Four weeks later their boss remarked, "You are all working very hard and I'm satisfied with your work. We have noticed a marked increase in the whole company's performance. However, one of our secretaries has disappeared. Do any of you know what happened to her?"

The cannibals all shook their heads, "No".

After the boss had left, the leader of the cannibals said to the others, "Which one of you idiots ate the secretary?" A hand raised hesitantly. "You fool!" the leader said. "For four weeks we've been eating managers and no one noticed anything. But NOOOooo , you had to go and eat someone who actually does something."

One of the more important things I think I did for my patients was to encourage them to bring in all of their medications and do a "brown bag biopsy" if necessary. A recent commentary in JAMA by Schiff makes some good points regarding conservative prescribing and bemoans the current status of pharmacology teaching in our medical schools. He encourages physicians to think beyond drugs and to treat underlying causes rather than solely treating symptoms; to be strategic in their prescribing and to learn to use a few drugs really well. He encourages physicians to avoid switching drugs without evidence based reasons and whenever possible to start only one new drug at a time; to have a heightened awareness about adverse side effects and to have a healthy skepticism regarding new drugs. This entire commentary is worth your perusal. (JAMA 2009 Feb 25; 865-867)

Two new interferon-gamma release assays have recently received FDA approval. These TB tests require a simple blood sample which is incubated with two or three tuberculous antigens. Even those individuals previously vaccinated with BCG can have this test. The new test is now available in Idaho at our state lab. Researchers have recently decided it is cost effective given it doesn't require a follow-up visit or reader interpretation. (Arch Intern Med 2009 Jan 26; 169:179)

About 80% of the influenza strains this season are influenza A and almost 99% of the isolates have been resistant to oseltamivir (Tamiflu). None though are resistant to the zanamivir (Relenza). Rapid nasopharyngeal swabs can now diagnose influenza within minutes or hours and because of recent resistance zanamivir is now the preferred treatment if rapid testing is unavailable. It should be taken within 48 hours of the onset of the illness. The drug is not recommended for use in children under 7 years old. For influenza B oseltamivir is still susceptible. (The Medical Letter Jan 25; 51:1304)

A recent survey of over 3000 adults age 57-85 showed that overall 81% of them use at least one prescription medication and nearly half use at least over-the-counter medication or dietary supplement. More than half used five or more medications or supplements. Researchers identified possible drug-drug interactions of which 46 involved over-the-counter medications. Our older patients are frequent users of over-the-counter medications and supplements and the potential for serious drug-drug interactions is always present so it is important we assess these medications and supplements routinely in our patients. (JAMA 2008 Dec 24/31; 300:2867)

John J. Mohr, MD