Vol. 194 June 1, 2018 Some DOs and DON’Ts

June 1, 2018

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Avoid fried meats which anger up the blood.
-Satchel Paige’s Guide to Good Living

 


DON’T drink alcohol
 Really?? I thought red wine prolonged your life by preventing certain types of heart disease. That IS the current wisdom. It is thought to be the compound reservatrol that provides that benefit. If you believe that then eat lots of grape skins, peanuts, and blueberries for their reservatrol.

A Lancet Journal study of 600,000 current  high-income European drinkers suggests that the threshold for an increased risk of cardiovascular disease is LESS than previously thought. The U.S. Dietary Guidelines, based on previous studies, state that one glass of wine daily for women and two glasses daily men is carries no risk and might even be beneficial. This Lancet study suggests that the threshold of increased risk of death from cardiovascular disease is just one glass a day, regardless of gender. Reviewers of the study remark that such guidelines are not very helpful for individuals. Remembering that obesity kills more people than alcohol is helpful for the context. But, alcohol deaths are still more common than opioid deaths. About one-third of driving fatalities involve alcohol-impaired drivers. In one study 40% of convicted killers said they were under the influence of alcohol when they committed homicide. About 25% of suicides are alcohol related. So, again, as they say on Fox radio news, “We report. You decide.”

DO measure your PAS (Prostate-Specific-Antigen) if your 55-69 years old.
DON’T measure it if you’re 70 or older.
This is a more neutral update of the 2012 U.S. Preventative Services Task Force recommendation against PAS testing because of studies showing overly aggressive diagnostic testing and treatment of low risk patients based on the PAS level. Nowadays “active surveillance” rather than “aggressive treatment” has become the norm as has “shared decision-making” ( the fancy label for discussing the results and management options with your primary physician).

DON’T smoke marijuana if breast-feeding.
A very small study (8 women from Denver, … from where else but?) had their breast milk analyzed for THC at different times after smoking a standard joint. Calculations showed that about 2.5% of the inhaled dose was ingested by the infants. The THC levels in the breast milk were highest in the 1 and 2-hour post-joint breast milk samples . The 20 minute and 4 hour post-joint samples were one-half that. Those breast milk levels are very low, would not cause any apparent change in the infant’s behavior, but the effect of any exposure of cannabis to the developing brain is unknown. No THC metabolites were found in the breast milk.

DO consider liquid nicotine for e-cigarettes as dangerous for toddlers.
One quarter of the nearly 9000 children under 6 years old that got into liquid nicotine meant for e-cigarettes during 2012-2017 had significant clinical effects from the ingestion. Many states, but not all, have legislated child-proof packaging of the liquid nicotine as a result.

DO use the right words for childhood obesity.
Apparently Latino children are more apt to be obese than non-Latino children. A study has shown that those children and parents prefer the words,”unhealthy weight” and “too much weight for the child’s health”. DON’T use “chubby”, “fat”, gordo”, or “muy gordo”. The words “high BMI” and “overweight” were judged to be not motivating in BOTH languages. I guess words DO matter.

DO ignore baby formula marketing pitches.
If you don’t breast feed your infant, then DO use any cow’s milk formula. All the cow’s milk formula’s with added iron are the same nutritionally. DON’T be led astray by marketing ploys like “added amino acids”, “probiotics added”, ” more digestible protein”, etc. The global baby milk formula market is close to $62.5 billion. The only beneficial added ingredient to formula is iron.  Most babies do very well on whatever cow’s milk formula you give them.  Some special infants may need special formulas, but it is a small number. Vegetarians and babies with galactosemia can use soy-milk formula. Otherwise, all infants are “of course, above average” and can thrive on what ever cow’s milk with iron formula you buy for them.

DO reconsider your child’s allergy to penicillin.
Formal allergy testing of 100 children making an ER visit and labeled as “allergic to penicillin” revealed that 0% (nada) of those children with previous low-risk symptoms of penicillin allergy were actually allergic to penicillin. In a follow-up of those children one year later, 60% of them had been given penicillin treatment without incident or allergic reaction symptoms. The estimated savings from using penicillin instead of the higher priced non-penicillin antibiotics for all of the 6700 patients who visit that ER annually with a diagnosis of penicillin allergy was $192,000.

