Think Before You Sue the Doctor

August 18, 2007

A lawyer writing in the Michigan Law Review has assessed the outcomes of medical malpractice suits, with some interesting conclusions.

1. Contrary to popular opinion, the jury is more likely to sympathize with the physician than with the patient, other things being equal.
2. Juries can usually recognize a weak case, agreeing with the legal experts 80% to 90% of the time.
3. Plaintiffs win 10% to 20% of the cases that independent reviewers feel they should lose, and 20% to 30% of the cases rated as toss-ups.
4. Physicians win roughly half of the cases that independent expert reviewers believe they should lose, based on strong evidence of negligence.

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Age-Defying Fitness: Putting It All Together

August 15, 2007

Putting It All Together

“You must do the thing you think you cannot do.”
Eleanor Roosevelt

Even positive lifestyle changes are challenging. But we see amazing people in our clinics every day, people of all ages and abilities, making astonishing strides toward fitness.

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Vitamin D, Calcium, and Cancer

August 14, 2007

Summarized by Robert W. Griffith, MD

Summary
In a prospective randomized study, calcium-plus-vitamin D capsules significantly reduced the risk of cancers of different types in postmenopausal women.

Introduction
It’s been known for more than 50 years that exposure to the sun’s rays protects against some cancers – breast, rectum, ovary, prostate, stomach, bladder, esophagus, kidney, lung, pancreas, and uterus, as well as non-Hodgkin lymphoma and multiple myeloma. Researchers first proposed that vitamin D was responsible 25 years ago. Since then, associations have been found between colorectal and prostate cancer and low blood levels of vitamin D. All these findings are based on what are called “observational studies”. Now a double-blind, placebo-controlled trial of calcium and vitamin D supplementation has been done, in which the occurrence of cancer was an important outcome. Its findings have been published in the American Journal of Clinical Nutrition, and are summarized below.

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Acupuncture for Hypertension – Is It Feasible?

August 13, 2007

Summarized by Robert W. Griffith, MD

Summary

In the study summarized here, acupuncture given by experienced Chinese clinicians to patients with hypertension produces significant reductions in systolic and diastolic blood pressure. The beneficial effect does not persist after the 6-week treatment period, and conflicts with a recently reported study of similar design.

Introduction

There have been many reports that acupuncture can lower blood pressure in hypertensive patients, but these are rarely well-controlled, randomized, blinded studies, which represent the gold standard for demonstrating effectiveness of a treatment. One of the most recent controlled trials, reported in 2006, showed no benefit of acupuncture over a sham procedure, and the approach is not widely used in Western therapeutics.1 However, a new study, this time from Germany, has found a significant benefit of the procedure over a 6-week period in hypertensives. It’s reported in the journal Circulation , and we summarize it here.

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Serum Uric Acid and Parkinson’s Disease

August 12, 2007

Robert W. Griffith, MD

Here’s another ‘re-discovery’. In 1996 Honolulu scientists reported that, in a population of 8000 men, those with above average serum uric acid levels had a 40% reduction in their likelihood of later contracting Parkinson’s disease. This was reported in the American Journal of Epidemiology . The scientists suggested that the antioxidant properties of uric acid might protect against oxidative damage and nerve cell death in Parkinson ‘s. And they advised further research.

Eleven years later (last June, in fact) the same journal reported data from the Health Professionals Follow-up Study, which comprised 18,000 men screened in1993-1995 and followed until 2000. 84 cases of Parkinson’s disease were matched with two controls by age, race, and time of blood collection. Then the participants were divided into quarters (quartiles) based on their serum uric acid. After corrections for age, smoking, and caffeine, those in the highest quartile were found to have a 55% lower likelihood of developing the disease than those in the lowest quartile. The principal investigator stated “”the data are very compelling, and if they are confirmed, urate could become the first biomarker of Parkinson’s disease”. Do we really need another study (in ten years’ time!) to re-discover this relationship?

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FDA Okays Stomach Drugs Prilosec And Nexium, For Now

August 11, 2007

The US Food and Drug Administration (FDA) said yesterday that a preliminary review of new data on the safety of two stomach drugs made by AstraZeneca, Prilosec (generic name omeprazole) and Nexium (generic name esomeprazole) suggests that long term use of these medications does not lead to heart attacks and other heart related events. The agency said for the time being, until a final decision and recommendation is made in three months’s time, health professionals and patients should not change their current practice in the use of these drugs.

Prilosec and Nexium are proton pump inhibitors (PPIs) used to control stomach acid. They are taken by patients with a range of gastrointestinal conditions such as ulcers and gastroesophageal reflux disease (GERD). Some GERD conditions erode the lining of the food pipe (esophagus) and PPIs help to heal the erosions or stop them getting worse. Prilosec and Nexium are available in the US by prescription, although Prilosec is also dispensed over the counter for heartburn.

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Migraine With Aura Linked To Stroke Risk In Women, US Study

August 11, 2007

A new US study suggests that women who have migraines with aura (seeing spots and flashing lights), particularly those who smoke or use oral contraceptives, are at increased risk of having a stroke compared with women who do not have migraines.

The study is published in Stroke, a journal of the American Heart Association, and was carried out by researchers from the University of Maryland School of Medicine, Baltimore, Maryland, the VA Maryland Health Care System, also in Baltimore, and the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

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