If a pharmaceutical representative walked into your office with a new drug that would reduce mortality by 15% and saved society $20,000 per year, would you start to use it in your practice? Continue reading
Category Archives: Uncategorized
Radiation risk
The Biologic Effects of Ionizing Radiation report was initially requested by the U.S. Environmental Protection Agency in 1996. Since then, there have been several revisions of the BEIR report, the last being the BEIR VII Report in 2005. BEIR VII was different in that it also looked at the effects of low dose (<100 MSv) radiation on humans.
BEIR VII estimated a 1:1000 risk for cancer from one 10 mSv exposure to radiation. This is the radiation exposure from one abdominal, pelvic, or chest CT. These are imaging studies we order very commonly in our practices. In fact, there were over 70 million CT scans ordered in the United States in 2007 with projections that this may cause 29,000 future cancers.
No one really knows whether there is significant risk from one CT scan. These estimates of risk are based on an analysis of large populations over time using a linear non-threshold extrapolation. However, even if the risk from one scan is small, it is not insignificant and people are exposed to so many studies over a lifetime.
Background exposure to natural radiation in the United States is about 3 mSv per year (mostly from radon). In 1980, the average radiation dose per person in the U.S. from all sources was 3.6 mSv per year. However, by 2007, the average dose in the U.S. had nearly doubled to 6.2 mSv per year. CT scans have become the biggest source of radiation exposure to humans after background radiation.
The risk of cancer varies by age and gender. The risk of cancer is much higher for those under 20 years of age and for females. We need to be especially careful in imaging children. There are over 7 million CT scans performed annually on children in the U.S. Pediatric radiologists practice ALARA (as low as reasonably achievable) in imaging children, but nothing is better than judicious ordering to protect our children.
| Age | 5 | 10 | 20 | 30 | 40 | 50 | 60 |
| Male | 1:557 | 1:692 | 1:1024 | 1:1458 | 1:1543 | 1:1692 | 1:2045 |
| Female | 1:296 | 1:383 | 1:608 | 1:939 | 1:1129 | 1:1351 | 1:1706 |
Estimated life-time risk of cancer, BEIR VII Phase 2, 2006
The radiation dose our patients receive varies by the type of study. Although plain films do not expose our patients to large doses of radiation, a CT of the abdomen or a barium enema is equivalent to about 750 chest x-rays, or more than 3 years of background radiation.
So yes, we need to be careful in ordering CT scans or other high-dose radiation imaging for our patients. This is our problem since the best predictor of radiation exposure in a population is the number of physicians in practice in that community.
Jim Cotter, MD MPH
Bye-bye bimanual
When I was the medical director of the Sonoma County Public Health outpatient clinics, which included the Family Planning and STD clinics, I would commonly discuss the lack of need for a bimanual exam of the, typically, young women who used our services if they Continue reading
Experts are growing hoarse warning us about antibiotic prescribing
If you are reading this post, you have repeatedly heard the cautions about avoiding overuse and inappropriate prescribing of antibiotics. Well, the national experts who continue warning us on this topic feel they are speaking into deaf ears. Continue reading
“I don’t want to hold your hand.” – C.S.Lewis. “I want to hold your hand.” – The Beatles
A recent survey of multiple large, national databases in the US has reported that Clostridium difficile (C.diff) colitis is now the 9th leading cause of gastrointestinal and liver related deaths. Way out of line with my own perception of GI-related mortality, Continue reading
For whom the bell tolls – steroids or antivirals for Bell palsy?
Sir Charles Bell first described the anatomy and function of the facial nerve in the 1800s. No wonder the eponymous Bell palsy bears his name (apparently we are no longer to refer to it as Bell’s palsy). The term Bell palsy is not synonymous with Continue reading
Knee MRI – are we getting TMI (Too Much Information)?
A recent BMJ study is an eye-opener about problems interpreting knee MRI’s in older adults. The bottom-line? A picture may not be worth a thousand words.
Let’s look briefly at Continue reading
The Great Imitator continues to fool primary care clinicians
If an august, gray-haired professor delivered your medical school lecture on syphilis, or if you had to suffer the pontifications of a wise-acre resident on the I.D. service during internship, you may recall that syphilis was formerly known as “The Great Imitator.” Continue reading
A crow dies in Dixon – authorities on the look-out for West Nile virus
Usually the death of a crow does not merit a front page news story. But the crow found down July 12 in Dixon, in Solano County, succumbed to West Nile virus and this fact garnered the poor bird much attention. With summer upon us, it is once again Continue reading
Welcome to PHCPrimaryCare Blog
The Medical Directors of Partnership HealthPlan of California, serving 200,000 members in 6 counties north of the San Francisco Bay, post items we think will be of interest to our primary care provider network. Our goals are to identify information that is clinically useful, based on good scientific evidence, data and expert opinion, and to present it in a conversational, accessible way that will improve quality of care for our patients to provide optimum value and cost-effectiveness in health care decision-making.
If you would like to suggest a topic or resource, please send an email to the blog editor, Richard Fleming: rfleming@partnershiphp.org
We would like to extend a special thank you to the primary care clinicians in our network, for providing respectful, caring, high quality care to our members. We share your commitment to your patients, many of whom are among the most vulnerable members of our community.
Sincerely,
Robert Moore, MD MPH, Chief Medical Officer
Richard Fleming, MD, Regional Medical Director, Solano and Yolo Counties
Marshall Kubota, MD, Regional Medical Director, Sonoma, Marin and Mendocino counties
Mark Glickstein, MD Associate Medical Director
Partnership HealthPlan of California
360 Campus Lane, Suite 100, Fairfield, CA 94534
www.partnershiphp.org