American College of Physicians: Internal Medicine — Doctors for Adults ®

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Thursday, April 30, 2009

Most egregious abuse of a pandemic

It's not surprising that many groups have taken advantage of the swine/H1N1 flu publicity to promote their own agendas. Some are calling for health care reform, or better vaccine funding and research, or increased sales of their own patient education materials--all ideas at least tangentially related to the issue at hand.

But today I received the press release that crossed the line. It began, "The worst case scenario for a Swine Flu epidemic looks grim, according to government sources. Two million dead. Hospitals overwhelmed. Schools closed."

Are you scared yet? Don't worry, this being a press release, everything will work out happily in the end. And yes, it turns out that these terrifying predictions can be avoided simply by the purchase of a new book, "Free Yourself from Sinus and Allergy Problems--Permanently." If that scientific-sounding title hasn't sucked you in already, perhaps a glimpse at the book's advice will: drink tea and eat chicken soup. Apparently these helpful tips are as effective at preventing pandemic flu as they are at eliminating allergies.

Wow. Stop the presses and tell Joe Biden to get back on Amtrak. Problem solved--Permanently.

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Wednesday, April 29, 2009

Product placement, of sorts, but for a good cause

Those same viewers who are learning about HIV transmission via TV show Grey's Anatomy may soon be funding research into skin cancer, Alzheimer's disease, and neurologic conditions.

The popular show has created an online wedding registry for betrothed Drs. McDreamy and Grey which includes the option of donating to the American Academy of Neurology Foundation, the American Skin Association, and the Alzheimer's Association. Loyal fans can give a straight-up cash donation to any of these charities, or for only $5, buy a "virtual brain"--essentially, a little brain icon with one's name and message slapped on it, which will appear on the AAN Web site.

Now, who says television rots the brain?

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Monday, April 27, 2009

Medical news of the obvious

What was it that Tolstoy said about happy families? That all research about them will have the same, obvious results?

Anyway, this week we learned that mothers actually serve a purpose. A new study found that the children of women in the military misbehave while their mothers are deployed. Special obvious commendation goes to this somewhat off-topic quote that made it into the HealthDay coverage. "Women find meaning in this work, just as a man finds meaning in this work," she said. "Like dads, moms feel they are contributing to a greater good in the world."

And, in case you parents were thinking of risking the likely consquences and getting away from the kids, you might want to know that hanging out at the beach is less stressful than ekeing out an existence in Appalachia. That's right, according to CDC reports, Hawaiians report less mental distress than the rest of the country, while residents of Kentucky and West Virginia have the most. No word on how those stats compare to the unhappiness of residents of 19th century Russia, though.

Next time the family piles into the station wagon for a vacation (Appalachian get-away, perhaps?), remember that aggressive driving is responsible for 56% of fatal crashes nationwide, said the AAA Foundation for Traffic Safety. AAA defines commonly witnessed behaviors as aggressive: speeding (a factor in a third of crashes) is only 15 miles per hour over the speed limit. Also cited were running red lights and speeding through yellows, blocking others trying to pass, tailgating, forcing others to speed, driving on the shoulder and failure to yield.

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Saturday, April 25, 2009

The goiter: the Botox lip pout of 1622?


Marie de Medici had a goiter, and Rubens painted her with it in 1622. According to Dr. Susan Mandel, who spoke on thryoid nodules at a session today, this painting made goiters all the rage. Other women of the period would actually ask their painters to add goiters to their portraits--even if they didn't have one--in order to be a little bit more like Marie.

Sounds crazy... but is it any worse than injecting yourself with botulinum toxin to get lips as fat as Angelina Jolie?

(Image courtesy of Olga's Gallery at www.abcgallery.com)

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This post will not teach you about syncope

I assume that the packed house of internists learned a lot from this morning's session on syncope, but since medical-writer school doesn't include a course on reading electrocardiograms, what I picked up were some jokes about bears.

So here goes: The president wants to decide which law enforcement agency is the best so he releases a rabbit into the woods and sends the CIA, FBI and NYPD to get it. The CIA interviews all the animals, can't find it. The FBI kills everything in the woods, including the rabbit. After the NYPD goes in, a badly beaten bear comes out saying, "Yes, yes, I swear I'm a rabbit." The point was something about how electrophysiology is like the NYPD--you get an answer but it might not be the right one.

