Little Evidence that Low-Salt Diet Prevents Heart Disease

We know that people with high cholesterol have a higher risk for strokes and heart attacks than people with low cholesterol. So if a medicine lowers cholesterol it should also lower the frequency of strokes and heart attacks too. Right? Not necessarily. Estrogen lowers cholesterol and doesn't lower stroke or heart attack risk. We also know that people with high blood pressure have a higher risk for strokes and heart attacks. Does that mean that a food that elevates blood pressure increases str...
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Suicide Rate Among Baby Boomers Increases Sharply

Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that he can't imagine how things could ever get better, that he would be better off dead. Unfortunately, suicide in the United States is increasingly common. An More

Avian Flu (N7N9) Makes Leap from Bird to Man

Do you remember the H1N1 swine flu that made tens of millions sick and killed thousands of people in 2009? Well, one if its cousins, a bird flu with the name H7N9, is causing some death and consternation in China. This strain has long been circulating among birds, but since earlier this year people have become ill with this respiratory virus, all so far in China. This week’s issue of the New England Journal of Medicine (NEJM...
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ACP Potpourri

Greetings from San Francisco, where I am attending the American College of Physicians 2013 Scientific Program, their annual conference covering the latest progress in internal medicine. Though the conference is obviously geared for physicians, I've compiled below a half dozen points from the various lectures that I think might be of interest to patients. Feel free to skim, and if you want to learn more about any point, follow the links.

A New Hope for Hepatitis C Infection

Hepatitis C is a viral infection that is usually spread through contact with infected blood. Prior to 1992, when testing of donated blood and organs became commonplace, many people were infected through blood transfusion and organ transplants. Now the most common method of infection is the sharing of needles or other equipment for injecting drugs. About 3.2 million people are estimated to have chronic hepatitis C infection in the U.S. Over decades, chronic infection can lead to liver failure a...
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Normal Test Results are Often Not Reassuring

Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren't even slightly suggestive of the disease the patient is worried about, but the patient’s neighbor’s brother-in-law was just diagnosed with the same disease, and so the patient is pretty sure that he has it too. The doctor is not at all suspicious that the patient has this disease. The doctor believes that the patie...
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Newsflash: Smoking is Very Unhealthy

I have shocking news. Smoking is very very bad for you. In 1964 the US Surgeon General issued a report summarizing the known adverse health effects of smoking. At that time about 40% of American adults smoked. A widespread campaign followed informing Americans about the link between smoking and lung cancer, emphysema, stroke, and heart attacks. Federal law required the placement of health warnings on cigarette packages, and school children all learned about the adverse health effects of smoki...
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Many Women Who Don’t Need Them Are Still Getting Pap Tests

My regular readers know that I frequently bemoan the fact that we have no effective way to test for most cancers, and that in many cancers early diagnosis does not improve survival. Cervical cancer is one of the few exceptions. Since Georgios Papanikolau developed the test named after him, the Pap test has dramatically reduced the incidence and mortality of cervical cancer. More recent advances have shown that cervical cancer is caused by human papilloma virus (HPV), a sexually transmitted in...
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Niacin: Ineffective, and Now with Fewer Side Effects!

I haven’t written about niacin for over a year, and like a misunderstanding of the Mayan calendar that won’t go away, niacin is in the news again this week. You can catch up on the old news by reading my previous posts (links below) but here’s the story in a nutshell. People with high levels of a cholesterol molecule called LDL tend to have more strokes and heart attacks than people with normal LDL levels. People with low levels of a cholesterol molecule called HDL tend to have more strokes a...
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