You are on page 1of 2

©KEVIN BERNE

KEVIN FOLEY, RESEARCH/ANGIE RIES, DESIGN

ARE SUBSPECIALISTS LOSING INTEREST IN CORE INTERNAL MEDICINE? PAGE 70

OSING I NTEREST IN C ORE I NTERNAL M EDICINE ? PAGE 70 Internal Medicine News

Internal Medicine News

www.eclinicalpsychiatrynews.com

www.inter nalmedicinenews.com

VO L .

38, N O.

10

The Leading Independent Newspaper for the Internist—Since 1968

M AY 15, 2005

Newspaper for the Internist—Since 1968 M AY 15, 2005 “Knowledge is necessary but not sufficient for

“Knowledge is necessary but not sufficient for change,” said Dr. Vincenza Snow, ACP’s director of clinical programs, with Dr. Alan C. Moses, vice president of medical affairs for Novo Nordisk.

ACP Effort Targets U.S. Diabetes Care

BY ROBERT FINN

San Francisco Bureau

— American College of Physicians and the American College of Physicians Foundation have be- gun a major 3-year initiative to improve diabetes care in the Unit- ed States. The initiative, announced at a press briefing during the annual meeting of the ACP, is aimed not only at physicians, but also at the entire diabetes management team, including subspecialists, physician assistants, diabetes ed- ucators, nurses, office staff, and the patients themselves. Of the 18.2 million Americans with diabetes, 5.2 million are un- diagnosed, according to informa- tion distributed at the briefing. Novo Nordisk, the Denmark- based pharmaceutical company that first commercialized insulin, has funded the initiative with an unrestricted educational grant of $9.27 million. “We believe this intensive 3- year project, combining an em- phasis on highest standards of care, measurable goals for prac- tice in office settings, and re- search, can dramatically improve diabetes care,” Charles K. Fran- cis, M.D., president of the ACP said in a prepared statement an- nouncing the initiative.

S A N

F RANCISCO

The

Some of the educational pro- grams and materials will be avail- able to the medical profession in general, while others will be lim- ited to ACP members. Vincenza Snow, M.D., the ACP’s director of clinical pro- grams, said that the project has three goals: to increase physician awareness of high-quality diabetes care and the gap between current practice and acceptable standards, to provide proven educational in- terventions for improving care to the entire diabetes team, and to recognize physicians and physi-

See Diabetes Care page 6

I N S I D E Shedding Light On Parkinson’s Radioligand tracers may help identify

I N S I D E

I N S I D E
I N S I D E Shedding Light On Parkinson’s Radioligand tracers may help identify affected
I N S I D E Shedding Light On Parkinson’s Radioligand tracers may help identify affected
Shedding Light On Parkinson’s

Shedding Light On Parkinson’s

Radioligand tracers may help identify affected patients.

Radioligand tracers may help identify affected patients.

PAGE

11

Drugs, Pregnancy, And Lactation

Drugs, Pregnancy, And Lactation

Column debuts with a look at asthma medications.

Column debuts with a look at asthma medications.

PAGE

30

Column debuts with a look at asthma medications. PAGE 30 Bent Out of Shape Be on
Column debuts with a look at asthma medications. PAGE 30 Bent Out of Shape Be on

Bent Out of Shape

Bent Out of Shape

Be on the lookout for joint hypermobility syndrome.

Be on the lookout for joint hypermobility syndrome.

PAGE

35

V

I

T

A

L

SS

I

G

N

S

Top 10 Diagnoses by Internists in 2004

Hypertension Diabetes mellitus Hyperlipidemia Hypercholesterolemia Routine medical exam Depressive disorder Esophageal disorder Hypothyroidism Asthma Allergic rhinitis

15.6% 6.5% 6.0% 2.5% 2.3% 2.1% 2.0% 1.9% 1.6% 1.5%
15.6%
6.5%
6.0%
2.5%
2.3%
2.1%
2.0%
1.9%
1.6%
1.5%

Note: Based on projected nationwide data from a monthly survey of about 360 internists. Source: Verispan

Statins May Lower Risk of Advanced Prostate Cancer

No link was found for localized disease.

