More Options for Colon Cancer Screening

Colon cancer is a leading cause of cancer death in the US, second only to lung cancer.  Fortunately, there are effective tests that can diagnose colon cancer early, or even prevent colon cancer while it is still a pre-cancerous polyp.  Given that this is one of the few cancers for which effective screening exists, I have been very enthusiastic about recommending colon cancer screening to all my patients over 50. The options for screening thus far have been colonoscopy, sigmoidoscopy, fecal occu...
More

Still In the Middle of the Flu Season

The recent news about this flu season has all been bad.  As reported in this Reuters article, the match between the strains in this year's flu vaccine and the strains that are actually making people sick in North America are not as close as in previous years, meaning the flu vaccine this year is giving patients less protection than it has in the past.  There are documented cases of vaccinated patients s...
More

How Much Good Do Cholesterol Drugs Do?

Last month BusinessWeek had a fascinating article about cholesterol-lowering medications.  The article also teaches us how we should calculate a specific medication's benefit and harm, and how pharmaceutical companies manipulate our opinions by reporting benefits in percentages but side effects in absolute numbers.  If you want an interesting lesson in evidence-based medicine, or just in cholester...
More

Merck Knows More about Zetia than They’re Telling Us

(or How I Learned To Stop Worrying and Love the Pharmaceutical Industry) I'd like to try to change the way you think about preventative medications. The goal of prescribing blood pressure-lowering medications is not to lower blood pressure.  The goal of prescribing cholesterol-lowering medications is not to lower cholesterol.  The goal of prescribing medications for osteoporosis (low bone density) is not to raise bone density.  Let me explain.  The goal of medications that low...
More

Learning to Say “I’m Sorry”

Medical mistakes have been receiving a lot of attention in the last few years.  The number of patients injured due to medical mistakes, especially in hospitals, has caused pressure at every level of health care to reexamine how patients can be protected.  Many of these error prevention measures are technical -- computerized drug interaction checking, pharmacy algorithms to prevent dispensing medications to which the patient is allergic, redundant verification of critical pieces of information li...
More

Statins Have Long-Lasting Benefits

The West of Scotland Study was a landmark in preventive medicine.  It was published in the early 1990s and was the first study to definitively show that statins (a family of cholesterol-lowering medicines) could prevent a first heart attack in people with high cholesterol.  It randomized over 6,000 middle-aged men with high cholesterol who had never had a heart attack to either pravastatin (Pravachol) or placebo.  In about 5 years of follow up, pravastatin clearly prevented heart attacks and sav...
More

Vitamin C Can Prevent the Common Cold in Extreme Conditions

The Cochrane Reviews are systematic rigorous reviews of the medical literature on medical therapies.  Because of the objective and comprehensive methods they use for finding all relevant studies and categorizing them by quality, they are regarded as one of the gospels of evidence based medicine. Recently the Cochrane Reviews published this review of the medical literature on vitamin C for the prevention and treatment of ...
More