THE FIVE MOST INTERESTING THINGS I READ THIS PAST YEAR.
I am routinely asked by individuals what the newest literature and research is showing and how it is affecting the practice of medicine. Every year I review this information to see if or how it will affect my practice. Sometimes I learn interesting things, sometimes I learn that what I recommended last year I won't recommend this year and sometimes I think I'll wait until more information is out there before I start making any medical decisions based on what I've heard or read.

The following is a brief summary of last year's "Top Things." Some are boring, some are interesting and some may surprise you but all are limited to the current medical literature available and liable to change in the future. Hence the 'practice' of medicine.

1) The Mediterranean diet has been correlated with a decrease in heart disease, a possible decrease in cancer rates and increase in life expectancy. This diet includes high quality fruits, vegetables, olive oil and nuts. The correlation is thought to be due to the relative high quantity of antioxidants found in these foods. This makes sense, especially in light of a statement made by the head of the Harvard School of public health that 80% of heart disease can be attributed to diet and exercise.

2) A recent study of 8000 women given vitamin C plus vitamin E and/or vitamin A showed no health improvements after 8 years. Another study of 1400 men given vitamin C and/or vitamin E showed no decrease in prostate cancer risk. Another of selenium in men showed no decrease in cancer rates after 5 years but a slight increase in type II diabetes. A review of the Women's Health Initiative (study of 161,000 women over 8 years) also showed no benefit to vitamin supplementation. So am I going to stop taking my vitamins? No. The problem with these studies is that they extract out single elements (vitamins) and then study them in complex systems (humans) without regard to how vitamins exist in nature. Some medical groups are now no longer recommending certain vitamin supplementation. I'm going to wait for more info on this one prior to changing my practice.

3)We have been recommending aspirin use for almost a decade. A study in 2009 showed that patients over 80 years of age probably shouldn't be taking aspirin due to the risks (i.e.- bleeding, ulcers, ect . . .) being greater than the benefits. It also showed that men are different from women. Aspirin works better for stroke prevention in women over 55 years of age and better for heart attack prevention in men over 45 years of age. However in both populations there are significant risks of GI bleeding and bleeding strokes. Each individuals risk factors should be considered prior to a blanket recommendation of taking aspirin. You should ask your doctor about this based on your personal risk factors.

4) Currently obesity related diseases account for 10% of all health care expenditures. A recent study at an elementary school showed that giving kids access to water fountains increased their water consumption by only 220ml daily but decreased their risk for obesity from 6% to 3.8% (a 37% reduction!). That is just from drinking a little more water every day!

Other interesting facts: 78% of patients who are successful at losing weight eat breakfast daily, 62% watched less than 10 hours of TV a week and 90% exercised an hour a day. Eating until you are full if you're a man or eating fast if you are a women doubles your risk for being overweight.

So drink more water, watch less TV, exercise daily, eat breakfast, eat slowly and don't eat until your full.

5) This is the most interesting and most controversial of the five. An editorial from the Cancer Journal for Clinicians published some results from their recent prostate cancer screening trial. What they showed was 1400 men must undergo prostate screening and 48 men must undergo diagnosis and treatment to prevent one death from prostate cancer. Screening doubled the rate of diagnosis for prostate cancer but does not significantly decrease the risk of death. They recommended against mass screening and recommended shared decision-making between patients and physicians based on informed consent. This is similar to the current recommendation by the American Academy of Family Physicians.