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The Good Intentions of Men’s Health Week Promotion

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This week has been proclaimed International Men’s Health Week – the week leading up to and including Father’s Day. And it’s part of what’s more broadly been proclaimed by some as Men’s Health Month.

The campaign offers a variety of men’s health “materials” – including the squeezy prostate stress ball pictured at left – if you’re into that kind of thing.

There are also brochures like the one below.  The “Facts About Prostate Cancer” state that men at high risk should begin yearly screening at age 40 – all others at age 50. The “should begin (at 50)” recommendation crosses a line not supported by the US Preventive Services Task Force and the American Cancer Society, among other organizations.

The campaign also commits fear-mongering with these statistics: Read more »

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

Nearly 12 Million Cancer Survivors In The U.S.

The number of cancer survivors in the United States increased to 11.7 million in 2007, according to a report released by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), part of the National Institutes of Health (NIH). Women survive more often, and survive longer, according to the report.

There were 3 million cancer survivors in 1971 and 9.8 million in 2001. Researchers attributed longer survival to a growing aging population, early detection, improved diagnostic methods, more effective treatment and improved clinical follow-up after treatment.

The study, “Cancer Survivors in the United States, 2007,” is published today in the CDC’s Morbidity and Mortality Weekly Report.

To determine the number of survivors, the authors analyzed the number of new cases and follow-up data from NCI’s Surveillance, Epidemiology and End Results Program between 1971 and 2007. Population data from the 2006 and 2007 Census were also included. The researchers estimated the number of persons ever diagnosed with cancer (other than non-melanoma skin cancer) who were alive on Jan. 1, 2007. Read more »

*This blog post was originally published at ACP Internist*

Behavior Vs. Disease: A New Way To Look At Health

What is the leading cause of death in the United States? Heart disease? Cancer? No, it’s smoking. Smoking? Yes, depending on how you ask the question.

In the early 90s, McGinnis and Foege turned the age-old question of what people die of on its head by asking not what diseases people die of but rather what the causes of these are. Instead of chalking up the death of an older man to say lung cancer, they sought to understand the proximate cause of death, which in the case of lung cancer is largely smoking. Using published data, the researchers performed a simple but profound calculation — they multiplied the mortality rates of leading diseases by the cause-attributable fraction, that proportion of a disease that can be attributed to a particular cause (for example, in lung cancer 90 percent of deaths in men and 80 percent of deaths in women are attributable to smoking). Published in JAMA in 1993, their landmark study became a call to action for the public health community.

When looked at the conventional way, using data from the 2004 update of the original study, heart disease, cancer, and stroke are the leading causes of death, respectively. This accounting may help us understand the nation’s burden of illness, but does little to tell us how to prevent these diseases and improve health. Through the lens of McGinnis and Foege we get the actual causes of death (e.g., the major external modifiable factors that contribute to death). This analysis shows that the number one cause of death in America is tobacco use, followed closely by poor diet and lack of physical activity, and then alcohol consumption. Read more »

*This blog post was originally published at BeyondApples.Org*

What Is A “Complete” Physical?

A reader requests:

Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last three doctors I went to, I realized they didn’t bring up my immunization records. Is this usually left for the patients to bring up on their own?

Good question. What exactly is a physical? Does it include blood work? What about an EKG? And a cardiac stress test? Is an “executive physical” an orgy of “more is better,” previously paid lavishly, really better than a “camp physical?”

Here’s the thing: There is no such thing as a “complete physical examination.” There are literally hundreds of different maneuvers and procedures that encompass various aspects of physical diagnosis. Performing every last one of these on even a single patient would not only take many hours, it would be a colossal waste of time.

A “physical” is a misnomer. The clinical portion of a medical workup is more correctly termed the “history and physical.” Of the two, everyone agrees that the history — information elicited from the patient, sometimes from family members or other medical records — is far more likely to yield useful information. It is the information gleaned from the history that guides the physical.

Knee pain? The history should include mechanism of injury, and physical exam should evaluate for McMurry, Lachman, and drawer signs, among other maneuvers. Bellyache? Need to know about associated symptoms such as nausea, vomiting, stool pattern, flatus, and the exam better include careful auscultation (listening) for bowel sounds and palpation (feeling) for masses, fluid, possible shifting dullness, plus eliciting any guarding or rebound, and probably a rectal exam looking for blood. It makes no sense to use a tuning fork for Rinne and Weber tests to evaluate different kinds of hearing loss on someone with heartburn. Likewise, evaluating the debilitating heel pain of plantar fasciitis does not require listening to the lungs. I trust you get the idea.

The question appears to be about the “routine physical” in the absence of any specific medical concern. A more accurate term for this is a “preventive service” visit, for which there are specific guidelines. Read more »

*This blog post was originally published at Musings of a Dinosaur*

What Is Secondary Prevention?

A November letter to the editor in American Family Physician chastises that publication for misusing the term “secondary prevention,” even using it in the title of an article that was actually about tertiary prevention.

I am guilty of the same sin. I had been influenced by simplistic explanations that distinguished only two kinds of prevention: Primary and secondary. I thought primary prevention was for those who didn’t yet have a disease, and secondary prevention was for those who already had the disease, to prevent recurrence or exacerbation. For example, vaccinations would be primary prevention and treatment of risk factors to prevent a second myocardial infarct would be secondary prevention.

No, there are three kinds of prevention: Primary, secondary and tertiary. Primary prevention aims to prevent disease from developing in the first place. Secondary prevention aims to detect and treat disease that has not yet become symptomatic. Tertiary prevention is directed at those who already have symptomatic disease, in an attempt to prevent further deterioration, recurrent symptoms and subsequent events.

Some have suggested a fourth kind, quaternary prevention, to describe “… the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.” Another version is “Action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.” But this is not a generally accepted category. Read more »

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

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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