Brain scanning technology that has developed rapidly since the early 1970s has given doctors a valuable tool for evaluating and treating brain tumors, stroke, head trauma or seizure activity. Because nuclear medicine scans are capable of showing blood flow and metabolic activity throughout the brain, there has been considerable enthusiasm for using scans to diagnose mental illnesses such as depression, schizophrenia and attention deficit disorder. So far, however, these scans have proven to be more useful for research than for actual diagnosis or treatment.

With so many variables and individual differences, doctors have found information from scans to be less reliable than they might wish for diagnosing mental illness.
[SOURCE: Benedict Carey, “Can brain scans see depression?” New York Times Health, October 18, 2005]

 Colorectal Screening Saves Lives                                                                                                 


Fecal occult blood testing (FOB), the least expensive and invasive screening test for colorectal cancer, has been found to reduce colorectal cancer deaths by 15 to 33 percent. That's similar to the rate by which mammography reduces breast cancer deaths. Screening with sigmoidoscopy reduces colorectal cancer deaths by 30 percent. Because it examines the entire colon, colonoscopy can be assumed to be more effective than sigmoidoscopy, but it's also more expensive and risky. Colon perforation occurs in about two of every thousand procedures, compared to one of every thousand for sigmoidoscopy. 
[SOURCE: "Screening for Colorectal Cancer," Internal Medicine Alert, January 29, 2002; D.F. Ransohoff and R.S. Sandier, NEJM, 2002:346:40-44]

 Concerns about Vaccines Unfounded
                                                                       

Concerns about the safety of commonly used vaccines spread rapidly among parents. Well controlled studies, however, have found these concerns to be unfounded.


·       No causal association between MMR vaccine and autism was found in large studies in England, Finland and Denmark. A 1998 study alleging a link has been rejected by all major health organizations and was retracted by its authors in 2004.

·       Contrary to allegations, data from 200,000 subjects in the Nurses’ Health Study found no link between hepatitis B vaccine and chronic fatigue syndrome or MS.

·      Tetanus, hepatitis B and influenza vaccines did not increase the risk of relapse in MS patients, according to a European study.

·      Several studies have found no increased risk of type 1 diabetes associated with any of the routinely recommended childhood vaccines.

·       Based on multiple large epidemiological studies, the Institute of Medicine concluded that “the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.” Because of concerns about the mercury in thimerosal (a preservative), all common childhood vaccines now contain either no thimerosal or only trace amounts of it.

[SOURCE: Sanford R. Kimmel, et al, “Addressing Immunization Barriers, Benefits, and Risks,” Journal of Family Practice, February, 2007]

 Depression Screening Now Part
Of Medicare Preventive Examination
                       

Depression screening is included in the one-time Initial Physical Examination offered for the first time this year to new enrollees in Medicare Part B.

For anyone testing positive on the screening exam, Medicare rules call for “education, counseling and referral.” 
[SOURCE: Stephen Barlas, “Depression Screening Included in New Medicare Preventive Exams,” Psychiatric Times, February 1, 2005]

 High Density Really Does Matter

HDL (high-density lipoprotein) is known as the good cholesterol, in part because it sweeps the bad LDL (low density lipoprotein) cholesterol out of arteries before fatty deposits form. As a result, some scientists have argued that if LDL is lowered enough, the HDL level becomes irrelevant. That theory is not true, according to a study of 9,700 patients at the Heart Institute in Sydney, Australia. Dr. Philip Barter and his international team of colleagues found that no matter how much LDL cholesterol was lowered through medication, subjects with a low HDL reading (40mg/dL for a male, 50 mg/dL for a female) still had a substantially increased risk of heart disease. The higher a subject’s HDL, the lower the risk of a heart attack or stroke. Some cholesterol-lowering drugs raise HDL levels, but by modest amounts compared to their effect on LDL cholesterol. [SOURCE: Gene Emery, “Lack of ‘good’ cholesterol always poses heart risk,” Reuters Health, September 26, 2007]

 Imaging Rarely Needed for Back Pain 
                                                                                               

Most patients with lower back pain will get better with conservative measures, and imaging studies are generally required only to rule out cancer, infection or other serious problems. When imaging is performed, MRI has been demonstrated to be superior to x-ray in detecting abnormalities and giving an accurate diagnosis, even when a less expensive rapid MRI test is used. In terms of outcome, however, one recent study found no difference between patients diagnosed with MRI and those having x-rays. And the patients diagnosed with MRI were more likely to undergo lumbar spine surgery–increasing the cost even more with no corresponding benefit in terms of pain reduction or ability to function.
[SOURCE: MRI versus X-Ray in Low Back Pain,” GP, April 19, 2004]