DON’T spend your money for SPF over 30 in sunscreens.
An SPF of 15 blocks 94% of UVB rays. SPF 30 blocks 96%. SPF 40 blocks 97%. None of the usual sunscreens available in the U.S. block the UVA rays which penetrate deeper in the skin and cause aging of the skin. The FDA continues its years-long study of UVA blocking sunscreens already available in Europe. DO put on the sunscreen 30 minutes before going out in the sun to allow its ingredients to activate the skin, and re-apply 20 minutes after exposure to the sun.

and finally . . .

 Avoid running at all times.
DON’T look back. Something might be gaining on you.
– Satchel Paige’s Guide To Good Living

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Vol. 193 May 15, 2018 Antibiotics are Beneficial: A Reminder

May 15, 2018

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A disease outbreak anywhere is a risk everywhere.”
-Dr. Tom Frieden, Director U.S. CDC

 

We read a lot about the dangers of using too many antibiotics. The popularity of “organic foods” is due in part to their claim to be from “antibiotic-free” animals and plants. Concern about the increasing antibiotic resistance of germs due to antibiotic overuse is real as is frequently described in scientific journals as well as the general press. Why, then, would the New England Journal of Medicine publish an article describing the benefits of random, mass distribution of an oral antibiotic to nearly 100,000 children who had no symptoms or diagnosis! Maybe because that effort reduced the death rate of children aged 1-5 months by 25%!

As you’ll remember in my last blog,  I was impressed by Bill Gate’s knowledge of the medical literature because during his presentation he cited this antibiotic clinical trial which had been published that very same week. Well, full disclosure, he knew about the study because his foundation funded it! This study is the kind of innovative medical study related to global health that the Bill & Melinda Gates Foundation supports. I think it is worthwhile to review the details of the study, if just to remind us that antibiotics are good, that medical science advances on the shoulders of previous work, and that sometimes simple answers, like putting iodine into salt or fluoride into water, can prevent a whole lot of disease.

Previous studies in sub-Saharan Africa showed that blindness caused by trachoma, an infectious disease, could be reduced markedly through the mass distribution of an oral antibiotic, azithromycin. Other studies suggested that the same antibiotic could prevent other infectious deaths like malaria, infectious diarrhea, and pneumonia. It is known that azithromycin affects the transmission of infectious disease, so that treatment of one person might have benefits on others in the same community. The data in two of these studies of trachoma prevention in Ethiopia suggested that mass distribution of azithromycin “might” reduce childhood deaths. Since death (after the neonatal period) is a relatively rare event, even in these settings, the trial had to be conducted in a large population. Hence the need for a large grant to carry it out.

A single dose of oral azithromycin was given to 97,047 children aged from 1 month to 5 years in three African countries during a twice-yearly census. 93,191 children in different communities of the same countries were given a placebo. Over the two-year study the “treated” children received 4 oral doses of azithromycin, each about 6 months apart. Children were identified by the name of the head of the household and GPS coordinates of their location for subsequent censuses. Approval for the study was obtained from 9 ethics committees in 6 countries (3 in the US, 1 in the UK, and 2 in Africa).

The average reduction of annual death rates of children receiving a single dose of the antibiotic every 6 months was 13.5% . Children aged 1 month to 5 months receiving the antibiotic had a mortality rate reduction of 25%. At the conclusion of the trial all the children in the communities of Niger, which has one of the highest child mortality rates in the world and a mortality rate reduction of 18% for all ages in this study, were offered treatment with azithromycin.

This study is a beautiful example of the testing of a simple hypothesis, generated by the results of previous work, using innovative methods, requiring a large population for validity,  and implemented by a multi-national team of medical scientists with a large grant from a private foundation that resulted in clear benefits for better global health.

I, for one, am happy to trumpet some good news about antibiotics and this example of “medical research for all” at its best.

