There has been substantial recent publicity about the sugar content of breakfast cereals. It is quite high, and you can review the link below from the Environmental Working Group:
Sugar Contents
Cereal is not the best breakfast. A balanced smoothie; or toast with some fresh fruit, eggs or similar is much healthier and includes vitamins and minerals in their natural forms; not as an additive. And no high fructose corn syrup!
Wednesday, May 21, 2014
Smoking Bans and PAP tests - You've Come a Long Way baby
Smoking Bans in public areas have become the norm. To see what effects this has had on general health, researchers looked at populations in both America and Europe.
Following the introduction of
smoke-free policies, reductions of 10% were promptly seen in rates of premature birth. In addition, rates of pediatric
asthma fell by 10%.
California's extensive tobacco control program has had a 100-1 return on investment. Many other states still have a way to go, especially Nevada where we spend most of our time. Now if there was only a way to convince the casinos that it would improve profits.....
There is good and bad news concerning PAP tests. The current recommendation is that, in women who have not had a hysterectomy, PAP smears are unnecessary after the age of 65 after 3 normal ones. Unfortunately the statistics that this data was based on did not seem to take into account the higher rates of hysterectomy in older patients, and therefore underestimated the true rate of cervical cancer. It seems that we might have to continue screening at least to the age of 70.
The good news is that there is a DNA test for Human Papilloma Virus that can determine the risk of Cervical Cancer and eliminate those women who may not need further testing. The final recommendations are still in the works.
Advances in Healthcare and Cancer Treatment
There have been several advances in treatment of cancer that are worth mentioning. We are beginning molecular treatments with minimal side effects that may quickly become mainstream.
If you watch the show "Grey's Anatomy" you might have seen the episode where a doctor injected a modified HIV virus and cured a child of a severe immune deficiency. Many of these programs adapt true events.
In two patients with a resistant and un-treatable terminal cancer (multiple myeloma) researchers injected a large dose of a modified measles vaccine virus (which is a live virus). Dramatically, one patient had complete remission while the other had a partial, with only one injection of the virus and minimal side effects.
Boston Globe Article
In another more complex type of treatment, researchers discovered that in most cancers there are killer cells, or lymphocytes, that can be found in the cancer. They surmised that there were not enough of these to kill the cancer. So they extracted the killer cells from the tumor, and went about cloning them. when they reintroduced this new and reinforced "army" they found that the patient's tumor began to melt away!
This is a promising preliminary report.
New York Times Article
If you watch the show "Grey's Anatomy" you might have seen the episode where a doctor injected a modified HIV virus and cured a child of a severe immune deficiency. Many of these programs adapt true events.
In two patients with a resistant and un-treatable terminal cancer (multiple myeloma) researchers injected a large dose of a modified measles vaccine virus (which is a live virus). Dramatically, one patient had complete remission while the other had a partial, with only one injection of the virus and minimal side effects.
Boston Globe Article
In another more complex type of treatment, researchers discovered that in most cancers there are killer cells, or lymphocytes, that can be found in the cancer. They surmised that there were not enough of these to kill the cancer. So they extracted the killer cells from the tumor, and went about cloning them. when they reintroduced this new and reinforced "army" they found that the patient's tumor began to melt away!
This is a promising preliminary report.
New York Times Article
Politics and Healthcare - Is it Oil and Water?
The Affordable Care Act, affectionately known as Obamacare, has been called both the most significant step forward or backward in the modern era.
I believe that healthcare is a right for all people, and so I strongly support universal coverage. In Canada there was a vote for the greatest Canadian of the 20th century. They voted for the man who introduced universal health care, Tommy Douglas.
But political agendas seem to continuously prevent forward motion. For example, detractors have said that the ACA will cause huge overcrowding of hospital emergency rooms. In actual fact, in Massachusetts, where (Republican!!) Governor Mitt Romney enacted universal coverage in 2006, there has only been a 2% increase in ER visits. But who ever said politics and fact checking go together.
