AUDIO FILES=========
Previous presentations: Remember concepts may have changed since recorded.
Aspirin Low Dose March 2006
SleepApnea Nov2005
RSV Infection Jun2005
Atrial Fibrillation Dec2004
Thyroid Nodule Dec2004
Multiple Myeloma Dec2004
Merck Vioxx and FDA 2004
Systolic Blood Pressure 2004
Fibromyalgia 2004
PSA
PSA and Prostate CA
Smoking in the 21st century......
Worldwide four million unnecessary deaths per year and
eleven thousand per day. Tobacco was responsible for
three million deaths anually in 1990 and it is estimated
that this will rise to 8.4 million in 2020.
Tobacco smoke content includes over 4000 chemicals
many of which are carcinogenic. Chemicals used as
paint strippers floor cleaners ant poison and lighter
fuel are included. Smoking is responsible for 90% of
lung cancers 75% of chronic bronchitis and emphysema
and 25% of heart disease. Smoking rates vary around the
world and while the % of smokers in the US is down into
22-24% range many other countries have very high
percentages. For example France 34.5% rate and Germany
35% Bosnia 48% Cuba 37.2% Turkey 44%.
Help stamp out this preventable death by supporting
the World Health Organization initiative to reverse these
numbers and continue to encourage smokers to be excluded
from public places. Theapies to help someone to
stop smoking are highly effective and if you need help
see your doctor. The following are pdf files with greater
detail which you can download.
Smoking effects
Smoking demographics
JOURNAL CLUB 02/16/03
When I take that pill....
My patients often say "When I take that pill...." and the ending has
many variations such as it gives me a headache or nausea etc. They imply
that while most people have no problem with this medicine they do and anyone
who has taken enough pills knows that what is good for one person may be
poison for another. A recent(02/06/03) NEJM review article by Dr. Weinshiboum
entitled -Inheritance and Drug Response- shows us this developing area and
gives hope that in the future we may by simple blood testing know that a pill is
not for us. Our genetic makup determines the enzymes which we have to
metabolize a particular drug. Now we may have a variant of what most people
have and thus if we take the drug it might build up to 10 times the level
that it would for the vast majority of people. This could prove to be damaging or
fatal for us. For example, fluorouracil a chemotherapy drug was found to
have a fatal central nervous system toxicity in several patients after
treatment with standard doses. The patients were shown to have an inherited
deficiency of dihydropyrimidine dehydrogenase the enzyme involved in the
drugs metabolism. While only affecting one percent of the population it
can be fatal for these people. For another drug nortriptyline an antidepressant
the level in the blood can be 60 times greater in some people with another
enzyme variant. Many other examples are given and this is only the beginning
of the story. Pharmacogenetics is only in its infancy. Tests will eventually be
developed to know the major types of enzymes you have and thus before hand
dosage ajustments or drug avoidance can occur. So the next time someone says
to you "but I never heard of anyone not being able to take that pill" then
you know that such things do happen.
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