POLLS UNDERESTIMATE RACIAL BIAS FACTOR

THE BRADLEY EFFECT, RACIAL BIAS UNDERESTIMATED

With the elections less than 2 weeks away, everyone is talking about the likely fact that polls have not reached Democratic voters that harbor racial prejudice.  A fraction of these people may vote for Sen. McCain or not vote at all.

Are the polls capturing all that bias?

One voter model attempts to factor in hidden racial bias that was published this month suggests it might drag down the numbers for Obama by 6%. 

The hidden factor is commonly called the “Bradley effect’ dating back to 1982 when Tom Bradley, an African American lost the California governors race despite being in the polls on Election Day.  A similar pattern in Virginias governors race by Douglas wilder, an African American had a 15% lead but won by a half percent.

Many African Americans have won mayoral, state, and congressional elections since.  Racial attitudes have certainly changed.  Dan Hopkins, a Harvard political scientist examined every gubernatorial and senate race since 1989 which had either an African American or female candidate, on rationale that a woman could also experience voter prejudice.  Of 133 elections only 18 had an African American.  There was no Bradley effect in any of them since 1996.  He does not expect a Bradley effect.

Kohut, president of Pew Research Center, which performs public opinion polls does not think people polled are dishonest when asked if they will vote for Obama.  But he thinks there are reluctant responders that refuse to be polled.  They have a less favorable attitude toward racial minorities and the polls may miss their intent.

Nine groups published their models this month in PS: Political Science & Politics and only one, Lewis-Beck from the Univ. of Iowa adjusted his model to take race into account.  He fine-tuned his model on voting patterns in the primaries and on how honest people are in saying they will support an African-American presidential candidate.

Beck's prediction:  Obama will get 50.1% of the popular vote but lose the election in the Electoral College.  When he did not take race into account Obama would get 56% of the vote.  It’s a feel good thing: people don’t want to admit race is a factor.  In the past he has been 1.5% off in his predictions.

It’s hard to detect hidden bias, since polling is done on the phone and involves a one on one interaction.  You really will not tell a stranger you have racial prejudice.

A study by Krysan in 1994 asked Detroit residents if they would vote for an African American.  Face to face 11% said no, while in a mail survey 22% said no, privately.

In 2007, sociology students at New York University asked three groups related race questions that were hidden and statistically the groups were all similar.  They found 14% of the people lied.  Democrats were more likely to be dishonest than Republicans, as were those with less education.

Racial bias is clearly visible, and it has shown in preference polls.

The bottom line is Mc Cain still has a shot at the White House.

Sources: Science Oct 10, 2008,Political Science & Politics Oct, 2008

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NEW BREAST CANCER RISK TEST AVAILABLE

NEW BREAST CANCER TEST AVAILABLE

An Icelandic company, decode Genetics has released a breast cancer risk test.  It promises women a chance to take a more aggressive breast screening.

The test cost is steep, $1625, and includes just seven genetic variants out of the 300 scientist expect to soon find.

This test is a no brainier. The science behind the test is solid.  All seven genetic variants, called SNPs, for single nucleotide polymorphisms, are linked to an increased risk of breast cancer, primarily in women of European descent.  Being in the public domain, companies can incorporate them into new products.

The more SNP links, the higher your breast cancer risks.  The risk of this test is meaningful.  But we are basing someone’s risk on the basis of a small subset of variants.  It’s like having a poker hand and you don’t know what the whole hand is. 

About 5% of you who take the test will find you have a 20% risk of breast cancer, compared to the average risk of 12%.

Many epidemiologists feel that any test, even based on the best SNP will probably misclassify a large number of women.  As more variants are found, the risk estimates might actually change.  A high risk now may be one that isn’t so bad or vice versa.  It is estimated that there will be 300 SNPs to make the whole hand.  But why wait till you discovered everything about breast cancer.

How would you react to learn you have a 20% chance of breast cancer ? How would you communicate this explosive information? Some of you  might freak out or even commit suicide if they tested positive. It might also raise your risk of heart disease. It certainly is very sensitive information.

Has the test reached its time?  Do you have $1625 lying around to find out that your chance of breast cancer is higher than the general public?  And how will this change your life in a positive way?

What do you think?  Your comments are always appreciated.

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Source: Science Oct 17, 2008

 

 

 

THE PRESCRIPTION CRUNCH

ARE YOU TAKING ALL YOUR PRESCRIPTIONS?

Patient prescriptions are down 13% this year.   Americans now spend $286 billion dollars a year on prescription drugs.  This is 10% of health care costs that amount to 2.26 trillion dollars.  They take over 12 prescription drugs a year.  There are 3.8 billion prescriptions filled annually since the paid medical prescription plan went into effect.

With loss of jobs and loss of senior savings, people are cutting down on which drugs they will continue to take and which they will not buy.  Pain medicines are a must, but cholesterol drugs that don’t leave an impact that the patient sees are forgotten.  Even the generic drugs are not affordable.  Groceries and housing necessities take precedent and some drugs will have to wait.

The trend, if it continues, could have potentially profound medical implications.  Controllable disease conditions will get out of control and our nation’s health care bill will certainly sky rocket. 

People are screaming for regulation of prices.  They are cutting pills in half and playing doctor by how they feel.  There is probably over prescribing in the United States anyway, but we after all in a drug culture.

 As long as you can get it free, why not fill all your prescriptions.  For every complaint, the doctor prescribes a drug.  Sometimes this leads to a new disease.  A cortisone tablet helps inflammation, but now it causes indigestion, an ulcer, or sugar problem.  All these things need new prescriptions, which leads to new side effects worse than the original problem.

We also need our left over pills from last year in our medicine cabinets in case we get diarrhea, an infection, or a headache.  Lets play doctor!

There is no free lunch.  We must pay for all this someway.  Universal health care may be the answer.  But where will the money come from?  We spend $286 billion on pills now, what will it be when everyone can go to a doctor, anytime, and get a prescription for what ails them at the moment.  TV drug advertising tells us what we need.

  And the doctor visit, the Cat scans and MRIs, and heart monitoring costs certainly will not go down.  We lost 2 trillion dollars in the market recently and we spend 2.6 trillion on health care now.  Lets just print more money.

Perhaps our standard of health care might improve if we went back to 8 prescriptions a year like we did ten years ago.  If the doctor talked to us, we might forgo some of these prescriptions.  But talking takes time and who in medicine has that luxury today?   We all need prescriptions but folks do we all need 12 a year?

