More Dangers of BPA

Although there have been many studies showing possible adverse effects of BPA. BPA, or bisphenol-A is a plastic used in may cans and plastic bottles. Although some products are BPA free, there are many which have not yet changed their composition.

In a recent well designed study, researchers found that when adults drank from 2 BPA containing cans their blood pressure rose significantly as opposed to when they drank the same substances from glass bottles.

Clearly we need to stay away from BPA. I think it is another product that should no longer be used in our foods.

Baby Monitors, SIDS and Effectiveness

The "back to sleep" campaign, advising parents that babies should sleep on their back on firm mattresses, has decreased the incidence of SIDS, which was already rare, by over 50%.

But many babies seem to sleep better on their stomachs, leaving parents with a dilemma. This has created a niche for devices that have breathing alarms and claim to allow babies to sleep on their stomachs.

However, these devices are sold as consumer devices, NOT medical; and therefore are not subject to FDA regulation and approval. Their claims have not been proven or studied.

Here's what you need to know:

• These devices are not regulated by the FDA and may be marketed with the vague enticement of “keeping babies safe.”
• One device is a sock that measures heart rate and oxygen concentration. Other monitors provide various data; for example, an ankle monitor tracks heart rate and temperature.
• These devices do not have alarms; they are sold as consumer products rather than as medical devices.
• In addition to wearable monitors, smartphone applications are available for parents to monitor heart rate, oxygen concentration, and skin temperature.
• Although the product materials state that they are not intended to prevent SIDS, safety is being emphasized in the marketing materials. No published data are offered to support safety claims.
• Some devices are marketed at costs of US$200 to US$300.

Although they may be justified and effective in some cases, parents should not rely on these completely.

Money and Medicine - Device Approval and Herbal Smoking Remedies

In Europe, one of the most popular smoking cessation medications is actually a plant derived substance called cytisine. This inexpensive herb has been found, in a recent study, to be more 30% effective than nicotine patches or gum. Why is this product not used more in this country? Perhaps checking the profits and sales of the nicotine replacement therapy would be a clue.

You may have recently read that the FDA withdrew recommendations for a procedure known as morcellation which was a technique used to remove fibroids. It involved an expensive new machine. In its initial approval the FDA relied on a report from a physician on its panel who said the adverse effects were not as bad as reported. This doctor had received over $150,000 in speaker fees from the manufacturer.

Indeed, the Wall Street Journal reported that of 122 FDA advisers who evaluated cardiologic, orthopedic, and gynecologic devices from 2012–2014, one third had received compensation (e.g., money, research grants, food, or travel) from device companies, and nearly 10% overall had been compensated by companies whose device they were assessing. The FDA disclosed almost none of these relationships.

I rarely recommend new treatments or devices unless they are a dramatic improvement or have been in use for a significant time. I have seen too many of these adverse events being reported long after approval; perhaps this again is part of the reason.

Family Dinners and Bullying

Family Dinners - Important Psychological Effects

In today's fast moving and electronic society, we may have lost the tradition of a family dinner where everyone can talk about their day and obtain support our family.

Researchers studied cyber-bullying (Internet bullying) found a 30% or more decrease in mental health or substance abuse problems in those children who had at least four family dinners a week.

The psychological support of a teens family should not be forgotten!

IBS is Real

Irritable Bowel, or IBS, is characterized by constipation or diahrrea, often associated with cramps; as well as being associated with certain foods.

Physicians often prescribe anti-spasmotic drugs. The diagnosis is most often one of exclusion; where we rule out all other causes. But many in the medical community believe this is a psychological and not physical disease.

However, in a recent study, researchers found that, in patients with IBS, certain foods induced microscopic changes in the wall of te intestine, with increased permeability (leakiness) and migration of inflammatory cells.

We can expect this confocal laser endomicroscopy technique to become more common and help establish which foods IBS patients are actually sensitive to. This may also be useful in gluten intolerance (as compared with real antibody induced celiac disease).

Flu Vaccine Less Effective

The flu vaccine, which is generally very good at preventing disease, is formulated 6-12 month before flu season, and is based on the best guess of researchers and what viruses are circulating in the far East.

The flu virus is composed of several strands of RNA (like DNA), and there are up to about 12 different variations of each strand. Some combinations can result if a more severe strain (like Bird Flu), some in a more contagious but less dangerous variety. It is when all factors combine to make a potent virus which spreads more easily (as in 1918) that we have a dangerous epidemic.

This is one of the reasons we need an annual vaccine; to account for changes in the virus. This years "guess" by researchers was less accurate than usual. The virus that was predominating in September of this year was found to be different from the H3N2 strain used in the vaccine (created in February). The strain this year is a slightly different H3N2 variety; but is a potent variety that may be associated with more severe illness.

