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!”

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Vol. 216 August 1, 2019 Parenting Choices and Other “Conventional Wisdoms”

August 1, 2019

 

The evidence supporting some of our most popular opinions is often not so compelling.

 

In 2015 31% of first time mothers were over 30 years old. In 1980 it was 8.6%, and it is safe to assume that those 2015 first time mothers got more of their parenting advice from the internet rather than from an experienced grandmother. One of those first time mothers, an economics professor at Brown, has written a book examining the presence, or absence, of real data on the conventional wisdom surrounding breast feeding, sleep training, and working mothers.

Breast Feeding
According to Emily Oster in her book Cribsheet, the current mantra is that it is best to breast feed your infant: it is easy to do, produces smarter babies with less diarrhea and ear infections, and makes “happier moms with better friendships”. In reviewing the evidence on the internet she notes that breast-fed babies in many of the observational studies of breast feeding are generally being fed by a mother with a higher IQ and in a higher educational and economically class than non-breast feeding mothers. “So which is the cause?” The difference in ear infections in one very large study was 2%. The difference in diarrhea episodes was 4%. One study of siblings, one breast fed and one not, found no difference in IQ or incidence of obesity at 6 1/2 years of age. Her conclusion: “The good news for guilt-ridden moms [who don’t breast feed their infant] is that there is very little evidence for long term effects [of not breast feeding]. Moms often feel selfish about thinking about their own wants and needs with decisions about their kids. In this case, the data gives you permission to put yourself first for once.”

Sleep Training
The internet is apparently full of stories of the extensive long-term damage to your infant if you let them “cry it out”, the code word for “sleep training”. This is apparently based on 1980s studies in orphanages in Romania. Dr. Ferber’s careful studies of sleep training and in 1986 outlined in detail how to do it. (“Ferberizing”)(1) Many studies of sleep training show sizable improvements in maternal depression, family functioning, and no negative effects on infants. But, one small study quoted all over the internet suggested that more stress was demonstrated by the infants a few weeks after sleep training even though the mothers were less stressed. Her conclusion: “Every family is different, and you may not want to let your baby cry. But if you do want to sleep train, you should not feel shame or discomfort about that decision.” ( Since it might take two or three nights to train the infant, I suggest to apartment dwellers to let the neighbors know what you are doing.)

Working Moms

In our pediatric practice we use “SAH” to describe the non-working mom as “stay-at-home”. Also for the non-working dad, but Oster restricts her discussion to the moms. She notes that there is very little data about the pros and cons of mothers working outside the house except for the evidence supporting longer maternity leave which is beneficial to mother and infant in those first months. Like other working parents I have observed, Oster finds that the switching back and forth from work mode (academic research) to child-care mode and back again can be satisfying (she uses the economic term: “marginal value”) as a change of pace that can reduce boredom and fatigue. The economic value of working outside the home is clear. Her conclusion: “Do whatever fits your family best.”

Oster relates that after she had unloaded a lengthy, multi-faceted, escalating stepwise concern to her pediatrician about what to do if her non-allergenic 2 year old child was stung by a bee on an upcoming vacation trip, she responded, “Hmm. I’d probably just try not to think about it.”

That reminds me of the old story of the 100-leg caterpillar merrily progressing along a road when a fly asked him how he coordinated all those legs. The more the caterpillar thought about it the more entangled his legs became, and he ended up curled up in a ball in the gutter.

Who Are the Real Screen Addicts?
Nielsen research found that Americans aged 35 to 49 used social media 40 minutes MORE each week than those aged 18 to 34. They were more apt to pull out their phones at dinner and spend more time on multiple devices, but they peeked at their phones while driving LESS than millennials. One researcher reported that her interviews of elementary school kids about screen times sometimes indicated that “Parents are the worst.” (2)

Stand or Sit At Work?
The 2015 studies suggesting that sitting for prolonged periods increased your risk of cardiovascular disease spawned a widespread wave of popularity for “standing desks”, but repeat analysis of the data indicated that alternating standing and sitting “may be useful for some people with low back or neck pain . . .but there is no scientific evidence for improved cardiovascular health”. (3)

References:
1.
Solve Your Child’s Sleep Patterns, Richard Ferber, MD, 1986 and revised 2006
2.
Wired, April 2018, pg. 67
3.
This Week, December 7, 2018, pg. 20


Vol. 217 July 15, 2019 NON-POLITICAL TIDBITS TO START CONVERSATIONS AT SUMMER COOKOUTS

July 15, 2019

READING TO CHILDREN: PRINT OR ELECTRONIC?

