"Hypoallergenic" - inaccurate and misleading

There are many products labelled hypoallergenic. But there is no standard; and, in a recent publication, many of these are found to contain a potent allergen ans skin sensitizer!

Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are preservatives in cosmetics and personal hygiene products. They can be potent skin sensitizers and are included in many patch tests used by allergists and dermatologists.

In this study, it was found that the low concentrations in patch testing could miss many patients who were actually sensitive in higher levels that are often found in cosmetics and creams. In a review of over 700 patients about 10% were found to be allergic in spite of negative patch tests at current concentrations. Three quarters of them responded to elimination of the products.

But the real frightening issue is the number of products that do contain these, and are very often labelled hypoallergenic!

Dermatitis 2013; 24:2

Partial list: (go to http://www.hindawi.com/journals/drp/2014/132564/

for a more complete list

Huggies Natural care baby wipes “Hypoallergenic"

 One & done refreshing baby wipes “Alcohol-free, gentle ingredients"

 Simply clean baby wipes “Alcohol-free, gentle ingredients"

Nice-Pak Products Baby wipes “Hypoallergenic, alcohol-free"

Parent's Choice Fragrance-free baby wipes “Hypoallergenic with aloe"

Fresh scent baby wipes “Hypoallergenic with aloe"

Rockline Inc. Pure ’n Gentle antibacterial hand wipes

“Hypoallergenic & alcohol-free with natural aloe & vitamin E"

Equate Antibacterial hand wipes “Hypoallergenic, with vitamin E & aloe"

Galvin & lvin London Kids Dubble trubble 2-in-1 shampoo & body wash “Certified organic"

Suave Kids body wash “Dermatologist-tested, gentle, tear-free, dye-free"

Sanrio Hello Kitty bubble bath “Tear-free, gentle, hypoallergenic formula"

Neutrogena Pure & free baby sunscreen SPF 60+ “100% naturally sourced sunscreen ingredients, #1 dermatologist-recommended suncare"

Marijuana and Reefer Madness

Marijuana and Reefer Madness

Forty years ago, when I was in college, I would never have believed that marijuana would ever have become legalized. Now that it appears decriminalization is inevitable, I should remind you that although it is quite safe, it is not without some issues.

Reefer Madness ( http://www.imdb.com/title/tt0028346/ ) was a 1936 movie that exaggerated the dangers of marijuana. However, in a recent study that compared siblings and identical twins, one of whom was a regular marijuana user, found there was an almost double risk of psychotic events and schizophrenia. In susceptible individuals chronic use can be dangerous. As well, there are certain compounds in marijuana that can be riskier, while others that may actually help; the problem is there is no standardization among different strains.

Goldman D., JAMA Psychiatry 2015 Aug 26;

In a second study of children who were at risk for schizophrenia (based on genetics) there was also a significantly increased risk in marijuana users (French L et al., JAMA Psychiatry 2015 Aug 26).

And now E-cigarettes are being used to smoke pot. About 6% of 3800 high school students in Connecticut admitted to using hashish or other oils to smoke marijuana through and E-cigarette. The authors are concerned that this relatively ease of use may induce more adolescents to smoke pot. In previous reviews it has been shown that smoking marijuana in teens can produce permanent brain changes. (Morean ME et al., Pediatrics 2015 Sep 7)

To summarize, like other psychogenic agents (like alcohol) recreational occasional use in adults is probably safe. Any use in children and adolescents is inappropriate. Chronic use is unhealthy!

Preventing Cancer

With the US Health department reminding us that processed meats, like hot dogs, can increase your risk of cancer, I decided to mention three recent articles concerning foods and cancer.

It is well known that the Mediterranean Diet (rich in vegetables, grains and olive oils - look it up) can lower your risk for heart disease. Now researchers have discovered that this diet, with use of extra virgin olive oil (not sure why it specified "extra virgin") was associated with a 40-60% lower risk in women for breast cancer. It seems the more olive oil had the lowest risk!

Andrew M. Kaunitz, MD Reviewing Toledo E et al., JAMA Intern Med 2015 Sep 14;

Have you ever wondered if those insecticides sprayed in your home are dangerous? Well in a small study researchers found that children exposed to pesticides in their home (but not those sprayed outside) or herbicides that were sprayed in their lawn, caused a significantly increased risk of lymphoma and leukemia (25% for herbicides and 50% for pesticides). Something to think about!

http://pediatrics.aappublications.org/content/136/4/719

Finally, the controversy about alcohol use continues. Many studies have shown that small amounts of alcohol daily (up to two drinks for men and one for women) probably lower our risk of heart disease, but higher amounts lose that benefit. Now researchers have found that even in light drinkers there was a small but significant increased risk of breast cancer in women - about 30-40%. In men the risk of cancer was only increased in smokers.

