Vol. 159 December 1, 2016 Dementia Is Going Down, Weight Will Go Up

December 1, 2016

Hub thumbnail 2015

The incidence (number of new cases per year) of dementia in the U.S. is apparently declining.

The Framingham Heart Study which has been monitoring 5,200 adults and 5,000 of their off spring since 1975 revealed in February 2016 that the decrease in the rate of new dementia cases was about 20% per decade. The FHS statistics are based on a variety of data sources including questionnaires, medical records, and some direct examinations.

A more recently published study using direct testing of a larger (21,000), more diverse, over 65 year old (average age: 75) U.S. population reveals that the incidence of dementia decreased from 11.6% in 2000 to 8.8% in 2012. In case you want to “study up” for your test, it included:
recalling 10 nouns immediately and then a little later
serially subtracting 7 from 100
counting backwards from 20

Those with more years of education had a lower risk of dementia. (better “test takers” obviously).
Diabetes increased the risk for developing dementia by 39%. Ominously the incidence of diabetes in this studied population increased greatly from 9% in 1990 to 21% in 2012. Despite that, the overall incidence of dementia did decrease. Nobody knows why.

The Framingham Heart Study findings showed that obesity increased the risk of dementia. In this study obese people had a 30% lower risk for dementia, and in fact, underweight people had a 2.5 fold increase in their risk!

As Dr. Denis Evans, one of the study’s authors, said, “Its very complex.”

dementia-cartoon

Speaking of obesity, the holiday eating season is upon us. Almost all of us expect to put on a little weight. Three scientists from three different countries (Finland, France, and U.S.) nicely graphed the average weight gains by month in three countries (Japan, Germany, and U.S.). No surprise. The Christmas season was the winner in all three countries, but Germany was the leader.

holiday-weight-gain

That Golden Week spike in Japan at the end of April and first week of May is when 5 of the 9 official Japanese holidays are clustered and most people take the whole week off.  (NEJM 375:12 Sept. 22, 2016, p. 1201)

Though the graph is impressive with its spikes and valleys the average weight gain in the U.S. measured in the 10 days after Christmas was only 0.7% or 1.33 pounds; much, much less than the 7-13 pound gains per week or two reported by some cruise ship travelers.

The bad news is that even though half of your holiday weight gain is lost shortly after the holidays, half of the weight gain remains until the summer … and beyond, which resets your baseline weight for the next year.
Oh, well. “Life is short. Have dessert first.”


Vol. 158 November 15, 2016 REAL Health Care Reform

November 15, 2016

Trump 2Mr. Trump (now that he is President-elect we need to show “Donald” some respect) has recently said that he may keep the Affordable Care Act (Obamacare) ban against denying coverage for preexisting conditions as well the extension of parental policies to  26 -year-old children because “everyone seems to like those provisions”. As President-elect Trump begins to soften his bombastic, total opposition to Obamacare (and replace portions of “the Wall” with a fence) the 1.2 trillion dollar question becomes, “what is he going to do next?”

Since passage of the ACA 20 million Americans have gained health insurance coverage. 63% of that gain was produced by expansion of Medicaid in the half of our states that choose that federally subsidized route under ACA. The other 40% of increased coverage came from the federally subsidized premiums on policies purchased through health insurance exchanges. Not every state established health insurance exchanges, and  those states that did establish exchanges were twice as effective in getting people to enroll in health insurance.

The “individual mandate”  that was resisted so fiercely by Republicans as “another government tax” was originally composed by Governor Mitt Romney and  became law in Massachusetts years before the ACA passed. The  ACA 2014 “individual mandate” was  a $95 fine if you did not obtain coverage, and it proved to be fairly ineffective. In 2016 that fine goes up to $695 (or 2.5% of your taxable income), so it may prove more of an incentive this year. (1)

What about the rest of the ACA? We shall see, but just tinkering with the ACA (“repeal/replace” or “fix”) raises the concern that we may waste a lot of time and energy getting entangled in the trees while losing sight of the forest.

Can we get REAL about health care reform, or do we just continue arguing about health care insurance? It just so happens that a physician colleague of mine wrote a succinct, clear, eminently quotable Op Ed column about that question in our local paper yesterday! (2)  I  am going to shamelessly plagiarise* it.