The prevalence of electronic media has spawned a number of pediatric studies of video gaming, use of smartphones, effects of media on learning, etc. A recent small study of 37 toddlers being read to by a parent using 3 book formats (print, basic electronic, and enhanced electronic – included animation and sound effects) showed some differences in interactions between parent and toddler. Parents showed twice as much dialogue with the child while reading print books than basic electronic. Interestingly the use of the enhanced electronic books came in third. Toddler book-verbalization was slightly higher when being read print books. (1)

These study result is certainly no blockbuster, but the authors opined that reading print books slightly increased “positive interactions between child and parent” and slightly decreased negative directions (“don’t touch that button”). With electronic media parents commented less about the story line and read the text out loud less often. At least one reading specialist I know and discussed this study with plans to continue her own reading on Kindle (even though she easily loses track of the book’s title) and will continue to use electronic media in her reading recovery work with elementary school children.

AN ANTI-CANCER VACCINE THAT IS REALLY EFFECTIVE

HPV (human papilloma virus) is the leading cause of cervical cancer and is sexually transmitted. The HPV vaccine (Gardasil), if administered prior to sexual activity, can prevent the asymptomatic, silent infection by HPV that can lead to cervical cancer or genital warts later on. The vaccine has not been around long enough to show a lowering of actual cervical cancer rates, but a Canadian study showed a 83% decrease of HPV presence among girls aged 13 to 19 since 2006 when the vaccine was introduced. the authors consider this result as “a first sign that vaccination could eventually lead to the elimination of cervical cancer as a public health problem.

LESS THAN 10,000 STEPS A DAY IS OK

A  Harvard study gave fitness trackers to 16.000 women over 62 yrs. old, counted the number of their steps for 7 days, and then monitored their health for 4 years. Those walking 4,400 steps a day had a lower “premature death” rate than those walking 2,700 steps a day. Those walking more than 4,400 steps only had a moderate additionally decrease in death rate and there was no advantage for taking over 7,500 steps. Where did the 10,000 steps a day target come from?— a 1960 marketing campaign by a Japanese pedometer manufacturer that recognized that the Japanese character for 10,000 resembles a man walking! (2)

TASTE?— THERE’S AN APP FOR THAT

IBM is developing a flavor-identifying device (“e-tongue”) which when dunked into a glass of liquid will analyze the composition of the liquid using an array of electrochemical sensors. The data is then sent via the cloud to an artificial intelligence program that compares the composition to a database of known liquids. It is currently able to accurately distinguish between different brands of water, identify counterfeit wines and whiskeys. 

The speculation about the potential medical use for dealing with unsavory biological fluids reminds me of the old, old story about the medical school professor showing the class how to diagnose a diabetic by tasting the sugar in their urine. After demonstrating by dipping his finger into the cup of urine and tasting it, he instructed the class to come up one at a time and do the same, so they would learn how it worked. It was only after the entire class did so that the professor revealed that the demonstration had nothing to do with diagnosing diabetes, but was actually a lesson about careful, accurate observation. “I dipped my forefinger into the urine, but tasted the third one.”

SUVs OR SMART PHONES?

The number of pedestrians deaths was 50% higher in 2018 than the 2009 rate, even though the overall rate of traffic deaths decreased for the second year in a row in 2018. Analysts blamed the proliferation of SUVs with their greater weight, higher bumpers, and diminished visibility, but anyone who has ever driven in a city might alternatively speculate that it is the increased number of “oblivious” pedestrians crossing the street while listening to, talking on, or even texting on their smart phones.

MILLENNIALS ARE NOT THE MOST ADDICTED TO THEIR DEVICES

Research by Nielsen found that americans aged 35 to 49 used social media 40 minutes more each week than millennials. Middle aged americans were more likely to pull their phones out at the dinner table and spent more time than millennials on every type of device—phone,computer, tablet. Millennials do win the prize for the most use while driving. Obligations of work and the ease of maintaining friendships and social connections after the kids have grown up are cited as “reasons” for these findings. But, a researcher interviewing elementary school children uncovered a lot of complaints from the kids about prying their parents away from their screens. “Parents”, she sighed, “are the worst.” (3)

HOW TO SILENCE YOUR SMARTPHONE

Just send $500 to Cohda  for a Komoru ( Japanese for “ to seclude oneself”)  which is a miniature Zen garden bowl of “sand-like” nickel-coated microspheres that block electromagnetic signals from reaching the buried phone. The microspheres won’t scratch the phone nor enter into any ports. (4) It will be ready for distribution just in time for Christmas for “those who have everything else.”

