Healthsifter by mary desmond pinkowish, since 2003

Gratitude

A perfect day to welcome the new year, a healthy one I hope:

• Sleep a little late
• Tree-bark cereal (or similar) for breakfast
• Trip to the gym
• Light lunch
• Watch a great movie (Pan's Labyrinth) with C.
• Deposit a paycheck for work well-done
• Manicure plus shoulder/neck massage (oh yeah)
• C. happy with friends
• Talk to M.
• Great dinner with P (lots of fish)
• Fresh snow tonight
• etc...

Happy, healthy, safe New Year to all...

Anxious? Depressed? Try Some Acetaminophen (Tylenol)

The areas of your brain that manage physical and social pain overlap. So is it any surprise that a common pain killer might alleviate social/psychological as well as social distress? Here's an excerpt from an article at PyschCentral:

In the first experiment, 62 healthy volunteers took 1,000 milligrams daily of either acetaminophen or a placebo. Each evening, participants reported how much they experienced social pain using a version of the “Hurt Feelings Scale” – a measurement tool widely accepted by psychologists as a valid measure of social pain.

Hurt feelings and social pain decreased over time in those taking acetaminophen, while no change was observed in subjects taking the placebo. Levels of positive emotions remained stable, with no significant changes observed in either group. These results indicate that acetaminophen use may decrease self-reported social pain over time, by impacting emotions linked to hurt feelings.

Continuing...

Muscle Activating Shoes (MBT, ShapeUps, FitFlop, EasyTone) : Really?

Tara Parker-Pope offers some skepticism in today's New York Times about fitness shoes that promise to "make your boobs jealous," as one ad campaign promises. An excerpt:

The shoes are designed only for walking, and because of the instability design, wearers are discouraged from running, jumping and engaging in other athletic activities while wearing them. So the real effect may come from simple awareness that they are wearing a muscle-activating shoe, causing them to walk more briskly and with purpose.

“I think buying them with this in mind is likely to increase mindfulness, which is good for health,” said Ellen J. Langer, a Harvard psychologist who has studied the connections between mindfulness, exercise and health. “It will probably result in even more walking, with the implicit and explicit virtues endemic to exercise.”

Having Surgery? Ask About Your Blood Clot Risk

ScienceDaily reports on a study in the British Medical Journal suggesting that the risk of post-surgical blood clots (venous thromboembolism, VT for short) is even higher than previously thought. Here's an excerpt from the ScienceDaily story:

"In real terms, this means that 1 in 140 middle aged women in the UK will be admitted to hospital with venous thromboembolism during the 12 weeks after any inpatient surgery, 1 in 45 after hip or knee replacement surgery, and 1 in 85 after surgery for cancer. This compares with 1 in 815 after day case procedure and only 1 in 6,200 women during a 12 week period without surgery."

The study was conducted in almost 1 million British women as part of the aptly named Million Women Study. If you're having surgery soon, ask your surgeon about your risk of VT in the aftermath of surgery and whether he or she plans to take preventive measures. This is a dumb thing to die of.

Teen Girls: Lots of Sexually Transmitted Infections

The current issue of the journal Pediatrics has the results of a survey of a representative sample of more than 800 girls aged 14 to 19 years who were interviewed, had physical exams, and were tested for five sexually transmitted infections (STIs): Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and any of the high-risk types of human papillomavirus (HPV).  The findings as presented in the article's summary:

"Prevalence of any of the 5 STIs was 24.1% among all and 37.7% among sexually experienced female adolescents. HPV (23 high-risk types or type 6 or 11) was the most common STI among all female adolescents (prevalence: 18.3%), followed by C trachomatis infection (prevalence: 3.9%). Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner."

So about one-quarter of adolescent girls have at least one STI, and the risk is significant even if the girl has had just one sex partner. She may have had just one partner, but he's infected, she soon will be. The word should get out. This research was conducted at the CDC.

Flu: Who Dies and Why

Why do some people remain healthy in the midst of epidemics? That mystery has been with us forever, and Jerome Groopman and Pamela Hartzband write about it in today's New York Times. Take H1N1 flu, for example. Think you're in a good place because you don't have an underlying condition, or UC? You're definitely in a better place without asthma or diabetes, but 25% of people who've been hospitalized with H1N1 and one third of the children who've died of the infection did not have a UC, according to Groopman and Hartzband. Other people have almost certainly been exposed to the virus and haven't even gotten sick, let alone been hospitalized or died. These patterns have been observed in other flu epidemics and during the great plagues throughout history, when one's continued good health while the neighbors were dying of smallpox was considered a sign of divine intervention. I'm all in favor of divine intervention, but what gives? As this article explain, studies of HIV infectivity may hold some clues. Interesting stuff. 

Eggs Be Gone: A New Way to Make Flu Vaccines, Finally

As reported by NPR, researchers are working hard to develop a faster way to make more flu vaccine that don't involve the old, slow way that requires eggs. The Wall Street Journal reports today that Novartis is ramping up to start producing these vaccines in cell cultures that will also be faster and make eggs unnecessary. In addition, Protein Sciences, Inc., of Meriden, CT, just landed a $35 million contract with the feds to start work on a system that "inserts genetic material from a flu virus into another virus that infects insect cells. The infected insect cells produce proteins that are then used to create a vaccine for humans," according to the Journal, which quotes Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, as saying that this vaccine is a year or two away from market.

