This week the US Preventive Services Task Force (USPSTF) revised their recommendations for screening mammograms. Their recommendations have ignited much controversy and have weakened the credibility of a formerly objective scientific body.
This post is longer than usual. It deals with an important subject in some detail. For the readers who like to delve into the details and see the data, set this aside for when you can give it some time, follow the links, and check out the articles yourself...
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Should You Have a Pap Smear?
Last week I lamented that we can prevent so few cancers. Cervical cancer screening is one of the success stories of prevention. Regular pap smears can drastically decrease the risk of cervical cancer and makes death from cervical cancer virtually unheard of.
Cervical cancer is a sexually transmitted disease, caused by human pappilomavirus (HPV). Pap smears check for telltale changes in the cervix that happen after HPV infection. Over many years these changes lead to cervical cancer.
But w...
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A Dose of Realism about Advanced Dementia
Dementia isn’t one disease. Like cancer, dementia is a family of different diseases that have important similarities. The diseases that cause dementia all lead to progressive memory loss and brain dysfunction. Dementia is caused by Alzheimer’s disease, vascular dementia, Parkinson’s disease and several other rarer brain disorders. The different diseases that cause dementia cause different symptoms initially and have different treatments. But unfortunately all the treatments are temporary an...
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The Challenge of Trusting Science
Around the turn of the last century medical practice was in a sorry state. Despite dramatic advances in physics, chemistry and physiology, the day-to-day practice of medicine was still entirely estranged from the scientific method. Medical training and medical practice was still what it had been for thousands of years – an apprenticeship in which treatments were passed down from teacher to student and applied by doctor to patient for generations without rigorous testing. At about that time le...
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Reservations Regarding Resveratrol
Resveratrol is a chemical found in the skin of red grapes, berries, plums and peanuts. It is being widely promoted as the latest antiaging wonder drug. Fortunately, to separate research from hype, this issue of The Medical Letter reviewed the current knowledge on Resveratrol.
Resveratrol has shown some interesting benefits in animal experiments. In obese mice, it increased insulin sensitivity and longevity. In non-obese mice it did not improve survival but increased other markers of good he...
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A New Blood Thinner May Outperform Coumadin
Atrial fibrillation is a very common abnormal heart rhythm affecting 3 million Americans. The most dangerous complication of atrial fibrillation is stoke, which can happen when a blood clot forms in the fibrillating heart chambers and travels to the brain.
Blood thinners have been the mainstay of treatment for atrial fibrillation. They reduce the risk of stroke by preventing blood clots. Warfarin (marketed under the brand name Coumadin) is the most effective available oral blood thinner, but...
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The Facts on Red Yeast Rice
Many of my patients ask me whether they should take red yeast rice to lower their cholesterol. This week’s issue of The Medical Letter has a very handy review of red yeast rice which I summarize below.
Red yeast rice is a food that is produced by fermenting rice with a specific species of yeast. It has been used in Chinese cooking and medicine for centuries. It contains many molecules that are similar to statins, the family of medicines including Liptor, Zocor and Crestor. In fact one of it...
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Weight Lifting Helps Breast Cancer Survivors with Lymphedema
One of my goals for these posts is to use individual studies to point out the broader trends they suggest. This week I want to focus on our increasing understanding of the value of exercise after illness or injury. A generation ago a heart attack meant weeks of bed rest in the hospital followed by strict instructions from the doctor to take it easy. The weakened heart couldn’t take much exertion, we thought. Now after a heart attack patients are told to start exercising as soon as they’re ou...
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Vertebroplasties: Not Very Valuable
Osteoporosis, the demineralization and weakening of bones, is common in older patients. A potentially incapacitating consequence of osteoporosis is a vertebral fracture, in which one of the vertebrae in the spine collapses and breaks under the weight it’s carrying. Like other broken bones, this is frequently very painful. Sometimes the fractured vertebra heals and the pain resolves after some time, but other times the pain can be incapacitating and prolonged.
A few years ago a procedure call...
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H1N1 Flu: Potential Pregnancy Problem
H1N1, the flu previously known as swine, is still in the news, but this week for a good reason.
Most of us still have little to worry about. The CDC estimates that over a million Americans have been sick with H1N1 flu as of July 24. The vast majority of illnesses were mild and resolved without incident, many without any treatment. As of that same date there have been 5,011 hospitalizations and 302 deaths. That means that getting sick with H1N1 flu caries half a percent chance of hospitaliz...
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