Archive for November, 2008

Being evidence based requires information

November 27, 2008

iphoneMy favoriate tool is the internet. Within seconds, via Google or Wikipedia I can find the answer to many of my medical questions.  If I cannot locate the answer directly, my second resort is UpToDate or Pepid.

However the Iphone blends all these tools into the palm of my hand.  Today I’m stoked because I learned how to sync my calender with Google calendar with NuevaSync.  The instructions to this fantastic tool are here.   I can type in an event on my Iphone and it magically syncs with the calendar on my computer.

I have also used the PubMed app on the Iphone, it is a little clunky but if I really need an article, I will probably just use my laptop.

NEJM: JUPITER trial…or how the drug companies pulled the wool over our eyes

November 26, 2008

Earlier this month, the NEJM published the results of the JUPITER trial which took patients with normal LDL, but elevated levels hs-CRP and randomized them to placebo or rosuvastatin.  The authors state the trial of 17,000 patients was stopped early, at year because of five, because rosuvastatin reduced the number of major cardiovascular events.

I have to thank Colin P Kopes-Kerr for pointing out the the lead author in the study also holds the patent for hs-CRP test and thus would have another dog in the fight each time a hs-CRP test is ordered.  Don’t you doubt for a minute that the pharmacutal company, who sponsored the study and had their minions monitoring the 1316 sites of this multi-center trial, forgot about the results either.

Rosuvastatin

Rosuvastatin

Rosuvastatin is more than $100 a month.  The results stated that the NNT is 95.  So you would need to give 95 patients rosuvastatin for 2 years to prevent one MI, stroke, hospitalization for UA or death.  That is just $228,000.  Chump change.

Maybe we should just put statins in the water.  However, then we wouldn’t be practicing medicine, just providing lining to the pharmaceutical companies without actually informing the patient of more effective less costly interventions like diet, exercise and smoking cessation (which have alway been unpopular anyway).  At the least when the pharmacutical companies through several million dollars at a study you get some pretty graphs.  I advise reading the article yourself to come up with your own conclusions.

Pretty graphs

Pretty graphs

Partner treatment in HIV and STDs

November 26, 2008
chlamydia

Chlamydia

Secondary syphilis

Secondary syphilis

New recommendations hot of the press at the CDC emphasize the importance of partner treatment.  Usually the most difficult task in this portion is identifying all the partners involved.  The recommendation is to test for all other STIs if one is positive.  So, in a patient who test positive for chlaymdia, she and her partner should be tested for HIV, syphillis, and gonorrhea as well. Intrestingly enough, the states hold legal authority for identifying and notifying partners of infected patients.  The situation can become sticky rather quickly, as it is the duty of the medical provider or the state to warn partners of possible exposure.

Understanding the evidence

November 25, 2008

book

The Annals of Internal Medicine tackle this tough task in their lead article.  I recommend listening to the pod cast summary of the article.  But here is the summary: make sure you are evaluating POEs (patient oriented outcomes) rather than DOEs (disease oriented outcomes).   It doesn’t matter if we can lower LDL but it may matter greatly if we can reduce death. What is the risk stratification? Well, you can find out now.  Listen here.

Ode to the colorectal surgeon…

November 24, 2008

Updated guidelines from the US Preventive Medicine Task Force on colonoscopy have emerged.  Annals of Internal Medicine 2008

All you folks age 77 who only expect to live to 84 can breath easier now.  Colonoscopy (every 10 years) or FOBT (fecal occalt blood testing yearly) is recommended for all persons aged 50-75.  Between 76 and 85 screening is only recommended if your life expectency is greater than 10 years.  And if your above 85 just forget screening.  Only pursue if there is a problem.  I always wondered when it was time to stop screening…I have to let my 95 year old great-grandfather Jake know that he got out of it this year.