A RE S UBSPECIALISTS L OSING I NTEREST
PAGE 70
VO L . 3 8 , N O. 1 0
Internal Medicine News
“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
S A N F R A N C I S C O — The
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.
www.eclinicalpsychia
www.inter nalmedicinenews.com
T he Leading Inde p endent Ne wspaper for the Inter nist—Since 1968
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
V I T A L
Top 10 Diagnoses by Internists in 2004
Hypertension
Diabetes mellitus
Hyperlipidemia
Hypercholesterolemia
Routine medical exam
Depressive disorder
Esophageal disorder
Hypothyroidism
Asthma
Allergic rhinitis
Note: Based on projected nationwide data from a monthly survey of about 360 internists.
Source: Verispan
IN C ORE I NTERNAL M EDICINE ?
tr ynews.com
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-
with a greatly reduced risk of ad- ering drugs had a third of the
vanced prostate cancer, according risk of metastatic and fatal dis-
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
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
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-
conducted as part of the Health tionnaires every 2 years through
Professionals Follow-Up Study, 2000 to report the use of choles-
an ongoing cohort study that be- See Prostate Cancer page 2
Report Conveys Scope of
Bent Out of Substance Abuse Problem
Shape BY DOUG BRUNK magnitude of our national prob-
Be on the lookout for joint San Diego Bureau lem with substance abuse, David
hypermobility syndrome. Fassler, M.D., a child and adoles-
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
parent or other adult uses tobac- factors and demonstrates the dra-
co, drinks heavily, or uses illicit matic impact on children of
S I G N S drugs. growing up in a family environ-
That’s one of the sobering ment where they are exposed to
facts contained in “Family Mat- substance abuse.”
ters: Substance Abuse and the The CASA report includes
American Family,” an 81-page these findings:
15.6% white paper produced by the Na- 씰 Thirteen percent of children
6.5% tional Center on Addiction and under age 18 live with a parent or
6.0% Substance Abuse (CASA) at Co- other adult who uses illicit drugs.
2.5% lumbia University, New York. 씰 Twenty-four percent of chil-
2.3% The report “underscores the See Substance Abuse page 31
K EVIN F OLEY, R ESEARCH /A NGIE R IES, D ESIGN
2.1%
2.0%
1.9%
1.6%
1.5%
2 News
MEETING COVERAGE
American Association for Cancer
Research
American Academy of Neurology
Society of Gynecologic Oncologists
American College of Cardiology
I N T H I S I S S U E
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
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
Internal Medicine News
Editor-in-Chief Mary Jo M. Dales
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INTERNATIONAL
MEDICAL NEWS
GROUP
INTERNAL MEDICINE NEWS • May 15, 2005
documented changes in testosterone
levels, ... but there is that possibility,”
she added.
To investigate these possibilities, the
men specifically about whether they investigators have measured serum
were taking statins, which were intro- cholesterol in a subset of these same
duced in 1986, or other cholesterol- men, in nested case-control studies. Dr.
lowering drugs. But the investigators Platz said she was not yet ready to re-
believe that most of the protective ef- veal the results of that analysis.
fect comes from statins because by She also said that although the rela-
2000, more than 90% of the men on tionship between cholesterol-lowering
cholesterol-lower- drugs and ad-
ing medication re- Although the finding is vanced prostate
ported using cancer is intrigu-
statins in particu- intriguing, randomized ing, randomized
lar. The investiga- controlled trials are needed controlled trials
tors did not gather would be needed
data about which to confirm the results before to confirm the re-
specific statins the making recommendations to sults before one
men were taking. could make rec-
The possibility patients. ommendations to
remains that the patients.
reduction in risk was due, not to the Andrew J. Danneberg, M.D., of Cor-
drugs themselves, but to their effects on nell University, New York, concurred. “I
lowering total cholesterol or the ratio think the result is extremely exciting.
of LDL to HDL. “By reducing choles- The suggestion has been made that
terol there are a number of factors the statins do not have an impact on the
that are altered,” said Dr. Platz, who incidence of prostate cancer, [but],
collaborated on the study with associ- rather, the natural history of the dis-
ates at the National Cancer Institute ease, thereby leading to a better prog-
and Harvard University. nosis,” said Dr. Danneberg, who was
“Cholesterol is overrepresented in not involved in Dr. Platz’s study.
prostate cell membranes. If you re- The study, he added, “also under-
move high levels of cholesterol you scores a growing theme in human dis-
might have some effect on the survival ease: the commonality of mechanism
of those cells. Cholesterol, of course, related to heart disease and cancer. In-
is also the precursor of sex steroid hor- flammation, for example, [is] shared by
mones. I’m not aware of work that has both.” ■
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