Then, presenter Fred Kusumoto, MD, told us about how premature ventricular contractions are like bear poop. If you're hiking in the woods and you see poop, you'd better watch out for a bear. Cleaning up the poop will not make you any less likely to run into a bear. Similarly, studies have found that using medication to get rid of patients' PVCs does not improve mortality.

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Friday, April 24, 2009

Fibromyalgia: Not just for women

Daniel Clauw, ACP Member, has a bone to pick with the American College of Rhematology's criteria for fibromyalgia.

He particularly dislikes the one which says there must be tenderness in at least 11 of 18 tender point sites to diagnose the disease. "When insurance companies come asking me about this, I say I don't know, and I don't care," said Dr. Clauw during a session on fibromyalgia this morning. "It's not even objective."

Indeed, one reason fibromyalgia is commonly--and erroneously--known as a women's disease is because women are more likely to report tender points than men, he said. It's true that the disease is 1.5 to 2 times more common in women, but there are plenty of men who have it, too--and they often go undiagnosed because of the "women only" myth.

"When males have fibromyalgia, the doctor keeps looking (for an alternate reason) until he finds a peripheral cause, like a bulging disc in the back. Then the patient gets surgery, and when that doesn't work, it's said that the patient 'failed back surgery,'....not that the surgeon failed by doing the surgery."

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The upside of losing your brain

Neurology is one of those specialties that always has case studies interesting to the layman, and yesterday's "update" was no exception.

Martin A. Samuels, MACP, told the story of a woman whose primary progressive aphasia caused her to become a great painter. As her frontal lobe deteriorated, her talent emerged. The theory is that the inhibitory part of her brain had previously been masking her creativity. Not sure whether it's inspiring or depressing to learn that us overly analytic scientific types might actually have artistic genius buried somewhere in our heads.

Dr. Samuels joked, "I've told my wife, 'If I ever paint anything halfway decent, get some long-term care insurance.'"

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Thursday, April 23, 2009

Warts and all

General internists must see a lot of crusty, itchy, oozing patients.

Today's "Essential Dermatology for the Practicing Internist" session was packed to the gills, with audience members consuming all available floor and wall space. Speaker Julia Nunley, ACP Member, even encouraged folks to sit down front in the area before the podium, "like little children at church."

Once settled in, we all enjoyed a pre-lunch earful and eyeful of scaly patches, inflamed sores, engorged pustules--and juicy clinical tidbits. Among them:

--Be sure to tell patients you treat for acne that it can take 2-3 months to clear up, and that the acne may not disappear completely. Many will quit treatment after three weeks if they don't see results.

--When female patients come in with acne, always ask about their menstrual cycles. "You don't want to miss PCOS," Dr. Nunley said. "When I'm checking out faces, I tuck my finger under the chin so I can feel to see if she's shaving. Often she won't tell you."

--Ask older patients with acne about flushing and blushing; you don't want to miss a diagnosis of rosacea.

--www.rosacea.org is a good site for patients to learn about things that can cause rosacea flair-ups. "You won't see this in any dermatology textbook, but rosacea flairs with menses," Dr. Nunley said. "For me personally, it flairs when I fly."

--Sun protection is the single most important treatment for rosacea. People are born with rosacea, and it gets worse with age-- but it can be stemmed if one is careful in the sun.

--Treatment for dandruff (Seborrheic Dermatitis) varies with ethnic background. African- Americans typically wash their scalps once per week, so shampoo treatments are of limited benefit. Ointments (fluocinonide) and oils (fluocinolone) should be used instead. For Asians and Caucasians, solutions (clobetasol) and lotions (triamcinolone) work well.

...and finally, the one that caused some gasps and murmurs to ripple through the crowd..

--HPV can actually live in liquid nitrogen. Never, ever double dip when performing back-to-back cryosurgery on warts.

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Is it wrong for you to pay patients?

In the "Ethics year in review" session this afternoon, Daniel P. Sulmasy, FACP, and attendees debated the moral and practical merits of paying patients to lose weight or quit smoking. The concept dramatically changes the way physicians would go about encouraging healthy practices, he said. "I think it begins to move us along the continuum from persuasion to manipulation." Financial incentives also may be ineffective, according to some research, because of the way they mess with people's motives. For example, patients can be reluctant to engage in healthy behaviors if they're not being paid, or suspicious of their physicians' motivations for providing compensation.

The discussion naturally led to the financial incentives that shape physicians' behavior, from pay for performance to pharma support. And that led to some hot debate on whether meetings like Internal Medicine 2009 should allow any industry funding--an issue that doesn't seem likely to be resolved any time soon.

