Vol. 140 January 15, 2016 A Review of 2015 Hubslist Blogs

January 15, 2016

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Click on the date to see the full blog


January 1 – 5 out of 10 of my resolutions were “kept”. You guess which ones.

January 15 – 6 reasons why patients are non-compliant , excuse me, “non-adherent”- the new PC term, with their medications.

February 1 – incidence of sudden death while watching the Super Bowl (Patriot fans probably don’t have to worry about that THIS year.)

February 15 – some myths revealed about cholesterol in your diet, global warming, measles vaccination rates, herbal supplements, and Dr. Oz, vendor of snake oil(s).

March 1 – 8 new causes of death caused by cigarette smoking added to the previously identified 12; a total of 20.

April 1 – Athena Health purchases MySpace which raises more concerns about privacy of health care data (April Fools edition).

April 15 – what does a “board certified physician” mean, and what does it have to do with Presidential candidates (Rand Paul)?

May 1 – physicians’ prognoses are often too optimistic for the same reasons patients’ are.

May 15 – E-cigarettes open new avenues for adolescent use of marijuana and synthetic cannabinoids (“bath salts”).

June 1 – annual review of sunscreens and bug repellents plus less universities providing student access to tanning booths.

June 15 – new forensic techniques of identifying individuals by bacterial, viral, and DNA “fingerprints”.

July 1 – 6 positive access outcomes and 4 positive health care delivery outcomes of Obamacare at 5 years of age.

July 15 – dangers of synthetic cannabinoids (attn: Chandler Jones?) and the minimal (“pending”) review of sunscreens by FDA.

August 1 – two websites with the best “symptom diagnosis” track record for helpfulness, and the one that is the worst.

August 15 – [ family vacation in a lighthouse without electricity or running water]

September 1 – why new drugs cost so much, no “gay gene” identified yet, and the myths of low testosterone, chronic Lyme, and  8 glasses of water a day.

September 15 – The health benefits of our “microbiome” and the “microbiome” of the New York City subway.

October 1 – the misleading, untruthful attacks on Planned Parenthood.

October 15 – the scope and magnitude of adverse effects of dietary supplements.

November 1 – transgender, transsexual, transvestite, and hermaphrodite, oh my!

November 15 – toddlers shooting people and other “norms” of gun deaths – “By Degrees“.

December 1 – changing advice about what NOT to eat during the holidays.

December 15 – the benefits of research using fetal tissue, short history of political attacks on Planned Parenthood, and why if you are NOT fat and live a long life you should thank your parents.


Vol.138 December 15, 2015 Who Buys Baby Parts?

December 15, 2015

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The Colorado gunman who shot and killed three people at a Planned Parenthood clinic in Colorado Springs is reported to have said “no more baby parts.”


The distorted flap about Planned Parenthood “selling baby parts” continues. On December 3 the Senate ( Republican-led) voted to strip Planned Parenthood (PP) of government funding. President Obama (a Democrat) will veto it if it reaches his desk. (I’m not suggesting that this is a political issue, of course) Planned Parenthood received $528 million from the U.S. government in 2014 to help support 700 clinics providing health services to mostly poor women. Why so much money? Basically because PP is providing subsidized women’s health services that in every other developed country except ours is provided by the government. The Congressional Budget Office estimates that if Congress were to succeed in blocking Medicaid patients from obtaining care at PP health centers 390,000 women would lose access to preventative health care in the first year alone. (1)

Who wants “baby parts”?

In 2014 NIH funded 164 research projects using fetal tissue with about 0.27% of its total grant money. (2) These projects were researching HIV/AIDS (39%) , eye development and disease (32%), Hepatitis C and other infections, (13%), diabetes (8%), and miscellaneous others including Alzeihmer’s and Parkinson’s. “Fetal tissue is a flexible, less-differentiated tissue … and it is a tool for research that can’t be replicated with adult tissue.” (3) It is different from stem cells, a medical tissue that came under attack back in W. Bush’s administration.

Use of fetal tissue has been legal since 1993 when Congress passed the NIH Revitalization Act which permits the tissue from any type of abortion to be used for fetal tissue research. The law requires complete and detailed informed consent from the woman to donate tissue from the abortion after she has made the decision to have an abortion. The law allows clinics to recover “reasonable payments” ($45-60 per specimen at PP) for providing the tissue to biological-research supply companies. The companies process the tissue and provide it to the researcher for about $800 per specimen. (I wonder if any Republicans have stock in some of those companies).

