Early in life we all have to choose which of the seven dwarfs we want to be. Most of us physicians, for mostly altruistic reasons, chose to be Doc. But it turns out that many of us instead ended up being Grumpy.
A survey of twelve thousand U.S. physicians released this week by the Physician’s Foundation paints a grim picture of our morale, and it received a lot of press. 78% of physicians believe that there is a shortage of primary care doctors today. 49% of doctors said that they were plan...
More
Crestor Prevents Heart Attacks and Strokes in Patients with Normal Cholesterol and High CRP
“If you think health care is expensive now, wait until you see what it costs when it’s free.” -- P.J. O’Rourke I’ve written several times about the proven benefits of a family of cholesterol-lowering medicines called statins. Statins include the medications Crestor, Zocor, Lipitor, Mevacor, Pravachol and others. The group has a solid base of evidence showing that they prevent strokes and heart attacks in patients with high cholesterol and in patients who have had...
In Women after Menopause, Testosterone Patch Improves Sexual Interest
“I can’t get no satisfaction” -- The Rolling Stones Many women after menopause experience decreased interest in sex and decreased satisfaction with sex. Some women accept this as a natural part of the aging process, but other women are quite distressed by these symptoms. The Diagnostic and Statistical Manual of Mental Disorders, the authoritative text on defining psychological illness, even lists “hypoactive sexual desire disorder” as a disorder marked b...
The Aspirin Controversy, Part II
My post last week created much confusion and worry. I received many emails asking “What about me? Should I keep taking aspirin or not?”
Let me clarify the issue by explaining what we already knew before last week’s study in the British Medical Journal. We knew that aspirin is valuable in:
More
- patients who have had a stroke
- patients who have had a heart attack
- patients who have had bypass surgery or angioplasty
- patients with angina (chest pain or d...
Aspirin Doesn’t Prevent Heart Attacks in Patients with Diabetes
Aspirin has been a mainstay in the treatment and prevention of cardiovascular disease for decades.
We know that in patients who have had a heart attack in the past aspirin prevents a second heart attack, and during a heart attack aspirin is life-saving. We also know that in patients with a prior stroke aspirin prevents further strokes. And in patients with symptomatic narrowing of the arteries, that is chest pressure with exertion (angina) or calf pain with walking (claudication), aspirin pre...
More
Medications for Osteoporosis
The current issue of the Annals of Internal Medicine published a clinical practice guideline from the American College of Physician on drug treatment for low bone density. It contains a valuable review of the known benefits and risks of the medications used for osteoporosis which I summarize below.
Bisphosphonates
This family of medicines includes Fosamax, Didronel, Boniva and Actonel. Fosamax, Didronel, Boniva and Actonel have been proven to prevent vertebral fract...
More
Arthroscopic Surgery Ineffective for Knee Arthritis
Arthroscopic surgery is a common treatment for moderate to severe knee arthritis. Through scopes inserted through small incisions the knee is irrigated and irregularities in the cartilage are shaved off.
In fact, no study has ever demonstrated that this surgery is effective for arthritis. Even worse, in a study in 2002 that randomized patients with knee arthritis to either arthroscopic surgery or sham surgery (in which skin incisions are made but nothing is done to the joint), the surgery gro...
More
Micardis does not Prevent Strokes Better than Other Blood Pressure Medicines
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...
More
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...
More
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...
More