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Are The Benefits Of Smoking Cessation Eclipsed By Obesity?

Epidemic by Tobyotter via Flickr and a Creative Commons license

Obesity is filling in for smoking as a cause of death in working class women, concluded researchers after reviewing mortality rates from a nearly 30-year study in Scotland.

In Europe, wealthier people either aren’t starting to smoke or are finding it easier to quit, which accounts for up to 85% of the observed differences in mortality between population groups, researchers noted.

Their analysis showed higher rates of being overweight or obese among those who’d never smoked in all occupational classes, with the highest rates in women from lower occupational classes. Almost 70% of the women in the lower occupational classes who had never smoked were overweight or obese, and severe obesity was seven times more prevalent than among smokers in higher social positions. Among women who had never smoked, lower social position was associated with higher mortality rates from cardiovascular disease but not cancer.

To investigate the relations between causes of death, social position and obesity in women who had never smoked, Scottish researchers conducted a prospective cohort study. They drew from the Renfrew and Paisley Study, a long term prospective community based cohort named for two neighboring towns in west central Scotland from which all residents then aged between 45 and 64 were invited to participate from 1972 to 1976.

Researchers reported their results online Read more »

*This blog post was originally published at ACP Internist*

Counter-Intuitive Results: Several Cancer Screening Tests Don’t Improve Health Outcomes

Nearly forty years ago, President Richard Nixon famously declared a “War on Cancer” by signing the National Cancer Act of 1971. Like the Manhattan Project, the Apollo program that was then landing men on the Moon, and the ongoing (and eventually successful) World Health Organization-led initiative to eradicate smallpox from the face of the Earth, the “War on Cancer” was envisioned as a massive, all-out research and treatment effort. We would bomb cancer into submission with powerful regimens of chemotherapy, experts promised, or, failing that, we would invest in early detection of cancers so that they could be more easily cured at earlier stages.

It was in the spirit of the latter that the National Cancer Institute launched the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening trial in 1992. This massive study, which eventually enrolled more than 150,000 men and women between age 55 and 74, was designed to test the widespread belief that screening and early detection of the most common cancers could improve morbidity and mortality in the long term. Not a few influential voices suggested that the many millions of dollars invested in running the trial might be better spent on programs to increase the use of these obviously-effective tests in clinical practice.

They were wrong. As of now, the PLCO study is 0-for-2. Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Medical School: Teaching Doctors About Patient Safety

Ten years after the release of the IOM report To Err is Human, which documented the toll taken by medical errors in this country, the question remains: What can be done to reverse the trend of ever-increasing morbidity and mortality due to medical errors?  Last December, a look back over the decade since the release of To Err is Human — and a steady medical error death rate of about 100,000 per year included a series of suggestions for tweaks to the health care delivery system that may help ameliorate the situation.  Earlier this week, a gadget that enforces good handwashing technique by sniffing caregiver and clinician hands for soap before a hospital patient may be touched has been touted as potentially saving significant costs related to HAIs.

Today, the Lucian Leape Institute released a report titled Unmet Needs: Teaching Physicians to Provide Safe Patient Care which focuses on moving back the point in time where an intervention is needed to reverse the trend documented in To Err is Human and since.  Leape and his colleagues at the National Patient Safety Foundation are now focused on reinventing the medical school curriculum, so that patient safety will be taught more effectively in medical schools. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

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Latest Book Reviews

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When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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