Thursday, September 30, 2010

Weight Gain in People Over 50 y.o. Increases the Risk of Diabetes

It is well documented that excessive weight gain in younger people increases the risk of diabetes, but recent work indicates that there is a 3-5-fold increase in diabetes for those who gain at least 9 kg (about 20#) after the age of 50 y.o. Of course, that also increases the risk of heart attacks, strokes, blindness, and kidney disease. The weight gain at that age consists mainly of an increase in fat. Thus it is important to lose excess fat and maintain it at a normal level. I have heard reports of a new type of chocolate that dramatically shuts down the appetite, resulting in significant fat and weight loss. It should be available through physicians in the next few months.

See JAMA (click here) 2010;303:2504-12.

Tuesday, September 21, 2010

Studies Dispute Benefit Claims of Statin Drugs

The July, 2010 issue of Family Practice News contains several articles that I will comment on over the next month. It is packed full of useful information. Leading off is a dynamite article that discusses two major critiques of the JUPITER Trial that trumpeted statin drugs as primary prevention of cardiovascular events. Dr. Michel de Lorgeril in France came just short of accusing the authors of total fraud, while earning billions of dollars for drug companies they had connections to. He documented how the study was improperly terminated early, allowing for inflated estimates of benefits and underestimated harms. The causes of death listed in the study in both the placebo and treated groups were way out of balance for what was expected. The case-fatality rate was actually 3 times higher in the rosuvastatin group than it was in the placebo group. Dr. Kausik Ray at the University of Cambridge in England did a massive meta-analysis of pharmacological lipid lowering that showed that the all-cause mortality of statin drug treatment for prevention was no better than placebo. This contrasts greatly with the 20% reduction claimed by the JUPITER study that has been the basis for most of the surge in statin treatment in recent years.

See Arch. Intern. Med. 2010;170:1032-6 and in the same issue pp. 1024-31.

Thursday, September 16, 2010

Some Good Measures in Health Care Reform

Many people are concerned about recent health care legislation. I share some of those concerns, but a lot depends on the way it is implemented. We must by vigilant in identifying any new rules that interfere with patient choice. However, there are some good things about the legalization that almost everyone can embrace. Coverage of pre-existing conditions is at the top of my list. Decisions by health insurance plans to deny coverage can now be appealed to outside authorities, and in urgent cases, expedited review within 24 hours is required. Insurance companies will now have to justify rate increases. The new Patient Bill of Rights will soon be released. Medical homes, in which family physicians and other primary care docs will coordinate care, are included in the Affordable Care Act, and they have recently been shown to cut costs, booster quality, and improve satisfaction for both patients and physicians. Our practice at the Celebration of Health Association is one of the early applicants to become certified as a medical home. We anticipate that certification will enhance acceptance of some of the alternative practices that we provide.

Tuesday, September 14, 2010

Brown Rice Proves to be Much Healthier than White Rice

Two large Harvard studies documented what we have known for a long time about whole grains. Regular consumption of brown rice resulted in a much lower incidence of diabetes than white rice. This has a greater significance in the orient, where rice can consist of 75% of the diet. But it is also relevant in the US, especially since a growing number of people have celiac disease or an intolerance to many grains. Rice is usually tolerated for such people, and brown rice is definitely the way to go.

See Arch. Intern. Med. 2010;170:961-9.

Thursday, September 9, 2010

Defensive Medicine Drive Up Medical Costs

Medical Economics references an eBook by Jackson Healthcare whose surveys revealed that defensive medicine is responsible for 35% of diagnostic tests, 29% of lab tests, 19% of hospitalizations, 14% of prescriptions, and 87% of surgeries. This obviously is a big factor in escalating health care costs. There is some evidence that defensive medicine actually increases the risk of medical malpractice lawsuits, rather than being protective.

Defensive medicine continues to be taught to younger doctors in training. It would be much better to establish trust in the doctor/patient relationship. Potential adversaries do not work well together to achieve optimal health.

See (click here) or August 20, 2010 issue of Medical Economics.

Tuesday, September 7, 2010

Annual High-Dose Vitamin D Actually Increases the Risk of Falls and Fractures

Australian researchers at University of Melbourne have detected an increase fracture and fall rate for those patients treated with a rather bizarre short cut. Patients were give 500,000 units of vitamin D once a year for 3-5 years. Many studies have shown the importance for raising the vitamin D level, but it is now clear that reasonable doses of vitamin D (about 5000 iu) should be on a daily basis. Careful monitoring with blood tests to make sure that the treatment is effective are probably needed.

See Family Practice News (click here), June 1, 2010, p. 20.

Thursday, September 2, 2010

Seasonal Flu Vaccine Raises the Risk for H1N1 Infection

Four studies by Canadian investigators in Vancouver found that those who were vaccinated with the usual flu vaccine had a lesser incidence of the flu, but had a 68% higher risk of getting H1N1 infection. For those less than 50 years of age, the increased risk jumped to 123%. The widespread use of flu and H1N1 vaccines, especially in children, is premature, in my opinion, especially since most of them contain Mercury. Mucococinium is a homeopathic that works quite well, in my experience, both as a preventative and a treatment for various forms of the flu. Further studies are really needed. Our current national approach appears to be ineffective and perhaps dangerous.

See Family Practice News (click here), April, 15, 2010, p. 23.

Wednesday, September 1, 2010

Bran Reduces Inflammation in Female Diabetics

The Nurses’ Health Study out of Harvard has produced yet another interesting finding. Female diabetics in the study had a 28% lower risk of all-cause mortality and a 35% lower risk of cardiovascular disease if they ate generous amounts of whole grains, particularly bran. Like many chronic degenerative diseases, diabetes is associated with moderately increased levels of markers for inflammation and endothelial dysfunction. Whole grains reduce these markers, and this is the mechanism suggested for the protective effect.

See Family Practice News (click here), June 1, 2010, p. 18.