Vol. 221 November 15, 2019 “Cassandra Speaking of Climate Change “

November 15, 2019

Cassandra: one who speaks a prophecy that no one heeds.

A friend of mine (actually his wife) was cleaning out his collection of many years of books, cowboy boots, framed certificates, and other cherished stuff when he found three 1996 pamphlets published by The Worldwatch Institute, an independent, nonprofit environmental research organization in Washington, DC. founded in 1974 and still going strong.  My friend thought I might be interested in them.  One of them, “Climate of Hope: New Strategies for Stabilizing the World’s Atmosphere” published in June 1996, prompted me to think about what were their predictions and did they come true? That is the subject of today’s blog.

Quotes directly from Worldwatch Paper #130 “Climate of Hope” June 1996:

  • “Climate change is likely to be erratic, disruptive, and unpredictable. . . The incidence of floods, droughts, fires and heat outbreaks is expected to increase in some regions.”
  • “Recent changes in global climate trends are almost certainly related to the rapid buildup of greenhouse gases.”
  • “Carbon dioxide is a greenhouse gas, letting in visible light from the sun but trapping heat near the earth’s surface.”
  • “Since carbon dioxide is a virtually inevitable product of fossil-fuel-based energy system, efforts to stabilize the climate will at some point have to require a fundamental revamping of that system. Exactly how to do this and at what cost have been subjects of considerable uncertainty and vehement debate.”

There are several greenhouse gases, including methane (hence the “target” on the backs of farting cows) and chlorofluorocarbons (CFCs, HFCs) which are manmade chemicals that have been largely phased out because of their depletion of the ozone layer. Sulfur gas, also from fossil fuel burning, is not a greenhouse gas but does produce acid rain. Stringent emission standards in the 90’s by most industrialized countries have significantly reduced the amount of sulfates in the atmosphere. Carbon dioxide is the largest greenhouse gas by volume in our atmosphere, and carbon dioxide level measurement have become a standard proxy for predicting world-wide temperature increases.

Prior to the industrial revolution in the 1800’s carbon dioxide levels in the atmosphere hovered just below 300 parts per million (ppm). In 1996 the level was 360 ppm. In order to slow global warming the carbon dioxide level will have to be below 500 ppm. Our world-wide carbon dioxide level is currently 420 ppm. “A 450 ppm target means cutting emissions by more than half by 2050. A level of 500 ppm, which would accelerate global warming, could be reached by 2050 if carbon dioxide emissions are not reduced.” (1996) Because carbon dioxide is a “long-lasting” gas in our atmosphere it’s effect on global temperature is cumulative over decades, so that if we (the world) wanted to return to 1996 levels we (the world) would have to go to zero carbon dioxide emissions, an impossible task.

More words from the 1996 Cassandra:
“We are still a long way from stabilizing the global climate, a far more complex challenge than repairing the ozone layer. Even with quick action, some greenhouse gases will linger in the atmosphere for centuries. Still, close observers note that a climate of hope has crept into negotiations recently. Insurance companies, small island nations, and others with major interests in a stable climate have re-shaped the diplomatic playing field. Finally, the time for serious policymaking may be at hand.”

Remember, these words are from 1996. As Yogi Berra said: “It’s like deja vu all over again.”

Meanwhile, as Stephen Colbert says occasionally,
Cause of the Vaping Lung Injury
In my last blog I reviewed a pathological study of lung tissue in 17 patients with the vaping related lung injury which showed no damages indicative of lipoid or oil-caused pathology. The researchers concluded that vitamin E oil was not the culprit, and that the lung injury was similar to that seen from inhalation of a toxic gas and not the inhalation of oil. They did not know what that “toxic gas” was.  The CDC has just released a study of 29 patients suggesting that the offending agent might actually be inhaled vitamin E acetate because they found that in the injured lungs. They also admitted that other unknown agents might be causing the injury.
Meanwhile, hospitals are reporting an increase (one a week in some places) of a hyperemesis syndrome, (persistent, prolonged vomiting), in heavy users of recreational marijuana. First identified in 2004 it can be difficult to diagnose as several other causes have to be ruled out with x-rays and lab tests, but it is increasing in states that have legalized recreational marijuana.

 

 


Vol. 220 November 1, 2019 Update on Vaping Lung Disease, Medical Marijuana, and CBD.

