June 2007

In This Issue

Some Medical Tests Are Costly -- And Not Always Necessary
TV and Sex and Adolescents - Five Startling Hypotheses!!
Surviving the Psychological Stress of the ICU
Low Salt Diet Helps People Whose Blood Pressure is Not Really High

Before You Order, You May Want To Check the Price
When prescribing medication, four out of five doctors take your out-of-pocket cost into consideration when deciding whether to prescribe a generic rather than a brand name drug. Some doctors give greater consideration to this than do others. In one study, HMO doctors were most likely to consider cost (almost 90%) (They may have been thinking about the HMO’s cost as well as yours.) Over 80% of primary care doctors considered cost, while only 75% of specialists did.

In contrast, only 40% considered cost when deciding what diagnostic tests to order. This is important because some diagnostic tests can be expensive, may not be covered by insurance, and sometimes are not really necessary..

In my experience, for some work-ups, most doctors find certain tests to be almost mandatory while they view others as discretional. Some of the latter are ordered because it’s more convenient to order a batch of tests at one time then to order one then follow up later with others if necessary. Some are ordered out of medical curiosity, some for the doctor’s legal protection, and some because the patient suggested them,.
It’s not bad manners to ask a physician who’s ordering tests how much they may cost. Sometimes, he or she may actually know, and, in certain circumstances, the test might reasonably be deferred without any increased health risk.

TV Viewing and First Intercourse in Adolescents
Almost 5,000 students (53% female and 77% white) younger than 16 who had never had sexual intercourse were interviewed. A year later, 14% of those who viewed less than two hours of TV a day during the previous year had had intercourse. 18% of those who watched more than two hours a day had done so.

Was the increase was due to sexual excitement generated by TV programming? Was it a consequence of teenaged boys and girls spending hours of unsupervised time on a couch in front of a flickering box? Did sex on TV entice the kids to experiment themselves? Was extra TV-watching just a proxy for a lack of parental supervision? Were families that were more permissive about TV more permissive about sex? Why am I generating so many hypotheses? Whatever the explanation of the findings, the study provides another good reason for parents to oversee and limit adolescents’ TV viewing. - Ashby SL et al. Television viewing and risk of sexual initiation by young adolescents. Arch Pediatr Adolesc Med 2006 Apr; 160:375-80.

Leaving the Intensive Care Unit in Good (Psychological) Health
Over 200 patients who had been in a hospital intensive care unit (ICU) were interviewed a week or two after discharge about their experience. Three months later almost 10% were found to be suffering from Post-Traumatic Stress Disorder (PTDS) related to their stay in the ICU. Three factors were most clearly related to the PTSD: physical restraint without sedation, prolonged sedation, and delusional memories. If these kinds of events occur, it may be useful to call in a psychiatric consultant to develop and oversee interventions that can minimize stress and its after-effects.

A Low Sodium Diet May Save Your Life Even If Your Pressure Is Not (Really) High
Over 3,000 people with high normal blood pressure were assigned to a low sodium diet or a regular diet. Ten to fifteen years later, those in the low sodium group had 25% fewer heart problems, and 20% fewer of them died. The authors of the article recommend less sodium for everyone. Sigh. British Med J 2007 April 28;334:885

Feedback from Readers
Re: Recent notes in Medical-Intelligence on TIA's and strokes: to find a nearby hospital that is accredited to evaluate and treat stoke aggressively, check the site www.jointcommission.org/CertificationPrograms/Disease-SpecificCare/DSCOrgs Then check for "Your state" and “Primary Stroke Centers”. Also see the NY Times May 28, 2007 for more extensive reporting on the topic.

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