Egg-produced vaccines are a problem for people who are allergic to eggs--if you can't eat them, you probably shouldn't get a shot made with them. According to the American Academy of Allergy and Immunology, about 1.6% of kids--and a smaller percentage of adults--have egg allergies. A bigger problem for everyone is the length of time it takes to produce flu vaccines. It sounds like help may be on the way.

What Pediatricians and Other Docs Really Think About the H1N1 Swine Flu vaccine...

Perri Klass, MD, writes about it in today's New York Times, and it's worth a good hard look, especially if you're on the fence about the vaccine, as many parents are. Here's an excerpt:

"We are not seeing an epidemic of devastating disease, at least not now. But we are seeing a lot of infections with a virus against which children have no immunity, and which has already caused more deaths in children under 5 than we would see in years of regular seasonal flu"

Calories on the Menu May Hurt, not Help

Here's an online-only piece from the Wall Street Journal about a recent study published in the journal Health Affairs on the effectiveness--not--of NYC laws requiring restaurants to post calorie counts for their products:

Before food czars get any more punch-happy on their own Kool-Aid, they need to be purged of the illusion that their laws are actually working. Last month, New York University and Yale medical professors published a ground-breaking study, which shows that New York City's law requiring fast food chains to post calories on their menus doesn't reduce their customers' caloric intake.

Actually, 85% of people ignored the info...and Allysia Finlay concludes:

The lawmakers who enacted the calorie posting regulations succumbed to the fallacy that everyone thinks like them. They probably reasoned that because they would make healthier choices if presented with nutritional information, everyone else would as well. But maybe what consumers actually want is a delicious meal at a low price.

The Cat Who has H1N1 Swine Flu

Here's Tara Parker-Pope's story in the New York Times about the cat with swine flu. As she points out, this surely isn't the first feline to catch flu from a human, but it was the first to be tested. Interesting. Did you see the one about the pigs in Indiana who got swine flu? That almost sounds like a weird variant of cannibalism...or something...

Bipolar Blogs: Best of the Web

Psych Central has compiled their list of the 10 best blogs about bipolar disorder. Check it out.

Acetaminophen to Reduce Fever After Vaccination: Skip It

Some babies and young children get a fever after vaccinations, so pediatricians sometimes recommend giving acetaminophen, the active ingredient in Tylenol and other pain relievers, before the shots to ward off the high temp. But research conducted in the Czech Republic on babies during the first 15 months of life and published in a recent issue of Lancet suggests that this may not be a great idea.

• Not that many babies actually got a high fever (39.5 degrees C or higher) after vaccination--or had serious adverse reactions or so-called febrile seizures.
• Babies who got acetaminophen at about the same time they were vaccinated produced much lower levels of helpful antibodies to the HIB bug, the diphtheria, tetanus, and pertussis bugs, and to several pneumococcal species. 

You can read a summary of the Lancet article here.

Tech Company in Denmark Hires Primarily People with Autism

What an intriguing story from The Independent in London:

"When Thorkil Sonne was told that his three-year-old son had autism, the Danish IT specialist ran the classic gamut of responses for parents of an autistic child, from anger that a doctor could burden his happy boy with the label of a lifelong disability, to a desire to learn everything about the condition.

Few, however, go so far as to embark on a one-man mission to revolutionise society’s isolating attitude to autistics by setting up a company staffed almost entirely by sufferers that has some of the world’s biggest corporations, including Microsoft and Cisco Systems, queuing to buy its services.

Specialisterne, which has a turnover of £2m and employs more than 40 people with an autism spectrum disorder (ASD) in Denmark, is set to open its first international operation in Glasgow early next year as a test run for an expansion strategy which would see people with ASD working as IT consultants world wide."

Adderall: Worth the Competitive Edge?

Walter Kirn details his experiences using the stimulant Adderall to get an edge in his work life. It's an interesting cautionary tale. So tempting, so tempting. See if he thought it was worth it...in today's New York Times Sunday magazine.

Poisoned by Her Denture Adhesive

This is out there, but if you know someone who has poorly fitting dentures, you might want to ask how much denture adhesive he or she uses. This wild story about a woman who developed severe and possibly permanent neurologic complications after using excessive amounts of denture adhesive on her old dentures appeared in today's New York Times Sunday magazine. The culprit? Zinc.

What You Should Do About the (Swine) Flu

The new head of the CDC, Thomas Frieden, MD, held a press conference today to discuss some new reports and data about the H1N1 (swine) flu pandemic. You can read the reports at the CDC web site. Much of today's discussion concerned the way in which the infection affects kids. As you know, the flu usually hits the elderly hardest and kills tens of thousands of seniors every year. But from what we know about H1N1, it seems to take a heavier toll on kids. To be sure, nearly all of the children and adolescents who got sick in the spring recovered, but kids with what are called "underlying conditions" seem to be a risk. Here's a summary of some of Frieden's major points today, with an emphasis on what you need to know to manage if you or anyone in your family gets sick with a flu-like illness in the coming weeks. 

