Vol.120 February 15, 2015 Disillusioned …Again and Again

February 14, 2015


 “Scratch any cynic and you will find a disappointed idealist.”
― George Carlin

Maybe it is just that time of year, the record snowfall, the frigid temperatures, the lack of sun, but I feel like the world as I have known it is crashing down around my ears. Brian Williams has fallen off his pedestal, Bill Cosby is canceling shows all over the place, Tiger Woods is not coming back, Jon Stewart is leaving The Daily Show, Steven Colbert has already left, the towns are running out of sand and salt, and the trial of Dominique Strauss-Kahn, former head of the International Monetary Fund, has come up with the unique defense of his “aggravated pimping” “at a sex parties with “you can’t tell the difference between a prostitute and a naked socialite”.

So many of the truths we have held dear in medicine, science, politics, and society are being revealed as mere illusions. To wit:

  • Cholesterol need no longer be a nutrient of concern”. So sayeth the “nation’s top nutrition advisory panel” after 40 years of telling us just the opposite! High cholesterol levels in your blood do increase your risk for heart disease, BUT dietary cholesterol contributes only about 10% of that level. Of course, the panel couldn’t just leave it at that. According to them the REAL danger lies in foods heavy with trans fats and saturated fats. However, if you follow recent arguments in the literature closely enough you will see that there is some debate about which are the “good fats’ and which are the “bad fats.” Maybe we’ll have  to wait another 40 years for consensus.
  • Mississippi and West Virginia, among the poorest states in our country, have the best rates of measles immunization, and it is because they are the ONLY states that refuse to accept a waiver from immunizations on the basis of parental beliefs when children enter school. Mississippi’s measles vaccination rate is 99.7% for entering kindergarten students. West Virginia is at 96%. Epidemiologists have established a 94% immunized rate for measles as necessary to sustain “herd immunity”. In California and Arizona ( where thousands of Super Bowl visitors came and went back to their own states) the rates are 90.7% and 91.4% respectively.
  • Spewing sulphur gas into our high atmosphere could help block sun radiation and help cool off a warming earth. Isn’t sulphur one of those toxic pollutants given off by burning coal and other fossil fuels? Well, yes, says the National Academy of Science, but the computer models of blocking the sunlight with released sulphur have such a positive logic about them that “we should test it in some small pilot studies”.
  • Four out of five bottles of supplements taken off the shelves of GNC, Walmart, Walgreens, and Target in New York did NOT contain ANY of the herbs listed on their label. Ginseng pills “for physical endurance and vitality” contained only powdered garlic and rice. Ginkgo biloba for “memory enhancement” contained powdered radish, houseplants, and wheat. That label even claimed that it was wheat- and gluten-free! The FDA can only target products that have dangerous ingredients. It took the NY State Attorney General’s office to reveal this harmless ingredient sham, aka “profit by placebo” (NY Times, Feb. 3, 2015, pg.1)
  • Half of the health information and recommendations given on The Doctor Oz Show and The Doctors is false. Not only did 80 recommendations from each TV show picked at random from the 900 recommendations identified have NO evidence to support them, but many were even contradicted by evidence. In typical academic, “English speak” the authors suggest that “consumers and clinicians should be skeptical about these TV show recommendations”. (BMJ 2014 Dec. 17, 2014, 34)

Is there any hope for us optimists?   Well …

  • Crime rates in Boston have plummeted during this cold snowy weather. Homicide is down by 70%, rape by 50%, and vehicle theft by 46%. I guess everyone is staying inside, wearing lots of clothes,  and skipping the shoveling needed to steal a car. Rates for violent crimes in New York City, which had less snow and higher temperatures, all increased during the same period.

Vol. 118 January 15, 2015 It Ain’t Just Vaccines That People Decline

January 15, 2015


Half of U.S. patients don’t take their medicines as prescribed by their physicians.(1,2)

We use to call such patients “non-compliant.” As “patient-centered care” became the mantra for contemporary medicine that “passive, judgmental” term of “non-compliant” was banished and replaced by “non-adherent”, a presumably less derogatory term implying a partnership of patient and physician. (3)

A cardiologist, struck by the number of her patients that did not comply with adhere to their heart medicine prescriptions, asked 20 of them who had survived a heart attack why they didn’t adhere to medications that had proven benefits of secondary prevention of a next event, an event that could cause death. (4) Their comments (listed first below)  were surprisingly similar to feelings expressed to me by parents who decline immunizations for their children (typed in bold italics ).

1. Risk Aversion
“Why take medicine that could wreak havoc on your body.”
In people with negative emotional reactions even a small risk of side-effects seemed to overpower any positive feeling about the proven benefits of a drug. Their perception of risk is greater than their perception of benefit. They are “far more sensitive to possibility than to probability”.(5)
Despite numerous studies showing that there is no probability of an association between measles vaccination and childhood autism some parents still feel that there is always the possibility. Arguing relative probabilities of vaccine side effects versus disease effects with them is not productive.