Perhaps this recession will contain this growing monster.  Lets evaluate how effective all our drugs really are.  Maybe we can really get by with less than the 12 prescriptions we now take annually  Source NY Times Oct 22, 2008

What do you think?  Your comments are appreciated.

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CONFUSED WITH TOO MANY MEDICATIONS

CONFUSED WITH TOO MANY MEDICATIONS?

 

When I ask patients to bring all their medicines in a bag to my office, it is usually double what they told me.  The sicker the patient, the poorer they can count.  There is mass confusion.  Some duplications, interactions of drugs, inappropriate off label uses of drugs, and inability to know the reason why they take each drug.  Every year grandma and grandpa should spread out all the bottles on the table and look at them.  If there are over 10 bottles, usually something is wrong.

Iron and Calcium tablets can interfere with thyroid absorption.  Two products containing amphetamine may cause liver damage.  Many drugs have expired or are no longer needed, but are saved, just in case.

Your parents should know the name of the drug they are taking and what it is for.  They may have memory problems or difficulty comprehending.  If they understand the reason for the medication, they will take it correctly and also know what to expect from it. 

Many times they stray from their doctor’s medication plan and the doctor is not aware of it. Their blood pressure soars and the doctor thinks the medication is not working, and in reality they are not taking the medication.  So the dose in increased or a second medication is added.  Have their doctor talk to them to insure they comply.  Often they can’t afford the medication or are worried about the side effects.  This intentional noncompliance occurs because the plan is too hard to keep up with.  Switching to a medicine once a day versus three times a day often works, or make the schedule simpler by treating two problems with one medication.  Medication charts on the refrigerator, pillboxes, or taking certain meds with other meds help.  Often getting rid of the childproof capsules can help.

Your parents wait for a half an hour for three prescriptions to be filled and just want to go back home.  Their doctor never told them about the reason for each drug and its instructions.

He may speak quietly and fast and this may be a challenge to your parents who still did not get their hearing aids.  Your kind parents feel intimidated and don’t ask question because the doctor looked busy and seemed to have no time to answer questions.

Side effects your parents have should not be chalked up to old age, and should not be treated with more drugs.  Older people have compromised livers and kidneys and all the drugs affect how the drugs are broken down and excreted.

Your parents  may experience  dry mouth, drowsiness, depression, insomnia, nausea and vomiting, dizziness and may fall.  Sedating antihistamines can be disastrous to them.  They often take over the counter sleeping aids, Tylenol pm, cold and allergy medicines as Benedryl.  Since the medications last longer, they may be confused in the morning and fall.  If your dad has prostate trouble, he may end up with urinary retention.

Parkinsonism drugs, and Neurontin can cause hallucinations.  Antipsychotic medications for depression or dementia can cause them to have more heart and lung problems and also a higher death rate.

The starting dose for elderly may be too high compared to one for you.  Start slow and go slow! Medicines must be monitored for side effects.  The labels and inserts must be read.  Someone should go with them to the doctor so questions are asked and answers are given.  The doctor should know about every OTC drug they are taking.

Make a point to clean out their medicine cabinet every year of expired or old medicines.  Make a medication list for them and give a copy to their primary doctor every time they make a visit.

Your comments are always appreciated.

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SMOKERS, SHOULD YOU GET YOUR CAT SCAN?

SMOKERS, GET YOUR CAT SCAN

The push is on for smokers and non-smokers to get a CAT scan.  The message is that it will catch tumors when they are small, and they can be removed before they spread.

Lung cancer kills over 160,000 of us a year.  If more tumors can be caught early, many lives could be saved.  Every one of you 45 million Americans is a prime candidate for this lung imaging.

Most  people agree on how good a CAT scan has become since 1995 when CAT scans were created.  The detectors now spin and slice through the body in 5 seconds.  An image can be taken in a single breath.  A computer can tune some densities in and out and make a 3D view of tissue and bone.  A scan might have 256 slices and a 0.3 mm square can be well visualized.

What happens after your initial scan?  If you have a nodule 5mm or a cyst 8mm you would probably get a biopsy and then possibly surgery.  At least you will be asked to come back in 3 months for another scan.

The logic is hard to argue with.  If you can find a small cancer at an early stage, why not go for the CT screening.  If you don’t treat it, you will die.

PROBLEMS

All this is based on a screening study on 32,000 people 40 or older, called I-ELCAP.  The study is riddled with flaws.  There never was an outside audit of their data. 

The procedures are very lucrative.  The initial CAT scan may be about $300, but that’s just the down payment with much more to come.  This results in all kinds of medical business.  There will be follow-up scans, biopsies, and other tests.  Since the people in the study were not picked at random, but  were smokers, it is markedly twisted.  The intense screening can flag many non tumors  or slow growing tumors as dangerous,when in reality they are nothing.  Over diagnosis can boost the number of people diagnosed with cancer and appear to recover from it when they don’t even have cancer. 

Another study, by Bach published in JAMA last year, this one  a random study, found no evidence that screening reduced the risk of death from lung cancer in 5 years. 

Biopsies were done 3 times more often than needed and lung surgery 10 times more than needed.

The basic principle of CT screening is wrong, says Bach.  Most of the lung cancer that kill come like a meteor, out of nowhere and is everywhere.  Screening is not going to catch them.

Random studies?  Is it ethical to recruit normal non-smokers with a promise of a high quality diagnosis and then give chest x-rays?

There is a fierce battle between a patient advocacy groups, Lung Cancer Alliance funded by GE the makers of Cat Scanners, and the National Lung Screening Trial by the federal government and the National Cancer Institute. 

The tobacco industry is fighting annual screening and feels it would set a precedent.  The tobacco industry gave $3.6 million to Weil Cornell Medical College in New York city to speak about the uncertainties of CT screening and the potential risks to people who might sign up for the study.

Those researchers doing the current CT study have a financial interest in the CT invention to be used with CT screening and have 27 patents for lung screening.   They receive royalties from General Electric who makes the CAT Scanners and have licensed the patents to GE.

 The National Cancer Institute has spent over $200 million on this Lung Screening Trial, which will be finished in 2010. 

Perhaps the air will clear by then.  In the mean time, could we spend some of this money on curbing smoking?  After all, this is the major cause of lung cancer.

