Monthly Archive
The March 21 issue of the Annals of Internal Medicine has a pair of excellent articles that highlight the unresolved questions in routinely testing men for prostate cancer: Viewpoint: Limiting Prostate Cancer Screening and Viewpoint: Expanding Prostate Cancer Screening. (The abstracts of the article are available by clicking on the links, and the full text is available for subscribers.)
The confusing state of affairs is that screening for prostate cancer has still not been proven to save lives (unlike, for example, screening for colon cancer). Long term studies are currently ongoing to discover if there is a benefit to diagnosing prostate cancer early, but the results of these studies will not be available for many years. The current recommendations of the American Urological Association and the American Cancer Society is that most men be screened for prostate cancer between the ages of 50 and 75 with an annual blood test called prostate-specific antigen (PSA) and a digital rectal examination. However, the U.S. Preventive Services Task Force, the most unbiased group that evaluates the benefit of preventive testing, has decided in its most recent recommendations that there is insufficient evidence to recommend either for or against prostate cancer screening at any age.
Given these contradictory expert opinions, what should you do? First, understand that unlike preventive tests such as periodic blood pressure checks, cholesterol tests, and tests to detect colon cancer which have been proven to save lives, the benefit of testing for prostate cancer is still not solidly established. So remember that for now there is no definitive answer. Second, discuss the benefits and risks of screening with your own doctor and together arrive at a plan that is comfortable for you.
I try to practice according to the advice given at the conclusion of the first article.
While awaiting results from the major screening trials, providers should not be screening outside the existing guidelines. Rather, they should be educating their patients about the uncertain benefits and potential harms of current screening practices.
A conversation with a trusted professional is much more valuable than a controversial test.
SureScripts is a company that allows physicians’ offices to send prescriptions to pharmacies electronically. It works with most electronic medical records (EMR) systems, including the EMR our office uses.
A recent article on eWeek.com reviewed SureScrips’ efforts to increase the number of physicians that are sending prescriptions electronically. There are many benefits of avoiding handwritten prescriptions. Legibility and avoiding errors due to poor handwriting is the most obvious benefit. Convenience is another. The article cites more.
Now, physicians using most EMRs can skip that paper-based step because prescriptions will be sent directly from the doctor’s office to the pharmacy. Pharmacies can also send refill requests back to the physician’s office for authorization.
Such connectivity will not just improve convenience, said Hutchinson, it will lead to enhanced care. For example, in February, SureScripts announced a plan to provide patients’ medication history to authorized physicians; this information can help doctors choose the best medication regimen.
Increasingly, doctors are realizing that quality care is based on reliable information, and that information can not be reliably stored or transmitted on paper.
Congestive heart failure (CHF) is a very common condition in which the heart becomes increasingly ineffective at pumping blood and fluid backs up and leaks into the lungs and other tissues. It is a very frequent cause of hospitalization. Diuretics (medications that remove fluid from the body by increasing the volume of urine produced) have been the mainstay of acute treatment, and in the last few years other medications such as beta blockers, ACE inhibitors, and aldosterone blockers have been shown to be important in chronic management.
A recent study, the results of which will be released in tomorrow’s issue of the Journal of the American Medical Association, compared treating patients hospitalized with CHF with diuretics and with blood filtration. Blood filtration is a method similar to dialysis that is used to remove fluid directly from the blood stream. It is a technique that has been used for decades in removing fluid from patients with kidney failure. The results were presented Sunday at an American College of Cardiology meeting in Atlanta, and were reported in this Associated Press article, which you may wish to read for the full details.
The results showed that filtration was more effective at removing fluid and led to fewer hospitalizations in the following three months.
“It’s really pretty exciting,” said Dr. Clyde Yancy, a cardiologist at UT-Southwestern Medical Center in Dallas and an American Heart Association spokesman who had no role in the study. “You could use this right now … based on this information.”
I agree. It is exciting to see a breakthrough in the treatment of such a common disease.
Alternative Medicine, Diabetes, Heart Disease, New Study
The recent clinical studies about dietary supplements have been largely negative, important reminders that most supplements can’t deliver on the expectations that patients have for them.
Given this bleak background, I wanted to share with you some good news about Coenzyme Q10 (CoQ10). The Medical Letter, one of the best unbiased sources of reviews of medical studies, reviewed CoQ10 in last week’s issue. Since the article is available only by subscription, I briefly review it for you below.
CoQ10 is an antioxidant involved in cellular energy metabolism in mitochondria, the cell’s power plant. As a dietary supplement, it has been suggested for many uses, many of which have not been tested rigorously. The following are the uses of CoQ10 listed in the article that have been shown to be effective in randomized trials:
The article also cited many more conditions in which CoQ10 was shown not to be helpful, or in which the studies were small, not randomized, inconclusive, or are ongoing. These conditions include congestive heart failure, hypertension, diabetes, drug abuse, ALS, Huntington’s disease and decreasing side effects of other medications. I would not recommend CoQ10 for any of these conditions until more evidence is found.
Finally, CoQ10 has been demonstrated to be safe in large studies, with no serious or bothersome adverse effects.