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Latest Posts

Cranberry Juice For Urinary Tract Infections? Evidence Is Still Lacking

It always somewhat surprises me how some interventions never seem to die. One therapy that refuses to be put to rest, or even to be clarified, is the use of cranberry juice for urinary tract infections (UTIs). PubMed references go back to 1962, and there are over 100 references. Firm conclusions are still lacking.

There is a reasonable, but incomplete, basic science behind the use of the cranberry juice for UTIs. E. coli , the most common cause of UTIs, causes infection in the bladder by binding to the uroepithelial cells. To do this, they make  fimbriae,  proteinaceous fibers on the bacterial cell wall. Fimbriae are adhesins that attach to specific sugar based receptors on uroepithelial cells. Think Velcro. Being able to stick to cells is an important virulence factor for bacteria, but not a critical one — it is not the sine qua non of bladder infections.

Are all E. coli causing UTIs fimbriated? No. It is the minority of E. coli that cause UTI that have fimbria, and the presence of fimbriae may be more important for the development of pyelonephritis (kidney infection) than cystitis (bladder infection). Read more »

*This blog post was originally published at Science-Based Medicine*

Prevention Magazine Pushes Non-Evidence-Based Heart Screening

Prev. mag pullout.jpgThe February issue of Prevention magazine has an article entitled “Surprising Faces of Heart Attack” profiling “three women (who) didn’t think they were at high risk. Their stories are proof that you could be in danger without even knowing it.” No, their stories are not proof of that.

The story is about three women in their 40s. The story varyingly states that the three should have had the following screening tests:

– Advanced cholesterol test, carotid intimal medial thickness test ( CIMT)
– Advanced cholesterol test and stress echocardiography
– Cardiac calcium scoring and CIMT

 There’s an accompanying piece: ”7 Tests You’re Not Having That Could Save Your Life.”

Harry Demonaco photo.jpgI asked one of our medical editors, Harold Demonaco, director of the Innovation Support Center at the Massachusetts General Hospital, to review the two pieces. As his day-job title suggests, he deals with review of the evidence for new and emerging healthcare technologies. He wrote: 

The section “7 Tests you are not having that could save your life” states: “If you have not had these cutting edge screenings, put this magazine down and call your doctor. Now.”

Wow. While much of the information is correct, it is the context that is disturbing. Suggesting that these tests are essential in everyone is a bit over the top. Some of the information provided for each test is basically correct. However in some cases the recommendations go well beyond national guidelines.

The major issue here is the tacit assumption that tests are infallible, without any downsides and are always a good thing. That is simply not the case. So who should get these tests? Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

HRT: No Wonder Women Are Confused

Confused about hormone replacement therapy (HRT)? I can’t imagine why…

*This blog post was originally published at tbtam*

Doctors, Voicing Concerns, And Fear Of Retaliation

Shouldn’t it be possible to voice a concern about a medical treatment, procedure, or claim without the fear of retaliation? If the claims are backed by science, then simply addressing my concerns would be enough.

Fear of retaliation silences discussion. Fear of retaliation makes it difficult to do the “right thing” when the public or an individual patient is at risk.

This incidence involves a British plastic surgeon threatened with libel action by the ‘Boob Job’ cream’s manufacturer after she voiced concerns/doubts of its effectiveness. Sense About Science has a great summary of the entire affair: ”Plastic surgeon threatened for comment on ‘Boob Job’ cream.” Read more »

*This blog post was originally published at Suture for a Living*

Coffee Grounds To Combat Cellulite?

Coffee groundsLast week a popular TV talk show featuring a bunch of doctors (I’m not naming names) discussed how coffee grounds can improve cellulite. They explained how rubbing coffee grounds into your skin imparts caffeine into the cellulite thereby improving the circulation and drawing the toxins out.

This is a great tip, except that rubbing coffee grounds on your skin does not impart any caffeine into it, and there are no toxins in cellulite.

Cellulite is a normal secondary sex characteristic of women. It is the result of thin connective tissue in women’s skin. Massaging the cellulite (with coffee, tea, grapes, cream cheese, or chocolate frosting) pushes the fat back into the skin, temporarly improving the appearance. There is no science behind using coffee to treat this normal condition.

Scientific studies have shown, however, that carrying a wet coffee filter filled with grounds into your bathroom will burn more calories, because you’ll spend 20 minutes later cleaning up the mess in your shower.

*This blog post was originally published at The Dermatology Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

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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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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