“Medications are chemicals and should not be in your body on a regular basis”.
Vitamins, herbs, and other health supplements of all kinds are often turned to because they are not “chemicals”.
“I don’t want to have any foreign proteins injected into my child”. Natural immunity, of course, depends on our body recognizing and reacting to foreign proteins so that symptoms resolve and our next exposure to the same foreign protein doesn’t make us sick again. “It is the additive proteins that we don’t want” is often the next statement from the parents. Pointing out that there are 315 “foreign proteins” in today’s vaccines  rather than the thousand’s in the vaccines before the 90’s does not reassure them.

“Men don’t like taking medicine because to do so they are admitting that they are not strong. Most people like to think that they are strong and mighty. …Their very sense of well-being after surviving a heart attack and quickly resuming healthy lives may convince them that medications are not necessary.”
Some parents feel that their unimmunized children are safe from disease because the rest of the children are immunized, the “herd immunity protection” argument. Pointing out that herd immunity is effective only when the community reaches the currently unachievable high percentage of immunity (a 94% threshold in measles and whopping cough) has no effect. You would think that the possibility of measles in their unimmunized child in a partially immunized community would override the small probability of side effects from the vaccine. It doesn’t with some parents.

4. Avoidance of Sick Identity
“Has having a heart attack become too easy?” People can spend more time being sick from flu than having a therapeutic cardiac cath within 90 minutes of arriving at the ER and walking out of the hospital 24 hours later.
Has the absence of children dying or being crippled by measles, polio, diphtheria, or croup dulled our ability to imagine our children in such a sick state? Sporadic epidemics of whooping-cough and croup in certain states have been successful in raising immunization rates a bit. If there were an Ebola vaccine, I wonder how the vaccination  non- adherent parents would have juggled that possibility/probability calculation for their children.

5. Difficulty Visualizing Benefits
“The benefits of cardiac medications may be imperceptible and the absence of perceived benefit is a well-documented reason for non-adherence”. Adherence to anti-platelet medications (“blood thinners”) is higher than other cardiac meds perhaps because the patient can easily visualize the “thinned” blood flowing smoothly through an unclogged pipe. That the medication is actually “doing something” is reaffirmed by the prolonged bleeding from a razor nick.
Maybe we pediatricians should develop an app and FitBit that could non-invasively measure antibody levels and send an alert to the child (via his/her own smart phone, of course): “Your antibodies against [insert tetanus, diphtheria, or whatever disease name here] have been declining for years and are now at a level that no longer protects you. Go immediately to your nearest [insert sponsoring drug/ convenience/department store name here] and get vaccinated.”

6. Avoiding Dependency
“Relying on cardiac medications is another form of addiction. I brought on this heart attack by my life style and it is my responsibility to avoid another by changing my life style.” Taking medications may be viewed as a loss of control, as “following orders” , as “being told what to do”.
This rejection of authority rings true in my experience with some parents who decline immunization for their children. It also may explain why pockets of unimmunized children who are not in poor families are sometimes clustered within tree-hugging, organic food eating, aging-hippy communities. Frustrating as this rejection of authority is to the physician, repeatedly battering the head and shoulders of these parents with all the scientific facts proving that vaccinating their child is safer than having them contract the disease is counter-productive.

The discussion with parents who decline immunizations for their children is hardly ever a rational one. Some beliefs and feelings seem impervious to facts. Certainly a parent’s personal knowledge of some child, usually a cousin or a nephew/niece, who had a vaccination and then had a seizure or who “has never been the same since” is a real conversation stopper. That personal experience can generate such deep feelings that I no longer even try to talk them out of that hole. We don’t experience that same depth of feelings if an older adult we know survives a heart attack only to die of a second one months or years later. We often feel, not knowing all the details, that “C’est la vie”.

1. NEJM 2005;353:487-97 Adherence to Medication
2. J Gen Intern Med 2008;23:115-21 Secondary Prevention After MI
3. Ann Pharmacotherapy 2004;38:161-2 Adherence or Compliance?
4. NEJM 2014;372;2:184-7 Beyond Belief
5. Psych Bull 2001;127:267-86 Risk as Feelings

Vol. 114 November 15, 2014 Selected Issues for Modern Kids Listed by School Level

November 16, 2014


“Everything I need to know… I learned in kindergarten.”
― Robert Fulghum, All I Really Need to Know I Learned in Kindergarten


Pre-school – Immunizations
When the first child under 2 yo. developed a severe seizure disorder after a measles vaccination it started the fire of resistance against immunizations which still burns today. Subsequent research proved that that child had a genetic abnormality as the CAUSE of her severe seizures, the Dravet syndrome. The immunization caused a fever that was a TRIGGER for the epilepsy.  One study of 14 children with onset of epileptic encephalopathy after vaccination revealed that 11 of them had a genetic abnormality, Dravet syndrome.  In a recent study of 45 children who had seizures within 24 hours of an inactivated virus immunization or within 12 days of a live virus vaccine, 65% of those children developing epilepsy after an immunization had an underlying genetic cause. The vaccines were NOT the cause. Fortunately only 16% of patients with that genetic defect will have a seizure from a fever following immunization. .(1)
Serious neurological illness is very rare after an immunization,… and the immunization does NOT cause it!

