Are Prostate Digital Exams Obsolete

It has been medical practice, much to the chagrin of men and their doctors, that a digital rectal exam be performed annually to examine the prostate. I always suspected the utility of this exam; I performed thousands yet never discovered any pathology.

Now a new study examined many previous studies and found that in 9000 screening there was no significant benefit.

It is probably unnecessary. Good news!

Ann Fam Med March/April 2018 vol. 16 no. 2 149-154

Blue Blocking Glasses and Manic activity

It seems that seasonality and light conditions can affect bipolar-disorder. There is more depression when the days are shorter.

It seems that the manic component of bipolar disorder (even mild) can be affected by light. The brain senses light and darkness exclusively by light in the blue spectrum. Using blue blocker lenses (orange lenses) we can "fool" the brain and melatonin systems into "thinking" it is totally dark.

In a small study (Henriksen TE et al. Bipolar Disord 2016 May. ) researchers found that manic activity decreased significantly when users wore these glasses, and increased again when they were not used.

This could lead to another treatment for manic disorder. I also wonder if it might have some uses in jet lag or sleep disorders?

Caffeine in Pregnancy and Obesity

To try and determine how to prevent obesity in children researchers have been looking at the diet of pregnant women.

Norwegian researchers studied over 50,000 mother-child pairs. The mothers completed food-frequency questionnaires during pregnancy, from which caffeine intake was estimated, and the children's height and weight were measured several times until age 8 years.

BMJ Open. http://bmjopen.bmj.com/content/8/3/e018895

They found that drinking 2 cups of coffee a day caused a 17% increased risk for the child being overweight at age 3 years, and very high intake (3 cups a day or more) conferred a 44% increased risk. This persisted.

It seems to be a good idea to limit coffee during pregnancy to one cup a day. 

Melatonin and Aggressive behavior?

Melatonin, a hormone released at night, is frequently used as a supplement to help with sleep and even migraine. It may also have effects on emotions and thinking.

Researchers in China examined how a 5 mg nighttime dose would affect 40 twenty-one year old volunteers.

They discovered that the nights they took melatonin, they were about 40% more likely to react aggressively to an experimental situation. In young healthy men, melatonin increased reactive aggression, which occurs when strong emotions are provoked. Whether this effect occurs in real-life circumstances is unknown.

However if someone you know appears to be a little more aggressive than usual it is worth asking about melatonin

Liu J et al. Psychopharmacology (Berl) 2017 Jul 21.

Skipping Breakfast - Bad for you or a sign of an unhealthy lifestyle?

Researchers in Spain studied 4000 men with cardiovascular risk factors. They found that those that skipped breakfast were almost twice as likely to have significant arteriosclerosis or blocked arteries than a similar group who did not. Both groups had the same measurable risk factors, such as smoking and cholesterol.

This was an association, not a definite cause. They speculated that although this may contribute in some currently unknown way, it is also possible that skipping breakfast is associated with other unhealthy lifestyles.

Still probably a good idea to eat breakfast!

http://www.onlinejacc.org/content/70/15

Polluting Developing Brains — EPA Failure on Chlorpyrifos

Our current EPA is intent on removing protections to our population so that business can thrive irresponsibly.

These policies seem aimed at hurting those in this country who can least afford it. When the government pulled back the Medicaid expansion, medical care for that section of our population suffered and recent studies confirmed that the poorest states, mostly in the South, have the sickest population.

Now the EPA has reversed a previous ruling on a widely used insecticide.

In 2016, just before the election, the EPA mandated a phasing out of the use of chlorpyrifos, based on evidence that it has been damaging our childrens' developing brains. Just as the EPA was poised to act, however, the plan was scrapped in March 2017 by incoming EPA Administrator Scott Pruitt, who overrode the recommendation of agency scientists to ban all commercial use of chlorpyrifos.

Organophosphate insecticides, like this one, were first introduced as nerve-gas agents during World War II, organophosphate chemicals were later repurposed by chemical companies as insecticides and other pesticides.

The adverse effects of this chemical will most strongly affect farm workers, their children, and anyone who cannot afford to buy organic foods. It is still widely used on fruits and vegetables, including apples, almonds, and dozens of other crops (see map in linked article).

By ignoring science and good sense, this government seems to be intent on creating a class separation in our society, pushing us to become more like many countries in South America with severe social issues related to a very rich class and a very poor class. For those of us who can, buy organic food!

Journal Article

http://www.nejm.org/doi/full/10.1056/NEJMp1716809?query=pfwNGTp&jwd=000005007879&jspc=GP

Breast Implants and cancer

Some years ago there were several lawsuits about breast implants and fibromyalgia. Even though this association has been disproven, it received enough publicity to frighten many people - and enrich many attorneys!

But it seems that certain kinds of implants, in rare instances, can cause a very rare and dangerous cancer. I'm not sure why this has not received the notice it should.

The FDA has received 414 reports of anaplastic large-cell lymphoma associated with breast implants, according to the latest numbers from the agency, which cover reports through September 2017. This was seen both with silicone and saline implants, but 90% of those were "textured".

