Don’t Do List for Family Physicians

The National Physicians Alliance has examined the evidence and published a short list of what is often ordered without justification by family physicians: X-rays for low back pain without unusual red flags within the first 6 weeks of pain, antibiotics for sinusitis in the first 7 days unless symptoms worsen after initial improvement, annual screening EKGs for asymptomatic patients, pap tests in patients less than 21 years old or in those who have had hysterectomies for benign disease, and DEXA scans for women under 65 or men under 70 with no risk factors. I agree. However, low back pain and sinusitis can be aggressively treated with natural remedies that do not carry the risk of standard meds, and ultrasound heel scanning can detect and monitor osteopenia quite well without the risk of radiation. See Arch. Intern. Med. 2011, p. 231, reported in Family Practice News (click here), June 1, 2011, p. 44.

Cardiac Surgeons Criticize the Decline in Bypass Rates

According to the SYNTAX trial reported in the New England Journal, there was a 15% reduction in the number of bypass procedures performed from 2001 to 2008. There was a lesser decrease in the number of stents placed. Their conclusion was that bypass was being underutilized, for some unknown reason. How about the possibility that far too many of these procedures have been done in this country for many years? The evidence shows that lifestyle changes as a primary treatment is often a better choice than surgery. We do many more cardiac surgeries for heart disease than any other country in the world. Further, there is an increased use of alternative medicine. The results of the TACT trial on chelation therapy is due out in early 2012. Hopefully, that will stimulate an even great drop in the use of cardiac surgery. See New England Journal of Medicine (click here, subscription needed). 2009;360:961-72.

Any Use of NSAID Drugs After a Heart Attack Increases the Risk

A large Danish Study contradicted the American Heart Association recommendation that NSAIDs such as Motrin, ibuprofen, and Celebrex are safe to use in patients who have had heart attacks. Even a short-term use of these drugs was associated with a 45% increase risk of death and 30 days of treatment increased the risk by 65%. This class of drugs is associated with kidney disease and ulcers as well. Generally speaking they should be avoided if possible. Alternatives include glucosamine, MSM, boswellia, curcumin, and many other natural products. See Family Practice News (click here), June 1, 2011, p. 16.

Women with Heart Disease are Often Missed

The American Heart Association points out that in 2007 one in thirty deaths in women were from breast cancer and one in three were from heart disease. Two thirds of women who die suddenly of heart disease have no previous symptoms. Those who do have symptoms are more likely to have shortness of breath or pain in the back or jaw than the typical sub sternal chest pain that men have. Obesity, even borderline hypertension or diabetes, and pregnancy complications can increase the risk. We suggest several tests that can detect vascular problems: Cardio Risk to detect early plaque in the carotid arteries, an ultrafast CT scan for calcium scores, and a heart rate variability test to look for micro vascular disease. If in doubt, chelation therapy might be a life-saving treatment. See the Associated Press article in the Toledo Blade(click here), July 6, 2011, Section A, p.3.

What to Do When Your Doctor is Stumped

The AARP magazine addressed this issue recently. They list common illnesses that are missed, partly because lab tests for them are often not definitive: Lupus, Parkinson’s, Celiac disease (gluten intolerance), chronic fatigue, fibromyalgia, M.S., and Lyme disease. Another problem is that standard treatments for these problems are often ineffective or have toxic side effects. Alternative medicine can be very effective and safe in treating these diseases. I suggest that the alternative approach should be tried first. The same issue lists four surgeries that should be avoided if possible, and I agree. They include: Stents in patients with stable angina, complex spinal fusion, hysterectomy, and knee arthroscopy without a distinct tear in the cartilage. See AARP, the Magazine, July/August, 2011 issue.

Double CT Scans Increase Your Risk

Medicare has determined that far too many CT scans are repeated right away to get more information, especially at community hospitals. The problem is more than the considerable cost. Each CT scan has the radiation exposure of 350 chest x-rays. Excess radiation increases the risk of cancer and other chronic degenerative diseases. If you are offered a second CT scan, it is probably better to just say no, unless of course it is a matter of life or death. Other major tests are expensive and potentially dangerous. For example, coronary catheterizations are often suggested just to see how a patient is doing. In fact, other means of testing can give similar info. What the caths do best is increase the pressure to do unnecessary cardiac surgery. See the Toledo Blade’s(click here) printing of a New York Times article, June 20, 2011, Section A, Page 6.

Taking Health Care Research Seriously

An editorial in the AMA journal described the explosion in research findings and how difficult it is to put the results into everyday practice. They recommend that social scientists become more involved in spreading the word about new developments. Also recommended is more emphasis on multiple interventions in research protocols to get greater effects. This would be a better approach to examine natural remedies, which are often synergistic with each other. Not mentioned in the article is that large, expensive studies are required to find statistically significant outcomes. What follows is the larger the study, the less likely the intervention will help the patient. For example large studies have shown that statin drugs might reduce heart attacks, but you have to treat 100 patients to prevent one heart attack.

See Pronovost PJ. Time to Take Health Delivery Research Seriously. JAMA, (click here subcription needed) July 20, 2011, 310.

Find Out Your Risk From Radiation Exposure

The American Imaging Management (AIM) has developed a Patient Safety Program. AIM is a separate company that provides utilization review for Anthem Blue Cross. If you go to their website, the program will help you calculate whether you are at high risk from cumulative X-ray exposure. The radiation from one abdominal CT scan is equivalent to that of 400 Chest X-rays, or 2.2 years of natural background radiation. Your risk is determined by your lifetime exposure.

Go to www.americanimaging.net/safety (click here)