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Old February 15th, 2003, 13:10
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Thursday, January 30, 2003

Environmental groups call for end to aesthetic pesticide use

Pest control on farmlands accounts for less than 20% of all pesticides used across New York state, according to several environmental groups. The great majority of pesticide use is in urban or suburban settings for purely cosmetic, aesthetic purposes. Comment: this is an important finding. Regarding excessive pesticide use, farmers aren't so much to blame as homeowners and metropolitan businesses. The environmental groups urge that legislatures focus more on the urban use of pesticides. [ 16-Jan-03 ]   

ACE Inhibitors Improve Coronary Blood Flow in Diabetics

This study compared the coronary blood flow of 10 non-insulin dependent diabetics compared to 10 control subjects using N-13 ammonia PET. Without ACE inhibition, the diabetics had a blunted response to dipyridamole compared to the control subjects. With ACE inhibition, both groups had a similar increase in their coronary blood flow. Comment: ACE inhibitors likely not only help preserve renal function in diabetics, but also have a direct beneficial effect upon the coronary arteries. [ Journal of Nuclear Medicine Vol. 44 No. 1 19-23 ]  
Wednesday, January 29, 2003

Balloon Angioplasty Better Than Medications in Renal Artery Stenosis

This study found that in patients with renal artery stenosis, treatment with balloon angioplasty led to both a lower blood pressure and the need for fewer medications compared with medical therapy alone. [ Amer J Med 2003;14(1):44 ]  

Scientific American Online Readers Overwhelmingly Support Medical Marijuana

By 4 to 1, readers of Scientific American online say that medical marijuana should be legal (2506 yes versus 572 no). Comment: the medical community has supported medical marijuana, e.g. the American Academy of Family Physicians came out in support several years ago. Clearly, this issue is more political than medical. [ Scientific American: longest running science & technology magazine in America ]  

Residence Near Power Lines and the Risk of Birth Defects

This study of 161 844 Norwegian residences looked at whether or not living near power lines increased the risk of birth defects. They found little evidence that residence near power lines affects the risk of birth defects. Comment: the conclusion given by the authors is sound. They did find a few statistically significant correlations...but two out of the three concluded that living near power lines actually reduced the risk of birth defects. The conclusions of this study should be reassuring to anyone living near power lines. [ Epidemiology 2003;14(1):95]   
Tuesday, January 28, 2003

In Women, C-Reactive Protein a Stronger Predictor of First Cardiac Events than LDL-Cholesterol

This study looked at 27 939 apparently healthy American Women over an average period of 8 years. It found the C-reactive protein and LDL cholesterol levels were only minimally correlated (r=0.08). They found that CRP was a stronger predictor of cardiovascular events than LDL cholesterol. CRP and LDL levels seemed to identify different high-risk groups. Overall, 46% of all events occurred in women with LDL levels below 130 mg/dl (3.36 mmol/L). Comment: the findings of this study almost certainly also apply to men. Several other studies have shown that CRP levels are highly predictive. [New Engl J Med. 2002;347:1557-1565.]  

US Cancer Statistics 2003

The American Cancer Society estimates that in 2003 the total number of deaths due to cancer in the US will continue to increase due to the aging and expanding population. It is estimated that 1.3 million new cases of cancer will be diagnosed, and 560 000 people will die from cancer in 2003. The ACS notes that the age-adjusted cancer death rates in the US declined during the 1990's. Furthermore, the largest decline (i.e. biggest improvement) was noted in African-American males. However, African Americans still carry the highest burden of cancer. Comment: it is not clear whether the overall decline in cancer death rates has been due to medical treatment, or less aggressive cancers. [ CA Cancer J Clin 2003; 53:5-26 }  

The Coming Perfect Storm

"So often I’ve lately heard the state of U.S. healthcare system as being on the verge of crisis, that the factors contributing to this crisis are the gathering of a perfect storm. I agree." - US Senator Max Baucus (D-Montana) speaking at the 2003 National Health Policy Conference. Comment: the "Perfect Storm" he's referring to is made famous it the movie The Perfect Storm which is a moving, real story about fishermen who get caught at sea during a confluence of weather events that ends up creating a horrific, monstrous, "perfect" storm. The healthcare field is being hit from several angles: 1) malpractice. How much it costs is arguable, but there's no question that it makes practicing medicine often unpleasant and intolerable. That's why more and more of our best and brightest students are no longer choosing medicine as a career. 2) rapidly increasing costs, due primarily to costs due to advances in technology, but also in the burgeoning, insidious bureaucracy that is infesting the field, 3) a slowing economy worldwide. [ article ]  
Sunday, January 26, 2003

