Risk of Perforation After Colonoscopy and Sigmoidoscopy: A Population-Based Study
This study looked at the incidence of perforation within 7 days of either colonoscopy or sigmoidoscopy in people over 65 years of age who were cancer-free. For colonoscopy, the incidence was 1.96 per 1000 procedures. For sigmoidoscopy, the incidence was 0.88 per 1000 procedures. Risk increased with increasing age and the presence of two or more comorbidities. Perforation significantly increased the risk of death. The risk of perforation seemed to decline over the 8 year study period, especially for screening procedures. Comment: this study mainly helps us decide what is the best way to screen for colon cancer. There are problems associated with all of the various methods, but colonoscopy seems to still be the gold standard, and the increased risk of colonoscopy probably is acceptable in a large number of patients. [ Journal of the National Cancer Institute 2003;90(3):230. ]  posted at 2/13/2003 09:22:42 PM
by Tom Heston, MD   

Herb-drug interactions: What physicians need to know
This review of interactions between medications and herbs states that there are serious problems with quality control in herbal supplements. For example, of 25 brands of echinacea, only 56% passed quality and quantity testing (according to ConsumerLab.com Comment: this has been a problem for a long time. For example, testing in the past of Chinese herbal medications sold in the US, some contained digoxin-- a medication which can have serious, life-threatening side effects and cause cardiac death. When purchasing herbal medications, quality should be your primary concern. I personally use Shaklee products, although there are other good companies out there. [ Integrative Medicine: Herb-drug interactions: What physicians need to know ]  posted at 2/11/2003 08:56:16 PM
by Tom Heston, MD   

Medical experts and the criminal courts
This editorial looks at the role medical experts play in criminal proceedings. It highlights a case were the medical experts misled, rather than illuminated the criminal case. The author recommends that medical experts that testify at trials be subjected to the same type of audits that practicing physicians must undergo. In his words, "Clinical audit is now established. Medicolegal work should be similarly audited and subject to quality assurance." Comment: this is an excellent idea. Too often, "hired guns" are paid to testify simply because their opinion agrees with the prosecution or defense, even though their expertise in the particular issue may be questionable. Having audits of medical experts....expecially those who make their living testifying at trials (not practicing medicine) .... is an idea that may have some merit. It should also be applied to civil cases, not just criminal cases. [ bmj.com Milroy 326 (7384): 294 ]   posted at 2/11/2003 05:00:44 PM
by Tom Heston, MD   

Influences on doctors' decisions to prescribe new drugs: the importance of who says what
This study looked at what influenced doctors in England to prescribe a certain medication over another. It found that pharmaceutical salesmen--not scientific evidence or the medical literature--was the dominant influence over which medication was prescribed. Comment: recently enacted laws (2002) in the US are attempting to address this issue. [ Family Practice Vol. 20, No. 1, 61-68 ]  posted at 2/10/2003 11:22:05 PM
by Tom Heston, MD   

70% of New Jersey Physicians Stop Work in Protest of Legal Liability System
To raise the public's and lawmakers' awareness of the liability crisis that is crippling the US healthcare system, 70% of the doctors in New Jersey participated in a work stoppage earlier this month. Elective surgery and office visits were cancelled, although emergency care was not interrupted. Comment: this is quite astonishing. It's truly amazing that so many lawyers, and the US Senate Democrats, still act as if there is no problem whatsoever. In spite of nationwide protests, work stoppages, diminished access to care, and the best and brightest college students no longer going into medicine, the US Senate Democrats pretend that everything is OK. Who's lining their re-election pocketbooks? Could it be the American Trial Lawyer Association? [ AMNews staff. Feb. 17, 2003 ]  posted at 2/10/2003 04:35:14 PM
by Tom Heston, MD   

Exercise myocardial perfusion imaging in elderly patients
This study looked at 361 men and 217 women aged 70.7 +/- 4.4 years old with interpretable ECG's who underwent nuclear perfusion imaging. Using multivariate modeling, the factors predictive of subsequent death or myocardial infarction were: a) older age, b) male sex, c) poor exercise tolerance, and d) number of ischemic segments on the nuclear perfusion scan. Comment: what is surprising about this study is what was not found to be predictive in the multivariate model: the Duke Treadmill Score, increased lung uptake on Tl-201 scanning, and ST depression on the stress test. It is also surprising the the left ventricular ejection fraction was not assessed, even on the patients who underwent Tc-99m agent scanning. [ Journal of Nuclear Cardiology, November/December 2002 • Volume 9 • Number 6 p.573 ]  posted at 2/8/2003 08:46:39 PM
by Tom Heston, MD   