November 1, 2019

“We thought vaping was safe, and it wasn’t. . . it isn’t.”
-Charlie Baker, Massachusetts Governor, justifying his state-wide 3 month ban of vaping

 

What Causes Vaping Associated Lung Disease?
The plot thickens as to the cause of the nation-wide epidemic of vaping-associated lung injuries, including deaths. Our immediate “conventional wisdom” was that it was probably related to inhalation of the vitamin E oil  used to cut the black market THC. (You may have read it here first) Oil inhalation associated injury is now doubted after examination of lung biopsy tissue and/or autopsy specimens from 17 patients. Pathologists from the Mayo Clinic in Scottsdale, Arizona found no evidence of inhaled oil or the expected microscopic hallmarks of lipoid pneumonia in the lungs of patients with the lung injury after vaping. What they did find was evidence suggesting a chemical “burn” or reaction to a toxic gas. There was no sign of an immune response (like an allergic reaction) that would have suggested that only certain individuals could develop the lung injury disease. The researchers did not speculate as to what could have caused the injury, except they are clear that it doesn’t appear that vitamin E oil is the culprit. It puts us back to considering all possibilities: something added to black market vaping material (both THC and nicotine vapers have been injured or killed), noxious gas produced by the device itself, or a combination of the two. This lung injury epidemic began in August 2019 despite several previous years of vaping use, so “something has changed”.  Stay tuned, and don’t vape.

Are There Any Benefits of Medical Marijuana?
Despite the many claims of the benefits of medical marijuana for a variety of conditions, current scientific evidence supports benefits in only three situations: 1. reduce nausea and vomiting after receiving chemotherapy, 2. subjective decrease of spasticity symptoms in multiple sclerosis, and 3. improve chronic pain in adults. The benefit seen in a very rare form of childhood epilepsy is due to CBD alone, not THC. The old idea of benefit in glaucoma treatment was disproven a while back (remember folks? you may have first read it here). A current controlled study of the benefits of medical marijuana is underway at MGH and one of its researchers gave a interim report of their early findings at a conference I attended last week.

The researchers are attempting to do a randomized study of the benefits of medical marijuana in patients 18-55 yo.already holding a medical marijuana card (obtained from a marijuana-use certifying physician for $300 for a single visit). Neither of the researchers, and, in fact, not one of all the MGH physicians are marijuana-use certifying physicians. Since these patients view the marijuana as a treatment for their condition it is unethical to randomize some into a control group who would receive none. Since the clinic can not handle all comers at once they assigned about a third of the patients to a 3 month waiting list for their medical marijuana card. Tests and questions of both the waiting list patients (“control group”) and the patients receiving medical marijuana immediately (“treatment group”) should reveal reveal any benefits or harms from medical marijuana use. A previous study showed that obtaining a medical marijuana card caused holders to double the number of days per month that they used marijuana for their symptoms (from 7 1/2  to 15 days per month).

Since the researchers (along with everyone else) don’t really know what exactly is in the products purchased at a marijuana dispensary, they test for 11 different cannabis metabolites (including CBD) in the patient’s urine each visit. Preliminary data on 84 patients reveals minimal decrease of pain, little improvement in sleep, and virtually no effect on anxiety or depression. Despite the fact that patients were told by the sellers that there was CBD in the purchased product (a “marketing plus” since CBD is touted to reduce adverse effects of THC), one third of the patients had NO detectable CBD in their urine!

Spoiler alert: Today’s cannabis is not your father’s kind of cannabis. Joints at Woodstock had about 1-2% THC. Today the average joint has 6-12% THC. A new edible form of cannabis oil or syrup, called a “dab”, can be 60-90% THC. So “a little dab could really do you.”

What About CBD?
We know even less about the medical benefits of CBD despite the many advertising claims, wide spread ease of purchase, and Gronk’s testimonial endorsement. Cannabis contains over 200 cannabinoids. CBD is one and THC is another. Stay tuned. (Remember, you may have first read it here.)


Vol. 218 September 15, 2019 Vaping and Fatal Pneumonia

September 15, 2019

“The rise in vaping-associated illness is a frightening public health phenomenon.”

– Andrew Cuomo, NewYork Governor

 

Severe pneumonia in over 400 people, including 10 deaths, in 36 states have been associated with vaping certain products. The CDC is investigating the phenomenon as a mysterious, previously unrecognized epidemic. Patients from 18 to 88 years of age have been arriving at Emergency Rooms with severe shortness of breath, cough, little or no fever, and a chest Xray with markedly abnormal diffuse infiltrates. Blood cultures show no bacteria, and the response to the usual antibiotics is sluggish or absent. Some patients require intubation and artificial ventilation in order to maintain oxygenation of their blood. A few die. All have a history of vaping, most often using flavored vaping solutions purchased “on the street” or over the internet, i.e. not from licensed vape shops.

