Vol. 150 June 1, 2016 Blockers of Sun and Bugs

June 15, 2016

Hub thumbnail 2015It is that time of year again.
The 4th annual review of sunscreens (can’t call them “blockers” anymore per the FDA) and insect repellents was just published by Consumer Reports (July 2016 issue). For those of you who don’t wish to read all that chaff-like verbiage under the new editor here are some bullet points to guide your purchases. (If you wish to wade through all the CR words,  the July issue also has recommendations about beach umbrellas that don’t blow away, replacing 15-year-old furnaces with a central heating and A/C unit, and the coolest coolers of them all.

SUNSCREENS 

  • An SPF (Sun Protection Factor) of 30 blocks 97% of UVB rays (the cause of sunburn)and is the minimum SPF recommended by the American Academy of Dermatology. An SPF of 50 blocks 1% more for more money. SPF 100 blocks 99%.
  • Almost half (48%) of the sun screens tested by CR actually provided LESS SPF then stated on the package. This has been true over the four years of CR analysis, and this year CR is sending their results to the FDA and asking, “How come you guys don’t test this stuff?” Use SPF 30 product as a minimum.
  • Mineral sunscreens (those with titanium or zinc oxide in them) were the poorest UNLESS the sunscreen left a whitish glow on your skin. Nano-particle mineral sunscreens do not leave a whitish glaze (customers prefer that), but they don’t work well. The FDA is “still studying the unknown unintended consequences of nano-particles in skin lotions”. Non-mineral manufacturers are jumping on this uncertainty by promoting “no nano-particles” advertising, just another meaningless advert phrase.
  • “Broad-spectrum” sunscreens penetrate deeper into the skin to also block UVA light which is associated with increased risk for melanoma and accelerated aging of the skin. UVA rays pass through clouds and glass. There is NO SPF number for UVA ray blockers. CR used a “standard from Europe” in judging UVA blocking ability.
  • “Natural sunscreens” (as opposed to “chemical sunscreens”) are labeled as such because they contain natural minerals, aka “chemicals from the earth”, like titanium and/or zinc oxide. All of them came in under SPF of 15 in CR ratings unless they left white streaks on your skin when applied.
  • The only real difference between kids’ and the adults’ sunscreens are the cartoons on the package. Sprays are NOT recommended for kids because of inhalation occurrences. If you want to use a spray, spray it on your hand and rub it on.
  • No sunscreen is waterproof and reapplication is recommended after coming out of the water. “Waterproof” and “sweatproof” are terms prohibited to sunscreen manufacturers by the FDA.
  • Most sunscreens lose effectiveness after three years in their container, and the FDA requires them to date them now.

CR’s TOP PICKS?
No-Ad Sport SPF 50: super protective, non-greasy, fragrance-free, no white streaks, at a great price of 63 cents an ounce.  (“No-AD” means the company does not run ads on TV; it does not refer to “no additives”.)
Coppertone Water Babies SPF 50: $1.31 per ounce

HIGHEST RATING?
#1 – La Roche-Posey Anthelios 60 Melt-in Sunscreen Milk SPF 60: $7.20 per ounce
#2 – Pure Sun Defense SPF 50 Disney “Frozen”: 79 cents per ounce! (go figure!?); other models with different Disney names like “Avengers”, “Spiderman”, etc. should be equally good.

WORST?
CVS Kids Sun Lotion SPF 50:
an actual SPF of 8
Banana Boat Kids Tear-free, Sting-free Lotion SPF 50: is also apparently sunscreen-free with an SPF of 8

BUG REPELLENTS

Choosing a mosquito and tick repellent is easier. Just buy one with either 20% Picaridin or at least 15 % DEET. Both provide protection for 5-8 hours.  Repellent concentration is key. 30% DEET gives a full 8 hours protection. 5% Picaridin (found in some OFF products) gives less than an hour protection.

  • 5 of 6 “Natural ” plant-oil-based repellents tested did NOT work. Burt’s Bee Herbal gives you a scant 1 hour protection.
  • The “natural” 30% oil lemon eucalyptus “Repel” DID work for 7 hours, but should be used only on people over 3 years of age.
  • Picaridin 20% is safe for pregnant women and children over 2 months of age. Canada restricts its use to children over 6 months.
  • “Avon Skin So Soft” works only when it contains 20% Picaridin, but NOT without it.
  • DEET 15-30% is safe for children over 2 months of age.
  • Children under 2 months should be protected with mosquito netting and clothes.
  • Products including Vitamin B1, garlic, wristbands, or ultrasonic devices have no evidence of effectiveness.
  • Like sunscreens, don’t spray your face. Spray on your hands and rub on your face.

OFF, CUTTER, REPEL are familiar brand names, but buy the repellent with the right concentrations since some of these brand products have insufficient concentrations of either Picaridin or DEET to afford adequate protection.

Have fun at the beach … or the Olympics… or wherever!