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Mummers on the Move



If you were in the Philly Convention Center Exhibit Hall today around 10:30 am, you may have seen-- or heard-- some Mummery afoot. (And if you've never heard the word "Mummer" in your life, stop now and read this.)

A small but potent parade of Mummers made a circuit 'round the hall, dressed in full regalia and blaring classics like "Baby Face" on their saxes and banjos. With luck, we may catch them again on Friday-- and they may play the penultimate Mummer tune "O Dem Golden Slippers." If so, I'll bet at least one person won't be able to resist doing a bit of the Mummers strut around the booths. You'll know it when you see it.

(The stock photo is courtesy of gophila.com. Today's Exhibit Hall Mummers were too fleet of foot for an action shot.)

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Another medical use for Twitter

Twitter has found another medical use--tweets from the paralyzed. We'd previously covered smoking cessation and dieting, but letting paralyzed people communicate more effectively goes well beyond those other uses.

Shameless plug alert! ACP is Twittering from Internal Medicine 2009, as is Vineet Arora, FACP.

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Fat is bad, you know

It was a small feeding of the mind to put you off feeding. The lecture this morning by Louis Arronne, FACP, reviewed all the negative consequences of obesity and offered a few additional tidbits:

  • Hoodia, the trendy OTC weight loss supplement, is not a good idea. The extract it comes from could have negative cardiac effects. "The good news is that most compounds that are said to have hoodia actually have no hoodia in them," Dr. Arronne said.
  • Exercise is important, particularly for weight maintenance. You're not going to lose weight with just exercise, unless you work out like Michael Phelps. But exercise can compensate for the increased muscle efficiency that follows weight loss, the doctor said.

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Wednesday, April 22, 2009

A sight no patient should see

I always appreciate it when session presenters try to engage the audience by asking multiple choice questions (especially when I can guess the answer by looking ahead to the next slide). But today's precourse session on hormone use was remarkable for how many of the questions the audience got wrong. On several questions, there were some hands raised for every single option! Guess it goes to show that they were good, tough questions. And to be fair, in some cases there were multiple correct answers. But for those of us on the outside of medicine, it's a little scary to think any randomly selected physician might give you a different randomly selected prescription. Not to worry, though, three more days of CME should fix all that.

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Some CAM humor

Tired of your patients declining proven medications because they want to take something natural? Douglas S. Paauw, FACP, who led a precourse session on headaches, has a snappy response. "You like tsunamis? They're natural, too."

Seriously, though, there is some evidence that riboflavin can be an effective migraine prophylaxis, Dr. Paauw said. It can't hurt to give it a try, but if it doesn't work after a few months, you might as well stop it. Unless your patients are really into having unusually colored urine, that is. A recent study also found that vitamin E helped with severity and disability from menstrual migraine headaches, Dr. Paauw noted.

In case the "natural" options don't work, and you run into a patient with moderate to severe headaches, Dr. Paauw also offered his basic treatment algorithm. First, try an NSAID with a motility drug like metoclopramide, then an oral triptan, and only if that doesn't work, prescribe oral narcotics. But don't let them take too many narcotics, or they'll get rebound headaches.

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Not a minute too soon.

Yesterday, news broke about two kids in California contracting swine flu.

Today, ACP's Board of Governors voted for more collaboration between human and veterinary medicine, in order to prevent disease transmission across species.

Are they on the ball or what?

(Ok, so the measure was originally inspired by West Nile virus, which was recognized by vets in animals before anyone noticed it in humans. Still.)

Specifically, the Governors' measure supports cross-species disease surveillance, and joint efforts to develop new diagnostic methods, medicines and vaccines to prevent and control the diseases.

I, for one, am comforted by the fact that this may prevent any of us from ever knowing what hippopotamus flu feels like.

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Tuesday, April 21, 2009

A collection of diabetes tidbits

I spent today at an Internal Medicine 2009 precourse on diabetes and picked up a lot of miscellaneous interesting info, particularly during the session by Irl Hirsch, FACP, on monitoring in diabetes.