• Children age 5 years and under are at highest risk. The younger they are, the higher the risk. Babies younger than 6 mos won't be getting the vaccine when it becomes available, so they're in the most danger. This means that if you're in contact with babies or young kids, you should take care to avoid getting the flu yourself--or spreading it to them.
• Two-thirds of the kids who died this spring had underlying conditions like cerebral palsy, muscular dystrophy, asthma, or other cardiorespiratory problems. Kids with these and other conditions need medical attention if they get flu-like symptoms--or even a fever during the flu season.
• Many of the remaining 30% of kids who died had bacterial infections, which brings us to the next point--
• A fever that returns as a person is recovering from the flu could be a warning sign of a bacterial superinfection. Get medical help.
• Pregnant womenare at risk from the flu and should do whatever they can to avoid the infection and should get the vaccine when/if it becomes available.
• A person without an underlying condition and who is otherwise healthy (not pregnant, not under the age of 5 years, no asthma/diabetes/other cardiorespiratory disorder, etc.) probably does not need medical attention--no diagnostic test, no flu medication. Staying out of doctors' offices and emergency departments if you don't really need to be there will slow the transmission of the virus and free up medical personnel to help people who are in more danger than you are. Stay home and rest. Do keep an eye on your fever.
• Stay home from work/school if you get the flu. 
• Stay home from work/school if you get the flu.

The CDC site has more info for specific groups of people. Not exactly sure how sick you are, or whether you're in a high-risk group? Find out here.  And let young Alexander Graden instruct you in the art of safe sneezing.

Your Kid and Skunk, the Super-Potent Marijuana

Read Dominique Browning's review of The Lost Child, A Mother's Story by Julie Myerson In today's New York Times Book Review. Chilling. An excerpt:

“I am flattened, deadened. I have nothing in my mind except the deep black hole that is the loss of my child,” she writes in “The Lost Child: A Mother’s Story.” Myerson undergoes a crash course in drugs. Her son is smoking skunk, she learns, a strain of cannabis whose THC content is much more potent than garden-­variety pot — except that it has become garden variety. I had never heard of skunk either, but a quick search online led me to a souk of seeds for the home farmer, advertising up to a toxic 22 percent tetrahydrocannabinol (THC) content in some strains. My shopping cart remained empty as I browsed in disbelief. Even as stronger varieties are being bred and marketed, medical research is linking cannabis use to behavioral and cognitive changes reminiscent of psychiatric disorders like schizophrenia, bipolar disorder, major depression and anxiety disorder. And yet we find ourselves arguing about whether pot is addictive or a gateway drug or should be legalized. We are collectively losing our minds. “The Lost Child” is a cry for help and a plea for a clear acknowledgment of the toll this drug is taking on our children. [empaphsis is healthsifter's]

Gain Weight, Lose Your Mind?

This article from New Scientist is certainly sobering. But it's more important information about weight gain, especially the pounds we tend to put on at midlife. Here's an excerpt of the New Scientist article about this research, which was conducted at UCLA by Paul Thompson and colleagues and published in the journal Human Brain Mapping.

High insulin levels and type 2 diabetes tend to accompany being overweight and are risk factors for brain tissue loss and dementia. However, the relationship between brain size and body mass index still stood when the researchers accounted for these conditions, indicating that body fat levels may be linked directly to brain shrinkage. Thompson suggests that as increased body fat ups the chances of having clogged arteries, which can reduce blood and oxygen flow to brain cells, the resulting reduction in metabolism could cause brain cell death and the shrinking seen.

I regret the ice cream I had last night, and also the night before (it's hot here). Then again, has anyone quantified the mental health benefits of ice cream? I didn't think so. 

10 Things We Don't Understand About Human Beings

There are only 10 things we don't understand about human beings? Well, who can blame New Scientist for sticking to just 10 of these mysteries, which include:

• Why is kissing fun?
• Why do some of us pick our noses? Why does a subset of that group actually eat snot?
• Why do we laugh?
• Why are we altruistic?
• What the heck is pubic hair for?
• Is blushing just punishment for lying or cheating?
• and the big one--why is human adolescence so much more prolonged, dangerous, problematic, and apparently infuriating than adolescence in other primates?

For some answers a discussion of these and other important questions, please take some time to read this special feature at New Scientist.

Newsweek.com Likes Health and Laughter!

Healthsifter got a nice shout-out from Newsweek.com for my article on the health benefits of laughter in the current issue of Ode magazine. Check it out, and thanks!!

Work Hard, Then Play Hard

In these economic times, you're lucky if you're actually working hard. You hate to complain about it. But all that work and the pressure to do well and not screw up right now can be draining. Here's an interesting perspective from Psych Central in an article by Rick Nauert, PhD. He writes about a study just published in Psychosomatic Medicine and conducted at the University of Pittsburgh. A few paragraphs from Nauert's article:

During the study, 1,400 adults recorded how often they participated in a variety of leisure activities, including spending time unwinding, visiting friends or family, going on vacation, going to clubs or religious activities or playing sports.

Individuals who spent more time participating in different leisure activities had lower blood pressure, waist circumference, body mass index and cortisol measurements...

“People who are engaged in multiple enjoyable activities are better off physically and psychologically,” said study co-author Karen Matthews, Ph.D., professor of psychiatry, epidemiology and psychology at the University of Pittsburgh School of Medicine.

“When one is under stress, the usual thing is to cut back on enjoyable activities because you’re feeling uncomfortable and you need more time to deal with the stress. But these data suggest that is the wrong thing to do and that continuing enjoyable activities you do can be helpful,” Matthews said.

