"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Pots and Kettles: Hard to believe, but people are getting up in arms over condom labels:
“This is completely pointless,” the 24-year-old Chicagoan said of the warning telling him that, while condoms can help prevent the spread of some sexually transmitted diseases, there are no guarantees.
Even so, that tiny bit of print is at the center of a raging debate now that President Bush has asked the Food and Drug Administration to modify the current warning to include information about human papillomavirus, commonly called HPV or genital warts.
...“The lack of information getting to the American public regarding this disease is beyond comprehension,” said Linda Klepacki, manager of the abstinence policy department at Focus on the Family, a Colorado-based organization.
She and others point to research showing that condoms don’t necessarily prevent the spread of HPV, in part because it may be found on parts of the body the latex devices don’t cover. Abstinence is the best way to prevent the disease, she argues.
Adding that information to a condom label would be “truth in advertising,” said Libby Gray. She’s the director of Project Reality, an Illinois-based group that teaches public school students about abstinence — and notes that most students she speaks with have no idea what HPV is.
But scientists who study HPV worry that abstinence groups are dismissing important information to promote their own values.
“I want to be polite. But it appalls me when I see scientific and medical studies being manipulated for a different agenda,” said Tom Broker. He’s a professor of biochemistry and molecular genetics at the University of Alabama at Birmingham and president of the International Papillomavirus Society, a coalition of experts who study HPV.
A label warning that condoms aren't 100% effective is probably a "different agenda" than Mr. Broker's, but is it really manipulating science or is it just common sense? Let's see what the trusted family physician has to say on the subject:
Can STDs be prevented?
Yes. The only sure way to prevent STDs is by not having sex. If you have sex, you can lower your risk by only having sex with someone who isn't having sex with anyone else and who doesn't have an STD.
You should always use condoms when having sex, including oral and anal sex.
Do condoms prevent STDs?
Male latex condoms can reduce your risk of getting an STD if used correctly (see the box below). Be sure to use them every time you have sex, during all types of sex, including vaginal, anal and oral sex. Female condoms aren't as effective as male condoms, but should be used when a man won't use a male condom.
Remember, though, that condoms aren't 100% safe and can't protect you from coming in contact with some sores, such as those that can occur with herpes, or warts, which can occur with HPV infection.
Who knew that the AAFP was a front for those right wing political organizations? posted by Sydney on
4/06/2004 08:05:00 AM
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Marlboro Men: Helena, Montana, banned smoking in public places for six months and saw a decrease in heart attack admissions. There were 16 fewer heart attacks in the region that serves 68,000 people during the six months of the ban. (The study is here in pdf form.) That's a very small difference, and could be accounted for by just about anything - from fluctuations in population size to other illnesses such as respiratory infections that might have been circulating in the community. But expect it to be used to support more public smoking bans. posted by Sydney on
4/06/2004 08:03:00 AM
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For Want of a Doctor, the Base was Lost: Even the military isn't immune to the effects of the medical malpractice insurance crisis:
.....the crisis could hurt Scott Air Force Base next year as the Defense Department embarks on another round of base closures.
That's because the Department of Defense will weigh quality-of-life issues, including access to healthcare providers and facilities, when it evaluates domestic military installations for closure starting next year.
...Republicans and Democrats agree that medical malpractice insurance premiums have risen sharply, making it costly for doctors to do business in Illinois. The Metro East has been hit particularly hard, officials said. Numbers are hard to come by, but John Baricevic, the Democratic St. Clair County Board Chairman, said that some 40 physicians have left Belleville's Memorial Hospital in the last year.
...The issue is "probably more important for the general fabric of the community than it is for Scott Air Force Base," Baricevic said. "But nevertheless it is a quality-of-life issue and it will be a piece of the puzzle, even if it is not the biggest piece." posted by Sydney on
4/06/2004 08:02:00 AM
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Not So Sweet Breath of Life: Emergency workers are overinflating the dead and the near-dead:
The researchers, led by Dr. Tom P. Aufderheide of the Medical College of Wisconsin, observed paramedics in Milwaukee giving CPR to heart attack patients.
The American Heart Association recommends administering 12 to 15 breaths a minute.
In the first seven patients observed, the paramedics gave about 37 breaths a minute, the study found. When the researchers retrained the emergency workers, the rate for the next six patients improved, going down to 22 breaths. Still, all the patients died.