Sources: Bach @ Memorial Sloan Kettering Cancer Center,  Science, May 2, 2008

What do you think?  Your comments are always appreciated.

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AUTISM FEARS ABOUT VACCINES

VACCINES AND AUTISM

In April 2008, the National Vaccine Advisory Committee asked the general public to help set up its safety research agenda for the next 5 years.  Can you imagine asking us to help the advisors?

There is still a lot of fear that vaccines might cause autism.  This has been fuel recently by a lawsuit involving a 19-month girl named Hannah who got 5 vaccines and two days later became lethargic and febrile.  Ten days later she got a rash seen in vaccine induced varicella.    Months later she developed neuralgic signs seen in autism.  Her parents believed the vaccines triggered her problems. She sued the Dept of Health and Human services who made a concession in the Federal claims court.

The government created in 1982 a Vaccine inquiry act, the VICP, to compensate families quickly who got paralysis after the polio vaccines, thrombocytopenia after the measles vaccine, Reye’s syndrome, transverse myelits, mental retardation and epilepsy.  This dropped dramatically the number of lawsuits.

It seems the VICP has recently turned its back on science.  In 2005, they ruled that if someone proposed a plausible biologic mechanism in which a vaccine could cause harm and a logical sequence of cause and effect, they would grant a financial award.

This resulted in many claims that MMR vaccine caused fibromyalgia and epilepsy, hepatitis B vaccine caused Gullian Barre syndrome and demyelinating polyneuropathy, and the Hib vaccine caused transverse myelitis.

In 2006, the VICP granted awards in Hannah’s case, and also for a hepatitis B vaccine causing multiple sclerosis.

SCIENCE AND DRUG COMPANIES  FIGHT BACK

Children, who have deficiencies, as Hannah, with mitochondrial enzyme deficiency, are more susceptible to infections and they should on the contrary get all the vaccines available. 

Multiple vaccines can overcome and weaken the immune system.  Thanks to advances in protein purification and DNA technology, the 14 vaccines given young children only have 150 immunologic components compared to 200 years ago with just the small pox vaccination.

Development of fever and varicella vaccine rash after getting 9 vaccines can put stress on mitochondrial enzyme deficiency, as in Hannah’s case.  They are a miniscule contribution to this ‘antigenic’ challenge.

Kids with mitochondrial enzyme deficiencies might have a lower risk of exacerbation if they did not get the vaccination, but the change would come at a price.  Pneumoccocus, varicella and pertusis are still common in the U.S.

THE GOVERNMENT SPEAKS

Center for Disease Control spokesperson Julie Gerberding, makes no statement indicating that vaccines are a cause of autism.  Since autism is a clinical diagnosis, children are labeled autistic because of a collection of clinical feature as difficulty speaking and communicating.  In Hannah’s case, what was considered autistic was really a part of a global encelopathy caused by a mitochondrial defect.  Other disease also has autistic features as tuberous sclerosis, fragile X syndrome and Down’s syndrome.

CONFLICT OF INTEREST

Dr. Offit who authored the above paper gets royalties for vitamins, and vaccines.  He serves on the advisory Board for Merck and is chief of infectious diseases @ Philadelphia children’s Hospital.  Who better to right an impartial analysis of autism?

COMMENTARY

Why not have the drug companies run a double blind study of kids not getting vaccines and those getting all 14?   In a couple of years we would have all the answers.

Most kids who get measles, whooping cough, and chicken pox recover with no ill effects.  It sounds like everyone who gets these viral infections will die.     HOGWASH.

Source; Science 5.15.08

Your comments always appreciated.

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YOUR FACE SHOWS YOUR INNER FEELINGS

YOUR FACE SHOWS YOUR INNER FEELINGS

 

Patients ask me why their face gets flushed, why they blush, and how can they hide their feelings.  Your face can show your inner feeling and can cause changes in your feelings as you talk, its not the words, it’s the dance of emotions, that trigger a particular emotion in the other person.  

   Any stimulus can become emotional, as the financial crisis, and the upcoming elections.  Feelings are the subjective aspects of emotion.

 

The bottom of the face dominates the expression.  A sad mouth with smiling eyes implies sadness.  A smiling mouth on sad eyes implies happiness.  Why do you clench your jaw when you are happy?  See my blog "Your face tells it all' 12.01.07.

Emotional gestures help restore and regulate the vascular system of the head.  Your face can trigger many emotions. When you blush, there is danger of blood flooding the brain.  The blood is shunted away from the brain and hence the face gets flushed.

Body temperature affects all the biochemical processes.  The brain can’t tolerate variations in the brain temperatures.  The brain cools itself by heat exchange. Facial muscles can change venous blood flow.  This changes the blood temperature in the brain.  The temperature changes affect the neurochemicals of the brain. 

Nose breathing is not just to get air.  The cavernous sinuses can become severely restricted.  Blood that goes through these sinuses is warmed 0.3 degrees centigrade.  Your forehead is like a thermometer.  Its temperature is very diagnostic of your brain’s temperature. 

Thumb sucking is an unlearned action hard to break.  Sucking forces nasal breathing.  This effectively cools the brain.  Kissing also forces breathing through the nose.  Screaming release opiates that act as analgesics.  Weight lifters and tennis players scream to relieve pain.

CONCLUSION

Feelings, both good and bad, are a result of your neurochemical brain activity.  This emotional activity is temperature sensitive.

Brain temperatures control the neurochemical activity of your brain.  The brain makes a lot of heat and requires cooling.  The cavernous sinuses cool the arterial blood to the rain.  All the facial veins and nasal airway brains drain into your cavernous sinuses.  Your face muscles and your breathing patterns control the brain temperature.

Source: Robert Zajosc, Charles Cooley LSA lecture, 1989

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IS IRRADIATED FOOD NUTRITIONAL?

IS YOUR FOOD NUTRITIONALLY IMPAIRED?

Are you buying nutritionally impaired foods? Most of you have heard of irradiation but know little about it.  Let's be honest. Chances are that you have probably already eaten irradiated food in some form during the course of your life, whether you knew it or not.

Over the past 12 years, the FDA has approved irradiation for most of our food.  Most meat, chicken, wheat, vegetables, fruits, sprouting seeds, spices and herbal teas are irradiated. Luncheon meats, salad bar items, and imported fruits and vegetables are now being considered.

