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Old January 8th, 2003, 17:30
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2002.11.01 Medical News

Saturday, November 30, 2002

Norway Plans to Ban All Public Indoor Smoking by 2004
The Norwegian government has plans to ban all public indoor smoking by the year 2004. The proposal would mean that people in Norway would only be allowed to smoke in their homes or outside. [ BBC Health News, Friday, 29 November, 2002, 14:51 GMT ] posted at 11/30/2002 07:47:08 PM by Tom Heston, MD comment on this article




Canadian Guidelines for the Diagnosis and Management of Osteoporosis
These guidelines for the diagnosis and management of osteoporosis are from the Osteoporosis Society of Canada. Major points:
Screening is recommended for both women and men starting at age 65
Bisphosphonates and raloxifene are 1st line therapies for prevention and treatment for postmoenopausal osteoporosis; bisphosphonates are recommended for men
Calcitonin is a first-line treatment for pain associated with acute vertebral fractures
Comment: the recommendation to screen both men and women starting at age 65 is new. DXA screening is recommended. [ CMAJ November 12, 2002; 167 (90100) ] posted at 11/30/2002 07:34:41 PM by Tom Heston, MD comment on this article




Delays in Cardiac Catheterization Associated With Adverse Events
This study of 8030 patients in Canada referred for cardiac catheterization identified adverse consequences associated with waiting. The average wait for inpatients was 4 days, and for outpatients it was 60 days. Of the 8030 patients, 0.6% died, 0.4% had a myocardial infarction, and 0.5% experienced congestive heart failure while waiting. Comment: the adverse event rate was 1.5% for patients on the waiting list. [ CMAJ November 26, 2002; 167 (11) ] posted at 11/30/2002 07:14:46 PM by Tom Heston, MD comment on this article




Mammography Beneficial in the Elderly
This study looked at whether mammography was beneficial to women 75 years of age and older. The retrospective cohort study looked at 12 038 women at least 69 years of age. It found that mammography increased the likelihood that a breast cancer would be discovered at an early stage in the disease. Comment: this study suggests that women in reasonably good health at age 75 should continue to get mammograms. [ 19 November 2002 Volume 137 Number 10 ] posted at 11/30/2002 01:15:53 AM by Tom Heston, MD comment on this article



Friday, November 29, 2002

Peanut Butter Associated With Lower Risk of Diabetes in Women
This analysis of the Nurses' Health Study (n=83 818, aged 34-59 years) found that over the 16 year follow up period, those women with higher dietary intakes of peanut butter and other nuts had a lower risk of type 2 diabetes. Comment: an unexpected finding; I have not seen this association before. This needs to be looked at more closely. For now, I still am skeptical, and believe that a wide variety of foods in the diet is probably best. [ JAMA. 2002;288:2554-2560 ] posted at 11/29/2002 02:53:18 AM by Tom Heston, MD comment on this article



Tuesday, November 26, 2002

Why is Cannibis Use Linked to Depression and Anxiety Only in Women?
This letter to the editor is a rapid response to the research article (listed below) showing a relationship between cannabis use and depression and anxiety---only in women, and not in men. The author discusses possible ways to discover whether or not there is a causal relationship. If these cannot be found, then most likely common societal and environmental factors cause both depression/anxiety and illicit drug use in women. Comment: the profound difference found between the sexes and cannabis use supports the hypothesis that there is not a causal, biological effect of cannabis (i.e. common societal factors cause both depression/anxiety and cannabis use). At this point, we just don't know for sure the nature of the relationship. A biologic, causal relationship certainly is a possibility, but so is the possibility that it is a purely societal relationship. [ BMJ Rapid Response ] posted at 11/26/2002 05:00:26 PM by Tom Heston, MD comment on this article




Weekly Use of Cannabis in Teenagers Associated With Increased Depression & Anxiety
This study of 1601 students aged 14-15, followed for seven years, found that daily use of cannibis in young women was associated with a fivefold increase in the odds of reporting depression and anxiety. Weekly use was associated with an approximately twofold increase. Comment: the findings were not statistically significant in women using cannibis 1 to 4 times a week, but did become significant for women using cannibis daily. There was not a statistically significant association between cannibis use by men and prevalence of depression and anxiety.This study is interesting in that it found a fairly dramatic difference in the effects of cannabis between male and female users. [ BMJ 2002;325:1195-1198 ( 23 November ) ] posted at 11/26/2002 04:41:03 PM by Tom Heston, MD comment on this article