Kindergarten – IQ tests
Over 7000 pairs of twins in the UK were given the Goodenough (named for the developer) Draw-A-Person test and a standard intelligence test at age 4 and then at age 14.  The Draw-A-Person test is a common measure of “school-readiness” for 5 year olds. The drawing of a “man, a woman, and themselves” is then scored for 14 different aspects (body parts, scale, etc.) producing a score composed of 64 items.  At 14 years of age the same children were given another IQ test. “Figure drawing scores at age 4 correlated significantly with verbal and non-verbal intelligence at both age 4 and age 14.”  This contradicted a previous study of 100 children (not in UK) that showed NO correlation between Draw-A- Person scores and standardized IQ test at pre-school age.
…But, you may only be as smart as you are in kindergarten.

Middle School – Apple Allergy
A 11 year old boy with a past history of patches of eczema previously responsive to usual treatment with steroid creams developed a whole-body dermatitis that did not clear up with 6 months of treatment.  A variety of skin patch allergy tests revealed a 1+ reaction to nickel, a commonly seen cause of dermatitis in some people. Presumably he was being exposed to nickel by contact with his iPad surface that was positive for nickel. A plastic cover for the iPad resolved the rash. Cell phones, clothing fasteners, ear-piercing, video-game controllers, lap top computers , and some wind-up toys can also be sources of nickel allergic reactions by direct contact. (3)
iPads and other metal electronic products can cause a persistent allergic rash.

High School – School Start Time
Chronic sleep loss can impair academic achievement, physical health, and mental health. The American Academy of Pediatrics recently recommended that school should not start any sooner than 8:30 AM. Studies of high school seniors revealed that on average they sleep less than 7 hours a night and have difficulty falling asleep before 11 PM. The desired goal is 8.5 to 9.5 hours of sleep at night, and that “naps, sleeping later on weekends, and coffee do NOT restore optimal daytime alertness”. (4)
Later starting time for schools is good for kids.

College – Marijuana, Alcohol Use
Too much to say here about that right now. More later.

1. Pediatrics 2014 Sept 15.
2. Psychol Sci 2014 Aug 20
3. Pediatrics 2014 Aug 1
4. Pediatrics 2014 Sept.

Vol. 110 September 15, 2014 Recent Updates From Around the World

September 15, 2014


“Some believe in eating anything, while the weak only eat vegetables.
Those who eat must not despise those who abstain,
and those who abstain must not pass judgement on those who eat.”
Romans 14:2-3

This biblical citation has nothing to do with this week’s contents, but I was so surprised to hear it read in a church service,  and I want to preserve it to use in my defense when my children try to push lima beans, brussels sprouts, and quinoa on to my plate. Plus, I don’t think that it should be only the fundamentalists who quote the bible out of context to support their biases.

My favorite grace, of course, is the Robert Burns grace reproduced here in English (absent the Scottish dialect which really makes it poetic):

Some have meat and cannot eat,
And some would eat, but want it:
But we have meat, and we can eat,
And so let the Lord be “thanket”.

High Dose Flu Vaccine, Hype or Truth?

A study of 32,000 people over 65 years of age during 2011-13 showed that the “high dose” flu vaccine in that age group provided more protection than the standard dose. 1.9% (301) of the standard dose vaccinees got the flu while “only” 1.4% (228) of the high dose vaccinees did. Both vaccines had the same percentage of adverse side effects (9%).

The study’s conclusion was that high dose vaccine is 24% more efficacious, but to me these small numbers hardly justify the high-energy, hyped-up TV ads telling me to “Ask your doctor for the high dose flu vaccine!” AND the authors also remind us that any flu vaccine works best if it matches this year’s flu viruses. That is not always the case. Each year’s flu vaccine is developed from last year’s virus.

Bottom line: get a flu shot, any flu shot.

Too Much Salt Does Kill People, But Not So Much in the U.S.

In a huge, multi-year study funded by the Bill and Melinda Gates Foundation daily salt consumption was determined for 74% of the world’s adult population! The data taken from previously published surveys, 24-hr urine collection reports, and dietary intake studies was fed into a computer (Bill Gates, of course, but the authors added a disclaimer that the “funder had no role in this study or report”). The computer kicked out an average daily salt consumption by age, sex, and year for 187 countries.

The average worldwide salt consumption was about 4 grams per day, twice the amount recommended by the World Health Organization (2 grams per day). 181 of the 187 nations exceeded the WHO recommendation. The computer model went on to estimate that 2 out of 5 premature deaths (under 70 yo.) were attributed to salt consumption above 2 grams a day. The Institute of Medicine has stated that there is little evidence that reducing salt consumption below 2.3 grams a day reduces cardiovascular events. There is even some evidence that a low salt intake (under 1.5 grams a day) can increase your cardiovascular risk!

The good news, for us, is that the  U.S. and Canada have one of the lowest salt consumption rates, but still over the 2 grams threshold. The highest salt consumption associated mortality rates were in Central Asia, Central, and Eastern Europe,  Only Australia and New Zealand had lower CV mortality rates attributed to salt consumption than the U.S. and Canada (again, they beat us!).

Bottom line: If you’re worried about your future cardiovascular events try a 2 gram a day salt diet for a few days. Then very slowly, add a little bit more  salt each day until the food tastes good again.

