Which begs the question: what do I/you do? Well, when it comes down to conflicting studies, we believe more strongly in the double-blind, placebo-controlled trial which demonstrates cause & effect, whereas as retrospective cohort & other observational studies only demonstrate an association but can't tell what caused what, if indeed one thing caused another. In this particular case, both studies are retrospective cohort studies, so that doesn't help us.
So let's take a look at the bigger issue. Use of PPIs is linked to multiple other unintended consequences as I pointed out in Part 6. Based upon that, I see no reason to take a PPI w/o good reason based upon one study that found no harm given the many others that did. Remember, first, do no harm. Primum non nocere.
I know cinnamon as a basic spice, although truthfully, I couldn't name off-hand any particular dish in which it is a definitive ingredient, aside from say, hot cocoa. However, I have heard rumblings of late (besides from my stomach) that it might have a salutary effect on diabetes. But as with all thing natural & organic, there is more than meets the eye. For instance, just as with vitamins D & E, there are various types/forms/species of cinnamon as denoted by Wikipedia. That might explain why a review published a year ago in the Cochrane Libraryfound no benefit for the use of cinnamon in diabetes, whether Type 1 or 2. Of course, one could counter-argue that the Cochrane review consisted of only 10 studies involving 577 participants.
So it's rather timely that I stumbled upon another review, this time published in this month's issue of Annals of Family Medicine, in which the authors concluded that use of cinnamon in Type 2 diabetes could potentially lower fasting glucose & improve a typical lipid panel by raising HDL while lowering total & LDL cholesterol along w/triglycerides. However, while use of cinnamon did lower fasting glucose, it did not appear to lower Hemoglobin A1c, a 3 month measure of average sugar control. In all fairness, this review & meta-analysis also included 10 studies (perhaps the same 10?) but this time including just 543 participants.
As the authors noted, the range of doses (from 120mg/d to 6g/d) along with the short duration of individual studies (from 4-18 weeks) made the data too heterogenous to conclude anything more than a need to study the use of cinnamon more rigorously in diabetes. And as I've learned while perusing several websites in preparing to post this blog, we also have to become more specific as to which cinnamon plant we are referring as well as develop a potentially more objective measure than just dose/weight, since the potential benefit may be derived from the 0.5-1% that consists of aromatic oils.
Tuesday was another amazing day of learning & renewal. The Congress of Delegates heard from several passionate candidates for the Board of Directors as well as Directors vying for President-Elect of this amazing group of people. The energy & enthusiasm was quite palpable and aptly summed up by one speaker thusly: Being a family physician is the best job EVER! So after a long day, I crawled back to my room to attempt to catch up on my journals (especially after Nevada State Senator Joe Hardy asked me point blank why I hadn't been actively blogging as I had previously).
So what are the women in our lives to do? Surgery vs pills? Follow in the footsteps of a famous actress? Luckily, the USPSTF followed up their systematic review with a Grade B recommendation statement published online yesterday in the same Annals of Internal Medicine which concluded that women at increased risk for breast cancer, as determined by the Gail Model, and who are also at lower risk for side effects, be given the option to consider chemoprophylaxis in the form of tamoxifen or raloxifene. On the other hand, the USPSTF also gave a Grade D recommendation statement against the routine use of said chemophylaxis in those women who are not at increase risk for breast cancer.
Most importantly, the USPSTF recognized the importance of shared informed decision making in which our patients are given enough information at an appropriate level of understanding to make a decision consistent with their stated goals & desires. Of note, these recommendation statements apply only to those women >35yo who are w/o diagnosis of either breast cancer or carcinoma in situ.
Aside from propitious timing, why discuss this article? Because as family physicians, we care for the whole patient, the whole family, the whole community. Because as family physicians, we prevent disease, rather than just treat it. Because as family physicians, we help our patients understand all the options available to them. And we help each one decide what's best for her (or him) at that stage in life. And finally, because as family physicians, we are not gatekeepers; we practice comprehensive care w/o discrimination, regardless of gender, age, setting (be it rural or urban, outpatient or inpatient) or any other laundry list item. We are vital to the foundation to a healthy America. We have the best job EVER!
As President of the Nevada Academy of Family Physicians, I'm spending the week here in San Diego, first to attend the Congress of Delegates and then the Annual Scientific Assembly. It's been an amazing day & half so far, learning about how policy is made, listening to heated yet respectful debates between professionals from different backgrounds w/diverse perspectives, all striving towards the same goal of caring for the whole person & family. It's been an amazing time of growth & renewal, rekindling friendships & making new ones.
So after tonight's meetings, I thought I'd try to catch up on my reading, seeing as how I got distracted by HealthTap's Summer 2013 Top Doctors Competition. It turns out that one of the major issues w/post-hospital care is sorting through all the medications our patients are discharged on, some of which may not really be necessary. Case in point are proton pump inhibitors (PPIs) which are often used during hospitalization to prevent stress ulcers and then just left on the discharge medication list even if the patient never had any complaints prior to hospitalization.
This doesn't mean that you shouldn't take your PPI if you need it. But like any other medication, procedure or surgery, don't take it if you don't need it! In other words, make sure benefit exceeds risk.
It's been a while since I've posted anything, though not for lack of reading. Instead, I'm on the losing end of a battle for HealthTap's Top Family Physician. The good news is the competition (which consists of answering medical questions posted by inquiring minds from around the globe) ends this coming Sunday, so if you have a chance, check it out (and maybe vote for me!).