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A RE S UBSPECIALISTS L OSING I NTEREST IN C ORE I NTERNAL M EDICINE ?

PAGE 70

VO L . 3 8 , N O. 1 0
Internal Medicine News www.eclinicalpsychia
www.inter nalmedicinenews.com
tr ynews.com
T he Leading Inde p endent Ne wspaper for the Inter nist—Since 1968 M AY 1 5 , 2 0 0 5

INSIDE
Statins May Lower
Risk of Advanced
Prostate Cancer
No link was found for localized disease.
Shedding Light BY ROBERT FINN gan in 1986 at the Harvard
On Parkinson’s San Francisco Bureau School of Public Health, Boston.
©K EVIN B ERNE

Radioligand tracers may help “When we limited advanced


identify affected patients. A N A H E I M , C A L I F . — Choles- prostate cancer to just those cas-
terol-lowering drugs, particularly es that were metastatic or fatal,
PAGE 11 statins, appear to be associated men who used cholesterol-low-
“Knowledge is necessary but not sufficient for change,” said Dr. with a greatly reduced risk of ad- ering drugs had a third of the
Vincenza Snow, ACP’s director of clinical programs, with Dr. Alan vanced prostate cancer, according risk of metastatic and fatal dis-
C. Moses, vice president of medical affairs for Novo Nordisk. Drugs, Pregnancy, to a large, prospective, observa- ease,” Dr. Platz of Johns Hop-
tional study presented at the an- kins University, Baltimore, said at
And Lactation nual meeting of the American a press briefing.
Column debuts with a look at
ACP Effort Targets asthma medications.
PAGE 30
Association for Cancer Research.
“Men who used cholesterol-
lowering drugs had about half
The study followed 34,438
male health professionals (in-
cluding dentists and veterinari-
the risk of advanced prostate can- ans) who were free of prostate
U.S. Diabetes Care cer,” as those who did not, said
Elizabeth A. Platz, Sc.D., the lead
cancer in 1990, when their ages
ranged between 44 and 79 years.
author of the study, which was They completed health ques-
BY ROBERT FINN Some of the educational pro- conducted as part of the Health tionnaires every 2 years through
San Francisco Bureau grams and materials will be avail- Professionals Follow-Up Study, 2000 to report the use of choles-
able to the medical profession in an ongoing cohort study that be- See Prostate Cancer page 2
S A N F R A N C I S C O — The general, while others will be lim-
American College of Physicians ited to ACP members.
and the American College of
Physicians Foundation have be-
Vincenza Snow, M.D., the
ACP’s director of clinical pro- Report Conveys Scope of
gun a major 3-year initiative to grams, said that the project has
improve diabetes care in the Unit-
ed States.
three goals: to increase physician
awareness of high-quality diabetes
Bent Out of Substance Abuse Problem
The initiative, announced at a care and the gap between current Shape BY DOUG BRUNK magnitude of our national prob-
press briefing during the annual practice and acceptable standards, Be on the lookout for joint San Diego Bureau lem with substance abuse, David
meeting of the ACP, is aimed not to provide proven educational in- hypermobility syndrome. Fassler, M.D., a child and adoles-
only at physicians, but also at the
entire diabetes management
team, including subspecialists,
terventions for improving care to
the entire diabetes team, and to
recognize physicians and physi-
PAGE 35
A bout half of children in
America—nearly 36 million
of them—live in homes where a
cent psychiatrist who practices
in Burlington, Vt., told this news-
paper. “It clearly outlines the risk
physician assistants, diabetes ed- See Diabetes Care page 6 parent or other adult uses tobac- factors and demonstrates the dra-
ucators, nurses, office staff, and co, drinks heavily, or uses illicit matic impact on children of
the patients themselves. V I T A L S I G N S drugs. growing up in a family environ-
Of the 18.2 million Americans That’s one of the sobering ment where they are exposed to
with diabetes, 5.2 million are un- facts contained in “Family Mat- substance abuse.”
diagnosed, according to informa-
Top 10 Diagnoses by Internists in 2004 ters: Substance Abuse and the The CASA report includes
tion distributed at the briefing. American Family,” an 81-page these findings:
Novo Nordisk, the Denmark- Hypertension 15.6% white paper produced by the Na- 씰 Thirteen percent of children
based pharmaceutical company Diabetes mellitus 6.5% tional Center on Addiction and under age 18 live with a parent or
that first commercialized insulin, Hyperlipidemia 6.0% Substance Abuse (CASA) at Co- other adult who uses illicit drugs.
has funded the initiative with an 2.5% lumbia University, New York. 씰 Twenty-four percent of chil-
Hypercholesterolemia
unrestricted educational grant of 2.3% The report “underscores the See Substance Abuse page 31
K EVIN F OLEY, R ESEARCH /A NGIE R IES, D ESIGN