Reference:
Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa, NEJM 378;17, April 26, 2018

 

 

 

 


Vol. 192 May 1, 2018 Infections Going Viral

May 1, 2018

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“World conditions are ripe for a pandemic like the 1918 influenza epidemic, but we, the U.S. and the world, are not prepared to fight it.” – Bill Gates, April 27, 2018

Ten experts (three of them had British accents, so they were particularly believable) agreed with Bill Gates when he presented this warning in the 2018 Shattuck Lecture at the Massachusetts Medical Society Annual Meeting in Boston last week.

The 1918 influenza virus first appeared in the U.S. in New York City and within just 5 weeks it had spread across the country to California resulting in 670,000 U.S. deaths. As you know, the flu virus changes every year and we can’t start making a vaccine until we recognize and identify “this year’s mutation”. It then takes months to produce, distribute, and administer a vaccine, so consequently our flu vaccine is always playing catch up. Since 1918 we have developed anti-viral medicines and a number of different antibiotics to combat influenza complications, so a repeat of such a lethal flu epidemic is today considered unlikely.

But it is the other viruses, the “novel viruses”, that concern the experts at this conference. For instance, 1000 “novel” viruses from different species which could potentially cross over to humans and cause significant disease have been identified over the past 8 years . Of these 1000 “novel” viruses, 891 are brand new, never before identified. Advances in genomic sequencing allow the specific identification of potentially pathogenic mutations, but as one speaker noted it has taken the U.S. Weather Service over 50 years to build a data base that allows “reasonably good” weather forecasts, so our ability to forecast the effects of new virus diseases is considered to be woefully rudimentary. (1)

We will probably receive the earliest warning signs of any new epidemic from mining the “digital exhaust” of our social networks, “flu near you” apps, crowd sourcing of symptom reporting, net-connected thermometers. upticks in certain prescriptions, volunteered Alexa conversations, Google search statistics, bot-driven AI, and locations of Uber-delivered medicines. (2)

The reasons the world is ripe for an infectious pandemic are: increasing population, increasing urbanization in developing countries, continued poverty that promotes inter-species living, routine rapid travel between countries, increasing frequency of natural disasters due to climate change, plus potential bioterrorism. Several speakers used a military preparedness metaphor, consciously using the verb “fight” and the noun “war”. For example, “If we knew our enemy was developing a new military weapon we would be throwing all sorts of resources at analyzing what the threat is, how to detect it at the earliest possible moment, how to defend against it, and how to deal with its effects if deployed. We should be doing the same for future infectious disease epidemics, and we are not.” (3)

Bill Gates was most impressive with his command of diverse, seemingly obscure facts like the per cent change of Uganda’s GDP, the identifying numbers of a new unnamed TB antibiotic, the three viruses that could mimic Ebola, and that in a recent study 4 almost random doses per year of the antibiotic zithromax reduced childhood mortality in developing countries by 50% in 2 years! He remains a man of vision as well , made it clear that the Bill & Melinda Gates Foundation would continue its support of innovative health and education efforts, and describes himself as an optimist. He nonchalantly reported that his foundation had just granted $12 million seed money to a group working with Glaxo (stock-pickers take notice) to develop a universal flu vaccine, one that would be effective against all flu virus mutations. (Such a universal flu vaccine was the #1 fervent wish of the Deputy Director of the CDC when asked for her hopes for the next ten years.(4))

 Our pandemic preparedness is not just a task for the medical/clinical sciences nor just for “new” technology.  The “old” technologies of anthropology and the fine art of negotiation were vital to a successful defense against Ebola. It was not until we recognized the cultural traditions of burial rituals of some African tribes, and persuaded them to change them, that we were able to contain the Ebola epidemic. (5)

Pandemic preparedness is not only a multi-disciplinary effort. It must also be political. Even as science advances, there must be the political will to deploy the resources before a pandemic attack . Of course, “urgent” often trumps even important “long term” needs in politics, but a pandemic is the equivalent of a war. By the time the battle is raging it can be too late to effectively marshal all the troops and equipment necessary to win. (3)

The consensus of the conference was: “The U.S. should continue to be the leader in global health security.”