Food irradiation is a process in which food products are exposed to a controlled amount of radiant energy to kill harmful bacteria such as E. coli Campylobacter and Salmonella. The process also can control insects and parasites, reduce spoilage, and inhibit ripening and sprouting.

What are the Benefits?

Food is irradiated to make it safer by destroying harmful bacteria, parasites, insects and fungi. Irradiation does not destroy all disease-causing organisms, which is why perishable irradiated foods must still be kept in the refrigerator or freezer. Nor does it cook foods; so irradiated meat is still not safe to eat raw.

Irradiation also reduces food spoilage. Like freezing, canning and drying, irradiation can extend the storage time of perishable food products. For example, irradiated strawberries stay unspoiled in the refrigerator for up to three weeks as compared to three to four days for untreated berries.

If you are worried about health risks, it was easy to avoid purchasing them, because the FDA required food to be properly labeled if it was irradiated.  The FDA has relaxed its rules on labeling of irradiated foods to allow some products zapped with radiation to be called pasteurized.  Foods soon will be labeled irradiated food only when the radiation treatment causes a material change to the product. The FDA defines a material change as an alteration in a food's characteristics caused by irradiation, such as extended shelf-life in bananas or changes in color, texture, or taste that exceed the normal range of variability for the food.  Other examples included changes to the taste, texture, smell or shelf life of a food, which would be flagged in the new labeling.

Irradiation supporters include: The American Council on Science and Health, which supports food irradiation as a science-based technology that has been proven to be safe and effective. ACSH supports informational—not warning—labeling requirements for irradiated food as approved by the FDA.

IRRADIATION CONCERNS

Irradiation damages food molecules and creates free radicals.  These kill some bacteria but also damage enzymes and vitamins in the foods.  These free radicals combine with pesticides and other chemicals forming new chemicals called radiolytic products.  These are toxins like genzene, formaldehyde, and lipid peroxides.  What effect these new chemicals will have on our bodies will take years to find out. 

Irradiated foods lose up to 80% of many vitamins as A, C, E, K, AND B complex.  Irradiation damages the natural digestive enzymes found in raw foods.  This makes the bodywork harder to digest them.  The high-energy electron beam used can result in trace radioactivity in the food irradiated.

Irradiation doesn’t mean clean food.  It doesn’t kill all the bacterial in food, and the ones surviving may be radiation resistant.  Some like botulism, viruses and Mad Cow prions are not killed by current doses of irradiation.

Food producers now can cut corners on sanitation because the food is cleaned up just before shipment.   Since the food lasts longer, it can be shipped further and still appear fresh.  The giant farms are replacing the local small farmers. 

However, irradiation is not a substitute for proper handling procedures during manufacturing and at home. For example, perishable foods must still be kept in the refrigerator or freezer at all times. . Foods labeled “organic” may not be irradiated.  Studies on animals fed irradiated foods showed increased tumors, kidney damage and reproductive failures. 

Raw food that is irradiated looks fresh, but are like cooked foods, with less vitamins and enzymes.  The FDA allows these foods to be labeled fresh.  Irradiated fats tend to become rancid.

Sources FDA consumer reports,

It looks like irradiation is here to stay, as is aspartame.  Neither have had long-term safety studies, but our large food packagers can now grow at the expense of your local farmer. Our bodies can’t handle foreign chemicals and metabolize them.  The kidneys and liver become toxic and overload our bodies.  Our immunity decreases and we have a hard time overcoming disease.  When foods look fresh they are not necessarily fresh and wholesome.  Time will tell the story.  In the meantime, when in doubt,you might choose organic.

What do you think? Your comments are always appreciated.

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ALZEHIMER'S GENETIC TEST AVAILABLE

DO YOU WANT TO KNOW IF YOU WILL GET ALZEHEIMERS ?

A Pennsylvania company is marketing a genetic test to tell whether you are at increased risk for Alzheimer’s.  Fifteen years ago the critical gene APOE was linked to Alzheimer’s.

You give a saliva smear and $399 and learn if you have a risk of Alzheimer’s that is 3-15 times higher than normal.

The science behind the test is solid.  It differs form many other gene tests for common adult diseases. 

How would you react to learn you have the APOE genotype and how will you communicate this explosive information?

There are  mental health consequences of telling people you MAY get a disease that is neither preventable nor treatable and is fatal.  Most researchers feel the benefits of knowing your genotype are trivial and the emotional risks are huge.

This test might help the 2% of people with the worst APOE combination: two copies of the allele that gives one a 15 times increased risk for the disease.

But about 25% of us carry one copy of APOE4 and your risk is roughly three ties higher than normal.  It isn’t helpful and there is nothing you can do about it medically.

Until recently the test has been done by Athena Diagnostics in Worcester, Mass. And the only ones that qualified for the test were those with dementia.  Smart Genetics recently has licensed rights to the test from Athena. 

Some people might freak out or commit suicide if they tested positive. It might also raise the risk of heart disease. It might be very sensitive information.

Has the test reached its time?  Do you have $400 lying around to find out that your chance of Alzheimer’s is higher than the general public?  And how will this change your life in a positive way?

ADDENDUM

Two days ago, Oct 6, Smart Genetics has gone out of business.  The two-year-old company sold HIV Mirror and Alzheimer’s Mirror, DNA tests for HIV progression to AIDS and Alzheimer’s risk respectively.

Ironically, the CEO and cofounder Julian Awad found that his own personal lifetime risk of Alzheimer’s disease to be about 10% compared to the general population rate of 15%.

Looks like you will have to keep your $400 for now till the new company opens.

What do you think?

Source: Science Feb 22, 2008

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BREAST CANCER RISING AROUND THE WORLD

GLOBAL BREAST CANCER

Breast cancer is the worst cancer for women throughout the world.  One million cases are found each year and about 500,000 patients die each year from the disease. One out of eight Americans will get breast cancer.

A few years ago, only rich white women in North America and Western Europe got cancer.  In the next ten years about 70% of all breast cancers will come from developing countries.   As the disease is spreading, the detection and treatment is not.   We in the states spend $8 billion dollars to diagnose and treat this cancer each year.  In the poor countries, there are no mammograms, no film, and no doctors.  You just sit and wait to die.

This bad news is a result of good news.  Women are living long enough to reach the age at which they are susceptible to breast cancer.  Poor nations now have more food; improved sanitation and life expectancies have risen from 50 to 65 years.  Western habits have been catchy as they are exposed to fatty foods, obesity and lack of exercise, all risk factors for breast caner.

