Mahatma Ghandi, as you know, walked barefoot most of the time, which produced an impressive set of calluses on his feet. He also ate very little, which made him rather frail and, with his odd diet, he suffered from bad breath. This made him (Oh, man, this is SO BAD, it's good) a super calloused fragile mystic hexed by halitosis.

Americans spend millions of dollars for vitamin supplementation every year. We are a nation that likes to take pills. Vitamin C and E, which have antioxidant effects, have been thought for years to help in the prevention of cardiovascular disease. This study in over 14,000 male physicians was randomized so that some received Vitamin E, 400 IU, Vitamin C 500mg, both vitamins, or neither. The men were at relatively low risk and were followed for a mean of eight years. Twelve-hundred and forty five cardiovascular events occurred but researchers found no differences in outcomes among the four groups. What was interesting is there was a near doubling in risk for hemorrhagic stroke although the absolute risk was still small. These data and previous studies show that there seems to be no cardiovascular benefit from extra supplementation with either Vitamins E or C in middle aged and older men. (JAMA 2008 November 12; 300:2123)

One of the ways the experts in healthcare hope to save money is by disease prevention and early detection. The U.S. Preventative Services Task Force (USPTF) has released new guidelines for colon cancer screening. The most notable change is that it recommends against routine screening for people who are over 75. It continues to recommend fecal occult blood tests, sigmoidoscopy or colonoscopy beginning at age 50 and continuing through age 75. They concluded that insufficient evidence exists to recommend fecal DNA testing or CT colonography for colorectal cancer. The latter has been popularized because it is not invasive, requires no sedation, and carries a very low risk of injury but it is less sensitive, especially for detecting smaller lesions and exposes the patient to radiation. If lesions are found a follow-up colonoscopy is required. Newer fecal occult blood tests are more sensitive but less specific than the older versions. This same group recommends against screening for prostate cancer in men age 75 years or older feeling that as patients age the benefits of screening attenuate as the possibility of harm increases. Needless to say there is much controversy surrounding this recommendation. (N Engl J Med 2008 December 11; 359:24 - Ann Intern Med 2008 October 6)

The Wisconsin Medical Society now prohibits its members from accepting any gifts including personal items, office supplies, food, travel, and time costs or payment for online continuing medical education. The policy further requires that physicians limit drug samples to patients and use a system of vouchers for evidence based drug choices. They are encouraged also not to serve on speakers bureaus for health product companies according to the new policy. (Medical Economics, December 5, 2008)

Finally, I want to thank all of you who gave feedback during the past year and along with Dave and Marie. I wish you a blessed New Year and much success in the practice of medicine.

John J. Mohr, MD