I was going to talk about it, but Bard-Parker beat me to it. I guess that's what headlines are for, but people simply read the headline ("Study Finds MRIs Better on Breast Cancer") and jump to a conclusion. Already had someone ask me for a screening MRI of her breasts this morning. It comes as no surprise that the MRI has the higher sensitivity (i.e. less ...

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It’s about time

Medicare will now cover a "comprehensive physical" and the appropriate screening tests that accompany it.

The "welcome to Medicare physical'' for new beneficiaries includes influenza and hepatitis B vaccines, mammograms, Pap smears and pelvic examinations and screening tests for prostate cancer, colon cancer, glaucoma and osteoporosis, among other conditions.

It will even cover things like a routine EKG, which is not even recommended by the USPSTF.

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I regularly receive the Cortlandt Forum and only recently realized they're on the web. It's an eclectic magazine, but has interesting malpractice cases. Here's another one.

Basically, it's a patient who came in with dyspepsia. The PCP ordered an upper GI series and it was read as normal. However months later, the symptoms continued, and an EGD found terminal stomach cancer. The ...

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As health plans trend towards a deductible-type insurance, more patients will have to shoulder the cost. To that end, some health plans in Massachusetts are posting costs of various tests on the web.

Patients being more aware of the cost of care, and being able to talk about cost with doctors, is generally "a good thing and desirable," said James F.X. Kenealy, MD, an otolaryngologist in Framingham, ...

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Response to recent articles

Medrants and RangelMD have chimed in with their opinions on the piece regarding the patient who demanded ovarian-cancer screening. Each makes fantastic points.

Also, in response to BMC hiring a managment consultant, symtym supports the idea, while Blogborygmi takes a more cautious take.

Medpundit links to an excellent article detailing how more cancer screening isn't necessarily better. There certainly should be further public education on taking a more balanced, evidence-influenced view - or else more physicians would be subjected to this.

Screen me or I’ll sue

So, I saw a woman in her 40's this morning who demanded to be screened for ovarian cancer. Knowing that no governing body recommends this, I had a long discussion regarding the risks and benefits of screening for ovarian cancer. Then came the line: "It is my right to demand this test, if you won't, I'll sue the clinic". Nice. Thoughts of this story came ...

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. . . to help curb cigarette use. Shock tactics. I love it.

All cigarette packs sold in Singapore will soon carry gruesome messages including images of a cancerous lung and a sliced brain oozing blood to scare smokers into quitting, health officials said.

Statins and cancer

So the big story today is how statins can ward off cancer. This is a classic case of media hype of questionable data that was discussed last week. In this case, the data is observational and can hardly be used for any recommendations. Even the article itself recognizes this (of course, not in the title):

However, researchers seem unanimous in saying the evidence is still ...

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Here's something interesting I came across from Internal Medicine News Online. It discusses whether the media overplays and overpublicizes clinical studies. Some excerpts:

. . . most studies cannot stand alone. "Rarely is a study conclusive enough or broad enough to establish public policy or direct individual action by itself," . . .

. . . Although they might be suitable for journal publication, very few ...

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Medpundit and DB has chimed in on the mainstream coverage of the deficiencies of PSA screening for prostate cancer that was discussed here on Tuesday and Wednesday.

Medpundit writes:
Beware of organizations made up of hospitals and urologists who call for lower thresholds for treatment. They have much to gain from the increased number of biopsies such lower thresholds would produce. Unfortunately, it's far from clear ...

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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 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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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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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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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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AMNews:
Smoking cessation success reported

Training nurses and medical assistants who register patients at primary care facilities to use specific, guideline-based methods to encourage smoking cessation increases the likelihood that patients will successfully quit, according to a study published in the April 21 Journal of the National Cancer Institute.

Researchers tested the effectiveness of guidelines developed by the Agency for Healthcare Research and Quality in a randomized, controlled ...

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I'm flying soon, and thought this would be a relevant article to share.

Prescriber's Letter:
Practical Tips for Avoiding "Economy Class Syndrome"

What Is Economy Class Syndrome?

Economy class syndrome is a condition that can happen after sitting in a cramped space, such as the economy class section of an airplane. This can lead to blood clots in the legs and sometimes the ...

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AMNews:
Final data from WHI's estrogen-only arm published

Estrogen-only hormone therapy for postmenopausal women does not affect coronary heart disease but increases the risk of stroke by 39% while decreasing the risk of hip fracture by 39%, according to a study published in the April 7 Journal of the American Medical Association.

Therapy was also associated with an increased risk of breast cancer, although this was not statistically ...

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