 

We have breast cancer awareness runs and marathons and wear pink ribbons.  In the developing countries breast cancer is a secret.  Women don’t want to talk about their breasts and so they ignore pain and illness.  The woman is afraid her mate may leave her.  Some think it is contagious and they are treated as lepers. They fear no one will want to marry their daughters if they know momma has breast cancer.

Race plays a role.  Most of us Americans are of European ancestry and get a cancer that is stimulated by estrogen exposure.  That’s why it is a middle age disease here.  Since the cancers need estrogen to grow, drugs that block hormone receptors on these cancer cells starve the disease.

Asian and black women even in the U.S. have a greater risk of getting a more aggressive kind of cancer that has no estrogen receptors.  These cancers strike 10 years earlier and don’t respond to drugs that block estrogen because the cancer is not fed by estrogen.  Asian women have denser breasts and have up to five times the risk for breast cancers, and they don’t show up easily on mammography.

As Asians abandon the low fat diets of tofu, vegetables, beans, fish and soymilk, and start eating in a Western way with candy, desserts, bread, milk and red meat they increase their chances of cancer by 60%.

Fewer children also increase their risks.  Pregnancy changes the breast tissue by building antibodies that prevent cells from becoming cancerous.  It seems an estrogen holiday once in a while may lower the risk.  No longer is there work on the farms and factories where one gets an all day workout.  There is less moving done with the shift to offices from the fields.  The leaner body mass an active woman has, the healthier diet is likely following.

Money and costs of mammograms is a problem.  In the U.S. only 40% get mastectomies because of lumpectomies and early detection.  Early detection results in hope and cure.  In developing countries, it’s a lot cheaper to do a one-time mastectomy and solve he problem.  Be glad you live in America, where health care saves lives, wear your pink ribbons proudly, and participate in the runs and breast awareness walks. 

Source; Time, Oct 15, 2007

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DO I NEED BRACES FOR A BEAUTIFUL SMILE?

SHOULD I GET BRACES?

We use to put braces on only after all the permanent teeth came in.  Now we use all kinds of dental appliances early in life to simplify later treatment.  Adults wanting straighter teeth, account for 20% of orthodontic patients.  Over 4.5 million Americans are wearing braces to get a beautiful smile and have healthy teeth.  The FDA regulates these appliances for safety and effectiveness.

Braces can move teeth that are overcrowding.  It is harder to brush and floss crowded and crooked teeth.  Improper cleaning leads to tooth decay and other dental problems

Braces also correct a severe bite problem that hampers eating cause gum disease and tooth and bone loss.  If the upper and lower jaw don’t close properly, the teeth will wear down, and cause jaw pain and make chewing difficult.

Most of us do not have naturally straight teeth.  About 75% of us could use some orthodontic care.  We inherit crowded teeth, too much space between teeth and bite problems of unmatching upper and lower jaws.  But we can develop crooked teeth by thumb sucking and tongue thrusting during swallowing. 

Braces put pressure against the teeth and gradually move them.  A metal wire called an arch wire running outside the teeth puts most of the pressure on the teeth.  Rubber bands from surgical latex add additional pressure that the arch wire alone cannot do.

In the past, this arch wire connected to big metal bands individually wrapped and cemented around each tooth.  There was a lot of pushing and shoving that hurt when the braces were adjusted.  Today the arch wire is attached to tiny ceramic brackets bonded to the front of the teeth with a glue agent.  There may be metal bands used on the back of teeth, but they are now light and smaller.

Adjustments use to be every three weeks and know it’s every eight weeks. 
The arch wires are now made of nickel-titanium mixture that was used by NASA to activate solar panels in outer space.  At room temperatures they are very flexible, which makes it easy to attach to the teeth.  As they warm in the mouth, they create constant pressure on the teeth.

One can today get clear or tooth colored brackets that are barely noticed.  Gold braces can also be chosen.  The colors are on the elastic ties attaching the brackets to the arch wire.  They can also be invisible when fitted on the inside of the teeth. They are called lingual braces, but have some drawbacks.  They can irritate the tongue and affect speech, and must be worn longer than other braces.

The teeth can’t be moved fast, or they will loosen and tooth loss may occur.  Braces are worn on the average of two years.  When they are removed a retainer must be worn until the bone grows around the teeth and stabilizes them.  As we age, teeth tend to shift, so a retainer may be a lifetime requirement.

Retainers are plastic with some metal wire. They can be permanent or removable.  They also come in different colors and designs.  The roof of the mouth may be pink or personalized.

 New devices or material, bonding agents, and color dyes are reviewed by the FDA before being placed on the market.  Devices used before 1976 are grandfathered and exempt from review.  Braces have some risks.  Teeth can be broken when the brackets are removed due to allergic reactions from the bracket materials. 

 

Braces require more frequent brushing, flossing and general care.  You can’t eat sticky, gooey, or hard foods.  No jawbreakers, peanuts, ice cubes, caramel or taffy either.  They can break the brackets, bend the wires, or get caught in the braces causing cavities. 

It’s a lifetime commitment for a pretty smile.  Is it worth it?  You bet!

Sources ww.braces.org, American Assoc. or Orthodontists

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KEEP THE BLOOD FLOWING AS YOU TRAVEL

HOLIDAY TRAVEL AND BLOOD CLOTS

Despite the recession, many of you will be traveling over the upcoming season. Time to take some precautions my friends.  They call this the economy class syndrome, because of the cramped legroom in economy class.

No matter if you go by air or car, sitting still for a long time makes it riskier for you to get a deep vein blood clot, DVT (deep vein thrombosis).  It is usually in the calf and sometimes the thigh.

WHAT SYMPTOMS WILL YOU NOTICE WITH DVT?

 

Sometimes these clots are silent, but most result in a swollen painful calf.  If this clot breaks off and shoots to the lung, you may have chest pain.  A pulmonary embolism occurs and it can give you the same pain as in a heart attack.  You might be short of breath and even cough up blood.  Yell and get to any emergency room pronto.

PREVENTIVE THINGS TO DO

  If you have a connecting flight with long hours of waiting between flights you must keep moving your legs to keep the blood flowing.  Walk when possible to let the muscles of the legs squeeze the veins and move blood to the heart. On any long flight periodically move and stretch your legs.