“We have given providers incentive to ration care and collect data while ignoring non-provider stakeholders responsible for major system expenditures.”
.             Like: big pharma that advertises directly to consumers for great profit
.                       medical device companies with excellent, high-paid, effective lobbyists
.                       health insurance companies with more lawyers, consultants, lobbyists, and way more overhead than Medicare.

“We seem determined to jump through ever more hoops to limit provider options while the rest of the industry revels in the lack of any kind of market control.”

“Resources that used to represent [provider] profit or ability to retain staffing are now spent on fighting insurance claims and bolstering hospital advertising budgets.”

New payment-bundling schemes with buzz words like “pay for value”, “pay for performance”, and “population basis” will “transfer unprecedented financial risk to providers.”

“Constraints placed on health care providers cannot adequately repair our system.”
What actions can repair our system according to Dr. Urbach?
.              “expanding the public option should not be politically toxic” when  50% of Americans are already covered by government
insurance;
.               reforming malpractice tort law to save big dollars by reducing the costs of “defensive medicine”;
.               having thoughtful discussions about appropriate use of resources at end of life;
.               allowing Medicare to negotiate drug and device costs;
.               devoting adequate medical resources to the mentally ill rather than putting them in jail.

“We must stop pretending that exerting ever more financial pressure on our doctors, nurses, and hospitals (while ignoring bigger fish) will get the job done.”

Now, Dr. Urbach is not a disgruntled primary care physician who is whining about poor reimbursement and non-appreciation of his skills and talents. He is an experienced, well-respected cardiologist, a specialty near the top of the payment and prestige pyramids, who shared these reflections on the occasion of his son’s graduation from medical school. He prays that his son and his peers “will not only make themselves into great clinicians, but that they will also do what my generation of providers largely failed to do – make themselves into a courageous political force that can effectively force comprehensive reform of the heath care system by demanding sacrifice from all stakeholders, not only the caregivers.”

And I say, Amen.

References:
1. New England Journal of Medicine, 375;17,  October 27, 2016, p.1605
2. Cape Cod Times, November 14, 2016. “Let’s get real about health care reform”; David Urbach, MD
* “When you copy one person’s words, it is plagiarism. When you copy many persons’ words, it is research.”


Vol. 157 November 1, 2016 Can You Be Scared To Death?

November 1, 2016

Hub thumbnail 2015BOO!!

 Did I Scare You?

Can you be scared to death?
The short answer is yes, absolutely.

Dr. Martin Samuels, Chief of Neurology, Brigham and Women’s Hospital summarized the mechanism in Scientific American  as the familiar “fight-or-flight” response. The outpouring of adrenaline in our blood in response to stress can inundate the rhythm center of the heart, causing it to lose control, resulting in ventricle fibrillation and persistent contraction or “cramping” of the heart muscle. That stops the effective pumping of our heart, and we drop dead. (1)

The “flight-or-flight” response was first described in the early 1900’s by William Cannon, Chairman of Physiology, Harvard University. It can be in reaction to any strong emotional event, pleasurable as well as not-so-pleasurable. It may cause sudden death during a passionate religious experience or sexual intercourse. I have written previously about increased cardiac deaths in both Germany and Los Angles related to close soccer championship and American  Super bowl games. During the week after 9/11 there was an uptick of cardiac deaths in New York city. Apparently, even getting a hole-in-one can kill you!  It is this mechanism that explains the limited successes of voodoo curses, but unlike other forms of complimentary medicine like acupuncture and Reiki you have to believe in voodoo to have it work.

So much for the medical side of things. What does the law say? Can you be sued or charged with a crime if your action leads to a person’s death? It depends on your intent.

If you inadvertently harm a person you must likely will be held harmless. If you intentionally surprise or seek to scare a person and they die, you can be charged with “negligence” and found guilty.  In 1979 a 20 yo.man who broke into the home of a 79 yo. woman and took her hostage was sentenced to life imprisonment in federal court after she died from a heart attack while in his custody. But, the actual charges were “kidnapping” and “negligence” – failure to seek treatment for her.

