No one will argue that smoking is bad for you.
However new electronic cigarettes, which produce just nicotine and none
of the other toxic tobacco chemicals have argued that they are safer
and that they help people quit smoking. This, unfortunately, is not the case.
Nicotine is highly addictive, and is the actual chemical that makes
cigarettes addictive. So no, the electronically pure is as habit forming
and possibly worse.
As well, electronic cigarettes were used
at least once by 12% of high school students and 3% of middle school
students, with almost 25% of high school students admitting to regular
smoking (regular or electronic). In another study researchers found that
adolescents who smoked either kind were more than five times more
likely to move on to more serious drugs, such as oxycontin and heroine
(but not marijuana). So nicotine has become a gateway drug.
We
need to continue to monitor and discourage our teens from any kind of
smoking; including marijuana since, as I have mentioned in previous
blogs, it can cause serious damage to the growing brain.
As we age our bodies change, and we become
more susceptible to complications or medications and supplements. In
most other countries, where there is universal health care, it is
relatively easy to do large population
studies and examine complications and effects of drugs and medications.
The government databases contain records of deaths, illnesses, and
medications.
In several studies, researchers have discovered
that drugs which were considered safe may have complications in those
with underlying illnesses. These include some common antibiotics.
UNSAFE ANTIOTICS
BIAXIN, ZITHROMAX, LEVAQUIN and its relatives all have very rare
cardiac side effects. These do not seem to be an issue in younger and
healthy individuals, but in older patients, and those with heart issues,
there is a small but significant increased risk of complications and
death. If possible we should try and avoid the use of these medications;
however when indicated they are usually safe. As well, SEPTRA has been found to be potentially dangerous in those who are taking certain blood pressure drugs called ACE or ARBs.
USELESS VITAMINS
In a related study, Dutch researchers addressed the concept that
elevated homocysteine levels were related to Alzheimer's and could be
treated with B vitamins. Although the association may be valid, and B
vitamins do decrease homocysteine levels, unfortunately there is no
affect on Alzheimer or heart disease.
DANGEROUS BLOOD PRESSURE TREATMENT
Blood pressure treatment is important in older patients, but in a
recent study it was found that the prevalence of orthostatic hypotension
(drop in pressure when standing up) increased by a level of 5 from 4%
to 20% between the ages of 60 and 80. This is associated with more
frequent falls and fainting.
It is important for doctors to
understand that those patients should not be as aggressively treated;
there needs to be a balance between treatment and over-treatment. If you
or someone you know is getting the symptoms of fainting or dizziness
when standing and they are on medications that can cause this discuss it
with your doctor!
Lately there has been a lot of hype concerning
Laser and Robotic surgery. But what is it and is it really better? Most
of the time it is not.
Robotic surgery is not R2D2 doing surgery. It is more like a remote control
hobby device; the surgeon is working from a remote control device while
the machine follows his instructions. He (or she) is usually watching
on a TV screen; but sometimes live. Recent advances may involve a 3D
virtual reality; allowing remote operations by tele-medicine.
The advantages of robotics include a finer control of movement with less
slipping of the knife likely. As well, surgery is possible in very
confined locations. Disadvantages include the lack of direct
visualization and two-dimensional pictures. A major issue is the lack of
sensory feedback; most robotics do not allow that. The surgeon does not
know when the tissue has a different feel or density.
So for
most surgeries an experienced surgeon doing it manually is far better
than robotics. Indeed in a recent study of benign ovarian lesions on
87,000 women researchers found there were 50% more complications in
robotic cases.
Lasers are being used in surgery as special
knives or scalpels. They burn a very fine line through tissue, and have
minimal bleeding due to the cauterization. However, like robotics, there
is no feedback from the tissue; and there effects of small surgical
errors by the operator are magnified.
There are several tissue
specific colored lasers but these also can damage normal tissue. I had
three cases of patients who had green laser prostate surgery by an
inexperienced laser surgeon. All three had severe complications and
required additional surgeries and long term incontinence.
Much
of the hype about laser and robotic surgeries has been promulgated by
the manufacturers of this very expensive equipment whose surgeries are
far more expensive than standard procedures. Like new drugs we need to
be cautious; they are rarely major advances.
I review a
surgeon's experience and complication rates. I much prefer an
experienced surgeon using standard instruments. Never be afraid of
asking how many of these procedures the surgeon has performed; if the
physician gets insulted I would strongly recommend you go somewhere
else.
Broccoli and AutismIn recent studies, researchers have discovered that a chemical found in broccoli, sulforaphane, seemed to result in a mild improvement of symptoms of autism in 80% of children (as judged by their parents).This is too preliminary to use as a treatment, but since it is believed that the changes that result in autism may begin before birth, it would be prudent for pregnant women to eat adequate vegetables and broccoli!