  • Most common reason that patients' finger-sticks are inaccurate? They don't wash their hands beforehand. If you eat an orange, then test blood from one of your sticky fingers, the glucose from the fruit could make the result inaccurately high.
  • But should your type 2 patients who aren't on insulin even be bothering to self-monitor? Given that there's no proof that home testing affects outcomes and test strips are expensive, Dr. Hirsch sees the main use being special occasions, like when a patient is eating something new and wants to see how her blood sugar responds.
  • A1cs are good, but not perfect. Anemia, in particular, can make their results inaccurate. Also, did you know that half of an A1c result is determined by glucose levels over the previous 30 days?
  • The newest big thing in diabetes monitoring--real-time continuous glucose monitors. They work great (i.e., significantly lower A1cs) if patients wear them all the time and pay attention to them, Dr. Hirsch said. Best used by patients and physicians who are tech-savvy and willing to devote some real time and attention.
  • The next big thing, however, could turn out to be a very old thing--urine glucose testing. If a currently underway study proves that it's as effective as home blood testing, payers could push for a move back to the older, cheaper option.
  • In the afternoon, David Kendall, MD, made a convincing case for incretin-based therapies. In addition to improving insulin secretion and response, the drugs reduce food intake and cause weight loss. So how to decide if exentide and the other on-their-way-to-market options in the class are right for your patients? That was a little fuzzier--you'll know 'em when you see 'em was the gist of his message.

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Monday, April 20, 2009

New drug use screening tool

Did the National Institute on Drug Abuse deliberately release its new drug screening tool on 4/20?

Er, anyway. This groovy online tool leads physicians through a short series of screening questions for alcohol, smoking and other substances, then spits out a score based on a patient's answers. The score suggests the intensity of the treatment needed.

The site also offers links to resources for carrying out a brief intervention, and for treatment referrals. Plus, one can use it to download waiting-room postcards which encourage patients to tell their docs about drug use.

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Medical news of the obvious

Elderly, hemodialysis patients are more likely to be hospitalized if they fall. Furthermore, reported researchers from the University of Virginia Health System presenting at the 29th Annual Dialysis Conference last month, hospitalization and/or mortality was even more likely if patients fell more than once during the three-year study period. Helpfully, researchers suggested that elderly patients get help with reducing their risks of falling.

The degree to which people smile in childhood photos predicts their later likelihood of divorce, said DePauw University researchers who asked adults for school pictures and rated their smiles. Those with the weakest smiles were more than three times as likely to divorce. It's not a genetic link between strong enamel and marital bliss, or that people with toothpast-minty breath kiss their spouses more often. The suspicion is that happier people (those who smile for pictures) might be more likely to work through marital problems, or might be marrying similarly happy people.

Tweets, those brief, annoying communications of 140 characters or less, might make users less moral and indifferent to human suffering. Not really, but researchers pressed on with the theory that the faster pace of news feeds doesn't allow people to fully empathize with the people to whom the news is happening. While we can rapidly process physical pain in others, emotions associated with morality take much longer to develop. We've heard it before here at Medical News of the Obvious (even if we paid attention for just a brief moment before moving on.)

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Thursday, April 16, 2009

Proven or placebo--take your pick!

A article by HealthDay reported this week that those acupressure wristbands that people use to stave off seasickness can also reduce nausea from cancer treatment. The article specifically noted that the improvement could not be attributed to the placebo effect, because patients who weren't sold on the benefits of the bands also reported less nausea.

Intrigued, I decided to engage in some heavy-duty journalistic investigation (Googling the press release mentioned in the article). I thought I found it here, but was surprised to find the study author saying, "But we think that the effect of the pressure bands was primarily a placebo effect. It appeared that the bands themselves did little or nothing, just as a placebo pill does nothing by itself." Wasn't that the opposite of the study findings?

Sure enough, it was. Because that press release was from a study released in 2003, by the same researchers, at the same university, published in the same journal, on effectively the same subject (one study covered nausea after chemo, while the other did radiation), with opposite results. The new press release for the 2009 study at least links back to the first study, but it still leaves one at a loss for the real implications of the research. Is the acupressure working, or the placebo?

Maybe it doesn't matter. As a recent ACP Internist article revealed, a lot of docs figure that if a treatment's cheap, not likely to cause harm, and the patient thinks it will work (all likely to be true of an acupressure wristband), why not give it a try?

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Wednesday, April 15, 2009

Digging for fun in the scientific program

With Internal Medicine 2009 less than a week away, it's time for another edition of "Ill-advised Session Titles." We are disappointed to report that ACP presenters are unusually matter-of-fact in their session-naming. Still, there are some awards to be distributed.