References:
1.  Pediatrics.2019;143 (4)
2. JAMA Internal Medicine 2019 May 29
3. Wired magazine, April 2018
4.  http://www.cohoda.com/projects/komoru/


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. 212 May 1, 2019 MMR Vaccination Updated and DTaP Explained

May 1, 2019

YET ANOTHER STUDY PROVES THAT MEASLES VACCINE DOES NOT CAUSE AUTISM
An eleven year study of 657,000 Danish children showed that those who received the MMR vaccine had no increased incidence of autism. In fact, the girls who received the vaccine had a 5% reduction in their risk for autism. In Denmark all vaccinations are free of charge and voluntary. When 95% of children in a community are vaccinated against measles the 5% of unvaccinated children are protected through “herd-immunity” due to the reduction of exposure to the highly contagious measles virus.

Measles was declared “eradicated” in 2000. Since then we have had unexpected U.S. measles outbreaks in 2014 and presently we are breaking all records for new cases (78 cases just this very week). Since January 1, 2019 the U.S. has had 465 cases in 19 states. Recent U.S. measles outbreaks in Brooklyn, NY, Portland, Oregon, and Rockland County, NY were caused by unvaccinated visitors to an annual Jewish pilgrimage in the Ukraine returning to their unvaccinated orthodox Jewish communities in the U.S.

Surrounded by states with nearly 700 new measles cases Dayton, Ohio is voicing concern about a measles outbreak in their city. Of the 9 counties in Ohio 8 have measles vaccination rates between 90 – 93%. Montgomery County, Dayton is the county seat, has a rate of only 88%. Remembering that herd immunity is achieved at 95%, Ohio, which requires proof of vaccination within 14 days of school attendance, is considering rewriting their current reasons for exemption (about 9% in Montgomery County) of “religious, medical, or reasons of conscience.”

THERE IS NO HERD-IMMUNITY FOR TETANUS
The “T” in the DTaP vaccine stands for tetanus. Tetanus is not a contagious disease like measles. It is caused by wound contamination with a bacteria that causes intense, painful muscle spasms, clenched jaw (“lockjaw”), and extremely unstable vital signs.  The tetanus vaccine is the only protection against tetanus.  It is rare because most children receive the tetanus vaccine. Oregon in 2017 reported its first case of tetanus in thirty years. An unvaccinated 6 year old sustained a cut on his forehead while playing on a farm and developed tetanus. His 2 month hospitalization cost $800,000. The total bill for his care including rehab services and transportation exceeded $1 million. Upon discharge the parents continued to refuse any immunizations for him  including a tetanus vaccine booster to complete their child’s protection!

PERTUSSIS (“WHOOPING COUGH”) OUTBREAKS HAPPEN IN THE SPRING
The “P” in DTaP immunization stands for pertussis and the standard recommendation is to get 4 DTaPs before age 18 months ,starting at 2 months, with a booster at 6 years and as a teenager. Our periodic pertussis outbreaks can not be blamed wholly on anti-vaxxers who refuse immunizations because the pertussis vaccine is not as effective as other vaccines in maintaining protection; the immunity created by the vaccine wanes over time. The little “a” in front of the “P” stands for “acellular”. The acellular vaccine has less of the side effects of injection site pain, temporary fatigue, and a fever than the earlier vaccine that contained cells of the bacteria. But, this newer vaccine (introduced in the late 1990s) produces a smaller increase in and a shorter duration of immunity. “P” vaccinated people can get pertussis, but unvaccinated children and adults are 8 times more likely to get pertussis.

Pertussis immunization is now recommended for all pregnant women since protective antibodies pass through the placenta to the unborn child affording protection to the infant in the first months of life. Pertussis can be diagnosed in some one with a persistent cough by a simple nasal swab done in the office, and it can be treated effectively with antibiotics.

WHAT ABOUT THE “D” IN DTaP?
Diphtheria is a bacterial disease with a terrible sore throat. When severe it can form a membrane in your throat that blocks off your air and sometimes it produces a toxin that attacks the heart, causing death.  In 1921 the U.S. had 206,00 cases of diphtheria with 15,420 deaths.  The diphtheria vaccine is so effective that such cases are extremely rare in the U.S. Herd immunity is important in diphtheria. The CDC estimates that 94% of kindergarten pupils in U.S. are immunized against it. The Soviet Union, India, and Yemen remain areas with large numbers of diphtheria cases.

