by James Hubbard, M.D., M.P.H.

A few months back, the American Academy of Pediatrics (AAP) recommended drugs for some children to lower cholesterol.  Outrage, controversy and indignation followed.  Apparently this reaction took the AAP by surprise.  I am not sure why.

Authors of an opinion piece called “Storm Over Statins: The Controversy Surrounding the Pharmagologic Treatment of Children” take a look at this dilemma in the Sept. 25, 2008, issue of the NEJM.

They write:

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The United Kingdom Prospective Diabetes Study began in 1997. Little did they know that a twist in their plans would result in some surprising findings a few years later.

by James Hubbard, M.D., M.P.H.

Long-term complications of type 2 diabetes can be numerous and severe.  How can you best decrease these?

Treat it hard, fast and early says a new NEJM study, online since September 10, 2008.  Details follow, but the bottom line is, get your sugar under control ASAP after being diagnosed and you will decrease serious complications, even risk of death down the road.   Diet, exercise, oral medicines and insulin, whatever it takes.

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by James Hubbard, M.D., M.P.H.

One hundred years ago today, the U.S. began adding chlorine to drinking water, says Andre M. Blackman, publicist for the industry association American Chemistry Council. Now I know there is a controversy with some regarding dangers of chorine, but can anyone truly argue that it hasn’t save lives? It has virtually wiped out the deadly diseases typhoid and cholera where it’s used–not to mention numerous viral, bacterial and parasitic infections.

Four of the points Blackman noted to JHMFD managing editor Leigh Ann Hubbard are:

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by James Hubbard, M.D., M.P.H.

Reader’s Digest website has “13 Things Your Pharmacist Won’t Tell You.” There are some good tips, such as asking about the $4.00 generics.  Some chains offer this on certain generic drugs, so it doesn’t hurt to ask.  Better yet, get a list to show to your health-care provider so he or she can prescribe one if it’s appropriate.  Just don’t insist since the drug for your condition may not be on the list.

My addition to tip number three (basically, “Pharmacists make mistakes, too”): Always check you prescriptions before you leave, if possible.  Make sure you have all your medicines, in the right quantity, and that they are what you were prescribed (having asked your doctor what he or she is prescribing before you leave the office).

As a consumer, I was surprised with Secret # 2.

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by James Hubbard, M.D., M.P.H.

Vaccinating an expectant mom also vaccinates the baby–for the first six months of its life outside the womb–according to a new study in The New England Journal of Medicine (NEJM).

Influenza causes more serious consequences in pregnant women and newborns than in the general public.  It can also lead to birth defects.  So what were the bottom-line findings of the study?

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by James Hubbard, M.D., M.P.H.

The New England Journal of Medicine published a study last week that found virtual colonoscopy is almost as accurate as the standard one in detecting polyps that can lead to colorectal cancer.

A virtual colonoscopy, called a computerized tomographic (CT) colonography in medicalese, is a fancy CAT scan that uses X-rays to look for polyps in your colon.  A regular colonoscopy (the gold standard of colorectal cancer screening) requires a long tube, with a camera on the end, inserted in the rectum, and snaked through your entire colon to look directly for abnormalities.  You remember Katie Couric’s live colonoscopy on Today, don’t you? (See video below.)

A polyp is a small stalk, usually less than 1/2 inch in diameter, growing from the lining of your intestine, that can progress to a cancerous polyp (usually takes five to 10 years for the progression).  Removing the polyps can prevent as many as 75 percent of colorectal cancers, according to the National Cancer Institute.

The problem is that people are not getting their screening colonoscopies.  What good is a test you if don’t get it? Physicians have been trying to find an alternative.  Will the virtual colonoscopy be it?

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by James Hubbard, M.D., M.P.H.

The better you stick to a Mediterranean diet the less likely you are to die of heart disease, have or die of cancer, and interestingly enough, develop Parkinson’s disease or Alzheimer’s.  This, according to a meta-analysis study published in the BMJ this month.

We already knew the diet could lower glucose, but the BMJ study looked at the bottom line of bottom lines–death–and found good news, as well as pleasant surprises.

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by James Hubbard, M.D., M.P.H.

For 2008 the U.S. Surgeon General’s call to action (the thing he or she wants to publicize nationwide, ie, his or her pet project) is to prevent deep vein thrombosis (DVT) and pulmonary embolism. From the press release:

Deep vein thrombosis is a blood clot in a deep vein, most commonly in the lower leg or thigh.  The clot can block blood flow and cause pain, swelling, and skin discoloration.

DVT can be a problem in itself.  Due to damaged veins, your leg may be chronically swollen for life, causing all sorts of problems.  But the big risk is that sometimes, a piece of this clot can break off and go directly into the lung (pulmonary embolism) to cause serious damage or even death.

According to the surgeon general, each year there are 350,000 to 600,00 cases of DVT, with as many as 100,000 deaths.

DVT is not to be confused with superficial thrombophlebitis, which is inflammation of the veins near the skin surface.  Varicose veins are prone to this condition, which is not susceptible to a pulmonary embolus.  But how can you tell the difference if your leg is red and swollen? Well, you can’t.  You will need to see a physician ASAP.

Obviously, you want prevent DVT.  And you really, really want to prevent a pulmonary embolus, but how?

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by James Hubbard, M.D., M.P.H.

If you haven’t heard of bisphenol A, you will.  A study coming out in the September 17 JAMA shows an association of bisphenol A (BPA) with heart disease, diabetes and lab abnormalities of the liver.

Bisphenol A is a very common chemical found in some plastics like certain children’s toys, baby bottles, the resin lining of cans and dental sealants. Although we can absorb it through the skin and inhale it, our main exposure is diet.

At JHMFD we’ve written about companies eliminating polyvinylchoride (PVC), which can contain BPA.  I’ve blogged about the NIH being concerned about exposure in children. It’s a hot topic, and everyone is exposed.  So what do we do?

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by James Hubbard, M.D., M.P.H.

Patients need to be informed. That’s what my blog and magazine are all about. But sometimes, how you think about that information can physically affect you.

The placebo effect, or placebo response, has been known for years. A placebo is a treatment that has no active ingredients–no logical reason to have any effect, a sugar pill. The placebo effect is when this inactive treatment provides active results. For instance, placebo has helped alleviate pain, lower blood pressure; the list could go on. That’s why the best medical studies compare the active treatment to placebo (placebo-controlled).

It can happen to anyone, and I see it frequently. If someone thinks a treatment will cause an effect, it can. There are loads of studies, some showing actually physiological changes in the body–the power of positive thinking, mind over matter.

But what happens when the opposite effect occurs?

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