High Homocysteine Levels Shown to be Causal for Cardiovascular Disease
This meta-analysis concludes that the association between elevated homocysteine levels and cardiovascular disease is causal. The authors not that other research has shown a rapid reduction in cardiovascular disease risk when the diet is supplemented with B vitamin supplements (folic acid, B-6, and B-12). Comment: usually, a good prentatal vitamin contains enough B vitamins to (theoretically) reduce homocysteine levels. Some multivitamin supplements, however, are unbalanced and do not have enough B vitamins--usually not enough folic acid. [ BMJ 2002;325:1202 ( 23 November ) ] posted at 11/26/2002 04:12:36 PM by Tom Heston, MD comment on this article



Sunday, November 24, 2002

Time to Think Outside the Box and Inside the Nucleus
Newsmax.com Wires / Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., Saturday, Nov. 23, 2002.

Ever since human beings began to suspect that the nuclei of atoms might be good for something besides creating the universe and blowing up the planet, the American understanding of nuclear energy has been, for the most part, at odds with reality.

By the 1970s, early enthusiasm about the potential for limitless nuclear energy had given way to a more rational appreciation of its potential. Nuclear power wasn't as cheap as hoped, but it is clean, available, and a practical way to decrease dependence on foreign oil.

But then the anti-all-things-nuclear movement attacked the industry, via junk science, a virulent fear & smear campaign, and astute politicking and bureaucratic gamesmanship at all levels.

Nuclear energy is neither sin nor salvation. It is, however, an option we need to look at anew, as war with Iraq edges closer and the "Privation Is Virtue" liberals start screaming about "energy independence" once again.

We begin with the obvious. America needs many different kinds of energy. Each kind, from nuclear to geothermal, has its place in the mix. The relevant issues are applicability (nuclear power won't run your car, but then neither will windmills) and cost, both economic and environmental.

Nuclear power deserves a larger place in the mix. But before we can proceed to the obvious reasons why, we need to examine several myths.

The first is unwarranted fear of radiation. For too many decades, too many people have clung to the utterly wrong "no threshold" concept, the disproved idea that any radiation in any amount is very bad for you.

Way back when atmospheric nuclear testing was a (pardon the pun) hot topic, Linus Pauling, an anti-nuclear physician/scientist, concocted the idea that any ionizing radiation, such as gamma or X-rays, does irreparable harm.

Pauling hadn't a shred of data to support his claim, but this idea continues to enjoy considerable currency, despite a growing body of evidence that small doses of radiation may actually be good for you.

Why the persistence of the lie? Fear a fear abetted by both the anti-nuclear left and the popular media. Fear sells.

The second myth builds on the first. Nuclear reactors don't blow up. But they can melt down and, like all human contrivances, can malfunction. Conventional wisdom holds here that even the smallest chance of a catastrophic release of radioactivity into the atmosphere would be so deadly, especially in urban areas, that it's not worth the risk. As proof, they offer Three Mile Island and Chernobyl.

The 1989 Three Mile Island accident, which was effectively contained, released only small amounts of radiation into the air. Only one person we know of died a motorist, fleeing the scene.

Chernobyl was far more serious, mostly because those reactors lacked many design and safety features required in the United States. Thousands of people did die ... in abortions demanded by panic-stricken mothers, sometimes thousands of miles from the site. The Russian government evacuated thousands of people from areas receiving less radiation than residents of Norway get naturally. In the end, fewer than 100 workers died from heavy dosages; no member of the public was exposed to such levels.

What about terrorists running airplanes into nuclear power plants? Airplanes are not designed to penetrate reinforced concrete up to four feet thick. "All nuclear reactor containment buildings are like bunkers, built of thick, steel-reinforced concrete. Inside the containment building, the reactor is encased in a steel pressure vessel up to a foot thick," according to the Nuclear Energy Institute.

If the United States has forsworn nuclear power for reasons both specious and emotional, other nations have not. In 2000, according to French government sources, nuclear power provided 76 percent of that country's electricity. In contrast, 69 percent of all American power is generated by fossil fuels. Only 20 percent is nuclear.