Men Still Worry after Negative Biopsy
                                                                                   

The PSA screening test is highly effective in detecting early prostate cancer but gives frequent false positives, usually requiring a biopsy of the prostate. After biopsy results proved negative, men in a recent study said their lives had been changed for the better; yet 49 percent continued to worry about developing cancer. Forty percent of the men said they worried "a lot." Based on these results, the researchers recommended that men should be counseled about the risks of false-positive results before undergoing PSA screening. 
[SOURCE: Charnicia E. Huggins, "Men Still worry after 'All Clear' Prostate Biopsy," Reuters Health, December 30, 2004; Mary McNaughton-Collins, American Journal of Medicine, November 15, 2004]

MRI Detects Early Breast Cancers 
                                                                                               

For women with a genetic mutation that puts them at high risk for breast cancer, magnetic resonance imaging (MRI) is more sensitive than mammography or ultrasound in detecting tumors at an early stage. In a surveillance study involving 236 Canadian women with BRCA1 or BRCA2 mutations, MRI detected 17 of 22 cancers while mammography detected 8, ultrasound 7 and clinical breast exam 2 cancers.
[SOURCE: “Might MRI Save Lives in Women at High Risk for Breast Ca?” Contemporary OB/GYN, January, 2005; Warner E. Rewes, et al, “Surveillance of BRCA1 and BRCA2 Mutation Carriers with Magnetic Resonance Imaging, Ultrasound, Mammography, and Clinical Breast Examination,” JAMA, 2004;292:1317-1325]

 MRI Improves Pre-Natal Diagnosis                                                                                                 


In cases involving suspected brain or spinal abnormalities in a fetus, one study found that MRI provided more information than ultrasound 48 percent of the time. In the other 52 percent of cases, the MRI and ultrasound diagnoses were in agreement. The authors of the study recommended that any woman counseled to terminate a pregnancy because of a brain or spinal abnormality detected on ultrasound should get a second opinion through MRI.
[SOURCE: Robert Finn, “Better Prenatal Diagnostic Accuracy with MRI over Ultrasound: For Brain, Spine Problems,” Family Practice News, February 15, 2004]

New Screening Test Being Evaluated 
                                                                                   

Among new screening methods for colon and rectal cancer being evaluated by researchers is a test involving molecular analysis of a stool sample. The new test has shown promising results in early clinical studies presented at the annual Digest Disease Week meetings. It's still too early to say if and when the test might be available in practice. 
[SOURCE: Bruce Jancin, "New Stool Tests for Colon Cancer Being Evaluated," Internal Medicine News, September 15, 2002]

New Screening Test for Heart Disease
                                                                                   

Your cholesterol is okay, but how about your c-reactive protein? Doctors now know that many heart attacks occur as a result of an inflammatory process in the blood vessels, and c-reactive protein is a by-product of inflammation that can be measured effectively in a blood test. A recent study published in the New England Journal of Medicine [November 14, 2002] found that a test for c-reactive protein was a better predictor of heart attack risk than LDL cholesterol. Some doctors now recommend both screening tests, since some individuals with low HDL cholesterol actually have a high risk of heart attack that can be detected through a high CRP reading.
[SOURCE: "Why Do We Need Another Test?" Harvard Health Letter, February, 2003]

New Way To Test for Triglycerides

A blood lipid profile–measuring total cholesterol, “bad” LDL, “good” HDL and triglycerides–is performed after an 8 to 12-hour fast. However, two recent studies published in the Journal of the American Medical Association [July 18, 2007] suggest that doctors should consider measuring non-fasting levels of triglycerides. Triglycerides help move and store fat, and blood levels of triglycerides rise after a meal. A study of 14,000 Danish men and women and another of 25,000 American women found that women with the highest non-fasting triglyceride levels were five times more likely to die of a heart attack or stroke than those with the lowest levels. For men, the highest levels had twice the risk of those with the lowest levels. Current guidelines recommend treatment for persons with fasting triglyceride levels higher than 150 milligrams per deciliter. [SOURCE: “New way to test triglycerides helps reveal women’s heart risk,” Harvard Women’s Health Watch, October, 2007]

 Pap Test Has Multiple Uses
                                                                                                           

A widely used form of the Pap test, the ThinPrep Pap test can now be used to run tests for human papillomavirus (HPV) as well as for gonorrhea and chlamydia. About half of physician practices in the United States use the ThinPrep technology. HPV tests on the specimen were approved by the Food and Drug Administration in 1997. Now the FDA has also approved testing of gonorrhea and chlamydia from the vial sample. In 2001 the U.S. Preventive Services Task Force recommended screening all sexually active women ages 25 and under for sexually transmitted diseases. The ThinPrep sample makes it possible to do all four tests from the same sample. 
[SOURCE: "Test for STDs from Single Pap Specimen," Contraceptive Technology Update, October, 2002]