You might go to any medical supply store and get some compression stockings if you have a long flight.  At least don’t wear sock with tight elastic bands at the top.  And please don’t sit with your legs crossed for long periods of time, as this constricts the veins.

Coffee before a flight and alcohol on the flight can contribute to dehydration.  Better to drink plenty of fluids.  Dehydration narrows the blood vessels and thickens the blood.  When driving, stop every couple of hours and walk a bit at a rest area.  Even if you are the driver, pushing on the gas pedal isn’t enough activity.

DVT FACTS

 Clots in the legs that travel to the lungs cause ninety percent of pulmonary embolism.  Ten percent of the time you die.  We see more than 600,000 cases a year, so it is not rare.  People die within an hour after symptoms START.

Your chances of getting one doubles for every 10 years after 60.  Chances also increase if you have varicose veins, are pregnant, overweight, are taking hormones or birth control pills, or have had cancer treatment.

Blood thinners, called anticoagulants, are the treatment, but they will not dissolve the clots already formed.  They will keep them from growing and prevent new ones from forming.

Reduce your risk of getting DVT or a blood clot to your lungs by taking these simple precautions.  Above all, keep moving.

Your comments are always appreciated.

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NEURONTIN COVERUUP

NEUROTIN COVERUP

Neurontin off label use seems worthless.  Many of you are taking Neurontin, made by Pfizer, or its generic Gabapentin, for all kinds of pain relief, including diabetic neuropathy, postoperative pain, and chronic pain. 

A lawsuit has just been filled in Boston, accusing Pfizer failed to release and altered conclusions on the use of this drug.  Health insurers and patients want their money back for being used as human experimental subjects.

HISTORY

The drug, made by Warner Lambert, later acquired by Pfizer, was FDA approved around 1998 as a treatment for epilepsy.  Pfizer bought Warner Lambert in 2000.  In 2002 the FDA approved the  drug for shingles.  Two years later, Pfizer pleaded guilty for promoting the drug for all chronic pain and bipolar disorders.  Pfizer paid back to Medicaid $430 million to settle the case.

You would think that would end it.  But Pfizer made over $12 Billion on the sales of the drug after this settlement.  The patent expired in 2004 but doctors are still hotly prescribing  this drug for off label use, chronic pain and bipolar problems.

 

COVERUP OF STUDIES

 

 

EUROPEAN STUDY ON DIABETIC PAIN

1998 European study failed to find a significant effect on diabetic pain. Warner Lambert team leader Rowborthan wrote an email in 2000 saying, “It will be more important how WE write up the study”.

 Scientific manager Roder wrote, “We should take care not to publish anything that damages Neurontin’s marketing success.”  Senior marketing manager Crespo wrote an email in 2002 about the studies results: “We are not interested at all in having this paper published because it is negative.” 

Two medical journals rejected to publish the studies, because the company was putting too rosy a spin on the results.

 

SCANDINAVIA STUDY ON POSTOP NERVE PAIN

The study on postoperative nerve pain found that Neurontin didn’t work measurably better than a sugar pill.  It never got published.

SPAIN STUDY ON BIPOLAR DISORDERS

The findings of this summary “did not show statistically any differences between Gabapentin (the generic Neurontin) and Placebo.  This five-year study also never hit the medical journals.

A Spanish psychiatrist Dr. Vieta, a paid consultant to Pfizer, came to Pfizer's rescue. He published a report on the study claiming a statistically significant benefit.  He modified the scale to assess the symptoms of bipolar disorders.  This increased the score for Neurotin in the study.  The change he made in the assessment never was mentioned.  He also included results on patients the doctors intended to treat, and excluded 16 patients from the study review because they did not take the entire pill given them.  These two changes in the report turned a negative study into a success story.

Vieta defended himself by saying he “ took a broader interpretation of the intention to treat concept."

OFF LABER DRUGS

If you are given a drug for a problem you have and it is listed as a drug for other illnesses other than your problem, it is called off label use.

 Off label uses for drugs are not supported by good evidence.  They account for 21 percent of all prescriptions written.  73% percent of them showed to have no scientific support.

ON THE PLUS SIDE,  your doctor is  free to prescribe drugs for any illnesses, it provides him important advantages.  Your doctor can be different and innovative especially when routine treatments do not work for you.  You are provided early access to drugs that might be valuable. It also allows your doctor   to apply new ideas on emerging evidence, and it may be the only treatment possible for unusual conditions.

But here are also negative consequences to off label drug use.    Newer drugs used for off label illnesses certainly increase health costs. It also downgrades your expectations of safety and effectiveness of the drug.  In Neurontin’s case, doctors are encouraged to use the drug even where it does not work.

Insurance is paying for products that are not proven.  Doctors want the freedom to try drugs on patients that were not made for their illness. It is hard enough to stay on top of rapidly evolving evidence. You, the public wants safe and proven drugs that are also affordable. Yet you also want the newest therapies as long as supporting evidence is disclosed.

NEURONTIN SIDE EFFECTS

Many patients exhibit side effects that they feel are due to their illness.  They range from brain symptoms of dizziness, wobbliness and in coordination, amnesia, hostility, and thought disorders including hallucination. Other symptoms are back pain, dry mouth, and itching and stomach pains.  The drug should not be taken if patient is taking alcohol or is on antidepressants.   I find many of my patients have several of these side effects while on the medication.  Is this enough to make you wonder and become cautious?

But withholding negative medical information from you and your doctors breaks this ethical obligation.  You were not taking Neurontin to be experimented on. 

Source WSJ 10.08.08

What do you think?

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FINDING YOUR SOUL MATE

FINDING YOUR SOUL MATE

SEXUAL INTEREST COMES AND GOES

People who are sexually frustrated fell unworthy, rejected, inadequate, and have low self-esteem and become sexually frustrated.

When you can’t bear the pain  that you are undesirable, you blow up that you lack sex.  As a defense mechanism you blame your partner for being frigid and inadequate.  This increases your frustration and you fear failing.  This makes you withdraw from wanting or having sex.

EXTRAMARITAL AFFAIRS

They are generally unsatisfactory despite it being very common in our society.  Your gratification is limited as you attempt to restore confidence in your own attractiveness or sexual capacity.  Hence you look for Viagra and Cialis for help.  Guilt often accompanies these affairs and makes the affair less pleasureable. 