Bottom line: Take time out precisely when you think you don't have the time. This is something I struggle with almost all the time, too. But an hour for a swim or lunch with a friend has its dividends. I'll keep trying. You should, too. 

Gluten Goblins?

Daniel Engber delves into the current anti-gluten movement today at Slate. He makes an important distinction between people with celiac disease and people who have made a decision to go gluten-free because they've made some assumptions about the health benefits. It's an interesting take on gluten issues and dietary fads (my wording--he doesn't call them that) in general.

Childhood Cancer Surviors: Risks that Come with Age

The risk-free magic bullet hasn't been invented yet. Cancer therapy for children prolongs precious lives for decades, but there can be ramifications years later, as described in an article by Dawn Fallik in today's Wall Street Journal. Here's a portion of that article:

"The biggest risk is believed to come from a class of drugs called anthracyclines, one of oncology’s workhorse chemotherapies that is effective against leukemia and a wide range of other cancers. The drugs’ toxic effect on the heart is well-established in adults. That they have similar effects in children is now becoming increasingly understood as these patients reach adulthood. Radiation treatments also come with risk of long-term side effects, especially when given in combination with anthracyclines."

If you need more information, check out Beyond the Cure, The National Cancer Institute, The Childhood Cancer Survivors Center at the University of Chicago, and of course, St. Jude's Children's Research Hospital.

FLU View: State-by-State Update on H1N1 from the CDC

An update published by the CDC yesterday shows H1N1 flu activity by state:

Health Benefits of Laughing! Again!

Thanks to my friend Polly Kreisman for posting the link to the ODE article at Get in the Loop! Spirited Hyperlocal News for Larchmont, Mamaroneck, Scarsdale, New Rochelle, and Rye, NY!

Whole Grain Cereal vs Heart Failure?

Read this from the WSJ Health Blog about a piece of evidence apparently linking whole grain cereal (the stuff that resembles tree bark) consumption to a reduced risk of heart failure. This is at least the second time the connection has shown up, this time from a very large observational study. Hey--chomping the twigs and buds won't compensate for your failure to quit smoking or take your blood pressure medicine, but it can't hurt.

Do Diets High in Linoleic Acid Lead to Ulcerative Colitis?

Is it possible that one third of ulcerative colitis cases are caused by linoleic acid in the diet? According to new research just published in the journal Gut (really, that's the name of the journal) and based on data from more than 200,000 people, the answer is Yes. Here's how Physician's First Watch wrote it up this morning:

"Over 200,000 subjects in five European countries submitted food-frequency questionnaires at the start of the study, and incident cases of ulcerative colitis were identified from disease registries, follow-up questionnaires, and hospital and pathology databases. After a median follow-up of 4 years, those with the highest quartile of linoleic acid intake showed a 2.5-fold increased risk for ulcerative colitis relative to the lowest quartile."

Linoleic acid is found in red meat and some margarine. Here's the study summary in Gut. Linoleic acid is an interesting substance that's been studied for various conditions. Here's a summary of some of that information from Memorial Sloan-Kettering. 

Quiz: What Do You Know About the Health Care Overhaul?

Take this quiz at WSJ.com, then read the accompanying article.

Are You Really in a Coma, Or Did Your Doctor Make a Mistake?

Scary: New Scientist reports on a study out of Belgium that raises the possibility that some people whose doctors think they are in a persistent vegetative state (VS) are actually in a minimally conscious state (MCS)--a small distinction, perhaps, but a very important one. Here's a portion of that article:

For the patient and the family, the difference between MCS and VS can make a huge difference, though. Drug treatments, painkillers, physical therapies designed to stimulate the brain, as well as techniques for encouraging communication, are more likely to be given to someone in a MCS.

And more...

The clinics and units all used a "clinical consensus" agreed by a range of specialists to diagnose patients. Some of the specialists relied on qualitative, "bedside" observations to diagnose patients, others used older diagnostic tools, but none used the CRS-R – the only one designed specifically to distinguish between MCS and VS.

Of the 44 patients diagnosed as being in a vegetative state by the clinicians, the researchers diagnosed 18, or 41 per cent, as being in a MCS according to the CRS-R.

"We may have become much too comfortable about our ability to detect consciousness," concludes Giacino. "I think it's appropriate for there to be some level of alarm about this."

Read more here. The original study was posted yesterday in BMC Neurology.

CDC Q&A About the H1N1 (Swine) Flu Vaccine

Here's everything the CDC wants you to know about the H1N1 (Swine) flu vaccine, which will probably be available this fall. You may end up getting two flu shots this year--one of the regular ones as well as the H1N1 shot.

As Medscape wrote here, the rush to production means that some shortcuts in safety testing may be necessary in order to have 60 to 80 million doses ready by the end of the year. An excerpt:

"Initial doses likely will go to those most severely hit by the pandemic so far: infants, toddlers, school-age children, pregnant women, and adults with risk factors for severe flu disease. Next week, the CDC's vaccine advisory board will recommend a priority list for exactly who will first get the vaccine.

Meanwhile, the Canadians say they will have a vaccine surplus. We'll see.

