Dr. Bray Links

Tuesday, November 21, 2017

The Death of Expertise

The Internet has provided people with an unprecedented abundance of information, but all too often it gives them the illusion of knowledge, encouraging them to believe they know as much as experts. They hear what they want to hear, and live in a bubble community of people with similar beliefs.

https://sciencebasedmedicine.org/the-death-of-expertise/

Thursday, November 16, 2017

Amish Mutation Protects Against Diabetes and May Extend Life - NYTimes.com

Amish people living in a rural part of Indiana have a rare genetic mutation that protects them from Type 2 diabetes and appears to significantly extend their life spans, according to a new study.

The findings, published on Wednesday in the journal Science Advances, shed light on the processes underlying cellular aging and could lead to new therapies for chronic diseases, some experts say. The researchers are planning at least one follow-up trial that will recreate the effects of the mutation so they can study its impact on obese people with insulin resistance, a precursor to diabetes.

The mutation described in the new paper affects a mysterious protein called plasminogen activator inhibitor-1, or PAI-1, that is known primarily for its role in promoting blood clotting. The mutation was first identified in 1991 in a secluded Amish farming community in Berne, Ind. An estimated 5 percent of the community carries the mutation, which causes them to produce unusually low levels of PAI-1.

Scientists have long suspected that PAI-1 has other functions outside of clotting that relate to aging. Dr. Douglas Vaughan, a cardiologist at Northwestern medical school, noticed, for example, that mice that had been genetically engineered to produce high levels of the protein age fairly quickly, going bald and dying of heart attacks at young ages. People who have higher levels of the protein in their bloodstreams also tend to have higher rates of diabetes and other metabolic problems and to die earlier of cardiovascular disease.

https://mobile.nytimes.com/2017/11/15/well/live/amish-mutation-protects-against-diabetes-and-may-extend-life.html

Monday, November 13, 2017

Mortality Lower When Inpatients See Their Own PCP in Hospital

A primary care physician (PCP)'s prior knowledge of a patient has a significant effect on outcomes when that patient is hospitalized, data from a new study suggest.

In a retrospective analysis of more than 560,000 Medicare patients, hospital care by a PCP who had previously seen the individual as an outpatient was associated with a greater chance of being discharged home and a lower 30-day mortality compared with care delivered by a hospitalist or other generalist who had never met the patient before, Jennifer P. Stevens, MD, MS, and colleagues report today in JAMA Internal Medicine.

These findings may be especially important for patients with multiple illnesses and those who require a complex level of care, Seth Landefeld, MD, coauthor of an accompanying editorial, said in an interview with the journal.

https://www.medscape.com/viewarticle/888520

Saturday, November 11, 2017

Mitochondrial Networks Explain Why Caloric Restriction Extends Worms’ Lives | The Scientist Magazine(R)

 "Low-energy conditions such as dietary restriction and intermittent fasting have previously been shown to promote healthy aging," lead author Heather Weir, who conducted the research while at Harvard T. H. Chan School of Public Health and is now a research associate at Astex Pharmaceuticals, tells the Harvard Gazette. "Understanding why this is the case is a crucial step toward being able to harness the benefits therapeutically."

Mitochondria exist in networks that alternate between "fused" and "fragmented" states, which affect how the organelles process energy. This dynamic fission and fusion of mitochondria has been linked to aging, and the new study provides two key players—AMPK and peroxisomes—in orchestrating those fluctuating connections and their effect on organismal health and senescence. 

"Although previous work has shown how intermittent fasting can slow aging, we are only beginning to understand the underlying biology," senior author William Mair, associate professor of genetics and complex diseases at Harvard Chan School, tells the Harvard Gazette. "Our work shows how crucial the plasticity of mitochondria networks is for the benefits of fasting. If we lock mitochondria in one state, we completely block the effects of fasting or dietary restriction on longevity."

http://mobile.the-scientist.com/article/50886/mitochondrial-networks-explain-why-caloric-restriction-extends-worms-lives

Friday, November 10, 2017

New Study Shows Antioxidant-Rich Foods Diminish Diabetes Risk

Consuming a diet rich in antioxidant foods may help decrease the risk of type 2 diabetes, according to a new study published November 9 in Diabetologia.

The trial is the first prospective investigation into the link between total antioxidant consumption and risk of type 2 diabetes, say the researchers.

