Do you remember when we talked last year about the purpose of preventive medicine? Then you remember that the point of blood pressure medicine isn't to lower blood pressure, it's to prevent strokes and heart attacks.
There are now many blood pressure medicines that have been proven to prevent strokes and heart attacks and have track records of safety lasting decades. These older medicines are also available generically and so ar...
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Healthcare Reform
The New England Journal of Medicine and the Massachusetts Medical Society released a video this week of a panel discussion on U.S. health policy. I thought it was a fascinating and intelligent discussion by representatives of all the stakeholders in the debate. The discussion covers many topics critical to American healthcare, including the dwindling numbers of primary care physicians, adoption of electronic medical records, providing care to the tens of millions of uninsured, and the...
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For Most Heart Patients Medicines are as Good as Angioplasty
Coronary angioplasty is a technical marvel. A thin tube is threaded from an artery in the groin to the heart. Through this tube a tiny balloon is threaded into a narrowed coronary artery. The balloon is inflated to open the artery, and then a stent (a metal mesh tube) is placed in the newly open artery to keep it open. About a million coronary angioplasties are done in the United States annually.
The procedure was initially developed with the hopes that opening narrow arteries would prevent...
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New Recommendation Against Screening for Prostate Cancer in Men 75 and Older
Two years ago I wrote about the controversy of routine screening for prostate cancer. Screening for prostate cancer is usually done with a blood test called PSA. But whether diagnosing prostate cancer early helps patients is still unknown, and there are many serious complications that result from prostate cancer treatment. That's why in many cases of prostate cancer watchful waiting is a reasonable choice.
The U.S. Preventive Services Task Force recently reviewed the existing evidence for an...
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The Exercise Transformation
I usually write about an item in this week's news or in the recent medical literature. Forgive me from straying from that path this week to share some personal reflections.
For sedentary patients there is an enormous psychological barrier to exercise. All primary care doctors face that barrier daily. We encourage, cajole, practically shove our patients to become more physically active. The vast majority of the time, despite the patient's and the doctor's best intentions, no change occurs. ...
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