistently have a life-span less than women, possibly due to men's reluctance to see the doctor. (article) posted by Thomas F. Heston, MD, FAAFP 06:29 GMT © medjournal.com
25% of South African Workforce Infected with HIV.
It is estimated that currently 25% of the South African workforce is infected with HIV. By 2005, it is predicted that 30% of the workforce will be infected. (article) posted by Thomas F. Heston, MD, FAAFP 06:21 GMT © medjournal.com
Statins shown to lower risk of Alzheimer's Disease.
In research presented at American Association of Neurology's 54th Annual Meeting, use of a statin (e.g. simvastatin) reduced the risk of Alzheimer's disease by 79%. posted by Thomas F. Heston, MD, FAAFP 05:14 GMT © medjournal.com
Thursday, April 18, 2002
Antibiotic Resistance Increasing.
For the first time documented, a large outbreak of antibiotic resistent group A strep has occurred. Previously, it was thought that strep throat (caused by group A strep) was uniformly susceptible to common antibiotics. Not anymore. Large scale resistance to erythromycin was seen in Pittsburg, as recently reported in NEJM. (Judith M. Martin, M.D., Michael Green, M.D., M.P.H., Karen A. Barbadora, M.T.(A.S.C.P.), and Ellen R. Wald, M.D. NEJM 2002;346:1200-1206. posted by Thomas F. Heston, MD, FAAFP 22:48 GMT © medjournal.com