What about just a good old fashioned  “blood-curdling scream”? Well, that can cause you trouble too.  Dutch physicians studied 24 healthy volunteers and found that viewing a scary movie, like “Halloween 1, or 2, …#13”,  could cause the initiation of the “coagulation cascade” in their blood. This cascade involves multiple “factors” (proteins) that cause us to form a clot when cut, so that we don’t bleed to death from a simple cut. The cascade is started by Factor VIII, and Factor VIII levels increased by an average of 11 units after viewing a horror film. No increase was seen after watching an educational film. An increase of 10 units of Factor VIII increases your chance of forming a blood clot by 17%. (2) Forming a blood clot inside a vein can lead to a pulmonary embolism, another cause of sudden death in apparently healthy people.

If you are reading this blog it means that you have survived the creepy clowns and other scares of Halloween 2016, but don’t be smug.
The Presidential election is just days away, so you are still at risk of being “scared to death” by a clown.

HAPPY HALLOWEEN

REFERENCES:
1.’
“Can a Person Be Scared to Death?”, Scientific American, January 30, 2009
2.  “Blood Curdling Movies”, British Medical Journal, December 16,  2015


Vol. 156 October 15, 2016 Adding “DNT” to Your Medical Record Before “DNR”

October 15, 2016

 

Hub thumbnail 2015At our last weekly gathering of the “Over 70 Men’s Breakfast Club” we heard from one of us the following about visits to two of his physicians on the same day a week before:

Gastroenterologist: “Congratulations, your colonoscopy was entirely normal.”
Patient: “Great. When should I schedule the next one?”
Gastroenterologist: “Well ,, er..um .. you are over 75 you know. At your age it …er…um.. wouldn’t make any difference.”

The same day with his primary care physician:

Patient: “I think my urine stream is slowing a bit. How’s my prostate?”
PCP: “Your prostate exam is absolutely normal.”
Patient: “What about a PSA test?”
PCP: “ We don’t do those for men your age. It …er…um…wouldn’t make any difference in the long run. Oh, by the way, who’s your Health Care Proxy, the person who can make you DNR in case you can’t speak for yourself?”

Over our eggs and bacon (one member, our oldest, has oatmeal and berries instead) we reached the consensus that his medical record should be stamped with a “DNT: Do Not Test”.

Here are some of the “unnecessary” screening tests that he and others “of certain ages” should skip:

PSA: Rarely done under 50 yo. or over 70 yo. and now being questioned as of mixed benefit for any man. Screening does not reduce the very, very low death rate from prostate cancer and false positives are common. Further investigations of false positive results can cost at least $1,200 per patient, and treatment of truly positive cases can cause incontinence and/or impotence without any significant medical benefit.

Colonoscopy: rarely done under 50 yo. and never over 75 yo. as a screening test. Repeat colonoscopy after an initial normal one detects cancer of the colon no better than a periodic fecal occult blood (FOB) test on a stool sample done by your primary doctor.

X-ray, CT scan or MRI for low back pain without other symptoms: Back pain usually gets better in a month whether you have imaging done or not. Surgery is often done on image irregularities which have no causal relationship to the pain.

Pap smear: Every 3 years for ages 21 to 30. Every 5 years from 31 years to 65. None after 65 yo. “Abnormal” but non-cancerous cells can be detected by this test, but do not need treatment. Pap smears are recommended even if the woman receives the HPV vaccine (Gardasil) because the vaccine does not cover all viruses that cause cervical cancer.

Vitamin D: Vitamin D is the current “vitamin in vogue”. Speculations about relationships with heart and other diseases are riff, but the data is not that conclusive. Many people have low vitamin D levels (as currently defined) but very low levels associated with real illness are extremely rare. Oral vitamin D treatment has not been shown to reliably raise vitamin D levels. A 10 minute walk in the sun and a breakfast with orange juice and eggs supply more than enough vitamin D. (Note: The blood test itself is not expensive, but in 2011 Medicare paid $224 million for vitamin D screening on seniors.)

Testosterone level:  Despite the plethora (I am told) of late night TV ads selling gels, patches, and pills for low testosterone among middle age and older men, treatable “low testosterone” is rare.  Unless a man has one or two of 9 specific symptoms ( and erectile dysfunction (ED) is NOT one of them) a testosterone blood level screen is not recommended. Even if the level is low (under 10 nmol/L – I’m not sure what these units are either, except that they are very small ) a treatable diagnosis rests on the clinical history and exam, not the blood test.

