While I was in Tel Aviv visiting family, five new medical journals arrived on my desk. Despite a case of major jet lag, I forced myself to read through them the weekend I came back. Immersed among the many scholarly articles were a few facts and comments that I thought I would (as briefly as possible) share with you in this week’s newsletter.
The safety of tomography (CT scans) was discussed in a section called “Perspective” in the New England Journal of Medicine. The author (from the University of California at San Francisco) calculated that the risk of cancer from a single CT scan could be as high as 1 in 80! She called for better standardization, monitoring and regulations as to how imaging equipment is used. In February 2010, the FDA did launch an initiative to reduce unnecessary medical imaging, but little has been done to implement their recommendations.
A second article in the same journal titled “The Uncritical Use of High -Tech Medical Imaging” continued an imaging critique. The authors pointed out that physicians often request imaging examinations in order to prevent future liability. We are sued if we don’t make a diagnosis but rarely are held accountable for overuse of testing. A recent survey of Massachusetts physicians showed that 28% of diagnostic imaging referrals were done as part of “defensive practice”. Moreover, the radiologists performing the imaging are often concerned about making a definitive interpretation with a single test and again, to avoid being sued, may suggest additional or follow-up CT scans. Patients expect an immediate and accurate diagnosis and often demand a scan; so excessive imaging is not entirely the fault of the physicians. The number of CT scans that are currently done is extraordinary high….we can’t all be that sick. Currently in the United States, approximately 10% of the population undergoes a CT scan every year adding up to a total of 75 million scans. (Obviously some patients receive multiple scans.) The authors also state that the use of CT continues to grow by more than 10% annually.
Everyone agrees that more has to be done to reduce the amount of radiation with each scan (it can be equal to 100 simple x-rays). Both physicians and patients should reconsider how often we have to look into our bodies to diagnose and treat a suspected or ongoing disease. The recommendations for getting a scan “just in case” or “to give the gift of good health” (the latter appears on ads for imaging centers) should be reevaluated. Non radiating tests such as ultrasound, MRI, as well as a good clinical examination and a thoughtful history can often be as helpful and less harmful to our health.
The same journal then had an article titled “Hunger and Socioeconomic Disparities in Chronic Disease.” The number of US households whose members are at risk for hunger because of an inability to afford food (food insecurity) has risen. The rate was 32% in 2008 and is higher each year. In 2008, 21% of US households with children were classified as lacking food security. Because of their inability to afford healthy food, the members of these households had to resort to buying the cheapest calorie-dense products, i.e. food with added sugar, fats and sodium. The authors pointed out that $1 can purchase either 1200 calories of cookies or potato chips or 250 calories of carrots. As a result of these more affordable and abundantly advertised products, the parents and, of course, their children risk obesity, hypertension, diabetes and other diet–sensitive chronic diseases. Confronting food insecurity and making healthful food affordable will help prevent an enormous future burden of disease. The number of children and adults who may be destined to develop chronic disease in the US as a result of an inability to afford appropriate nutrition shames all of us!
Okay, I want to review just 2 more articles…
JAMA reported that proton pump inhibitors (PPI’s) such as Prevasid, Nexium and 6 other types that are currently on the market (and I have tried just about all of them) will carry revised labeling that warn that these stomach acid reducing medications can increase patients’ risk of hip, wrist and spine fractures. The new warnings are based on 6 of 7 studies that showed a relationship between PPI use and an increase in fracture risk. Most of the patients in the studies were 50 years or older. The reason for this increase in risk is not known. Unfortunately, those of us who suffer from horrific “heartburn” (and let me take this opportunity to state that if it lasts for more than a few weeks and/or does not respond to a PPI you should have an endoscopy), there are no other terrific solutions. So if you need this type of medication, make sure you tell your physician, and she or he will probably order bone density tests.
Finally, the last article that I thought I should review dealt with the effect of glucosamine on chronic lower back pain caused by osteoarthritis (wear and thinning of the discs that separate the vertebrae). Glucosamine has been shown to help the body restore cartilage and seems to help knee and hip pain due to osteoarthritis. The current study on glucosamine’s affect on back pain was also published in JAMA. It was double blinded, randomized and placebo controlled (all the right things) and carried out in 250 Norwegian patients older than 25 who suffered from chronic back pain. (I can almost see a movies title here… “Back pain in Norway”). The patients were given 1500 mg of glucosamine or placebo for 6 months. And despite hopes that this over-the- counter product would help, there was no affect on their back pain. Twenty million individuals in the United States have chronic back pain from osteoarthritis, so this news was disappointing. I guess we’ll have to go back to Pilates and our orthopedists!