Best pun: Shocking Developments in Resuscitation
Most likely to be a spam email: How to Live (and Want) to Be 100!
Most likely to be a cable show: The V Words
Best session for the whole family: Adventures in Liver Land
Best follow-up to the above: Adults Beware! Children Are in the Building
And finally, the grand prize goes to the session that makes us nervous about wandering the halls here at headquarters: Anorectal Disorders Encountered in the Office Setting

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Tuesday, April 14, 2009

Is that your skin crawling...or something else?

Here's a conference that's likely to have attendees squirming in their seats. The EPA's National Bed Bug Summit is being held in Arlington, Virginia, today and tomorrow. The first-ever gathering is open to the public, so all sorts of "stakeholders" are expected, but the country's bedbug epidemic should be of particular interest to primary care physicians.

From personal experience (as one of the epidemic's early "victims"), I know that not all docs are completely familiar with the signs of bed bugs. I was diagnosed with first an allergic reaction to dust mites, then scabies, and tried antibiotics, steroids, antihistamines, scabicide and Lysol before catching one of the little buggers for a positive ID.

So if you've got a patient with inexplicable itchy bumps (example photos available here), you might want to suggest referral to an exterminator. Or moving. And if you want to join the fight against this scourge of humanity, get yourself down to the Crystal City Sheraton (a bed bug-free location, according to the Washington Post).

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Monday, April 13, 2009

Medical News of the Obvious

--People use the tint of your skin to judge how healthy you are, a new study from St. Andrews University found. Those with a pink or reddish complexion were judged as healthier than those with greenish or pale, washed-out skin. All of you who've been using green eye shadow to liven up your cheeks might want to stick to standard rouge from now on.

--Turns out 90% of couples experience a decrease in marital satisfaction after their first child, especially right after birth, an eight-year study of 218 couples found. A baby accelerates the process, which is also seen in childless couples, according to research in the Journal of Personality and Social Psychology. Dirty diapers and constant sleep interruption aren't so romantic, it seems.

--Once a couple has a child, they should work hard to instill a sense of self-control. Young kids with low self-control are more likely to become overweight by their preteen years, because they lack the ability to delay gratification for a larger reward, a new study in the Archives of Pediatrics and Adolescent Medicine finds.

--And once that child gets a driver's license, couples should be on high alert for any suspicious smells leaking out from his or her bedroom door. Turns out marijuana use and reckless driving are related, according to Canadian researchers: "Our study found that men with self-reported DUIC (driving under the influence of cannabis) tend to be associated with an increased risk of being involved in a car accident," said study author Isabelle Richer, according to an article in U.S. News and World Report.

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Friday, April 10, 2009

Paging Big Brother...

Urine drug tests are de rigueur for new employees of many companies-- but what about a test to ensure that novel accountant is eating her leafy greens?

A Toronto research group has found that, by measuring levels of urinary potassium, one can get a good idea of whether a person is hitting the salad bar on her lunch breaks-- or taking a trip to Mickey D's.

Researchers evaluated urine samples from 220 people aged 18 to 50 with kidney stones, over a period of 24 hours. The patients also filled out questionnaires about the kind of food they ate over that same time period. Turns out, those with more potassium in their urine reported eating healthier foods like veggies, fruit, whole grains and low-fat dairy, while the low-potassium crowd more often reported eating fast food, red meat and sugary drinks. The study is in the April issue of the Journal of Nutrition.

The absurdist possibilities of such a test are endless. Will health nuts take to measuring their urine every few hours, to ensure they are getting the proper ratio of flax to wheat germ? Or will insurance companies require urine tests as pre-requisites, trying to spot heart-attacks-in waiting via a Whopper-a-day dinner habit? The mind reels...

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Another recession health trend

What's the latest luxury to go out of style? Fertility! According to today's New York Times, vasectomy rates have been on the increase since the economy went into its decrease. Men don't see kids in the budget and want the procedure taken care of now in case they lose their insurance, the article says.

Since Slate.com has an entire department devoted to debunking these sorts of trend stories, you'd be well-advised to take this news with a serving of salt (even if the NYC health department would disapprove). But it does raise some interesting questions. Is a slowing of population growth going to be a silver lining to the economic crisis? Is this good or bad for medicine? Sure, there'll be less strain on overcrowded maternity wards, but who's going to grow up to fill the dwindling ranks of primary care physicians?