Don't feel bad, EMS people. Your breath is still superior to flagellation, fumigation, and the bellows method. And actually, CPR has an abysmally low success rate. It isn't at all clear that adminstering fewer breaths per minute would result in better outcomes. Often, it's just that the person is already dead and nothing's going to bring them back.
posted by Sydney on
4/06/2004 07:58:00 AM
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Prohibition: The Teletubbies will no longer be allowed to corrupt the world's children:
The Teletubbies and Tweenies are to be banned from promoting unhealthy children's food, the BBC announced yesterday
...Tweenies and Teletubby chocolate bars, marshmallows and jellies will disappear completely, although the characters will still be allowed to appear on Easter eggs and birthday cakes.
...The Fimbles, Bill and Ben and Andy Pandy will also be covered by the new rules. However other favourites, such as Bob the Builder, Thomas the Tank Engine and Postman Pat are not owned by the BBC. Rupert Gavin, the chief executive of BBC Worldwide, said: 'We are conscious of the small but high-profile part we play through our licensing of children's TV characters to food manufacturers.
Do Thomas the Tank Engine and Bob the Builder have food products?
UPDATE: Bard-Parker says that, yes, Bob the Builder is a corrupter of youth:
My kids eat some sort of Bob the Builder themed gummy-bear type candy. The Tweenies are so annoying that any foodstuffs they promote are forbidden in the Parker household. posted by Sydney on
4/06/2004 07:56:00 AM
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Across the Netherlands hotel owners are lengthening beds and raising door mantles to stop the nation's tall youth suffering from irreparable anatomical damage.
According to a New Yorker essay on the subject last week, Dutch ambulances are even having to keep their back doors open on many occasions to allow for the prodigious dimensions of their patients' legs.
Better check those children for steroids.
It's difficult to take this article seriously, though. Especially in light of this explanation for why "during the Little Ice Age, in which temperatures plummeted across the world between 1300 and the mid-19th century, there was a noticeable decrease in human stature":
Firstly, all mammals get shorter and rounder when climates cool. It is a physiological response to cold. Short, round bodies preserve heat better than tall cool ones.
I can only think of one part of the body that shrinks as a physiological response to cold, and only about half of us are endowed with it.
UPDATE: A reader notes:
This article is so obviously biased in its anti-Americanism, it's laughable. On its face it doesn't make sense because we are the fattest group of people on earth, and slinging around the term, "poor nutrition" without citing any evidence for that, such as a dietary analysis, is pure conjecture. Something tells me there are a fair amount of vitamins and proteins sneaking in with all those calories.
Furthermore, they also tossed out the racial mix as a possible explanation without adequately analyzing it, either. They did not look at the current racial mix of Denmark, the UK and the US- they only pointed out that in the past, the US had lots of immigrants, too, and came out ahead of Europe. However, I would be willing to bet that the height measurements done in the nineteenth century may have completely ignored entire groups of immigrants, race relations and health care being what they were in those days.
Simply put, until they know the racial makeup of the people who were
actually measured, this study is worthless. On the other hand, if you
compared the height of North Dakotans against the Danes, you'd have much more closely matched groups.
P.S. As an interesting aside, in another article the Guardian noted
that it's taking up to 18 months to get an MRI in the UK. There's that good ol' socialized medicine at work again!
Some critics apparently think that raising any ethical concerns regarding uses of biotechnology is tantamount to reviving the war of religion against science. They would rather have an ethics council that, after fussing a little, simply pronounced its blessings on the technologically inevitable. We, by contrast, mean to give the ethical issues preeminence, while trying always to be accurate about the relevant science and hearing always from all sides of the debates.
Scornful Academics: I have some thoughts on Elizabeth Blackburn, the cell biologist whose term on the President's Council for Bioethics was not renewed and who has made quite a fuss about it in the media, over at Tech Central Station.
An additional bit of information that I wasn't able to fit into the column, but that shows just who on the Council is driven by agendas, is this appendix by Janet Rowley, (Dr. Blackburn's co-author in the PlosBiology article, which charges the Council of being politicized) in the Council's most recent report, Reproduction and Responsibility: The Regulation of New Biotechnologies (emphasis mine, although she emphasized those points, too, along with others.):
In my view, the report should have done much more to applaud the medical advances that have occurred leading to the effective treatment of an important medical problem, namely infertility, rather than focus primarily on the potential hazards and misuses of the new technologies. In addition, I think it is important to note plainly that some of the major concerns highlighted in the Report could be resolved relatively painlessly by changes in current governmental regulation, at the State and at the Federal level. I am also disappointed that the Report does not call for federal funding of basic and clinical research seeking improved methods of assisted reproduction or for mandated health insurance for ART services. Both of these measures would help to reduce the risks of ART to women and children.
