Wednesday, June 27, 2012

More tests may not be better

Just a handful of studies I have collected recently showing that getting more tests done does not always translate into better outcomes, or even more accurate information. A trusting doctor-patient relationship and the application of a little science may be all you need to get a good assessment of your health.
  1. After accounting for traditional risk factors (smoking, obestity, etc.) 101 genetic markers of heart disease did not improve the detection of heart disease. (Paynter et al)
  2. Five different blood tests barely improved the ability to predict heart disease (Schnabel et al)
  3. Screening for lung cancer with annual chest X-rays did not increase the detection of cancer and did not reduce the risk of dying from lung cancer (Oken et al)
But more testing should be better right? In these cases, it turns out that using heart disease risk factors was a strong enough predictor that the extra genetic and blood tests did not make a difference. For lung cancer, chest x-rays just may not be sensitive enough to detect the cancers, or the earlier diagnosis may not actually impact the ultimate result and lifespan. 

Tuesday, June 12, 2012

A couple more videos...

The first is a link to a discussion about how two doctors successfully incorporate social media into their daily lives.

The second is a TEDMED talk from Ivan Oransky (of Retraction Watch) talking about What Medicine can learn from Moneyball.

Monday, June 4, 2012

Slowtech and the dangers of electronic distractions

Thanks to @drjohnm for the link to this great video from Joe Kraus talking about our relationships with our electronic devices, some risks with them, and some suggestions on how to best use them.

Saturday, March 10, 2012

Atrial fibrillation, a video from the Heart Rhythm Society

The Heart Rhythm Society is a leading organization in the area of cardiac arrhythmias and their treatment. They have recently released this video for patients explaining basics about the most common heart rhythm abnormality, atrial fibrillation.

Saturday, March 3, 2012

Over the counter does not equal safe

In a surprising paper published in the Archives of Internal Medicine, doctors from Israel report on a series of 11 patients who suffered complications from the use of phosphate enemas. 8 of them just used the standard, one-time 250 mL enema dose, with the other three using larger volumes. All of the patients suffered kidney damage, with 2 requiring dialysis, and 5 of them died. While there are many ways to alleviate constipation, the authors caution that perhaps phosphate enemas should only be used in patients who are otherwise relatively healthy. I would tend to agree, as I see patients with heart failure and the sodium load in some enemas has been reported to cause water retention and acute heart failure. The other important message that I think should be drawn from this report is the reminder that just because something is available at the drugstore without a prescription, it can still be dangerous. The same goes for herbs, supplements, and concoctions that are billed as "natural".

Saturday, February 25, 2012

Salt hides everywhere

When I talk to patients about their "sodium" intake, the routine assumption is that I am referring to table salt. Almost every patient says, "I never add salt to my food" and assumes that this is an adequate strategy to reduce sodium intake. The problem is that table salt, or sodium chloride, is but one of numerous foods that add sodium to your diet. Look at the ingredient list and nutritional information for macaroni and cheese. 540 mg of sodium, or 23% of your recommended daily intake, comes in a serving that is 1/6th of a box of macaroni. In the ingredients, we see both sodium phospate and sodium tripolyphosphate as additional sources of sodium. This amount of sodium is a common finding in grocery items that are boxed and processed.

Other hidden sources of sodium? Bread is a big one, and the focus of the news article that prompted this post. the CDC reported data from a 2007-2008 survey of diets and found that nearly half (44%) of the daily sodium intake comes from just ten sources of sodium.

  1. Bread, 7.4%
  2. Cold cuts, 5.1%
  3. Pizza, 4.9%
  4. Poultry, 4.5%
  5. Soup, 4.3%
  6. Cheeseburgers and sandwiches, 4.0%
  7. Cheese, 3.8%
  8. Pasta, 3.3%
  9. Mixed meat dishes (meatloaf), 3.2%
  10. Savory snacks (chips and pretzels), 3.1%
So, potato chips made the list, but just barely, and they were outclassed by lots of other foods, few of which you might think have lots of sodium.

For one other illustration, NPR posted a calculation of the sodium in a simple turkey sandwich, up to 1500 milligrams! Going low sodium on everything cut that nearly in half to about 800. 

Saturday, February 18, 2012

A balanced review of "heart healthy" foods

The media seems to love the numerous studies about diets and foods, each hoping and promising to be the simple solution to your ailments. If you find all the conflicting reports confusing, you might enjoy this article from the Washington Post, which is actually reprinted from a book by Robert Davis called "Coffee is Good for You". Anyway, it succinctly summarizes the current data on several foods at just how healthy they are for you including: coffee, coca, olive oil, fish oil, nuts, and more. For background, Davis is a PhD at Emory. He has blogged over at the HuffPo in January on food label tricks to avoid and he runs a website called