nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, July 15, 2008

WHO WANTS A BIG BRAIN IF I STILL CAN'T THINK STRAIGHT?

Researchers explore role of physical fitness in slowing mental decline.

The CBS Evening News (7/14, story 8, 0:20, Couric) reported that "a powerful weapon to fight Alzheimer's could actually be the treadmill."

A new study published in the July 15 issue of the journal Neurology found that "[p]hysically fit patients with mild cognitive impairment had less brain shrinkage than those who weren't so well conditioned," Bloomberg (7/15, Alesci) reports.

According to the AP (7/15, Ritter), lead author Jeffrey Burns, M.D., of the Alzheimer and Memory Program at the University of Kansas School of Medicine in Kansas City, and colleagues, examined "57 people with early Alzheimer's" whose "physical fitness was assessed by measuring their peak oxygen demand while on a treadmill." Using magnetic resonance imaging scans, the researchers measured participants' "brain shrinkage." But, even though analysis revealed "participants who were more physically fit had less brain shrinkage than less-fit participants," they still did not do "significantly better on tests for mental performance."

Doc D: The key phrase is the last one. Exercise gives you a bigger brain…that still doesn’t work. Why this got national attention, I don’t know. The first sentence is misleading. Classic case of misrepresentation by the media.

Home caregiver abuse involving the elderly increasing.

On the front of its Personal Journal section, the Wall Street Journal (7/15, D1, Shishkin) reports that abuse, neglect, fraud, and even killings by home caregivers are growing "as more Americans age, and try to avoid nursing homes," according to law enforcement officials and "advocates for the elderly." Both groups are calling "for better oversight of an industry" that provides the "two kinds of jobs [that] are the second- and third-fastest growing occupations in America," those of caregivers who provide "basic health services, and those who provide housekeeping, cooking, and non-medical help."

Doc D: I don’t deny that this occurs. The problem with the story is that there’s no data. I think it was the 19th century British Prime Minister Benjamin Disraeli who said that by the time a problem becomes widely accepted by the general population, it’s already going away. We saw this with crime in the 90’s: by the time the administration and Congress had poured resources into fighting crime, the data showed that the crime rate had already been falling for a couple of years. In any case, we don’t need another panic, like MRSA or west nile virus. We just need hiring and performance monitoring for home caregivers…something we’re not doing now.

Study suggests easy access to cigarettes may increase risk of addiction.

In the New York Times's (7/15, F6) Vital Signs column, Eric Nagourney writes that easy access to cigarettes makes it more likely that sixth graders will "become smokers by the time they are in high school," according to a study published in the Annals of Family Medicine.

Doc D: Oh, no! You mean if there were free heroin dispensers in every convenience store, more kids might become addicted? Who would have thought!

This kind of dopey study probably represents the clash between those who want limit children’s exposure to bad things (sex, drugs) and those who say we can’t stop them, so why not make it safer for them to do bad things.

Standardized care may prevent clinicians from addressing patients' individual needs, op-ed says.

In an op-ed published by the Boston Globe (7/14), Victoria Rogers McEvoy, M.D., of Harvard Medical School, wrote that black patients "with diabetes fare worse than" patients who are predominantly of European descent, "even when they see the same doctor who orders the same tests, visits, and referrals to specialists," according to findings published in the Annals of Internal Medicine. While "[s]ome will surely assume that the doctors were -- perhaps unconsciously -- racist," the study's lead investigator, Thomas Sequist, M.D., M.P.H., surmises that physicians may "have failed to consider cultural differences when they, for example, assigned the same low-carbohydrate diet to all their patients, regardless of their traditional foods." Dr. McEvoy pointed out that "[i]n today's medical climate, we doctors are expected to standardize our care," which can "encourage doctors to check boxes on a form, rather than tune in to the needs of" patients.

Doc D: This is my token serious entry. For those who are concerned about quality and errors in medical care, the answer is to regulate and standardize. If we had a standardized patient that needed the same things and always reacted the same way—like a car—this would make sense. In our efforts to improve healthcare, we must not forget that everyone is different.

Doc D

Opinions are entirely my own. Quotations from AMA Morning Rounds (© U S News Custom Briefings)

JAMES J DOUGHERTY, Brig Gen, USAF (Ret)

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