So we really should be discouraging use of textured implants.

FDA Report

Germs are Eevrywhere - So What?

Update! The world is not sterile. We see many news reports about germs being everywhere (for example

Rossen Reports

Or this article about germs in your rubber duckie

Rubber Duckie

What is missing from all these articles is the fact that no one has ever shown there is a danger from these bugs. And maybe this improves our natural immunity. We are, after all, loaded with bacteria, mostly helpful.

So really, do you need to sterilize the airplane seat, tray, armrests, lightswitch (wings?). I don't think so.

Here is a blog from Dr Paul Sax, a Harvard physician:

Paul Sax Blog

California Gives Coffee cancer Warning!

Recently, you may have heard that California mandated that coffee must have a cancer warning label. This is based on the presence of small amounts of acrylamide, a chemical produced when coffee is roasted. Acrylamide is thought to be carcinogenic, and a non-profit group filed suit in 2010 to have these warning labels.

While it is true that acrylamide is likely toxic, its presence in roasted coffee does not seem to have consequences. There have been numerous studies looking at coffee ingestion that have been associated with living longer (some in this blog).

In some cases we need to look at the results not the components. That is, although this chemical may be potentially toxic, we have good studies that show coffee drinking is not only safe but actually may be beneficial. Tell that to the judge. Once again lawyers becoming scientists?

New York Times Article

Fish and Rheumatoid Arthritis

Fish Oil has been recommended for arthritis, now a new study shows it is beneficial in Rheumatoid arthritis.

In Arthritis Care Res (Hoboken) 2018 Mar, researchers found that patients who ate fish more than twice weekly had significantly lower inflammation scores than those who ate fish less than once monthly. For each additional serving of fish weekly, inflammation score was reduced significantly.

This was a small study, but it certainly wouldn't hurt!

"Liquid" Biopsy - Blood Test for cancer

As cells divide and die, they release some of their DNA into the bloodstream. Only in recent years have we had equipment sensitive enough to detect this - hence we can detect many prenatal diseases in a baby through a blood test from the mother.

Cancer cells grow and turn over quickly, so it makes sense that they would also release DNA. But can we detect this accurately? Since medicine has discovered many of the mutations involved in cancers, specially the common ones, searching the blood for these should predict recurrence or even a new cancer.

Cohen JD et al. in Science 2018 Feb 23 developed a test for both DNA acid and protein remnants shed by early cancers of the ovary, liver, stomach, pancreas, esophagus, colon, lung, and breast. The test was used in 1005 patients already diagnosed with these cancers, The test was 63% accurate, it only missed about 2% (although higher in breast cancer) and had a false positive in less than 1%.

Clearly not ready for prime time, this is a substantial step towards blood tests for recurrence and even screening.

Virus Producing Insulin?

Viruses are tiny DNA containing packages that use our body's metabolism and cells to help produce more. They are sometimes not even considered alive, as they do not have any mobility and cannot reproduce without the host. In some ways they are higher on the evolutionary scale since they had to develop after we did!

But scientists recently discovered some unusual properties of viral proteins that suggest a possible symbiotic relationship. In Proc Natl Acad Sci U S A 2018 Mar 6, researchers discovered that members of a relatively innocuous family of viruses, members of the Iridoviridae family, often present without symptoms in our intestines, have the ability to produce hormones that closely resemble human insulin and insulin-like growth factors (IGFs). These hormones are biologically active!

Perhaps our intestinal microbiotome (bacteria in the intestine) should now include viruses. The more we know, the more complex it gets. We have studied the DNA of less than 2% of known human viruses!

New Hope for MS - Stem Cells

MS, or Multiple Sclerosis, is often a relapsing disease that can lead to severe disability and death. Most current treatments offer some minimal help or delay in progression, but are often poorly effective.

Now researchers, in a preliminary study, http://www.sth.nhs.uk/news/news?action=view&newsID=1035, have published early promising results.

They split a group of 110 patients who were having relapses despite best medical therapy into 2 groups of 55, and gave one group a type of stem cell transplant. The transplant gorup had 1 relapse, versus 39 in the other.

This is probably the most dramatic treatment we have seen in MS, and if the 5 year study shows continued good results may be the new normal treatment for MS!

Gun Laws - "When Will We Ever Learn"

Unfortunately many of the politicians in our current government like to only believe the scientific evidence they like; no matter how clear the studies are.

So for those of us who believe in science and not lobbyists, a recent study was quite clear about gun laws and deaths from those weapons.

In JAMA Intern Med 2018 Mar 5, researchers found that states with the strictest laws had 50% less gun related homicides and suicides. Interestingly, proximity to a state with lax gun laws resulted in only a 25% decrease.

In Australia, which regulated automatic weapons following a massacre in 1996, the evidence is even stronger. Prior to 1996 there were 13 killings of 4 or more people in the 18 years previous. Since the new law - none. And gun related homicides dropped by over 50% to record low rates.

As Bob Dylan once said, "when will we ever learn?"