Be Ready to Give Up Beliefs
Physicians practice medicine with great sincerity. They want to help their sick patients get well and stay well, and they dole out treatments in good faith and with the best of intentions. From time to time, however, data emerge suggesting that the treatments upon which they rely are of little or no benefit.
For example, in the December 5 issue of the Journal of the American Medical Association (2007;298:2487-2496), researchers report on a study of effectiveness of amoxicillin and topical budesonide in treating acute maxillary sinusitis, a common ailment seen in primary-care practice. The investigators concluded that “neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the primary care setting.”
In this issue of Renal & Urology News, we discuss a study that casts doubt on a widely used intervention for nephrolithiasis (see the Renal Nutrition Update column on page 19). The study, published in Urology (2007;70:634-637), shows that urinary citrate levels do not correlate with urinary pH. The finding challenges the use of calcium citrate supplementation to inhibit stone formation. Although this study is unlikely to lead to an immediate change in clinical practice, it is a reminder that medicine continues to evolve, and physicians should be open to the potential upending of commonly accepted therapies.
This study is not the only one discussed in this issue to provide new insight in nephrolithiasis. As part of our Renal Week 2007 coverage, which begins on page 9, we report on a study suggesting that gender may affect stone composition, with men significantly more likely to form calcium oxalate stones and women more likely to form stones containing phosphate.
On a final note, my Renal & Urology News colleagues and I would like to welcome three new nephrology members of our editorial advisory board: Csaba P. Kovesdy, MD, of the Salem VA Medical Center in Salem, Va., and the University of Virginia in Charlottesville, Rulan Parekh, MD, MS, of Johns Hopkins Children's Center in Baltimore, and Suphamai Bunnapradist, MD, of the David Geffen School of Medicine, University of California, Los Angeles. We are privileged to have them on board.