1. The Internet Medical Journal
This Week in Medicine
13-March-1998
The big news in medicine this week was the publication of a study that found high salt intakes to be
correlated with longevity. This contradicts standard medical advice to decrease dietary salt intake in
order to lower blood pressure. This study contained a lot of confounding variables, and the effect was
small. Those with salt intakes in the highest quartile had a death rate of 19 deaths per 1,000 person-
years, compared with 23 deaths per 1,000 person-years in those people in the lowest quartile of dietary
salt intake. Guess what? Moderation seems to be the best advice! This age old wisdom continues to
stand the test of time (story).
In a related issue challenging standard medical advice, scientists are wondering whether a low
cholesterol level is associated with violent behavior. Evidence continues to support the notion that low
cholesterol levels are actually harmful. Cholesterol acts as a cell membrane stabilizer, and the theory is
that when cholesterol levels are too low, cells in the brain are adversely affected. The result, according
to the theory, is a lowered brain serotonin activity, leading to a higher rate of death from violence
(usually defined as homicide, suicide, or accidents). But just what is a "low" cholesterol level? That
remains mysterious, but some studies have defined it as a level below 160 mg/dL (story).
The number of new cases of cancer in the US population declined by an average of 0.7% annually from
1990 to 1995. This compares to an average annual INCREASE of 1.2% yearly from 1973 to 1990
(story).
Recommended reading this week is Psycho-Cybernetics by Maxwell Maltz, M.D. This classic book on
using your mind as a tool in the healing process was written by a plastic surgeon. Dr. Maltz found that
even after facial scars and other deformities had been surgically corrected, many patients continued to
complain of being ugly or unattractive in some way. He realized that the person's self image often
played a bigger role in the healing process from plastic surgery to correct deformities from facial
trauma. Over and over again, we are finding that the mind has a significant influence upon the healing
process, and Maltz's book describes practical and effective ways to use and control your mind. An
update of this book written by one of his students is also highly recommended. In Psycho-Cybernetics
2000 by Bobbe Sommer, Dr. Maltz's techniques are further refined and new methods of making your
thoughts work for you are introduced in an easy to read and understand manner. Another great book on
human cybernetics by U.S. Anderson is Success Cybernetics. This is a hard hitting, down to earth book
on cybernetics written by a former professional football player. The best work on how the mind can be
your greatest ally in the healing process, however, is the landmark book by Norman Cousins, Anatomy
of an Illness. If you are challenged by any physical illness, you should make reading this book a top
priority. Norman Cousins book is a true classic, and on my required reading list for doctors, nurses, and
everyone involved in the healing professions. Get the hardback edition since the cost difference is
minimal and because this is a book you'll want to keep in your personal library.
Now for the pearls of the week---

2. Low dose aspirin has been recommended by the American Diabetes Association to help prevent heart
attacks in diabetics over 30 years old. American Diabetes Association. Diabetes Care, NOV 1997,
020:1772.
Among smokers who want to quit, sustained release bupropion (Zyban) approximately doubled the quit
rate compared to placebo: at 1 year the placebo group had a 12% quit rate compared with a 23.1% quit
rate among those who used Zyban for 7 weeks at 300 mg/d Hurt RD ... NEJM, 23-OCT 1997,
337:1195.
In men who ate fish at least once a week, compared with those who ate fish less than once a month, the
risk of sudden cardiac death was significantly reduced (by about 50%, controlled for age, asa, risk
factors) . Total mortality was also reduced. Albert CM ... JAMA, 7-JAN 1998, 279:0023.
In this study of 742 adults with signs and symptoms suggestive of a pulmonary embolus (PE), the D-
Dimer blood test was 99.5% sensitive in detecting a PE. The specificity was 41.4% Perrier A ... Am J
Respir Crit Care, 1997, 156:0492.
In this study of 612 patients with an acute pulmonary embolism (PE), treatment with low molecular
weight heparin was as safe and as effective as standard therapy with unfractionated heparin. Simonneau
G ... NEJM, 1997, 337:0663.
Antibiotics are of little to no benefit in the treatment of acute maxillary sinusitis. van Buchem FL ...
Lancet, 1997, 349:0683.
In this study of elderly white women not on hormone replacement therapy, supplementation with
calcium (500 mg/d) and vitamin D (700 IU/d) was effective in lowering the rate of nonvertebral
fractures. Dawson-Hughes B ... NEJM, 1997, 337:0670.
In this rehash of the NHANES data, those in the highest quartile of salt intake had a lower risk of death
than those in the lowest quartile (19 vs 23 deaths per 1,000 person-years). Lancet, 1998, 351:0781.
Children of smokers have both an increased rate of illness AND death. In the US, annually there are an
estimated 5 million excess pediatric illnesses and 6200 excess pediatric deaths due to parental smoking.
Aligne CA ... Arch Pediatr Adolesc Med, 1997, 151:0648.
In this study of 3397 Swedes, the use of calcium channel blockers was associated with an increased
suicide rate. Lindberg G ... BMJ, 7-MAR 1998, 316:0741.