Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 100,000 physicians trained in internal medicine. The following highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. The full text of selected articles can be accessed on the Internet at http://www.acponline.org/journals/annals on July 1,1998. * * *
Study Looks at Chiropractors Use of Manipulation According to Appropriateness Criteria
Using appropriateness criteria developed in 1990, researchers studied records of people who received spinal manipulation from chiropractors for low back pain in the U.S. and Canada between 1985 and 1991. They found manipulation met criteria in 46 percent of cases, did not meet the criteria in 29 percent, and was uncertain in 25 percent of cases. (Article, p. 9.) The study looked at the appropriateness of beginning the treatment not at the number of sessions. Recent U.S. practice guidelines recommend spinal manipulation for some patients with low back pain. In an accompanying editorial, a writer says that the medical community must develop training and research protocols to make sure complementary or alternative medicine is measured for positive clinical outcomes. (Editorial, p. 65.) * * *
The Language of War, Applied to Breast Cancer, Has Polarized Discussion
>From the 1930s until today, discussions about breast cancer have often used military rhetoric. This language has polarized scientific discussion and contributed to the difficulty of developing realistic guidelines for early detection of breast cancer, says Barron H. Lerner, MD, PhD, of Columbia University. (Medical Writings, p.74.) He says the wartime mentality favoring early intervention fostered overuse of prophylactic mastectomy. As breast cancer knowledge moves onto the 'genetic battlefield' with tests to identify the 'time bombs' of genetic mutations, he says history shows how damaging such rhetoric can be when women and physicians do not know what use can be made of the screening tests. * * *
Three Case Reports of Severe Liver Disease Associated with New Diabetes Drug
Two cases of severe liver disease and a case of liver failure leading to transplantation, all apparently associated with troglitazone, a new drug to treat diabetes, are reported in this issue of Annals. (Case Reports, pp. 36 and 38.) While such reactions are uncommon but idiosyncratic, the reports caution physicians to monitor liver function regularly after prescribing the drug. * * *
Fluoride Plus Calcium Decreased Spine Fractures, Compared with Calcium Alone, in Women with Mild-to-Moderate Osteoporosis (Article, p. 1.) # # #
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