The speculation at this point is that flavored vaping solutions have additives that are causing this illness.  The current focus is on Vitamin E oil, added to flavored vaping solutions as a thickening agent. Vitamin E is well recognized as a beneficial skin emollient and an oral nutrient supplement, so it sounds harmless and enjoys a “good-health” reputation. It is inexpensive and readily available, so is a “logical” additive for cheaper, unlicensed vaping solutions sold on the black market (“street-made”) and the internet. The street vendors use the cheaper additives to cut the expensive THC oil and make more profit per vaping cartridge.

In an e-cigarette the Vitamin E oil is heated up and vaporized by a battery-fed hot wire, and the vapor is inhaled. As the temperature of the Vitamin E oil vapor lowers to the normal body temperature of 98.6 degrees Fahrenheit the Vitamin E vapor in the lungs reverts to its liquid form, oil. Any form of oil is extremely toxic to lung tissue. Just ask any physician who has dealt with a patient with oil-aspiration pneumonia, sometimes called “lipoid pneumonia“. The first case report of lipoid pneumonia after vaping was actually reported in 2015 in the journal Chest  as a unique, interesting, never-before seen case of a 31 yo. West Virginian woman who required intubation in the ICU after presenting to the ER in severe respiratory distress after vaping.

There are so many additives in vaping solutions that it is not absolutely certain that Vitamin E oil is the culprit, but some of the counterfeit vaping solutions used by recent respiratory-distress patients contained more than 50% Vitamin E oil!  A 2015 Harvard study that tested 51 of 7,000 vaping solutions found Vitamin E oil in all the flavored ones, and it commented on the potential dangers of inhaling flavored vaping solutions. None of the vaping solutions containing “only” nicotine  or marijuana (THC) contained Vitamin E oil. By the way, the FDA and the various state cannabis commissions have NO idea of the ingredients and additives in vaping solutions. There are currently NO regulations requiring the listing of vaping solution ingredients, even those sold in licensed vape shops. “The cannabis commission does not regulate the ingredients in licensed marijuana stores’ vape cartridges. . . Licensed producers can source their ingredients from anywhere.”

As an aside, this reminds me of a story told by my cousin, a biochemical Ph.D candidate in the 1960’s researching how chlorophyll (the green substance) carried on photosynthesis. In his chromatographic analysis of all sorts of substances, including tobacco, he determined that Marlboro cigarettes had no tobacco in them. They appeared to be made of cabbage leaves infused with nicotine. Incensed (he was a smoker), he wrote an emphatic letter to the company documenting his findings and scolding them for false advertising.. The company’s response was a polite letter pointing out that at no time did they claim in their ads that their cigarettes had any tobacco in them, that they merely promised a smooth taste  . . .and “good luck on your quest to synthesize an artificial chlorophyll.”

The CDC is foraging ahead aggressively with detailed investigations, state legislatures are composing all sorts of ingredient disclosure laws for vaping manufacturers, and, I am sure, many personal injury lawyers are trolling for potentially lucrative suits. In the meantime, I think it would be the better part of valor if everyone stopped vaping until the dust . . . er . . . the vapor settles. Who would guess that we would ever say, “It appears to be much safer to just smoke a joint!”


Vol. 214 June 1, 2019 JUULING AND SCHOOLING

June 1, 2019

“Nicotine addiction begins when most tobacco users are teenagers, so let’s call this what it really is: a pediatric disease.”
-David Kessler, MD. Commissioner of FDA, 1995

 


When I was a young parent my kids’ souls were threatened by the dangers of  “sex, drugs, and rock ‘n roll”. THEIR kids are facing a new triple threat, “marijuana, video games, and vaping”. Vaping? (pronounced with a long ”a”) Really? (pronounced with a short “a”)

How can inhaling flavored water vapor with either no or just a touch of nicotine be dangerous? Let Jonathan Winickoff, MD, MPH, Professor of Pediatrics at Harvard Medical School and Director of the MGH Tobacco Research Treatment Center list the reasons:

First of all, there is no water in vaping solutions. Vaping is NOT inhaling water vapor. It is inhaling particulate matter of numerous chemical compounds in mostly propylene glycol and glycerin. When heated these compounds degrade to formaldehyde. The vapor also contains carcinogenic organic and inorganic chemicals, cytotoxic nano-sized metallic particles from the heater coil, silicates (like in sand), and ALWAYS nicotine. All vaping solutions contain nicotine despite the label that says “contains no nicotine”, or even more cleverly “contains no nicotine tar”, which means of course “no tar”. Currently there are no FDA regulations about labeling vaping solutions. Companies can label and market anyway they wish without any accountability.