 

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Vol. 126 June 1, 2015 Suncreen and Bug Repellent Effectiveness

June 1, 2015

hubHere comes the sun
Here comes the sun,
and I say, It’s all right

Little Darling
It’s been a long, cold lonely winter
Little Darling
It feels like years since its been here.

– George Harrison, Beatles Abbey Road album 1969

A sure sign that summer is coming is the Consumer Report annual update on sunscreens and bug repellents (July 2015 issue, just received). Of the 1000 sunscreen products on the market, they tested and rated only the 15 lotions, 13 sprays, and 6 ultrahighs which actually delivered close to the advertised SPF (sun protection factor). Their conclusions include:

  • Advertised and labeled SPF factors are often untrue. ( actual can be 16% to 70% less) So what? If they drop below an SPF of 30 they are not as protective as the dermatologists want them to be. This is one reason they are not labeled “sunblocks” anymore.
  • Look for broad-spectrum sunscreens that reduce BOTH UVA and UVB exposure to the skin
  • “Natural” sunscreens, even those that tout a mineral base, don’t work so well. (CVS Baby Pure & Gentle SPF 60 provided an actual SPF of 18.)
  • You can get good protection for $1.65 an oz. or pay $7.20 an oz. for top rated ultra sunscreens.(SPF 70+)
  • Adult and infant sunscreens are the same except for fragrance and color and are interchangeable in terms of protection.
  • No further word from the FDA on nanoparticles.
  • Don’t forget to slather your ears and the tops of your feet.

Consumer Reports bottom line:
Best for Kids: Coppertone Water Babies SPF 50 $1.31/oz.
Best Buy: Walmart’s Equate Lotion or Spray SPF 50 $0.56/oz. for lotion and $1.33/oz. for spray.
Best “Natural” Sunscreen: California Baby SPF 30 (the only one that reached close to 30 SPF) $6.90/0z.
Not recommended: Yes To Cucumbers Natural SPF 30 provided actual SPF of 14 for $4.00/oz.
Truly Fragrance-Free: Coppertone Ultra Guard SPF 70 (actual SPF of 59) $1.38/oz.

Check out the July 2015 issue of CR for many more details and my previous blogs for pros and cons of sprays and specific recommendations of products.

Sidebar on tanning: In October 2014 a UMassMedSchool study of 125 top universities revealed that 48% had tanning booths for their students on campus despite growing evidence that exposure in tanning booths increased the rate of skin cancer. About 15% also allowed students to use their campus cash cards at off-campus tanning booths. By May of 2015 several colleges have disallowed the use of cash cards for off-campus tanning booths, in part as a result of a focused campaign led by UMMS researchers to reduce student access to tanning booths.

Battle of the Bugs
The same issue of Consumer Reports lists the results of 15 different bug repellents worn by their stalwart volunteers who subjected themselves to hordes of disease-free culex and aedes mosquitoes (the ones that do carry West Nile fever and chikungunya). Before you laugh at “chikungunya” or laugh at just trying to say it, you should know that this viral non-fatal disease has become a significant problem in South and Central America, including the Caribbean Islands. Panama has roadside billboards exhorting citizens to visit a doctor at the “first sign of fever, don’t treat your fever at home”.

Results of this torture of CR volunteers:

  • DEET is effective and NOT dangerous for you or your kids over 2 months of age as long as you use the right concentration. Concentrations of 15% or more work and above 30% work no better. Potential side-effects are much less under 30% concentration. So, use DEET 15-30%.   Off! Deep Woods – 25% or Repel Scented Family – 15% are recommended. Several Cutter products have 7% or less of DEET and are not recommended.
  • Non-DEET repellents containing 20% picaridin (a synthetic compound that mimics a chemical in black pepper plants) OR 30% oil of lemon eucalyptus (another synthetic chemical) provide up to 7 hours of protection. FDA says the oil of lemon eucalyptus should not be used on children under 3 years because it can cause temporary eye injury. Sawyer Fisherman’s Formula Picaridin (20%) and Natrapel 8 Hour (20% picaridian) are recommended.  Off! Family Care is only 5% picaridin and is not recommended.
  • Don’t spray any of the products in your face. All bug repellents cause eye irritation. Apply with your hands, especially with children.
  • “Natural” repellents don’t do the job. All of the plant-oil products failed immediately or within an hour. The “organic” label is meaningless.
  • Wristbands don’t work either. One manufacturer is being taken to court by the Federal Trade Commission for deceptive advertising.
  • For the patio, before they bite? Unfortunately the citronella candle buckets, though pleasing, offered no protection, and neither did a battery-operated diffuser of plant oils. A high-speed pedestal oscillating fan reduced mosquito landings by 45% to 65%, especially for those sitting closest to the fan, but I suspect their warbly-sounding words were an unexpected addition to the BBQ party.
  • What about Skin So Soft? Avon makes no repellent claims, and in this case the manufacturer is right. CR found it offered no protection in 1993, and this time too. Avon is now marketing combined sunscreen and repellent (picaridin) products, but the repellent concentrations are too low for protection. They are not recommended.