How did the French do it? By educating the public with facts, not fear. New reactors will be even safer than older models which, for the past 40 years, have been almost totally safe and have done far less environmental damage than oil or coal.

And there's another reason to revive the nuclear option the coming oil glut. As the Russian petroleum industry revives, as all those central Asian fields come on line, and as (hopefully) a post-Saddam Iraq turns up the spigot, the world will be awash in oil. What better time to drive the price and our dependency further down, than by cutting the use of oil in our generating plants?

How paradoxical (or so think this pair of docs) that ultimately our best offense may be the good defensive use of nuclear power to protect ourselves from the addictions of oil and war.

Comment: I agree-- nuclear power is one of the cleanest source of energy currently available, and it is very safe. [ Newsmax.com article, reprinted with permission. ] posted at 11/24/2002 02:25:54 AM by Tom Heston, MD 1 comment



Friday, November 22, 2002

Honey Can Kill Antibiotic-Resistent Bugs
Researchers have found that covering wounds with honey--a treatment dating back to ancient Egypt--can help kill the antibiotic-resistent bacteria Staphylococcus and Enterococcus. Comment: this type of research into alternatives to traditional antiobiotics is taking on increased importance as new crops of vancomycin resistent staph are popping up. Antibiotics are becoming less effective with time. [ Nature 19 Nov 2002 ] posted at 11/22/2002 07:54:13 PM by Tom Heston, MD comment on this article



Tuesday, November 19, 2002

Stroke Trial Under Review After Financial Conflicts Revealed
A major stroke trial promoting the use of alteplase (tPA) is under review after it was revealed that the majority of the experts used for the original analysis had financial ties to the manufacturers of the drug. Comment: the original analysis, done by experts with financial ties to the pharmaceutical company, concluded that tPA is "definitely recommended" for stroke, in spite of continuing controversy over the treatment. These financial ties undoubtedly had at least a subtle influence upon the experts and their recommendations. Congratulations to the National Institute of Neurological Diseases and Stroke for calling for a new analysis. Thanks also has to be given to BMJ for bringing the financial conflicts to light. [ bmj.com Lenzer 325 (7373): 1131 ] posted at 11/19/2002 07:15:31 PM by Tom Heston, MD comment on this article



Monday, November 18, 2002

Bezafibrate Does Not Reduce Incidence of Coronary Artery Disease & Stroke
This study of 1568 men with lower extremity arterial disease looked at the effect of bezafibrate at 400 mg daily upon coronary heart disease and stroke. It found that although bezafibrate did improve lipid profiles, it did not reduce the combined incidence of coronary heart disease and stroke. There was a substantial reduction, however, in non-fatal heart attacks, especially in men aged < 65 years. Based on the lipid changes, a greater effect upon coronary heart disease and stroke was expected. The authors postulate that the reason was because bezafibrate increase homocysteine concentrations, an important risk factor for vascular diseases. Comment: perhaps it would be wise to have anyone on this medication take a multivitamin supplement (with folic acid) daily, and get their homocysteine levels checked regularly. [ bmj.com Meade et al. 325 (7373): 1139 ] posted at 11/18/2002 05:33:17 PM by Tom Heston, MD comment on this article



Sunday, November 17, 2002

Gore Proposes Socialized Healthcare Plan
Former Vice President Al Gore last week proposed that the US begin drafting a single-payer national health insurance plan. This is a change from his previous policy of saying with the current private-payer system. Comment: certainly, an improvement in the current US healthcare system is needed. #1- reform tort laws that greatly increase the cost of healthcare by both increasing malpractice insurance premiums and also forcing doctors to practice defensive medicine (ordering unnecessary tests and procedures in order to protect against legal action). #2- employer based health insurance needs to shift to individual based, in the same manner automobile insurance works. All citizens must purchase the healthcare insurance of their choice, and provide proof of insurance on their tax returns, and if employed, to their employer. If the citizen chooses not to buy insurance on their own, they automatically get coverage through the government, with their insurance premiums added to their tax returns. Basing insurance on the individual, not the employer, allows people to shift jobs or move without jeopardizing their health insurance. It would be a more reliable formula to ensure near-universal coverage, while maintaining freedom of choice and competition among insurance companies. [ Newsmax.com Nov 14, 2002 ] posted at 11/17/2002 09:06:21 PM by Tom Heston, MD comment on this article