Vaping solutions are flavored to lure teens into using because teen age vaping does lead to dependency on nicotine and a significant percentage of teenage vapers go on to smoking cigarettes (“combustible tobacco”). This assures a continued revenue stream for tobacco companies. Mint, menthol, and mango are apparently the favorite vaping flavors (gives new meaning to “3M” doesn’t it). Flavors in cigarettes were banned by federal law in 2009 except for “menthol and mint”, but the federal ban specifically did not apply to e-cigarettes. There are over 8,000 vaping flavors available.

Juul (jewel) is the most successful vaping company owning about 75% of the market. Juul is so successful that it has become a verb, as in “Do you Juul?, Lets Juul.”

A Juul pod of vaping solution contains about 200 “hits” or puffs which is the equivalent of a pack of 20 cigarettes. Pods are used in devices that previously looked like cigarettes, hence the term e-cigarette, but now vaping devices can look like pens, superhero figures, a miniature coke can, and, most  commonly, a computer thumb drive. One middle school kid laughed at his father’s confusion by saying, “We don’t use thumbdrives any more. Every thing is in the Cloud. If you see a kid with a thumb drive, he is vaping.”

Taking 300-400 hits a day is common. Unfortunately taking an occasional hit as an “experimental rite of passage” can progress to increased use and an unrecognized dependency. JuuLing periodically on the week ends can lead to withdrawal symptoms of anxiety, distraction, and increased body movements on non-use school days. Those are the same symptoms of ADHD.

A popular device, a Sourin Drop, is available in many different colors and is small enough to hold (“conceal”) in the palm of your hand/ It is a refillable device (unlike a JuuL pod which you buy pre-filled) that lets you mix flavored vaping solution and marijuana (THC) so that they can be inhaled together as a mixture.

Juuls are much easier to use than cigarettes to use; you don’t need a match, there is very little aroma, there is no butt to get rid off, they can be used in NO SMOKING zones, and there is certainly no tell-tale stain on your fingers.

A pod cost about $4 and can be bought online easily without proof of age despite the requirement to be over 18.. Needham, MA was the first town in America to ban sales to those under 21, and Hawaii was the first to establish a state-wide ban. Fourteen states have now followed Newton’s example and prohibit stores from selling vaping solutions to those under 21.

Tobacco companies are investing heavily in e-cigarettes. They know that the younger a person is when nicotine is introduced the more likely they will become a life-time tobacco user. They deliberately, purposefully, and relentlessly market vaping to young people. Nearly 40% of high schoolers and nearly 15% of middle schoolers have vaped at “least once”. Use of vaping in places where smoking is prohibited also helps produce a second income stream for tobacco companies.

A lot of this “threat-to-teen-agers-talk” does sound like old hat to some of us old guys , but vaping has the potential of some serious unattended future consequences for our youths. Most of us did survive the dangers of sex, drugs, and rock’n roll after all, and what will be the inevitable triple threat for future teen agers : “space dust, AI simulations (‘feelies’), and audio-visual implants?”

Action plan:

  1. Call your Massachusetts statehouse representative to support the passage of H. 1902 which bans the sale of “all flavored tobacco products” in Massachusetts.
  2. Lobby in your own town to ban the sale of flavored tobacco products to anyone under 21 years of age.
  3. Let your kids and grandkids read this blog.

Vol. 205 January 1, 2019 Hemp, MJ, THC, and CBD . . . Wha.a.a.a?

December 31, 2018

Hub thumbnail 2015

Hemp and marijuana are both cannabis plants. 

But they are not the same.

There are 80 different cannabinoid compounds in cannabis plants. THC and CBD are the largest in volume. Both hemp and MJ have THC (the chemical that gives you the high) and CBD (the chemical that does not); but in vastly different amounts.  Hemp products have only 0.3% THC.  Marijuana contains from 5% to 30% THC. The CBD in MJ actually regulates (moderates) the effect of THC, produces no euphoria, and is non-addictive.

