Dr. Bray Links

Saturday, March 17, 2018

Physical Fitness Tied to a Nearly 90% Reduction in Dementia Risk

A high level of cardiovascular physical fitness in middle-aged women is associated with close to a 90% reduction in dementia risk in later life, results of a longitudinal study show.


Thursday, March 15, 2018

'Reinventing Healthcare' Without the People Who Care for Patients

Unfortunately, too many of those who seek to disrupt healthcare have dollar signs in their eyes, making it impossible for them to see and acknowledge their ignorance—their lack of any real insight in the daily practice of healthcare. Those with the practical experience to help shape a better system that integrates the potential efficiencies of telemedicine, machine learning, and big data with current practice patterns in order to provide efficient and high-quality care are too often relegated to the sidelines; changes are imposed upon them from above by people with no understanding of the potential unintended consequences of their unilateral decisions.

I believe the US healthcare system is poised for significant change in the coming years. This may be rudderless navigation directed overwhelmingly by profiteering individuals from a business and technology background, merely seeking a short-term exit strategy to maximize their wealth rather than a true transformation of healthcare in a meaningful, beneficial way. But there are new entrants in the healthcare arena who may have the more noble goal of creating a US healthcare system that truly works, rather than being dragged down by colossal inefficiencies and the deliberate foot-dragging of the incumbent stakeholders who benefit from this. The recently announced collaboration among Amazon, Berkshire Hathaway, and JP Morgan to create and demonstrate a path to efficient medical care in America[1] may have the needed power and, possibly, the long-term vision to execute on this promise.

To do so, it will be critical to welcome the participation not only of the medical dilettantes who consider themselves experts because they technically still see a few stray patients as a small fraction of their workweek, but the vast majority of working doctors who unfortunately remain an afterthought of far too many who expect to redefine how healthcare is delivered. At the same time, physicians who fit that bill and care for patients day to day should strive to play a more active role in these initiatives. We only have the right to not be shepherded around by those outside healthcare if we, as practicing physicians, are not complacent enough to act like sheep.


Arsenic, Lead Found in Popular Protein Supplements - Consumer Reports

Whether for weight loss, muscle building, or simply as a convenient quick meal on the go, many Americans turn to protein powders and drinks.

But a new study shows that many of the top-selling powders and drinks may contain concerning levels of heavy metals such as arsenic, cadmium, mercury, and lead, and toxins like bisphenol A (BPA), a chemical found in some plastic containers and food can liners.

These substances have been linked to cancer, brain damage, and reproductive issues.


Thursday, March 8, 2018

America's Love/Hate Relationship With Doctors

The truth of the matter is that a large degree of America's love/hate relationship with doctors is fueled primarily by our idealized notion of what a doctor should be. When asked to describe their vision of an ideal doctor, patients often use such words as "empathetic," "wise," "confident," "attentive," "brilliant," "dedicated," and "altruistic." But they want trust, friendliness, respect, honesty, timeliness, and sincerity, too.

That's an awfully high pedestal. And these expectations extend to physicians' lives and behavior outside the office as well.

How did we get here? Once upon a time, long ago (before third parties inserted themselves into medicine), we had the doctor and the patient. Alone. In one room. Many times, in a bedroom during a house call. The relationship between doctor and patient was undisturbed by layers of bureaucracy, faxes, and phone trees, uncorrupted by superbills and CPT codes.

This fairy-tale physician—our savior in a white coat—who will come to our aid any time of day or night lives in our collective consciousness. Doctors yearn to be heroes, and suffering patients seek a savior. We fulfill each other's core needs. After all, without patients, doctors couldn't exist.


Wednesday, March 7, 2018

Male urinary biomarkers of antimicrobial exposure and bi-directional associations with semen quality parameters


Antimicrobials including parabens, triclosan, and triclocarban have endocrine disrupting properties. Among 501 male partners of couples planning to become pregnant, preconception urinary biomarkers of parabens, triclosan and triclocarban exposure were quantified in spot urine samples. Men also provided two fresh semen samples collected approximately one month to undergo 24-h semen quality analysis. Linear mixed-effects models, adjusted for creatinine, race, age and body mass index, were utilized to assess the relationship between log transformed chemical concentrations rescaled by their standard deviations and semen parameters. Methyl, ethyl and butyl parabens, were associated with diminished sperm count and several sperm motility parameters. Hydroxylated paraben metabolites and triclosan were significantly positively associated with select semen quality parameters. Overall, our findings suggest that specific urinary parabens found in consumer goods (methyl, ethyl and butyl parabens) may adversely impact sperm quality parameters among reproductive-age male partners of couples trying for pregnancy.