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Thursday, April 9, 2009

Comparative effectiveness needs publicity, along with research

Since you're reading this blog, you probably already know that the evidence against vitamins has been piling up. Several recent studies have indicated that the disease-preventing properties of fruits and veggies don't carry through when extracted into vitamin pills.

But apparently the word has not gotten out to the general public. Or so it seems from a recent New York Times article which is likely to send shivers down the spine of any believer in evidence-based medicine. The article describes a recession-linked upturn in vitamin sales (new customers up 20% at the Vitamin Shoppe in the last six months) and quotes several economizing shoppers who are replacing their prescription meds and doctor visits with vitamin and supplement purchases. There's even a physician-assistant student who has cut back on fruits and vegetables to buy fish oil and antioxidant supplements.

Ack! It's one thing to spend a little disposable income on probably useless vitamins, but to buy them instead of healthy food? Of that $400 mill the government's planning to spend on comparative effectiveness research, maybe a little should go toward telling people about the things we already know are ineffective.

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More bad news for the BMI

You may remember, awhile back, the study which found BMI wasn't of much use for athletes and college-age folks. Well, new research finds that the BMI-- created mostly from data on whites-- isn't a great measurement of obesity for non-whites, either.

The article in the British Journal of Nutrition compared DXA measurements to BMI for white, African American, Hispanic, Asian and Asian-Indian men and women age 17-35 years. Here were some results:

--The DXA estimate of percent fat for African American women was 1.76% lower than in white women with the same BMI. So, assuming you trust the DXA as more valid, the BMI for obesity in African American women should be about 32, not 30 as it is for white women.

--For Hispanic, Asian and Asian-Indian women, the DXA of percent fat is higher by 1.65%, 2.65% and 5.98%, respectively, than for white women of the same BMI. Based on this data, the BMI threshold for obesity in Hispanic women should be 28, not 30.

--For African American men, DXA was 4.59% lower than it was for white men of the same BMI; for Asian-Indian men, it was 4.29% higher.

So the lesson here is, if you use a non-diverse sample to construct a measurement or screening tool, you limit its applicability. Hmm, sounds a little...obvious?

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Wednesday, April 8, 2009

Send your idea into space

With twitter, blogs and Facebook, it's become an everyday affair to send your hypotheses into cyberspace. But now the NIH is offering medical researchers the opportunity to send their experiments into actual outer space. According to the press release, the government (specifically a NIH/NASA collaboration) is collecting research projects for astronauts to conduct on the international space station. How cool is that?

Here at ACP Internist, we're better at critiquing research ideas than coming up with them, so feel free to send your ideas along to us first, and we'll save you the embarrassment of hearing from NASA that they don't need any more research into whether depressed people are unhappy.

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Tuesday, April 7, 2009

The honeymoon's over

Obama's out collecting love from the rest of world, but back home he's earned his first negative press release from a health organization. The AIDS Healthcare Foundation today expressed "deep disappointment" at Obama's proposed domestic spending on AIDS awareness--$45 million. The foundation wants to see $200 million spent on testing to combat recent dramatic increases in CDC-estimated infections. Someone was bound to be disappointed sooner or later; hopefully, this isn't an indicator of underwhelming funding coming for other health initiatives.

The president did make a move likely to gain support among the fake doctors of America. Kal Penn, who had a role on the TV show House but is best known as stoner/would-be med student Kumar (of Harold and Kumar Go to White Castle), is now going to the White House as a liason between the administration and arts groups, news organizations reported today. Makes us wonder--has anyone considered Neil Patrick Harris (aka Doogie Howser, MD) for the open surgeon general slot?

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Monday, April 6, 2009

Medical news of the obvious

People diagnosed with cancer are at increased risk for depression, concludes a study in the Journal of Clinical Oncology. Researchers collected an impressive amount of data and performed some complicated regression analysis and risk-adjustments to come up with the important, though not particuarly surprising, recommendation that physicians treating cancer patients should look for signs of depression and initiate early treatment.

Children prefer bright colors. So concluded a study in the Journal of Clinical Nursing that assessed hospitalized children's perceptions of nurses wearing non-traditional, brightly colored uniforms vs. the traditional drab attire. I bet smiling works, too. But that's another study.

