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Friday, February 5, 2010

reading the Internal Medicine News

Once a month I get a large journal in the mail which I don’t pay for.  It is called the Internal Medicine News.  Authors write about reports from meetings or new ideas posed by scientists, but without the scientific rigor of a real journal article. It is possible to review all sorts of topics in a short amount of time, and some of the information is even true.

Diabetics don’t necessarily have an increased risk of heart attacks: researchers looked at the results of a Cat scan of the arteries around the heart of over 800 diabetics and found that 40% of them were absolutely fine. Cool. This is something I have found too. Some diabetics who I think should really have heart disease are absolutely fine, with no narrowing of the coronary arteries at all. But the authors add that maybe we should do this Cat scan on all diabetics to see who is who, even though studies of this test show that it is close to useless and we know it exposes people to radiation at a level that does cause cancer. The authors don’t mention this.

Mammography experts rail at new reduced recommendations for mammogram screening in patients between 40 and 50 years of age: Mammography experts, who happen to be radiologists, and therefore do make their money through mammograms, deliberately misunderstand and spin the new recommendations to stop routine screening mammograms in the 5th decade of life. Ack. The medical profession seems completely unable to address the question of limited resources and the fact that more useless mammograms do take away money from the overall health care pie that is supposed to serve, but is not serving, everyone.

Fructose may be causing increase in heart disease: On average, each American eats 150 lbs of sugar a year, and a great deal of it is fructose, in the form of high fructose corn syrup.  This raises blood pressure, uric acid levels, reduces good cholesterol levels and increases bad cholesterol levels. The effect of all this fructose on blood pressure can be reduced by taking a drug that reduces the uric acid level. This is new and interesting, and explains why the study was sponsored by a drug company. Clearly the solution to this problem lies with reducing the use of high fructose corn syrup, though it was spun in the direction of treating gluttonous patients with the uric acid lowering drug.

Australian study shows that all of the so called warning signs for colon cancer don’t predict colon cancer at all: Patients who are encouraged to get colonoscopies to look for colon cancer because they have blood in their stool or change in bowel habits or abdominal pain are no more likely to have colon cancer than another random person their age.  This is interesting, but I’m afraid it can’t particularly influence my practice since people who have these symptoms, if they are significant, would like to know if their colons are the culprit. Still, it is nice every once in awhile, to find that something that I believed rather firmly is not true.

Bladder infections can be diagnosed and treated over the phone just as effectively as if the patient is seen in the office: This applies to what we call “uncomplicated urinary tract infections” which means that the person isn’t terribly sick and hasn’t been treated recently. Still, this saves tons of money and time for both patients and doctors. It raises the question of how to be reimbursed for phone medicine, since treating a bladder infection over the phone is not necessarily trivial.

Despite a “cost transparency” law in California, costs are not transparent: Researchers posing as uninsured patients asked for price information at various hospitals.  They got answers from fewer than 1/3 of the hospitals visited, and the information they did get was not standardized in a way that allowed them to compare different hospitals.

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