PSA Testing: Pro and Con                                                                                                 


Prostate cancer deaths declined 16 percent between 1996 and 2000, shortly after the PSA blood test became widespread, but there is controversy as to whether testing is responsible for the decrease. The drop in prostate cancer deaths occurred at similar rates in areas such as the United Kingdom where PSA testing is much less common than in the United States. The PSA test is believed to be capable of detecting prostate cancer five to seven years before an abnormality will show up on a digital rectal examination but has not been proven to reduce prostate cancer mortality. The drop in the prostate cancer mortality rate during the 1990s followed an unexplained increase in mortality during the 1980s.
[SOURCE: Does PSA Screening Decrease Mortality?” Family Practice News, September 1, 2004; The Johns Hopkins White Papers, Prostate Cancer, 2003]

Planning Health-Oriented Gifts?
                                                                                               

Are you planning to give one or more health-oriented gifts this holiday season? About 69 percent of survey respondents indicated that they would consider giving a health-oriented gift and 80 percent said they would appreciate receiving such a gift. The survey was conducted by the Jenny Craig, Inc. weight loss organization.
[SOURCE: Cozette Phifer, “survey reveals health-related items make popular gifts for both the naughty and the nice,” JennyCraig.com, December 9, 2003]

Scans That Show Function
                                                                                               

Nuclear medicine scans such as PET (positron emission tomography) and SPECT (single photon emission computed tomography) use small doses of radioactive materials combined with special cameras and computer technology to create images of internal organs.

Showing function as well as structure, nuclear scans can be used to detect tumors, aneurysms, poor blood flow, blood cell disorders or inadequate functioning of organs.
[SOURCE: Craig C. Freudenrich, Ph.D., “How nuclear medicine works,” howstuffworks.com]

 X-Raying Treats Not Recommended
                                                                                               

Many hospitals in the past offered free x-ray screening of Halloween candy, but this practice has largely been discontinued because it is costly and gives parents a false sense of reassurance. 
Parents should note that x-rays are incapable of detecting poisons, glass, wood or plastic and are an ineffective means of identifying needles and razors. 
Most hospitals focus their efforts instead on educating parents on methods of checking candy for possible tampering.

[SOURCE: “Concerns Regarding Safety and Need Prompt Enloe To Cancel Halloween Candy Screenings,” Enloe Medical Center news release, October 4, 2002]


 Ultrasound Useful for Treatment

In addition to its role in providing diagnostic scans, ultrasound is frequently used for the treatment of soft tissue injuries such as tennis elbow or plantar fasciitis. Ultrasound can deliver deep heat that speeds healing by increasing blood flow to a joint, muscle or tendon injury. And in a recently developed procedure, an ultrasound-guided needle is used as a tiny surgical instrument to break up scar tissue and restore function much more rapidly than is possible with arthroscopic surgery. [SOURCE: “Deep Heat Treatment,” Clinical Reference Systems, 2004; Peggy Peck, “New Ultrasound Therapy for Tennis Elbow,” WebMD Medical News, December 6, 2002; Paula Moyer, “Painful Muscular Condition Responds to Noninvasive Ultrasound,” WebMD feature, February 28, 2002]

 Using Sound To Measure Bone Density

New, compact ultrasound devices have given doctors another way to measure bone mineral density and identify persons at risk of fractures related to osteoporosis. The ultrasound device takes measurements from the heel without exposing the patient to radiation. A 2001 study published in the Journal of Bone and Mineral Research found it as accurate as x-ray scans in identifying at-risk patients. Although an ultrasound scan is less expensive, dual energy x-rays (DEXA) and CT scans are generally considered more sensitive since they take measurements from the spine or wrist where bone density changes are likely to show up sooner. [SOURCE: Jim Kelly, “Ultrasound Takes Osteoporosis by the Heel,” WebMD Medical News, February 20, 2001]

 Women Prefer Female Endoscopist
                                                                                               

Even though women are generally more health-conscious than men, they are less likely to undergo colorectal cancer screening with sigmoidoscopy or colonoscopy. Part of their reluctance may be associated with the gender of the practicing endoscopist.
In a survey of 202 women, 43 percent indicated that they preferred a woman endoscopist. Of these, 87 percent said they would wait 30 days in order to have a female perform the test; 14 percent said they would pay an additional fee; 5 percent said they would refuse the test unless it were performed by a female.

[SOURCE: “Women Prefer Female Endoscopists,” Family Practice News, October 1, 2005]