Bisphosphonates must have very interesting pharmacologic properties. You can apparently give a new bisphosphonate once yearly and get the same benefit as weekly olendronate (Fosamax). I wonder how long until we have this available in the U.S. - Once-yearly brittle bone treatment

Heartburn Drug May Be Over the Counter This is a difficult one for me. Prilosec OTC will cost $1 as opposed to $4 per pill by prescription. This is the same company - AstraZeneca - with the Nexium controversy. My patients will financially benefit - and that's the main issue.

The money advantage aside, I do have some reservations. While patients will avoid many unnecessary office visits, unfortunately they will also avoid some necessary visits. Patients aren't perfect at diagnosing heartburn. Sometimes a good history will reveal a different diagnosis (including coronary artery disease). How long will patients delay seeking medical care? Regardless this is a very interesting development which I will continue to follow. Another good story about OTC Prilosec - Nonprescription Prilosec Backed

Health care costs continue to increase. The leading offenders are prescription drug costs and insurance costs. In my opinion, our last foray into trying to decrease costs gave us Managed Care. We held the line briefly, but we no longer save much money with this new bureaucracy. Health care costs more; physicians get paid less; administrative costs soar. Unfortunately, we are unlikely to have a reasonable debate. The issues have too much complexity for sound bites. Health concerns blossoming for voters

This article brings no surprises. Programs are getting ready. I'll be ward attending next month and plan to try to achieve the new limits with my team. The challenge will come in trying to get our new interns out of the hospital at 2:00 p.m. on post-call days. AMA endorses limit on residents' hours

We have an obvious theme developing. Our first line physicians are not given the time to do their jobs properly. The insurers, whether private or government, demand unreasonable volume of both patients and paper work. 'We need a new NHS contract' say England's general practitioners.

Thanks to the Bloviator for this link - Man interrupted in sex act assaults passerby with pipe. Rather incredible story which ends with this memorable line:

"Spontaneous interruption of a public sex act to engage in an aggravated assault should be considered as a strong indication of a seriously unaddressed anger management problem," the complaint states.

The Secretary of HHS released this report today - HHS REPORT HIGHLIGHTS BENEFITS OF PHYSICAL ACTIVITY FOR DISEASE PREVENTION

President Bush walks the walk - actually he runs the run. He is in shape, and as I've previously documented, more of his staff are getting in shape. He appropriately wants to influence our citizens to do a better job of diet and physical fitness. Good for him!!! - Bush leads physical fitness initiative. Check out the government's new web page devoted to this initiative - Healthier US.Gov

Two Harvard researchers have reviewed the literature and recommend that all adults take a daily multivitamin. Your patients might ask you about this one - Multivitamins should be daily habit for adults

Read this very nice discussion of the placebo effect (mostly with treatment of depression) - Make-believe medicine

Very interesting link from the Boston Globe tells the story of patients who develop hyponatremia from replacing sweat with water. I like this reporting for its clarity. If you have exercising patients, this link could be valuable. Have your patients read it prior to long bike rides or long runs - When drinking too much water means disaster

This take from the San Francisco Chronicle - Doctors see loopholes in limits on workweek: Residents say medical culture of long hours hard to change . This remains a difficult question. Can you work long hours and retain your balance and humanity? I believe that educational leadership can help. We, as attendings, need to work as housestaff allies. We must modify our expectations to their circumstances. By recognizing their difficult nights and modifying rounds appropriately, we can help them. Housestaff need respect more than they need rules. I read this article and see housestaff who don't have the respect of their attendings or their hospital. Maybe that's the biggest problem.

With a resounding duh, we have this article published in JAMA - Variation of Mood and Empathy During Internship . All internal medicine attendings know this. All who have done an internal medicine internship know this.

Conclusions We found that, in this sample, enthusiasm at the beginning of internship soon gave way to depression, anger, and fatigue. Future research should be aimed at determining whether these changes persist beyond internship.