The Kentucky Supreme Court decided years ago that marijuana and hemp were the same. Woody Harrelson in 1996 was charged with “illegal possession of marijuana” in Kentucky when he announced that he had “planted 4 hemp seeds.” Four years later a Lee County jury acquitted him of that charge. The jury knew that marijuana and hemp were not the same. Hemp has about 25,000 different manufacturing uses and was one of Kentucky’s leading crops until the Marijuana Tax Act of 1937 shut down production. 

Both MJ and hemp are touted to help treat medical illnesses. Some studies show that CBD may be effective in selected medical illness. Our medical knowledge about CBD’s ability to “enhance wellness” is about at the same stage as our scientific understanding of probiotics. Neither seems to do any harm, but there are few studies that indicate they provide any real benefit.

The few studies of medical marijuana have used THC in pill form. Most promoters of medical marijuana believe that the whole marijuana product has to be smoked or ingested to get any benefit. Nobody smokes marijuana for its CBD. Interestingly, marijuana does NOT treat glaucoma. It turns out that the early studies suggesting that were too small and not controlled enough to support that conclusion.

Medical marijuana is now legal in 33 states and D.C.. Hemp products have been legal in all 50 states for some years.

It is the “hemp-derived” CBD oil that is legal and available on Amazon, at Target, or at your local gift and wellness store as one of 150 “wellness” CBD products derived from hemp. Any “marijuana-derived” CBD product carries all the baggage of current marijuana laws. Hence, a good deal of confusion.

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“Hemp-derived” CBD was a $591 million(M) dollar business in the U.S. this year. With the 2018 Federal Farm Act (spear headed by Mitch McConnell, R- Ky) that lifts decades-long U.S. prohibition of hemp cultivation on January 1, 2019 (today), the U.S. hemp industry is predicted to grow to $22 billion(B) by 2022.

The largest marijuana-producing company in Canada is salivating (Hey, remember that the U.S. Supreme Court has ruled that corporations are persons, so why can’t they salivate?) about going into the distribution of hemp-derived CBD-infused “sports” beverages in the U.S.  Vogue magazine calls CBD wellness products one of the top 10 trends in 2018.

Because of severe federal restrictions on research on marijuana there is little reliable scientific data about its medical benefits.  What few studies there are or not always clear about what is actually being tested; THC, CBD, or the other 80 cannabinoids. So there is ample room for scientific and public discussion about the relative medical benefits of THC, CBD, hemp seeds, hemp oil, or other compounds in marijuana and hemp. The lack of real data about relative benefits and risks will continue to allow proponents of one product to shill louder than the others for the consumer’s dollar.

It is helpful to remember that this lack of knowledge about marijuana is such that a physician can NOT write an actual  prescription for it. A physician’s prescription for any medication has to designate the medication’s name, dose, form, and instructions for frequency and duration of use. There is no data to allow the physician to know how to do that for marijuana. Selective physicians can only certify a person as eligible for medical marijuana use. The “patient”  then takes the certificate (not a prescription) to the marijuana store and buys the type, the form, and the dose of the substance he or she chooses.  How does the user know what to buy? By word of mouth, advice from the store keeper, and good old trial and error. Hardly deserves the term “medical use”, does it?


Vol. 173 July 1, 2017 Bugs and Drugs

July 1, 2017

 

“Eat dirt, and thrive”

 

Since Fleming discovered a mold that produced penicillin which killed Streptococcus bacteria, scientists for decades have been mining soil as a source of new antibiotics. There are so many bacteria competing for nutrients in the dirt that some bacteria will produce toxins to kill their neighbors. The current belief is that soil extraction for new antibiotics has been going on for so long that soil is about tapped out as a source for novel ones.

Antibiotics kill bacteria by attacking their cell walls. Bacteria develop “resistance” to antibiotics with changes in their cell walls that resist the medicinal attack. Individual bacteria cells can’t change their cell walls, but the population of pathogen bacteria as a whole, the “microbiome”, can become “resistant” as the bacteria cells replicate again and again. When only the bacteria which have mutated to ones with a different “resistant” wall remain, the bacteria has become “resistant” to the antibiotic. Your body does not become “resistant”, the bacteria community does..

