July 17th, 2007 by Dr. Val Jones in Uncategorized
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Just because a drug is new, doesn’t mean it’s more
effective. A recent
article published in the Annals of Internal Medicine demonstrated that older
diabetes medications may be equally effective as some of the newer, more
expensive drugs.
Now this comes as no surprise to physicians, who know very
well that some of our “old standby” meds work just as well as their newer, more
expensive versions.
For example:
For mild to moderate acne treatment, good old Clearasil may be all you need.
A study
published in the Lancet found that over-the-counter topical treatments (benzoyl
peroxide based) worked just as well as more expensive new oral antibiotics
(including minocycline).
For mild to moderately elevated cholesterol, there doesn’t appear to be much
advantage to taking a newer statin than on older one. The cost difference may be as much as ten
times more, for small gains (if any).
For example, mevacor (lovastatin) is as inexpensive as 0.24 cents/pill
while lipitor (atorvastatin) can run up to $2.54/pill.
Dr.
Charlie Smith, former president of the American Board of Family Practice,
recommends these very cost effective medications to his patients as needed:
Hydrochlorothiazide for hypertension (from 8 cents to 20 cents/pill)
Bactrim (trimethoprim/sulfamethoxisole) for urinary tract infections (15
cents/pill).
Ibuprofen for pain relief/arthritis (about 7 cents/pill).
So consumer beware – those medications that you see in all the TV ads may not actually provide substantial benefits over older, less expensive drugs. Be sure
to ask your doctor if a less expensive medication might be appropriate for you… or
better yet, healthy lifestyle changes can sometimes make the difference between needing
a medication and not needing it at all.
*Drug prices may vary.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 15th, 2007 by Dr. Val Jones in News
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I read an interesting series of articles about improving nutritional status in the US and Britain. First, the New York Times reports that trendy Manhattan bars are offering vitamin-fortified cocktails – fresh, organic fruits and/or veggies are muddled with vodka martinis to create a “healthy” alternative to your typical beverages. I’m skeptical – given the volume of fruits and veggies recommended for a healthy diet, you’d have to drink a whole lot of vodka martinis to get the vitamins you need in a day. Probably better to go for a fruit salad.
The British are still debating the utility of a “fat tax” as a way to discourage people from eating food high in refined sugar, flour or unhealthy oils. So far the government’s position is that taxing non-nutritive food is too controlling (creates a “nanny state”), and that people will just find an unhealthy alternative to the taxed foods. Interestingly, some research suggests that if all unhealthy foods were taxed, and healthy foods were made less expensive, thousands of heart attacks and obesity-related conditions might be avoided each year. However, this study has been received with much skepticism.
And a new British study also showed a surprising similarity between middle class and lower income eating habits. Both groups ate equally poorly, though the lower income group was more likely to smoke and engage in less physical activity. The similar eating habits came as a surprise, as it had been incorrectly assumed that the lower income group had a substantially poorer diet.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 14th, 2007 by Dr. Val Jones in True Stories
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This story is from my intern year diary. It’s a quick snapshot of a patient who had overdosed on heroine, coded, and was resuscitated. I think about him sometimes… especially when I read about the rampant drug abuse problem in the US.
—————
I poked my head into the 4-bed communal room on the sixth
floor. The nurse had called to say that
one of the patients was agitated and required restraints. I was asked to assess the situation.
It was immediately clear to me which of the four patients required
my attention. In the far, right corner
was a pale young man, stark naked and thrashing about in his bed. He was babbling something about Ireland and how
he needed to get home. I had gathered
from a quick review of his chart that he had overdosed on heroine, was
resuscitated after coding in the E.R. and transferred to the floor for
observation as he detoxed from the overdose.
I approached the flailing body tentatively. “Hello.
I’m Dr. Jones. You appear to
be quite distressed. What seems to be
the matter?” I said as I pulled a sheet up from the bottom of his bed and
placed it over his genitals.
The young man, barely in his twenties, lay very still as I
spoke to him. He stared at my face with
bulging eyes, speechless for a full 10 seconds.
“Are you alright?” I asked.
“Where am I?” asked the man in a quiet voice.
“Where do you think you are?” I asked, using the opportunity
to assess his mental status.
“I’m somewhere in Ireland,” he said, head turned
towards the window with a view of the Chrysler building.
Seeing that his reasoning was not intact, I replied kindly,
“Well, actually you’re in a hospital in New
York City. You
took an overdose of heroine and your heart stopped…”
“Wow, that sucks,” said the man, sincerely surprised by the
news.
“We were able to resuscitate you in the emergency room,” I
added.
“Cool,” he said, as if the event had transpired in another
person’s life.
“So right now you still have a lot of drugs in your system
which is why you feel confused,” I said, “I think it will take several days
until you return to your normal state of health.”
“Sounds good,” nodded the man.
“Do you know where you are right now?” I asked, suspecting
that his short-term memory had been completely lost.
“I’m in Amsterdam,”
he said, undisturbed by his delirium.
I sighed as I realized that nothing I said to him would
register for longer than a second or two.
“Such a young person, what a waste,” I thought.
The man started to thrash about in his bed again.
“What are you doing?” I asked.
“The back stroke,” he said, surprised that I didn’t know.
I glanced at the man in the bed nearby. He was watching our interaction with some
amusement. He had been reading the New
York Times with a book light. He was a
private patient on a heparin drip for a deep venous thrombosis behind his right
knee. I nodded at him and shook my
head.
Weeks later I heard that the young man’s thoughts were no clearer than they were that night, and that he was transferred to a nursing home for long term care. The brain damage that he suffered from his drug use (and lack of oxygen during his cardiac arrest) had caused permanent, irreparable damage. Another tragic victim of a brain on drugs.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 12th, 2007 by Dr. Val Jones in News
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The New England Journal of Medicine published a letter to the editor about a man who was struck by lightning while wearing his iPod. He was jogging home in a thunderstorm, listening to some energy-boosting music when -whammo- the poor Canadian man got more than he bargained for on the energy front. A nearby tree was struck by a lightning bolt, and the side flash reached him, and followed the wiring to his ear buds. The electrical shock passed from one ear bud to the other, blowing out his ear drums and causing such a violent contraction of all his facial muscles that his jaw snapped under the tension.
So this begs the question: could this happen to you? Does carrying a cell phone or iPod put people at higher risk for being struck by lightning?
Well, because lightning strikes are exceedingly rare there are very few case reports in the literature about folks who have been struck while talking on their cell phone or carrying an electronic device. And best I can tell, this is the bottom line: carrying a cell phone or iPod does not increase your chance of being struck by lightning (there is not enough metal in those items to act as a lightning rod). The lightning is more likely to strike a nearby tree or tall object than it will a human. However – if you are struck (such as the man described above) any metal objects (even ions found in your sweat) that you are in contact with can influence the direction of the current. Normally, lightning passes over the skin externally, but if you are wet or have metal in your ears, it can direct the electricity internally, where it can do more damage.
So if you’re caught in a lightning storm, I’d consider keeping metal out of direct contact with your skin. But the chance of you being struck by lightning in your lifetime is almost one in a million, so I think there is little cause for general alarm. Or to use a bad pun: we can all lighten up about lightning risks.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 11th, 2007 by Dr. Val Jones in Medical Art
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Nikon’s 33rd Annual Small World Photomicrography
Competition is a must-see. The top 100 photos of microscopic life forms, cells, and chemicals are on display – and you can vote for your favorites. There will be a special “people’s choice” award based on your votes. These photos are truly awe inspiring and make you think about the amazing complexity of the invisible world all around us. Enjoy!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