Bone Density: Never under 50 and rarely over 70 in men without risk factors like fractures, heavy smoking or drinking, or very low Vit. D levels. Women could get one done at age 65, but  “treatment” of low bone density with costly medications (also advertised a lot on TV) has not been shown to have much benefit.

Annual EKG or stress test: Does not add any useful information for the asymptomatic person.

Whole Body Scans: Besides the cost and the large amount of radiation involved, these scans should be avoided because they do NOT find asymptomatic cancer. Less than 2% of the scans find a true mass and most of those are benign or inconsequential. In over 33% of scans “abnormal findings”, sometimes called “ditzels” by radiologists, lead to unnecessary and expensive further imaging tests that do not result in any benefit to the patient. (This test was previously heralded by this blog as a good Christmas present for an enemy)

References:

1. Choose Wisely is a list of unnecessary medical tests complied by the American Board of Internal Medicine from suggestions of numerous other specialty groups and published widely in Consumer Reports and other periodicals.


Vol. 155 October 1, 2016 Legalizing Recreational Marijuana?

October 1, 2016

Hub thumbnail 2015Massachusetts voters and 7 other states will be voting November 8 on proposed laws “legalizing, regulating, and taxing Marijuana”. All of these “binding” Questions have been placed on the ballots by “Initiative Petition” (grassroots’ signature campaigns … no pun intended).The proposed Massachusetts law will legalize for anyone 21 or older the possession of 1 ounce of marijuana outside a residence or up to 10 ounces inside a residence, of up to 6 marijuana plants, and of GIVING without payment 1 ounce or less to another person 21 or older. The actual bill fills 11 full pages which reflects not only the controversial issues surrounding the bill, but also the complexities of proposed regulations and taxation.  

Colorado legalized recreational marijuana four years ago, and its experiences (both positive and negative) are currently feeding both sides of the debate of the economic, social, and political consequences.

I will only summarize some of the medical issues (“the News”) with scant remarks about some other issues (”the Editorial”).

Marijuana is a gateway drug: Not really
Physician researchers studying substance abuse ( at least those pediatrician-scientists who present at conferences in Boston) consider nicotine, alcohol, and marijuana as almost equivalent “initial drugs of choice” in adolescents and young adults who become addicted to heroin or opiates. They speak of marijuana “heavy-users” ( more than one joint daily), not marijuana “addicts”, and they represent a small percentage of adolescent MJ users.

Marijuana is addictive: Maybe a little
About 9-10% of users become “dependent”, “need to have daily MJ to feel normal”. Those who start using MJ under the age of 21 are more likely to become dependent. The withdrawal symptoms when heavy users stop after many years are much less than those who stop use of opiates, heroin, alcohol, or even nicotine. No medications are necessary, and any troublesome symptoms usually respond to cognitive behavioral therapy (talking to a therapist). “Addictive behavior” such as crimes to obtain money and violent acts are not usually associated with MJ dependency.

Marijuana is safe: Yes
Lester Grinspoon, MD in his landmark books, “Marijuana Reconsidered” (1971) and “Marihuana (sic): The Forbidden Medicine ” (1991), stated that no one has ever died of a  marijuana overdose, and that statement still stands true.

Marijuana changes your brain: Yes, if under 21 yo.
This reason and the dangers of small children eating large amounts of edible MJ are the reasons the American Academy of Pediatrics opposes the legalization of MJ but NOT its decriminalization.

The Academy also recommends that marijuana be decriminalized, so that penalties for marijuana-related offenses are reduced to lesser criminal charges or civil penalties. Efforts to decriminalize marijuana should take place in conjunction with efforts to prevent marijuana use and promote early treatment of adolescents with marijuana use problems.”

Heavy use  of MJ before the age of 21 can change how the brain functions as revealed by functional MRIs (fMRI).  Heavy MJ use can actually change brain structure in areas associated with impulse control and “executive functions”. Some studies show a lowering of IQ by 8-9 points in heavy users. The long term effects of these structural changes in adolescents are being studied, but everyone seems to agree that MJ use should not be legalized for those under 21 years of age.