In another disturbing turn of events, the Republicans are fighting the bipartisan nomination of Vivek Murthy MD as the next Surgeon General. Dr Murthy, with a Harvard degree and Yale MD and MBA has stated that his primary goal would be to attack the epidemic of obesity in this country.
Why is his nomination in doubt? Would you believe the NRA????
In conjunction with virtually every medical society and organization Dr Murthy, when questioned, stated that he that he advocates reasonable and mainstream forms of gun control. However that is a personal choice, since the surgeon general's office has no influence on gun control.
Yet the NRA has launched a campaign against his nomination! I quote the New England Journal of Medicine:
"The critical question is this: Should a special-interest organization like the NRA have veto power over the appointment of the nation's top doctor? The very idea is unacceptable.
Despite the continuing American tragedy of mass shootings — Newtown, Aurora, Fort Hood, Virginia Tech — the NRA has redoubled its efforts to prevent enactment of stricter firearm regulations. Lawmakers who run afoul of the NRA face political retribution. By obstructing the President's nomination of Vivek Murthy as surgeon general, the NRA is taking its single-issue political blackmail to a new level. With the record of past surgeons general as their guide, senators should do what is right for the health of our country by confronting the NRA and voting their own conscience. Dr. Murthy is an accomplished physician, policymaker, leader, and entrepreneur. He deserves the President's continued backing and should be confirmed."
I believe that healthcare is a right for all people, and so I strongly support universal coverage. In Canada there was a vote for the greatest Canadian of the 20th century. They voted for the man who introduced universal health care, Tommy Douglas.
But political agendas seem to continuously prevent forward motion. For example, detractors have said that the ACA will cause huge overcrowding of hospital emergency rooms. In actual fact, in Massachusetts, where (Republican!!) Governor Mitt Romney enacted universal coverage in 2006, there has only been a 2% increase in ER visits. But who ever said politics and fact checking go together.
In another disturbing turn of events, the Republicans are fighting the bipartisan nomination of Vivek Murthy MD as the next Surgeon General. Dr Murthy, with a Harvard degree and Yale MD and MBA has stated that his primary goal would be to attack the epidemic of obesity in this country.
Why is his nomination in doubt? Would you believe the NRA????
In conjunction with virtually every medical society and organization Dr Murthy, when questioned, stated that he that he advocates reasonable and mainstream forms of gun control. However that is a personal choice, since the surgeon general's office has no influence on gun control.
Yet the NRA has launched a campaign against his nomination! I quote the New England Journal of Medicine:
"The critical question is this: Should a special-interest organization like the NRA have veto power over the appointment of the nation's top doctor? The very idea is unacceptable.
Despite the continuing American tragedy of mass shootings — Newtown, Aurora, Fort Hood, Virginia Tech — the NRA has redoubled its efforts to prevent enactment of stricter firearm regulations. Lawmakers who run afoul of the NRA face political retribution. By obstructing the President's nomination of Vivek Murthy as surgeon general, the NRA is taking its single-issue political blackmail to a new level. With the record of past surgeons general as their guide, senators should do what is right for the health of our country by confronting the NRA and voting their own conscience. Dr. Murthy is an accomplished physician, policymaker, leader, and entrepreneur. He deserves the President's continued backing and should be confirmed."
Progress in Anti-Aging and Alzheimers - Good and Bad news
As we age we lose our youthful immortality and look for ways to stay young and healthy. I have many friends who send me articles, recommend vitamins and alcohol, and other magical anti-aging treatments.
But what do we know, and what are some recent stories of interest?
First, it is quite clear that regular exercise, proper diet with plenty of fresh fruits and vegetables, and avoidance of excess alcohol and toxins is well established in producing a long and healthy life. But we keep looking for more!
At first everyone thought that substances like Vitamin E had "anti-oxidant" effects. Using the theory (and it is a theory only) that oxidative damage results in aging, these supplements should help. Well they all have failed, and many actually lead to premature death or disease.
