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Experts Better at Mammogram Readings

April 27, 1998

Radiologists vary widely in their ability to read mammograms, according to a study presented April 20 at the National Conference on Breast Cancer in Washington, D.C. Researchers presented 100 high-quality breast images--55 normal cases and 45 with cancer--to 100 radiologists attending continuing education meetings and to four mammography experts.

The four experts detected an average of 81% of the tumors, with their scores clustered between 76% and 86%. The general radiologists, many of whom may normally read only about two images per day, detected an average of 70%, but their detection rate ranged from as high as 98% to as low as 8%. In one case, 85% of the generalists missed a tumor detected by all of the specialists. The team recommended that women visit centers where large numbers of mammograms are processed.

Creatine May Be Harmful to Those With Kidney Disease

People with kidney disease should avoid creatine, a dietary supplement becoming widely used by athletes hoping to improve their strength, British physicians report in the April 25 issue of Lancet. Researchers at Hope Hospital in Salford reported on a 25-year-old man who took creatine supplements to augment his preseason soccer training regimen.

The man had a preexisting kidney ailment that was well-controlled, but routine screening tests showed a sudden deterioration in kidney function. When he stopped taking the supplements, his kidney function returned to normal. The supplement was previously linked to the deaths of three American wrestlers who took it while trying to lose weight.

Stroke Drug Could Have Major Cost-Saving Benefit

Routine treatment of stroke patients with the expensive clot-dissolving drug tPA could save the U.S. health-care system $100 million per year, according to researchers at the National Institute of Neurological Diseases and Stroke. They studied 1,000 patients who received the drug and 1,000 comparable patients who did not.

They reported in the April 23 issue of the New England Journal of Medicine that patients treated with tPA averaged 10.9 days in the hospital, compared to 12.4 days for those not treated with the drug. The treated patients were also more often released to their homes rather than to rehabilitation centers and nursing homes. For every 1,000 patients treated with tPA, the initial cost of treatment was $1.7 million higher, but the treatment resulted in a savings of $4.8 million in nursing home costs and $1.3 million in rehabilitation costs--for a net decrease of $4 million per 1,000 patients treated.

Physician-Assisted Deaths Rare in U.S., Study Shows

The first national survey of physician-assisted suicides found that 6% of the doctors who responded have hastened patients' deaths with lethal injections or prescriptions. The results also suggest that although physician-assisted suicide does occur, it is rare and accounts for a small number of deaths in the U.S.

The survey was conducted in 1996, a year before Oregon became the first state to legalize doctor-assisted suicide. Dr. Diane E. Meier of Mount Sinai School of Medicine in New York City sent questionnaires to 3,102 doctors, and 1,902 answered anonymously. She reported in the April 23 issue of the New England Journal of Medicine that 18% had gotten requests for assistance. Five percent said they had given at least one lethal injection, and 3% had written a prescription. Some had done both, and overall about 6% said they had done one or the other.

Possible Treatment for Corneal Ulcers

An ointment made with a genetically engineered hormone called "nerve growth factor" may prove to be the first effective treatment for ulcers of the cornea caused by lye burns and other problems. Currently, doctors may surgically remove the ulcer, but this does not restore eyesight, and patients can be left with severely impaired vision. There is no good medical treatment.

Doctors in Rome used the hormone on 12 patients whose ulcers resulted from such things as lye burns, overuse of anesthetics for corneal abrasion and the herpes zoster virus. They reported in the April 23 issue of the New England Journal of Medicine that the ulcers began to heal within two weeks. All the patients had complete healing after 10 days to six weeks of treatment, and their vision improved considerably.

Doctors' Income Climbs Despite HMO Concerns

Despite doctors' fears that managed care threatens their livelihood, their annual earnings have risen to an average of nearly $200,000, according to the American Medical Assn. Some physicians believe they're working harder to maintain their incomes, and they still complain that managed care interferes with the doctor-patient relationship and causes mountains of unnecessary paperwork. But Dr. Richard F. Corlin, speaker of the AMA's House of Delegates, said on Tuesday that doctors are hardly victims.

Four years ago, doctors' incomes from their medical practices had declined by 4% to an average of about $182,000, the first decline in more than a decade, the AMA reported in 1996. But the Chicago-based association said its latest annual income survey shows physicians' earnings subsequently climbed to an average of $199,000 in 1996, an increase at a rate higher than that of most other professions.

--Compiled by THOMAS H. MAUGH II

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