An estimated 5.8 Billion (yes, a “B”) people have received vaccines made with the two cell lines derived from fetal tissue. (Oh, NO, another red flag! “VACCINES”, “Guns”, “abortions” – all mentioned in the same blog! It’s almost enough to make you believe that there is a government conspiracy to enslave us all.)

“People are talking about fetal tissue, but really what the discussion is about is abortion.” (4) ( Duh!!)   3% of PP services are abortions, done in 1% of the clinics, and in just 2 states. (5) Planned Parenthood leaders have now instructed any PP clinic providing fetal tissue NOT to accept the measly 60 bucks.

Planned Parenthood has experienced 15 smear campaigns in 10 years according to its medical director (5). The current campaign has included:
1) six votes in Congress to restrict woman’s health care,
2) five Congressional committees currently investigating PP,
3) submission of 25,000 pages of documents by PP, and
4) 5 hours of testimony to one committee by its president.

Abortion politics appear to be as complex and almost as emotionally provocative as Presidential election politics, but the outcome of election politics will immediately affect only two women, not hundreds of thousands.

Another learned cardiologist has reaffirmed the Hubslist axiom: “Just pick your parents right .” Dr. Lee Goldman, Dean of Columbia School of Medicine, explains that obesity is due to our genes in his new book, “Too Much of a Good Thing: How Four Key Survival Traits Are Now Killing Us.” He thinks that our overreaction to stress and our cravings for sweet, fatty, and salty foods all served us well in the cave man years when we had a life-span of 30 years, but that these “survivor genes” are now mismatched with our environment as we live into the 80’s. Of course, being a modern scientist he knows it is too late to “pick your parents”, so he is placing his hopes on future drug therapies that will turn off or block specific genes. Dr. Goldman says, “Gaining weight doesn’t mean that you are a terrible, non-virtuous person. This is the way you were built.” (6)

So, my holiday (includes New Year’s eve, of course) mantra for me and you is:
“Merry Christmas. Don’t beat yourself up. YOU are NOT in control.”

1. CBO cost estimate on H.R. 3134, Defunding Planned Parenthood, September 16, 2015
2. Nature Magazine, Dec. 9, 2015, Meredith Wadman
3. Carrie Wolinetz, Associate Director for Science Policy, NIH
4. Shari Gelbar, MD. Weill-Cornell Medical College
5. Tearing Down the Fetal Tissue Smokescreen, NEJM, December 10, 2015, p.2376, Reagan McDonald-Mosley, M.D., M.P.H.
6. Boston Globe December 14, 2015 , B11

Vol. 137 December 1, 2015 Holiday Season Eating Advice

December 2, 2015

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With the passing of the Thanksgiving turkey we are officially in the “holiday season”. Weight gain during the 6 week holiday season represents 51% of our annual weight gain which is actually only about a pound or two on average. Much less than the average weight gain during a 7-day ship’s cruise of a pound a day. So, what foods should be avoided in the next 6 weeks?

Junk Food has been the traditional scapegoat for our increasing obesity. But, what is junk food? Decades ago I remember a very savvy pediatric endocrinologist, Dr. Gilbert Forbes, challenging a forum of physicians at a national pediatric meeting to define junk foods.
“Food high in sugar and carbohydrates”, was our immediate response.
“Like grandma’s apple pie?” was Dr. Forbes’ equally quick reply.
“Oh… high starch foods” was our second try.
“Like potatoes? How come all Germans aren’t fat?”
Our working definition after an hour or more of back and forth boiled down to “anything wrapped in cellophane or delivered by a vending machine.” Dr. Forbes’ point was that it is the total number of calories ingested and not any particular food that contributes to obesity.
Today that definition still holds true

In its inexorable march towards the truth medical science has just thrown a stone at the junk food glass house. A Cornell study (1) based on nearly 5,000 surveys done by the CDC in 2007-2008 surprisingly showed that for 95% of the people their BMI  (a measure of obesity) was NOT linked to soda, fast food, or even candy. The researchers expected to find that the more junk food people ate the more apt they were to be obese. Instead they found no correlation between eating junk food and a higher BMI; no link between junk food and obesity. The researchers concluded that it was our increased intake of grains and added fats that was driving up the number of calories consumed by the average American.  “Junk foods may not be the central difference between fat and thin. Limiting those foods is a part of a healthy diet, but it might not be the whole thing.” (2)

Sugar continues to get a bad rap, and we consume more and more sugar substitutes. But, as we say in medical science, “there ain’t no free lunch”. Studies showing that Canadian lab mice were more prone to develop bladder cancer if fed saccharine (Sweet and Low) certainly caused a bit of a flap until someone calculated the comparative human doses to be several shovelfuls a day. Sucralose (Splenda) is now under investigation because its effect on our gut bacteria may make us more prone to gain weight and develop diabetes. Like Fox radio news says, “We report, You decide.”