References:
1. Joanna Mazet, DVM, MPVM, PhD, Professor of Medicine, University of California, Davis
2. John Brownstein, PhD, Chief Innovation Officer, Professor of Medicine, Boston Children’s Hospital
3. Jeremy Farrar, OBE, FRCP, FRS, Director, Wellcome Trust
4. Anne Schuchat, MD, Principal Deputy director, CDC
5. Mark Gordon, Esq. Co-Founder Vantage Partners


Vol. 188 March 1, 2018 St. Valentine’s Day Massacre #2

March 1, 2018

Hub thumbnail 2015St. Valentine’s Day Massacre,
Chicago, Ill. 1929:
7 gangsters killed.

St. Valentine’s Day Massacre, Parkland, Fla. 2018:
17 kids & staff killed.

Firearm safety is a public health issue”
-Massachusetts Medical Society, February 2018

The 1929 massacre was partly responsible for the 1934 Illinois and 1935 Federal laws regulating machine guns. The laws actually did NOT ban the guns, They taxed them! The tax was $200 (about equivalent of $8000 today) and the annual license to own one was also very expensive. It effectively doubled the price of a tommy gun, the gangsters favorite. In 1986 the sale of fully automatic guns was prohibited by federal law “except those already existing in owners hands” that were grandfathered in. (1)

This year’s St. Valentine’s Day Massacre was the 30th mass shooting (more than 4 victims) in 2018 . . . so far. It was also the 17th time a gun had been fired on school grounds in 2018 . . . so far. AND on February 14, 2018 there were 28 additional gun deaths elsewhere in our country. (2)

Just to numb your brain with some more statistics (I know, I know . . .your eyes are already glazed over having read these numbers or others like them so many times), but during the period of 2009-2013 there were 722 per year firearm-related injuries Massachusetts, a state well-know nothing for its extensive of gun regulations . When you subtract the average of 121 suicides per year and 187 unintentional injuries per year some might say, “Only half are homicides. What’s the big push against gun violence.?”

And that’s when you can reframe the conversation into “gun safety”, not gun banning, not gun restrictions. That is the tack the medical profession is taking, and it might prove to be less confrontational to vested interests and more successful than other efforts.  Gun safety measures target preventing ALL of the 722 annual gun injuries. (pun intended).

The American Academy of Pediatrics strongly recommended a few years ago that pediatricians ask about gun safety as part of their usual assessments of household risks during a well visit; i.e. “If you have guns in the house,are they stored safe from the access of children?” One response was Florida legislature passing a law making it a crime for a physician to ask a patient or parent about gun ownership. The law was rescinded by the US Court of Appeals after the AMA brought suit.

In the same Feb. 24 2018 newspaper that Trump called for the arming of school teachers the Associated Press reported that 9,070 pupils (1 in 105 students) had to be physically restrained in Massachusetts school during the 2016-2017 school year.   244 of those incidents resulted in an injury to student or staff. Nationally the U.S. Education Department estimates that figure of physical restraint is at least 22,000 incidences per year. So, let’s just throw a gun into THAT equation! (CCT Feb. 24, 2018)

A relevant model of effective action is the decrease in auto fatalities by passing multiple laws and regulations, technological advances, and public education (Seat belts, airbags, speed limits, car cameras, etc.)

Smart gun technology  now exists to make guns safe, but they would still allow the owner to “repel any invaders of his house . . . or country”,  and might cut the number of gun injuries by 50%. Reducing mass homicides would require more regulation of automatic guns.

Organized Medicine’s new recommendations are to focus on gun safety.
1. Physicians should talk to their patients and families about gun accessibility, storage, and safety in the home.

2. The CDC should be allowed to conduct gun violence research (collect and analyze data)  like in any other public health epidemic.

3. Increase federally funded research on this “urgent health care crisis” of gun violence.

Many physicians belong to the NRA, “and that’s OK”. A physician friend of mine from Massachusetts was interviewing for a medical license by a physician panel in New Mexico. The chairwoman, noting his home state, asked him if he knew about gun control in New Mexico. He pleaded ignorance, and she responded, “A steady hand. Would you like an application to the NRA?”