Viruses have no cell walls, and that is why antibiotics don’t work on viruses, like the ones causing the common cold. Anti-viral medicines against the flu and HIV work by attacking the internal functions of the virus. Some anti-viral medicines attack the virus DNA, others attack the virus RNA, and others attack intracellular proteins or enzymes necessary for virus replication.

Scientists at Rutgers have recently described a whole new class of antibiotics extracted from soil (Italian soil to be exact, if you think that’s important) that don’t work by attacking the cell wall. The new compound inhibits an internal protein, a polymerase, in the bacteria which is necessary for the bacteria to survive. The compound is 10 times less likely to trigger a mutation that leads to drug resistance than current antibiotics. Also it can kill dormant, non-replicating bacteria much better than current antibiotics. Similar compounds that attack polymerases has been successful in treating viruses like Hepatitis C and HIV, but this is the first example of a successful antibacterial effect. It will send many scienticists looking for new antibiotics back to the dirt.

Could this just be another reason to eat dirt? Eating dirt, or geophagia, is a recognized way for animals, and some humans in special situations, to obtain minerals. Pica , eating non-food substances, in a child can indicate that the child is iron deficient or anemic. Pregnant women in Africa are known to eat dirt to enrich their stores of calcium for the fetus. Parrots, bats, and some pregnant women have been observed eating soil with a high clay content to help with gastrointestinal distress. Since dirt can contain lead and other toxins, most people are advised to just take a swig of Kaopectate.

Why not just skip the dirt and go right for the pure mixture of bacteria, a probiotic? In fact, the evidence for the benefits of the use of probiotics is mixed. The use of probiotics has not been dramatically positive in treating diarrhea, eczema, and preventing the side effects of antibiotics. True that probiotics have no significant side effects (the FDA has labeled them as “safe”), but some researchers are concerned that overuse may have deleterious effects on our normal gut bacterial flora.

There are approximately 100 Trillion (that is a “T”) bacteria in our gut. They have been officially awarded recognition as the “gut microbiome”. It is a hot research topic focussing on its roles in digestion, metabolism, immunity, dementia, and even autism. Fecal transplant therapy  (infusion of a solution of healthy donor feces through a nasogastric tube) repopulates the intestine with “good” bacteria as treatment for certain diseases caused by “bad” bacteria (Clostridium difficle) (1) More recently, the dscription of a “breast microbiome” in association with some breast cancers is spurring research into using bacteria as biomarkers in screening for breast cancer.

” The Hidden Half of Nature”, published in 2008, tells a positive story of a couple changing their lives by enriching their garden soil with bacteria-heavy materials while enriching the bacteria of their own intestines by “eating healthy”. One of the authors summed up their approach as: “Mulch your soil, inside and out”.

  1. N Engl J Med 2013; 368:407-415, January 31, 2013

Vol. 171 May 15, 2017 Medical Updates (Real News)

May 15, 2017

 

“The Only Thing That Is Constant Is Change -”― Heraclitus

 

 


Those TV ads work … for the drug companies.
A study of the effectiveness of TV ads (Direct-to-Consumer Advertising or DTCA) for prescribed testosterone supplements (no effectiveness in men without endocrine disease) in 75 regional markets from 2009 to 2013 showed that the addition of ONE TV ad per household per month for 4 years was associated with an increase in new blood tests of testosterone level, new prescriptions with blood level testing, and new prescriptions without any blood level testing. About 2% of the middle-aged men in this study of 17 million men received a testosterone prescription. (JAMA,Mar 21, 2017)

In other news, the British Medical Journal published a study of over 900,000 men which showed that those taking testosterone were 63% more likely to develop potentially fatal blood clots in the legs or lungs during the first six months of taking it. (BMJ, Nov. 13, 2016)

Vitamin D gets an “F”.
Vitamin D supplements became very much in vogue when some studies suggested that people with low blood levels had a higher risk of cardiovascular disease. BUT, in New Zealand 2500 adults were given 1000 units of vitamin D once a month and a matched group of 2500 were given placebo. The vitamin D blood level doubled in the supplemented adults, but at the end of 3 years both groups had identical rates of adverse cardiovascular events (12%). (JAMA Cardiol Apr 5, 2017)

PSA testing -“D” or “C”? It depends.
In 2012 the U.S. Preventative Services Task Force (USPSTF) gave the PSA blood test screening for prostate cancer a “D” – (not recommended) because of false positives leading to unnecessary procedures and treatment, and the fact that PSA screening prevented less than 1 prostate cancer-related death per 1000 men screened.