Second Hand Killers: A new study says that living with smokers can kill you:
Evidence that living with a smoker can shorten your life has emerged from a study in New Zealand.
The study, one of the largest ever done, looked at deaths among people aged 45 to 74 who completed census returns in 1981 and in 1996.
Those who had never smoked but lived with people who did were 15 per cent more likely to die in the three years after each census than were those who had never smoked and lived with non-smokers.
The original article is available here, but only in pdf form. The actual numbers aren't as impressive as the relative risk reported in the London Times and other media stories would have you believe. Here's what they found:
From 1981 to 1984, men who were never exposed to tobacco smoke had a mortality rate of 1,530/100,000, or a mortalty rate of 1.5%. Men who had been exposed to someone else's tobacco smoke had a mortality rate of 1,684/100,000, or of 1.7% - only a 0.2% difference. For women during those years, the numbers were 1009/100,000 for those who were never exposed to tobacco smoke and 1050/100,000 for those who were exposed to second hand smoke. Both translate into a mortality rate of 1%.
From 1996 to 1999, men who were never exposed to tobacco smoke had a mortality rate of 1025/100,000 or 1% and men who were exposed to second hand smoke had a mortality rate of 1198/100,000 or 1.2%. Again, a 0.2% difference. For some reason, women during this time period had more of a difference than the previous decade. Women with no history of tobacco smoke exposure had a mortality rate of 672/100,000 or 0.7%, but those who had exposure had a mortality rate of 855/100,000 or 0.9%.
The authors call the increased mortality rate among those exposed to second-hand smoke "modest but consistent," although in the case of women, it isn't even consistent. And it's far too modest to justify Draconian anti-smoking laws.
Waiting decades for upper management to retire would surely stifle this renewing energy and slow the pace of innovation—with costs for the institutions in question and society as a whole.
Tales from Cloud Cuckoo Land: Shannon Brownlee has a lengthy piece in the Washington Monthly about the corporate corruption of scientific research. Even the editors of major medical journals know there's a problem:
As Dr. Drummond Rennie, deputy editor of The Journal of the American Medical Association (JAMA), puts it, 'This is all about bypassing science. Medicine is becoming a sort of Cloud Cuckoo Land, where doctors don't know what papers they can trust in the journals, and the public doesn't know what to believe.'
But isn't science a bastion of truth?
Such statements reflect the ideal of science, not the reality, says Dr. Marcia Angell, former editor in chief of The New England Journal of Medicine. Public protestations aside, she says, "Clinicians know privately that results can be jiggered. You can design studies to come out the way you want them to. You can control what data you look at, control the analysis, and then shade your interpretation of the results." Even the most careful research can be fraught with murky results that require sifting and weighing, a measure of judgment that the researcher hopes will bring him closer to the truth. Was this patient's headache caused by the antibiotic you gave her, or does she have a history of migraines? Is that patient's depression lifting because of the drug you are testing, or because a kindly doctor is actually listening to him?
But doesn't the peer review process keep everyone honest and insure that only scientifically sound papers get published?
When researchers submit papers to a journal, the editor has little choice but to trust the authors have employed a ruthless skepticism when viewing their own results, that they have bent over backwards to minimize self-delusion. Editors and peer reviewers can ferret out sloppy reasoning, look at how an author has designed and executed a study, and correct faulty statistics, but as Angell remarked, "We don't put bamboo slivers under their nails. If they wanted to lie, they could lie."
But, as we've seen with the recent MMR controversy, it isn't just corporate money and patent deals that drive the baser scientific instincts. Even studies funded completely by government or universities can be tainted by a researcher's agenda. If you've spent you're entire career arguing that A causes B, you're not going to be eager to publish data that says otherwise.