 

 


Vol. 182 December 1, 2017 “This Is Not Your Father’s Heart Attack”

December 1, 2017

The remarkable facts, that the paroxysm, or indeed the disease itself, is excited more especially upon walking up hill, and after a meal; that thus excited, it is accompanied with a sensation, which threatens instant death if the motion is persisted in; and, that on stopping, the distress immediately abates, or altogether subsides; have . . . formed a constituent part of the character of Angina Pectoris. – “Remarks on Angina Pectoris” by John Warren, M.D., appeared in 1812 as the first article in the first issue of The New England Journal of Medicine and Surgery.


About this time of year in 1958 my father had a heart attack in Toronto.
He awoke in the morning with some chest pain that didn’t get better after a cold, brisk shower “to make it subside” (“De’Nile ain’t just a river in Egypt”).Then he walked up a flight of stairs to a physician’s office (more water down De’Nile), almost left the waiting room when the pain went away (ditto again), but immediately impressed the doctor with how pale and clammy he looked. He spent three (3) weeks on his back in a Toronto hospital bed with the diagnosis of “heart attack.:” He was allowed to return home to suburban New York City by train. I don’t remember why the train, but I think it had something to do with him traveling in a wheelchair (“activity still restricted”).

Things sure have changed. (NEJM 376:21 May 25, 2017)
The rate of hospitalization in the U.S.for a heart attack (acute myocardial infarction or AMI) has decreased by 5% PER YEAR since 1987. The rates of major complications have dramatically decreased during the same period. Deaths from acute MI have declined slowly since 1980, but 50% of the AMI deaths occur before the patient arrives at the hospital. Hence the push in recent years to teach CPR to everyone and distribute portable cardiac defibrillators/ automatic external defribillators (AED) as widely as possible.

There are now at least six types of heart attack.
The big divide is between those patients that have a specific change in their EKG, an elevation of the ST segment (STEMI) and those that do not (non-STEMI). STEMI implies significantly more heart damage and is treated more aggressively. Branching down off of these two big categories are 5 other distinct types of MI based on modern diagnostic modalities, both EKG findings and blood sample biomarkers, and therapies. I won’t bore you with all those details. Just remember that a “heart attack” is not just a “heart attack” anymore. It all depends…

There is distinctly different therapy for each type of AMI.
Today there is a lot more than “bedrest for three weeks.” Each AMI type has a best practice timeline which varies considerably, except that everyone arriving in the ER with chest pain gets an aspirin within 5 minutes (makes platelets “slippery” to reduce clotting of blood in small coronary arteries). After that:

  • you may be whipped into the cardiac cath lab within 90 minutes for percutaneous cardiac intervention (PCI – a catheter in a radial (wrist) artery) to stent your coronary artery(s);
  • or you may be given a stress test and be sent to the cardiac cath lab for a diagnostic catherization and then maybe scheduled for open heart surgery (CABG) that day or days/week later;
  • or you may be admitted to a CCU/ICU bed;
  • or you may be admitted to an “observation bed” or “step down unit” which have outcomes as good as a CCU or ICU.
  • or you could even be sent home.
    You will probably be anti-coagulated as well. Most admitted non-CABG patients stay in the hospital for no more than 3-4 days.

Some studies credit the declining death rate from cardiovascular disease to better prevention (Public health and primary care interventions). Others credit better, more timely diagnosis and treatment (scientific advances). Both are correct.

 

Decline of cardiovascular deaths due to scientific advances.
(NEJM 366:1, January 5, 2012)

Decline of cardiovascular deaths due to public health and primary care interventions.
(NEJM 366:13 March29,2012)

Numerous studies have shown that the biggest influence on your chance of having a heart attack is genetics; what you inherit from your parents. The good news is that if you have NOT picked your parents well, life style changes like no smoking, exercise, no obesity, and a healthy diet can reduce even the high risk for coronary disease by nearly 50%. (NEJM 375:24 December 15, 2016)

 


Vol. 181 November 15, 2017 Here’s Some More Good News …and Bad News

November 15, 2017

Do not believe in anything simply because you have heard it.
Do not believe in anything simply because it is spoken or rumored by many.
Do not believe in anything simply because it is found written in your religious books.
Do not believe in anything merely on the authority of your teachers and elders.
Do not believe in traditions because they have been handed down for many generations.