“Good ole” Montgomery County, Ohio had one of the last reported U.S. diphtheria cases; a teen age girl with a bad sore throat in 2014. That rare event got lots of press coverage which might be why Montgomery County is a particularly skittish about a possible measles outbreak in 2019.

Diphtheria can be treated effectively with antibiotics and anti-toxins. Any contacts of the person with diphtheria can also be treated to prevent spread of the disease. A simple skin test (Schick test) identifies people with no immunity to diphtheria, so efforts to control its spread can be highly targeted.

MY MODEST PROPOSAL MAY NOT BE THAT “FAR OUT”
My previous blog suggesting that one way to change the behavior of anti-vaxxers would be to sue the parents of an unvaccinated child for neglect to recover the cost of the medical treatment, loss of wages of caretakers, loss of school performance, continued rehabilitation of complications, etc. of any person who then got measles from the unvaccinated case. Perhaps that might send an effective message to anti-vaxxers of a personal financial risk where scientific data holds no sway. What if the parents of the Oregon tetanus-afflicted child were sued by tax payers in Oregon to “recover” the medical care costs of nearly a million dollars presumably borne by Oregon’s tax payers?


Vol. 206 January 15, 2019 Updates on 2018 Blogs

January 15, 2019

Causes of Deaths of U.S. Children in 2016
Firearms-related deaths are #2, just behind motor vehicle crashes.  60 % of the three thousand plus firearms-related deaths were homicides. 35% were suicides. Both motor vehicle and firearms-related deaths percentages have increased every year since 2013. The ratio of causes of firearms-related deaths of adults (over 20 yo.) was the opposite: 62% suicide and 37% homicide. Cancer was #3 at 9% of all children deaths both years.

Continued resistance to gun safety reform legislation has been called “another example of U.S. public health intervention being cast as an attack on individual liberty.”

Driver safety being the other example, of course.

Benefits of Aspirin in Elderly or Diabetics
Three studies published in the New England Journal of Medicine this October showed that daily low dose aspirin provided no benefit to the elderly against all types of deaths, cancer-related deaths, dementia, physical disability, or cardiovascular events. They did reveal an increase in non-fatal significant bleeding events. 3% of those taking the aspirin suffered such an event compared to 2% taking the placebo.

A fourth study published in the same issue appeared to show that low dose aspirin reduced the incidence of non-cardiac vascular events in adults (all ages) with diabetes. The percentages of adverse bleeding events (mostly gastrointestinal) was again 1% higher in those taking the aspirin. In contrast to other studies the use of aspirin did not reduce the incidence of gastrointestinal cancer.

Immigrant Children in Detention
The latest independent estimate of children held in 9 U.S. centers is 15,000. The Department of Home Security does not publish statistics, and, in fact, is not too sure itself how many they have. There have been two instances when Home Security could not account for 1400-1500 children. Most of the children are held in large centers with up to a thousand children. The length of stay has been from 104 to 240 days. Currently nearly 300 are children whose parents have already been deported, so that their eventual disposition is up for grabs. 

The recent deaths of two Guatemalan children in detention (one 7 yo. and the other 8 yo.) remain under investigation, but in reading between the lines I suspect that they were caused by flu-like illnesses in dehydrated, malnourished, and tired kids, i.e. eminently preventable deaths.

More About the Southern Border Immigrants
The number of people arrested trying to illegally cross the Mexican border has been decreasing each year since 2005 (President Bush) and is now at the lowest point since 1971. The number of “people in families” arrested monthly during the same period has increased 2.5X from under 10,000 to 25,172 this November. Hence, one reason for the recent development of an “humanitarian crisis”. The number of arrests of “unaccompanied children” has remained the same at about 5,000 per month

The Mexican border is the primary entry point for cocaine, heroin, and methamphetamine which is mostly carried by trucks through official border crossings.

Texas is the only state that has statistics on crimes by immigrants (the federal agencies have none). In 2015 the relative rates of crimes per 100,000 residents in Texas analyzed by the Cato Institute were:

All Crime – (3307 per 100,000 persons) – 
           54 % native born
           27% undocumented immigrants
          18%  legal immigrants

Larceny – (403 per 100,000 persons)
           66% native born
           15% undocumented immigrants
           18% legal immigrant

Sex crime – (64 per 100,000 persons)
            45% native born
            41% undocumented immigrants
            14% legal immigrants

Probiotics for Diarrhea/Effects on Your Microbiome
Two recent very large studies in children showed that twice daily doses of a certain probiotic did NOT shorten the duration of diarrhea or reduce the number of bowel movements per day. This is yet another study showing no real benefit from probiotics, but believers point out that maybe they were using the “wrong” probiotic. 

