Soft drinks are the new cigarettes

Although 1 in 5 Americans continues to smoke cigarettes, many doctors and public health professionals are now setting their sights on soda and other sugar-sweetened beverages, which many consider to be nothing less than the “new tobacco.” Read the rest of this entry »

The doctor will “tweet” you now

Doctor TweetsThere’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications.

Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables. Read the rest of this entry »

Vitamin D may be vastly overrated

Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me last week that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice. This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages.

While vitamin D has always been thought to play an important role in keeping bones strong, researchers are suggesting that low levels may increase one’s risk for a variety of diseases, including cancer and cardiovascular disease. Read the rest of this entry »

Postpartum depression in dads? Believe it

Although it’s long been accepted that as many as 1 in 10 new mothers experience symptoms of postpartum depression, due to some combination of hormonal changes and changed life circumstances, until recently, few people, including physicians, gave much thought to whether new fathers were vulnerable to depression as well. Read the rest of this entry »

Obstacles to Reversing the Obesity Epidemic

If you go to the website of the U.S. Centers for Disease Control and Prevention, you can download a colorful slide presentation that illustrates with stunning clarity how much worse the problem of obesity has become in the past twenty years. In 1990, every one of the 50 states could boast that fewer than 15 out of every 100 adults had an unhealthy weight; by 2008, more than 25 out of every 100 adults in 32 states were classified as obese.  So who’s to blame, and what can be done about it? Read the rest of this entry »

Over 50? Don’t forget to get screened for colorectal cancer

If you’re a man or woman over 50, chances are that you’ve been told about the importance of being checked for cancer of the prostate or breast. Finding some types of cancers at early stages (before they cause symptoms) may increase one’s chances of survival with proper treatment. Read the rest of this entry »

Does one drink a day keep dementia away?

A recent conference held at the National Institutes of Health on preventing Alzheimer’s disease (the most common form of dementia) found little evidence that medications or dietary supplements are any help in slowing cognitive decline in old age. Read the rest of this entry »

Does the type of birth affect postpartum health?

Baby_and_MotherMy daughter, who turns two years old next month, is becoming something of a medical rarity. This isn’t because she is showing signs of a late-developing handicap or extraordinary ability for her age – it’s because she came into the world as a vaginal birth after Cesarean section (VBAC).

Although more than three-quarters of women who choose a trial of labor over a repeat Cesarean section (including my wife) successfully deliver vaginally, studies showing slightly elevated risks of rupture or infection of the uterus with VBAC, pressure from insurance companies concerned about lawsuits, and restrictive medical guidelines discourage most women from even trying. Read the rest of this entry »

Improving Your Understanding of Health Risks

When there is a plane crash in the news, my mother-in-law, who dislikes flying anywhere but has driven coast-to-coast many times, says that she will never get on a plane again. But according to the National Center for Health Statistics, the odds of being in a serious car accident during your lifetime are a mere 1 in 100, while the odds of being in an accident involving a plane are 1 in 20,000. (And my mother-in-law did much of her driving in the days before seat belt laws and airbags.) Read the rest of this entry »

Why you should say no to “routine blood tests”

You’re at your family doctor’s office to have a complete physical. Maybe you’re starting a new job, or have recently joined a wellness program in your community,  or it’s been more than a few years since you’ve had a checkup and you (or your spouse or significant other) just want to make sure that everything’s OK.

blood_tests

Your doctor briefly reviews your medical history, performs a physical examination, says a few encouraging words about eating a healthier diet and exercising more, and then you’re done.

You picked this doctor out of the five in the practice because your friend told you he was a sharp young fellow, but now you’re not so sure. What about the blood work? You don’t need any blood work, he says. Not even a urine sample? This is confusing. You’ve always had blood work and urine tests at your other physicals, and your insurance is footing the bill, after all. You wonder if this doctor really knows what he’s doing.

This is a common situation that I faced while working as a physician in private practice in northern Virginia a few years ago. For years, patients have been used to having blood samples drawn even if they felt completely well. Even today, when we know better (or ought to), up to one-third of primary care physicians still perform “routine blood work” (usually consisting of a complete blood count, a chemistry panel, liver function tests, thyroid tests, and a urine analysis) at adult physical examinations. So why is this such a bad idea? In 2007, I co-authored an editorial in the journal American Family Physician about this topic. We wrote:

“‘Big-ticket’ tests [such as CT scans and MRIs] are easy targets for those seeking to reduce waste in health care. But what about the seemingly innocuous practice of performing routine tests such as a complete blood count (CBC) or urinalysis? … These tests would be useful only if they provided additional diagnostic information that would not otherwise be obtained during a history and physical examination. In fact, large prospective studies performed in the early 1990s concluded that these tests rarely identify clinically significant problems when performed routinely in general outpatient populations. Although the majority of abnormal screening test results are false positives, their presence usually mandates confirmatory testing that causes additional inconvenience, and occasionally physical harm, to patients.”

Don’t misunderstand me. There are certain situations in which targeted screening tests can provide valuable information for the early detection of diseases. To learn more about which tests are recommended for your or your family members, I recommend that you visit the excellent website Healthfinder.gov. But the next time you go to a doctor’s office and he or she proposes to check some “routine blood work,” be sure to ask what these tests are for and what would happen if any of them turn out to be positive, so that you can make an informed choice about what’s right for you.

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