Sunday, December 29, 2013

The most popular posts from 2013

- Kenny Lin, MD, MPH

It's been a terrific year for the AFP Community Blog. Page views have exceeded 5000 every month, with a high of 6,172 in November. To put these numbers into perspective, readers visited the blog nearly as much this year as in 2010, 2011, and 2012 combined! Looking back at the top ten most-read posts of 2013, two key themes emerge: potential harms from over-the-counter drugs and supplements (acetaminophen, NSAIDs, and calcium); and questioning the benefits of preventive services (vitamin D and cancer screening, diet and exercise counseling). The most-read post of the year was viewed more than 1200 times.

1. Are IUDs a reasonable option for birth control in adolescents? (May 21)

What are your thoughts about the intrauterine device for teens? If you are recommending it, what spurred you to do so? If not, what is making you hesitate?


Given how important many medical professionals feel diet and exercise is to good health, why is our counseling so ineffective? Is something more than just counseling necessary to effect behavior change?

3. Pros and cons of vitamin D screening (April 29)

No study has demonstrated that measurement of serum 25-hydroxyvitamin D levels offers outcome benefits over clinical assessment alone.

4. Steroids for pharyngitis? (July 15)

One dose of a corticosteroid (either dexamethasone PO, dexamethasone IM, or prednisone PO) increased the number of patients who reported resolution of pain in twenty-four hours (number needed to treat [NNT] = 4).

5. Is routine stress testing necessary for resolved chest pain? (May 29)

Are the benefits of routine pre-discharge stress testing in patients with resolved chest pain worth the harms? If not, is reducing medical liability risk enough reason to continue a low-value practice?

6. Are calcium supplements bad for the heart? (February 5)

Is it time to abandon routine calcium supplementation in healthy adults? If not, what additional evidence might make you change your practice?
7. Does acetaminophen help nasal congestion from the common cold? (August 12)

A lack of high-quality studies supporting efficacy isn't the same as a high-quality study showing that it doesn't work. I still recommend acetaminophen for headache, myalgias, and fever, and if it gets some of those nasal symptoms, that'd be a nice bonus.

The increasing diversity of the U.S. population has made it more likely that family physicians will care for many patients with cultural backgrounds, beliefs, and practices that are dissimilar to their own.


If the results of this survey are representative of the practices of U.S. family physicians, then more than 90 percent of us aren't telling patients that there are any downsides to undergoing routine mammograms, colonoscopies, and Pap smears.

10. Another strike against NSAIDs? (July 1)

Long-term use of all non-steroidal anti-inflammatory drugs (NSAIDs), selective COX-2 or non-selective, doubled the risk of heart failure.

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