Aspirin was hailed as a wonder-drug in the 1800s when it was first purified – the first anti-inflammatory medication that did not have the severe side effects of steroids. More recently aspirin’s benefits in stroke and heart attack prevention have been proven. This week another possible benefit of aspirin has been uncovered.
An important study published in The Lancet attempted to find any effect of aspirin on cancer prevention. I’ve written frequently about the myriad substances that are fal...
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The Most Recent Celebrity Vitamin: D
Every now and then some vitamin or dietary supplement becomes all the rage. A couple of generations ago vitamin C was the miracle drug that could prevent all diseases, despite lots of evidence to the contrary. Lots of my patients still take it for colds, demonstrating its persistent mythology. Vitamin B12 became the wonder-drug a few decades ago, leading to a whole generation of patients getting monthly injections for reasons that remain scientifically mysterious. And many lesser stars can b...
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Apathy about Anacetrapib
The new cholesterol medication generating hubbub this week is anacetrapib.
Why is the world holding its breath for another cholesterol medicine in an already crowded field? Well, the most successful family of cholesterol medications is statins. Statins have solid evidence for stroke and heart attack prevention. Statins lower LDL, the “bad cholesterol” that you hear about whenever your doctor discusses your cholesterol results. But another important risk factor for heart disease is low HDL. ...
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Safety: It’s not Just for Airlines Anymore
Preventing medical errors is a subject that is belatedly attracting a lot of attention. The way in which hospitals prevent errors and manage them after they happen is undergoing a major transformation. (See the links below to my prior posts on medial errors.)
The traditional plan for error prevention in medicine can be summarized as “we should all be more careful”. Physician autonomy and diversity of practice styles were thought to be sacrosanct and it was thought that errors could be minimi...
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A Screening Test for Lung Cancer
This week brings very exciting news, but everybody seems worried that we’ll misunderstand and read too much into it.
There are very few cancers for which we have a good screening test. A good screening test is a test that is done on people without any signs or symptoms of cancer and that diagnoses the cancer accurately enough at an early enough stage so that lives are saved. Mammograms save lives from breast cancer. Pap smears save lives from cervical cancer. Screening for colon cancer save...
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A Meta-Post about Meta-Research
… or, How to Love the Null Hypothesis
First, bear with me for an important definition. “Meta” used as a prefix, has come to mean self-reference, or “an X about X”. For example, meta-analysis is an analysis of other analyses. If you are arguing with your boyfriend about how unfairly he argues, you’re having a meta-argument, an argument about other arguments. You with me?
I usually write about a current study in the medical literature, but this week I’m writing about a researcher, John Ioann...
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Spiriva: A New Option for Asthma Patients
Patients whose asthma symptoms are only mild and intermittent usually don’t need daily asthma medications. They just use a rescue inhaler, like albuterol, whenever symptoms come up.
Patients with daily or almost daily symptoms, on the other hand, need daily preventive medications to control their asthma. The first choice for a preventive asthma medicine is a low dose of an inhaled steroid. If this first choice doesn’t control symptoms well, patients generally face a choice between increasing...
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Is There a Patient Educator in the House?
… or, An Angioplasty Also Won’t Make You Taller
Over a million coronary angioplasties are performed in the US each year. In this procedure a thin tube is threaded into a narrowed coronary artery. Through this tube a balloon is inflated to open the narrowed artery, and then a stent (a metal mesh tube) is placed to keep the newly expanded artery open.
Some large well-designed studies in the last few years have taught us that angioplasty is a life-saving procedure in the setting of an a...
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Admitting Our Mistakes
I’ve written before about how the error rate in the practice of medicine is far greater than that in other industries. I’m not talking about when doctors make a difficult decision that in retrospect was wrong; I’m talking about just plain mistakes, such as when one medication is ordered but another is dispensed or when the dose dispensed is 10 times greater than what was what was intended because of an extra zero was written in the order. We are finally looking to fields such as aviation to le...
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Startling Scientific Finding: Dieting Leads to Weight Loss
What sort of diet helps people lose more weight? Do overweight people lose more weight on a low-carbohydrate diet (like Atkins) or on a low-fat diet (like Weight Watchers and others)?
A carefully designed study published in the current issue of the Annals of Internal Medicine answers that question. The study enrolled over 300 obese adults and randomized them to a low-carbohydrate diet or a low-fat diet. Importantly, patients with diabetes, high cholesterol and high blood pressure were exclud...
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