Seat Belt Reminder System Only Slightly Increases Usage
This study looked at the effect of a reminder system build into some Ford cars. It found that the use of seat belts without the system was 71% and with the system it was 76%. Comment: studies have shown that seat belts are as effective at preventing motor vehicle deaths as air bags are. Anything that will increase seat belt use should be studied. [ Inj Prev 2002;8:293-296 ]  posted at 2/8/2003 08:02:48 AM
by Tom Heston, MD   

Screening for Diabetes in Adults
Updated USPSTF recommendations are that only adults with hypertension or hyperlipidemia be screened for type II diabetes. Comment: I believe that a HgbA1C test every 5 years or so won't break the budget, and will pick up some early diabetes. The result probably would save money. Thus, while the US Preventive Services Task Force recommendations may correctly follow the current evidence, sometimes it makes sense to go ahead and screen even when their is "insufficient evidence." What they fail to say is that there is also "insufficient evidence" to recommend *against* screening. [ article ]  posted at 2/7/2003 02:09:22 AM
by Tom Heston, MD   

Access hurt in liability crisis states
This survey of the 42 Blue Cross and Blue Shield companies suggests that access to care is worse in states facing a medical liability insurance crisis. Comment: this is certainly no surprise to those of us in the medical field. [ AMNews: News in brief - Feb. 10, 2003 ... American Medical News ]   posted at 2/5/2003 07:12:03 PM
by Tom Heston, MD   

Cervical Cancer Screening Guidelines Updated
The USPSTF has updated recommendations on screening for cervical cancer. There is little new in the recommendations, which are basically a) screening sexually active women who have a cervix is a good idea, b) in the elderly, if there is an immediate history of several normal pap smears, screening can stop (comment: the age of 65 is used as a cutoff for "elderly"), and c) women who have had a hysterectomy for benign disease do not need to be screened. The USPSTF states there is insufficient evidence in regards to newer screening technologies. [ U.S. Preventive Services Task Force Update, 2003 Release ]  posted at 2/4/2003 04:57:37 AM
by Tom Heston, MD   

Improved Air Quality in Reunified Germany Decreases Childhood Respiratory Symptoms
This study looked at 7632 children in the region formerly known as Eastern Germany (now reunified with the west into one country). During that time, the level of pollution declined. The researchers found that for every 50 ug/m**3 decrease in total suspended particulates, the risk of bronchitis decreased by 2/3rds, the risk of colds decreased by half, and the risk of sinusitis decreased by 60%. Comment: this study has two important findings, 1) that air pollution dramatically affects the respiratory health of children (it affects adults also, but this study did not look at adults), and 2) that the reunification of Germany has led to improved air quality in the former communist country of Eastern Germany. [ Epidemiol 2002;13:394-401 ]  posted at 2/2/2003 03:53:45 PM
by Tom Heston, MD   

Internet Filters Block Up To a Quarter of All Healthcare Websites
This study of Internet filters found that up to 24% of health web sites are blocked by the software, when placed on their most restrictive level. At the least restrictive level, 1.4% of the sites were blocked. The difference in blocking pornography was minimal when comparing the least restrictive to most restrictive settings. The most restrictive settings blocked 91% of porn, and 24% of health sites. The least restrictive settings blocked 87% of porn but only 1.4% of health sites. The researchers recommend that the least restrictive settings be strongly considered by libraries and schools. Their reasoning? Teens are more likely to seek important health information online than from a qualified healthcare professional. The greatly improved access to health information is likely more important than the 4% gain in filtering pornography. "Whoever is making the decisions needs to think really hard about the settings they are picking because when they make decisions about the settings, they are also making decisions about access to health information," said Dr. Richardson. [ AMNews Jan. 20, 2003 ]  posted at 2/1/2003 09:16:27 PM
by Tom Heston, MD   

American MD killed serving troubled corner of the world
Martha C. Myers, MD, was killed by a suspected terrorist in Yemen on 30-Dec-2002. She was working at a local hospital, and killed along with the hospital director. [ AMNews Jan. 27, 2003 ]  posted at 2/1/2003 09:07:23 PM
by Tom Heston, MD   

FDA Puts Positive Spin on Direct-to-Consumer Advertising
According to doctor groups, the US FDA has put a positive "spin" on recent surveys about direct-to-consumer advertising of pharmaceuticals. Comment: the FDA should be looking at how big an effect DTC advertising has upon the price of pharmaceuticals. The amount of money spent on DTC advertising certainly has an effect upon medication prices. [ AMNews Feb. 3, 2003 ]  posted at 2/1/2003 09:01:12 PM
by Tom Heston, MD