TEMPORARY FRUSTRATION

Sure there are times when you become frustrated when sex falls short of your sexual expectation when you or your partner climax at different times or one of you may not be ready for sex.  When sex is not followed by sexual release, chronic frustration results.  You may be anxious and uncomfortable about your sexuality.  As a male you may be frustrated if your partner only sees sex as bad, dirty, painful, or fulfilling a need to procreate.  You may be frustrated so you can  show control over your partner.  If you feel a sense of unworthiness, you sure cant get gratification with someone you truly love.

Frustration can still exist despite orgasm.  It often results in seeking t sex with other partners.  Often one will seek a  nurturing partner when depressed, to fill the painful void.  Some men purposely fail to reach orgasm in an attempt to deny power to his mate.  Another reason for Viagra or Cialis.

A woman may say:  “I will not allow you to bring me to orgasm because your penis is too short.  The man responds ‘you are not stimulating enough to inspire an erection or ejaculation in me”.

TROUBLE FINDING YOUR SOUL MATE

You may wonder why they have trouble finding your soul mate, but indirectly you may be  broadcasting indirectly non-verbal cues that you are bored or disinterested.  Here are things to look for.

Vagueness is a great advantage when courting.  The rules still prohibit direct invitations.  A woman may try desperately to communicate by smiling, standing closer than usual to you and accidently brushing her hand against your body.

Courtship also involves vague body language, like glances, smiles, or choosing to sit next to you.  A girl knows  what you many mean but she has a choice to reject you if she is not interested in you.

The first physical contact changes the relationship from being social to being sexual.  Often a noncommittal way of touching, by helping you up the stairs or by dancing, which allows each of  you to touch and keep touching.  Sitting next to you side by side and turning inward to you allows your date to close out other people.  If she likes you, she may sit in an open position with arms and legs uncrossed.

Women go to great trouble to flatter their figures and best display their bodies.  Since society still insists we cover our genitals, they get around this by wearing tight sweaters and pants to clearly outline their breasts and genitals.  If a woman likes you, she may smooth her hair, or straighten her sweater or pants, and even blush.

Look at the face!  True feeling come out in a nonverbal way and are betrayed by gestures rather than facial expression.  A gaze that is held may signal sexual interest, by gazing down your body. Attention is paid to its target.

Pay attention to all this and you will not bypass your potential soul mate.  Good luck.

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MEDICAL WHISTLE BLOWERS WANTED

WOULD YOU BE A MEDICAL WHISTLEBLOWER

 

The government has a new weapon to get some of the $345 billion lost in taxes because of fraud and underpayment.  Be a whistle blower and get up to 30% of the amount the IRS recovers because of your being an informant.

The law in the past was a payment of a discretionary reward and the whistle blower had no process to appeal their rewards.  Now the rewards range from 15% to 30% of the dollars recovered and the amount received can be appealed to the U.S. Tax court.

It seems that about 5% of Medicaid providers (30,000) received over one billion dollars in 2006 ,and had accumulated substantial assets including million dollar house and fancy vehicle without paying their federal taxes.

Federal law will not allow taxpayer data to Medicare and Medicaid nor to their states.  They have no mechanism to prevent the providers from getting Medicaid payments.  So they are asking doctors and their employees  to detect the tax frauds that are occurring.

A form requires the whistle blower to give his personal information and the fact related to the violation, how he learned about the fraud, and the amount the taxpayer might owe.  The IRS initiates information if they think the case is worth their pursuing, since they would be the prosecutors.  They only investigate claims that will bring them substantial monetary return.

This seems like a valuable tool to stop tax fraud and waste by providers of Medicare, Medicaid, and other health care providers.

You would be wise to get an attorney to help you compile the information needed to submit to the IRS Whisteblower’s Office.  The valuable information you give, might give you a sizeable part of the recovery money.

Source:  IRC 7623 code

Would you blow a whistle for money?  Your comments are always appreciated.

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IMMIGRANTS MUST GET HERPES VACCINATIONS

MUST  IMMIGRANT CHILDREN GET  A HERPES VACCINATION?

Immigrant children are required to have a herpes vaccination in addition to all the other vaccinations required for our children.  Green card applicants must ante up $120 for the first of three shots to prevent HPV, which one can only get by sexual contact.  It does not endanger kid in a school setting or put our population at risk. 

The vaccine Gardasil was added to the CDC list of mandated vaccines and is a statutory requirement.  It is very controversial since older girls may already have been exposed to HPV in their lifetime.  A side effect can be seizures.

There are 13 vaccinations that must be given, all to fight infectious diseases transmitted by the respiratory route.   All are considered highly contagious.  This Gardasil vaccination is now #14 and it is the sole exception.  It costs $360 for the three-dose regimen.  Immigrants females ages 11 to 26 must get one dose.

Not withstanding, the  $500 application fee and fees for the other 13 vaccinations, it seems having to get the first vaccination at $120 might be pricey.  The other two doses required for immunization would probably never be given.

We sure don’t want people coming into the country without vaccination against measles and chickenpox, but this one is sure not on our high priority.

What do you think? 

Visit my blog of  12.01.2007 Herpes Vaccination for your young daughter.

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ONCOLOGIST SHORTAGE

ONCOLOGISTS WANTED, SHORTAGE LOOMS

Just when the outlook for cancer patients improving with new early diagnoses, new treatments, and improved survival rates, we find our doctors don’t want to go into the oncology specialty.

By 2020, there will be a 4000 shortage in cancer doctors.  It will be gradual as our cancer doctors are aging with over half of the oncologists now over 50 years old.

With our aging population, it is estimated the number of cancers will double in people over 65.  Many doctors are ready to retire, and those left will be female.  Its great to have a balance in the sexes, but women oncologists see fewer patients than their male counterparts.  It may be they work fewer hours because of family obligations or they spend more time with their patients. 

Nevertheless, one wonders if cancer patients really need to be continually cared for by cancer specialist.  We might be able to train nurse practitioners to cover some of the aspects of cancer care when patients go into remission or the cancer is eliminated.  Another solution might be to have an entire team providing care for patients at different stages of their disease.

All the possible available solutions, might diminish the quality of care that our patients with cancer deserve.

Source: American Society of Clinical Oncology, Sept 2008 report

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BACTERIA NEEDED FOR GOOD HEALTH

WE NEED BACTERIA TO STAY WELL

As we take antibiotics to get rid of diseases as ulcers, an odd trend is happening.  As we eliminated the harm bacteria do, we lower the protections they provide us.  We have been taught to think of all bacteria as harmful germs.  We use in the U.S. antibacterial products to the tune of $1 billion annually.