From the “Duh Department”

Norwegians who have large, complex, or multiple non-cancerous polyps removed from their intestine by colonoscopy have a slightly higher death rate from colon cancer within 10 years than those people with small, single “low-risk” non-cancerous polyps. (3)

People in low income countries have lower risk factors for cardiovascular deaths, but have much higher death rates from heart attacks than middle- and high-income countries (Also true for “deaths from any cause”).(4)

1. NEJM August 14, 2014 vol. 137, no. 7, pg. 635
2. Ibid; pg. 624 and 677 Editorial
3. NEJM August 28, 2014 vol. 371, no. 9, pg.799 and 860 Editorial
4. Ibid; pg. 818

Vol. 104 January 1, 2014 Hubslist’s Blogs of 2013

January 1, 2014


“Happiness is Not a Warm Gun” – Jan 1, 2013
In half of my lifetime our culture has moved from arguing that sometimes it was “better to not wear a seat belt in case there was a car fire” to having my grandchildren remind me that I shouldn’t start the car until MY seat belt is buckled. No ONE law accomplished that, and it happened despite critics and opposition from big time lobbyists. Why can’t we do the same for gun control?

Ten Ways To Improve Your Health – Jan 15, 2013
 This list, “backed by scientific research”, was complied by AARP.
1.  Throw a Party – Social connections help you live longer.
2.  Adopt a Pet – Exercise it (and you) and count it as another social connection.
3.  Choose Dark Chocolate – An ounce a day keeps the doctor away.
4.  Savor Your Coffee –  Three cups a day keeps Alzheimer’s away.
5. Have a glass of wine or beer – “Guinness is Good For You” One glass a day for women, two for men!
6. Have Sex – There is nothing bad about releasing endorphins. It also counts as aerobic exercise.
7. Listen to Your Favorite Music – A song a day keeps the heart pumping away.
8. Take a Nap –  A nap a day keeps the brain hoarder at bay.
9. Go Outdoors – Go look at the greens, don’t just eat them.
10. Use Soap. regular soap – Antibacterial soaps with triclosan aren’t worth the cost and may not be safe.

The MYTH of Antioxidants – Feb. 1, 2013
A 2007 systematic review of 68 clinical trials concluded that antioxidants do not reduce the risk of death. Certain antioxidants were linked to a 5%  INCREASED risk of death. The American Heart Association and the American Diabetes Association now advise “that people should not take antioxidant supplements except to treat a diagnosed vitamin deficiency”. “The literature is providing growing evidence that these supplements – in particular at high doses –  do not necessarily have the beneficial effects that they have been thought to…We’ve become acutely aware of potential downsides.”

The ATF has no ammunition – Feb. 15, 2013
The Tiahrt Amendment, passed by Congress in 2006, permits gun dealers to destroy gun registration applications within 24 hours of completion so as “to avoid any inadvertent errors from being promulgated” . It placed these prohibitions on the ATF;  the federal agency overseeing firearms

prohibited from establishing a registry of gun owners (imagine no one keeping a registry of car owners)
prohibited from requiring gun dealers to maintain inventories of their wares
prohibited from inspecting any gun dealer’s records more than once a year
prohibited from revealing firearms trace data to anyone other than law enforcement personnel (firearm tracing is done for  firearms used in crimes. One study showed that 57% of guns used in crimes in one state were traced to only 1% of gun dealers.)
prohibited from requiring gun dealers to respond to police inquiries.

 So we may not need any more laws or regulations for gun safety. We could just repeal the one “Tiahrt Amendment”, and let the ATF begin to do its job.

Take a Pill – March 1, 2013
“Something like a third of consumers who’ve seen a drug ad have talked to their doctor about it,” says Julie Donohue, a professor of public health at the University of Pittsburgh who is considered a leading expert on this subject.”About two-thirds of those have asked for a prescription. And the majority of people who ask for a prescription have that request honored.”  Our mantra continues:
“Hey, Doc,
Forget the Mediterranean Diet.
I’m an American.
Give me a pill.”

The New Pope – March 15, 2013
The medical question I have not been able to answer despite my extensive, exhaustive research (at least an hour on Google) is:  Which Pope had the ulnar nerve palsy? The classic hand gesture of the “Papal Blessing” or “Papal Benediction”, despite erudite analysis by reverent writers on the religious symbolism of his hand and fingers, is, in fact, the result of a nerve palsy of the hand. Even the Vatican tourist guides know this.popesign1The Italian bishops were surprised that the Bishop of Milan, Angelo Scola, was not elected, and much to their embarrassment they prematurely released a report that he had been. I, too, was disappointed that Angelo Scola did not get elected. We all could have called him Pope Scola.

