October 2007

Table of Contents
Cancer Risk from CT Scans?
Break a Leg - or Not
Psychotherapy Increases Survival in Some Breast Cancer Patients
Keep It Clean
Needed: A PhD Program in Patienthood
Brief Notes

Cancer Risk from CT Scans?
Does the radiation from a CT scan increase your risk of cancer? Ask most doctors, and they’ll say no (91% in one study). On the other hand, the keynote speaker at the annual meeting of the National Council on Radiation Protection and Measurement, the Chair of Diagnostic Radiology at Yale, says YESSS!! While 44% of radiologists thought a CT scan was equal to between one and ten chest X-rays, he reported that a single scan is actually equal to (put on your lead apron before you read this...) between 100 and 250 chest X-rays. Having numerous scans, which is not uncommon, puts one in the medium dose range of the atomic bomb (no joke). So, avoid CT scans when MRI or ultrasound offers comparable information, and avoid repetitive exams unless absolutely necessary.

Break a Leg - or Not
Calcium and Vitamin D supplements may reduce the risk of bone fracture in older people by as much as 25% if they are taken conscientiously. The medical journal, Lancet, found the effect to be strongest with doses of 1,200 mg of calcium and 800 units of vitamin D. It is not yet clear whether Vitamin D really makes a difference, but Lancet feels that if you are going to take it at all, take it at their suggested 800 unit dose, not the 400 units usually recommended.

Psychotherapy Increases Survival in Some Breast Cancer Patients
One hundred and twenty five women with metastatic or recurrent breast cancer were given supportive-expressive group psychotherapy or no psychotherapy for at least one year. Overall there was no difference in survival. But the subgroup of 25 women with estrogen receptor-negative cancer showed a highly significant improvement in survival with psychotherapy (30 months survival vs 9 months with no psychotherapy).

Keep It Clean
An important clue about the cause and treatment of urinary infection in children is the identification of colony forming bacteria in the child’s urine. It has been thought that collecting the urine starting a few seconds after the child starts urinating would reduce the bacterial contamination from the skin surrounding the penis or labia. To test this, mid-stream urine samples were collected from 350 children seen in an ER for a urinary tract infection. About half the children had the skin around the end of their penises or around their labia wiped with gauze and liquid soap. This group was more than three times more likely to provide a urine sample that accurately identified the cause of a urinary tract infection than was the group that had not been cleaned.

Needed: A PhD Program in Patienthood
A doctor tells a patient that he can choose one of three new treatments to prevent a heart attack. All three treatments were studied over a five year period. It was found that 13 patients had to be receive the first treatment to prevent one heart attack. The second treatment postponed a heart attack for 8 months for a quarter of the patients, but had no benefit for the rest. The third treatment postponed a heart attack for the average patient for 2 months. Which one should the patient choose?

Wait a minute, what did doctor say??? You’re not alone. A third to a half of 3,000 adults given these choices had trouble understanding and comparing the benefits of the treatments. It turns out that this was a hypothetical treatment study, and the three outcomes are equivalent - that is, there is no statistical difference between them. Still, 93% of subjects chose treatment number one, 82% chose number two, and only 69% chose number three. The difference was largely attributed to the fact that the more the subjects understood the statistics of the benefit, the more likely they were to accept the treatment.

Brief Notes
Estrogen and Heart DiseaseHealthy women between 50 and 59 who took estrogen alone were found to have no increase in coronary heart disease and significantly lower levels of coronary artery calcium than those who took placebo.

Vitamins Again
A study of over 8,000 women failed to show an overall benefit from taking Vitamin C, vitamin E, or beta carotene for prevention of heart problems. These are all anti-oxidant vitamins heavily advertised as conferring a cardiovascular benefit.

Bumper Pads
Over a recent twenty year period, there were 27 infant deaths related to the use of bumpers or pads in infant cribs or bassinets. Even the very low risk of strangulation or suffocation greatly outweighs the potential benefit of using the pads to reduce the incidence of minor bruises.

Asthma That Does Not Respond to Treatment
Occasionally difficulty breathing is misdiagnosed as asthma when it is actually due to the vocal cords pulling towards each other, rather than separating, during heavy breathing following exercise. If conventional treatment for asthma is not working, this condition should be considered.