Year in Review

calendarIt’s time once again for Baskin Clinic’s annual Medical Year in Review, where we bring you developments in medicine and science that have either escaped the popular press, or deserve deeper scrutiny than most sound-bite shows offer.

You’ll notice a number of topics involve research that reexamines widely-accepted practices or beliefs.

At Baskin Clinic we welcome questions (both from our patients and our colleagues) that challenge the status quo. This constant re-evaluation of what we do, and why we do it, is a big part of our core principles: “Participate, Communicate, Educate.” Read on….

1. No more fasting for cholesterol tests. This longstanding practice was debunked in several excellent studies over the past three years, but only recently gained popularity in the clinic. Even the federal government — not known for its culture of change — has adopted the guideline of not requiring patients to fast. The end result is far more efficient (and just as accurate!). Now patients can combine their lab draw and physical exam at any time of day, without going hours without food.

2. Calcium and vitamin D have no value in the prevention or treatment of osteoporosis. This one was difficult even for us to absorb, especially since it goes against the guidance of several advisory groups.

First, some definitions. Osteoporosis is the medical term for fragile bones caused by structural thinning. Osteoporosis contributes to fractures, which are a major cause of death and disability in older patients.

That supplemental calcium and vitamin D could help reinforce weak bones seems highly plausible, and goes something like this. Bones are made of calcium compounds. Vitamin D helps the body absorb calcium. Taking supplemental amounts of these raw materials should help grow more bone, right?

But sometimes even perfectly reasonable theories turn out to be wrong, as was discovered with the failure of the homocysteine trials at the turn of the millennium. The few studies that have examined supplemental calcium and vitamin D have shown no reduction in fracture risk. And just because recommendations come from an official source, doesn’t always mean they have been well-researched.

Bottom line: supplementing your diet with additional calcium and vitamin D is probably doing little more than enriching the vitamin industry (and raising your risk for kidney stones and heart disease).

3. We disagree with the growing criticism of the annual physical exam. Even The New York Times joined the chorus, publishing an opinion piece by the former White House Special Advisor for Health Policy Ezekiel Emanuel. Dr. Emanuel writes that he’s skipping his annual physical, but will continue to get his evidence-based treatments like annual flu shots and periodic colonoscopy.

That’s easy for him to say, because as a medical professional, Dr. Emanuel knows which treatments are recommended at what ages — something the general public is not always aware of. (Do most lay people know that there now are two recommended vaccines for pneumonia?)

Emanuel argues that the annual exam encourages needless testing on asymptomatic persons — and is therefore a worthless exercise. We’ll concede this point. As a result, you won’t find any routine EKGs or stress tests at a Baskin Clinic annual exam. What you will find (and what Dr. Emanuel overlooks) is the real value of the annual visit: a thorough review of your health goals and health status (including a full review of systems, immunizations, blood pressure and weight).

4. Speaking of blood pressure, what is the ideal goal for patients? The SPRINT trial, a study of over 9,000 middle-aged patients with one or more risk factors for cardiovascular disease, has touched off a lively debate in the medical community about how low is too low in blood pressure control.

True, participants in the experimental arm (BP 120/80 or less) had fewer cardiovascular events — mainly in the categories of heart attack and heart failure — but had higher rates of serious adverse events (faints, low blood pressure, electrolyte abnormalities, or falls). In fact, only 45 people would have to be treated to a lower blood pressure to cause one serious adverse event.

Our take: for the right patient, it’s a reasonable approach, but with caveats. Additionally, there are contradictory data in the ACCORD trial, which studied similar blood pressure goals in diabetics (and found no benefit). Tough to reconcile all this in a tweet, but that didn’t stop thousands from trying. Thanks #SPRINT!

5. In addition to the existing pneumovax, or PPSV-23, there’s a new pneumonia shot recommended for those over age 65. Called the PCV-13, it protects against an additional (you guessed it) 13 strains of pneumonia-causing bacteria. It’s recommended to receive the PCV-13 first, followed eight months later by the PPSV-23. Already had the PPSV-23? Just wait a year before getting the PCV-13. Confused? Scroll down to the graphic at the bottom of this link.

6. Those intestinal bacteria continue to amaze. The gut microbiome is now implicated in the efficacy of certain cancer treatments utilizing the body’s own immune cells (so-called immunotherapy). In two separate papers published just last month in Science magazine, gut bacteria played essential roles in whether or not these treatments were successful. The next logical question: could probiotics someday become a routine therapy for cancer?

7. And we’d be remiss if we did not mention the most pressing health event for the future: global warming. While the topic has received plenty of press since the Paris Climate Change Accord was signed, we’re still amazed that critical issues like groundwater depletion and shrinking snowfalls are receiving only scant coverage. Let’s face it: many organisms can live without oxygen; none can live without water. We’re going to have to get a lot more creative with how we use the fresh water we have left.

8. Lest we leave you feeling depressed, here’s one to rejoice: we may be witnessing a new generation of healthier Americans. The latest tables from the aptly titled Health, United States, 2014 (just published in May, 2015) show that for U.S. children ages 2-5, obesity rates dropped from 12.5% to 10.2% of children measured. Nice work America!

Have a healthy and happy New Year from your friends at Baskin Clinic. Please let us know if we can be doing anything differently for you in 2016.

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