HUB's LIST of medical fun facts

Lately I have noticed more than the usual number of strangers holding doors open for me and hailing me with a cheery “Good morning, young man” or “After you, young man”. I feel I am being pushed back from my denial of growing old. My crumbling denial wall was completely shattered by the latest edition of the NEJM Journal Watch in General Medicine. It cited so many medical studies ( 8 out of 12) relevant to the elderly , excuse me ,  “older people” (and to me), that just picking through the rubble created this blog.

New Blood Test Can Diagnose You as “Old”
Thirty years of research has been unsuccessful in accurately identifying when your cells, and you, were actually getting old. A new study measured 3000 proteins in the blood of 45,000 British residents and concluded that about 200 of those proteins accurately predicted whose biological age was more than their chronological age. Those with higher levels of those 200 proteins had “older cells” and were more apt to show age-related physical declines, have more age-related diseases, and had earlier all-cause deaths. The study results were validated by separate studies in China and Finland, . . . but the blood test is not yet available at your neighborhood Urgicenter  . . . just yet.

Screening for Atrial Fibrillation (AF) Doesn’t Prevent Strokes
AF is usually an asymptomatic irregular heart rate, but the blood clots it can produce may cause a stroke. It was hoped that screening people with heart monitors could identify AF at the initial onset so that early anticoagulant treatment could avoid subsequent strokes. (Perhaps you have seen the TV ads about buying a wrist band or a wallet sized credit card-like device to diagnose your own AF heart rate. “Isn’t capitalism/consumerism wonderful?”) Unfortunately a study of 12,000 people over 70 years old in the U.S. who wore a heart rate monitor for 14 days, so that treatment of any AF could be started immediately, did NOT reduce the incidence of stroke (less than 1% anyway) nor prevent hospitalization (also about 1%). The study did find that slightly more than expected (5% rather than 3%) of people showed short periods of AF, but it was NOT of clinical significance. The current medical consensus is to treat patients with anticoagulants only if they have a sustained period (over 24 hours) of AF.

False Positive Mammograms May Delay or Prevent Future Screening for Breast Cancer
More than half (>50%) of women who start getting screening mammograms in their 40s receive at least one false positive reading. Besides causing anxiety, distress, and sometimes further expenses of short-term repeat exams or even biopsy, the women with a false positive reading were less likely to return for a follow-up screening 9 to 30 months later. Non-compliance with follow-up mammograms raises the risks of missing a growing mass or even a new mass. Options to reduce this “non-compliance” after false positive tests include an MRI for dense breasts or switching from an annual mammogram to a biennial schedule (apparently has a lower false positive rate). ( Ann Intern Med 2024 Sep. 3)

MRI-targeted Prostate Biopsy Is the Way to Pursue an Elevated PSA.
If a man 50-60 years old has an elevated blood PSA (prostate-specific antigen) level of 3-10 units the current next diagnostic step in looking for the cancer is usually 10-12 needle biopsies of the prostate as an outpatient. Many studies have shown that prostate cancer can often be indolent (“not clinically significant”), and it is believed that this diagnostic sequence in response to an elevated PSA causes too many unproductive biopsies and even an over diagnosis of “clinically significant” prostate cancer. A study of 13,000 middle-aged men in Sweden who had elevated PSA levels showed that a biopsy of just the suspected lesion seen on MRI was better than the standard multiple biopsies in diagnosing clinically significant prostate cancer. The MRI-targeted biopsy patients had no clinical downside after 4 years of follow-up. Longer term outcome studies are already underway. The number of “incurable” prostate cancers was rare, and nearly equal in both the MRI-targeted (23) and the standard multiple biopsy (15) groups.

If You Are Over 65 Get the High Dose (HD) Flu Vaccine
The HD (high dose quadrivalent) flu vaccine has a higher (4x) antigen content than the SD (standard dose quadrivalent) vaccine. It reduced the subsequent hospitalization rate from 91 per 100,000 patient years for SD receivers to 70 per 100,000 patient years for HD receivers in a French study of the 2021-2022 flu season. The researchers sadly noted that twice as many of the over 65 vaccinees received the SD dose rather than the HD dose in this study of 2 million people.

Do Antiviral Meds Lower the Risk of Long Covid?
No one knows for sure just yet. This study of the antiviral oral medication Lageviro (Merck, Sharp, and Dohme), similar to Paxlovid (Pfizer), showed slightly less persistent COVID symptoms in users 3 to 6 months after the acute illness compared to placebo.. This was not different from Paxlovid. Both meds did reduce somewhat the acute symptoms when taken early in the illness, though Paxlovid is slightly more efficacious for the acute illness. The effect on subsequent long-COVID of anti-viral treatment is under many studies of all antiviral medications.

The Tinfoil Hat for Depression Gets Another Thumbs Up
Two more randomized studies showed that some depressed/anxious patients who have not improved after two or more anti-depressant meds could have significant improvement in their depression and listlessness with 4-6 weeks of transcranial magnetic stimulation (TMS).  TMS treatment consists of 30 sessions 5 times a week of sitting in a recliner in the doctor’s office with a “tinfoil hat on your head”  (it’s real name: “magnetic coil”). Health insurance may cover it, believe it or not.     

“Cologuard Plus” is now FDA approved
If you have been released from the current recommendation to skip colonoscopies for colon cancer screening because you have reached the magic age of 75, you can now screen yourself with this new, highly sensitive self-administered stool test, Cologuard Plus. It tests for DNA markers of cancer cells, some pre-cancer cells, and hidden blood. Though FDA approved, this new test has not yet been incorporated into official colon screening recommendations.  The FDA has also approved a new DNA-based, cell-free blood test for colon cancer, also assumed to be added to the next official screening recommendations. . . but not yet available at your nearby Urgicenter or doctor’s office.

The END, appropriately I must say. Pun intended.