Since the introduction of he back to sleep campaign (infants sleeping on their backs) there has been a more than a 50% decrease in Sudden Infant Death Syndrome (SIDS). However, accidental suffocation has not changed.
In an analysis of infant deaths, researchers found that there was a significantly higher risk in infants sleeping on sofas. Some of the causes probably include the baby rolling into the corner, and the softness of the pillows.
One of the theories of SIDS is that when a baby is on their stomach, especially on a softer surface, their nose and face forms a small indentation. When we breath we breath out carbon dioxide; this gas is heavier than air. With a baby, who moves much less and has a less powerful breath, the carbon dioxide gas may remain around their face. Their reflexes and motion can then lead to suffocation.
So don't let your babies sleep on the couch! Leave that for Grandpa!
There have been some questions about the use of cows milk in adults. Many state that cows milk is for calves, not humans, but the protein, vitamins and calcium in milk do have a high nutritive value.However there are some compounds in milk that could produce adverse effects. D-galactose, found in milk, has been shown to induce oxidative stress damage and chronic inflammation in animals, and such changes have been associated with cardiovascular disease, cancer, bone loss, and sarcopenia in humans.
Researchers in Sweden followed almost 100,000 patients for almost 20 years. They found that in the higher consumption groups (3 glasses per day) had almost double the risk of cardiovascular disease, as well as an increased risk of fractures as compared to those that drank less than one glass a day.
As usual, moderation is the key!
Eczema in children is treated by use of moisturizing creams to help restore the normal skin barrier. But can the use of these creams actually prevent the development of this rash?In a study in Great Britain parents were randomized to using one of three creams (sunflower oil, Cetaphil cream, or Aquaphor Healing Ointment, their choice) daily even the absence of a rash in infants. They started at 6 weeks and were evaluated after 6 months. The group was higher risk; having a first degree relative with atopic dermatitis.
The study discovered a 50% reduction in eczema. This is significant.
My daughter uses coconut oil on her baby; this child has had beautiful skin and no diaper rash! I would recommend it to everyone.
I recently reported that many dietary supplements included dangerous and unapproved compounds, in varying and sometimes dangerous concentrations. These included anabolic steroids, Prozac and Viagra. Some have been associated with fatal liver disease.
In response to the earlier report the FDA recalled many of the supplements.
In this follow up study, researchers found that 27 products recalled between 2009 and 2012 still contained the substances that were banned by the FDA. And 20% of these products contained an additional banned product.
The FDA needs more teeth to enforce their rules. And all of us have to continue to be more careful about using supplements. As you know I am against virtually all of these.
As many of you have probably heard, the study that purportedly showed the use of green coffee beans causing weight loss was false. The "researcher" changed weight numbers and results intentionally in order to show its efficacy.
Then the manufacturers paid Dr Oz for his endorsement, and undoubtedly made millions of dollars. We need to be more careful with these "fringe" treatments before accepting them.
Incidentally, in most coffee plantations the beans are picked both green and red. The red ones go to premium coffee, and the green to regular brands.
Diabetes is caused by either inadequate production or no production of insulin. This is related to either a decrease (Type 2), or total destruction (type 1) of Beta cells. These cells in the pancreas respond to high levels of glucose (sugar) in the blood by releasing appropriate amounts of insulin.
Now a team from the Harvard Stem Cell Institute have developed a technique to convert stem cells (which are now relatively easy to find) into working Beta cells. If these can be re-introduced into diabetic it may be a way to cure them.
The caveat, of course, especially in Type 1 diabetics is the initial cause of the loss of the beta cells. If it was an autoimmune process it is possible these new cells will also be destroyed. However we may be able to suppress this reaction.
We hope for a time that this treatment will really cure diabetes. Of course I wonder what the multi-billion dollar diabetic drug industry would do if this became close to being a reality!
Some good news has finally appeared in this terrifying epidemic. It seems that no one else has developed the disease from Mr Duncan in Texas; and Nigeria announced that they have had no cases in the past 21 days; meaning it is likely gone form that country. As well, some evidence has arisen that intensive re-hydration may decrease the mortality by a significant factor.
In terms of treatment, the experimental antibodies ZMapp seems to be very effective in monkeys. Unfortunately these are grown in modified tobacco plants and take several months to produce. They work by decreasing the total virus count and allowing the body to fight the infection.
People who have been cured develop antibodies which can last 10 years (hence the transfusions of their serum into sick patients). The NIH was close to finding an effective vaccine in 2001 when funding to this (and many other medical projects) was drastically cut in order for us to pay lower taxes. I'm sure Mr Duncan would have been happy to pay a few extra dollars.
In any case, researchers are now close to being able to create an effective vaccine. Accelerated animal testing has been successful and we should hopefully have a working vaccine within a year.