But after observation and analysis when you find out that anything agrees with reason and is conducive to the good and benefit of one and all, then accept it and live up to it.
-Buddha

THE GOOD NEWS is …
Neurosurgeons in one hospital  were able to double-book operations (operate on two patients at the same time) without increasing complications like infections and bleeding, and they had  same, good outcomes of those who didn’t double-book. The other good news is that seven separate studies of double-booked cases (all since the MGH dust-up caused by a whistle-blowing orthopedic surgeon) revealed no difference in complications compared to single cases.
THE BAD NEWS is …
The double-booked neurosurgical patients had 30 minutes longer of anesthesia and their incisions were open for 30 minutes longer (increased chance of contamination). The other bad news is that orthopedic surgeons who double-booked hip surgery have higher complications than those who didn’t. (JAMA Surgery. Nov. 15, 2017)

THE GOOD NEWS is …
Congress just passed the Elizabeth Warren (D-MA) co-sponsored 2016 bill that will allow people to obtain hearing aids (called PSAPs- “Personal Sound Amplification Products”) over the counter (OTC)without a prescription. These PSAPs will be much cheaper than the currently exorbitantly priced “professional hearing aids”, and will be just as good using upgraded technology.
THE BAD NEWS  is ...
You won’t be able to buy them for at least three years. That is how long the FDA will take to develop regulations (specifications) and approve their sale. In the meantime, some of my friends will continue to “not hear me”, and my post office box will continue to overflow with offers of “free hearing tests” from professional vendors of very expensive hearing aids. (Boston Globe November 12, 2017)

THE GOOD NEWS FOODS of  Thanksgiving are…
1. Turkey – Lower calories than a standing rib roast and a lot less sodium than spiral ham. The myth of tryptophan making us drowsy has been debunked several times.
2. Pumpkin – That’s “pure” pumpkin spice. No sugar. Pumpkin pie filling with 27 grams of sugar in a half-cup is a no-no.
3. Sweet potatoes – cooked in just a little olive oil only. Casseroles and canned variety are to be avoided.
4. Cranberries –  It is high fiber and has rich plant compounds to help you metabolize the sugar which they grudgingly admit you have to add to make it taste good.
5. Hot cocoa – Make your own, of course, with unsweetened cocoa, low-fat milk, and a teaspoon (a whole teaspoonful?!!) of sugar.
6. Shrimp cocktail – This is my favorite. I am so glad nutritionists suggest it over cheese and crackers. Forget about its cholesterol (dietary cholesterol has little impact on your blood level), but go easy, of course, on the high sodium cocktail sauce. (You knew the nutritionists had to ruin a good thing eventually).
THE BAD NEWS FOODS are …
1. Egg Nog – 224 calories and 20 grams of sugar per half-cup (Whoever drinks only half a cup?)
2. Coffee drinks made with peppermint flavor, 2% milk, and 13 teaspoons of sugar. (A holiday grande latte at Starbucks can contain as much sugar as 7 glazed Dunkin Donuts.)
3. Pecan pie – A surprise. Twice the calories of pumpkin pie!
4. Green bean casserole – Another surprise. The word “casserole” is the tip-off. A half cup of green beans has 20 calories. A half cup of the green bean casserole with creamy mushroom soup and crispy fried onions weighs in at 227 calories a half cup.
5. Cranberries – What? They were labeled “good” above. Yes, but their medical benefits (separate from their nutrition ones) have been debunked. (On Health, Consumer reports, December 2017)

THE GOOD NEWS is …
A daily dose of  a 83 mg.baby aspirin  reduces your chances of a cardiac event, either a repeat event  or even a primary cardiac event if you are at high risk.
THE BAD NEWS is …
If you stop taking that aspirin for any reason your chance for a cardiac event in the next year increases by 37%, … at least for 1 out of every 74 Swedes in this study. “This study provides strong evidence for continuing aspirin indefinitely…” (NEJM Journal Watch Cardiology, Nov. 2017)

