Monday, December 22, 2003

My Take on This Year's Flu Season 

Headline should read: Flu Season Early This Year.

That's it. That's the whole story.

Why do we have to explain influenza every year? Every season it's the same articles in the paper. Doesn't anyone remember the principles?

This year is unique only because of the hype.
For those Peter Senge (the theory and practice of the learning organization and Amazon.com: Books: The Fifth Discipline) fans each flu season is The Beer Game all over again.

Next year vaccine demand will remain high.
Subsequent years will have declining demand.
After some mild flu years we will again experience a year with antigen drift/shift and the cycle will repeat.

Wednesday, December 17, 2003

Medical Meme #2 Pseudoephedrine and Hypertension 

This comes up a lot. OK to take or not OK?
I went to OVID and found little in the way of new information.
At least a few years ago, somebody (Journal of Family Practice. 40(1):22-6, 1995 Jan) did get around to measuring the effect.

The conclusion was: "At standard doses, pseudoephedrine has no significant effect on systolic or diastolic blood pressure in patients with controlled hypertension".

What about uncontrolled HTN? The answer isn't so clear.

Remember, bad medical information is an infection and we're the vector.

Thursday, December 11, 2003

JAMA Thoughts #1 

I'm reading the 12/3/03 issue over lunch. This is what I'm thinking about each contribution:
1. The first article is comparing calcium blocker (Verapamil) therapy against non-calcium drugs. My initial take is: "seems important since I've used a lot less calcium agents even before and especially after ALLHAT". I'm OK with the data but wonder if another trial that showed no difference would get the same emphasis. Studies that don't show a change in outcomes tend to be minimized. I suspect this is an important issue for the proprietary drugs (i.e. non-thiazide and non-beta blocker). Also, the section on financial disclosures, funding/support, and role of sponsor raise validity issues in my mind. If the fonts were the same size the sections would rival the comments. Oh well, at least they put it in there.
2. The next article is about pancreas transplants. This does not seem relevant to my practice so I don't read it.
3. The third article is about the use of Echinacea for URI's. While I'm not surprised the intervention doesn't work when subjected to a randomized controlled trial (RCT) I doubt it will change many minds. At least I can my patients that ask, somebody finally measured it.
4. Article number four is about Hodgkin's survivors. Once again, not important to me today so I skip it.
5. Next up is a study about the discussion of medical errors in morbidity and morality conferences. The results match my experience over time. Typically the discussion is about the various benefits and not the net effect of our interventions. The disclosure section is short and relatively untainted. Perhaps there is a message here?
6. Because the next article is about advanced colon cancer I don't read it.
7. Last up is a clinical article about pulmonary embolism. I'm OK with the importance and validity but somehow I feel it won't change my behavior. I find the diagnosis of suspected PE to remain problematic. What could be worse than a fatal disease that is often asymptomatic? By the way, no disclosure issues here. Like Deep Throat says...."Follow the money".

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