Fitness Blog

What's in a Title? Sometimes, when someone wants to get our attention, they call themselves "Dr. So and So." Sometimes it's a ruse to get around the receptionist. "Dr. So and So is on the line about Mrs. X." And we drop everything wondering who is "Dr. So and So," and what's he doing to (with) Mrs. X only to discover it's Dr. So and So of the English department, a close relative. Rather annoying.

Sometimes it's just done to impress. One evening a phone call came to my home when I wasn't available. One of the children answered and took a message, but not a good one. "Some doctor named Joe, couldn't understand the last name." I couldn't imagine why any of the doctors named Joe of my aquaintance would be calling me late in the evening, and at home instead of through the answering service, so I was left with the mystery - until the next day when I was confronted by an irate relative who was definitely not an MD. There's a lesson in that. The children of doctors are not impressed by doctors.

Actually, about the only people who are impressed by the title are those who hold it:

Feelings about "Dr." are bound up in that bitch-goddess, Status. (Yes, I know: James said Success. But Status is a sister.) The best line in either Austin Powers movie belongs to Dr. Evil, who, when addressed as "Mr.," says, "I didn’t spend six years in evil medical school to be called 'Mr.,' thank you very much!" Our senior editor Jeffrey Hart, professor emeritus of English at Dartmouth, remembers serving as a campaign adviser to Nixon (not that this is necessarily a segue from evil). To Jeff's amusement, Nixon called him "Dr. Hart." This accords with the Nixon we know: class-conscious, status-nervous, chip-on-the-shouldery, the boy from Whittier who received a tuition scholarship to Harvard but couldn’t go, because the family didn’t have the money to transport him to and from Massachusetts. Nixon, according to Jeff, would also say, "I’m no Ph.D., but . . .," before launching into a disquisition on some arcane topic.

For some, to be called "Dr." is a way of saying, "I am somebody," in the words of the Rev. Jesse Jackson. (Ah, "the Rev. Mr. Jackson" and "the Rev. Al Sharpton" — that’s "a whole 'nother" article, as we say in my family.) Many years ago, another NR senior editor, Rick Brookhiser, surveying all the mail sent to Bill Buckley, adjudged that the most interesting letters were those from prison. And the least interesting? The ones from people who signed themselves "Ph.D." I know someone who's a lawyer in West Virginia who has found that the surest way to rattle his opposition's expert Ph.D. witness is to refer to him as "Mr."

Heh.

A Disruptive Innovation of Our Happy Little Empire: The happy little empire is the medical profession, the disruptive innovation is the retail clinic:

Dr Arnold Milstein, chief physician at Mercer health consultancy, says doctors are playing on patient fears to thwart change.

"[Doctors] wrap themselves in the holy garb of quality ... completely ignoring the facts that all the research shows current care stinks," Dr Milstein says. "The weaknesses that are endemic in the current healthcare system are being trotted out to block innovation and change."

The clinics see themselves as advancing medical care, not diminishing its quality, with a retailer’s focus on service: the slogan of CVS's MinuteClinic, for instance, is "You’re sick, we're quick".

Hal Rosenbluth, chairman of clinic company Take Care and head of the industry group Convenient Care Association, says any pushback against the clinics actually validates their existence, andadds that the concept is here to stay.

"That’s what people are clamouring for - they want healthcare on their terms not the system’s," says Rosenbluth. Doctors’ quality concerns, he says, are merely anti-change "turf protection."

Is it true that "all the research...shows current care stinks?" No. There is a perception, though, that quality means fast. It doesn't. You know what they say about fast, good, and cheap.

Innovative Web Uses: Though this blog is often critical of the editorial stances taken at the New England Journal of Medicine, kudos to them for this feature, which not only polls readers on treatment preferences, but allows comments. It adds a new dimension to learning from journals. (Their procedure videos are innovative, too, and a valuable learning tool.)

The British Medical Journal also deserves mention for its reader comment section at the end of every research article.

This comprehensive CBC web report chronicles “a study conducted by Dr. Mark Tarnopolsky, director of the neuromuscular and neurometabolic clinic at McMaster University in Hamilton and Simon Melov of the Buck Institute for Age Research in Novato, Calif., wherein they compared tissue samples from 25 healthy older men and women who did six months of weight training and a similar group of 26 younger people.”

 

“Exercise was linked to a reversal back to levels similar to those of younger adults.”

 “Melov said the researchers were surprised at the extent of the results in humans.

‘The fact that their 'genetic fingerprints' so dramatically reversed course gives credence to the value of exercise, not only as a means of improving health, but of reversing the aging process itself, which is an additional incentive to exercise as you get older.’"

This study shows that it is never too late to start an exercise program.  Check with your doctor if you are starting from scratch.

 

There is no way to reverse the aging process, but a regular exercise program may be the closest thing there is.

Living Causes Heart Disease: The cardiology group at the Cleveland Clinic has found another drug that causes heart disease:

A widely prescribed drug to treat Type 2 diabetes substantially increases the risk of heart attacks and death from cardiovascular disease, according to a study released Monday that critics say questions the government's ability to monitor drug safety.

Patients who took Avandia to reduce their blood sugar levels were 43 percent more likely to have a heart attack than patients who were given other medications or a placebo.

Researchers also found the drug boosted the chances of dying of heart disease by 64 percent, according to the report in the New England Journal of Medicine.

The actual numbers of patients taking the drug who had heart attacks, however, are not so impressive. A difference of 1-2 events between people taking the drug and those not taking it hardly warrants a significant difference. And despite the trumpeting of their results, the authors acknowledge the limitations of their analysis:

Our study has important limitations. We pooled the results of a group of trials that were not originally intended to explore cardiovascular outcomes. Most trials did not centrally adjudicate cardiovascular outcomes, and the definitions of myocardial infarction were not available. Many of these trials were small and short-term, resulting in few adverse cardiovascular events or deaths. Accordingly, the confidence intervals for the odds ratios for myocardial infarction and death from cardiovascular causes are wide, resulting in considerable uncertainty about the magnitude of the observed hazard. Furthermore, we did not have access to original source data for any of these trials. Thus, we based the analysis on available data from publicly disclosed summaries of events. The lack of availability of source data did not allow the use of more statistically powerful time-to-event analysis. A meta-analysis is always considered less convincing than a large prospective trial designed to assess the outcome of interest. Although such a dedicated trial has not been completed for rosiglitazone, the ongoing Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes (RECORD) trial may provide useful insights.

Perhaps it would be best to wait for the results of the RECORD trial before accusing the FDA of malfeasance in this case.

Also, these findings aren't as new as they're being spun. Avandia has been known to increase the risk of heart failure for a couple of years. Which is one reason why this doctor avoids it.