A Country Doctor Writes:

Vitamin D as Cancer Therapy? Insights From 2 New Trials – JAMA Network

All right, I’ve been less than enthusiastic, even downright acerbic, about the widespread interest in Vitamin D. I’ve written many times about it. Then I started taking Functional Medicine courses….

This is from this week’s JAMA:

It may be tempting to interpret the preliminary findings regarding recurrence- and progression-free survival as specific antineoplastic effects of vitamin D3 supplementation. However, higher vitamin D levels have been associated with substantially decreased mortality and morbidity among hospitalized patients with a range of nonneoplastic diseases as well as with cancer.14-16 Thus, the findings of the 2 trials may reflect relatively broad biological effects of vitamin D.

In summary, the SUNSHINE and AMATERASU clinical trials reported in this issue of JAMA provide new information regarding the potential use of vitamin D among patients with colorectal cancer and other luminal gastrointestinal malignancies. Confirmatory trials are needed to evaluate these preliminary findings, ideally with longer follow-up to obtain better estimates of effects on survival as well as biological measurements to clarify underlying mechanisms.

— Read on jamanetwork.com/journals/jama/fullarticle/2730095

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Billion dollar Medicare Fraud depends on doctors signing papers without reading – The New York Times

In this day of electronic medical records, we still get a lot of paper to sign, and we really never have time to read much of it. Home Health nursing orders require a signature on every single spaced page, for example.

This week, the New York Times wrote about the billion dollar market for fraudulent prescriptions for a back braces etc. I get these often, always return faxed with the comment “MEDICARE FRAUD!”, and I also get prescriptions “needing” my signature for compounded enormously expensive pain creams.

www.nytimes.com/2019/04/09/us/billion-dollar-medicare-scam.html

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Leonardo da Vinci – The Lancet

We may laugh or shrug at the Brits, but when it comes to their medical journals, I am always impressed by their depth, from both a humanistic and historical perspective. Last week’s The Lancet has a nice article about Leonardo da Vinci:

“It is a sobering thought”, said the satirist Tom Lehrer, “that when Mozart was my age he had been dead for 2 years”. Leonardo di ser Piero da Vinci lived almost twice as long as Wolfgang Amadeus Mozart, but his life and work provoke an even deeper sense of hopeless awe. Leonardo made three of the most influential and most parodied artworks in history—the Mona Lisa, The Last Supper, and his sketch of Vitruvian Man. Throughout his life, he kept notebooks, works of art in themselves, crammed with crisp observations and lists of questions from every field of life. No-one, wrote Giorgio Vasari in his gossipy biography of the Renaissance masters, was ever his peer in “vivacity, excellence, beauty and grace”. What can we do but throw up our hands and call him a genius?

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Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study – The BMJ

This population based, sibling controlled analysis showed a clear association between clinically confirmed stress related disorders and a higher subsequent risk of cardiovascular disease, particularly during the months after diagnosis of a stress related disorder, in the Swedish population. This association applies equally to men and women and is independent of familial factors, history of somatic/psychiatric diseases, and psychiatric comorbidities. These findings call for enhanced clinical awareness and, if verified, monitoring or early intervention among patients with recently diagnosed stress related disorders.
— Read on www.bmj.com/content/365/bmj.l1255

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Writing the body – The Lancet

The Lancet offers free access to some of its articles by just signing up. This week has an interesting book review:

Ned Beauman argues for the utility of the appendix, arguing in favour of the theory that in less hygienic times it served as a reservoir for helpful bacteria, ready to repopulate our insides after infection had purged us. Appendicitis, he says, is the mark of an immune system “deranged by tedium”.
— Read on www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30801-3/fulltext