I went to Walmart the other day. I was only in there for about 5 minutes. When I came out there was a cop writing out a parking ticket. I went up to him and said, "Come on buddy, how about giving a senior a break?" He ignored me and continued writing the ticket. I called him a Nazi. He glared at me and started writing another ticket for having worn tires. So I called him a SOB. He finished the second ticket and put it on the windshield with the first. Then he started writing a third ticket. This went on for about 20 minutes. The more I abused him the more tickets he wrote. Personally, I didn't care. My car was parked around the corner.

I try to have a little fun each day now that I am retired. It's important at my age.

Conventional wisdom suggests that antibiotics are indicated in asthma exacerbations only when evidence of a bacterial infection is present. Most exacerbations in children and adults are caused by viral infections but there is evidence that acute infection with atypical pathogens such as mycoplasma and chlamydia are also associated with acute episodes. Patients were randomly assigned to receive 10 days of telithromycin (Ketek) 800 mg a day or a placebo in addition to their usual care and medications. Those in the antibiotic treated group had significant improvement in their asthma symptoms throughout the 10 day treatment period compared with the placebo group. They did not have an improvement in their peak expiratory flow rates as measured at home. This antibiotic has previously been reported in association with a severe liver injury but the adverse effects in this study were the same in the treated and the placebo group. The mechanism by which the telithromycin was associated with the improvement was not evident in the study but it seems likely that a non-antibiotic effect was responsible. Frederic Little, in an accompanying editorial, said that we're not quite ready to treat acute asthma exacerbations with antibiotics based on this very excellent study. (N Engl J Med 2006;354:1589-600)

An estimated 66% of US adults are over weight or obese as are 17% of children. Excessive adiposity is a serious problem and is associated with insulin resistance, dyslipidemia, diabetes, atherosclerosis and some types of cancer. Now evidence is accumulating that it is also associated with accelerated aging. Heilbronn recently reported a randomized trial that evaluated 6 months of caloric restriction on surrogate markers of longevity. Their study showed that prolonged caloric restriction by diet or by a combination of diet and exercise resulted in reduced weight, fat mass, reduced fasting serum insulin levels and reduced core body temperature. Their findings also indicated that caloric restriction results in a decline in DNA damage. This study indicates that we have yet another reason to encourage our patients to lose weight. (JAMA 2006 April;295:1539-1577)

John J. Mohr, M.D.