Saturday, November 16, 2002

Even Short-Term Exercise and Dietary Intervention Significantly Decreases Cardiac Risk Factors
This study looked at 11 volunteers (all men) over a 3 week period during which the volunteers underwent a rigorous exercise and dietary program. The volunteers all exercised for 45 to 60 minutes daily. The diet was low in fat and high in fiber. After just 3 weeks, statistically significant improvements were seen in blood pressure, fasting insulin, blood lipid levels, and body mass index. Comment: the fact that significant changes where seen in multiple measurements, when there were only 11 subjects is quite remarkable. However, in the abstract confidence intervals were not reported, thus we do not know how fragile the data is. For example, if 10 volunteers did not improve at all, and one volunteer saw dramatic improvements, when examined as a group there may be a significant improvement. But, when examined individually the findings wouldn't be impressive at all. Because of this, many journals are not using p values but rather confidence intervals. Confidence intervals are much easier to interpret, and it is unfortunate that the researchers chose only to report p values in their abstract. [ Circulation. 2002;106:2530 ] posted at 11/16/2002 08:51:32 PM by Tom Heston, MD comment on this article



Friday, November 15, 2002

Sceening Adult Men for Abdominal Aneurysms is Cost-Effective
This study looked at 67 800 men aged 65-74 years to determine whether or not screening for an abdominal aneurysm with ultrasonography was cost-effective. After 10 years of screening, the cost per life year gained was estimated to be under $15 000 US (8000 GBP). [ BMJ 2002;325:1135 ( 16 November ) ] posted at 11/15/2002 09:24:26 PM by Tom Heston, MD comment on this article



Thursday, November 14, 2002

Home Defibrillators
Regulators have approved the first cardiac defibrillator designed to be used exclusively in the home. Philips Electronics, the manufacturer, has predicted that heart defibrillators in the home will become as common as smoke alarms. [ BBC News Nov 14, 2002 ] posted at 11/14/2002 06:56:05 PM by Tom Heston, MD comment on this article




UK to Give Top Hospitals 'Freedom'
The United Kingdom is set to free hospitals from centralized governmental control. Top rated NHS hospitals may soon be able to establish not-for-profit trusts, and set their own clinical standards for the first time. Hospitals will be accountable to their local communities rather than the Department of Health. Comment: it is interesting to note that while the UK system is moving towards more local control over their hospitals, the US is steadily increasing centralized governmental regulation and oversight. [ BBC News, Nov 13, 2002 ] posted at 11/14/2002 06:53:32 PM by Tom Heston, MD comment on this article



Tuesday, November 12, 2002

Olestra Effective at Reducing Body Fat
This study looked at 36 men over a 9 month period. The men were divided into three groups: a normal diet (33% of calories from fat), a fat-reduced diet (25% of calories from fat), and a fat-substituted diet (a third of the dietary fat was replaced by olestra, with total metabolizable fat = 25% of calories). The olestra group lost a total of 6.27 kg (15.9 lbs) in total body weight, with a reduction in body fat of 5.85 kg (14.9 lbs). Comment: it is notable that 20% of the men starting out this research project ended up dropping out (the initial number was 45 men, the final number was 36), thus the conclusions of the study may or may not be valid. However, overall, the results obtained by the olestra group looked promising. [ AJCN -- Abstracts: Bray et al. 76 (5): 928 ] posted at 11/12/2002 09:35:51 PM by Tom Heston, MD 1 comment



Monday, November 11, 2002

Malpractice costs driving doctors out
This report from the Chicago Sun Times notes that during the 12 month period ending in July, 2002, malpractice insurance premiums increased 24.7% for internists, 25% for general surgeons, and 19.6% for obstetricians. [ Chicago Sun Times, Nov 11, 2002 ] posted at 11/11/2002 10:55:49 PM by Tom Heston, MD 1 comment




Osteoporosis Also Common in Men
At 60 years old, the average white mail has a 25% chance of having a fracture related to osteoporosis in his remaining lifetime. Men account for 30% of hip fractures. Comment: the most important risk factor for osteoporosis seems to be age--not sex, race, or body mass. [ AMNews Nov 18, 2002 ] posted at 11/11/2002 10:43:07 PM by Tom Heston, MD comment on this article




President Takes Action to Lower Prescription Drug Prices By Improving Access to Generic Drugs
Whitehouse Press Release, 21-Oct-2002: President Bush announced a new rule to lower prescription drug costs for millions of Americans by improving access to generic drugs, which are safe and effective and can be much less costly alternatives to brand-name prescription drugs. The proposed rule is expected to lead to savings in drug costs of over $3 billion per year for Americas consumers.