BY ROBERT FINN

San Francisco Bureau

A NAHEIM , C ALIF. — Choles- terol-lowering drugs, particularly statins, appear to be associated with a greatly reduced risk of ad- vanced prostate cancer, according to a large, prospective, observa- tional study presented at the an- nual meeting of the American Association for Cancer Research. “Men who used cholesterol- lowering drugs had about half the risk of advanced prostate can- cer,” as those who did not, said Elizabeth A. Platz, Sc.D., the lead author of the study, which was conducted as part of the Health Professionals Follow-Up Study, an ongoing cohort study that be-

gan in 1986 at the Harvard School of Public Health, Boston. “When we limited advanced prostate cancer to just those cas- es that were metastatic or fatal, men who used cholesterol-low- ering drugs had a third of the risk of metastatic and fatal dis- ease,” Dr. Platz of Johns Hop- kins University, Baltimore, said at a press briefing. The study followed 34,438 male health professionals (in- cluding dentists and veterinari- ans) who were free of prostate cancer in 1990, when their ages ranged between 44 and 79 years. They completed health ques- tionnaires every 2 years through 2000 to report the use of choles-

See Prostate Cancer page 2

Report Conveys Scope of Substance Abuse Problem

BY DOUG BRUNK

San Diego Bureau

A bout half of children in America—nearly 36 million

of them—live in homes where a parent or other adult uses tobac- co, drinks heavily, or uses illicit drugs.

That’s one of the sobering facts contained in “Family Mat- ters: Substance Abuse and the American Family,” an 81-page white paper produced by the Na- tional Center on Addiction and Substance Abuse (CASA) at Co- lumbia University, New York. The report “underscores the

magnitude of our national prob- lem with substance abuse, David Fassler, M.D., a child and adoles- cent psychiatrist who practices in Burlington, Vt., told this news- paper. “It clearly outlines the risk factors and demonstrates the dra- matic impact on children of growing up in a family environ- ment where they are exposed to substance abuse.” The CASA report includes these findings:

Thirteen percent of children under age 18 live with a parent or other adult who uses illicit drugs. Twenty-four percent of chil-

See Substance Abuse page 31

2 News

I NTERNAL

M EDICINE

N EWS

May 15, 2005

M E E T I N G

M E E T I N G
C C O V E R A G E

CC O V E R A G E

American Association for Cancer Research
American Association for Cancer Research

American Association for Cancer Research

American Association for Cancer Research
American Academy of Neurology
American Academy of Neurology

American Academy of Neurology

American Academy of Neurology
Society of Gynecologic Oncologists
Society of Gynecologic Oncologists

Society of Gynecologic Oncologists

Society of Gynecologic Oncologists
American College of Cardiology
American College of Cardiology

American College of Cardiology

American College of Cardiology

7

Opinion

Pro & Con: Is coiling better than clipping when an aneurysm can be treated by either method? Guest Editorials: Dr. David Dahl sees a lesson in the Schiavo case, 7; Dr. Alan B. Fleischer Jr. has doubts about black box warnings for tacrolimus and pimecrolimus, 8

Letters, 10

11

Clinical Rounds

Neurology, 11

Early Parkinson’s may be detected by

a

simple olfactory test.

Mindful Practice: Dr. Jon O. Ebbert and Dr. Eric G. Tangalos examine evidence on combination therapy for neuropathic pain, 15

Psychiatry, 16

States face obstacles in dealing with methamphetamine addiction.

Women’s Health, 22

A

new guideline covers vulvodynia

diagnosis and treatment.

Adolescent Health, 31

Early intervention may be needed to prevent child molestation by teens, 32

Rheumatology, 35

Bone mineral density in early menopause is a strong predictor of bone health 10 years later, 37 Exercise Rx: Dr. Willibald Nagler offers exercises to relieve acute lumbago, 42

44

Rx

Belimumab and rituximab appear promising for rheumatoid arthritis. New & Approved: Experts comment on Boniva for osteoporosis and Hyzaar for lowering stroke risk, 45

48

Cardiovascular Medicine

Statins may improve survival markedly in advanced heart failure.

63

Infectious Diseases

Micafungin, a new echinocandin, is available to treat fungal infections.

67

Gastroenterology

Medical management is first step in treating constipation.

70

Practice Trends

Some subspecialists are recertifying only in their subspecialty.