Excess (added) salt does seem to correlate with higher blood pressure.  I don’t have the space here to summarize again the whiplash swings of research on salt and disease, but I can tell another story from the past that makes the point more succinctly.
A bunch of physicians (all male – I told you this was a story from the past) who were having lunch at the same table in a hospital cafeteria started remarking about the prodigious amount of salt a cardiologist was pouring on his food. As the discussion heated up, the cardiologist looked up from his plate and stopped it with a question, “How many of you have talked to your father in the past year.” Half of us raised our hands. “You guys can eat what you want. The others better watch their diets. You just have to pick your parents right.”

After decades of branding eggs as “bad” because of its cholesterol the federal government’s Dietary Guidelines Advisory Committee reported in 2015 that “eggs are OK.” A 1999 Harvard study showed that there was no correlation between an egg a day and the risk of heart disease in healthy people (3). 90% of our cholesterol is manufactured by our own liver as directed by our genes. Restricting our intake of certain fats can normally decrease our cholesterol level by about 10% at most.

Previous studies have shown that wine drinkers seemed to experience less heart disease and certain cancers. Efforts to analyze why wine seemed so healthy resulted in tagging resveratrol, a chemical in grape skin, as the “active ingredient”. Dozens of nutritional supplements containing resveratrol ($12 – $25 for a month’s supply) immediately hit the market. Four Danish scientists thought that answer might be too simple and launched a study of what else those wine drinkers were buying at the food store. After examining 3.5 million store receipt transactions from 98 supermarkets they found that wine drinkers were more apt to buy olives, low-fat cheese, fruits and vegetables, low-fat meat, spices, and tea. Beer drinkers were more likely to buy chips, ketchup, margarine, sugar, ready-cooked meals, soft drinks, and, of course, beer. (4)

BOTTOM LINE for this holiday season?

1. Boston Globe, B12, November 23, 2015, Megan Scudellari
2. David Just, Cornell University Professor of Applied Economics and Management
3. Boston Globe, March 15, 2015, Walter Willett, MD, Professor of Nutrition and Epidemiology, Harvard School of Public Health
4. The Dorito Effect: The Surprising New Truth About Food and Flavor, Mark Schatzker, May 2015 as reported in The Atlantic, June 2015

Vol. 114 June 1, 2014 Much Ado About Nothing

June 1, 2014


“[In response to] an announcement from another U.S. infant formula manufacturer
about its plans to decrease the caloric density of some of its formula to 19 kcal/fl. oz,
Mead Johnson Nutrition (MUN) would like to assure youthat we have
NO plans to modify the density of our formulas from 20kcal/fl oz to 19 kcal/fl oz.”
-Mead Johnson news bulletin to pediatricians, April 1, 2014


My last two blogs discussed the evils of added sugar documented by the movie “Fed Up” and the possibility of an FDA ban of added trans fats in manufactured foods.  Both describe politically correct responses to the growing awareness of U.S. and global obesity rates and prevalence. We are urged to become ingredient list readers and to “buy healthier” as a defense against food corporations’ slick advertising and successful lobbying against transparent ingredient lists.

Abbott is the latest food corporation to claim to save us all from the scourge of infant obesity, all by reducing its Similac calories by  1 kcal/fl. oz.   Mead Johnson’s (Enfamil) rebuttal warns that reducing the formula calories means that infants would need to consume 1.5 more ounces per day to “meet their daily energy requirements during the first six months.”  All my kids have left more than that on their bibs  and chins every day, or as Stephen Colbert might say,  “Give me a f&*king break!”

Abbott’s stated reason for the formula change, already labeled by Abbott as “Innovative”, is to help decrease excessive infant weight gain by matching its formula content more closely to breast milk. In my increasingly skeptical (cynical) view Similac is merely adding new marketing buzz words to the current debate about what makes obese infants and do they become obese adults?

