Monday, December 20, 2010

Staying Current

Information technology has transformed the everyday practice of medicine. I use my i-pad constantly: looking up medication interactions, calculating body mass indices and assessing future risk of heart disease. The Department of Public Health sends a fax with the most recent flu data. I have electronic access to the most current treatment guidelines.

However wonderful these new tools are, there is no substitute for peer-reviewed medical literature to keep a physician current. Newspapers and television programs might report the latest news, but there is no substitute for reading the original article. In order to really understand the material one has to delve into ‘materials and methods’ and determine if the conclusions are truly supported by the data. There is often a critical editorial, written by an expert in the field, which will add another perspective. The new information then must be integrated into the body of current knowledge.

Every week there is a fresh New England Journal of Medicine and JAMA. More important to my practice is the biweekly Annals of Internal Medicine. Not only do these journals present cutting edge medicine, they also have review articles that summarize the state of the art for various diseases and conditions. The NEJM has a clinical problem every week – it’s fun to guess the diagnosis just from the title (Shepherd with a Cough, Bolivian Immigrant with a Rash, Accountant with a Headache).

Right now, printed journals work best for me. However, once I read them I toss them into the recycling bin, since the contents are available on-line. My affiliation with Yale allows unlimited access – much better than the piles of journals that cluttered the office in the olden days. 

Wednesday, December 15, 2010

Body Mass Index

Measuring the body mass index (BMI) is the first step in determining if a patient is overweight. The BMI is easy to measure, reliable and correlates well with the percentage of body fat – it’s more accurate in assessing body fat than weight alone. The relationship between BMI and percent body fat is different among different ethnic groups. The risk of future disease is reached at a lower BMI for certain groups (South Asians) and in others at a higher BMI (blacks) as compared to whites.  In the United States, the risk of becoming overweight is 50% and the risk of becoming obese is 25%.

The highlight from this week’s New England Journal of Medicine is that fatter people were more likely to die from all causes. A meta-analysis (a study of many studies) yielded not surprising news. Persons with a BMI of 25-29.9 (overweight) had 13% increased mortality and those patients with a BMI of 35-39% increased their risk of death by 88%.

After studying 1.5 million patients, the authors of the study concluded that the optimal BMI is 20-24.9. Achieving a BMI of less than 22 in the mature adult can be challenging, especially if food intake is so restricted that one worries about nutritional deficiencies. The optimal body weight for any person should be part of a health maintenance discussion.