Paul S. Mueller, MD, MPH, FACP reviewing Cao Y et al. BMJ 2015 Aug 18. Rehm J. BMJ 2015 Aug 18

So eat a proper diet, with plenty of extra virgin olive oil. Don't drink too much alcohol. Don't smoke. And don't use herbicides in your yard or pesticides in your home. I would think that the "natural" pesticides such as peppermint or chili spray, or diatomaceous earth may be OK

Sleep, Genes, Behavior and Illness

Scientists have struggled with why we sleep. A general consensus is that it allows a rejuvenation of the body, repairing and removing toxins, as well as allowing our brains to consolidate information.

Recently, a couple of studies have been published showing some unexpected adverse effects of poor sleep.

In the first, researchers tried to evaluate why some young children seem to sleep less, and asked if this can affect behavior. They found that a certain gene seemed to create a risk for these effects.

A significant association was found between short sleep duration during the first 3 years of life and frustration, fear, discomfort, sadness, and inattention in children with the 5-HTTLPR short allele but not in others!

Martin T. Stein, MD Reviewing Bouvette-Turcot AA et al., Pediatrics 2015 Oct 136:e914

In a second study, 164 volunteer adults were studied in a sleep lab, then infected with the cold virus by nasal spray. They found that those with less than 7 hours sleep, on average, were four times more likely to develop symptoms! They did not do a genetic analysis.

Thomas Glück, MD Reviewing Prather AA et al., Sleep 2015 Sep 38:1353

It appears that sleep duration can affect behavior and risk of illnesses. We do not know what else it may affect. Just try and get enough!

The FDA and Big Pharma

In many cases we have seen drugs either approved, or allowed to remain on the market when they have had unacceptable side effects (for example Vioxx), or been shown to be essentially ineffective (The new female sex pill). In addition, when President Bush passed part D (drugs) coverage for Medicare, the law was amended to specifically prohibit negotiating prices with drug companies (as do every other government sponsored plan throughout the world).

Many have surmised this is related to the powerful drug lobby. And it does seem to be so. That is why it is so disturbing that the FDA, our supposed independent agency that regulates the drug companies, has appointed Dr Robert Califf to head the agency.

He received received roughly $200,000 in consulting fees from pharmaceutical companies from 2009 to 2015, and has spoken out against regulation by the government. An interesting choice.

Check out New York Times Article

Colon Cancer and Aspirin

In the past, aspirin and NSAID (motrin, aleve, etc) use has been shown to decrease the risk of colon cancer by 20-40%. Although the mechanism is obscure, some believe it is related to the prostaglandin receptors in the colon.

Few of us take full dose aspirin or NSAIDs on a daily basis, and there had been no studies using 81mg or baby aspirin which is much more commonly taken.

Now, in a new report researchers showed that continuous use of low-dose aspirin (75–100 mg per tablet) for ≥5 years was associated with a 27% reduction in colorectal cancer risk. Long-term use of nonaspirin NSAIDs (≥2 prescriptions annually for ≥5 years) was associated with a 36% reduction in risk. There was no clear benefit from irregular use.

Unless you have a bleeding disorder, or a contraindication such as an ulcer, taking a baby aspirin a day, starting at about age 40, may be beneficial. You should discuss this with your physician to be sure this is OK for you.

Douglas K. Rex, MD Reviewing Friis S et al., Ann Intern Med 2015 Sep 1; 163:347

The Mammography Controversy

Today a new recommendation about mammograms was published by the American Cancer Society (ACS).

http://www.nytimes.com/2015/10/21/health/breast-cancer-screening-guidelines.html?_r=0


We used to do yearly tests starting at age 40; but there was really no hard evidence about how often and when to start. The US Preventative Services Task Force (USPSTF) started recommending every other year beginning at age 50.

http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening

The basis for these decisions is mainly the cost-effectiveness of the procedure and the risks involved. The risks are very minimal; the adverse complications from a negative biopsy are minuscule. We do not know the rate of false positives, which can result in unnecessary mastectomies. Cost benefit analyses are relatively arbitrary, but generally if the cost of finding one case exceeds $250,000 it is considered not cost effective.

In an editorial in the Journal of the American Medical Association, they commented:

"Because the risk of breast cancer is low for women in their 40s and to some extent women in their 50s, the modest relative benefit of 15% translates to a very small absolute benefit (approximately 5 of 10 000 women in their 40s and 10 of 10 000 women in their 50s are likely to have a breast cancer death prevented by regular mammography). The absolute benefit will be higher for women with a higher absolute risk of breast cancer, underscoring the importance of identifying higher-risk women. Especially for average-risk women, decisions to undergo regular mammography screening must also consider the harms of mammography—most notably the possibility of overdiagnosis and resultant overtreatment (age-specific estimates of which are lacking) and also the risks of false positives and unnecessary biopsies (known to be greater in younger women and women screened more frequently).
Despite the vast literature on screening mammography, the evidence needed to help women make decisions remains incomplete. "

For now, I would recommend continuing with yearly mammograms until the age of 75; and considering dropping to every second year after about age 60. But hard evidence is lacking and, as we develop better mammography methods it may be difficult to really know what to do.