The mainstream press has caught wind of the NEJM study that was discussed here yesterday. Here are some quotes from the article:

. . . "This study adds to information that perhaps the PSA threshold may be dropped to 2.5 or so," said Gomella, the Philadelphia urologist. "The number 4 may not be the, quote, normal that we look at anymore."

. . . Some ...

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In today's environment where drug companies are being monitored closely (take TAP's recent lawsuit in the Boston area for instance) for physician kickbacks for prescribing drugs, comes this story from Italy:

A two-year investigation by the financial brigade found that the Italian subsidiary of Glaxo had mounted an illegal incentives scheme involving 4,713 people, including 4,440 doctors.

Glaxo clearly wasn't subtle in their efforts to influence physicians:


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In the May 27th issue of the NEJM, a study was released that concluded that biopsy-detected prostate cancer was not rare among men with PSA levels of 4 or less. Prostate cancer was diagnosed in 15 percent of cases in the group with PSAs of less than 4, and of those cases, 15 percent were high grade.

This begs the question - should the threshold ...

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Hiccups

Medpundit wrote about hiccups today. It reminded me about one of my patients who had protracted hiccups for 5 years - you could only imagine how frustrating this was. He was a 70-yo male who started having hiccups after surgery. Multiple medications were not successful: PPIs, H2 blockers, Thorazine, Reglan, Compazine, Neurontin and Dilantin were given without success. Endless GI and neurology consults were not ...

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AMNews compared two Medicare discount cards with Drugstore.com and a Canadian mail-order pharmacy. As you can see, the discounts still aren't enough. There is also pretty wide variability between the two Medicare cards:

Medication / Card 1 / Card 2 / Drugstore.com / Canada

Celebrex $105.64 / $162.87 / $76.99 / $38.69
Lipitor $60.85 / $66.82 / $62.99 / $49.85
Nexium $109.39 / ...

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From the Archives of Internal Medicine, comes a study that suggests that the majority (82 percent) of osteoporotic and hip fractures occured in women with T-scores greater than 2.5 (i.e. at osteopenic, not osteoporotic levels). This suggests that treatment at an earlier stage (i.e. with T-scores between 1 and 2.5) may be considered.

Remember that the USPSTF recommends that women aged 65 and older be screened routinely ...

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Toxic neckties?

This story caught my eye - guess I'll think about dry-cleaning my ties from now on:

A small study of neckties worn by doctors at a Queens hospital found almost half the 42 ties tested harbored microorganisms that can cause illness.

Of the 42 physician neckties sampled, 20 contained one or more microorganisms known to cause disease, including 12 that carried Staphylococcus aureus, five a gram negative ...

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A recent study concluded that "about one in 10 people suffer weekly from [restless legs] syndrome that causes leg discomfort and leads to sleeplessness, and few are properly diagnosed by their physicians." I've certainly diagnosed my fair share of this, but only after having a high enough index of suspicion. More information can be found on this patient information page.

The VA hospital has always been special to me. My very first clinical rotation as a medical student was inpatient wards at the Jamaica Plain VA Hospital in Boston. Today, I still do occasional shifts in the VA emergency room, and see first hand the work and effort that is put in every day caring for our veterans, despite serious shortages in money and personnel. Today's Boston ...

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Good stuff from the UK today - first the Lancet editorial on OTC statins and now this article form the BMJ.

Entitled The first generation of e-patients, the article comes up with these observations about the world of the e-patient:

. . . many clinicians have underestimated the benefits and overestimated the risks of online health resources for patients . . . Many e-patients say ...

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Graham from Gross Anatomy, agreed with previous assertions that the motive for OTC statins is all about the money. I continue to have mixed feelings about it, but still believe there are too many driving forces (i.e. drug company profits, insurance savings) to prevent it from happening in the US.

In the May 22nd issue of The Lancet, the editorial slams the recent UK OTC decision, ...

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I came across this case from JAMA in January, 2004. Here are the basics:

1) A third-year resident, Dr. Merenstein, saw an educated 53-yo man for the first time at his resident clinic. A PSA level had never been done before.
2) A documented discussion about the risks and benefits of screening was done, and the patient was enouraged to consider the information. He was never ...

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Low-carb diets

The Annals of Internal Medicine reported a study comparing a low-carbohydrate, ketogenic diet program (i.e. Atkin's) with those of a low-fat, low-cholesterol, reduced-calorie diet.

The study concluded the following:
Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than ...

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I've been recently beta-testing Google's upcoming (and free I might add) Gmail service and used my allotted invites to give my fiance and brother Gmail addresses. Little did I know what else I could have received for the invites, or how high the bids on eBay went for them.

Packaging antibiotics in "paks" is nothing new and is only gaining popularity. Patients love it, and it's easy for physicians to write "***-pak, use as directed". Azithromycin has the popular 5-day formulation (Z-pak) and a 3-day formulation (Tri-pak).

Levaquin now has the 5-day Leva-pak (750mg x 5 days) - which has the potential for wide-spread (ab)use. This is especially troubling given the emerging ...

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From EMedConcepts, a physician took this picture of a "mobile lawyer van" parked outside the emergency room. When security chased the van away, it moved across the street where it stayed for the rest of the day. Unbelievable.

Just noticed this headline as I was drinking my diet soda. I'll have to see the actual study myself to come to any conclusion, but here are the salient points from Reuters:

A team at Tata Memorial Hospital in India found a strong correlation between the rise in per capita consumption of carbonated soft drinks in the past 50 years and a documented increase in rates of esophageal ...

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Just saw a patient with warts on her hands and remembered there was a small study that was released comparing duct tape and cryotherapy. I quickly Googled it and here's the data:

In the study, researchers randomly assigned 51 patients, aged 3 and 22, to receive either a maximum of six cryotherapy treatments or two months of "duct tape therapy."

Duct tape therapy consisted of a nurse ...

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A laparoscopic approach to colon cancer was initially explored in the early 1990's, but then abandoned due to questions regarding the efficacy for achieving appropriate resection. A recent study from the NEJM, did a controlled trial which concluded similar rates of cancer recurrance between open and laparoscopic resection.

Here is an excerpt from the accompanying editorial:
Approximately 250,000 colonic resections are performed each year in ...

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Associated Press:
Some of the world's biggest drug companies are working behind the scenes to convince regulators to let older cholesterol-lowering drugs be sold without a prescription in low doses, as Britain has just done.

While doctors say the drugs are safe, less than one-half of Americans who could benefit take them, mostly those at highest risk of heart disease, other complications and death, experts say. Most of the ...

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