Tuesday, March 6, 2018

HbA1c Below 8% in Diabetes for 'Most' Says ACP, But Others Disagree

"ACP's analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7% or less, compared with targets of about 8%, did not reduce deaths or macrovascular complications, such as heart attack or stroke, but did result in substantial harms," said Jack Ende, MD, ACP president, in a statement.

"For most people with type 2 diabetes, achieving an HbA1c between 7% and 8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs," he added.


For all their risks, opioids had no pain-relieving advantage in a yearlong clinical trial

By some measures, the people using non-opioid drugs such as Tylenol, ibuprofen and lidocaine experienced more pain relief than people using medications like morphine, Vicodin and oxycodone — though the differences weren't large enough to be considered statistically significant. Patients in both groups saw similar improvements in their quality of life.


Sunday, March 4, 2018

Diabetes is actually five separate diseases, research suggests - BBC News

The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.

    Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
    Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
    Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
    Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
    Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder


Saturday, March 3, 2018

Calcium Supplements Up Risk for Precancerous Serrated Polyps

Calcium supplementation alone more than doubled the risk for serrated sessile adenomas or polyps (SSA/Ps), and when combined with vitamin D, it almost quadrupled the risk, according to the results of a large randomized chemoprevention trial published online today in Gut.


Wednesday, February 28, 2018

Urinary Phthalate Metabolites Are Associated With Decreased Serum Testosterone in Men, Women, and Children


Multiple phthalates were associated with significantly reduced T in both sexes and in differing age groups. In females, the strongest and most consistent inverse relationships were found among women ages 40–60 years. In boys 6–12 years old, an interquartile range increase in metabolites of di-2-ethylhexyl phthalate was associated with a 29% (95% confidence interval, 6, 47) reduction in T. In adult men, the only significant or suggestive inverse associations between phthalates (metabolites of di-2-ethylhexyl phthalate and dibutyl phthalate) and T were observed among men ages 40–60 years.


Sunday, February 25, 2018

E-cigarettes leak toxic metals, study finds

In a previous study, Rule and colleagues identified a series of toxic metals — cadmium, chromium, lead, manganese, and nickel — in e-cigarette liquids.

The new research took these findings and went further, testing the e-cigarettes of actual users in order to try to understand how exposed people were to these toxic substances, and under what circumstances.

Rule and team worked with 56 participants who used e-cigarettes on a daily basis. The researchers tested the participants' e-cigarettes, verifying the presence of 15 metals in the refilling dispensers, the vaping liquids "loaded" into the e-cigarettes, and the vapors that resulted from the liquids' heating.


Saturday, February 24, 2018


Nixtamalization /nɪʃtəməlaɪˈzeɪʃən/ typically refers to a process for the preparation of maize (corn), or other grain, in which the corn is soaked and cooked in an alkaline solution, usually limewater (but sometimes wood ash lye[1]) washed, and then hulled. This process, originating in Mexico, is known to remove up to 97–100% of aflatoxins from mycotoxin-contaminated corn.[2] The term can also refer to the removal via an alkali process of the pericarp from other grains such as sorghum.


Impact of Cleaning Products on Women's Lungs as Damaging as 20-a-Day Cigarette Habit: Study

Regular use of cleaning sprays can have as much of an impact on health as smoking a pack of cigarettes a day, according to a new study.

Scientists at Norway's University of Bergen tracked 6,000 people, with an average age of 34 at the time of enrollment in the study, who used the cleaning products over a period of two decades, according to the research published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

They found that lung function decline in women who regularly used the products, such as those who worked as cleaners, was equivalent over the period to those with a 20-cigarette daily smoking habit.

"While the short-term effects of cleaning chemicals on asthma are becoming increasingly well documented, we lack knowledge of the long-term impact," said Dr. Cecile Svanes, a professor at the University of Bergen in Norway and  senior author of the study. 


