1. The Internet Medical Journal
Friday, February 19, 1999 7:48 AM
21-October-1998 (1998;2:7)
The US News and World Report (October 26th, 1998) shows itself to be clearly out of touch with what
is happening in the health care job market. Stating that becoming a primary care physician is a "hot
career track" ignores the clear trends that physicians--even primary care physicians--are having a
difficult time finding a job (see the pearl below). Also, the salaries listed for physicians are
misleading--because they fail to state that several doctor groups were excluded from the average,
including resident physicians, military physicians, and federally employed physicians. The hot job
market in the health care field is becoming a allied health professional, such as a nurse practitioner or a
physician assistant. The income is nearly identical, but the expense in time and money in getting the
degree is much less. Do you disagree? Thoughtful responses will be published in the IMJ. Send your
article to the editor.
Recommended reading this week is the novel A Confederacy of Dunces by John Kennedy Toole. This
book will fill your life with good humor and laughter. Did you know that humor and laughter really do
make you healthy? The landmark book on this topic is Anatomy of an Illness As Perceived by the
Patient : Reflections on Healing and Regeneration by Norman Cousins. This is a must read for every
doctor; make sure your doctor has read it! By the way, the hardcover price for these books is nearly
identical to the paperback price, so be sure to order the hardback.
With this issue, the IMJ will recommend music for readers interested in improving their health will
want to get Music for The Mozart Effect Vol 2 - Heal the Body. Research has proven the healing
powers of Mozart's music. This collection is specifically designed to help your body heal.
Be sure to check out Amazon.com for online book and music browsing.
Now for the pearls of the week---
The 10 most effective preventive services in order: childhood vaccines; flu & pneumonia vaccines;
smoking cessation; BP monitoring; ERT; Folic Acid for women of childbearing age; and newborn,
cervical cancer, & cholesterol screens. Partnership for prevention , 1998.
Successful exercisers in this group of older women tended to engage at least part-time in a solo
exercise program; less successful were exercisers who only participated in group exercising. Perri M J
Consulting Clin Psychol, 1997, 065:0278.
Just over 1 out of 5 resident physicians are finding it difficult to get a job upon graduation from their
residency program; the number of nonphysician medical providers (e.g. nurse practitioners) doubled in
just 4 years from 1993 to 1997. Miller R et al. JAMA, 1998, 280:0777.
To identify the early detection of melanoma, use the ABCDE rule: Assymetry, Border irregularity,
Color variegation, Diameter over 6 mm, Enlargement/Elevation/Erythema. Using the ABCD rule only
will miss some cases of melanoma. Brodell RT, Helms SE. Postgrad Med, 1998, 104:0145.
A new t-PA dosing regimen was found to be better than the current standard regimen at promoting
TIMI grade-3 flow. The NEW regimen is an initial 20 mg IV bolus followed by 80 mg IV over 60

2. minutes. Gulba DC et al. JACC, 1997, 030:1611.
Raloxifene (Evista) has been shown to improve bone mineral density and lower LDL cholesterol. It
seems to be an estrogen ANTAGONIST at the breast and uterus, but an estrogen AGONIST in bone
and lipid metabolism. Delmas PD et al. NEJM, 1997, 023:1641.
The risk of a hemorrhagic stroke after receiving t-PA for an acute myocardial infarction was 0.95% ; of
those, 53% died. Gurwitz JH et al. Ann Intern Med, 1998, 129:0597.
Low back pain persisted for at least one year in this study of 463 patients with a new episode of low
back pain. At 3 months, 21% had reported full recovery, and at 1 year, only 35% reported complete
recovery. Croft PR et al. BMJ, 02-MAY 1998, 316:1356.
Patients taking nortriptyline as an aid to smoking cessation were about 5 times more likely to be
abstinent at 6 months, as compared with a placebo controlled group (both groups received counseling).
The placebo quit rate was 3% at 6 months. Prochazka AV et al. Arch Intern Med, 1998, 158:2035.
Warfarin is underutilized among the elderly who have already had a stroke and also have atrial
fibrillation. Brass LM et al. Arch Intern Med, 1998, 158:2093.
PSA screening has uncertain, if any benefits. Ann Intern Med, 1998, 129:0212.
If blood is present in the stool, a flex sig and barium enema is recommended. Ann Intern Med, 1998,
129:0212.
Even if only small polyps are found on flexible sigmoidoscopy, a full colonoscopy is recommended.
Ann Intern Med, 1998, 129:0212.
The D-dimer test, with a cutoff value of 500 mg/dL, has a negative predictive value of 99%. The
sensitivity is 99% and specificity is 41%. Ann Intern Med, 1998, 129:0212.
Aspirin reduces the 6-month mortality and moderate/severe disability after a stroke (NNT=43).
Unfractionated heparin was not shown to be helpful. Ann Intern Med, 1998, 129:0212.