Biodiversity Helps Reduce Infectious Disease

This article concludes that diversity in vertebrates has the effect of reducing the spread of Lyme disease, a tick-borne infection. Comment: this article suggests that humans benefit when there is a large variety of other animals, and presents a scientific argument for preserving diversity and protecting endangered species. [ Proc. Natl. Acad. Sci. USA, Vol. 100, Issue 2, 567-571, January 21, 2003 ]  
Wednesday, January 22, 2003

Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men

This study of 38 077 men over a 12 year follow-up period found that the risk of a heart attack was lower among those who consumed alcohol at least 3 days a week, compared with those who consumed alcohol less than once a week. There was no difference between white wine, red wine, beer, or liquor. Comment: this study is incomplete because it only looks at a single relationship- alcohol and heart attacks. But our concern is quality of life, and overall mortality. Thus, without correcting for other significant diseases (e.g. stroke, hepatitis, or dementia) or for overall mortality the significance of this study is questionable. [ NEJM Volume 348:109-118 January 9, 2003 Number 2 ]  
Tuesday, January 21, 2003

The Longitudinal Association of Lead with Blood Pressure

This study of 496 men found that blood pressure was positively associated with blood lead levels. For every standard deviation increase in blood lead levels, the systolic blood pressure rose 0.64 mmHg. Comment: this is a poor study and is highlighted only to show the tricks used by some researchers to make their data look more significant. For example, this study concludes that for every standard deviation increase in blood lead levels, the blood pressure increased by 0.64 mmHg. So for example, if a person with normal blood lead levels had a blood pressure of 120 mmHg, then the person with levels a standard deviation above would have a blood pressure of 120.64 mmHg. I've never seen a sphygmomanometer that measured blood pressures to two decimal places. This change is clearly absurd. Furthermore, the researchers report changes in blood pressure as the mean +/- standard error (not standard deviation or confidence intervals). To put this in terms of standard deviations, the change in blood pressure for each standard deviation increase in blood lead levels is 0.64 +/- 5.6 mmHg (clearly this is not statistically significant). To prevent such statistical shenanigans by researchers, many journals have required that confidence intervals be used. The journal Epidemiology should do the same. [ Epidemiology 2003:14(1):30-36 ]  

The Risk of Osteoporosis in Caucasian Men and Women with Obstructive Airways Disease

This article concludes that airway obstructive disease (COPD, emphysema) about doubles the risk of osteoporosis. The authors state that osteoporosis screening in patients with airway obstructive disease is important. Comment: furthermore, recommendations from Canada have suggested that everyone over 65 be screened. [ Amer J Med Volume 114 , Issue 1 , Pages 10-14 ]  
Thursday, January 16, 2003

President Bush Calls for Malpractice Lawsuit Reform

President Bush, speaking to an audience at the University of Scanton (in northeastern Pennsylvania) called for national tort reform laws. Pennsylvania has been hit recently by walk-outs by physicians protesting skyrocketing liability insurance premiums. [ ]
Tuesday, January 14, 2003

It's Not Just 'Sue the Docs' Anymore

Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D.
Tuesday, Jan. 14, 2003

The nation is becoming more medically and legally paralyzed daily. Lets examine a few items telling us more about what we're becoming as a country than perhaps we might care to admit.

East Coast

As 2003 approached, physicians in several states pondered whether or not to go on strike. In West Virginia, one work stoppage actually occurred; as of this writing it's still under way.

The issue there and elsewhere: ruinous increases in malpractice insurance premiums, driven by predatory lawsuits, that have forced physicians to stop performing certain procedures, move their practices, or retire early. The American Medical Association lists 12 states where lack of certain specialists – most often surgeons and obstetricians – has become a significant problem.

Also as 2003 approached, the government abolished a program that permitted U.S.-trained, foreign-born doctors to gain permanent residency status if they work in "underserved" areas, mostly rural, for five years. The program, which sponsored over 3,000 foreign doctors, was canceled for security reasons, most notably difficulties in monitoring the travels and non-medical activities of these aliens.

Some are – of course – suing, and Sen. Sam Brownback, Kansas Republican, wants remedial legislation. "Immigration," he told the Wall Street Journal, "plays a critical role in the health-care infrastructure of rural America. ... In many communities in my state, were it not for foreign-born doctors, there would be no doctors."

So, what do we have here? To put it bluntly, American doctors refusing to practice, and to live, under constant threat of legal action, financial ruin, hundreds of thousands of changing pages of regulations, and jail, while America scrounges up medical personnel desperately needed in their own homelands because we can no longer get eno
ugh young Americans to go into medicine, or stay there.

But what does it mean?

It means – again to put it bluntly – that our health care and legal systems may be approaching the first stages of collapse. Unthinkable? Think again.

