My top seven posts of 2014

Im now in my fifth year of blogging. Thanks to everyone who has taken the time to read what I have written—especially those who have commented. Ive learned a lot from you.

My seven most read posts of 2014 are listed below. Click on the title to read the post.

"That electric hand dryer study was bogus" was an analysis of a study that made outrageous claims about electric hand dryers and dispersal of bacteria.

"What are the residency prospects for graduates of offshore medical schools?" took a look at the realities associated with graduating from medical schools outside the 50 states and Puerto Rico.

"Preventing infection: The "bare below the elbows" rule for doctors doesnt go far enough" discussed the role of clothing in the transmission of disease and the ultimate solution to the problem.

"A medical student says to abandon the match" was my take on a proposal to do away with the residency matching program in the US. Spoiler alert: I didnt think it was a good idea.

"How to select surgical residents: The evidence" was a review of the limited evidence concerning how surgical program directors select candidates to interview and rank.

"A paper of mine was published. Did anyone read it?" spoke to the proliferation of medical journals, the likelihood that a single paper will be read, and what the future may hold.

"Health Care and the $20,000 Bruise: A different take" raised a lot of questions about a Wall Street Journal article written by a doctor who took his son to an emergency room for an 11-day-old bruise on his head.

And the all-time winner so far is this post, "Appendicitis: Diagnosis, CT Scans and Reality," which was the tenth post I ever wrote and is approaching 22,000 page views.







Best wishes to all.

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My top seven posts of 2015

I’ve been blogging since July of 2010. Here is a list of my most viewed posts of 2015. Thank you for reading and commenting.

“How much money do journal publishers make? A lot,” a look at the highly profitable world of journal publication, was number 1. Profit margins of the top for medical publishers range from 32% to nearly 42%. It’s a good business to be in.

Next was “A shallow water blackout is a silent killer.” What can happen if you hyperventilate before swimming underwater? You might die.

“How to pick the leading physicians of the world” was a humorous take on an “honor” bestowed upon me by a company that is a little careless about choosing its candidates.

In “Narcotics addicts can sue doctors and pharmacies for ‘enabling’ them,” we learned of a ruling by West Virginia’s highest court that spells trouble for both patients and physicians.

“Antibiotics for appendicitis? No thanks” was a critique of a Finnish randomized prospective trial of antibiotics vs. surgery in uncomplicated appendicitis. I had some serious concerns about the way the study was done and interpreted.

“Do surgeons still do postop care?” was a guest post by a medical hospitalist who felt that surgeons were no longer interested in taking care of their patients after operating. It drew a number of comments.

The seventh most-read post was “So you want to be a radiologist,” written by a radiologist who I asked to respond to an email I received from a pre-med student. It was a nice discussion of the pros and cons of the specialty.

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Another reason not to rely on medical advice from the Internet

On New Years Eve, The Daily Beast published an article with suggestions about how to avoid a hangover.

Some of the tips were reasonable such as limiting yourself to one alcoholic drink per hour and maybe avoiding certain beverages like wine, bourbon, and Scotch, which contain congeners and have been associated with worse hangovers.

However, some of the advice is wrong.

The article recommends this on the day you plan to party:

6 a.m.: Rise and hydrate! Drink early and drink often. One of the main causes of a hangover is dehydration. Women should be drinking 2.7 liters per day, and men should get 3.7 liters. Thats 0.7 gallon and 0.97 gallon, respectively.

After you party, at 12 a.m.: Drink some water and get to bed. It’s your last chance of the day to hydrate, so seize it! Sip some water before your head hits the pillow, but avoid popping any anti-hangover pills.

The 6 a.m. recommendation has two important bits of misinformation. One, dehydration is probably not a major factor causing a hangover. A 2010 literature review explains that hangovers are much more complicated than most people think. From the abstract:

Markers of dehydration were not significantly related to hangover severity. Some studies report a significant correlation between blood acetaldehyde concentration and hangover severity, but most convincing is the significant relationship between immune factors and hangover severity. The latter is supported by studies showing that hangover severity may be reduced by inhibitors of prostaglandin synthesis. Several factors do not cause alcohol hangover but can aggravate its severity. These include sleep deprivation, smoking, congeners, health status, genetics and individual differences.

Two, the idea that you need to drink 8 glasses of water per day is a myth. The best plain English explanation of this appeared in the New York Times last summer.

The 12 a.m. suggestion may also be incorrect. Do you really need more water right before you try to sleep?

As the 2010 review pointed out, blocking prostaglandins by taking an anti-inflammatory drug like ibuprofen might be useful. However, a small risk of bleeding from gastric mucosal damage with the combination of alcohol and anti-inflammatory drugs is a concern.

Abstaining from alcohol or drinking it in moderation is the best way to avoid a hangover. Once you have a hangover, the best remedy is time.

A Washington Post article on the dangers of overhydration in marathon runners quotes an expert as follows: “Drink when you’re thirsty. It’s not something you have to tell your body to do.”

If you have normal kidneys and drink as much water as The Daily Beast recommends, you may avoid hangover because instead of getting drunk, you will be spending a lot of time in the bathroom peeing.

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Overactive bladder Is it a disease

According to the Urology Care Foundation, the official foundation of the American Urological Association, 33 million Americans suffer from overactive bladder (OAB). Thats 30% of all men and 40% of all women in the United States. The foundation estimates that the actual number is much larger because many people who have overactive bladder problems are embarrassed and do not seek care.

This represents a nearly twofold increase since 2001 when a paper written said 17 million people had the problem.

Its not clear how either of the two sources cited above obtained their information.

Maybe you didnt know that there are two kinds of OAB. "Dry" is the one where the patient is able to get to the bathroom on time. "Wet" is the form that is accompanied by leakage of urine also known as the urge incontinence.

Here is something else you probably didnt know. The disease was virtually unknown before 1997.

What happened in that year?

A drug company, Pharmacia, had a drug called Detrol that they were originally going to market for the treatment of urinary incontinence. However the number of people with urinary incontinence was small. They decided to focus on people who had urinary frequency and urgency and declared that incontinence was not absolutely necessary to make the diagnosis of OAB.

As related in the book "Our Daily Meds," the drug company had to convince people who went to the restroom frequently and were previously treated with conservative measures such as restricting fluid intake and eliminating caffeine from the diet that OAB was not just an annoyance or inconvenience but a serious condition requiring professional medical care. They named it "Overactive Bladder."

A special supplement to the journal Urology in 1997 contained 30 articles about OAB, a number of which were written by doctors who were paid by Pharmacia.

Here is a graph by year for the 4803 papers listed in PubMed on the subject of OAB since the term first appeared in 1977.

Of the 69 papers written before 1997, only 7 used the term "overactive bladder."

There are now seven drugs for the treatment of OAB on the market. Consumer Reports says that none of the seven is clearly more effective than the others. The monthly cost of these drugs can be as low as $4.00 for a generic to $300 for a brand name medication.

In 2010, the website Decision Resources predicted that "the OAB drug market will increase from approximately $3 billion in 2009 to nearly $4 billion in 2019 in the United States, France, Germany, Italy, Spain, United Kingdom and Japan."

Not a bad return for treating a disease that did not even exist until 18 years ago.

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