Red wine and chocolate? A glass of wine a day, or some dark chocolate seems, in a few studies to be associated with a decreased risk of heart disease. I certainly think its a good idea! Once again people have begun to look too closely. One common compound is resveratrol. In large doses in some animals it seems to have that effect. But in a recent look by researchers looking at elderly residents of Tuscany found no association between levels of resveratrol and longevity. Does this mean wine and chocolate need to go off your diet? Heaven forbid! All it means, once again, is that we have failed to find the reason for the beneficial effects and should stick to the original products and not try to find a vitamin pill to replace it!
Vitamins and Supplements
The US public health task force, and independent organization has reviewed vitamins and supplements again and found:
- Substantial and consistent
evidence shows that vitamin E supplementation has no effect on CV disease,
cancer, or mortality. Not recommended (Grade: D)
- Supplementation with β-carotene
does not lower risk for CV disease or cancer, and it confers excess risk
for lung cancer among patients at high risk for the disease (e.g.,
smokers, people exposed to asbestos). Not recommended (Grade: D)
- Evidence is insufficient to
determine if supplementation with multivitamins or single vitamins or
minerals (except vitamin E and β-carotene) lowers risk for CV disease or
cancer. Evidence is insufficient to assess the balance of benefits and
harms of such supplementation. No recommendation (Grade: I [no
recommendation])
Once again, the editorial remarks that there is no substitute for a well balanced diet!
Now some Promising News:
Anti-aging Molecule in Mice
You may have read about older mice who received a transfusion from younger ones developed signs of anti-aging (new muscle growth, better tone, etc). By looking more closely researchers at Harvard found a molecule, Growth Differentiation 11, worked almost as well. Evidently this is one of the molecules involved in the anti-aging effect.
This line of research shows promise. It is still far from human applications, however, and we do not know if there could be long term adverse effects. But a first step.
Prion Antibodies in Alzheimer's
Many of you may have heard Mad Cow Disease - it is one of several "prion" diseases caused by a protein that gets into the brain and causes abnormal folding of brain proteins. Think of Kurt Vonnegut's novel "Ice-Nine". Researchers have been trying to produce antibodies against these proteins as a treatment. Since there are some similarities in Mad Cow Disease and Alzheimers they tried the antibodies on Alzheimer's patients. They discovered that a single injection could slow the progress of the disease dramatically in many patients. If this proves to be the case in larger studies, and shows no significant adverse effects this could be a major breakthrough.
Making a Market for a New Drug - Pharma Marketing and Pain addiction
The big pharmaceutical companies seem to be the largest utilizers of advertising these days. Just count how many drug ads you see during the most popular shows.
And although big pharma claims their very high drug prices are caused by development costs; it is important to understand they spend millions on advertising - and often to create a market for a drug that really is not indicated.
We have already seen the overuse of Testosterone and the artificial and dangerous creation of "low-T". Millions of cases of Restless Leg Syndrome were "discovered" because certain drugs needed a market. And who wuldn't want to take an anti-depressant these days - smile!!
But more dangerous is the recent marketing of inhaled fentanyl - off label. This drug is more potent than morphine and very addictive. The nasal inhaler produces rapid blood levels and is useful and indicated in the severe pain of cancer - ONLY. But this market was apparently too small for the manufacturer and it has been pushed off label for chronic pain. This is extremely dangerous due to addiction potential.
In a recent New York Times article Interviews
of former sales reps by the Times
"suggest the company [Insys Therapeutics] ... has aggressively marketed
the painkiller, including to physicians who did not treat many cancer
patients," and paid higher sales commissions for selling higher doses.
Thursday, May 8, 2014
Causes of Autism
In a recent study of over 2 million children
who were closely related researchers discovered that the risk of autism
was about 50% related to genetics. For example identical twins had a 150
time increased risk, while cousins had a two times increase. Their
conclusion was that 1/2 the cause is a genetic pre-disposition, while
unknown environmental factors contribute to the other 50%
The question of course is whether these environmental factors are behavioral or related to exposures to chemicals, etc.
The question of course is whether these environmental factors are behavioral or related to exposures to chemicals, etc.