It is hard for me to get too excited about minimal formula calorie changes when I remember that one can of Coke, Pepsi, or Sprite contains more sugar than  100% of the total daily requirement of sugar as defined by the American Heart Association (36 g).  Mayor Bloomberg’s campaign against the super-size soda which contains 128g of sugar and the efforts to remove soda vending machines from schools even make some sense. One kcal/fl oz. or 1.5 more ounces of formula a day certainly pales by comparison on the spectrum of “sublime to ridiculous”.

One of the perks of being a pediatrician is being reminded daily about the flexibility, innate wisdom, and versatility of infants and toddlers. In a two-page  news announcement peppered with scientific journal citations the American Academy of Pediatrics Committee on Nutrition notes that ” the number of formulas choices have increased and the selection process is more complicated”.  It concludes in one of its more common-sense statements that “infants appear to eat to satisfy energy needs and will compensate for low food energy density … by increasing food intake.” Duh? More importantly,  “Neither parents nor pediatricians should assume that newer and more expensive products have health benefits for infants.”

Vol.113 May 15, 2014 More “Bad Stuff” For You

May 15, 2014


“I have a chef who makes sure that I’m getting the right amounts of carbs, proteins and fats
throughout the day to keep me at my max performance level.”
Barry Bonds

My last blog reviewing the movie “FED UP” listed many of the compelling reasons why “added sugar” is bad for you and why food manufacturers keep adding it. Just as I was getting used to looking for the total grams of sugar on processed food labels, some active health food advocates are urging the FDA to declare partially hydrogenated oils (“trans fats”) as bad too. Now I will have to start scanning ingredient lists for that!

These particular “health food advocates” happen to be two scientists from Stanford University and Temple University writing an article in the New England Journal of Medicine (1). This bicoastal duo reports that since 1911 food companies have been adding artificial trans fats to foods to prolong shelf life, improve stability during deep-frying, and enhance taste. Unfortunately, added trans fats alter the balance of good and bad cholesterol in a harmful direction. The CDC estimates that 20,000 coronary events and 7000 deaths per year could be prevented by NOT ADDING trans fats to processed food. Denmark banned it in 2003. New York city banned it in restaurants in 2006, and California did so in 2008.

In 2006 the FDA required food processors to list trans fat as an ingredient, and many manufacturers reduced the amount added to their products to avoid having to declare it as an ingredient. Recently the FDA has proposed a regulation removing trans fats from its “GRAS” category (“Generally Regarded As Safe”) and declaring partially hydrogenated oils (trans fats) as “unsafe” in any food sold in the U.S.

The authors note that “over the past few decades, food-safety concerns have expanded from issues of food borne illness and contamination … to the effects food ingredients have on chronic diseases such as heart disease.” They end their essay optimistically with “regulatory reconsideration of ingredients such as sugar, caffeine, and salt may well be next on the agenda.”

Reeling from this latest disclosure of potentially dangerous things that I unknowingly put into my mouth, I sat back in my recliner with a relaxing glass of red wine only to read in WIRED magazine that wine is not the pure libation that I thought it was! Some of the FDA-approved additives in wine include:

  • sulfur dioxide to kill microbes and prevent oxidation,
  • ammonium salts to revive dying yeast to enhance fermentation,
  • pectic enzymes to improve clarity and color,
  • oak adjuncts (chips, sawdust, or oak “essence”) instead of oak barrel maturing,
  • gum arabic to soften a bitter wine,
  • Velcorin (dimethyl dicarbonate) to kill a half-dozen different bacteria and yeasts,
  • and, of course sugar.

Added sugar  from beet, cane, or corn syrup increases the alcohol content from fermentation. The process is called “Chaptalization”, invented by a Frenchman and illegal in California, Italy, and Australia.

It is simply a wonder that any of us live to be over 65.
I think I’ll just pop open a beer and settle back to read yet another article about how the ills of the elderly are bankrupting our country.
… Or better yet, a martini.
I almost have my physician convinced that gin is “a clear liquid”.


1. NEJM 370:19, May 8, 2014, Brownell and Pomeranz)
2. WIRED, April 2014

Vol. 112 May 1, 2014 Sugar is Bad! Oh no, Not Again.

