Family physician Frank Domino, M.D., reminded his colleagues here Sept. 15 that they have "the best job in the world."
Family physician Frank Domino, M.D., distills some of the most interesting study findings of the past year in one lecture during the 2017 Family Medicine Experience in San Antonio.
Domino has a pretty good gig himself. In addition to serving as a professor and pre-doctoral education director in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School, Domino is editor-in-chief of The 5-Minute Clinical Consult, editor of the weekly Evidence Based Practice Updates blog, host of the Frankly Speaking about Family Medicine podcast and co-author and co-editor of the Epocrates Lab database.
"Someone pays me to keep current," he said.
Domino was a young physician attending his first AAFP Scientific Assembly (now the Family Medicine Experience, or FMX) when he attended a lecture titled "20 Things I Wish I Had Known Last Year." Domino has since perfected the concept, delivering evidence-based updates at AAFP conferences. His keynote address "Top Ten Updates in Evidence-Based Medicine" drew a big crowd Sept. 15 at FMX.
- Family physician Frank Domino, M.D., spoke about important updates in evidence-based medicine at the 2017 Family Medicine Experience.
- The news -- collected from a year's worth of studies and distilled in once lecture -- might be welcome by patients and physicians alike.
- One study found that people who exercise a few times a week and those who exercised more regularly had similar reductions in risk for cancer, cardiovascular disease and all-cause mortality compared to those who were inactive.
And much of the news -- collected from a year's worth of studies and distilled in once lecture -- might be welcome by patients and physicians alike.
For example, a study published in JAMA Internal Medicine(jamanetwork.com) separated participants into different groups based on their levels of exercise and found that those who exercised a few times a week and those who exercised more regularly had similar reductions in risk for cancer, cardiovascular disease and all-cause mortality compared to those who were inactive.
"Two days a week is great," Domino said. "A little bit of exercise has a great impact. We don't have a pill that can reduce all-cause mortality like a little bit of exercise, so get them out there, folks."
There also were surprising -- and not so surprising -- findings related to nutrition.
For starters, the authors of a recent Lancet study(www.thelancet.com) recommended that dietary guidelines should be reconsidered in light of their findings. They said that in their study of more than 135,000 individuals, high carbohydrate intake was associated with increased risk for mortality, but total fat and types of fat were not associated with cardiovascular disease, myocardial infarction or cardiovascular disease mortality. In fact, saturated fat intake was associated with a lower risk of stroke.
"We had a lot of false assumptions," Domino said.
The same was true for milk. A meta-analysis of 29 studies in the European Journal of Epidemiology(link.springer.com) found that milk -- whether high or low-fat -- was not associated with all-cause mortality, coronary heart disease or cardiovascular risk.
It might come as no surprise that light and even moderate alcohol intake was found to have a protective effect(www.sciencedirect.com) on all-cause and cardiovascular-specific mortality, according to a report in the Journal of the American College of Cardiology. But Domino got a big laugh when he pointed out that evidence indicated that moderate drinkers and heavy drinkers had longer life expectancies than teetotalers, according to a Health Affairs analysis(content.healthaffairs.org).
Although alcohol, fat and milk might not be quite as sinister as some suspected, there was no reprieve for diet soda. A study in the journal Stroke(stroke.ahajournals.org) found that artificially sweetened drinks were associated with an increased risk of ischemic stroke and dementia.
Oh, and about that diet part?
"Diet sodas don't make you thin," he said. "The more you drink, the worse outcomes are."
Domino also dismissed the idea of using fecal transplant capsules from a thin person to help a person with obesity lose weight.
"There's no data to support that," he said. "You'd have to be … 'unique' to think that's a good idea."
An idea that might have potential, however, is using fermentable carbohydrates to decrease appetite(www.nature.com). Small studies have shown that adding inulin to the diets of obese and overweight patients alters glucose tolerance and appetite sensation. Foods high in inulin include onions, leeks, chicory root, rye and wheat.
"Consuming 30 grams of inulin from onion is not going to make you popular," said Domino, who added that the prebiotic fiber is available as an over-the-counter supplement.
Domino also pointed out that the U.S. Preventive Services Task Force stated this year that evidence is insufficient to recommend for or against screening for celiac disease in asymptomatic patients. Deciding which patients with symptoms to screen is still tricky, he said, because patients with diabetes and auto-immune disorders are at increased risk, and symptoms can include an array of gastrointestinal issues as well as muscle cramps, anxiety, depression and more.
"It pretty much encompasses everyone," he said. "That's every single patient in my practice."
Here are a few other pearls from Domino's presentation, which is available as part of FMX On Demand(fmx.ondemand.org):
- A study in JAMA Internal Medicine(jamanetwork.com) found no benefit to using statins in patients over 65 without cardiovascular disease.
- A study in the Journal of Clinical Psychiatry(www.psychiatrist.com) evaluated the risk of postpartum depression and concluded that women with a history of depression should be assessed during their third trimester.
- Self-monitoring blood glucose levels(jamanetwork.com) "doesn't do anything" for patients with type 2 diabetes who are not on insulin.
- Evidence does not support pelvic exams for screening asymptomatic patients. Similarly, the net benefit is small for screening men aged 55 to 69 years for prostate cancer.
- Patients on sulphonylureas had a higher risk of major cardiovascular disease-related events(www.ncbi.nlm.nih.gov) than those on other glucose lowering drugs.
- A CDC report(www.cdc.gov) found that the safest way to prescribe opioids was with short-acting medications with prescriptions of less than five days.
- A PLOS One survey(journals.plos.org) of more than 2,000 U.S. adults found that more than half (54 percent of women and 65 percent of men) are sexting.
Domino also had some recommendations -- including adequate sleep -- for physicians experiencing symptoms of burnout:
- A study in the American Journal of Medicine(www.sciencedirect.com) found that meditation reduces stress and anxiety and improves resiliency.
- A BioScience study(academic.oup.com) of 1,000 adults in the United Kingdom found that people living in neighborhoods with ground cover and birds had reduced levels of depression, anxiety and stress.
"Buy a birdfeeder," he said.
Finally, Domino suggested that something as simple as a gratitude journal -- taking note of a few things you are grateful for each day -- can help.
"I wouldn't be on this stage if it wasn't for the love of my family and friends," he said.
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2017 AAFP FMX: Day Four(storify.com)