Are Health Insurers using Obamacare to Deny Service?
Under the ACA, if Medicare approves a
screening test (such as mammogram or colonoscopy) the private insurance
must approve it without co-pay or deductible.
Recent studies have shown that in higher risk groups, such as smokers, an annual CAT scan screening for lung cancer will prevent deaths. There have been several recommendations to include this in preventative screening.
However, the ACA has opened the way for lobbying groups to oppose additional testing as ways for the insurance companies to keep their costs down (even though they pass everything off to us).
The US Public Health Task Force is an independent group that issues preventative care recommendations based on strong clinical evidence. If they give an A or B recommendation it means we probably should be doing it.
A Medicare advisory panel voted on Wednesday against paying for annual lung CT screening in heavy smokers — despite the fact that the U.S. Preventive Services Task Force issued a grade B recommendation in favor of screening high-risk groups in December 2013.
This decision is not binding on Medicare. But are we seeing politics and money once again making decisions which adversely affect our health?
Recent studies have shown that in higher risk groups, such as smokers, an annual CAT scan screening for lung cancer will prevent deaths. There have been several recommendations to include this in preventative screening.
However, the ACA has opened the way for lobbying groups to oppose additional testing as ways for the insurance companies to keep their costs down (even though they pass everything off to us).
The US Public Health Task Force is an independent group that issues preventative care recommendations based on strong clinical evidence. If they give an A or B recommendation it means we probably should be doing it.
A Medicare advisory panel voted on Wednesday against paying for annual lung CT screening in heavy smokers — despite the fact that the U.S. Preventive Services Task Force issued a grade B recommendation in favor of screening high-risk groups in December 2013.
This decision is not binding on Medicare. But are we seeing politics and money once again making decisions which adversely affect our health?
License to Eat Fats?
Calorie and fat consumption increased significantly from 1999 to 2010 among statin users — but not among nonusers — according to a JAMA Internal Medicine study. The researchers conclude that "the importance of dietary composition may need to be reemphasized for statin users."
They add that the aim of statin therapy "should be to allow patients to decrease risks that cannot be decreased without medication, not to empower them to put butter on their steaks."
So eat properly - whether you take medication or not!
Does Chemotherapy Make You Old?
Researchers looked at several markers of aging, including telomere length, and certain blood markers that seem to increase as we age.
Using breast cancer survivors, they found that those with chemotherapy had markers that suggested they had aged 10-15 years over controls. However, we do not know if this is a long term effect, or whether this will affect total longevity. I hope not.
Peer Pressure - Hormonal Basis??
Using college students, researchers found that when a group was given oxytocin, and then asked to report results of a guessing test where the percentage of correct responses benefited the entire group.
When compared with a group who were not given the hormone, the oxytocin group lied almost twice as often as the control group.
This might have implications as to why some people would perform activities they would not normally do when faced with peer pressure. Perhaps evolution has provided a hormonal basis for group co-operation!
Are Nurses the New Doctors?
Nurses are Not Doctors
In a recent editorial in the New York Times, a cardiologist noted that patients of nurse practitioners had 25% more referrals to specialists and 41% more hospital admissions.
He stated that he is concerned about the trend of non-physicians providing primary care. I agree with the fact that these providers lack the experience and expertise to properly diagnose many potentially dangerous conditions. I still remember a patient who came to me with a diagnosis of "mumps" from a pharmacy clinic. Not only was it not mumps, but if she really thought it was that she was obligated to report it - but she did not. It did turn pout to be sarcoidosis.
However there is a shortage of primary care doctors. I have tried to find part time work in Las Vegas, and have been discouraged due to the high cost of part-time malpractice (I have never been sued in 35 years of practice) forcing me to look for replacement work only.
One comment to the article stated that if specialists were paid less and primary care doctors more this would not be an issue. I couldn't agree more. Why does 2-3 years additional training mean a doctor can earn over 3 times (on average) more than primary care. Many specialist routinely earn over $500,000!