This is why "peer reviewed journals" have such a cache of influence. The peer review process is supposed to weed out the bad science from the good science, to reign in author enthusiasm and unsound conclusions. But in reality, it doesn't. My husband, who in his academic days did peer review, explains it like this: Rather than giving submitted papers to a broad range of general experts in a field for review, they are given to a handful of specialized experts in the whatever field the paper is in. So, for example, a paper on the effect of radiation on man in the moon marigolds wouldn't be given to a broad panel of botanists, physicists, and biologists, but to a group of scientists whose only interest is radiation and marigolds. And within very specialized fields, most of the researchers know each other. Some will love the paper just because it's written by someone they like or don't want to offend, and others will savage it because it's written by someone they don't like - or because the conclusions don't agree with their own work. An example of the former is the recent paper in JAMA that turned the most frequent causes of death from diseases into sins. One of its authors was the head of the CDC. Now, tell me, who in the public health community is going to tell Julie Gerberding that her science is flawed? No one. It takes an outsider.
None of this is new, of course. A scientist has to believe in his work in order to be motivated to do it. And the best of them have a passion for it. But even the most concrete of sciences can be influenced by observational bias, and passion can get in the way of reason, even among scientists. We, the public, have to remember that, and not treat every finding published in journals, no matter how respected, as the unimpeachable truth. (And the press needs to do the same.)
UPDATE: One of the members of the President's Bioethics Council
notes that in the case of the council, it's the scientists who are most agenda driven:
Scientists are no less drawn to power, and have no fewer agendas, than others. Indeed, years from now, when the full story of the council's work can be adequately told, I suspect it will be clear that ideological conformity has been sought at least as fervently by scientists as by any other group in our society. posted by Sydney on
4/03/2004 01:48:00 PM
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Medicare and Drugs: Kay Daly argues that the Medicare drug benefit is needed to protect elderly cancer patients, who have been "overtaxed all their lives" from greedy oncologists:
The GAO said that "physicians are able to obtain Medicare-covered drugs at prices significantly below current Medicare payments, which are set at 95 percent of AWP. Wholesalers' and GPO's prices that would be generally available to physicians were considerably less than AWPs used to establish the Medicare payment for these drugs."
According to Thomas A. Scully, former CMS administrator, "numerous studies have indicated that the ...reported wholesale prices, the data on which Medicare drug payments are based, are vastly higher than the amounts drug manufacturers and wholesalers actually charge providers. That means Medicare beneficiaries, through their premiums and cost sharing, and U.S. taxpayers, are spending far more than the "average" price that we believe the law intended them to pay."
Imagine that! A government program is not operating on accurate information, but relying upon an entirely flawed system of overpayment? And we wonder why Medicare is going broke?
Medicare always claims they pay too much for everything, when in reality they pay too little. And Medicare is going broke because there are more elderly people than ever, and they're living longer than ever, not because they overpay providers, believe me. posted by Sydney on
4/03/2004 08:07:00 AM
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Patient Education: The CDC has a new patient information sheet out - What You Should Know About a Smallpox Outbreak. And what should you do in the event of a small pox outbreak? Turn on your television and radio and they'll tell you. Presumably it will be one of those "emergency broadcast system" things. posted by Sydney on
4/03/2004 07:25:00 AM
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Friday, April 02, 2004
Medpundit Ad Scandal: From the following email, I gather there's a perception floating around somewhere in the cybersphere that some of my posts may be bought:
I have a source telling me that your post of 3312004 5:19:46AM was "placed" by an ad agency. Is this true? Do you have a policy of allowing content to be placed on your site? Do you receive compensation for this? Is there a way readers might know that your posts are essentially paid advertisements?
No one pays me for any of the posts on my blog. I post things that are interesting to me and that I think readers will find interesting. I often get emails from people - other bloggers and readers mostly - who have found something interesting that they want to pass on. Sometimes I even get press releases, believe it or not. If I think it's interesting, I post it. But no one pays me for it.
The closest thing I have to advertisements are the Amazon links to the left. I do get a small percentage from any purchases made through those links, even if the items purchased aren't the items advertised, but it's a very small percentage. In a good quarter I receive about ten dollars, which I get in the form of an Amazon gift certificate. (And thanks to everyone who has purchased items through those links. The resulting gift certificates have been used to bribe my children into leaving me alone in the mornings while I blog.)
I also receive free review copies of some of the books I review. A practice which is, I believe, quite common for book reviews - and book reviews that get a whole lot more attention than my little blog gets. And I do get paid for my Tech Central Station columns, but the opinions expressed in them are entirely my own. No one at Tech Central Station ever tries to influence the tenor and tone of my columns.
