Quotes of the Month

     Sorry about the delayed Webletter, but I made a major change in my career on August 31, 2002.I retired from the practice of clinical medicine and I have had some difficulty reorganizing my schedule and daily routine. I don't plan to sit on the couch and vegetate for that would defy all of my principles of preventive medicine. Instead I am going to pursue a career as a writer of both fiction and nonfiction literature. The nonfiction will primarily be related to the history of medicine and the fiction will feature the adventures of a trauma surgeon, Robert Thompson, M.D. I am going to continue the preventive medicine Webletter and since I am now retired, I hope that I can keep it more current.

     West Nile Virus: This has been a pesky problem during the past summer. With the onset of colder weather hopefully the worst is over. Recently, in Atlanta the CDC, FDA, and Florida State Department of Health blamed a clustered outbreak of West Nile virus on contaminated transplanted organs. A Georgia woman who was the organ donor received multiple blood transfusions before she died and it is not clear whether she had been infected with the virus by a mosquito bite prior to her accident or if the blood transfusions were the offending mechanism. Two Georgia residents were recipients of the woman's donated organs and became ill with fever and encephalitis. One died. Then two Florida residents who also received organs from the female donor developed illnesses compatible with a West Nile infection. Fortunately neither of these patients died.

     Ed. West Nile virus is primarily a vector borne disease. Transmission by blood transfusions and organ transplantation, although theoretically possible, has not been previously detected according to CDC officials. About 45 people have died and more than a 1000 have developed the illness this season. If this continues, researchers will be pushed to discover a test that can screen asymptomatic individuals.

     Prostate Cancer: Diet and especially one high in fats has been incriminated as a contributing cause of prostatic cancer. A recent study by Alan Kristal, M.D. at the Fred Hutchinson Cancer Research Center in Seattle, Washington determined that a diet high in fat and calcium does not increase a man's risk of developing prostate cancer but if he already has the disease this type of diet may enhance it's advancement. Dr. Kristal said, "Our findings clearly show decreased risk for late stage disease in men with diets that are low in fat and moderate in calcium, perhaps because these diets slow progression of prostate cancer".

     Ed. Moderating fat and calcium consumption by patients who have an early stage cancer could also reduce the risk of recurrence after appropriate treatment.

     Breast Cancer: An article in the October issue of Hem/Onc Today reported that an analysis of seven Swedish counties found that mortality decreased significantly after mammography screening was introduced. This came from an article by Duffy, Tabar, L., and Chen, et al in Cancer. 2002; 95; 451-457. They reported a 44% drop in mortality after screening programs were introduced.

     Ed: Dr. Lazlo Tabar (one of the paper's authors) is one of the world's most experienced mammographers and he has reported repeatedly on this same effectiveness. I hope we can put the egregious mammogram problem to rest so women will not continue to be confused. There is no doubt about the effectiveness of mammography for screening and diagnosis of breast cancer. The problem lies in the interpretation and evaluation of the procedure in conjunction with the physician's physical examination of the woman's breast. The mammogram is not the "end all" test. If the patient has a palpable mass then this should be addressed even if the mammogram is reported as negative. The dense breasts of younger females are what impedes the mammogram's accuracy, but this doesn't mean it shouldn't be used.

     Discontent with American Healthcare: Data from the recent Harris poll indicate that the public, physicians, and health plan and hospital managers agree fundamental changes in the United States health care system are necessary. The gap between public and physician dissatisfaction has significantly narrowed. This trend started in 1999 and was attributed to doctor's relationships with managed care. The chairman of the Harris Poll, Humphrey Taylor, further stated that they expected public dissatisfaction to increase.

     Ed: This increase in public discontent with American healthcare is fueled by higher out-of-pocket costs, increase in uninsured, and concern about high drug prices. Would a single party payer salve the general dissatisfaction? Who knows, but many physicians are willing to take a chance on it.

     Costly prescriptions: Continuing with a subject related to health care discontent; Dana Gelb Safran, ScD who is director of The Health Institute at Tufts-New England Medical Center was recently quoted in the October 2002 issue of Hem/Onc. She said, "Almost one-third of low income seniors skip doses or do not fill prescriptions because they find it too costly and for seniors without drug coverage, the percentage increases to 42%." She further stated, "The absence of a Medicare drug benefit is widely regarded as a problem that needs to be addressed".

     Ed: Congress needs to quit playing politics with this major problem and solve it, NOW.

     Mortality in young people: Archie Bleyer, M.D., Mosbacher Chair and professor at M.D. Anderson Cancer Center in Houston, Texas was quoted in Hem/Onc's October 2002 issue. He stated, "A review of the NCI's SEER data since 1975 found a striking lack of progress in survival and mortality rates among people aged 15 to 44 years old and particularly young adults aged 25 to 39." Bleyer found, "The number one explanation that accounts for most of this chasm is the lack of participation in the very trials that have led to progress in the younger and older patients." He further said, "Age groups that have the least participation (25 to 35) have the worst outcomes."

     Ed: Diagnostic delays in this group are also much higher. Young people are reluctant to go to the doctor and when they do go, physicians do not think "Cancer" in this age group.

"The four stages of man are infancy, childhood, adolescence and obsolescence."
     - Art Linkletter (1912-) Radio and TV personality
     A Child's Garden of Misinformation, 8

"What is an adult? A child blown up by age."
     - Simone de Beauvoir (1908-86) French writer
     La Femme rompue

"Man arrives as a novice at each age of his life."
     - Nicolas Chamfort (1741-94) French writer and wit
     Caracteres et anecdotes, 576
Take care until next time,
Richard J.Turner, III, M.D., F.A.C.S.

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     History of Preventive Medicine
     Smoking Risks/Depression/The Western Diet
     Food Consumption/Cancer and Treatment Relationships
     Notes from the Spring Texas Surgical Society Meeting
     Alternative Medicine
     Breast Cancer Symposium
     Vitamin B, Passive Smoking, Statin Therapy, Common Cough
     Type 2 Diabetus Mellitus
     Antihistamines and Alcohol
     The Journal Club
     Let's Keep It Simple
     Number One Cancer Killer - Lung Cancer