May 1, 2014


I say “oh, no, not again” because 30 years ago I spent some time in my practice and in the community
defending “bad” sugar against accusations that it caused hyperactivity and attention deficit syndrome.
Research, then and now, has shown that in only about 25% of hyperactive children
eliminating, not the sugar,but the dyes and other additives in sugary foods can reduce their hyperactivity.


The film “FED UP” which I just saw in advance of its general release on May 9 makes a compelling argument that the amount of “unaccompanied” sugar (the American Heart Association calls it “added” sugar) that we eat is causing our obesity epidemic. It is narrated by Katie Couric and produced by the producer of “An Inconvenient Truth”.

The film simplifies complex nutritional and biochemistry processes with an easily understood cartoon diagram showing sugar ingested without accompanying fiber or protein being absorbed quickly, traveling directly to the liver where it ignites a burst of insulin that converts the sugar directly into fat. If fiber or protein is ingested along with the sugar this absorption is slowed, less insulin is released, and less fat tissue results. Hence the campaign against super-size sodas in New York City and efforts to ban soda vending machines from our schools. The film points out how detractors try to reframe the soda discussions into terms of “individual liberty vs. an over-reaching government”, rather than that of a serious health issue.

“FED UP” explicitly demands that we demonize sugar the way we have demonized tobacco. “Both are extreme health hazards”.

The average daily consumption of sugar in the U.S. is 84 grams. The American Heart Association recommends 36 grams a day of added sugar. “Processed food” with its high sugar content gets the black mark here as compared to “real food”, which if it has sugar, also has fiber which delays its immediate conversion into fat. The film’s examples of the success, power, and money of the “sugar lobby” and big food corporations are particularly provocative. The film removes all blame from the fat individual and places it squarely on the persistently clever, seductive advertising (particularly to young children) of food processors and distributors. The film’s revelations of the ability of the food and sugar lobbies to resist truthful, transparent labeling and to continue to outmaneuver an amorphous front of three different federal regulatory agencies is compelling .

Fun facts presented by “FED UP” include:

  • When President Reagan cut the school lunch federal subsidy in the 80’s many schools outsourced lunch preparation to fast food suppliers and closed their school kitchen to lower costs. Today 80% of schools in U.S. have their school lunches provided this way (pizza, french fries, cheeseburgers, and sodas – Pizza Hut, MacDonald’s, etc.) Do you know where your schools get their lunches?
  • Promoting student choice of healthy alternatives is an easy, obvious answer to outsourced vendor lunches, but in a school where a healthy alternative is offered a cafeteria worker reports that “only about 25 out of 350 students actually choose it”.
  • Multiple sugar products are often hidden on ingredient labels by use of unfamiliar names.
  • All the fat taken out of milk and other dairy products during the 1980’s rush toward “fat-free” food has been successfully re-marketed as increased cheese products. Many food manufacturers added even more sugar to restore the taste of “reduced fat” foods.
  • Sugar is the ONLY ingredient on the ingredients list that is NOT accompanied with a “percentage of daily requirement” number. This “% number” has been kept off the labels by the sugar lobby. If it were added, we could quickly see that we often exceed our “daily requirement of sugar” about half way through lunch. The film depicts a bowl of corn flakes as actually a bowl of sugar.

A couple of reservations about the film:
1. The film touches only briefly on the genetic contribution to obesity. It explains the two, clearly thin brothers running around in the background of one of the featured fat families, as TOFI (Thin Outside Fat Inside), a recent concept which depends on specialized total body MRI imaging to identify.

2. Its explanation of why the rest of the world is also getting fat is “that we are so good at exporting our ads and processed food to the rest of the world”. I think that is too weak to explain the rise of obesity in countries like Spain, Switzerland, and Korea.

Internatl obesity rates
“FED UP” closes with some specific recommendations and challenges:

  • Reduce sugar intake by 50% by cooking “real” food.
  • Any food with more than 12 listed ingredients is a processed food not a “real” food.
  • Eat fresh, buy local
  • GO SUGAR FREE FOR 10 DAYS. A difficult thing to do because of all the hidden sugar in soups, sauces, catsup, yogurt, and canned foods. A family in the film did do it for 10 days, liked it, extended it, and lost dozens of pounds.
  • Ask your legislators to pass laws requiring the inclusion of “% of daily requirement” for sugar on all labels, just like all the other listed ingredients.

Dare I close with the tag line that this thoughtful, polemic film provides us (U.S.) with “much food for thought”?
.                                     Look for “FED UP” after May 9.

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

January 1, 2014


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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