Using Music to Help Kids with Autism Spectrum Disorders

ScienceDaily reports about an ongoing study at UCLA that uses music to help kids with autism spectrum disorders understand emotions and social interactions. Here's an excerpt:

"The 12-week program uses elements from the Orff method — including games, instruments and teamwork — and combines them with musical games. The idea is to pair emotional musical excerpts with matching displays of social emotion (happy with happy, sad with sad, etc.) in a social, interactive setting."

The Orff method is a music education method developed by German composer (Carmina Burana) Carl Orff that uses movement and rhythm--clapping, dancing, chanting--as the foundation of musical education in all kids. The goal of this study is to see if the Orff training will enhance social communication and emotional functioning in children with autism.

As Claudio Monteverdi wrote in 1638, "The end of all good music is to affect the soul."

For more on the Orff-Schulwerk Association, a Cleveland-based organization dedicated to movement and music education for everyone, click here. Read more about this study at the UCLA site.

Seriously: The Health Benefits of Laughter

From my article in the current issue of Ode magazine:

In the past decade or two, scientists have gathered evidence of laughter’s perks. Laughter blunts stress and pain; hearty chuckling increases levels of the "happy" brain chemicals known as endorphins. Laughter staves off black moods, which can damage heart health and increase the risk of stroke. It reduces levels of cortisol, the stress hormone that’s tied to several health problems, including deposition of fat in the abdominal area, the most dangerous place for it. Laughter can ease anxiety disorders, while the breast milk of mothers who laugh hard contains higher levels of melatonin, which can reduce the chances of eczema in newborns. Laughter may also mitigate the damaging effects of inflammation, a process linked to heart attacks, arthritis, allergies and other conditions. The progress of diabetic kidney disease may be stymied by laughter, and laughter is linked to better respiratory function in those with chronic lung disease. Best of all, you burn more calories when you laugh.

Child Born with Half a Brain Has Normal Vision and a Fairly Normal Life, Too

What an amazing story in New Scientist online about a girl born with half a brain. Apparently what brain she does have managed to reorganize itself, and she not only sees perfectly but also has a fairly normal life overall except for some weakness on one side a history of seizures. In fact, doctors didn't know she was missing part of her brain until she started having seizures at age 3 and they started investigating. Read the full story here. Who'd have guessed?

How to Eat Less

Wow, this is exactly the same admonishment I heard as a kid: Take small bites and chew slowly.
The current issue of the American Journal of Clinical Nutrition has the results of study in which participants were tested for satiety (how full they felt) after gulping large bites of food rapidly and after taking dainty bites and chewing for a longer time. The smaller the bites and the longer they chewed, the less they ate. They probably also ran out of time and had to get back to the office. Whatever, it's an interesting reminder. Read the study summary here.

Guess Who Doesn't Know How to Wash Their Hands! Facial Plastic Surgeons

This is disturbing and surprising: Just out in current issue of the Archives of Facial Plastic Surgeons are the results of a survey of members of the American Academy of Facial Plastic and Reconstructive Surgery, presumably the cream of the plastic surgeon crop. They took a web-based survey about patient safety that included questions on handwashing. This is what they found: Only 53% knew which hand-washing agents are the best killers of microorganisms, 74% knew the most effective way to washed hands with visible dirt, and only 42% knew the indications for hand washing. That means they weren't actually sure when to wash their hands. Here are the authors' conclusions:

"Adherence to hand hygiene practices is suboptimal among facial plastic surgeons. There seems to be a lack of knowledge regarding indications, methods, and appropriate agents for hand hygiene. Promotion of Centers for Disease Control and Prevention guidelines is an important step in increasing hand hygiene compliance among facial plastic surgeons."

These folks are surgeons? Here are the CDC's directions on hand washing for people working in health care.

More on Doctors and Celebrity Patients...Groan

From this week's AMNews, a publication of the American Medical Association:

How do physicians prevent special privacy accommodations for famous patients from bleeding over into clinical care? Could the acceptance of gifts from celebrity patients -- anything from glossy head shots to tickets to red-carpet movie premieres or public endorsements -- influence a physician's objective judgment about the patients' medical care? How does the star patient's fame affect the doctor-patient relationship?

Physicians can get starstruck too, and may unconsciously try to please these special patients in ways that are medically inappropriate.

Drew Pinsky, MD, said doctors should check themselves before taking on famous patients. He is medical director of chemical dependency services at Las Encinas Hospital in California -- a stop on many a Hollywood star's passage through drug addiction and recovery -- and is well-known as a radio talk-show host and star of VH1's "Celebrity Rehab with Dr. Drew."

"You really have to assess your own liability," Dr. Pinsky said. "Are you seduced by the opportunity to bask in the glow of celebrity? Is it particularly appealing to you to have a powerful person say you did a good job? Will you be able to sustain that same person saying, 'I can't believe you won't give me what I want'? You had better be prepared, because that is exactly what you'll get. You have to do what's best for the patient and not be seduced by the fame."

...Gary Brazina, MD, is an orthopedic surgeon in Marina del Rey, Calif., who specializes in sports medicine and has cared for his share of famous patients. His clinic is the official medical center for the NHL's Los Angeles Kings and the NBA's Los Angeles Clippers.

Some celebrities "are really, really nice" but "others are extremely manipulative, and there is a lot of drug-seeking behavior," Dr. Brazina said. "They have a true sense of entitlement where there's a sense of, 'I'm special, I'm different; I don't have to follow the rules.' "

Dr. Brazina recalled one famous patient who refused to fill out paperwork, saying, "Oh, my assistant does that." The physician took a stand.

