COMMENT: These techniques are rarely recommended but should be first line treatment before drugs. Realize that such drugs work in a minority of patients and do have side effects. In addition, acupuncture is probably even better at resolving these symptoms.

COMMENT: This is ridiculous. The study was negative. This is just an attempt to increase the use of MRI scans unnecessarily. ESI's fail in most people and do not provide long term relief even when they do work, plus there are many other less costly but more effective methods to reduce back and leg pain (ESI's cost about $7500 for 3 injections). In addition, MRI's often show abnormalities that do not correlate with the symptoms.

COMMENT: This is important because these tests are increasing steadily and the doctors performing them usually do not warn patients about thyroid dysfunction and most other doctors are unaware of the relationship. If you've had such testing and have developed unexplained symptoms (hair loss, unexpected weight gain/loss, fatigue or hyperactivity) you should have your thyroid tested. (Refer to my book, BOOM or BUST, for further discussion of thyroid testing with reverse T3).

COMMENT: Knee replacements have increased eightfold in recent decades, but that is because of aging and obesity. Now other people are also getting more symptomatic knee arthritis. It certainly could be due to some environmental factors that have not been recognized as of yet. The important thing is to realize that knee replacements may not be necessary in most patients (and have lots of problems...see past posts) and you should consider treatment with low level energy laser instead (see laser article from home page).

COMMENT: This is not good. Specialty care increases health care costs, increases waste (Unnecessary and ineffective treatments) and studies have shown that outcomes are actually not as good with specialty care as with primary care. The article and editorials suggested several reasons, one of which was the increasing complexity of patients with multiple disorders. I don't think patients have changed that much over the years...what has changed is the training of doctors and the advent of technology. There has been a persistent devaluation of primary care over the past few decades and physicians in training are not learning the same skills they used to: Now they rely more on technology for answers than common sense and basic histories and physicals. A major problem is that they don't have the time to address each patient issue and also may not get paid for the extra time needed, so it's just easier to refer to a specialist. Finally, more and more patients are feeling empowered and demanding referrals themselves, although they don't realize it may not be in their best interests. All of this bodes poorly for our health care system.

COMMENT: Other researchers caution against drawing definitive conclusions from this data. In the Women's Health Study and the Physician's Health Study, both of which are very large prospective studies, no such findings were found. For this reason, the routine use of aspirin to prevent or treat cancer cannot yet be made. Aspirin also can have side effects of GI bleeding and stomach pain. The data also suggest that the risk is reduced only about 25%. Recommendations at this time is to take aspirin only if you have increased risk factors for colon or esophageal cancer, such as Barrett's esophagus or colon polyps and only if you're between the ages of 55 and 75.

COMMENT: This is an interesting advance and may be helpful especially in those people who don't like injecting themselves once to several times a day. However, the drug may cause pancreatitis and has the potential risk of causing medullary thyroid cancer. It also may be quite expensive.

COMMENT: This study is observational only, showing an association between sleeping pills and death/cancer risk, but not a cause-and-effect. Many experts are urging caution in jumping to conclusions, but the data is very strong. There are many good non-medical approches to sleeping that should be tried first and sleep studies should be done if you have excessive daytime sleepiness or abnormal sleep patterns nd treated appropriately. Incidentally, these results included all types of sleeping pills, including antihistamines and benzodiazepines.

COMMENT: Both phentermine and topiramate have been used for weight loss, although both have various side effects. The pill could raise the risk for heart problems and birth defects, so shouldn't be used in pregnant women. Regarding the heart problems, the advisors suggested that the manufacturer should conduct a study for heart problems and wqere split on whether this should be done before or after approval. I peronally think it should be before...what do you think?

COMMENT: The cobalt-chromium surfaces of the implants can wear down, leading to the release of metallic ions. In a February post, I discussed a study that showed that the new metal-on-metal replacements were no better than the traditional metal-on-polyethylene implants and were more expensive. Unfortunately, 1 million of these have already been placed in Americans.

In addition, as described in my books, with cold laser treatment and/or acupuncture, you may be able to avoid hip replacements altogether.

