In the U.K. Cluster Randomized Trial for PSA Testing for Prostate Cancer (CAP), more than 400,000 men in primary care practices between 2001 and 2009 were either invited to receive a single PSA screening test or usual care. After a median follow-up of 10 years, there were more prostate cancer diagnoses in the screening group, but no effect on prostate cancer mortality. (Men diagnosed with localized prostate cancer were invited to participate in a separate trial comparing active monitoring, surgery, and radiotherapy, which Dr. Middleton discussed previously on the AFP Community Blog.) In a seco ..read more

I have a personal stake in the answer to this question. For most of my adult life, my body mass index (BMI) has ranged between 22 and 25 kg/m2, which is considered to be in the normal range (the threshold for overweight is a BMI of 25, and obesity a BMI of 30). But it turns out that I've been overweight for most of that time if one applies a race-specific definition of overweight (BMI greater than 23) for individuals of Asian descent. Where did this race-based cutpoint come from, and is it still relevant in an era when we generally frown on using race as a surrogate for social determinants of ..read more

Since human papillomavirus (HPV) vaccines were first added to the routine U.S. childhood immunization schedule nearly two decades ago, the evidence of their effectiveness has become stronger every year. In 2019, a Medicine by the Numbers in American Family Physician summarized a Cochrane review of 26 randomized, controlled trials comparing HPV vaccines to placebo. The authors found that vaccination reduced the risk of precancerous cervical lesions (cervical intraepithelial neoplasia [CIN] grades 2 or 3 and adenocarcinoma in situ) with numbers needed to treat (NNT) ranging from 55 to 73, depen ..read more

I believe that I'm a pretty safe driver. I don't use my phone in the car except for calls on my Bluetooth hands-free system, I come to a complete stop at stop signs even when no one else is around, and I never get in the driver's seat after I've been drinking. During the fall of 2020 and spring of 2021, though, I paid more attention than usual to driving safely. Our auto insurance company offered a discount for installing a device in my car that monitored my driving behavior, and my then 15 year-old son (in Utah, the minimum age for a learner's permit is 15) began learning to drive. There has ..read more

Originally posted on Common Sense Family Doctor on February 7, 2018. ** The February 1, 2018 issue of America Family Physician marked the first time since 1988 that a family physician other than Dr. Jay Siwek was serving as the journal's editor-in-chief. Dr. Siwek, who bade farewell to readers in a poignant, memory-filled editorial in the January 15 issue, will stay on as editor emeritus. This month, Dr. Siwek introduced his successor, longtime associate editor Dr. Sumi Makkar Sexton. You can read about Dr. Sexton's extensive qualifications and experience in ..read more

In an earlier post about my frustrating experience serving on a District of Columbia grand jury that handled indictments for drug-related offenses, I wrote approvingly about Portugal's novel approach to decriminalizing illicit drug use. In short, rather than receiving criminal sentences and jail time, people caught using small amounts of drugs in Portugal receive citations and are offered counseling and medical treatment. Since then, the city of San Francisco and the state of Oregon have both implemented versions of Portugal's non-punitive approach, with mixed results. A January 31 N ..read more

Last November, the Centers for Disease Control and Prevention (CDC) reported that cases of congenital syphilis in the U.S. had soared 755% over the past decade, peaking at more than 3,700 in 2022. The CDC’s review of that year’s cases revealed that nearly 90% were potentially preventable, resulting from a lack of timely testing and adequate treatment. An analysis of 2017-2019 Medicaid claims in 6 Southern states (Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee) found that despite state laws mandating prenatal syphilis screening, actual screening rates ranged from 56 ..read more

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A recent KFF Health News article highlighted misdiagnoses of type 2 diabetes in several Black female patients who actually had latent autoimmune diabetes in adults (LADA), a slowly progressive form of type 1 diabetes. Although the article suggested that the patients’ race may have played a role in delaying their LADA diagnoses, this condition commonly goes unrecognized in primary care. According to Dr. Jeff Unger in a 2010 American Family Physician editorial, an estimated 10% of patients with a diagnosis of type 2 diabetes actually have LADA. Unlike patients with classic type 1 diabetes, pati ..read more

Six years ago, I was promoted to the rank of deputy editor at American Family Physician. On the whole, I continue to find translating the latest scientific evidence into continuing medical education for family physicians and trainees to be satisfying and intellectually rewarding. As I pass the likely midpoint of my career, I have achieved all of my editorial goals, save one. In pursuit of that goal, in March 2023 I applied for the position of editor-in-chief at The Journal of Family Practice, a widely respected primary care journal for nearly 50 years (AFP will celebrate its 75th ann ..read more