This regulatory action will close loopholes in the implementation of the Hatch-Waxman law, which governs how generic drugs can compete with brand-name drugs. As a result, patients will benefit from greater and more predictable access to safe, effective, low-cost generic alternatives to brand-name drugs.

DETAILS OF FDAS PROPOSED RULE ON GENERIC DRUGS

The new FDA rule will:

Implement Federal Trade Commission (FTC) recommendations for improving access to generic drugs by making significant changes in the use of automatic 30-month stays and in the drug patent listing process.

Allow one 30-month automatic stay at most in patent infringement litigation involving a generic drug application: Drug manufacturers would be limited to only one 30-month stay per generic application, to resolve allegations that a generic drug maker is infringing a drug patent. According to the FTC, this is an appropriate time period for courts to resolve cases of patent infringement. Multiple 30-month stays, which have led to delays in generic entry of an additional 4 to 40 months, would not be permitted.

Tighten requirements and increase disclosures for drug patent listings: Drug manufacturers would no longer be allowed to list patents in the FDA Orange Book for drug packaging, drug metabolites, and intermediate forms of a drug. Permitted listings include patents on active ingredients, drug formulations, and uses of a drug. In addition, a more detailed signed attestation accompanying a patent submission will be required, and false statements in the attestation can lead to criminal charges. This will significantly reduce opportunities to list inappropriate patents just to prevent fair competition from generic drugs.

Provide billions of dollars in savings for public and private health insurance programs: The rule will not only provide savings for patients by giving them more safe and effective, low-cost prescription drug alternatives; it will reduce budgetary pressures on state Medicaid programs, and reduce the cost burdens facing employer-provided coverage.

Lower the cost of improving Medicare with prescription drug coverage: The rule provides important relief for seniors, but it is only a first step. Seniors really need an improved and strengthened Medicare program like the President has proposed, with better and more secure coverage options. While the House of Representatives took an important first step this year by passing legislation to provide drug coverage, the Senate failed to act. The President is calling on the leadership of the Senate to put politics aside and pass a prescription drug benefit for Medicare. The proposed rule makes this job easier by reducing the cost of a Medicare prescription drug benefit.

BACKGROUND ON TODAYS PRESIDENTIAL ACTION

Todays Presidential action improves the FDA regulations implementing the Hatch-Waxman law. These regulations govern when generic drugs can compete with brand-name drugs. As a result, patients will benefit from greater and more predictable access to effective, low-cost generic alternatives to brand-name drugs.

Under the Hatch-Waxman law passed in 1984, generic competition is allowed when a new drugs patent and market exclusivity protection expires, or when a 30-month stay terminates. The intent of the law is to provide incentives to develop valuable new drug treatments through patent protection, but also to facilitate access to generic versions of the drug after the innovators patent expires.
FDA-approved generic drugs are safe and effective alternatives to many brand-name prescription drugs, at a cost that is often only one-third as great. Almost half of all prescriptions filled today are for generic drugs, and generic alternatives exist for many commonly-used brand name medications providing an equally safe and effective but much less expensive alternative for millions of Americans.

In recent years, however, access to generic drugs has sometimes been delayed by litigation. Under FDAs past interpretations of the Hatch-Waxman law and the Orange Book patent listing process, drug manufacturers have been able to file additional patents on packaging, ingredient combinations, and other minor matters in order to get repeated 30-month automatic stays in court that significantly delay access to generic drugs.