1) Incident diabetes and increased blood sugar are possible with statin use

2) memory Los and confusion are possible although rare and are reversible.

3) Routine monitoring of liver enzymes are no longer erquired, unless indicated by symptoms but should be done before starting statins to rule out liver disease. Serious liver injury is rare and cannot be prevented with routine montioring.

COMMENT: The main risk of which to be aware is diabetes, since this is so prevalent in the U.S. Many diabetics have high cholesterol as well and will need to be on statins, which can increase the blood sugar even more. Muscle pain is still a known side effect, but doesn't usually cause permanent damage unless it leads to rhabdomyolysis...this is rare and is more likely to occur of statins are given with drugs like itraconazole (Sporanox) for fungal and yeast infections or erythromycin (this is pimarily seen with the statin, lovastatin or Mevacor).

COMMENT: As discussed in my book and videos, statisics reveal that 60% of the world's drug costs are paid by Americans. None of our politicians (including the Affordable Care Act) have yet to to address this problem even though $300 billion a year could be saved by directly negotiating drug costs with manufacturers, as the rest of the world does. Until then, us generics when you can, even though we also pay more for generics than other countries.

COMMENT: It is well known that sinusitis is not often caused by bacterial infection and antibiotics do not help. The negative consequences is that you build up a resistance to those antibiotics, which can affect you if you do succumb to later infections. Unfortunately, many patients insist on getting antibiotics and doctors go ahead and prescribe them. The best treatment for sinusitis is aupuncture, which can relieve symptoms quickly and keep them from returning.

COMMENT: Biphosphonates are the primary drugs prescribed for osteoporosis and they help prevent bone loss. Many joint replacements have to be revised because the bone next to the implant wears down, loosening the implant. Revisions are expensive, much less successful and do not last as long. So, it may benefit you taking these drugs after surgery. In other posts, I have recommended strontium over biphosphonates for osteoporosis: I wonder if it would work as well or better since it is cheaper with less side effects.

COMMENT: Robotic surgery has been ballyhooed as being superior to regular surgery with proponents saying there can be better visualization and less blood loss with smaller incisions. However, most of the hype is due to aggressive marketing by hospitals and and the companies who make the devices in order to pay for it: they cost about $1.5 million, not including the cost of surgeon training and annual service contracts. As a result of the cost, the procedure is much more expensive as well.

In an earlier study, men who had the robotic procedure were actually less satisfied in the long run.  In the above study, men undergoing robotic surgery were more optimistic than those undergoing traditional surgery, and thought that robotic surgery would have less side effects and they would recover faster. The only difference was getting out of the hospital 8-12 hours sooner.

Many surgeons prefer the regular surgery because they get "tactile feedback", which is important. I have seen a number of patients whose cancers were too far down to be reached by robotics and had quicker recurrence because the cancers weren't adequately visualized and thus not resected. This primarily occurs with inexperienced surgeons, so it is very important that, if you do choose robotic surgery, make sure the surgeon does at least 40-75 procedures a year.

The bottom line, however, is that it is more expensive and does not have any better outcomes. It simply increases the cost of medical care unnecessarily.

COMMENT: This is yet another example of unnecessary testing due to greed. An editorialist correctly points out that in many of these cases, financial incentives affect the quality of care.

COMMENT: It is commonly assumed that newer is better and the latest technology has advantages over previous technology. This study disproves that. In fact, the newer implants are more expensive and thus are unnecessary, simply increasing the costs of health care. Unfortunately, they will still be used due to incentives from the company to orthopedic doctors. be sure to ask your doctor what type of implant he will use. Of course, be sure to undergo cold laser treatment first....it may prevent the need for hip replacement in the first place and is significantly cheaper.

COMMENT: It is very common for doctors to repeat these tests every 2-3 years, which is unnecessary. As I have mentioned previously, there are many doctors who treat osteopenia, also unnecessary. However, there are other factors that can affect fracture risk and this study did not address those factors. They include cigarette smoking, excessive alcohol consumption, low body mass index (BMI), low dietary calcium intake, vitamin D deficiency, prolonged immobilization, little or no physical activity, visual impairment and frequent falls.