Routine medical exam


$9.27 million. Depressive disorder 2.1%
“We believe this intensive 3- Esophageal disorder 2.0%
year project, combining an em- 1.9%
Hypothyroidism
phasis on highest standards of
Asthma 1.6%
care, measurable goals for prac- 1.5%
Allergic rhinitis
tice in office settings, and re-
search, can dramatically improve
diabetes care,” Charles K. Fran-
Note: Based on projected nationwide data from a monthly survey of about 360 internists.
cis, M.D., president of the ACP
Source: Verispan
said in a prepared statement an-
nouncing the initiative.
6 News INTERNAL MEDICINE NEWS • May 15, 2005

Initiative Seeks Better Outcomes source (PIER); the medical knowledge self-
assessment program (MKSAP); and the
“Beating diabetes is our passion, not just
our business,” said Alan C. Moses, M.D.,
Diabetes Care from page 1 college’s Web site (www.acponline.org). vice president of medical affairs for Novo
Versions of MKSAP will be developed Nordisk. “We try to distinguish ourselves
cian practices that improve the care of pa- mented and that they don’t disappear once for nonphysician members of the diabetes from other companies by acting in accor-
tients with diabetes. the intervention goes away.” management team. And ACP will develop dance with our triple-bottom-line principle,
“Knowledge is necessary but not suffi- The initiative was inaugurated at the a self-management tool kit to help patients [which] emphasizes a commitment not
cient for change,” Dr. Snow said, noting ACP annual meeting with a diabetes track become working partners with their only to the economic success of the busi-
that all internists have extensive training in consisting of 16 workshops and courses. health care providers in diabetes care. ness, but just as importantly, to environ-
diabetes care. “It’s not necessarily that This track will be a feature of future an- These materials, available in both English mental soundness and social responsibility.”
our members don’t know what to do. We nual meetings, and clinical skills modules and Spanish, will include versions intend- The initiative will include a research
need to empower them to do that in their will be offered at local chapter meetings. ed for patients whose literacy is at the component that will assess measurable
real-life practices. What has been shown is Other parts of the program will be in- third- or fourth-grade level. outcomes as the project progresses. “I
that multifaceted and multi-intervention troduced at a rapid pace, Dr. Snow said. Additionally, ACP will develop a Web hope that 3 years from now we’ll be here
educational programs are what works. For example, enhanced diabetes informa- portal collecting all of its diabetes infor- again talking about the positive results of
You have to hit people over the head many, tion will become part of the ACP’s Web- mation in one place, offering clinical de- the project and the real changes that have
many times in many different ways to based point-of-care decision support tool, cision support, CME credit, and the latest occurred in diabetes care,” Dr. Francis
make sure that new things are imple- Physicians’ Information and Education Re- research in diabetes care. said. ■

Revamped Federal Food Pyramid Draws Mixed Reviews


B Y P AT R I C E W E N D L I N G “Recommending people eat that
Chicago Bureau much oil I think may exacerbate
obesity rather than help reduce

E
xperts are applauding the in- it,” Dr. Ornish said. “On the one
clusion of exercise in the na- hand, they’re asking people to ex-
tion’s revamped food pyra- ercise more, but then if they’re
mid guide, but they also question going to be eating that many calo-
the value of a national dietary icon ries from fat, it’s going to be hard
that lacks details and requires the to control the number of calories
use of a computer to interpret. as requested.”
The new “My Pyramid” replaces Emphasizing a balance between
the familiar horizontal configura- food and physical activity is a step
tion of the 1992 Food Guide Pyra- in the right direction, but the new
mid with six vertical color wedges pyramid may not be able to help
that represent the five food groups teach that concept in the clinical
and oils, and adds a staircase to setting, according to Monica Myk-
symbolize the importance of phys- lebust, M.D., director of Integra-
ical activity. tive Medicine clinical services at
Instead of one pyramid, there the University of Michigan, Ann
are now 12 different versions. They Arbor.
contain 23 general recommenda- Even after an electronic session
tions and 18 specific suggestions with their physician, it will be chal-
for the elderly, children, and other lenging for patients to carry the
special populations. necessary information in their
M Y P YRAMID. GOV