Newly invented eyedrops could replace glasses altogether

 A revolutionary eyedrop invention from a team of Israeli ophthalmologists has been found to heal damaged corneas and improve the vision of pigs. Clinical trials for humans are expected to begin later this year.

The recently patented 'nanodrops' developed by a team at Shaare Zedek Medical Center and Bar-Ilan University's Institute of Nanotechnology and Advanced Materials improved both short-sightedness and long-sightedness in tests on pigs.


EHR Time Exceeds Patient Face Time in Family Practice Visits

Primary care physicians spend less time interacting face-to-face with their patients than they do working on electronic health records (EHR), according to a cross-sectional study published in the February issue of Family Medicine.

"The majority of family physicians worked through lunch, stayed late at clinic, or took their work home to complete the day's EHR work," write Richard A. Young, MD, from the JPS Family Medicine Residency Program in Fort Worth, Texas, and colleagues.

"Significant predictors of visit length included the number of reasons for the visit, new patients to the practice, the number of medications prescribed, whether the physician was Hispanic, whether a resident physician presented the patient to an attending physician, whether the patient had one or multiple physicians caring for him or her, and a few other factors," the authors explain.


Friday, February 23, 2018

Health care’s fundamental problem: Your doctor doesn’t work for you | TheHill

Once the backbone of America's health care system, primary care physicians have been overtaken by medical middlemen that drive up costs and get between doctors and our patients. Every step of the way, the patient's interests are subordinated to another customer. Doctors answer to their hospital employers. The hospitals are eager to please the insurance companies that decide whether to pay medical claims.

Throughout its history, the health insurance industry has paid lip service to controlling costs while actually driving them higher. At any time, your doctor's years of training and knowledge of your unique condition can be vetoed by your insurance company. By overriding a doctor's recommendation, a patient's condition can deteriorate and lead to more costly procedures. 


CMS Wants in on Direct Primary Care (Healthcare Blog) | Medpage Today

Just as the direct primary care movement to take insurers and government intermediaries out of medicine gains traction, the Centers for Medicare and Medicaid Services is getting involved, one proponent writes for The Healthcare Blog.

There are 770 direct primary care clinics in the country, Niran Al-Agba, MD, writes. But as the movement grows, CMS is edged out. Now, the agency is holding focus groups in four cities, asking how it can get involved.

At best, Al-Agba said, that's patronizing.

"The DPC movement offers the first successful and innovative alternative healthcare approach to emerge in years," he writes. "Make no mistake, CMS is the enemy of independent physicians everywhere and our best defense is to have a good offense – leading with transparency to our patients and the public. "


Wednesday, February 21, 2018

The Key to Weight Loss Is Diet Quality, Not Quantity, a New Study Finds

Anyone who has ever been on a diet knows that the standard prescription for weight loss is to reduce the amount of calories you consume.

But a new study, published Tuesday in JAMA, may turn that advice on its head. It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat.


Monday, February 19, 2018

Advanced glycation endproducts, dityrosine and arginine transporter dysfunction in autism

Changes in plasma AGEs were likely indicative of dysfunctional metabolism of dicarbonyl metabolite precursors of AGEs, glyoxal and 3-deoxyglucosone. DT is formed enzymatically by dual oxidase (DUOX); selective increase of DT as an oxidative damage marker implicates increased DUOX activity in ASD possibly linked to impaired gut mucosal immunity. Decreased renal clearance of arginine and CMA in ASD is indicative of increased arginine transporter activity which may be a surrogate marker of disturbance of neuronal availability of amino acids. Data driven combination of these biomarkers perturbed by proteotoxic stress, plasma protein AGEs and DT, gave diagnostic algorithms of high sensitivity and specificity for ASD.


Acetaminophen Use Alters Sex Hormones, May Cause Birth Defects?

"The surprising thing that we observed in people who were taking acetaminophen (paracetamol) was that all of them had a peculiar profile in hormone metabolites," senior author Amalio Telenti, MD, from J Craig Venter  Institute, in La Jolla, California, explained to Medscape Medical News.

The researchers speculated that they might find liver dysfunction with large doses of acetaminophen, "because that is normal toxicity," but surprisingly they found that acetaminophen was associated with changes in certain hormonal metabolites.

For example, the effect of taking acetaminophen on pregnen-diol disulfate was roughly equivalent to the effect of 35 years of aging, or the normal decrease in levels seen in menopause.