Pope Francis Bails Out Obamacare – April 1, 2013
In a solemn Easter Mass Pope Francis dramatically offered the help of the Roman Catholic Church in funding universal health care in the U.S. He noted that because the U.S. is the only civilized Western country without universal health care and is currently having financial problems, it is the Christian thing to do. “Since neither disease nor money is restricted by national boundaries, it makes good sense to protect the rest of the world from the health problems of  the beleaguered U.S. ” The Pope’s plan was immediately dubbed, “Francincare” (pronounced  as “Frankincare” with the Italian hard “c”). At the end of the press conference Pope Francis returned briefly, showed the persistent Papal nerve palsy to the gathering, and closed with a benediction in Italian: “Felice Aprile Ingannare Giorno”, in Spanish: “Felize Abril Enganar Dia”, and finally in English: Happy April Fools Day”.

Patient Centered Medicine – April 15, 2013
PARENT:  So, I should breast feed Leonard for a whole year, but could have started solid foods two months ago?  Most of my friends swear that giving food makes their babies sleep longer at night.
PHYSICIAN: Exclusive breast feeding for 6 months has lots of advantages for the infant. There is no evidence that giving solid foods makes the infant sleep longer at night, but there is probably no harm in starting him on cereal now.
PARENT: Any particular kind of cereal?
PHYSICIAN: A 1994 Swedish study showed that introducing wheat before 6 months of age caused a big spike in gluten allergies and celiac disease, but a more recent one there showed that giving wheat to breast-fed babies at 4 months actually decreased the later occurrence of celiac disease and gluten allergy.
PARENT: So, wheat cereal could be either good or bad at his age? This is very confusing.
PHYSICIAN: Science can be confusing. It often changes its mind as new data is gathered.

Lessons Learned from the Development of Polio Vaccines – May 1, 2013
1. Even in science, what you know is important, but WHO you know can be also.
2. Yesterdays “field trial” is today’s mass immunization campaign, and NOBODY tests drugs or vaccines, whether from mice brains or monkey kidneys, on themselves and their family members anymore!
3. The history of testing vaccines and drugs on impaired or incarcerated populations reminds us again of the necessity for “informed consent”.
4. As more academic institutions seek joint contracts with big pharma to replace reduced NIH support of research (MGH and Sanofi, AztraZenenca, etc.) accusations of being a “commercial scientist” seem moot.
5. Some immigrants can be very smart, focussed, and hard-working, and they can contribute immensely to our country’s health and wealth.
6. Science keeps gathering data and testing hypotheses, so we should not be surprised when its recommendations change.

Medical Marijuana – May 15, 2013
1. Marijuana use before the age of 20 does have structural and functional effects on brain development, primarily but not limited to the frontal lobe. (“The frontal lobe, responsible for impulse control, is the last to develop and the first to go.”)
2. After the age of 20 there is little current evidence that MJ causes any permanent effect on brain function or structure.
3. There are  currently no predictors that will identify an occasional user of MJ as one who will become dependent or addicted to MJ (daily use), but the earlier one starts using marijuana (13 yo.) the more likely brain function will be effected.
4. Despite the “trustworthy karma” of medical marijuana, marijuana prescriptions will result in the dispensing of varied, complex, and inconsistent products.
5.Access to marijuana by middle and high school students in 2013 is now so easy according to both students and researchers that medical marijuana dispensaries will provide little increased access to adolescents.

The three drugs of adolescent choice today, tobacco, alcohol, and marijuana, do share a common denominator in that those who use one of the three drugs by age 13, will use one or more of the others before 18 yr. There is NO evidence that one is the “gateway” to another. In fact, one researcher remarked that the concept of a gateway is more of a myth than a reality. He called development of addiction to one or the other substance as a “shared vulnerability”.

Sunscreen SPF Ratings Escalation – June 1, 2013
This year Consumer Reports states that the according to their tests the maximum effective SPF is now 40. Paying for anything above that is wasted money. Two years ago Consumer Reports tests showed that any sunscreen with a SPF (Sun Protection Factor) over 30 gave no more protection than a 30. They also recommended that year-old sunscreen might have lost some of its effectiveness, so new sunscreen should be bought each year. New FDA regulations require the sunscreen to be labeled with a three-year expiration date.

What Massachusetts Docs Think About Medical Marijuana – June 15, 2013  Common threads in the  118 comments posted were:
1. Does marijuana even belong in the purview of physicians? “Just legalize it and let patients decide whether to use it or not”
2. Most physicians who supported its medical use would do so “in certain circumstances”; implying strongly that physician control over use was assumed by supporters.
3. All camps called for more research to move toward a stronger basis of evidence.

Do You Have Obesity or Are You Just Fat?- July 1, 2013
The House of Delegates of the AMA just voted to designate obesity as a disease. This means that you will no longer “be fat”. You will “have obesity” like you “have diabetes”.  The AMA Scientific Council recommended to retain obesity as “a condition”. A spirited debate about the consequences has begun. I suspect that much of the controversy  is about money. Medicalizing a societal condition will cause more money to be spent on surgery and drugs.  “Insurers will pay more.” The upside of that could be more provider reimbursement for prevention and life style counseling by primary care providers, but surgery and big pharma are usually first in line. Two new anti-obesity drugs (Belvig and Qsymia) came on the market this past year. More than one-third of Americans will instantly be labeled as “ill” and therefore eligible for more medical services.

