“Health professionals need to talk to men about their problems in the sort of language they use and should move primary care into the workplace to make it easier for men to access health services, a debate held by the Mens Health Forum heard.

Men currently use healthcare services far less effectively than women, and a recent Cancer Research UK survey found that men are almost 40% more likely than women to die from cancer (http://info.cancerresearchuk.org/cancer stats).”

“Richard Doll was a luminary of clinical research whose case control study, published in the BMJ in 1950, first identified smoking as an important cause of cancer and other diseases.

He carried his research out on doctors in the UK who smoked, and tracked their mortality over the course of 50 years. The latest paper being published in the BMJ in 2004.”

Smoking now is linked to a large number of disease and it affects virtually every organ system of the body.

Information on how to quit smoking from Medline Plus: Quitting Smoking

Muscle pain is quite common in people (up to 10%) who take one of the several statins for lowering their cholesterol levels. However, there is no strict consensus on how to define, diagnose and manage such muscle pains.

The Annals of Internal Medicine recently published an excellent review on “Statin related myopathy.” Here is a brief summary of the article.

Definition:

There is no consensus definition. Each group (ACC/AHA, FDA etc) have their own definitions. For most clinical purposes the following definitions should be adequate:

Myopathy: Muscle disease with creatine kinase > 10 time upper limit

Rhabdomyolysis: Creatine kinase elevation with end organ damage

Pathophysiology:

Incompletely understood. Proposed mechanisms include:

1. Decreased cholesterol content of skeletal myocyte membrane leading to instabilty
2. Depletion of isoprenoids and/or coenzyme Q10
3. Mitochondrial dysfunction

Risk factors for developing myopathy:

• Advanced age
• Smaller body size
• Multi-system diseases (including hypothyroidism)
• Alcoholism
• Major surgery, excess physical activity
• History of myopathy while on other lipid lowering agent
• Family history
• Higher doses of statin
• Interaction with other drugs leading to increased bio-availability of statins

Clinical Features:

Major site of muscle pain were in the thighs, calves or it was generalized. Pain was described as heaviness, stiffness or cramping and sometimes was associated with exertion. Physical exertion was a common trigger of myalgia. Tendon pain may also be present.

Management:

• Check creatine kinase (CK) levels in high risk patients
• If CK levels > 10 times upper limit, stop statin
• Re-initiate statin with a lower dose once CK levels return to normal
• Try switching to fluvastain (better tolerated) or rosuvastatin (less interaction with other medications)
• Atorvastatin and Rosuvastatin have long half life and can be administered on alternate days
• Trial of other lipid lowering agents (e.g. Bile acid binders, ezetimibe, niacin etc)
• Co-enzyme Q10 supplementation may tried. No clear benefit but is very safe.

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A new study published in the Journal of American Medical Association has found a link between being obese in early adulthood and the risk of developing pancreatic cancer.

Individuals who were overweight (BMI of 25-29.9) from the ages of 14 to 39 years or obese (BMI > 30) from the ages of 20 to 49 years were at about twice the risk of developing pancreatic cancer (OR 1.67 & 2.58 respectively), independent of diabetes status. Also obesity at older age was associated with lower overall survival in patients with this malignancy.

The main drawback of the study is that this is a case control study, therefore the 2 factors studied (viz. pancreatic cancer and obesity) could occur together but not be causally related (although the authors did do adjust for most other risk factors of pancreatic cancer).

Reference: JAMA - Body Mass Index and Risk, Age of Onset, and Survival in Patients With Pancreatic Cancer

Links for more information on pancreatic cancer: Mayo Clinic, National Cancer Institute

Update (6/29/2009): YouTube Video from JAMA

“In this video, Dr. Joe Bresee with the CDC Influenza Division describes swine flu - its signs and symptoms, how it’s transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.”

Map: Weekly Influenza Activity Estimates Reported by State and Territorial Epidemiologists