In response to bipartisan Congressional concern about this issue, the FTC conducted a detailed study of Generic Drug Entry Prior to Patent Expiration. The study was issued in July 2002. It identified cases involving seven major brand-name drugs between 1994-2000 where the repeated use of automatic stays on late-filed patents had delayed access to generic drugs. The FTC made the following recommendations:

Allow only one automatic stay per generic drug application; and
Tighten the Orange Book patent listing process to help ensure that only appropriate patents are filed.
The proposed rule can be viewed at www.fda.gov/ohrms/dockets.

[ article ]
posted at 11/11/2002 01:31:58 AM by Tom Heston, MD comment on this article



Sunday, November 10, 2002

The Cancer of the Anti-smoking Puritans

Newsmax.com wires. November 7, 2002. Editorial by Barrett Kalellis.

Two decades ago, before it became fashionable to detest tobacco products, anti-smoking zealots used to argue that their interest in banning smoking only extended to prohibiting the practice on plane flights. This was only reasonable, they argued, because aircraft ventilation systems had no way to filter smoke-tainted air, and non-smokers had no recourse if they didn't want to inhale it.

This proposed restriction was presented to the public as the outer limits on curtailing people's freedom to enjoy smoking. But with the stealth that guile brings, the long march to stamp out smoking everywhere was under way. Buoyed by the relentless drumbeat of sympathetic media propaganda and vested interests in the health care industry, the wheels of disapprobation ground inexorably finer by a thorough demonizing of tobacco producers and users.

The overt demonology became political correctness, leading corporate executives, facility managers and assorted government functionaries to curtail smoking in the workplace. Everyone has seen the sorry spectacle of huddled groups of beleaguered smokers, furtively sneaking puffs outside their workplaces in the cold and damp.

Demagogues like California Congressman Henry Waxman and Savonarola-like activist John Banzhaf have called for Draconian tobacco regulation far and wide, encouraging tort lawyers across the country to belly up to the bar and file whatever personal injury or class action lawsuit will allow them to pick the pockets of tobacco companies.

Not to be outdone, state and local politicians in league with anti-smoking groups push ballot measures in numerous states and municipalities that either increase already onerous tobacco taxes or outlaw smoking in various public areas and workplaces.

Following similar measures in California and Delaware, Michael R. Bloomberg, the mayor of New York City, is now pressuring New York's City Council to ban smoking outright in bars and restaurants in all five boroughs. Since 1995, smoking has been prohibited in city office buildings and in restaurants seating more than 35 customers. The new proposed restriction would affect an additional 13,000 establishments.

This heavy-handed coercion is all done under the banner of health care advocacy, which, in the minds of political animals, always seems to trump the rights of individuals to pursue their own pleasures, unless the lawmakers' own pockets are at stake. The recent defeat of Michigan's Proposal 4 ballot initiative, which would have redistributed tobacco settlement monies to private health care organizations, was heartily cheered by state politicos, since they were being used to fund other projects.

This long-running anti-smoking jihad is not unlike the Zeitgeist demonizing the liquor industry that brought about Prohibition in 1920. In the similar attempt to solve all sorts of social problems, proponents argued that by reducing the consumption of alcohol, crime would decrease, health and hygiene would improve and the tax burden of building prisons would be lifted.

As time would show, the Noble Experiment was a miserable failure. In the long run, alcohol consumption actually increased, organized crime and corruption got a foothold, an underground economy was born and the touted health benefits were not realized.

There is no question that heavy long-term smoking represents a health hazard to the smoker, as does habitual alcohol consumption for the heavy drinker. And while some argue that "second-hand smoke" might jeopardize the health of people in close proximity to smokers, over-consumption of alcohol certainly modifies the public and private behavior of drinkers, often to the detriment or peril of those around them.

The question remains: Should government regulate smoking as it tried to do with alcoholic beverage production and consumption? Have smokers no rights? Should a man who risks his investment in a bar or restaurant be put at an economic disadvantage because he is proscribed from allowing smoking in his place of business? Hasn't he the right to establish his own rules and policies to attract the customers he wants? After all, those who are offended by tobacco smoke also have the right not to patronize his restaurant.

The anti-tobacco and anti-alcohol crusades are cut from the same cloth. Today, anti-smoking forces are mercilessly metastasizing to kill off the last redoubts that remain for those who might enjoy a postprandial cigarette, cigar or pipe.