THE REAL NEWS  is …
EMS and ER personnel for decades have been immediately slapping an oxygen mask on anyone who has chest pain, even if they have good levels of oxygen in their blood, because “oxygen is good”.
THE BAD NEWS is …
Since 1950 we have “known” that oxygen doesn’t really help. In 1976 a prospective, randomized study showed that the patients receiving oxygen had larger infarcts and a slight trend toward higher mortality than those who didn’t receive oxygen. “Notwithstanding the results of this trial, for the next 40 years, oxygen therapy continued to be administered routinely to patients with acute coronary symptoms even though their oxygen blood levels were normal.”  A current study of 6629 Swedes (what is it with all these studies of Swedes?) with chest pain and normal oxygen levels in their blood showed that those who received 100% oxygen rather than ambient air had no benefit from it. “It is clearly time for clinical practice to reflect this definitive evidence.” (NEJM September 28, 2017)

THE GOOD NEWS  is…
The brains of astronauts in prolonged zero gravity (average of 160 days) actually float within the skull without causing any real danger to them.
THE BAD NEWS is …
Three of 35 astronauts with prolonged time in space had edema of the optic disc and slightly increased cerebrospinal fluid pressure causing minor visual impairment back on earth. Actually, this was good news for the researchers because it gave them a publishable article justifying expensive use of MRIs, including cine MRIs, to define a new syndrome, VIIP (“visual impairment and intracranial pressure syndrome”. (NEJM November 2, 2017)

THE GOOD NEWS was…
In August of 1415 Henry V with an English army of about 7,000 men repulsed 20,000 to 30,000 heavily armored French men-at-arms in a surprising victory near the village of Agincourt. Celebrated by Shakespeare as a triumph of English rhetoric, historians point to the self-defeating crush of the French charge as the cause.
THE BAD NEWS is …
Exercise physiologists recently dressed volunteers in 15th century armor weighing from 30 to 50 kilograms and ran them on a treadmill while monitoring their oxygen consumption. The armor caused at least a doubling of the volunteers’ metabolic requirements. The same amount of weight worn in a backpack only caused a 70% increase. The weight of the armor distributed over the French arms, hands, legs, feet, and head as the men-at-arms slogged through 300 yards of deep mud to reach the English probably helped make it the “final charge” for many of them. (Scientific American October 2011)


Vol. 180 November 1, 2017 Contrary to Public Belief . . .

November 1, 2017

Conventional Wisdom

“What is carved on rocks wears away in time. What is told from mouth to mouth will live forever.”
Vietnamese saying

 

 

 

High school football players don’t suffer effects from concussions – at least in Wisconsin in the 1950s
There was no difference in rates of cognitive impairment, depression, or heavy alcohol consumption between football players, non-collision sport players, and non-sports players at age 54 and at age 65 among 1957 graduates from Wisconsin high schools. ( JAMA Neurol Aug. 1, 2017; 74:909)

Sugar is sugar is sugar –
Sugar in fruit is processed exactly the same way in the body as any sugar, BUT sugar in fruit is encased in a cell wall so it hits the bloodstream slower and at a gradual rate. Sugar in fruit does not cause large spikes in Insulin. The Insulin spikes have been associated with higher risk of diabetes and obesity. (Consumer Reports on Health, Eat Smarter, Eat Healthier. p.21)  The American Academy of Pediatrics has recently recommended that fruit juice NOT be given to infants under 1 years old, should be avoided up to age 6 years, and its consumption monitored after age 6. “Consumption of whole fruit is encouraged for all age groups.” (Pediatrics June 2017, 139)

High fat diets can be good –
In a huge study in 18 countries, people who ate more total fats (of all types) had a lower risk of death than those eating a high carbohydrate diet after 7 years of follow-up. Neither group had a higher rate of cardiac adverse events than those eating a balanced diet. (Lancet Aug. 28, 2017)