"This work complements our current knowledge of the effect of isolated foods and nutrients and provides a more comprehensive view of the relationship between food and type 2 diabetes," senior author Guy Fagherazzi, PhD, of the University Paris-Sud, Villejuif Cedex, France, said in a press release.

Prior research has suggested that oxidative stress may contribute to the development of type 2 diabetes. While some studies have found that the antioxidant vitamin E may help decrease the risk of type 2 diabetes, others have not confirmed this effect for the antioxidants vitamin C, flavonoids, and lycopene.

https://www.medscape.com/viewarticle/888350

Wednesday, November 8, 2017

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy — NEJM

Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.

http://www.nejm.org/doi/full/10.1056/NEJMsa065779

How Has the Physician-Patient Relationship Changed?

We know from [our experiences from] the early 1970s to now that talking about your dissatisfaction by itself doesn't lead to meaningful change. We need physicians and providers, people who work in the practice, as well as patients, to be willing to make change at a grassroots level. We need to stop looking for a silver bullet from either the government or health insurers to fix healthcare. We need to take that burden on ourselves.

If people say, "I will shift to doctors who spend time with me; I will shift my health insurance to places that treat me like a person and not like a number," then we will see a shift. The thing that is helping people is that more of the healthcare dollar—how much we pay for healthcare—is being shifted to people, and so they can vote with their dollars.

https://www.medscape.com/viewarticle/887853

Tuesday, October 31, 2017

What to Do When Patients Don't Heed Your Advice

The overwhelming majority of my patients act with good sense. Nevertheless, the confusion of preexisting patient conclusions and the use of self-validating search engine searches as a substitute for either research or offered wisdom and experience are seemingly on the rise. It is human nature to seek confirmation bias. However, we've been a nation that has sought education and knowledge, and celebrated wisdom. Increasingly, I've seen the consequences of a societal derision of the educated as being uncool and of the wise as unworthy of notice.


https://www.medscape.com/viewarticle/881711_2

Pesticide Residues in Food May Impair Female Fertility

Women undergoing infertility treatment who consumed more high-pesticide residue foods had a lower likelihood of clinical pregnancy and live birth compared with their peers, a new prospective epidemiological study showed.

Compared with women in the lowest quartile of high-pesticide residue fruits and vegetable intake (<1.0 servings/day), women in the highest quartile (≥2.3 servings/day) had an 18% lower probability of achieving a clinical pregnancy (95% confidence interval [CI], 5% - 30%) and a 26% lower probability of having a live birth (95% CI, 13% - 37%).

Moreover, substituting just one serving/day of low-pesticide residue produce for one serving/day of high-pesticide residue produce was associated with 79% higher odds of clinical pregnancy (95% CI, 11% -188%) and 88% higher odds of live birth (95% CI, 16% - 205%).

"These data suggest that dietary pesticide exposure within the range of typical human exposure may be associated with adverse reproductive consequences," write Yu-Han Chiu, MD, ScD, from the Department of Nutrition and the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston, Massachusetts, and colleagues.

https://www.medscape.com/viewarticle/887794

Acupuncture for Chronic Pain: Unprecedented Advances

The last two decades have seen "unprecedented advances" in the use of acupuncture to treat pain conditions, with a "rapid rise" in the number and quality of related published studies, according to a physician who is an experienced acupuncture practitioner.

"Right now, we have a pretty solid foundation for the efficacy of acupuncture" for headache, osteoarthritis (OA), and musculoskeletal conditions, said Farshad M. Ahadian, MD, clinical professor of anesthesiology, University of California, San Diego.

"I think it's fair to say that acupuncture is here to stay. It's going to be a permanent addition to our tool box."

Dr Ahadian presented the data here at the Academy of Integrative Pain Management (AIPM) 28th Annual Meeting.

https://www.medscape.com/viewarticle/887754

Maternal Use of Acetaminophen Linked to ADHD in Kids

A pregnant woman's use of acetaminophen may be associated with an increase in her child's risk for attention-deficit/hyperactivity disorder (ADHD), the authors of a large, prospective study report.

