Our Legal Department just approved the following Holiday greeting:

Please accept with no obligation, implied or implicit my best wishes for an environmentally conscious, socially responsible, low stress, non-addictive, gender neutral, celebration of the winter solstice holiday ™, practiced within the most enjoyable traditions of the religious persuasion of your choice, or secular practices of your choice, with respect for the religious/secular persuasions and/or traditions at all…and a fiscally successful, personally fulfilling, and medically uncomplicated recognition of the onset of the generally accepted calendar year 2007 but not without due respect for the calendars of choice of other cultures whose contributions to society have helped make America great, (not to imply that America is necessarily greater that any other country or is the only "America" in the western hemisphere) and without regard to the race, creed, color, age, physical ability, religious faith, choice of computer platform, or sexual orientation of the wishee.

By accepting this greeting, you are accepting these terms: This greeting is subject to clarification or withdrawal. It is freely transferable with no alteration to the original greeting. It implies no promise by the wisher to actually implement any of the wishes for her/himself or others, and is void where prohibited by law, and is revocable at the sole discretion of the wisher. This wish is warranted to perform as expected within the usual application of good tidings for a period of one year, or until the issuance of subsequent holiday greeting, whichever comes first, and warranty is limited to replacement of this wish or issuance of a new wish at the sole discretion of the wisher.

As our population ages more people in our society are turning to hormone supplements to delay the aging process. Blood levels of dehydroepiandrosterone (DHEA) and testosterone decline with age and because of the popularity of the Internet many people are seeking supplementation to reverse the affects of aging. DHEA and sulfated DHEA are the most abundant steroids secreted from the adrenal cortex and their exact function remains an enigma. DHEA is regarded not as a drug but rather a dietary supplement and is not monitored by the FDA. Many online vendors extole its use as the fountain of youth with erroneous and misleading claims. Commercially available preparations contain from 0-150 percent of the amount stated on the package. A recent double-blind placebo controlled randomized trial included 87 men and 57 women aged 60 or older. The men received a DHEA tablet of 75mg, a transdermal testosterone patch or a placebo. Women received DHEA 50mg or a placebo. Treatment with neither DHEA nor testosterone had any detectable affect on physical performance, insulin sensitivity, or the physical and mental components of the quality of life. An accompanying editorial calls for DHEA to be regulated by the FDA and in light of the evidence suggests that there is no basis for using DHEA as a food supplement. Age related testosterone changes are physiologic and replacement should not be done unless medical indication is found. (N Engl J Med 2006 Oct 19; 355:1647-59. N Engl M Med 2006 Oct 19; 355:1724-7)

The US Preventative Services Task Force concluded in 2004 that evidence was insufficient to make a recommendation for or against screening asymptomatic patients for lung cancer. Wide spread screening is done to detect early cancers of the breast, colon, cervix, and prostate and this has resulted in somewhat lower mortality for these cancers. The five year survival rate among patients with stage I lung cancer is about 70% but declines to 5% in patients with stage IV lung cancer. Many of the stage I cancers presently are found serendipitously in asymptomatic people. This study enrolled more than 30,000 participants who were screened by spiral computed tomography. Lesions that were detected on CT scan under went an appropriate diagnostic procedure, usually fine needle aspiration and resection of their cancers. All the patients enrolled were at increased risk for lung cancer by virtue of their smoking history or occupational exposures and all were deemed healthy enough to undergo surgery. Cancer was diagnosed in 484 patients, 85% of whom had clinical stage I disease. In this study the 10-year survival rate was 88%. The authors make a strong argument for screening patients at risk with this study. Presently a low dose CT scan costs less than $200.00. It seems to be quite cost effective. It remains to be seen if the insurance companies will reimburse for screening in asymptomatic patients. (N Engl J Med 2006 Oct 26; 355:1763-71. N Engl J Med 2006 Oct 26; 355:1822-4)

John J. Mohr, M.D.