April 2007

Eliminating the Yuck Factor from Doing CPR
Most by-standers don't stop and give CPR if they come upon someone in the street who's just had a heart attack. They might be willing to do the chest compression part but find breathing into the mouth of a complete stranger off-putting. Would more people do CPR if they didn't have to go mouth-to-mouth? Investigators in Japan studied what happened to over 4,000 adults who had a cardiac arrest outside a hospital. About three quarters got no CPR at all. By-standers gave full CPR to 20% and chest compression only to 10%. Not surprisingly, the investigators found that CPR gave better neurological outcomes (less brain damage) than no CPR. But the surprising and good news was that doing just chest compression gave better results than doing full CPR. This is probably because interrupting chest compression to do mouth-to-mouth breathing reduced the amount of blood that was being pumped to the brain. So if you see someone who needs CPR, don't worry about the germs. If the victim is not breathing normally, coughing or moving, just place the heel of one hands over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keeping your elbows straight, position your shoulders directly above your hands. Push down on the chest 1 1/2 to 2 inches at the rate of 100 pushes per minute.

Update on the Risks of Estrogen and Progesterone for Post-Menopausal Women
Two recent studies involving over 25,000 women found...
* Women over 50 taking estrogen only (not progesterone) had 5% fewer adverse health events (heart attack, stroke, breast cancer, etc) than those taking a placebo.
* Women in their 50's taking estrogen and progesterone combination (Prempro) had a slightly increased risk of stroke and breast cancer but no increased risk of heart attack. It is recommended that if women this age take hormone treatment that they monitor their blood pressure and have regular mammograms.
* Women in 60's and 70's taking Prempro had a definite increase in the risk of heart attack, stroke, and breast cancer. There must be strong reasons to justify taking it.
* Women who had hot flashes and night sweats were found to be at a higher risk of heart attack even without hormones, and this risk was increased by taking hormone therapy. (This data was reported in one study and will need to be confirmed.)
The term hormone therapy was used in this study to include both estrogen only treatment and also progesterone plus estrogen treatment. Since the former seems safe and the latter not, lumping them together makes one treatment seem more risky than it really is and the other more safe. It would be more informative to use the terms "estrogen treatment" and "progesterone treatment" in reporting the results of studies such as these..

Making Friends and Influencing People
Physicians who receive payments and other favors from pharmaceutical companies may have a conflict of interest when deciding whether to use treatments sold by those companies. Investigators tried to get information about such payments to physicians in the five states that have laws mandating public disclosure. In one of these states, only a quarter of pharmaceutical companies disclosed complete data. Access to data was restrictive and cumbersome. Companies labeled some payments "trade secret". In other cases, lawsuits were required to force disclosure. In one state, data showed that 7,000 physicians received a median payment of $1,000. Without access to better information, one can only guess what effects these payments have on prescribing habits. Console yourself with the knowledge that these payments probably have no greater effect on physicians' prescribing practices than pharmaceutical companies' contributions have on the votes of your congressional representatives or on the regulations of U.S. Food and Drug Administration, another willing recipient of their beneficence.

Time for the Annual Check-Up?
Periodic health exams (PHE) have the primary purpose of assessing the overall health and risk factors of an apparently healthy person by taking a history and doing a physical exam. PHE's may lead to early discovery of treatable diseases but they may also lead to tests and services that have no proven benefit. Reviewing over 30 studies, the authors found that PHE's were associated with more GYN exams, Pap smears, cholesterol testing, and blood tests of the stool. However, they had no consistent effect on clinical outcomes like disease detection, health status, cost, disability, or mortality. Their greatest benefit may be that they make some people worry less. On the downside, they're not generally covered by insurance or Medicare, so you'll probably have to pay for them yourself.