In other probiotic news: In contrast, another recent study suggests that probiotics can change a person’s own gut microbiome in such a way to make the person’s gut microbiome LESS protective against illnesses.

The Microbiome and Obesity
A study of multi-generational Southeast Asian immigrants showed that soon after arrival in the U.S. the diversity of their gut microbiome began to decrease to the level resembling the less-varied microbiome of European Americans. “Just living in the U.S. reduced their microbiome diversity by 15%.” At the same time their obesity rate spiked!  Previous studies indicated that the more diverse gut microbiome in people in less developed countries protected them from developing metabolic diseases like diabetes.

We Are All Getting Heavier
In the U.S. both the average man and the average woman gained 24 pounds from 1960 to 2002.
By 2016 men had gained an average of 8 pounds more; women 7 pounds.
Both white and black men increased an inch in waist size. White woman increased their waist size by 2 inches; black women reduced theirs by an inch.
The average American man is now 5 feet 9 inches, weighs 198 pounds, and has a 40 inch waist. The average American woman is 5 feet 4 inches, weighs 171 pounds, and has a 39 inch waist. Both have a BMI near or at 30, the “high end of overweight.”
These results are from actual measurements because “ people tend to overreport their height and underreport their weight.”

Editorial note: Our local YMCA “free sign-up day” on January 1 was mobbed. On January 6 the men’s locker room was quite crowded. Overheard from the next cubicle: “Just wait 3 weeks. There’ll be plenty of room again.”
Update in the near future.


Vol. 199 September 15, 2018 Nature vs. Nurture . . . an update

September 15, 2018

Hub thumbnail 2015

“The closer scientists get to understanding the impact of individual genes,
the smaller that impact seems to be.”
– Evan Horowitz, Boston Globe, 9/11/18,C1

The discussion about what influences our upbringing the most, the environment (“nurture”) or our genes (“nature”), has been going on for decades. Sets of twins, particularly comparison of fraternal twins (two genetically different people born at the same time) and identical twins (two genetically identical people born at the same time), have been the subjects of much research trying to tease out the answer to which has the most influence. Why is one twin smarter than the other? Why does one love football and the other the violin? Why do they have the same walk, the same tastes in clothing, and the same gestures, but one has no sense of humor and the other is the class clown?

Despite the revelations in the recent movie, “Three Identical Strangers, many ethical and scientifically-rigorous twin studies have added a great deal of insight into the nature vs. nurture conundrum, and the discussion continues in the absence of consensus. The completion of the human genome project in 2003 was heralded as an historic step in finally settling this question. The hope was that, at last, we would be able to correlate a specific gene, or maybe just two or three genes, with a human characteristic, a human condition, and even a human disease.

In a recent study of the human genome, researchers found 1,271 different genes that seemed to improve educational outcomes. However, the cumulative effect of these educationally significant genes explained only about 11-13% of real world, actual educational attainment. (1) In a separate study by other researchers, the role of inherited genes in height, obesity, and education seemed to have much less influence than previously estimated . . . and a drastically much smaller role than suggested by twin studies. The influence of genes was highest for height (55%) and lowest for years of schooling (17%). The gene effect on cholesterol level was about 31% and the gene effect on determining your body mass index (BMI) was 29%.(2) There is no single “fat gene.”

One group of researchers suggested that perhaps the genes of the parents that are NOT passed to their offspring are important. What if the parents’ genes made them “slightly more attentive to kids and more willing to sacrifice their own happiness for the benefit of the kids”? Perhaps that could result in those children receiving a richer education. They suggested calling this influence of the parents’ genes on the children’s environment “genetic nurture”. (Thanks a lot for mudding the waters some more!)

There is no doubt that the genes we inherit from our parents influence our health and longevity. The adage, “To enjoy a long life, pick your parents right”, was dramatically brought home to me one day in the hospital cafeteria many years ago. A dozen of us physicians were discussing over lunch the pros and cons of a new study that daily baby aspirin could prevent some heart attacks, and different opinions about this brand new data were being voiced. A cardiologist espousing the strong genetic influence on heart disease interrupted our lively discussion with the question, “How many of you can call your father on the phone right now?” Only three could.

So the discussion of nature vs. nurture continues despite our growing knowledge of the human genome, but we have nothing to worry about as long as we have picked our parents right.

References
1. Nature Genetics, July 2018, as reported in Boston Globe, September 11, 2018
2. Ibid


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