If I ever do accept ads, they will be easily distinguishable as such. My opinions will never be bought. I guarantee it.
Electric Miracles: An Ohio man has been cured of his Tourette's Syndrome thanks to implanted brain electrodes:
Until doctors attached electrodes deep into Matovic's brain Feb. 9, Tourette's syndrome had made everyday tasks nearly impossible and reduced him to someone in need of childlike care. That was until he was ``turned on'' by University Hospitals of Cleveland doctors.
When the electrodes first pulsed into his brain, the twitching stopped, the spasms ended, and, for the first time in years, 31-year-old Jeff Matovic was just another guy from Northeast Ohio who can once again shoot hoops with his brother.
``This has been a long, long time coming,'' Matovic said with a broad, steady smile ina news conference Thursday. ``This is truly the day of my life.''
Matovic's day was made possible by a revolutionary procedure in the treatment of Gilles de la Tourette syndrome -- a condition characterized by motor and vocal tics, which curiously can include profane outbursts.
The procedure, called deep brain stimulation, has been used for other movement disorders such as Parkinson's disease. It involves the implantation of electrodes into the part of the brain that coordinates body movements. The electrodes are attached to platinum wires that run beneath the skin from the brain to two pulse generators implanted just under the patient's collarbone.
The pulse generators, powered by batteries that last three or four years, shoot low-level electrical impulses through the wire into the patient's brain at regulated increments and levels. These pulses interrupt the brain's poorly functioning motor firings and restore them to normal -- giving the brain's symphony back its conductor.
You can read more about deep brain stimulation here. And here's a CT scan image of the electrodes in the brain. (D'oh! What's wrong with me? That's an MRI, not a CT)
posted by Sydney on
4/02/2004 08:31:00 AM
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Benders: Binge-drinking is more common among Midwesterners than any other group. By "Midwest" they mean places like South Dakota, Wisconsin, Minnesota, Iowa, and Nebraska, those cold and/or desolate parts of the Midwest. Who can blame them? posted by Sydney on
4/02/2004 08:26:00 AM
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A Brigham Young University sociologist says data from national surveys show Mormon women are less likely to be depressed than American women in general and show no major differences in overall life satisfaction compared to women nationwide but do score lower on measures of self-esteem.
Useful Illnesses: The Army (or more precisely, the Reserves and National Guard) has a worker's comp problem:
But Pentagon data and interviews with soldiers at six bases in the United States and Europe show combat wounds represent a minority of casualties during wartime. The Pentagon 'Operation Iraqi Freedom U.S. Casualty Update' on Tuesday listed a total of 2,998 soldiers wounded in action, in comparison to the 18,004 medical evacuations described by Winkenwerder.
The Pentagon defines a casualty as 'any person who is lost to the organization by having been declared dead, duty status-whereabouts unknown, missing, ill, or injured.'
More mundane wartime injures seem more prevalent: back and neck injuries, torn knees and elbows, heart and lung problems and mental problems like post-traumatic stress disorder that may not be diagnosed for months after returning from combat.
Sounds like the same kind of complaints I find myself filling in on worker's comp forms. People are often dissatisfied with their care and their progress in worker's comp injuries, too. In fact, they sound an awful lot like the National Guard and Reservist complaints that are being given a Congressional airing. It makes one wonder how much of the disgruntlement is due to a general dissatisfaction with their lot rather than real medical issues. Most National Guard and Reservists sign up thinking they'll never see action, let alone deployment overseas. (There really is a difference between the real army and what the English call the "territorial army." ) And it's been the National Guard and Reservists who have been loudest in their complaints, from worrying about anthrax vaccinations to complaining about the length of their deployment. They are some very unhappy campers. posted by Sydney on
4/02/2004 08:05:00 AM
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Autistic Roots: Evidence continues to grow for a genetic mechanism in autism:
There is growing evidence that the condition may be inherited. Studies suggest parents with one child with autism are 100 times more likely to have another child with the condition compared with other families.
However, scientists agree that the condition is complex and that more than one gene is involved.
Dr Joseph Buxbaum and colleagues at Mount Sinai School of Medicine in New York carried out genetic tests on 411 families, who have members with autism.
They found that they all had variations in the SLC25A12 gene, which is involved in the production of ATP.
The researchers suggested this flaw could disrupt the production of the fuel needed by cells. They said even minor disruptions could affect the ability of cells to function properly.