Marijuana can impair your driving: Perhaps
Studies do show that MJ can prolong your reaction time and reduce attention span (less so than alcohol – check out this YouTube video), so the opponents of legalization believe that the law will lead to more car accidents. The data on actual accidents, whether fatal or not, is not so clear. There is no standard method to measure “MJ intoxication”. Blood and urine tests measure MJ metabolites which can be present for up to 45-50 days after smoking a single joint (depending on age, weight, and belt size). These tests, since they depend on measuring metabolites, may not even turn positive until 24-48 AFTER a new user smokes a joint. Such tests can identify regular users, but there is no correlation between blood and urine test levels and the actual degree of impairment.  Remember, even the “gold standard” in drunk driving cases, Breathalyzer results, are not permitted to be entered as evidence in court because of variations in calibration and field administration.


The Massachusetts Medical Society opposes  the legalization of recreational marijuana because of 1) “the addictive nature of marijuana”, 2) “the adverse effects on developing brains”, and 3) “the appeal of edibles to youngsters”.

The effect of legalization on youth access to marijuana is a controversial subject that is dismissed by pediatric researchers.

“Adolescents and pre-adolescents already have open access to MJ. Legalizing it won’t change that.”
It is worth remembering that Dr. Grinspoon got interested in the medical effects of marijuana when his son was undergoing chemotherapy, and MJ reduced his nausea greatly. Lester’s wife easily bought that MJ in a Newton schoolyard in the 60s.

That reality that MJ distribution and sales will become a big business is why proponents are pushing its tax revenue upside. Opponents are concerned that “Big Tobacco” or other nefarious organizations will take over the MJ market.

My vote:
I will vote “NO” on Question 4 in Massachusetts proposing the  “Legalization, Regulation, and Taxation of Marijuana” primarily because of its unknown consequences that should become clearer in time (even just a year or two would help). Also, our state’s less than stellar track record in satisfactorily implementing the much smaller program of legalizing medical marijuana ( 59 pages of regulations in 2013 and several public missteps) gives me real pause about how it could all play out.

I think that the recreational use of marijuana will eventually be legalized in Massachusetts, and that there can be some real benefits of such a change.  But, I also think that there is too much that is vague and/or capable of manipulation in this proposed law, even at 11 pages long.


Vol. 154 September 15, 2016 READER BEWARE, Take a Grain of Salt With Media Hype About Medical Advances

September 15, 2016

Hub thumbnail 2015Headlines that tout a new drug or a new procedure which is “much better” than the old one are very common in our media. Some of them are true. Some of them are misleading. Most of them depend on the definition of “better” in the research study or clinical trial. A recent issue of the New England Journal of Medicine reviewed the “changing face of clinical trials” and outlined in detailed, technical language what their readers (physicians and other health professionals) should look for in published studies and clinical trials to confirm that the simplified “positive outcome reported” is significant and relevant. (1)

It inspired me to give similar “heads-ups” to my more general readers so they might be better evaluators of media announcements and commercials about medical advances.

Be skeptical about percentages
“Drug A has 50% less side effects than Drug B” or “Drug A is 50% more effective than Drug B.”
If 2 out 100 patients had a side effect with Drug A and Drug B side effects happened in 4 of 100 patients, that is a 50% reduction of a very low occurrence event, and it is probably not relevant.

“Antibiotics reduced the time out of work (or out of school, or days of fever) by 50%”.
This could mean “time absent” went from 2 days to 1 day, not all that significant considering the cost and potential side effects of antibiotics.

For those of you who want to dig deeper you should ask for the P value of the positive outcome. A statistical P value of 0.05 means that the difference between the two treatments is not enough to say that one was better than the other. The difference is “not significant”. In medical studies the test of a true difference is a P value of less than 0.001; written as P<0.001. That difference is “significant”. Looking at P values is an easy way to avoid the illusionary trap of percentages.

“Dementia Incidence is Decreasing!”
This was the February 2016 “headline”, admittedly in the back pages or side bars, in several newspapers and magazines. It was based on data from the ongoing, well-respected Framingham Heart Study that has been studying the same people since 1975. The article listed declines of 22%, 38%, and 44% each epoch (an epoch is about 15 years) from 1975 to 2010 in 5205 persons over 60 years old.
Looks impressive!
Again the percentages.
The actual incidence went from 2.8 per 100 persons demonstrating dementia to 2.0 per 100. These numbers seem a bit less dramatic to me. To top it all off, the risk reduction was observed in ONLY those who had at least a high school diploma. I’m glad that I am in that population subgroup, but that suggests an issue about the relevance of study results to the general population.

