August 2010

Medical Intelligence
A Periodic Review of Selected Medical Research
by Marc D. Schwartz, MD
MarcDSchwartzMD@GMail.com

Penny (and in some cases) -Life Savers

1. Lower Your Homocysteine Levels with Folic Acid and B12? Not.
Higher blood levels of homocysteine are clearly associated with a higher risk of cardiovascular disease. Folic acid and vitamin B12 are known to decrease the blood levels. It has therefore been very disappointing that now an eighth large scale study, this one involving 12,000 high risk patients, showed absolutely no benefit for cardiovascular disease or cancer from taking them.

2. Take Glucosamine for Low Back Pain and Lumber Osteoarthritis? Not.
Two hundred and fifty patients mean age 29 took either placebo or glucoamine for low back pain or lumbar osteoarthritis of at least 6 months duration. The groups did not differ on any outcome at 6 months or 1 year.

3. For diabetics: Carry out intensive glycemic control and keep your blood pressure under 130. Not. (But be sure to check with your doctor before changing your regimen) In a study of 10,000 patients over a period of at least 3.5 years, both regimens were found to either have no effect or result in higher mortality. Intensive glycemic control did not reduce vision loss. Maintaining blood pressure between 130 and 140 seemed to be the most healthy approach.

4. For women at low risk for cervical cancer: Have a PAP smear every year. Not. National practice guidelines recommend repeat Pap smear testing for this group every 2 to 3 years yet more than two thirds of a thousand surveyed physicians recommended the test be done yearly for this group.


The Last You Will Ever Hear from Me about Painful Night Cramps
For those of you who have not been following this soap opera, please review the past few issues for a catch-up. The characters in the previous episodes who took magnesium citrate tablets for relief found that its benefits (placebo) wore off in a few days to a few weeks. Desperate, veering even further off the path suggested by the name of this series (Medical Intelligence), one tried calcium carbonate, various vitamins, and glasses of water at bed time. Things got so bad that one character (who will remain nameless but was not the Editor) tried a cure widely recommended on the Internet, a bar of soap under the bedsheets, but to no avail. What finally seemed to work (for at least three weeks anyway) is the following: while lying on one's back in bed at before going to sleep, stretch your legs out straight. Then flex your ankle as far up as you can (really feeling the stretch in the calf muscle) for the count of eight. Then relax for about 15 seconds. Repeat x 3. Don't call me in the morning.

Some Reasons Why Medical Incompetence or Impairment May Go Unreported
Only a third of doctors with direct personal knowledge of an impaired or incompetent colleague in the prior three years had reported that colleague to the medical authorities. The most common reasons given were "thought someone was taking care of the problem, believed that nothing would come of the report, and fear of retribution."

The information above is for educational purposes only.
For advice about your personal medical care, consult with your care provider.