However, the researchers said the genetic variations they identified in this study appeared to be quite common.
By themselves, they do not cause autism. They said people with autism probably had this and other genetic mutations. posted by Sydney on
4/01/2004 09:37:00 AM
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Health Insurance Conundrums: I've put down some more thoughts on the difficulties faced by small businesses when it comes to healthcare insurance, over at Tech Central Station.
I agree with one of the commenters that the real solution is to divorce healthcare insurance from employment and make each person responsible for purchasing their own, just as we do with auto insurance and homeowner's insurance. But, until that day comes, the reality is that health insurance benefits are a critical factor in attracting employees. And in the current climate, small businesses are at a distinct disadvantage as a result. posted by Sydney on
4/01/2004 09:32:00 AM
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This Just In: Immunizations do not cause diabetes. There never was any good evidence that they did. Now, there's very good evidence that they don't, and it's time to move on to better things:
The scientific community should now move on to the most important tasks: identifying the genetic, immunologic, and environmental phenomena that are actually responsible for the development of diabetes and finding the means to prevent and treat this chronic disorder,' Levitsky adds.
CR*P: The latest hot trend in cardiovascular risk prediction, C-reactive protein, is coming under fire:
In the latest research, Danesh and his colleagues used data from an Iceland study of heart disease that began in 1967. They compared 2,459 people who had a heart attack or died of heart disease over 20 years of follow-up with 3,969 participants who did not have a heart attack. Frozen blood samples were tested for CRP levels.
The researchers calculated that those with higher levels of CRP had a 45 percent increased risk of heart disease compared with those with the lowest levels. The researchers also analyzed 22 studies on the topic and found that patients with higher CRP levels had a 50 percent higher risk of heart disease.
That is far less than the early studies indicated. Eleven of the 22 studies analyzed were done before 2000, and together they showed a 100 percent increase in risk, or a doubling of the danger, the researchers said.
"It's a cautionary tale about how high the bar really needs to be before we roll out scientific advances into the community and into the clinic," Danesh said.
That's a fair criticism. Tests that are touted as predictors of future disease really should be held to a high standard. If 33% of people who never get disease have high CRP levels compared to 44% of people who end up with disease, then its predictive value is rather limited. (The study's abstract is here.)
The authors of the study aren't shy about pointing this out:
'There's no good scientific reason to be using it as a predictive test,' said Dr. John Danesh, one of the British researchers at the University of Cambridge.
Danesh and his colleagues said groups that recommend the test should rethink their advice.
Which has Dr. Paul Ridker, the biggest CRP proponent in the country, and not coincidentally holder of a patent for a high-sensitivity CRP test, riled:
The authors "have the nerve to say it's not comparable to other risk factors, but it's exactly the same as blood pressure," says Paul Ridker of Boston's Brigham and Women's Hospital and a pioneer of CRP testing.
The nerve of them! To challenge the media's favorite Harvard cardiologist. Judging from the CNN article, there was quite a bit of pressure at the American Heart Association/CDC panel to adopt CRP more enthusiastically:
Dr. Thomas Pearson of the University of Rochester said the panel noted the weakness of the evidence and urged further study when it drew up the guidelines. He said the panel members were criticized as "way too conservative, stodgy and sticks-in-the-mud" by those who wanted more widespread testing.
"I think this is validating our conservatism," he said.
Yes, it does. And good on them for ignoring the name calling and sticking to reason in adopting their guidelines.
UPDATE: A reader comments:
Each year I accumulate a list of questions to take to my next annual physical. This year's exam was two weeks ago, and the value of CRP testing was on my list. (Interestingly, when I went to the Quest Diagnostics office for a blood draw a week ahead, there was a poster on the wall of the examining room that was basically an advertisement for CRP testing. I now wonder if Dr. Paul Ridker might somehow have had an involvement. In response to my question, I learned they are doing quite a few more of them these days.)
I went into the exam understanding that CRP is an enzyme produced in the liver in response to inflammation just about anywhere in the body, and that there was some association with inflammation in coronary arteries. I wondered how the test result would in fact be actionable.
I was not surprised to hear my physician say the evidence didn't yet seem to show a sufficiently high predictive value for the test relative to coronary artery disease for it to be used routinely for that purpose--that if an elevated result came back in my case, it would not be very useful to him in terms of further tests or altering the existing medication regimen.