This is not only wrong, it is, as Prohibition showed, against nature. People must be free to choose even if it means their own poison. The more intense the regulation, the more potent tobacco becomes as people find other sources to pursue their pleasure.

The spreading cancer of the anti-smoking Puritans should be of concern to free men everywhere. As economist Ludwig von Mises cautioned, "Once the principle is admitted that it is the duty of government to protect the individual against his own foolishness, no serious objections can be advanced against further encroachments."Reprinted with permission from NewsMax.com.

Comment: what is the proper balance between personal freedom and governmental control over bad behavior? Lots of arguments can be made for more governmental regulation of cigarettes (I personally have consistently promoted increasing the excise tax on cigarettes), however, freedom is of vital importance to people's health and well-being. We have to remember that optimum health requires that we take care of both the body *and* the spirit. Anti-smoking laws help the body, but what does the erosion of personal freedom do to the spirit? [ article ]




posted at 11/10/2002 09:37:42 PM by Tom Heston, MD comment on this article



Saturday, November 09, 2002

Zinc Helps Decrease Death From Diarrhea
This study of Bangladeshi children, those treated with zinc at 20 mg per day for 14 days were less likely to die than those who did not take the zinc supplementation. All children received oral hydration therapy in addition to the zinc. [ BMJ 2002;325:1059 ( 9 November ) ] posted at 11/9/2002 01:53:45 AM by Tom Heston, MD comment on this article



Friday, November 08, 2002

Crosswalk Markings Can Increase Risk of Pedestrian / Motor Vehicle Accidents
This study of 6 cities in Washington and California found that elderly pedestrians were more likely to be hit by a motor vehicle at certain intersections with crosswalk markings. Crosswalk markings increased the risk at intersections with no stop sign or stoplight. [ JAMA. 2002;288:2136-2143 ] posted at 11/8/2002 04:08:55 AM by Tom Heston, MD comment on this article



Tuesday, November 05, 2002

Grandparent's Diet Shown to Affect Grandchildren
Researchers from Sweden have found that the grandchildren of "well-fed" grandfathers were four times as likely to die from diabetes. Comment: it is generally accepted that the diet does not change genes, thus this finding likely is due to cultural habits and traditions that are passed down generations. So, if you lead a healthy life, with good dietary and exercise habits, it's possible that you will not only benefit personally, but also help your grandchildren. If you don't have children, it's possible that your good habits will rub off on your neighbors and friends. [ Nature 1-Nov-2002 ] posted at 11/5/2002 05:01:49 PM by Tom Heston, MD comment on this article



Monday, November 04, 2002

UK Bans Aspirin Use in Under 16 Year Olds
Stating that there is no need to expose children to even a small risk of Reye's syndrome, the United Kingdom has now recommended that aspirin products should read "Do not give to children aged under 16 years, unless on the advice of a doctor." Comment: with the wide availability of acetaminophen and ibuprofen, waiting until maturity before taking aspirin is a good idea. [ BMJ 2002;325:988 ( 2 November ) ] posted at 11/4/2002 11:15:12 PM by Tom Heston, MD comment on this article



Sunday, November 03, 2002

European Union Rejects Direct-to-Consumer Advertising for Pharmaceutical Companies
Members of the European parliament have rejected plans to allow pharmaceutical companies to market their drugs directly to consumers, as is the current practice in the United States. Comment: this was a lopsided vote, rejecting the proposal 494 to 42. The primary concern is that the price of pharmaceuticals is increased significantly through direct-to-consumer advertising, without a significant benefit to people's health. Many physicians in the US are strongly against direct-to-consumer (DTC) advertising, but because of free speech concerns, DTC advertising is allowed. [ BMJ 2002;325:990 ( 2 November ) ] posted at 11/3/2002 08:16:48 PM by Tom Heston, MD comment on this article



Saturday, November 02, 2002

Majority of Americans Support Medical Marijuana For Patients
Washington, DC: Eighty percent of Americans support the legal use of medicinal marijuana by patients, and 72 percent say that adults who use marijuana recreationally should be fined, but not jailed, according to a nationwide poll conducted last week by Time Magazine and CNN. Only 19 percent of respondents favored jailing recreational pot smokers. [ more... ] posted at 11/2/2002 02:21:32 AM by Tom Heston, MD comment on this article
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