Wicked Good

I grew up in Maine and wicked is an adverb or adjective meaning “very” or “especially” that can be attached to almost any verb or adjective.  Wicked good is by far the most prevalent use though, and so I thought I’d take a minute on what I hope you think is a wicked good health blog to talk about what I think is wicked good medical care.

Let’s talk about what would qualify a specific care as wicked good.

First it would need to have excellent evidence that it is beneficial.  In this regard effective treatment of hypertension could qualify as wicked good, but pushing for a HemoglobinA1C or less than 6.5% rather than less than 7% in a diabetic wouldn’t as the evidence for significantly better outcomes is unconvincing.  Second it would have to be something that is realistic to do for most or at least many patients.

For example here effective treatment of CHF with an ACE inhibitor or an ARB and a beta blocker would qualify, whereas counseling patients to lose weight by better diet and exercise wouldn’t as it is just something that seldom is successful.  The third and most challenging criterion is that it needs to be applicable to a large number of patients.  The more patients for whom a medical intervention can be used, the more likely it is to be wicked good medicine.  Here is a list of Dr. Pullen’s wicked good medical interventions:

  1. Flu Shots.  Cheap, safe, efficacious.  Just do it.
  2. Aggressive treatment of hypertension.  >50% of Americans develop hypertension by age 80.  More effective treatment can prevent strokes, coronary deaths, and much misery.
  3. Beta-blockers, ACE inhibitors and Statins in post MI and coronary recanalization patients.  All inexpensive, proven secondary prevention measures.
  4. CHF treatment with beta-blockers and an ACE or a generic ARB.  Reduces hospitalizations, improves function and quality as well as length of life.
  5. Annual diabetic eye exams:  Could nearly eliminate a leading cause of blindness in the US.
  6. Glaucoma screening and treatment.  Get screened every 2 years after age 50.  Get treatment if needed.

Stay tuned for some wicked bad options soon.  Please leave a comment on the medical blog comment section so I can see what you think warrants being called wicked good medicine.

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news and policy from a primary care physician’s perspective at his blog, DrPullen.com.

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5 replies »

  1. There had been a doc contributing regularly to THCB, Novack I think, whose approach to EBM ran along these lines. He called them “always” and “never” interventions and claims that they’re very well known at least around academic medical centers. He said we could get most of the way to where we want to be by making sure the always stuff is always done, and more importantly that the never stuff is never done. Once again, this is a task for The Guild.

  2. Love these additions. I think I’ll post soon on how oral health affects systemic health. Science does change often and this is a great idea too. DrP.

  3. Great concept of listing wicked good things, followed soon by a list of wicked bad things! When you get bored with that how about a list of things that used to be “wicked good” and are now “wicked bad” and visa versa just to remind us how changable medical science can be.
    Margarine/butter, salt, high fat/low fat diets, stents/open heart surgery, tight glucose control, aggressive evaluations of children UTIs, antibiotic prophylaxis, and CPR methods are just some that immediately spring to mind. Other readers may wish to add to the list.

  4. Please don’t forget to remember the importance of good oral hygiene. Brush and floss daily. Use a waterpik and/or an antibacterial mouthrinse. See your dentist regularly, which for most people means having your teeth scaled every 3 months. There is increasing evidence of a correlation between periodontitis and several systemic problems (your head is connected to the rest of your body, go figure).