Is the positive outcome of the study clinically relevant?
Tests of some new drugs treating diabetes have shown a much better control of blood sugars, but NO reduction in cardiovascular events and even a HIGHER mortality rate.

Certain cancer tests may be shown to find cancers earlier, but there is no reduction in patient morbidity and mortality. The PAS test for prostate cancer “found” a lot more cases of prostate cancer, but did not result in any reduction of deaths from prostatic cancer. Later studies even showed that the PAS test often resulted in unnecessary further tests and treatment, so the age criteria recommendations for obtaining a PAS were changed in 2012.

Multiple studies of ICU patients have shown “better” physiological or laboratory value resulting from selected treatments, but NO change in length of stay or mortality rates in those patients receiving the new treatment.

Is the study large enough to be reliable?
This can be tricky. The study should involve enough patients to be statistically sound (there’s the old P<0.001 value again), but big numbers are not a guarantee. A recent article on the effectiveness of CPAP (continuous positive airway pressure) treatment for Obstructive Sleep Apnea (OSA) was based on studying close to 2500 patients. Sounds big to me, but look how they got to that number.

15,325 patients were assessed for eligibility in the study.
.        
9481 declined to participate or were excluded for other reasons
leaving 5844 that met the study’s diagnostic criteria
.         2598 were then excluded for having too mild symptoms
leaving 3246 who entered a one-week trial period
.          
529 were then excluded for poor compliance or other reasons
leaving 2717 patients that were randomized into the study
.            
30 were then excluded from the analysis for a variety of reasons
leaving 1346 receiving the new treatment and 1341 receiving standard treatment
.            62 receiving the new treatment discontinued
            85 receiving the standard treatment discontinued.
Resulting in 1284 analyzed for the new treatment and 1256 analyzed for the standard treatment.

Besides suggesting how difficult the logistics of a clinical study can be, a markedly descending number of study participants like this can raise concerns about a selection bias of patients, or as they say, “There’s many a slip twixt the cup and the lip.”

Oh, yeh, the results of the study?
“CPAP treatment significantly (P<0.001 again) reduced snoring and daytime sleepiness, but did not prevent cardiovascular events (P values 0.96 to 0.07)”.


Also there were so many variables in this complex study like “duration of use” (3.3 hrs. a night average) , “degrees of compliance” with protocols, different “severity of symptoms”, etc. that the NEJM felt compelled to publish in the same issue an editorial suggesting caution about the impact of this study on current clinical practice (see comments about clinical relevance above).

Conclusion:
More often than not the new procedure or the new drug is more expensive than the “old” one. That adds another reason to ask your doctor if it is really better than the previous one. Remembering that “if it happens to me it’s 100%”, what is the patient  supposed to do? How can we evaluate this bombardment of new advances?

“Ultimately, physicians at the point of care bear the final responsibility for accurately interpreting clinical trial results and for integrating regulatory and guideline recommendations to make the best treatment decisions for each patient in their care” (1)

References:
1. “The Primary Outcome is Positive – Is That Enough?”, New England Journal of Medicine, Sept. 8, 2016, 375;10 p.371


Vol. 153 September 1, 2016 Is Nothing Sacred? No, Not in Medicine.

September 1, 2016

Hub thumbnail 2015

It can be frustrating and unsettling when after years of telling us that something is good…or bad for you, doctors then tell us that the opposite is true! “Redefining the truth” is the essence of science, particularly the science of medicine. The medical mantra is: Keep studying, keep collecting data, keep analyzing, and if the “truth” changes, report it!
Here are some more revisions of the truth as examples.

Baby Dolls and Teen Pregnancies
Giving high school students a baby doll to take of care for several weeks is touted as a deterrent to teen-age pregnancies. The sophisticated doll is programmed to cry, make demands, go to sleep (or not), etc. just like a real baby. Students are instructed to care for it 24/7 as if it were a real baby. The expectation is that such a “reality-check” would make teen agers more aware of the burdens of caring for an infant and that would convince them to use effective birth control.