One of the joys and challenges of medicine involves the constant influx of new information. How we practice, and how we should practice is an evolving matter. A new analysis suggests that we still have many questions to ask and answer concerning statins and coronary artery disease - Timing the use of cholesterol drugs gets second look. If you like to read the original article, it's in JAMA - if you have a subscription you can view this online - Early Statin Initiation and Outcomes in Patients With Acute Coronary Syndromes

Unfortunately, having bills introduced in Congress does not lead to intelligent discourse. My greatest disappoint in democracy involves the level of spin. This article predicts the response to the Republican bill to provide a Medicare benefit. I'm not certain how I feel about the bill, but I'm certain that I won't hear a reasoned analysis from either the Republicans or the Democrats - A Health Care War Is Raging in the House

We didn't really need this study to tell us what we see in our offices and hospitals or even shopping malls. More Americans are obese than ever before - Obesity may be beginning earlier.

I generally don't rant on malpractice - I just read Medpundit. Since she is on vacation, I provide this link - AMA supports a cap on malpractice awards

Uplifting story from the LA Times which discusses the benefits of fitness training for older patients - In Their Iron Years.

Sleep Won May Come at a Price tells the story of mismanagement from the "passing off" of patients from one resident to another. The new regulations shouldn't lead to this conclusion. However, the story, as all stories, has value in keeping our focus on what our real goals are.

Fit to Govern, And Then Some

Interesting reference from Medscape - When Managing Diabetes, Good Glycemic Control Is Not Enough. You may have to register to view articles from Medscape, but it is free, and a good site. For those who don't want to register, let me excerpt the highlights.

When it comes to managing diabetes, doctors may achieve good glycemic control but have a lower priority for controlling or treating other cardiovascular risk factors, according to two presentations June 15 at the annual American Diabetic Association meeting.

"An opportunity exists to improve treatment rates and goal attainment for glycemic, lipid, and blood pressure control among patients with diabetes," write Richard Bergenstal, from the International Diabetes Center in Minneapolis, Minnesota, and colleagues. "Only by understanding how physicians prioritize and address these risk factors will we be able to develop more effective strategies to reach goals and reduce the burden of cardiovascular disease in diabetes."

• Feet


• Lipids


• Eyes


• Control


• Kidneys

Not much to add here, the article says a lot - Young type 2 diabetics face severe problems.

Type 2 diabetes is the most common form of the disease, affecting at least 90% of the more than 17 million Americans with diabetes. It is associated with obesity, lack of exercise and genetics, and until about 20 years ago, almost never occurred in teens or children.

Unlike type 1 or juvenile diabetes, type 2 is most often detected in middle age or older, but is increasingly being found in children, especially among ethnic minorities, a "dramatic and very alarming fact of our lives," says Eugene Barrett of the University of Virginia, vice president of the diabetes association.

For many physicians, the AMA seems irrelevant. If organized medicine has importance, then it should lobby for our crucial issues. Physicians feel under attack from malpractice, Medicare, managed care and hospitals.

This year's agenda also includes reports suggesting the AMA needs to heal itself to retain influence over shaping medical issues. The organization lost more than 12,000 members last year, one of its steepest recent declines and a continuation of a nearly 20-year exodus.

AMA leaders' average age is nearly 60, a decade older than that of doctors they claim to represent. Many younger physicians choose instead to join specialty medical societies if they want any part of what the AMA calls "organized medicine."

The latest figures show 278,302 AMA members, fewer than one-third of the 928,036 U.S. physicians and medical students.

AMA delegates from Texas are proposing action to address that. In a resolution, the delegates warn that the AMA "will not be able to sustain its viability if it continues to function as a 'status-quo' organization, poorly positioned for success in the future."

The resolution says the AMA should spend less time tackling social issues indirectly related to medicine and refocus on core values such as malpractice reform, doctors' reimbursements and issues directly affecting the doctor-patient relationship.

I plan to follow news from the meeting carefully this week, and will link to relevant stories.

Drug costs represent a recurring rant subject. I can't resist articles which discuss this problem. Today's NY Times discusses the Republican proposal for a drug benefit - Experts Wary of G.O.P. Drug Plan. I'm probably wary also.