Sunscreens Are Poisonous? – July 15, 2013
The culprit is oxybenzone  and other similar chemicals in chemical sunscreens first described as “endocrine disruptors”, a code word for “estrogen effect” which directly connects it emotionally to breast cancer, particularly by Dr. Oz.   Oxybenzone is such a common ingredient in skin products that a CDC survey of Americans in 2003 detected it in 97% of urine samples. The link to breast cancer in humans has not been proven. One reassuring fact is that hormones, like all chemicals and unlike radiation, have to reach a certain blood or tissue level to have any significant effect.  An average woman would have to apply 1 and 1/2 quarts of sunscreen to 25% of her body (arms, legs, and face) each year for 277 years to attain the levels of oxybenzone that had uterine effects in lab rats!

Too Much Sun in Vermont?! – August 1  , 2013
I am in a hammock in Vermont reading, much to my surprise, that Vermont, the land of a severely short summer, has one of the highest melanoma rates in the country.  About 29 people per 100,000 in Vermont get diagnosed with melanoma as compared to the national average of 19 per 100,000. Bennington County has the HIGHEST rate of melanoma of any county in the nation, 179% above the national average!

Somezhiemer’s – Sept. 1, 2013
News releases and internet blogs this week are full of buzz about a protein that apparently is related to the memory loss of aging; something I call Somezhiemer’s as opposed to Allzhiemer’s (sic).  In this Columbia University School of Medicine study a deficiency of the protein RbAp48 in a specific part of the brain in both older mice and 8 older humans (both postmortem) was correlated with memory loss ; at least the ability of the mice to remember a water maze pathway.
The good news is that one specific biological cause of memory loss has been discovered, as contrasted with speculation about aluminum, cooper, mercury, zinc, and other environmental agents.The bad news is that us older people will probably not, in our lifetime, be able to take a “RbAp48 pill” each morning, so we don’t misplace our car keys, glasses or …. forget to write an August 15 blog.

Fear of Fever – Sept. 15, 2013
Many parents think that a temperature over 98.6 F is a fever. Most pediatricians consider a temperature of 101 F or higher as a fever, except in infants under 3 months where we pay attention to temperatures over 100 F. Any pediatric practice worth its salt has a handout or a website page describing fever as one of nature’s way to fight infection. Fevers are usually caused by common viruses for which antibiotics are no help, and discomfort from them is relieved easily by simple medicines.
We desire zero risk level in our lives, and a fever, no matter how small or how short in duration, indicates that something may be wrong. Speaking of risks, how can we accept that everyone must remove their shoes at the airport because one person had a bomb in a shoe, but we don’t register gun owners and accept the much greater risks of our kids being shot?

 Obamacare Begins – October 1, 2013
Like the Bible, Obamacare is open to interpretation. Your view of it may depend on your political party rather than your religion. Both are vulnerable to quoting out of context in support of opposing viewpoints. Both have overall, encompassing goals which can often be lost, or at least obscured, by minute details of excess verbiage. Both have, and will continue to have, “unintended consequences” (like the Inquisition and the Crusades) that we mere mortals have to deal with.
Everyone certainly agrees that Obamacare is NOT divinely inspired. Congress has clearly rejected the idea of a central authority (like the Pope, or Donald Berwick, MD as “Czar” of CMS). The Bible is no longer chained in the dark in the back of the church.  Obamacare is now out in public, out in the market place. We shall eventually see how well it meets the needs of our citizens for affordable health care.
By the time the Republicans win the presidency Obamacare will have so many beneficiaries (voters) that they won’t dare to kill it, and they’ll have to rename it. I wonder WWJD?

Flu Vaccination – October 16, 2013
The trivalent vaccine is the most readily available (at both your physician’s office or a retail store) and there is no compelling reason to seek out the quadrivalent vaccine. The vaccine’s effectiveness in preventing the flu depends on which flu strain is circulating in your area. Effectiveness may be as high as 80% in young adults, but is almost always lower in the elderly. A high dose vaccine that allegedly delivers four times the usual prod to your immune system is being marketed for the over 65ers , but it is not recommended since there is no independent study of its success.
In Massachusetts last year there were 5 flu deaths in children under 17 yo.  None of the five had been adequately vaccinated. Two of the five had no pre-existing health problems. Nationally there were 146 pediatric deaths from the flu last year compared to 34 the previous year.  40% of those deaths were in children who were otherwise very healthy.  90% of them were unvaccinated.

Paranoia – Nov. 1, 2013
Former Vice President Dick Cheney recently said during a “60 Minute” interview that he had his cardiologist turn off the wireless function in his implanted pacemaker “in case a terrorist tried to send his heart a fatal shock.” Years later, he saw that scenario played out in an “Homeland” episode. We knew that his DC residency was pixellated in the Google satellite view, and we wondered if he was on the NASA phone surveillance list.  But then, we remembered that he had ordered it.
Polls taken in Boston after the Marathon bombings indicate that more people think that “such attacks are likelier, but fewer live in dread of them.”.”In the United States since 9/11 Islamic terrorism has resulted in the deaths of 37 people. During that same period, ten thousand times that many have been killed by guns wielded by their countrymen or themselves.”