Policy & Practice

The Rest of Your Life: Doctors talk

about raising a child with special needs, 72

74

Indications

Reader Services

Index of Advertisers, 72 Classifieds, 73

A Beneficial Statin Side Effect?

Prostate Cancer from page 1

documented changes in testosterone

levels,

she added. To investigate these possibilities, the investigators have measured serum cholesterol in a subset of these same

men, in nested case-control studies. Dr. Platz said she was not yet ready to re- veal the results of that analysis. She also said that although the rela- tionship between cholesterol-lowering drugs and ad-

vanced prostate cancer is intrigu- ing, randomized controlled trials would be needed to confirm the re- sults before one

could make rec- ommendations to patients. Andrew J. Danneberg, M.D., of Cor- nell University, New York, concurred. “I think the result is extremely exciting. The suggestion has been made that the statins do not have an impact on the incidence of prostate cancer, [but], rather, the natural history of the dis- ease, thereby leading to a better prog- nosis,” said Dr. Danneberg, who was not involved in Dr. Platz’s study. The study, he added, “also under- scores a growing theme in human dis- ease: the commonality of mechanism related to heart disease and cancer. In- flammation, for example, [is] shared by

both.”

but there is that possibility,”

terol-lowering drugs and whether they had been diagnosed with prostate can- cer. The study investigators reviewed the medical records of all men with a prostate cancer diagnosis. The reduction in risk held only for advanced prostate cancers, defined as cases in which the cancer was region- ally invasive, metastatic, or fatal. The investigators found no association be- tween the use of cholesterol-lowering drugs, and disease that was confined to the prostate. Through January 2000, during 313,728 person-years of follow-up, the investigators confirmed 2,074 cases of prostate cancer, of which 283 were ad- vanced. Among those cases, 206 were metastatic or fatal. The hazard ratio for advanced prostate cancer was 0.54 for men using cholesterol-lowering drugs, compared with nonusers of such drugs. Similarly, the hazard ratio for metasta- tic or fatal prostate cancer was 0.34. The results were adjusted for “pur- ported prostate cancer risk factors” using Cox proportional hazards regression. The study also yielded statistically significant evidence that the risk of ad- vanced prostate cancer declined with increasing duration of the use of cho- lesterol-lowering drugs. Only the final questionnaire, cover- ing the years 1998 to 2000, asked the

men specifically about whether they were taking statins, which were intro- duced in 1986, or other cholesterol-

lowering drugs. But the investigators believe that most of the protective ef- fect comes from statins because by 2000, more than 90% of the men on

cholesterol-lower-

Although the finding is intriguing, randomized controlled trials are needed

to confirm the results before making recommendations to

patients.

The possibility remains that the reduction in risk was due, not to the drugs themselves, but to their effects on lowering total cholesterol or the ratio of LDL to HDL. “By reducing choles- terol there are a number of factors that are altered,” said Dr. Platz, who collaborated on the study with associ- ates at the National Cancer Institute and Harvard University. “Cholesterol is overrepresented in prostate cell membranes. If you re- move high levels of cholesterol you might have some effect on the survival of those cells. Cholesterol, of course, is also the precursor of sex steroid hor- mones. I’m not aware of work that has

Internal Medicine News

President, IMNG Alan J. Imhoff

Editor-in-Chief Mary Jo M. Dales

Publication Editor Calvin Pierce

Publication Associate Editor Christina Chase

Senior Editors Kathryn DeMott, Denise Fulton, Catherine Hackett, Gina L. Henderson, Sally Koch Kubetin, Teresa Lassman, Catherine Cooper Nellist, Kathy Scarbeck, Terry Rudd, Elizabeth Wood

Associate Editors Jay C. Cherniak, Richard Franki, Deeanna Franklin, Joyce Frieden, Gwendolyn Hall, Mark S. Lesney, Jennifer Silverman, Robin L. Turner

Bureaus Betsy Bates (Los Angeles), Sherry Boschert (San Francisco), Doug Brunk (San Diego), Robert Finn (San Francisco), Bruce Jancin (Denver), Kate Johnson (Montreal), Timothy F. Kirn (Sacramento), Jane Salodof MacNeil (Southwest), Diana Mahoney (New England), Damian McNamara (Miami), Michele G. Sullivan (Mid-Atlantic), Nancy Walsh (New York), Patrice Wendling (Chicago), Sharon Worcester (Tallahassee), Mitchel L. Zoler (Philadelphia)