"Well, then, I guess I'll have to treat your assistant, because I'm not going to treat you until you fill it out," he told the star.

It's a good read. See more here.

How Smart, Overweight Kids Outwitted Medical Researchers

OK, I'm glad it wasn't a medical study that I was running, but it's pretty funny anyway. As reported by the WSJ Health Blog, some overweight kids in the UK who were enrolled in an exercise study put their pedometers on their dogs! Very funny. The researchers were surprised to find how active the "kids" had become, but without losing weight. First reported at the BBC.

The 8-Way Kidney Transplant

It sounds dirty, but it's great. Really great. A snippet from the WSJ Health Blog this morning:

...imagine an eight-way kidney transplant involving surgeries with 10 women and six men in four states over the course of three weeks. It’s thought to be the longest chain of kidney donations on record, according to the Washington Post.

This is actually called a "domino transplant," and this one got started at Johns Hopkins. Here's how it works, again from Health Blog:

...a living donor wants to give a kidney to someone they know but isn’t a biological match for them. Instead, they are matched to a recipient they don’t know. Ideally, another donor then provides his or her organ to the first recipient. These types of transactions are rare because they’re difficult to arrange, even with just one donor and one recipient.

Doctors to the Stars: A Pain

Do you ever wonder about the other side of stories like those about Michael Jackson, Heath Ledger, Anna Nicole Smith? If so, read the column by Dr. Kent Sepkowitz in today's Slate. Here's an excerpt detailing his brush with celebrity patients. He goes on to describe how easily docs get sucked into the celeb cycle.

So now are we awaiting the news on poor Michael. His version of Dr. Nick, a physician named Conrad Murray, had, by report, been a member of the retinue for just a few months. Murray's entry into the news was characterized by his apparent attempt to exit the news; he is said to have high-tailed it from the scene of the dead or dying Michael even as police and others descended on the house. His exact contribution to the death will be revealed in the weeks, months, and probably years ahead but is likely to resemble that of his predecessor Dr. Feelgoods—whose pen and syringes and customer-is-always-right attitude ended up creating a corpse where once an icon stood.

In a strange way, I actually stand in awe of these guys. I have taken care of a few celebs in my career, and for me it was an awful experience. If you fuck it up, you're toast. Once I took care of a very important person, a person you have heard of and are very interested in, someone you would be shocked to know had the problem—asthma—that I treated him for. Well, almost treated him for. His complaints and his recollection of near death last time he had the identical symptoms so unnerved me that I asked a colleague to assume his care.

Vinegar the Fat-Fighter?

News from Japanese researchers via ScienceDaily that at least in rodents, vinegar (aka acetic acid) keeps the fat off. MedicalNewsToday also reported this a few weeks ago, and this is an excerpt from that article:

"...laboratory mice fed a high-fat diet and given acetic acid developed significantly less body fat (up to 10 percent less) than other mice. Importantly, the new research adds evidence to the belief that acetic acid fights fat by turning on genes for fatty acid oxidation enzymes. The genes churn out proteins involved in breaking down fats, thus suppressing body fat accumulation in the body."

I'm always eager to find a weight-loss miracle that doesn't kill you in the process. This sounds like something to try, although I have no idea how much--is two salads a day with oil and vinegar enough, or should I be doing vinegar shots? That sounds terrible. I wonder if it's dangerous. Thanks to Cecil Adams over at The Straight Dope, I got an answer to the question "Is Consuming Vinegar to Excess Dangerous?"  I won't be doing the shots--that actually could be dangerous. But a tablespoon or two before meals might be worth a try.  

Interested in the folk history of vinegar as a health tonic? Read this article from Nutrition Forum. If you're interested, this is the original journal reference: Kondo et al. Acetic Acid Upregulates the Expression of Genes for Fatty Acid Oxidation Enzymes in Liver To Suppress Body Fat Accumulation. Journal of Agricultural and Food Chemistry, 2009; 090609114939008 DOI: 10.1021/jf900470c

Darvon/Darvocet/Propoxyphene: New FDA Warnings

It's been around since 1957, but propoxyphene, aka Darvon/Darvocet, today is the subject of increased FDA warnings about the potential for fatal overdoses. Here's a Q&A from the agency, which answers most of the important questions about this pain medication. The FDA will require manufacturers to bolster the warnings on the drug label and to produce a Medication Guide that will be given to everyone who gets a prescription or refill. The Agency decided against a phased withdrawal of propoxyphene from the market, as requested by Public Citizen and the European Medicines Agency.   

Use that Trampoline (Safely): Rules for Your Next Garden Party

Trampolines are the new see-saws, with clamoring from some corners to restrict their use. As in, "I can't believe they got a trampoline for their backyard!" Trampolines are great fun and good exercise for kids. According to researchers in the U.K., there are just three things you need to remember to keep your kids out of the emergency department:

• One person at a time on the canvas. This is the most important rule.
• Use a net
• Make sure an adult supervises.