COMMENT: These results are similar to other studies in which commercial weight loss programs, including Weight Watchers and Jenny Craig, were superior and cheaper than weight-loss advice and diet medications. In fact, many doctors have concluded that it would be less expensive for insurance to pay for such programs instead of medical care for weight loss.

COMMENT: Hepatitis C is a slowly progressive disease that may not cause any symptoms until the disease has progressed for years. The main killers of HCV is progression to liver cancer or fibrosis (much like cirrhosis from drinking too much alcohol). Since there are many effective anti-HCV drugs that recently have been approved and are in the pipeline, it is a matter of detecting who has the disease early. HCV testing may be a good idea for all baby boomers.

COMMENT: This is an important study since many people get their fiber mostly from fruits, legumes and vegetables. there is no question that eating those types of foods are beneficial and healthy in many ways and are definitely recommended. However, don't forget the cereals and whole grains!

COMMENT: Unfortunately, guidelines for many diseases are often not followed, leading to unnecessary screening and treatment as well as non-treatment when indicated. Screening for osteoporosis should not be initiated until age 65 and women should be considered for treatment only if they have osteoporosis and are at elevated risk, not if they have osteopenia or at low risk.

COMMENT: In patients who are severely depressed, taking an SSRI with anti-platelet blood thinners may have more benefits than risks, but for those mildly or moderately depressed, other agents should be considered instead.

COMMENT: Chondroitin is commonly used with glucosamine, the latter which has definitive evidence of benefit on osteoarthritis of extremity joints. Chondroitin alone has been shown not to be effective in arthritis of the hip or knee, but apparently does in the hand. Nevertheless, I recommend using glucosamine either alone or with other additives that appear to work better.

COMMENT: These studies are very important and blood pressure medication should be taken at night. Many people, however, are on twice daily medications, but if taking a single agent and/or long-acting agent once daily, evening doses are better. It should be noted that other drugs, such as statins (and also fish oil) for high cholesterol are more effective when taken at night, primarily because that's when most cholesterol is manufactured in the body.

COMMENT: I recommend cannabis use to many of my cancer patients because it is very effective for controlling nausea, pain, anxiety and stimulating appetite. A "legal" form of marijuana for these purposes is called Marinol (dronabinol), but it may not work as well as actual marijuana. No studies have been performed to see if marijuana helps symptoms of other diseases,. It is interesting to note that patients paid out-of-pocket for the marijuana even if their insurance covered the prescription meds; patient only do that when they get better relief with less side effects.

COMMENT: Several clinical trials have showed that nicotine replacement had better success than in this trial. However, most of those trials were financed by the companies making the products. In the real world, the results are much poorer.

There's no question that smoking is tough to stop. However, there are alternative methods, such as auricular acupuncture (which decreases the desire to smoke) and mind-body methods (such as hypnosis) that addresses the underlying reasons for smoking that are much more successful.

COMMENT: Many people swear by Saw Palmetto in decreasing their BPH symptoms, but this study certainly disputes its benefits. You should realize that many products for BPH contain other herbs along with saw Palmetto, such as pygeum and pumpkin seed. Perhaps these combinations work synergistically to improve symptoms. My advice is that, if you decide to take it, take it in combinations and stop taking it if it doesn't work within 1-2 months.

COMMENT: Triptans have been available for a long time and are used almost like Tylenol or Advil. If you have atherosclerosis and migraines, be aware that you should not take triptans because they can cause cardiovascular side effects. Better yet, try acupuncture: it is very effective for decreasing or resolving migraines long term so that you don't have to take triptans.

COMMENT: Vitamin D deficiency is widespread and can be linked to many medical conditions, so it is important to maintain normal levels. However, 33 ng/ml is higher than that recommended by the National Institutes of Health (30 ng/ml). Many authorities recommend levels above 50 ng/ml. This study shows that you must have good Vitamin D levels for the best effect from biphosphonates. No studies have been done regarding vitamin D levels and strontium for osteoporosis (which I recommend over biphosphonates), but it is probably just as important.