The CDC recommends that anti-viral medications (such as Tamiflu) be used early in the diagnosis; even before confirmation cultures are back, especially in high risk individuals. If you fall into that group seek medical care as early as possible if you think you have the flu. You can check this web site to help you make that decision.

http://www.cdc.gov/flu/about/qa/testing.htm

Diet, Alcohol Health and Parenting

A couple of recent studies have emphasized how important parenting is to the health and habits of our children.

Many parents believe that introducing alcohol in a controlled manner can influence future responsible drinking. However studies do not support any change in the behavior of our children and their response to peer pressure. Teaching proper attitudes and not allowing underage drinking seems more appropriate.

In another interesting study, researchers examined the nutritive content of lunches sent from home and compared them to the current guidelines of the National School Lunch Program. They found that the home lunches had substantially more sodium, and less vegetables than recommended. Similar to our problems with fast food in this country we need to educate our society on better eating habits.

My daughter Jodi is a nutritionist, and we often comment on how difficult it is to obtain our daily balance of fresh fruits and vegetables.

Allergy Testing - Is Profit the Motivation?

I once knew a physician very well who would refer almost every patient with even minimal allergy symptoms for a $ 600 (almost all profit) panel of allergy tests. He would proudly show how this, and the subsequent allergy shots, was increasing his revenue. 

Like many doctors he (I hope) believed the sales pitch and was drawn to the increased profit; rather than paying attention to the actual facts.

We are all aware of allergy symptoms; for example a rash after eating shrimp, or nasal congestion and itchy eyes when exposed to ragweed. And physicians have developed many tests, including blood and skin testing for these allergens.

Unfortunately, the only certain way to detect allergies is to have an actual exposure. IgE blood tests are an expensive way to guess at allergies, and only correlates with real symptoms, whether food or otherwise, about 50% of the time. That means that 1/2 the test results are totally wrong; either you are allergic to something where the blood is negative , or not allergic to something that shows positive. Skin testing have a similar inaccuracy.

So why are these done? In certain cases, IF you show an allergy to something AND the skin or blood test CONFIRMS it then SOMETIMES allergy shots can desensitize you to this. But the testing should be restricted to ONLY those possible allergens you know you could be allergic to, AND only if the patient is willing to get allergy shots! Unfortunately, in many cases the motivation is profit.

The National Institute of Allergy and Infectious Disease has issued recommendations for food allergies based on these facts. To summarize:

• A high proportion of food allergy is caused by relatively few allergens (cow's milk, hen's egg, soy, wheat, peanuts, tree nuts, fish, shellfish).
• Evaluate patients with latex allergy for possible cross-reactivity to banana, avocado, kiwi, chestnut, potato, green pepper, and other fruits and nuts.
• For infants with family history of atopy or eczema , consider partially or extensively hydrolyzed infant formula to prevent rashes.
• Do not routinely recommend that patients with chronic hives avoid foods containing additives.
• Use prick tests and/or serum tests for specific blood testing (IgE) to diagnose food allergy; testing should be focused on suspected foods and test results alone should not be considered diagnostic.
• Do not routinely obtain total IgE levels to diagnose food allergy.
• Unproved tests (allergen-specific IgG measurement, cytotoxicity assays, applied kinesiology, provocation neutralization, hair analysis) should not be used to diagnose food allergy.
• Routine use of patch tests to diagnose food allergy is not recommended.
• Recommend a nutritionist consult for growing children, as elimination diets might affect growth. Be aware of nutritional consequences of elimination diets, including deficiencies of vitamins C and D.

In children with purported food allergies on "elimination" diets, 90% were able to re-introduce these foods without any problems.

Complications of Cosmetic Surgery

This type of surgery has become very popular as we try to maintain our beautiful youthful appearances. As was recently evident by the untimely death of Joan Rivers these procedures can be very risky.

Aside from death from anesthesia errors, not many studies have looked at actual complication rates.

The news is good. In a recent review of over 20,000 dermatologist cases there was less than a 1% rate of permanent complications such as scarring or pigmentation. There was, however an almost 25% rate of short term complications, such as bleeding or infection; most of which resolved without permanent damage.

If you decide to get that cosmetic procedure choose an experienced surgeon. If you need to be put to sleep do it in an outpatient surgical center; not in a physician's office unless there is a certified anesthetist and an up-to-date crash cart (meds and equipment on these need to be tested frequently) present.

Alcohol, Marijuana, and Moderation

In general, moderation is the key to a healthy lifestyle. This includes exercise, eating, alcohol and marijuana.

A recent study confirmed that heavy (daily) marijuana use is associated with decreased "gray matter" or brain tissue when compared with controls. Heavy alcohol use (more than 1 drink daily) causes liver disease as well as changes in the brain.

Our bodies are well adapted to small doses of many toxic substances, like alcohol, marijuana, saturated fats and cholesterol. It is only when we start overwhelming our normal detoxifying systems that we poison ourselves.

The issue with alcohol, tobacco, cocaine, and narcotics is the addiction potential that creates a craving and essentially prevents moderate use!