A foolish consistency: topical NSAIDs for acute pain and lung cancer screening

I be recognized that I don’t echo having speak Ralph Waldo Emerson’s essay “Self-Reliance, ” which contains the quotation: “A foolish consistency is the hobgoblin of little intellects, adored by little statesmen and philosophers and divines.” Instead, this sentence permanently inscribed itself into my mind after watching the 1998 dreamy slapstick “Next Stop Wonderland, ” which remains my favorite movie set in Boston. And it feels more applicable today than ever, as state officials from Dr. Anthony Fauci to Surgeon General Jerome Adams have been unfairly pilloried for the modification of their early standings on the threat that COVID-1 9 been submitted to Americans and the need to wear face treats in public. In both cases, impelling new data persuasion them to change their thinkers; rather than adhering to “a foolish consistency, ” they accommodated their public statements to indicate current technical understanding of the virus and how it is transmitted from person to person.

In the past week, I’ve done a couple of about-faces on major medical topics in the face of new exhibit. A committee for which I represented the American Academy of Family Physician published a clinical practice guideline that recommends topical non-steroidal anti-inflammatory medicines( NSAIDs) as first-line therapy for adults with acute grief from musculoskeletal traumata( tightens, sprains, and nonoperative ruptures) not involving the low-toned back.( A previous guideline reported what to do for patients with acute or chronic low-spirited back pain .) I was caught when the systematic review and meta-analysis we commissioned for this guideline showed that topical NSAIDs were as effective as oral NSAIDs for acute sorenes; I previously had just been prescribed topical NSAIDs for patients with chronic osteoarthritis. In February, in accept the the first thematic NSAID for over-the-counter use, the U.S. Food and Drug Administration actually territory that it “is not for immediate relief” and “has not been shown to work for strains, dislocates, traumata or athletics injuries.” That was a true statement at the time, but our understanding of the science has derived since then. Although cost will be an obstacle for some patients – topical NSAIDs are substantially more expensive than oral NSAIDs – there is now good evidence to elevate the topical accounts, which have fewer adverse impact, for acute musculoskeletal pain when feasible.

On a different subject, I announced in a Medscape commentary that “I’ve Changed My Mind on Lung Cancer Screening.” I acknowledge that I am the same Dr. Kenny Lin who nearly a decade ago posted “4 Reasons Not to Be Screened for Lung Cancer” on my now-defunct U.S. News and World Report “Healthcare Headaches” blog. I don’t disavow what I wrote previously; it’s still important to consider the potential mischief I mentioned under 2011 in any gossip with a patient eligible for lung cancer screening( according to the USPSTF’s 2020 draft recommendations, adults age 50 to 80 times in good health who have at least a 20 pack-year smoking history and currently smoke or have retire in the past 15 times ), and some patients may choose not to be screened, just as some patients reject mammograms or screening tests for colorectal cancer. Given the current evidence that overall benefits of lung cancer screening outweigh the sufferings, I will recommend this screening measure to my patients at the same time I urge them to quit smoking.

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