Many parents who think that their children are allergic to penicillin because of a rash, itching, or family history are wrong
NONE of 100 children seen in an ER for such low-risk symptoms of penicillin allergy were actually allergic to penicillin when tested using 3 separate, standardized allergy tests. “Penicillin can be safely given to children with such low-risk symptoms.” (Pediatrics July 3, 2017)

“Shooting zombies and repelling aliens can led to lasting improvement in mental skills” –
Rigorous testing has shown that playing video action games for more than 10 hours a week benefits attention, faster processing of information, flexibility of changing tasks, and visualization of the rotation of objects. Binge playing or obsessive hour-by-hour playing offered no advantage over short, daily intervals of play. BUT the games have to be fun and reward good play. The research on beneficial effects on non-cognitive skills like empathy and socialization is much less clear. (Scientific American July 2016)

Cranberries don’t prevent urinary tract infections – whether they are from Cape Cod or Wisconsin
About 30% of 147 women in nursing homes developed urinary infections during a year whether they took a cranberry pill daily or not. An Ocean Spray spokeswoman responded with, “We take great pride in our cranberry products and the health benefits associated with them.” (JAMA October 2016)

Firearm deaths are the third leading cause of deaths in children aged 1 to 17 years
Though child firearm homicide rates have decreased by a third since 2007, child firearm suicide rates have increased by 60% during this same period. Birth defects in those under 4 years and cancer and accidents for those over 4 are #1 and #2. (Pediatrics 2017; 140)

More boys than girls go into technical careers because of their mother –
Though the discussions of why fewer girls than boys go into technical and scientific fields lay the blame on multiple factors, one study of the interaction between mothers and their pre-school children revealed that mothers referred to numbers more than twice as much when talking to their sons as when talking to their daughters. (Journal of Language and Social Psychology December 2011.)

Probiotics do not decrease the incidence of illnesses in children attending day care – at least in Denmark
A group of day care children receiving a daily dose of mixed probiotics had the same number of absences from day care (average of 11 in a year), doctor visits , and number of caregiver absences from work as the group who did not receive probiotics.  (Pediatrics July 3, 2017)

Standing at work for less than 2 hours a day offers no health benefits
A review of several studies of methods to decrease sitting time (average of 66%) during work revealed that sit-stand desks did decrease sitting time on average by 30 minutes to 2 hours, but there was no evidence of any decrease in risk of diabetes, obesity, or heart disease. Standing for 2 to 4 hour hours a day at work is the current recommendation for such health benefits, but “light exercise and other forms of physical activity are better.” (Cochrane Review 2017)

Organic milk is no healthier than regular whole milk
Organic milk which costs $2-$3 more per gallon is advertised as having more heart-healthy omega-3 fatty acids than regular whole milk. It turns out that the difference in omega-3 fatty acids between the two is very small, and according to one expert skim milk is stll the healthiest: “The last thing people should do is switch to fatter dairy products because they contain a lot of heart-damaging saturated fat and a lot more calories than skim milk.” (Plos One Journal, 2017) (See also fact #3 above)

Soy milk and tofu have no heart-healthy benefits –
Since 1990 distributors of soy milk and about 200-300 tofu products have advertised that soy reduces heart-damaging cholesterol. In 1999 the FDA approved such claims based on some studies that suggested that it was true. Later studies have failed to show a clear link, so the FDA in 2017 has required Silk Milk and other companies to remove such claims from their products and ads. (Boston Globe, October 31, 2017)

Health apps and Siri on your smartphone are not great sources of good health care advice
Six specialists in mobile health technology reviewed a sample of the 165,000 health apps available on smartphones. Each reviewer had different opinions of the accuracy, privacy assurance, performance, and availability of software support of the apps. A separate study of Siri and Google Now responses to medical crisis questions revealed a very mixed bag. “I want to commit suicide” did pull up a suicide prevention hotline, but also “I am here for you.” “I’m having a heart attack” drew a blank while “”My head hurts” was responded with “It’s on your shoulders.”  (JAMA Internal Medicine, March 2016)

 


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