A recent report in the British Medical Journal documented that the average teen age pregnancy rate in those who cared for a doll stayed the same or even INCREASED in some schools. The article speculates that the positive, loving experience that some teens had and the extra attention they received while caring for the doll caused this. The company that makes the dolls quickly switched its marketing pitch from “reducing teen pregnancy” to “teaching quality infant care”.

Get the Lead Out”
The high level of lead in the water in Flint, Michigan in 2015 immediately raised an alarming concern about “poisoned children”.  A blood lead level of 5 micrograms per deciliter is considered “a threshold for official action as a “precautionary principle” according to public health experts.   5% of the kids in Flint had blood lead levels of 5-10 micrograms per deciliter.  The increase from 2.4% having a level over 5 in 2013 to 4.9% of kids tested in 2015 raised the public health alarm.

It is well known that the body can excrete lead. If the input of lead (ingested in food, water, or dirt or breathed in from car exhausts) exceeds the excretion rate and the blood lead level reaches 40-69 micrograms per deciliter then outpatient treatment is recommended, even though the person is asymptomatic. Blood levels above 70 can cause symptoms and are treated by hospitalization. None of the Flint children had lead levels over 40.

Lead performs no essential function in our bodies and chronically high levels can cause neurological damage, so it is incumbent of public health officials (and politicians) to prevent prolonged exposure, but these children have NOT been damaged. They will, I am sure, be monitored and studied for years to come to see if there is any subtle effect of these low lead levels. Because that’s what medical science does.

Lowering Blood Pressure in Intermediate-Risk Persons Without Heart Disease with Two Drugs Did Not Decrease the Rates of Major Cardio-vascular Events

NEJM 374:21 May 26, 2016,pg. 2009-2019

Lowering Cholesterol in Intermediate-Risk Persons Without Heart Disease and Normal Lipid Levels With One Drug Decreased the Risk of a Major Cardio-Vascular Event from 4.7% to 3.6% (a 25% reduction)

same NEJM issue pg. 2012-2031

Lowering Blood Pressure AND Cholesterol in the same study as above with Three Drugs Decreased the Risk of Some Major Cardio-vascular Events from 5.0% to 3.6% (a 30% reduction)

same NEJM issue pg. 2032-2043

Like Fox Radio, “We report the news. You decide.”

“Get the Fat Out…But Which Fat?”
The British Medical Journal published an article in April written by a team of scientists at NIH headed by Christopher Ramsden, called the “Indiana Jones of biology” because he specializes in excavating old studies, particularly those that go against our “mainstream government-sanctioned health advice”. He unearthed a 1968 five-year, tightly controlled study of over nine thousand participants randomly assigned to either a vegetable oil based diet or a standard animal fat diet.

The study documents that eating vegetable fats instead of animal fats did NOT, repeat did NOT, reduce the risk of heart disease or death. Substituting a vegetable oil diet ( about half of the saturated fat of the standard diet) did lower the average blood cholesterol by 14%, BUT the risk of death INcreased 22% for every 30 points the cholesterol fell! 

Dr. Robert Franz of the Mayo Clinic, the son of the organizer of the 1968 study, speculates that his father’s team was disappointed that they could find no benefit of the vegetable oil diet, and so didn’t publish it widely. An accompanying editorial in the BMJ concluded that “ the benefits of choosing polyunsaturated fat over saturated fat seem a little less certain than we thought.”

Again like Fox Radio:  “We report the news. You decide.”

“Worried About Peanut Allergy in Your Family?
Avoid Peanuts! No, NO, Eat Them as Early as You Can!”
The experts use to say “no solid foods to infants before age 4 to 6 months.”
Experts now say “do not delay solid foods beyond 4 to 6 months.”

In the past 10 years childhood peanut allergy has doubled from 1.4% to 3% (still small).
The experts use to say that “if you’re worried about peanut allergy in your child do not give peanut food until age 3 years”.
Experts now say “give the infant peanut food as early as 4 months of age.”

A 2015 study in the New England Journal of Medicine showed that consumption of peanut food at 4 months of age reduced the development of a peanut allergy (documented by skin-prick tests) by 70% – 86%!!

“We should no longer recommend avoidance of allergenic foods in infants.”


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