Consumers can obtain personal- heads and apply it in a restaurant,


ized dietary and exercise recom- Dr. Myklebust said.
mendations by plugging in their Her own Healing Foods Pyramid
age, gender, and physical activity (www.med.umich.edu/umim/
levels to either the “My Pyramid The 12 available versions of the new food pyramid represent 23 general recommendations and clinical) includes such images, and
Plan” or “My Pyramid Tracker” 18 specific suggestions for the elderly, children, and other special populations. has water as its foundation, followed
features on the U.S. Department of by a variety of fruits and vegetables,
Agriculture’s Web site (www.mypyramid.gov). dairy consumption increases blood levels of insulin-like then grains and legumes. There are separate categories for
“It’s as basic ...or as sophisticated as you want it to be,” growth factor-1 (IGF-1), which has been related to a num- herbs, monounsaturated fats, organic dairy, lean meats,
Secretary Mike Johanns said at a press briefing sponsored ber of cancers, he said. and wild fish.
by the USDA. A statement by the Center for Science in the Public In- “All of this reflects the recent data that we need to be
Although printed materials will be available this fall in terest also called the new pyramid a “missed opportu- eating in a plant-based manner,” Dr. Myklebust said.
English and Spanish, the Web site is the centerpiece of nity” because one has to go to a Web site for details. It “Such recommendations help to prevent and treat dia-
the new program. The Web site includes a “For Profes- chided the government for bending “over backward to betes, obesity, heart disease, chronic pain, mood disor-
sionals” section, which provides information to help pa- avoid upsetting any particular commodity group or food ders—the list goes on and on. [The USDA] uses the term
tients apply the new guidelines. company by not showing any food that Americans plant based, but I don’t feel there was enough emphasis
Leading physicians and other parties who spoke with should eat less of.” on it.”
this newspaper expressed concern regarding the new The inclusion of oils in the pyramid for the first time The food pyramid was never meant to serve as a treat-
program. is a step in the right direction, but the recommendations ment algorithm, observed Scott M. Grundy, M.D., who
“It’s a lost opportunity to convey information about do not distinguish among them, according to Dean Or- has served on several federal dietary guideline committees.
healthy food choices to the American public,” said Wal- nish, M.D., clinical professor of medicine, University of The question about the new pyramid is whether it fol-
ter Willett, M.D., chair of the department of nutrition at California, San Francisco. lows the guidelines established by the “Dietary Guidelines
Harvard University, Boston. “It’s good that it does em- The pyramid guidelines advise adults who consume for Americans 2005” document, which when released in
phasize physical activity, but the pyramid itself gives no 2,000 calories a day to consume the equivalent of about January were the strongest ever put forth by the govern-
information about what people should be using sparing- 6 teaspoons (or 2 tablespoons) of oil daily, with most of ment, Dr. Grundy said.
ly and what they should be emphasizing in their diet.” it coming from fish, nuts, and vegetable oils. Solid fats like The 70-page scientific document is accessible on the
Not everyone uses the Internet, and even if they have butter, stick margarine, shortening, and lard should be Web site, along with links to a variety of topics such as
access, it takes quite a bit of motivation to look up the limited. coronary heart disease, federal nutrition assistance pro-
information, he said. Canola oil and fish oil are high in omega-3 fatty acids, grams, and food labeling.
A new recommendation that adults should consume up but olive oil and corn oil have almost none, Dr. Ornish “You have to work with it,” said Dr. Grundy, director
to the equivalent of three glasses of milk daily represents said. Secondly, each tablespoon of oil is equivalent to of the Center for Human Nutrition, University of Texas
a “radical change” in the adult diet, said Dr. Willett, not- about 28-30 g of fat, and fats are the densest form of calo- Southwestern Medical Center at Dallas. “It’s not some-
ing that most men consume only about one-half glass of ries. Only about 3 g of fish oil or flax oil is needed to pro- thing that just strikes you in the face like the old pyramid,
milk per day. Moreover, there is definitive proof that high vide the necessary omega-3 fatty acids. but I’m not sure how effective that was either.” ■
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