After discovering that the Helicobacter bacterial causes ulcers, ulcers and stomach cancers have dramatically declined.  However we see asthma tripled and higher rates of hay fever and allergies as eczema.

We have ten times more bacteria in our bodies than cells.  There are alone over 500 different bacteria in our bowels and another 500 species in our mouths.  There are 113 different sets of colonies on the forearm and other bacteria in the bend of the elbow.  There are over 10,000 bacteria per square centimeter on the surface of the skin and 1-minion bacteria per square centimeter just under the skin.  Some can cause damage, but most are good.

Half of all humans carried the H.Pylori stomach bacterial until recently.  Now only 5% of people have it, because of widespread antibiotic use.  Those who have the H. Pylori bacteria are two thirds less likely to have asthma, hay fever and rashes.

It seems by changing who lives in our guts, we may prevent Type 1 diabetes.  Yale researchers recently found that doses of the right stomach bacteria can stop Type 1 diabetes in lab mice.

We living human beings co-evolved with these microorganisms.  Every mammal has its own unique variety of bacteria.  Bacteria live with us and are a part of us.  Bacteria are crucial to our well being.  Perhaps even protecting us from cancer?

Sources: Journal of Infectious Disease, NYU Dr. Blaser, National Human Genome Research Institute, NY times 10.3.2008,  NIH,

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DR. NEEDLES MEDICAL MINIBLOGS OCT.2008

 DR. NEEDLES MEDICAL MINIBLOGS OCT 2008

BOTTLED WATER

Sen. Frank Lautenberg, D-N.J., introduced to Congress Wednesday the Bottled Water Right-to-Know Act, which would require labels with information about the source and treatment of the water, as well as their environmental impact.   40% of bottle water comes from tap sources.  Most tap water ha has fluoride, some lead, arsenic, drugs from antibiotics to sex hormes.

You spend hundreds of dollars a year on bottled water and only 51 cents a year on tap water.  Only 12% of the 30 million plastic bottles of water are recycled and it takes 1.5 million barrels of oil to make and transport the bottles.  The EPA tests tap water and the FDA regulates bottled water.

Would you back the bill?

PARENTAL RELATIONSHIP HURT KIDS

Kids whose parents argue a lot are more likely to have problems both in school and psychologically.  40%-50% of parents expressed dissatisfaction with their relationships. Kids who worried about their parents’ relationship had more attention problems a year after their concerns were raised, increasing the likelihood of school problems, found the study,

source Univ. of Rochester, Univ. of Notre Dame and Syracuse Univ.

TRAVELERS BE CAUTIOUS

Do you travel long distances on airplanes regularly or work at a job that requires you to sit still for hours at a time? You could be at risk for deep vein thrombosis,  caused when a blood clot forms in the deep veins of the body, most often in the lower leg or thigh. If the clot travels to the lungs and blocks blood flow, the condition is called pulmonary embolism, which is potentially fatal.

Travelers with risk factors for developing clots -- those over age 60, those with recent surgery or injury or varicose veins, and women who are pregnant or recently gave birth, among others -- should wear compression knee socks to prevent swelling in feet and lower legs.

Source USA today, Laura Bly Sept 2008

THE FAMILY THAT EATS TOGETHER STAYS TOGETHER

 

Mealtime -- from prep to cleanup as well as the actual eating part -- may help couples bond just as the family dinner has been shown to benefit kids. Major complaints of parents was balancing their work and time together.  The tasks that surround mealtime, including preparing the food and cleaning up after the meal, can strengthen the relationship because of the additional shared time.

Couples who start out their marriages with such mealtime rituals are more likely to eat together when they do have children.  Family dinners foster connectedness among members; teens are less likely to engage in risky behaviors; and children who eat with parents eat more healthy foods than kids who don’t have dinner with parents.

Source: Schramm, Columbie Mo.

ASPIRIN

Aspirin is one of the 'cornerstone' drugs in our current management of cardiovascular disorders. However, despite the prescription of aspirin recurrent vascular events still occur in 10-20% of patients.  Switching to other antiplatelet drugs (e.g. clopidogrel) or even combination antiplatelet drug therapy might not help much more.

Given the multifactorial nature of atherothrombotic disease, it is not surprising that only about 25% of all cardiovascular complications can usually be prevented by any single medication.

Source Journal of Translational Medicine 2008, 6:47

AMERICANS GETTING SHORTER

 

As more and more Americans turn to a fast-food diet, its effects may be creeping up the social ladder, so that even the wealthy are growing wider rather than taller.  Height, they’ve concluded, is a kind of biological shorthand: a composite code for all the factors that make up a society’s well-being. Height variations within a population are largely genetic, but height variations between populations are mostly environmental, anthropometric history suggests. If Joe is taller than Jack, it’s probably because his parents are taller. But if the average Norwegian is taller than the average Nigerian it’s because Norwegians live healthier lives. That’s why the United Nations now uses height to monitor nutrition in developing countries. In our height lies the tale of our birth and upbringing, of our social class, daily diet, and health care coverage.

 

 The height gap between Americans and Europeans is a relatively new development.  The average American soldier during World War I was still two inches taller than the average German.

The Germans and other Europeans grew an extra two centimeters a decade, or a little under an inch, and some Asian populations several times more.  Yet Americans haven’t grown taller in 50 years.

 

But sometime around 1955, the data began to shift. In our height lies our history. the average South Korean is three inches taller than the average North Korean.  There appears to be a growing gap in height between North and South Koreans, likely due to poor nutrition.

Americans have a similar height gap to worry about, and it also appears to be due to a lower standard of living, poor health care and inadequate nutrition.  Americans are, quite literally, falling short of Europeans.  In 1880, Americans were the tallest people in the world.   By 2000, American men, at an average height of 5-feet-10.5-inches, ranked 9th, and women, at about 5-feet-5-inches, fell to 15th. Several Northern European countries rank the highest in height, with the Dutch coming in first, at just over 6 feet for the men and 5-feet-7-inches for the women.

The real answer may be that Northern European countries do a better job of spreading the wealth and taking care of their children   The U.S. health care and diet are not as good as in Western Europe. Western Europeans live longer.”

  Source: Krugman’s “America Comes Up Short.” NYTIMES  9.29.08

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