New York Times Article
In a recent editorial in the New York Times, a cardiologist noted that patients of nurse practitioners had 25% more referrals to specialists and 41% more hospital admissions.
He stated that he is concerned about the trend of non-physicians providing primary care. I agree with the fact that these providers lack the experience and expertise to properly diagnose many potentially dangerous conditions. I still remember a patient who came to me with a diagnosis of "mumps" from a pharmacy clinic. Not only was it not mumps, but if she really thought it was that she was obligated to report it - but she did not. It did turn pout to be sarcoidosis.
However there is a shortage of primary care doctors. I have tried to find part time work in Las Vegas, and have been discouraged due to the high cost of part-time malpractice (I have never been sued in 35 years of practice) forcing me to look for replacement work only.
One comment to the article stated that if specialists were paid less and primary care doctors more this would not be an issue. I couldn't agree more. Why does 2-3 years additional training mean a doctor can earn over 3 times (on average) more than primary care. Many specialist routinely earn over $500,000!
New York Times Article
The PSA Prostate Testing Controversy Revisited
The use of the PSA test for prostate cancer has become very controversial since some studies have shown no increase in overall survival using this test.
Now some researchers have suggested, through analysis of results, a more specific screening regimen.
They found that if men at age 60 had a PSA of under 2.0, further screening would not have an affect on life spans. However if it was 2 or over, they found that annual testing was worthwhile.
To me this sounds like a good approach. Under the age of 60 Prostate cancer can be aggressive, so I will continue to test annually. However, over the age of 60 I will give my patients the option of following these recommendations.
Saving 37,000,000 People?
Researchers in England reviewed 6 modifiable
risk factors which, if corrected, would prevent 37 million deaths over
the next 15 years.
These include:
• reducing prevalence of tobacco use by 30%
• reducing per-person alcohol consumption by 10%
• reducing mean population consumption of salt by 30%
• reducing prevalence of hypertension by 25%
• stopping the increase in diabetes prevalence
• stopping the increase in obesity prevalence
Unfortunately we do not seem to be doing that much about it. In a related story, the incidence of diabetes in young adults in the United States increased by over 20% in the past 8 years. I believe this is due to our predilection for fast and processed foods.
On the other hand, some "good" news today reported that Whole Foods has had a decrease in profit, due, according to them, to more stores carrying organic and otherwise healthy foods. Good for all of us.
These include:
• reducing prevalence of tobacco use by 30%
• reducing per-person alcohol consumption by 10%
• reducing mean population consumption of salt by 30%
• reducing prevalence of hypertension by 25%
• stopping the increase in diabetes prevalence
• stopping the increase in obesity prevalence
Unfortunately we do not seem to be doing that much about it. In a related story, the incidence of diabetes in young adults in the United States increased by over 20% in the past 8 years. I believe this is due to our predilection for fast and processed foods.
On the other hand, some "good" news today reported that Whole Foods has had a decrease in profit, due, according to them, to more stores carrying organic and otherwise healthy foods. Good for all of us.
Pheromone for Social Anxiety?
Social Anxiety is fear of public speaking, new
situations, or performing in public. Most of us have some anxiety
before speaking in front of a large group, or performing in public. This
even occurs with famous musicians and actors.
Current treatment includes many mental exercises (imagining the audience naked for example), as well as medications such as low dose beta blockers and Valium. Both must be taken at least 30 minutes prior.
Researchers have found an intransal Pherine (in the family of pheromones) rapidly calms people and prevents social anxiety. Interestingly it seems to target nasal smell receptors, so we are unsure how it works.
If further studies confirm this action and the lack of adverse effects this will likely become very commonly used.
Current treatment includes many mental exercises (imagining the audience naked for example), as well as medications such as low dose beta blockers and Valium. Both must be taken at least 30 minutes prior.
Researchers have found an intransal Pherine (in the family of pheromones) rapidly calms people and prevents social anxiety. Interestingly it seems to target nasal smell receptors, so we are unsure how it works.
If further studies confirm this action and the lack of adverse effects this will likely become very commonly used.
Subscribe to:
Posts (Atom)