Vol. 264 October 15, 2021 “Science Marches On”

Gun violence is killing more American children
More kids this year are dying from gun accidents (toddlers), turf wars (young adults) , and wrong things on social media (teens).  Gun violence deaths in children hit its 20 year peak in 2017, and has never gone down.  Gun violence deaths among 17 yo. or younger in 2019 was 991;  in 2020 – 1375;  in 10 months of 2021 – 1179 so far, with 3300 injured. Homicides of people 19 yo. or younger increased by 21% in 2020. And remember, only 40% of gun-related deaths are homicides. 60% are suicides.

According to the Children’s Defense Fund the 2020 ratio of fatally shot black children to white children was 4 to 1.  In 2016 gun deaths of all ages by race were 71% white and 26% black according to the CDC. According to an emergency room doctor at St. Louis Children’s Hospital, it is now not uncommon to see repeat victims. “What is that scar over there?” asks the doc of the shooting victim. “Oh, I was shot once before”, is the response.

Statistics in 1998 showed that for every time a gun was used in self defense of a household, a gun caused injury or death in 4 accidents, 7 criminal assaults or homicides, and 11 attempted or completed suicides. In 2015 80% of American adults owned a gun. In 2017 the third highest cause of  deaths in children under 17 yo. was gun shot(s).  A well known pediatrician, who shall remain nameless, wrote an 2018 op ed column about the “Epidemic we aren’t studying: gun violence” (Cape Cod Times, June 1, 2018) . . . and it never mentioned Covid 19! (see also past blog: Smart guns, SCIENCE MARCHES ON   )

Coffee does not cause heart arrhythmias
For years the caffeine in coffee has been thought to cause irregular and too fast beatings of the heart. That common wisdom is embedded in the guidelines of several professional societies. A recent 12 year study of 400,000 middle aged people indicates that that is not true. The results even suggested that each ADDITIONAL cup of coffee consumed daily LOWERED the risk of cardiac arrhythmias. Though it is an observational study its validity is supported by many laboratory analyses of caffeine metabolism.  (JAMA Intern Med July 19, 2021) SCIENCE MARCHES ON

Youth vaping continues to decline
According to a national survey the number of high school students who reported vaping from 27% in 2019 to 20% in 2020 to 11% this year. Before we celebrate this trend as real (and good), remember that:

1. The FDA warned of an epidemic of youth getting addicted to nicotine through e-cigarettes in 2018,
2. That the Trump administration banned fruit flavored e-cigarettes, but they remained on the market due to regulatory loop holes,
3. That of those high schoolers who vape, a quarter of them do so every day,
4. AND that the FDA recently green-lighted the R.J. Reynolds company (remember them: the makers of Lucky Strike?) to market its tobacco-flavored cartridges under the brand name Vuse (second only to Juul in volume) because “the benefit of helping cigarette smokers to stop smoking outweighs the risk of ensnaring a new generation” of nicotine addicts,
5. and finally, how do you do a national survey of high schoolers when schools are closed by Covid-19?

A baby aspirin daily to reduce heart attack or colon cancer risk:  yes or no?
Used to be “yes” in 2016. Is now “no”, or at least a “depends”.

The original studies of the benefits of a daily baby (81 mg.) aspirin, now confirmed by an extensive review by an expert panel, showed that for those people who have had a heart attack or a stroke taking a baby aspirin a day could lower the risk of ANOTHER one. The baby aspirin makes the platelets “more slippery” and less likely to start a blood clot in an artery or vein. The adult aspirin ( 350+ mg.) made platelets too slippery and resulted in unintended stomach and other organ bleeding, especially in older (over 60 yo.) patients. The expert panel now considers a baby aspirin as a bleeding risk for those over 60 — unless you have been taking aspirin for a while. Wha-a-a-? It turns out that those over 60 who have significant unexpected bleeding almost always have it within a few months of starting the aspirin. The panel confirmed by its review that there is NO aspirin benefit to people who have NOT had a heart attack or a stroke. A daily baby aspirin does not protect you from your FIRST heart attack or stroke, and can cause unexpected bleeding in some people, especially over 60 yo..

The same 16-expert panel reversed its five-year old endorsement of aspirin for reducing the risk of colon cancer because of a recent study indicating that aspirin use actually increased the risk of dying from colon cancer. SCIENCE MARCHES ON!

Dr. Andrew Chan, director of cancer epidemiology at MGH noted, “This again highlights that we need to think about personalizing who we give aspirin to, and move away from one-size-fits-all solutions” (i.e., discuss with YOUR doctor (or provider, of course)).

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