"[L]ong-term acetaminophen use during pregnancy is related to more than a twofold increase in risk for offspring ADHD," after adjusting for genetic risk factors, indications for the mother's acetaminophen use, use of the drug before pregnancy, and other potential confounders, lead author Eivind Ystrom, PhD, and colleagues write in an article published online today and in the November issue of Pediatrics.

https://www.medscape.com/viewarticle/887773

Thursday, October 12, 2017

$200 Million Gift Could Transform This School's Medical Training

When Susan and Henry Samueli gave $200 million to UC Irvine's College of Health Sciences in late September, they set the stage for a first-of-its-kind educational institution: The Susan and Henry Samueli College of Health Sciences will be the first university-based health sciences enterprise to incorporate integrative health teaching, patient care and research across its schools and programs, according to a university press release.

"Integrative health redefines the relationship between the practitioner and patient by focusing on the whole person and the whole community," the release noted.

"It is informed by scientific evidence and makes use of all appropriate preventatives, therapeutic and lifestyle approaches, and health care professionals and disciplines to promote optimal health and wellness."

https://www.massagemag.com/irvine-integrative-health-program-86917/

Tuesday, October 10, 2017

Quercetin alleviates generalized hyperalgesia in mice with induced adenomyosis

The results demonstrated that treatment with quercetin improved the generalized hyperalgesia by extending the hotplate response latency, reduced myometrial infiltration and decreased the expression levels Trpv‑1, p‑p38 and p‑ERK in dorsal root ganglion neurons. The results indicated that quercetin decreases the incidence of hyperalgesia in mice with tamoxifen‑induced adenomyosis, and the potential mechanism is through reduced central sensitization, which may be a promising treatment for adenomyosis.

https://www.ncbi.nlm.nih.gov/m/pubmed/28849202/?i=3&from=Tamoxifen%20endometrial

Monday, October 9, 2017

Prescribing Pitfalls in Heart Failure With Comorbidities



Interest in the popular supplement coenzyme-Q10 (CoQ10) in heart failure stems in part from its biochemical role in mitochondria, antioxidant effects, and cell-membrane integrity, plus the observation that its levels are reduced in HF patients[4], Chow said.

Clinical trials of CoQ10 in heart failure include a 1993 study with 641 patients in NYHA class 3–4 on medical therapy that was standard for the time[5]. The supplement was associated with significantly reduced risk of HF hospitalization (P<0.001).

Much more recently, the Q-SYMBIO trial randomized 420 patients with NYHA class 3–4 heart failure to receive the supplement or placebo for 2 years on top of standard care, which included ACE inhibitors in 90% and beta-blockers in 72%[6].

Risk of the primary end point (worsening HF, CV death, implantation of a mechanical assist device, or urgent heart transplantation) declined by about half on the supplement (HR 0.50, 95% CI 0.32–0.80; P=0.003). The mortality risk alone went down 42%.

http://www.medscape.com/viewarticle/886762

Woman loses sight in one eye after marathon session playing Honour of Kings on her mobile phone

A doctor was quoted as saying that retinal artery occlusion was a condition associated with elderly people and rarely seen in the young, adding that the woman's blindness was most likely caused by severe eye strain.

http://m.scmp.com/news/china/society/article/2114214/chinese-woman-loses-sight-one-eye-after-marathon-session-playing

Saturday, October 7, 2017

Association Reported Between Fluoride and Reduced IQ

A mother's exposure to fluoride during pregnancy could lower the intelligence of her children, researchers say.

Following a group of Mexican children from the time of their mother's pregnancy to early adolescence, an international team of researchers found an association between high fluoride levels in the mothers' urine and reduced scores on the children's cognitive tests.

http://www.medscape.com/viewarticle/886379

Thursday, October 5, 2017

PPIs Not Superior to Dietary Intervention for Reflux

A primarily plant-based, Mediterranean-style diet with alkaline water showed significantly greater improvement for laryngopharyngeal reflux (LPR) symptoms than treatment with proton-pump inhibitors (PPIs), according to a retrospective study published September 7 in JAMA Otolaryngology–Head & Neck Surgery. 

"This study indicates that, by supplementing with alkaline water and a Mediterranean-style diet, effective control of symptoms as defined by the RSI [Reflux Symptom Index] may be obtained without PPI use," write Craig H. Zalvan, MD, from New York Medical College in Valhalla, and colleagues. "Other benefits of this diet-based approach include decreased risk for and improved control of cardiovascular disease, diabetes, stroke, and cancer, and avoiding the risks of drug interaction or complication."