Sugary soft drinks were associated with more weight gain than other beverages, according to researchers. To come to this conclusion, researchers looked at 810 adults and weighed them over an 18-month period, doing unannounced 24-hour dietary recall interviews by phone during the study. Sugar-sweetened beverages were the only ones significantly associated with weight change. What rescues this study from being totally obvious is that it tracked how much weight could be cut by not swigging sodas. Cutting liquid calories was associated with losing 0.25 kg at 6 months and 0.24 kg at 18 months. Cutting just one sugary drink was associated with losing 0.5 kg at 6 months and 0.7 kg at 18 months. Lay off the soda already, especially those of you who start the day with a can or two.

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Cancer study bullish on broccoli

New research shows that if you want to prevent stomach cancer it really helps to like broccoli. While scientists have known for a while about the green vegetable's potential cancer-protective effects, there isn't much hard evidence on whether it prevents bacterial infections in humans. But a small study in the April issue of Cancer Prevention Research reports that eating 70 grams of fresh broccoli stems a day for eight weeks significantly lowered Helicobacter pylori levels in 48 infected Japanese men and women.

Researchers assessed the severity of H. pylori in participants at enrollment and again at four and eight weeks using standard breath, serum and stool tests, according to an American Association for Cancer Research news release. Reducing H. pylori levels presumably will lead to a lower risk of developing stomach cancer, said researchers, noting the well-established link between the two.

It's food for thought, and many may deem broccoli the lesser of two evils considering the alternative: alfalfa sprouts. The study randomly assigned participants to an equivalent daily amount of the sprouts, which had no effect.

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Friday, April 3, 2009

Unusual argument for EMRs

One advantage to electronic medical records that doesn't come up very often: they are easy to move. In Massachusetts, an entire practice-worth of patient records are about to be trashed because no one (including the state medical society) can afford to store or move them, the Boston Globe reported today. The papers were thrown into limbo when the doc in question didn't renew his license and was evicted from his office.

It may be a hassle to get to a paperless system, but at least it's not so much trouble when it's time to get rid of stuff. Between the move to electronic recordkeeping and the demise of American consumerism, it must be a depressing time for self-storage businesses.

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Thursday, April 2, 2009

A helping hand or a snatch and grab?

Walgreens has announced a new plan that could be good news for patients but trouble for primary care providers. Under the Take Care Recovery Plan, patients who lose their jobs can get free basic care from the stores' minute clinics. That is, as long as the patients were clinic customers before they lost their jobs.

It's hard to criticize any program that provides care to the uninsured, but this plan does seem designed to use fear of the recession to lure insured patients away from their doctors' offices. Will this lift some of the burden of unpaid care from internists, or realize the concerns of the anti-minute-clinic crowd? Tough call.

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Wednesday, April 1, 2009

When times look bad, focus on what's right

There's much to criticize about the current state of the nation's healthcare system but bloggers at Physicians Practice are reminding doctors to count their blessings. They've compiled a list of the Top 10 reasons to be happy you're a doctor. No. 8 on the list: "You relieve more than just physical pain," which goes on to explain:

"Particularly in primary care, you address your patients' vulnerability to not just disease, but also to loneliness, fear, and anxiety. True, a disturbing number are noncompliant with the help and advice you offer, but never doubt the effect you've had on people who survive and thrive simply because you bothered to listen."

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Primary care surplus looms

The U.S. is now facing a serious surplus of primary care physicians, according to a new report from the Rarepoverty Fund. In addition to attracting a majority of U.S. med school grads, the field of general internal medicine is filling with former hospitalists and subspecialists, who are competing to provide care, particularly to the elderly and uninsured. According to the survey, conducted in several regions around the country, a continuation of current trends will result in general internists outnumbering patients within the next decade. Rapid government action is needed to avert this potential crisis and to encourage physicians to enter specialties such as dermatology and radiology, the experts said.

When asked for an explanation of the trend, Rarepoverty president Fay Kinnitt attributed the field's growth to the popularity of certain blogs dealing with primary care. "What can I say? They've made internal medicine cool again."

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A polypill for the rest of us

Researchers today announced a successful trial with a new "polypill" that will eliminate baldness, vanquish impotence, cure insomnia, melt pounds and eliminate cellulite. The pill comprises existing imported remedies which, while currently sold off-market, are expected to be approved by federal regulators once combined.

There are no side effects to the medication, which will cost 77 cents per pill and should be in stores by Memorial Day-- "just in time for class reunions and the summer beach season," said lead researcher Shirley Ujest, PhD, of Arcadia University.

The study was presented April 1 at the annual meeting of the Society of Human Ambition Medicine (SHAM) in Santa Claus, Indiana .

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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