Having just one person on the trampoline at a time appears to be a pretty important factor in reducing injuries; in two major studies 74% to 80% of injuries occurred with multiple users.  And adults should pretty much never go on with a child--the weight discrepancy means that the kid is about 5 times more likely to get hurt. The original article appeared in the British Medical Journal. And don't you love that dry British wit? Here's the last line of their short article:

"We note that children have been hurt while being supervised or bouncing with adults who have been drinking at a summer garden party, for example. Adults, please note that lager, wine, and trampolines do not mix."

Psychs on Twitter: Tweeps

What a cool column over at Psych Central. Sandra Kiume has assembled a list of her favorite psychs and other mental health pros who are active at Twitter. Have a look. These are the criteria she used to include/exclude people:          

• NO marketing (including “free” e-books, how-to guides, etc.)
• not just “broadcasting” or re-feeding, follows others and reads their feeds
• interacts with friends and followers, replies to people
• shares more than just factoids, quotes, or pop psych aphorisms
• active but not overactive
• not too off-topic, talks mostly about psychology, psychotherapy and/or mental health
• humour, taste, talent, good writing and personality

A Vote to Ban Vicodin, Percocet; Lower Doses for Acetaminophen

A panel convened by the FDA yesterday voted to recommend banning the prescription pain killers Vicodin and Percocet because of concerns about liver toxicity when these drugs are taken with acetaminophen, the active ingredient in many over-the-counter pain and cold products. Then panel also recommended that the maximum daily dose of acetamophen be reduced. Here's part of the story from Physician's First Watch:

The FDA does not have to heed the advice of its expert panels, but it frequently does, according to the New York Times. If the FDA follows the panel's recommendation, seven other prescription drugs combining acetaminophen and narcotics could also be banned.

In addition, the panel voted to reduce the maximum daily dose of acetaminophen to less than 4000 mg and the maximum dose in over-the-counter formulations to 325 mg (down from 500 mg).

According to the Washington Post, 124 million prescriptions for Vicodin or its generic equivalents were written in the U.S. last year.  The New York Times also covers this story today and closes with some good advice:

Consumers need to be better educated about the risks of popular medicines, most panel members agreed.“If you keep track of what you’re taking, none of this is an issue for you,” Dr. Jan Engle, a panel member and head of the Department of Pharmacy Practice at the University of Illinois in Chicago, said in an interview after the meeting.

Find more on acetaminophen from the FDA here.

Drug-Induced Celebrity Deaths: Isn't There a Better Way to Learn These Lessons?

Drugs.com says that Michael Jackson's death drove a huge increase (really huge) in Internet queries about the drug Demerol (meperidine hydrochloride), which has been implicated in his death (pending the rest of the toxicology reports). Similar spikes of interest about drugs like Xanax (alprazolam), Valium (diazepam), OxyContin (oxycodone), Ativan (lorazepam), and Restoril (temazepam) followed the deaths of Heath Ledger and Anna Nicole Smith, according to Drugs.com. Here's an excerpt from that article:

Drugs.com reported a massive 20,900% increase (yes, you read that correctly – twenty thousand, nine hundred percent) in interest for information on the prescription medication Demerol – allegedly prescribed for the legendary entertainer Michael Jackson. More than 135,000 page views were logged on the Drugs.com web site by people researching Demerol this past Friday – the single biggest spike in daily interest for a medication since the similarly tragic and untimely death of Heath Ledger.

Demerol (meperidine) is a narcotic pain relieving medication. It works by dulling the pain perception center in the brain. Interest in the medication exploded from around 650 page views per day on average to 135,164 page views on Friday, June 26.

So some people may now know more about the dangers of these meds. Will lives be saved? Who's actually doing the reading?

Adios NyQuil?

Even she reads the label, and she wears a stethoscope to work!

As reported at the Wall Street Journal Health Blog today, the FDA has convened a panel of experts to recommend ways of reducing the risk of acetaminophen overdoses. Acetaminophen is the active ingredient in medications like Tylenol. It's also used widely in products, like NyQuil, that contain other ingredients, usually to manage head colds and flu symptoms. According to eMedicine, about 100  products include acetaminophen. That's a lot of acetaminophen. Close to 500 people die of acetaminophen toxicity every year in the U.S., and about 25,000 people require hospitalization for treatment of overdoses. Acetaminophen kills livers, and it is  now a more common cause of acute liver failure in the U.S. than viral hepatitis. It's the second most common reason Americans need liver transplants.

How do people get into jams with this stuff? It's pretty easy, especially if you don't read drug labels. Some make the common mistake of assuming that if you can buy a drug without a prescription, it must be safe. Not so. In fact, as they point out in the Health Blog, the maximum daily dose is uncomfortably close to not-much-higher doses that can cause injury. Other people, also non-drug-label readers, may not realize that they're doubling or tripling up on acetaminophen if they are visited by, say, a head cold and sprained ankle on the same day and take two different medications for two different problems, not realizing that both products have acetaminophen.

And here's a really bad one: Did you tie one on last night and wake up with a killer hangover this morning? If so, stay clear of acetaminophen--which can be dangerous if you've been drinking that other popular liver toxin--booze. According to the Hepatitis C Support Project, people who routinely have 2-3 alcohol-containing drinks a day should not take more than half of the usual recommended dose of acetaminophen--that's no more than 2 grams (2,000 milligrams) in 24 hours. But hey--this is all on the label.

If you have no idea what a drug label is or how to read it, check out the Tylenol site, which has a pretty good tutorial on how to read a drug label.