Is It a Strep Throat or Just a Virus Cold? – Nov. 15, 2013
A team of Boston research physicians have recently come up with a potential APP for that! These physicians combined two clinical findings that the patient could recognize with real-time data about the occurrence of positive strep tests in the community in the past 14 days to generate a “Home Score” to tell you if you really need a strep throat test.
There may soon be a home kit for that! Other physician researchers in Boston are ready to test a home-based, patient-administered Rapid Strep Test. A positive home-based RST would be enough to initiate treatment and prevent complications.

The Myth of Multi-Tasking – Dec. 1, 2013
“Multitaskers are terrible at every aspect of multitasking…When we talk to multitaskers they seem to think that they’re great at it and seem totally unfazed and totally able to do more and more and more.” Actually, those who did it the least, did it the best. “We are worried that multitasking may be creating people who are unable to think well or clearly.”
Recent work involved study of the erosion of social and emotional development by the increasing use of social media. “We have to get back to that saying, ‘Look at me when I talk to you’”.

Aspergers or Autism – Dec. 15, 2013
Confusion about these syndromes  increased in the 2000’s as screening tools improved and awareness of the syndromes grew.  The authors of the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , the bible of insurance company reimbursement, has attempted to simplify and clarify the situation by lumping all the diagnostic names into one billing code, “Autism Spectrum Disorder” (ASD).
The attempt has not succeeded according to its critics and many practicing physicians.
Parents of Asperger children could lose insurance benefits now tied to that diagnosis. Grant-supported educational and enrichment programs for Asperger’s may dry up. Asperger’s has always been a less terrifying diagnosis than autism.  People with Asperger’s, and probably more important, their parents, don’t want to be labeled with the stigmata of “autistic”. Dan Akroyd and Daryl Hannah  self-proclaimed their Asperger’s in 2013.

Vol. 99 October 16, 2013 Flu Vaccine Update

October 16, 2013

hubSeasonal flu vaccine is effective and should be offered to everyone over 6 months old
who does not have a specific medical contraindication. (1)

Remember how excited we got about swine flu?
And then how concerned we became about the swine flu vaccine?
We began calling it H1N1 flu in hopes of reducing some of the stigma attached to its name.
We thought it might cause much more illness and deaths than seasonal flu, H1N2.
It didn’t.
That was in 2009 and 2010.

There is no such flu excitement this time around, but there are a lot more flu vaccines. There are 20 flu vaccine preparations made by 9 different pharmaceutical companies for prices ranging from $9.50 to $32.00.  (The highest priced one is for people with egg allergy.)

The “flu shot” delivers inactivated (or killed) virus, provides protection against three strains of flu (“trivalent”), and most preparations, but not all, are suitable for any one over 3 yo.

The nasal spray, “Flumist”, delivers live virus providing protection against four strains of flu (“quadrivalent”) and gives excellent protection to children over 2 yo. It can not be given to people over 42 yo. This live virus vaccine may cause shedding of the virus from the vaccinee for a few days, but serious illness from such person-to-person transmission has not been reported.

Children from 6 months to 8 years old receiving a flu vaccine for the first time or who have NOT received at least 2 doses since July 2010 need a SECOND vaccine administration at least 4 weeks later.

The trivalent vaccines protect against influenza A (California strain) which is “H1N1-like”, influenza A (Victoria strain) which is “H3N2-like”, and influenza B (Massachusetts strain) which is “2012-like”. Influenza virus strains are named after their site of origin, and, yes, Massachusetts can now proudly claim a place along other locales that gave their name to diseases; like Coxsackie, N.Y. for hand-foot-and mouth disease and Lyme, Connecticut for…you know. The quadrivalent vaccine adds an influenza B (Brisbane strain) which is “2008-like”.

The trivalent vaccine is the most readily available (at both your physician’s office or a retail store) and there is no compelling reason to seek out the quadrivalent vaccine. The vaccine’s effectiveness in preventing the flu depends on which flu strain is circulating in your area. Effectiveness may be as high as 80% in young adults, but is almost always lower in the elderly. A high dose vaccine that allegedly delivers four times the usual prod to your immune system is being marketed for the over 65ers , but it is not recommended since there is no independent study of its success.

In Massachusetts last year there were 5 flu deaths in children under 17 yo.  None of the five had been adequately vaccinated. Two of the five had no pre-existing health problems. Nationally there were 146 pediatric deaths from the flu last year compared to 34 the previous year.  40% of those deaths were in children who were otherwise very healthy.  90% of them were unvaccinated. (2)

So, don’t be flu-ish, get your flu shot …or spritz in the nose.


1. The Medical Letter, Volume 55, Issue 1425, September 16, 2013
2. Massachusetts Department of Public Health, October 16, 2013

Vol. 89 May 1, 2013 Science, Personalities, and Politics of the Polio Vaccines

May 2, 2013

hub_2Dr. Hilary Koprowski, the creator of the live polio vaccine, died last month at age 96. What? I thought Dr. Albert Sabin developed that vaccine.