Summer is here, along with the sun and uninvited flying guests!

 


Vol.111 October 1, 2014 ; How Does Your Doctor Rate?

October 1, 2014

hubI think this is actually a trick question. I know very few people who have only one doctor. They have several, spanning different specialities.

 “Doctor Rating” sems to be  a thriving business. Consumer Reports Magazine (October 2014) lists six websites that present some sort of doctor ratings that go beyond the basic info provided by the AMA, Medicare, and state Boards of Registration in Medicine and state medical societies.

I examined these websites to see what I could learn how each one rated some primary care doctors that I know in my own vicinity. What I found was not particularly helpful nor illuminating for a variety of reasons.

The websites usually used two sets of criteria for ratings, one for the office (“ease of making appointment, friendly reception, etc.”) and one for the physician (“bedside manner, waiting time, clarity of discussion”,etc.”). Most used a rating of 1-5 stars, but one used “A-F”. Physician groups were rated, but to learn about individual doctors within the groups I had to scroll through individual patient text comments.  All of the websites had errors such as listing physicians who were dead, retired, back in India, or now in New Zealand.

I searched under “internists” and often also got dentists, obstetricians, cardiologists, oncologists, and even “lice doctors”. There seemed to be no rhyme nor reason to the sequence in which doctors were listed, except for the one website that highlighted the “Top 10” (apparently “patient satisfaction” was the sole criteria). Some websites forced me to scroll through all the names alphabetically to find the one name I was looking for. Some allowed me to search by individual name. Despite entering my zip code as a clue I got lists of doctors from many miles away. Some websites listed nurse-practitioners (NP) in the list which is not bad, might even be helpful, but it was not always clear with which physician(s) the NP was affiliated.

In the instances that I was able to find physicians about whom I had my own rating opinion, I did find that the website ratings generally matched my own bias. In the few instances that I could find the same physicians on different websites, the website ratings agreed.

Here are comments on my experience with specific websites:

Angieslist.com    “A to F”    Access to doctors’ rating for a year costs you $20.($16 if you use PayPal)
Gives number of reviews used to decide the rating (usually single digits); Have to click and scroll individual patient comments to identify individual physician rating in a group; three“A” reviews plus one “F” review created a “B” rating (4 reviews).

Healthgrades.com      1-5 Stars   Free Listed
177 internists near me, but listed only alphabetically; the first dozen or so listed would fit my “marginal” category; gives number of reviews used to decide the rating, but no patient comments/reviews presented; also included cardiologists and ophthalmologists.

Vitals.com    “Where doctors are examined.” 1-4 Stars   Free
136 internists near me, but the highest number of dead, moved, or wrong specialty doctors; had search “filters” to help me narrow my list, and the “patients’ choice” was the most helpful; you can choose a video that presents the ratings in a pleasing, non-revealing, fourth-grade-educational-level cartoon.

RateMDs.com     1-5 Stars     Free
Can search by name or “find a doctor by locale”; lists a “top 10” presumably based on patient satisfaction, but my doctor was NOT listed even though he is “the BEST doctor in the world” because no patients had submitted reviews.

Yelp.com   1-5 Stars   Free
The worst mix of wrong specialities and very few physicians listed; I suspect that doctors have to enter their own offices to this website or even pay for a listing, but I am not certain.

CastleConnolly.com   “Lists America’s Top Doctors”  An annual List and Book
Doctors are nominated, reviewed, and screened by a professional staff for this list founded by two men (neither one a physician) on the Board of Trustees of NYU Medical School; list is heavily weighted to academics in the NY metropolitan area.

Whosmydoctor.com    A work in progress; “not yet ready for prime time”
Leana Wen, MD, Rhodes Scholar, Director of patient-centered research at George Washington University, and a recent TEDMED presenter surveyed patients about what they wanted to know about their doctors. Almost everyone wanted to know that their doctors were competent, certified, and free to make evidenced-based medical decisions uninfluenced by whom they were paid. No surprise there. BUT, she also found that patients wanted to know something about the doctor’s values; what the doctors held dear to their heart!

“One after another, our respondents told us that the doctor-patient relationship is a very intimate one, that to show their doctors their bodies and share their deepest secrets, they want to first understand their doctor’s values.”

Dr. Wen set up a website “Who is My Doctor?” in which doctors could voluntarily state their feelings about reproductive medicine, alternative medicine, and end-of-life-decisions. This information, obviously beyond competency and source of compensation information, would be accessible to all patients and potential patients in an effort toward “total transparency”. The website and Dr. Wen apparently ran into a hailstorm of resistance from some physicians who did not believe that “total transparency” was a good thing. The website is currently just collecting signatures of those who support the concept, 387 to date.

Bottom line:
Doctor rating lists are not very helpful if you are blindly doctor-shopping in your area. If you do the usual thing and get some names of “good docs” from your friends and neighbors, then the rating websites could help you check out the opinions of other patients. None of these websites are as illuminating nor as complete as Trip Advisor…yet.


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