The researchers retrospectively analyzed the medical records of two cohorts from different timeframes who received different treatments for LPR. One cohort of 85 patients, from 2010 to 2012 with a median age of 60 years, took esomeprazole twice daily or dexlansoprazole daily. They also followed standard reflux dietary precautions, including avoiding coffee; tea; chocolate; soda; alcohol; and greasy, fried, fatty, and spicy foods.

The other cohort, 99 patients from 2013 to 2015 with a median age of 57 years, received alkaline water and a 90% plant-based Mediterranean-style diet in addition to standard reflux precautions. (The water had a pH above 8.0.) Patients with potentially confounding comorbidities, such as a cough, a history of neuropathic pain, or dysphonia, were excluded.

The researchers compared the change in RSI scores between the two groups after 6 weeks of treatment. Among those taking PPIs, 54.1% of the patients had at least a 6-point reduction in their RSI, the minimum improvement deemed clinically meaningful. The average reduction in RSI across the group was 27.2%.

Meanwhile, 62.6% of those receiving the alkaline water and diet had a meaningful improvement in their RSI (difference between the groups, 8.05; 95% confidence interval [CI], –5.74 to 22.76). This group had a 39.8% average reduction in RSI (difference between groups, 12.1; 95% CI, 1.53 - 22.68).

http://www.medscape.com/viewarticle/885356

Wednesday, October 4, 2017

Las Vegas shooter Stephen Paddock was taking psychiatric medications that increase killing behavior by 45%

Records from the Nevada Prescription Monitoring Program obtained Tuesday show Paddock was prescribed 50 10-milligram diazepam tablets by Henderson physician Dr. Steven Winkler on June 21.
A 45% increase in "killing" behavior

Diazepam is a known to promote violent behavior and psychotic episodes. Via the Las Vegas Review-Journal:

"If somebody has an underlying aggression problem and you sedate them with that drug, they can become aggressive," said Dr. Mel Pohl, chief medical officer of the Las Vegas Recovery Center. "It can disinhibit an underlying emotional state. … It is much like what happens when you give alcohol to some people … they become aggressive instead of going to sleep."

Pohl, who spoke to the Review-Journal from the Netherlands, said the effects of the drug also can be magnified by alcohol.

A 2015 study published in World Psychiatry of 960 Finnish adults and teens convicted of homicide showed that their odds of killing were 45 percent higher during time periods when they were on benzodiazepines.

https://www.naturalnews.com/2017-10-04-breaking-las-vegas-shooter-stephen-paddock-was-taking-psychiatric-medications-that-increase-killing-behavior-by-45.html

Monday, October 2, 2017

Arthritis pill: Daily intake halts disabling bone loss and damage

"This drug heralds a new dawn in the treatment of this disease as it is the first evidence we have of a drug which can have a significant benefit on the structure of the bone."

Professor Conaghan, previously chairman of the National Institute for Health and Care Excellence group on the management of osteoarthritis, added: "We now need larger studies to replicate these findings, the results of which we hope will open up a new class of drug."

The treatment, known as M1V-711, is based on a molecule involved in the turnover of bone and cartilage in the joints. It works by interfering with the process that leads to joint breakdown.

It was tested against patients given a placebo and after six months those receiving the treatment showed a 65 per cent reduction in bone loss.

Those on the dummy pills showed slight increases in bone loss. The drug, which was shown to have relatively few side effects, also halted cartilage loss, with those on low doses experiencing a 70 per cent reduction in cartilage thickness and those on higher doses showing a slight increase in cartilage thickness. 

http://www.express.co.uk/life-style/health/860834/Arthritis-pill-disabling-bone-loss-and-damage-osteoarthritis-new-treatment

Tuesday, September 26, 2017

Coffee sold in California could carry cancer warning labels | Fox News

A nonprofit group wants coffee manufacturers, distributors and retailers to post ominous warnings about a cancer-causing chemical stewing in every brew and has been presenting evidence in a Los Angeles courtroom to make its case.

The long-running lawsuit that resumed Monday claims Starbucks and about 90 other companies, including grocery stores and retail shops, failed to follow a state law requiring warning signs about hazardous chemicals found everywhere from household products to workplaces to the environment.

At the center of the dispute is acrylamide, a carcinogen found in cooked foods such as French fries that is also a natural byproduct of the coffee roasting process. The coffee industry has acknowledged the presence of the chemical but asserts it is at harmless levels and is outweighed by benefits from drinking coffee.

http://www.foxnews.com/health/2017/09/26/coffee-sold-in-california-could-carry-cancer-warning-labels.html