Tomorrow, the FDA panel will vote on the best way to reduce the risk of acetaminophen toxicity. They may reduce the maximum dose--or goes so far as to pull combo products like Nyquil, according to the WSJ. 

This would all be a lot easier if we all just read the label.

Read this Book: The Mirror Effect: How Celebrity Narcissism is Seducing America

Don't go there, baby!

I don't plug books often in posts (although I have a typelist of good health books over there...to the left), but I want to recommend this one, which I've just finished: The Mirror Effect: How Celebrity Narcissism is Seducing America, by Dr. Drew Pinsky. You'll find mostly positive reviews over at Amazon. As the mother of two teens (ok, buddy, I know you're actually 20 now...) I urge parents of younger kids to read this too, before they become inculcated with celebrity-itis and all its attendant nonsense. Don't wait to learn about this till they're in 6th or 7th grade and you find yourself doing more explaining about celebrity behavior and misbehavior than you ever dreamed you'd need to do.

One example: My daughter and her friends became insanely brand-conscious starting in late elementary school. I was denied very little in the material department when I was a kid, but only rarely did my friends and I crave particular brands of shoes or jeans. We had a rough few years with our daughter on that score. I call it the Battle of the Brands--so many confrontations about what we would and would not purchase for her. The problem wasn't necessarily the thing she wanted so much as the source of the brand-itch: Britney was carrying a particular bag or Paris (OMG--NO!) had a certain breed of dog.

Anyway, read the book.

Fibromuscular Dysplasia: A Not-So-Rare Cause of Strokes, Aneurysms, and Sudden Death

According to this article in the Wall Street Journal, doctors learn in medical school that fibromuscular dysplasia (FMD) is a rare disease. But physicians who specialize in vascular medicine think that as many as 3% to 5% of Americans have this strange condition that causes the walls of arteries to grow inward, toward the center of the vessel, blocking blood flow. This can happen in any artery--including those that feed the brain, heart, and kidneys. The first sympton is sometimes the last one--sudden death. FMD was first described in 1938, but it was listed as a cause of stroke by the National Stroke Association only in 2005. Apparently, not everyone who has FMD will run into trouble, but doctors have a lot to learn about this condition. A good first step would be for them to start unlearning some of the things they were taught about FMD in med school. Here's an excerpt from Thomas Burton's excellent article (Dr. Olin, a professor at Mt. Sinai Medical School in NYC, is one of the world's few authorities on the condition):

Dr. Olin has prepared a top-10 list of doctors' misconceptions and missteps. They include, "Telling patients that the symptoms are all in their head. Telling patients that FMD is a rare disease. Telling patients with severe headaches with FMD that there is nothing that you can do for them."

The signs of FMD are frequently the same: young patients with high blood pressure, or who have had a stroke or temporary symptoms of a stroke; patients whose blood makes a swishing sound indicating turbulent flow; or patients with brain aneurysms.

You can find more information at the Fibromuscular Dysplasia Society of America and MayoClinic.com. Dr. Olin co-authored a review article about the condition in the New England Journal of Medicine in 2004; it's written for doctors, but you can get something out of it even if you don't wear a stethoscope to work.

Music and Your Heart

In 1638, Claudio Monteverdi, the granddaddy of opera, said that the purpose of all music was to move the soul.  Modern cardiovascular research is confirming his assertion--if you substitute "heart" for "soul." It's a stretch, but stick with me on this. Researchers present data about the effect of music on the heart in the current issue of Circulation, a journal published by the American Heart Association. Here is a segment of the press release about the study:

Five random tracks of classical music were played — including selections from Beethoven’s Ninth Symphony; an aria from Puccini’s Turandot; a Bach cantata (BMW 169); Va Pensiero from Nabucco; Libiam Nei Lieti Calici from La Traviata — as well as two minutes of silence.

Researchers found:

• Every crescendo led to increased narrowing of blood vessels under the skin, increased blood pressure and heart rate and increased respiration amplitude. In each music track the extent of the effect was proportional to the change in music profile.
• During the silent pause, changes decreased, with blood vessels under the skin dilating and marked reductions in heart rate and blood pressure. Unlike with music, silence reduced heart rate and other variables, indicating relaxation.
• Music phrases around 10 seconds long, like those used in “Va Pensiero” and “Libiam Nei Lieti Calici,” synchronized inherent cardiovascular rhythm, thus modulating cardiovascular control.

Music can induce physiologic changes that may precede the psychological appreciation. Such autonomic modulations could be of practical use to induce body sensation which might reach the level of consciousness, or at least create a continuous stimulus to the upper brain; moreover, the inter-individual synchronization of body physiology mediated by music could aid in strengthening the sense of sharing within the human relationship.

The researchers think that these and other, earlier findings may lead to the inclusion of music in stroke rehab, for example. At the very least, rehab sessions will be more fun. Music makes everything better, right?

Obesity Linked to Cancer Again, and Teens are in Special Danger

From the Health Blog at WSJ:

Studies have tied obesity to increased risk of pancreatic cancer, but new findings suggest that weight control early in life is especially important. Obesity in early adulthood is associated with both increased risk and earlier onset of pancreatic cancer, a study in the Journal of the American Medical Association shows. In fact, overweight teens are twice as likely to develop pancreatic cancer later in life than similar adults who had never been overweight.