Dr Lemmon
I am Dr. Robert Lemmon. I have been a family doctor for 14 years. I practice in rural South Carolina at the foothills of the Appalachian Mountains. My areas of special interest are evidence based medicine, obesity, type 2 diabetes, lipid disorders, diet and physical fitness.
An informed, inquisitive, skeptical and even cynical patient is a good patient; same for the doctor. I hope this site will help my readers become good patients. My advice: Get a feel for what is good evidence. Get a feel for risk and benefit. Beware of quacks. Do not become dogmatic. Welcome a good argument. Do not develop an emotional attachment to your beliefs.
I decided to start blogging for 3 reasons:
1. Because my profession, Family Medicine, is dying. Maybe I can help save it.
2. I want to help people become better patients (see above).
3. I want to help people improve their health.
Great reasons to blog. I have similar reasons, though I pray family medicine is not dying. I’ve been at it over twice as long as you have, and have seen family medicine go up and down. I think at this time we are in a down time, mostly as a result of the compensation disparity between procedural medicine and patient and disease management. Keep your spirits up and you will continue to thrive.
I’m so proud of you. I just read some of your blog and hope you can help me. Me and my daughter are extremly over weight.
Just subscribed to your blog. Love it. Sorry you do not practice in my area. Best wishes to you.
Hi, what does NNT mean regarding osteoporosis studies? Thx j
NNT means number needed to treat to benefit 1 patient.
Dr. Lemmon: read your piece on statins and thought it was terrific, and I gave you a plug in my latest patient safety newsletter which is here: http://www.patrickmalonelaw.com/files/patrickmalonelaw_jan2011.html.
I wonder if you would want to update your review with any comments on the recent Cochrane review of the same subject, which I paste in here:
Taylor F, Ward K, Moore THM, Burke M, Davey Smith G, Casas JP, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD004816. DOI: 10.1002/14651858.CD004816.pub4.
Plain language summary
Statins for the primary prevention of cardiovascular disease
Cardiovascular disease (CVD) is ranked as the number one cause of mortality and is a major cause of morbidity world wide. Reducing high blood cholesterol which is a risk factor for CVD events is an important goal of medical treatment. Statins are the first-choice agents. Since the early statin trials were reported, several reviews of the effects of statins have been published highlighting their benefits particularly in people with a past history of CVD. However for people without a past history of CVD (primary prevention), the evidence is less clear. The aim of this systematic review is to assess the effects, both in terms of benefits and harms of statins for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE until 2007. We found 14 randomised control trials with 16 trial arms (34,272 patients) dating from 1994 to 2006. All were randomised control trials comparing statins with usual care or placebo. Duration of treatment was minimum one year and with follow up of a minimum of six months. All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations. Statin treatment reduced blood cholesterol. Taking statins did not increase the risk of adverse effects such as cancer. and few trials reported on costs or quality of life. This current systematic review highlights the shortcomings in the published trials and we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.
Thanks for the information from Cochrane. I trust Cochrane and I am sure their review of the evidence was better than mine. I interpret the line “we recommend that caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk” as meaning they are not sure. I take on a case by case basis and let a well informed patient make the final decision.
I read your blog on bisphosphonates. I have osteoporosis and was on actonel for 3 yrs and my t score didnot get any better. I discontinued the med and now my endocrinologist recommended reclast. I am hesitant to take it after reading the the blogs of patients who were treated with Reclast.I don’t have any fractures and have always exercised and have been taking calcium and vit d. i value your input please. Iam 59 yrs old
Many factors go into fracture risk. Try the Frax tool.
If you not Caucasian go to the heading “calculation tool” and then “North America” and “US” and finally select race. You will need to know your T-scores, you can get them from your doctor.
So, I cannot give good advice to a patient I have never examined. Keep in mind the drug will not help much to prevent hip fractures, will probably help more in preventing vertebral fractures and there is some risk of potentially serious side effects. So it is a tough decision as the benefits are small and the risks are small too. You should explain your concerns to your doctor and then you listen to what he has say about YOU and YOUR particular situation and then make your best decision. The best health care is customized to the particular patient. That’s why I prescribe bisphosphonates from time to time; but discontinue them as well in many patients. The final decision, of course, rests with the patient.