2017 was a year that saw guidelines in flux, with some being strengthened and others toppled altogether. We witnessed the continuing fallout from practices that produced tragically unintended consequences. And we saw artificial intelligence enter the medical field like never before — producing some amazing successes and some humorous failures.
First, a bit of health advice for 2018 — get your flu shot! With this year shaping up to be one of the worst in recent memory (largely due to the predominance of strain A/H3N2), it’s even more important to get vaccinated. Getting a flu shot is the best (and really only) way to prevent flu. Since 2010, annual flu deaths have ranged between 12,000 and 56,000 persons — around the same number as die annually from car accidents. And tamiflu? Despite the CDC recommendations, it shortens flu by only a day, with significant side effects of nausea, vomiting and headache. In fact, the World Health Organization recently downgraded the medication from beneficial to complementary.
We first reported on the lack of benefit of calcium and vitamin D supplements for fracture prevention in older adults back in our 2015 summary. A new meta-analysis in the Journal of the American Medical Association adds further support to the recommendation that we should get our nutrients from our diet, not a pill. The study showed calcium and vitamin D supplements have no role in fracture prevention, even in patients with existing vitamin D deficiency or prior fractures. The US Preventive Services Task Force agrees on the lack of evidence supporting these supplements for women and men.
High Blood Pressure
High blood pressure continues to garner significant news coverage, and for good reason. The vast majority of us (80-90 percent, depending on your ethnic origin) will receive a diagnosis of hypertension in our lifetimes. And high blood pressure brings with it increased risks for heart attack and stroke, by far the largest combined cause of death in this country. The big news came from the SPRINT study, which showed that in higher-risk individuals (those with a 10-year risk for a cardiac event exceeding 15 percent), controlling blood pressure to less than 120/80 reduced heart attack and strokes. It’s a great paper, but realize that its results only apply to a small subsection of the population. For the rest of us, it’s a bit of a gamble to follow these guidelines, as significant side effects were twice as common — nearly 1 in 20. And who wants to take more medication unless there’s a proven benefit?
The Weather and Your Health
Despite the rarity of a white Christmas in Portland, our weather is changing in ways that will have negative health consequences. Northwest summers are becoming drier and hotter, and that means a longer fire season with larger conflagrations (and more smoke in the air). Not to mention the human costs of higher temperatures in disease, crop failures and water shortages. Take a look at this series of reports from The Lancet and learn more about what warmer temperatures will mean for human health.
The opioid epidemic shows no sign of abating despite new limits on prescribing. We doctors created this mess, and we’ve been very slow to educate the public and clean up our own act. Not until 2012 did opioid prescribing rates start to fall, and while this year saw the lowest numbers since 2006, prescription opioids are still the culprit in more than 40% of all opioid overdose deaths. And sadly, overdoses hit a record number in 2016, killing more than 42,000 Americans. Make no mistake: opioid misuse, like all forms of addiction, crosses all racial, gender, economic, social, and cultural boundaries, (and our patient population at the clinic is no different).
More than half of US adults have looked online for health information in the past year. But are Siri and Google voice assistants up to the challenge of answering our most pressing questions about sex? Alas, even in the internet age it’s still better to type those queries rather than ask them out loud. This playful list of sex questions posed to Apple and Google voice systems (Where were you, Alexa?) resulted in some hilariously odd results. Siri was as vague as a 1950’s TV show in response to “Show me pictures of how people have sex,” displaying pictures of sex with aliens, men wrestling, and people kissing. Siri also fielded questions on menopause by directing the user to Menopause the Musical, currently enjoying its 16th year in production from coast-to-coast.
AI and Skin Cancer Detection
Lest we laugh too hard at our hapless voice assistants, researchers at Stanford built a deep neural network algorithm and trained it with nearly 130,000 clinical images of skin cancer, then tested it against board-certified dermatologists to see who was more accurate. The results were astonishing; the computer matched the performance of the human specialists across both melanoma and non-melanoma skin cancers, correctly identifying malignancies while dismissing the benign lesions. It’s not difficult to envision this algorithm deployed in conjunction with smartphone cameras to diagnose skin cancers in the field, or specialized booths with arrays of cameras to perform an entire body scan, all without ever seeing a human physician.
The benefits of angioplasty, that most profitable and satisfying of medical procedures, was called into question. Who wouldn’t want their clogged artery opened with a balloon and a stent? It makes so much sense! Researchers enrolled 230 patients with stable angina and severe (>70% blockage) of a single coronary vessel. Those patients were then randomized to receive angioplasty (with or without stent), or placebo (a sham procedure designed to mimic the process of angioplasty). The results showed no difference between the two treatment groups in terms of exercise capacity of participants. Whether the medical-industrial complex will incorporate these results into practice remains to be seen.
Happy and healthy New Year to our patients and friends. We appreciate your trust in us and look forward to working with you toward better health for the coming year.