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

I confess that I don’t withdraw having speak Ralph Waldo Emerson’s essay “Self-Reliance, ” which contains the quotation: “A foolish consistency is the hobgoblin of little psyches, admired by little statesmen and philosophers and divines.” Instead, this sentence permanently inscribed itself into my head after watching the 1998 nostalgic slapstick “Next Stop Wonderland, ” which remains my favorite movie set in Boston. And it feels more applicable today than ever, as health officials from Dr. Anthony Fauci to Surgeon General Jerome Adams have been unfairly pilloried for the modification of their early situates on the threat that COVID-1 9 been submitted to Americans and the need to wear face extends in public. In both cases, obligating new data persuaded them to change their minds; rather than adhering to “a foolish consistency, ” they adapted their public explanations to wonder current technical to improve 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 panel for which I represented the American Academy of Family Physicians published a clinical practice guideline that recommends topical non-steroidal anti-inflammatory remedies( NSAIDs) as first-line therapy for adults with acute sorenes from musculoskeletal hurts( strains, sprains, and nonoperative crackings) not involving the low-toned back.( A previous guideline crossed what to do for patients with acute or chronic low back tendernes .) I was startled when the systematic review and meta-analysis we commissioned for this guideline showed that thematic NSAIDs were as effective as oral NSAIDs for acute aching; I previously had only prescribed topical NSAIDs for cases with chronic osteoarthritis. In February, in approving the the first topical NSAID for over-the-counter use, the U.S. Food and Drug Administration actually stated that it “is not for immediate relief” and “has not been shown to work for stress, sprains, injuries or boasts injuries.” That was a true statement at the time, but our understanding of the science has advanced since then. Although cost will be an obstacle for some patients – thematic NSAIDs are substantially more expensive than oral NSAIDs – there is now good evidence to promote the topical editions, which have fewer adverse effects, for acute musculoskeletal pain when feasible.

On a different subject, I announced today a Medscape commentary that “I’ve Changed My Mind on Lung Cancer Screening.” I be recognized 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 harms I mentioned under 2011 in any conversation with a patient eligible for lung cancer screening( according to the USPSTF’s 2020 draft recommendations, adults senility 50 to 80 times in good health who have at least a 20 pack-year smoking history and currently inhale or have cease in the past 15 years ), and some patients may choose not to be screened, just as some patients wane mammograms or screening evaluations for colorectal cancer. Given the current evidence that overall benefits of lung cancer screening outweigh the sufferings, I will recommend this screening experiment to my patients at the same time I urge them to quit smoking.

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