At a physicians’ educational meeting last month, Dr. Larry Pickering of the CDC and the University of Georgia recounted the headline-grabbing, fearsome, panic-causing polio epidemic of 1952-53 and gave us some insight into the sometimes dramatic duel between Dr. Sabin (with his oral live virus vaccine) and Dr. Salk (with his injectable killed vaccine) in everyone’s urgent efforts to stop the spread of the disease. I read Dr. Koprowski’s obituary the next week.

Dr. Koprowski was a Polish immigrant, earned his MD at the University of Warsaw, and helped develop a yellow fever vaccine with the Rockefeller Foundation. That success led him to the idea of using the same process to develop an attenuated live virus vaccine for polio. He was working for the Lederele pharmaceutical company in Pearl River, NJ at the time, and so was some times dismissed as a “commercial scientist”. He was described as a loner who was most comfortable in the lab, never sought public attention, but occasionally referred to himself as the “developer of the Sabin polio vaccine” .

Koprowski first tested the safety of the vaccine by having himself and his family sip a grey slurry of the seventh pass of the virus through the brains of Swiss albino mice in 1948 (1). When none of them got polio, he then tested its efficacy by administering it, at the facility’s request, to 20 retarded residents of Letchworth Village, NY  in 1950. All showed excellent development of antibodies against polio. Dr. Koprowski sent a sample of his vaccine to Dr. Albert Sabin.

Dr. Albert Sabin, also a Polish immigrant and a Rockefeller grantee, received his MD from New York University and developed his live virus vaccine from Dr. Koprowski’s sample using monkey kidney tissue at Cincinnati’s Children Hospital. After testing vaccine safety on himself and his family, he gave it to institutionalized children in a Ohio reformatory in 1954. All developed antibodies, and none got polio.

Meanwhile Dr. Jonas Salk, also a graduate of New York University School of Medicine, received a grant from the National Foundation for Infantile Paralysis to study the three types of polio virus at the University of Pittsburgh. The grant allowed Dr. Sabin to finally establish his own lab after several years of difficulty due to the traditional “academic jewish quotas” of the time. When he succeeded in developing a killed-virus vaccine, he successfully tested it in 1953 in 43 children at the D.T. Watson Home for retarded and feeble-minded children in Pittsburgh.

In 1938 Basil O’Conner, CEO of the National Foundation and a former law partner of Franklin D. Roosevelt (the most famous polio victim in the world), had started a fund-raising effort called the March of Dimes which in its first year literally inundated the White House with coins and letters. When Salk’s vaccine proved efficacious in 1953 Basil O’Conner successfully urged the U.S. government to launch a field trial of his grantee’s vaccine. That “field trial” eventually distributed vaccine to 1.8 million children with the help of 20,000 physicians, 64,000 school personnel, and 220,000 other volunteers. (Now THAT’S a “field trial”.) The success of the trial was announced on April 12, 1955 in a Waldorf Astoria Hotel press conference and radio broadcast supported by a $250,000 grant from Eli Lilly and Company, and Salk became a superstar. Salk, himself, valued his privacy, abhorred the resulting publicity, and refused any effort to patent the vaccine.

Basil O’Connor was much more energetic in promoting the use of the Salk vaccine and a fearful public embraced it. An adversarial situation soon developed between Salk and Sabin as each pushed the government in Congressional committee hearings to use their vaccine. Sabin became “openly hostile to Salk” and would provide immediate “specific critiques of his presentations at scientific meetings”. Basil responded in the newspapers by saying in 1955, “Those who would prevent its [Salk vaccine] use must be prepared to be haunted for life by the crippled bodies of little children who could have been saved from paralysis had they been permitted to receive the Salk vaccine.”

The oral live virus vaccine was used to immunize over 100 million Russian children between 1955 and 1961, but it’s first U.S. trial was in 1961 on 180,000 school children in Cincinnati, Ohio. The live virus vaccine reproduces itself in the intestines of those vaccinated and spread of the attenuated virus from those vaccinated can protect others in the community. This was an advantage in endemic, poorly developed countries, but caused the U.S. to stop using the Sabin vaccine for fear of secondary spread.

The polio vaccine we give today is a 1988 refinement of an injectable killed-virus for all 3 types of polio and is 100% protective after three injections in the first year of life and a booster at 6 yrs.

All three physicians went on to develop or lead separate, stellar research organizations bearing their name and  continuing their superb work.

In 2007 Dr. Hilary Koprowski was awarded  the annual Albert B. Sabin Gold Medal given by the Sabin Vaccine Institute.

Relevance today?
1. Even in science, what you know is important, but WHO you know can be also.
2. Yesterdays “field trial” is today’s mass immunization campaign, and NOBODY tests drugs or vaccines, whether from mice brains or monkey kidneys, on themselves and their family members anymore!
3. The history of testing vaccines and drugs on impaired or incarcerated populations reminds us again of the necessity for “informed consent”.
4. As more academic institutions seek joint contracts with big pharma to replace reduced NIH support of research (MGH and Sanofi, AztraZenenca, etc.) accusations of being a “commercial scientist” seem moot.
5. Some immigrants can be very smart, focussed, and hard-working, and they can contribute immensely to our country’s health and wealth.
6. Science keeps gathering data and testing hypotheses, so we should not be surprised when its recommendations change.

References:  1. NY Times, April 21, 2013, pg.18

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