Advice….. "Wise men don't need it and fools won't heed it"…… or so goes the old saying. What is the motivation for giving advice? Maybe to appear wise…to be in control… or maybe to try, altruistically, to help another human.  Physicians often give advice upon solicitation: lose weight, exercise, take your medications, get more sleep, drink less, drive the speed limit, and buckle up. So why aren't we a nation of tee-totaling,  thin people who are well rested and drive sanely? Free will.  The great Quaker-pacifist , Mulford Q. Sibley (his real name), made a great case for "Academic freedom" while making sure that people understood that "Academic responsibility" came with it. He contended that we are free to do whatever we wish as long as we are willing to deal with the consequences. Same is true of health decisions but there is something wrong with the equation. With employers or the government responsible for about 80% of the costs people have no incentive.  People know that they will only be "responsible" for 20% of the cost if do not do what will be "best" for themselves. What most people deny is that death, like pregnancy, is 100%… either you are or you are not.  Looks for successful approaches of the future to make the pain or gain more immediate. Defined contribution plans which allow yearly carryover and which are portable from job to job to unemployed to job to job to retirement will likely help to lead people to the right health choices. But then again a large burger and fries sounds good right now, its raining and I don't feel like running.

Question: What did the psychiatrist tell his kleptomaniac patient when called in the middle of the night?Lexapro, a relatively new antidepressant in the SSRI class, shows promise in treating kleptomania. It works for obsessive compulsive disorder and kleptomania has many similarities. Good thing pharmacists keep it behind the counter! http://www.pharmalive.com/news/index.cfm?articleID=173420&categoryid=9&newsletter=1#

 2) Bush sends more than a greeting card to constituents….

Low income people will receive a new Medicare discount card even without asking. Will go to just under 2 million people and become effective the day before the election. (Coincidence?….could be). This is where the Fed should have started instead of making people sign up for them. The lowest income people probably did not understand what the cards were for and didn't realize that they could get them for free.  We will see if Uncle Sam learns from this when 2006 rolls around and the REAL benefit kick in. http://www.nytimes.com/2004/09/23/politics/23drug.html?th  (sorry… free registration required)

FDA has approved another long acting narcotic for use against pain. This time the company, Purdue Pharma ,  promises to promote the drug but not the abuse…. We'll wait to see how long it takes for Palladone (palliative therapy with hydromorphone) to make someone's most wanted list…

 now for the advice portion of our program…

 5) New pyramid discovered to prolong life!

It’s a food pyramid that goes against the latest fad diets. It says nothing about weight control but has some pretty impressive data about long life. It even includes alcohol.

http://www.cheshire-med.com/services/dietary/nutrinew/mediter.html

 6) For all of you road warriors….avoid blood clots in the legs.

Travelers should avoid constrictive clothing around the legs and waist, drink plenty of water to avoid dehydration, and stretch calf muscles frequently. If you are at risk then use  below-knee compression stocking or a dose of injectable anticoagulant before departure. Aspirin is no longer recommended for prevention of travel-related blood clots.

http://www.medscape.com/viewarticle/489427?src=mp

National Clean Hands Week just ended. This is still one of the best public health practices available to limit the spread of disease. When I was a Pharm.D. resident at the VA hospital in Minneapolis, the infectious disease specialist did a completely unscientific survey of hand washing by the medical staff. He went around to the staff area on each ward and touched the bar soap in use at the time. His theory was that if the soap was wet then SOMEBODY was washing his or her hands. Less than half of the soap was wet so he raised the issue with attending staff. I don’t know if hand washing went up but a week later there were more wet bars than there were dry!

http://www.cdc.gov/cleanhands/