The present crisis was decades in the making. Once (Messrs. Shakespeare and Dickens notwithstanding) a lawsuit was an ex extremis remedy, not an everyday tool of greed, extortion, political activism and governmental oppression. A confluence of circumstances – especially the increased use of punitive damages, lawyers' contingency fees (a large percentage of any settlement), class action lawsuits, "runaway juries" and endless new incomprehensible laws and regulations – turned malpractice law into a racket and a lottery.

Insurance companies responded accordingly, raising premiums to cover their losses and then some. Even worse, a diabolical alliance of social engineers and bureaucrats dating back to the Progressive Era undertook to socialize medicine by making it impossible for private physicians to function, let alone succeed. "Disaster by Design," we call it, the deliberate manufacture of crisis and scandal and criminality.

It's working. Now add to this the malice of managed care, the financial shakiness of so many HMOs and hospital chains, and the post-9/11 emergency public health powers that governments at all levels have awarded themselves, and it is far from inconceivable that American medicine as an institution could, in its own way, collapse.

West Coast

In Southern California – particularly Los Angeles and Orange counties – the trial lawyers are up to their newest creative entrepreneurial shakedowns directly against the people.

A small cadre of Beverly Hills trial lawyers has been using lawsuits to extort millions of dollars from business owners and, in effect, from their customers. They are targeting thousands of small and minority-owned businesses such as nail salons
, automotive repairs shops and small restaurants with defendant names gathered right from the yellow pages.

Maryann Maloney, Executive Director of Orange County Citizens Against Law Suit Abuse (OC-CALA), notes:

"Shamelessly, they send extortion letters to these employers, who face language barriers in some cases, and limited resources in all cases, threatening to sue for minor violations which may have already been resolved. These lawyers pressure employers to essentially pay up or go to court. But with no actual plaintiffs, victims or damages, the only parties benefiting are the lawyers."

And All Around the Town

Since the state bars rarely discourage anything that puts more money in their legal briefcases, it's time for the attorneys general and legislatures in California and throughout the nation to act against these abuses.

It's time they represent and defend the people who elect them rather than advocate for the trial lawyers who donate millions to their legal shills to keep them "in power" – money that comes from attorneys' billion-dollar "war chests" painfully extracted from defendants.

At this point we know you probably have little or no concern for your physicians – but it's not just the doctors who are getting sued systematically any more – it's all of you, from pre-cradle to post-grave. Scream out loudly and boldly while you still can!

* * * * * *

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a former president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail at

[ Reprinted with permission from ]   

Hip Pads Help Reduce Hip Fractures

This study looked at 942 nursing home residents at high risk for falling and found that hip protectors significantly reduced the incidence of hip fractures. Comment: another article in this same issue of BMJ found that various multifactorial interventions failed to reduce falls in the elderly with dementia. The hip protectors used were Safehip from Tytex, Denmark. The hip protectors seem to definitely be of benefit if a person falls. Preventing falls is more difficult. Unfortunately, the other study did not look at Tai Chi, which has been shown to reduce falls in the elderly. [ Meyer et al. 326 (7380): 76 ]  
Thursday, January 09, 2003

Fish Oils Improve Cholesterol Profiles in Women

This study of 31 women looked at the effect of EPA, DHA, and GLA upon lipid profiles in women. The group that received 4g of
EPA+DHA plus 2g of GLA seemed to get the most benefit from the supplementation. [ American Journal of Clinical Nutrition, Vol. 77, No. 1, 37-42, January 2003 ]  
Tuesday, January 07, 2003

Obesity a Significant Risk Factor for Early Death

This analysis of the Framingham data found that obesity at age 40 increased the risk of premature death as much as smoking, cutting approximately 7 years off of the person's life span. [ BBC News 1/7/2003]  
Friday, January 03, 2003

Migraine Sufferers Benefit From Angiotensin II Receptor Blockers

This study found that the medication candesartan effectively helped prevent migraines. The 60 patients studied were given candesartan, 16 mg PO daily. When on placebo, the volunteers had an average of 18.5 days (over a 12 week period) with migraines versus 13.6 days when on the candesartan. Comment: this is a small, but important improvement. On placebo, the patients had approximately 6 migraines a month (about 1 every 5 days). On the medication, they had about 4 and a half migraines a month (about 1 every 7 days). [ JAMA. 2003;289:65-69 ]  

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Thursday, January 02, 2003

Spend (slightly) less on health and more on the arts

This editorial from the BMJ proposes that public health would be improved if more money was spent on the arts, and slightly less on healthcare. Currently, the British government spends about $80 billion USD a year on healthcare, compared with $480 million USD supporting the arts. Comment: I agree. Ultimately, the health of a population depends not only upon physical health, but also spiritual health. [ BMJ 2002;325:1432-1433 ( 21 December ) ]  
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