Saturday, August 31, 2013
My desk looks like the dog arranged it. She suspects that there’s food somewhere in that mess, but it’s mostly scientific stuff that’s hard to chew on.
I sort through everything from The New England Journal of Medicine to The New York Times, Consumer Reports and slick brochures that are pitching a cancer center or the latest gizmo the center is promoting.
I find that deciding what to focus on for a twice-a-month feature is challenging. My new approach will be to alternate between a single subject and highlights that jump up from my desktop.
If you want to delve deeper, I’m larrymulkerin, author, on Facebook. I exchange ideas there and look for ideas to include in the U-B. I can answer email requests, but generally don’t have the time. Sorry.
The U-B is pretty willing to print your opinions. I can’t speak for the editor, but you know what I mean. Starting an exchange there is sometimes a stimulating experience.
- As a child, I had my tonsils removed by a shaky-handed GP.
In those days, a few episodes of ear infections provided a sufficient reason to remove tonsils and adenoids.
Touch your neck beneath the jawbone, very lightly. That pulsation is your carotid artery and it is very close to a child’s tonsils. Death from tonsillectomy is very infrequent these days. Mortality may be one in thousands.
Lesser complications are more common. Doctors have limited the number of reasons to remove tonsils. About 75 percent of removals are done for trouble breathing at night, obstructive sleep apnea.
The results of a 464 patient trial were reported in the June 20 NEJM. The results were disappointing.
- Taking a statin drug?
The journal Circulation reported a meta-analysis of 135 reports on complications.
Be careful, a meta-analysis attempts to weigh the value of journal articles and determine how the data averages out. The risk of muscle and joint complications, as well as an adverse effect on mental function are hard to assess. An increased risk of diabetes has been reported to be one in 250 users.
The general recommendation is that statins save lives and the risk is relatively small. Simvistatin and pravastatin are suggested to have the best safety profile.
This new meta-analysis of statins is reassuring. Talk with your doctor about monitoring for problems.
- Do CT scans cause cancer?
The July 13 issue of Scientific American takes on the question.
This is not a peer-reviewed journal, but the discussion fits with my understanding of the facts.
CT scans give higher doses of radiation than routine radiographs. The use of CTs is tapering off and newer machines use lower doses. The use of atomic bomb exposure is questionably valuable in quantifying risks from X-ray equipment. We simply don’t know what very low doses of photon radiation might do.
For a long time, people went into radium mines to get health benefits. I’d call that a bad idea.
For a long time, the rule for the radiology community has been the ALARA rule. “As Low As Reasonably Achievable” still makes sense.
- Can low-dose screening decrease the risk of lung cancer deaths?
A NEJM article published July 18 indicates the answer is yes, but with caution. It appears that one life can be saved for every 161 scans, but only in the high-risk group. Be aware that false positives mean unnecessary procedures.
My suggestions are to stop smoking and develop a relationship with your grandkids that allows you to influence them, if only a little.
- Do lifestyle changes reduce serious outcomes in diabetes?
Another NEJM article showed no decrease in cardiovascular problems in a study that focused on weight loss.
An editorial in the July 11 edition challenges the conclusions without suggesting they are clearly wrong.
My recent articles in the U-B have considered the possibly that the more important concern is dietary sugar. L-carnitine also looks like a worrisome chemical.
Weight loss, alone, may have many benefits, but not mainly on cardiovascular health.
- The journal Science reports on the subject of increasing numbers of earthquakes, related to the things we inject into the earth.
Pressures can weaken fault lines. The effects of fracking have caused some relatively small quakes. Wastewater disposal injections were probably a factor in an Oklahoma quake that destroyed 14 houses. Larger volumes of fluids seem to increase risk.
Monitoring for seismic activity may detect some impending events, but it isn’t clear that it will detect small tremors that could lead to larger ones.
- Injection of Radium-223 was shown to increase survival of prostate cancer patients who have bone metastases that are not responsive to hormonal treatments.
The difference between a median of 14 months and 11.2 months seems better than what might be expected from other approaches. The study was done against a placebo.
The research was industry supported and published July 18 in NEJM. It will be interesting to see the study repeated against best alternative therapy, to report on quality of life and to find out what a series of Radium-223 costs.
Next time: Why we age and what, if anything, we can do to bend the curve.
Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at firstname.lastname@example.org.