In 2017 the USPSTF is upgrading that “D” to a “C” (maybe a small benefit) but only for men aged 55-69. (Dare we call it a “gentlemen’s C” ?) The “D” remains for those over 70. This upgrade for the younger men is based mostly on the emergence of the “active surveillance” option to immediate surgery or radiation for positive PSA tests and biopsy. The USPSTF strongly recommends that physicians 1) explain all the risks and benefits of PSA testing to men from 55-69, 2) be aware of the patient’s “values and preferences”, and 3) practice effective “joint decision-making” with the patient. (J Watch General Medicine May 15, 2017)

In other news, a Michigan study of 431 men with localized prostate cancer discovered by PSA testing and confirmed by biopsy who opted for “active surveillance” rather than immediate surgery or radiation showed that only 31% actually followed the complete “active surveillance” protocol. (PSA testing every 6 months and annual repeat biopsy.) Another 31% complied with just the PSA test repeats, but not the biopsy. 22% did neither repeat PSA tests nor biopsy. Outcomes were not measured in this study, (J Urol Mar 2017)

Aspirin may get a third “A”
Aspirin is well-known to relieve pain, reduce inflammation, reduce fever, and reduce blood clotting. It does that by inhibiting the production of prostaglandins, a hormone-like substance in play in all those conditions. In 2000 scientists discovered that aspirin also increases our production of resolvins which also reduce our inflammatory response. We make resolvins from Omega-3 fatty acid precursors (hence the contemporary popularity of fish oil).

Investigators are very interested in a newly defined, third effect of aspirin which is unrelated to its role in anti-inflammation – aspirin’s interference in the ability of cancer cells to metastasize. Cancer cells apparently need to be coated with clumps of platelets in order to survive their trip through the blood stream to distal sites. In mice, aspirin’s anti-platelet action (the “reducing blood clots” function) has been found to interfere with platelet clumping around the cancer cell and successful migration of the cancer cells through blood vessels is inhibited. (Scientific American May 2017)

Trying to avoid sugary beverages? Don’t jump to diet soda.
A 10 year study monitoring 4000 people without diabetes for strokes and cognitive decline found that people who drank diet soda every day were three times more likely to develop strokes and dementia. In a separate study people who drank more juices and more sugar-sweetened soda than others were more likely to have poorer memory and smaller brains on MRI imaging than the other people. The researchers state clearly that this is not a cause and effect situation, just an “association”. (Stroke April 24, 2017)
“More research is needed.” Of course.
“Water is best.”

Bilingual brains remember their first language, even when they can’t speak it!
Korean-born adults who were adopted by Dutch families before the age of six and who did not speak nor understand Korean were better at distinguishing between the sound contrasts of the Korean language and could pronounce the Korean sounds much better than those Dutch adults who had no exposure to the Korean language as children. This better discrimination of sounds is not genetically based because numerous studies have shown that all infants are capable of reproducing all the sounds of all languages. “Remarkably, what we learn before we can even speak stays with us for decades.” (Duh!) (Royal Society Open Science, Mar 2017)

No federal money to study pistols or pot.
According to David Hemenway, Professor of Health Policy, Harvard School of Public Health, an average of 300 people get shot in the U.S. each day. One-third of them die. Twenty years ago the CDC funded about $2.6 million a year (“a small amount”) for firearms research. Now that funding is ZERO. Since 2006 Congress has pprohibited the CDC from gathering any gun-related statistics and developing a gun-related data base, but there is apparently no formal, official prohibition for funding gun-issue research,; just the CDC’s desire to “stay out of congressional crosshairs”.

NIH apparently has the same reticence. In the past 40 years over 486 NIH grants have been awarded in the areas of cholera, diphtheria, polio, and rabies which have caused 2000 deaths in the U.S. Over the same 40 years while 4 million people were shot in the U.S. , NIH has awarded 3 gun-issue research awards. (Note: this period of time is during the relatively scientific-friendly Clinton, Bush, and Obama administrations .)

Marijuana is still classified by the FDA and the DEA as a Schedule I substance which prevents any clinical trial or study of its medicinal benefits. Medicinal marijuana must have FDA required “drug development” studies to get off Schedule I, and those studies are virtually impossible while it is on Schedule I. (Note: current Attorney General Jeff Sessions said in April 2016: “Good people don’t smoke marijuana”) (Scientific American May 2017)


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