1. The Internet Medical Journal
This Week in Medicine
23-Jan-1998 Issue
Monday, February 22, 1999 2:30 AM
People are walking less and less. A report this week in the British Medical Journal
(http://www.bmj.com/archive/7127/7127e2.htm) estimated that people are walking 22% less today than
they did in 1972. The greatest decline in walking was among 5 to 15 year olds. Thought to be primarily
responsible for this decline is the rising use of the automobile. The report estimated that one fourth of
all car trips are less than 2 miles. Also, since 1975 the percent of children travelling to school by car has
increased from 12% to 23% in 1994. No amount of money devoted to medical care will make up for
the decline in activity by our youth.
This week the Lancet reports on a patient with intractable hiccups that apparently was cured by
smoking marijuana.
(http://www.thelancet.com/lancet/User/vol351no9098/letters/research.html#marijuanafor).
Recommended reading this week is Don't Sweat the Small Stuff... and It's All Small Stuff: Simple
Ways to Keep the Little Things from Taking over Your Life by Richard Carlson. $7.96.
Now for the pearls of the week...
About 1 in 20 Americans have asthma, with about 1 in 10 children suffering from it; the good news it
that a SINGLE daily dose of inhaled steroids can control symptoms (I.e. 4 puffs once a day is as
effective as 1 puff 4 times a day). J Allergy Clin Immunol 1997 100:0771.
The combination of aspirin and coumadin (mean INR 1.47, mean dose 4 mg/d) was successful in
preventing a heart attack in 5,085 men. Treating 1,000 men with aspirin OR warfarin a year would save
3 deaths; if both used for a year, 5 deaths avoided. Lancet 1998 351:0233.
The International Study of Infarct Survival (isis 3) concluded that contrary to earlier reports, sex has a
minimal effect upon outcome after a heart attack. Age and other confounding factors are much, much
more important. NEJM 1998 338:0008.
It is advocated the the use of bisphosphonates for the treatment of osteoporosis be restricted to 80 year
olds with at least one spinal compression fracture and also a low bone mineral density. Arch Intern Med
1997 157:2617.
Treating chronic anal fissures with botulinum toxin was found to be more effective than saline
injections in this study of 30 patients. Maria G … NEJM 1998 338:0217.
Aspirin is as effective as cholesterol lowering medications in the primary prevention of a myocardial
infarction. Lancet 1998 351(9098).
HMGcoA reductase inhibitors are useful in the primary prevention of stroke. Bucher HC … Ann Intern
Med 1998 128(2).
In Kentucky, 60% of medicaid patients with an upper respiratory infection were given antibiotics

2. although only an estimated 6% actually needed them. The cost savings for unnecessary antibiotic
prescriptions in Kentucy is $1.62 million dollars a year. Mainous AG … Arch Fam Med 1998
007:0045.