Senior Writers Jeff Evans, Kevin Foley, Elizabeth Mechcatie, Mary Ellen Schneider, Heidi Splete, Miriam E. Tucker, Kerri Wachter

Copy Chief Felicia R. Black Copy Editors John R. Bell, Therese Borden, Virginia Ingram-Wells, Rachel Keith, Jane Locastro, Carol Nicotera-Ward

Rachel Keith, Jane Locastro, Carol Nicotera-Ward INTERNATIONAL MEDICAL NEWS GROUP Executive Director,
INTERNATIONAL

INTERNATIONAL

INTERNATIONAL

MEDICAL NEWS

GROUP

Executive Director, Operations Jim Chicca

Director, Production/Manufacturing Yvonne Evans Production Manager Judi Sheffer Production Specialists Anthony Draper, Rebecca Slebodnik, Mary D. Templin

Senior Systems Administrator Lee J. Unger Application Systems Specialist Doug Sullivan Operations Assistant Melissa Kasimatis

Art Director Louise A. Koenig Assistant Design Supervisor Elizabeth B. Lobdell Design Staff Sarah L. Gallant, Forhad S. Hossain, Julie Keller, Angie Ries Photo Editors Lolita Jones, Vivian E. Lee, James E. Reinaker

Project Manager Susan D. Hite Assignments Coordinator Megan Evans Departmental Coordinator Vicki Long

H.R. Manager Philip Cooksey

Regional Manager of Facilities Chris Horne Receptionist YoLanda L. Mitchell

INTERNAL MEDICINE NEWS is an independent newspaper that provides the practicing internist with timely and relevant news and commentary about clinical developments in the field and about the impact of health care policy on the specialty and the physician’s practice. The ideas and opinions expressed in INTERNAL MEDICINE NEWS do not necessarily reflect those of the Publisher. Elsevier Inc. will not assume responsibility for damages, loss, or claims of any kind arising from or related to the informa- tion contained in this publication, including any claims related to the products, drugs, or ser- vices mentioned herein.

Founding Publisher: Jack O. Scher Founding Editor: William Rubin

V.P., Med. Ed./Bus. Development Sylvia H. Reitman Senior Director, Marketing/Research Janice Theobald Program Managers, Med. Ed. Sara M. Hagan, Margo Ullmann

Sales Director Jeffrey R. Davis Sales Manager, Primary Care Mark E. Altier National Account Manager Barbara Napoli Classified Sales Manager Robin Cryan

Director, Bus. Operations/Recruit. Adv. Bari Edwards Bus. Manager Brian O’Connor Adv. Services Manager Joan Friedman Credit Supervisor Patricia H. Ramsey Manager, Administration/Conventions Lynne Kalish Sales Assistant Evelyn Ploch Secretary Gloria DeMaio

Editorial Offices 12230 Wilkins Ave., Rockville,

MD 20852, 877-524-9332,

imnews@elsevier.com

Advertising Offices 60 Columbia Rd., Building B, Morristown, NJ 07960, 973-290-8200,

fax 973-290-8250

Address Changes Fax change of address (with

old mailing label) to 301-816-8736 or e-mail

change to subs@elsevier.com Reprints Call 301-816-8726

POSTMASTER Send changes of address (with old mailing label) to Circulation, INTERNAL MEDICINE NEWS, 12230 Wilkins Ave., Rockville, MD 20852.

INTERNAL MEDICINE NEWS (ISSN 1097-8690) is published semimonthly by Elsevier Inc., 60 Columbia Rd., Building B, Morristown, NJ 07960, 973-290-8200, fax 973-290-8250. Subscription price is $105.00 a year. Periodicals postage paid at Morristown, NJ, and additional offices. ©Copyright 2005, by Elsevier Inc.

is $105.00 a year. Periodicals postage paid at Morristown, NJ, and additional offices. ©Copyright 2005, by

I N

T HIS

I SSUE

ing medication re- ported using statins in particu- lar. The investiga- tors did not gather data about which specific statins the men were taking.