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Friday, September 30, 2016

Epigenetic clock can calculate biological age, predict lifespan

Using a series of molecular methods, the scientists measured each individual's rates of aging. One of the techniques used was an epigenetic clock, designed by Prof. Horvath in 2013.

Prof. Horvath's epigenetic clock works by tracking methylation. Methylation is a process where methyl groups are added to DNA; this generally leads to a reduction in gene transcription, altering a person's phenotype without altering their genotype.

Methylation is natural and steadily occurs over time; the team found that by comparing an individual's chronological age with their blood's biological age, they could predict life expectancy.


Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease

Crohn's disease (CD) results from a complex interplay between host genetic factors and endogenous microbial communities. In the current study, we used Ion Torrent sequencing to characterize the gut bacterial microbiota (bacteriome) and fungal community (mycobiome) in patients with CD and their nondiseased first-degree relatives (NCDR) in 9 familial clusters living in northern France-Belgium and in healthy individuals from 4 families living in the same area (non-CD unrelated [NCDU]). Principal component, diversity, and abundance analyses were conducted, and CD-associated inter- and intrakingdom microbial correlations were determined. Significant microbial interactions were identified and validated using single- and mixed-species biofilms. CD and NCDR groups clustered together in the mycobiome but not in the bacteriome. Microbiotas of familial (CD and NCDR) samples were distinct from those of nonfamilial (NCDU) samples. The abundance of Serratia marcescens and Escherichia coli was elevated in CD patients, while that of beneficial bacteria was decreased. The abundance of the fungus Candida tropicalis was significantly higher in CD than in NCDR (P = 0.003) samples and positively correlated with levels of anti-Saccharomyces cerevisiae antibodies (ASCA). The abundance of C. tropicalis was positively correlated with S. marcescens and E. coli, suggesting that these organisms interact in the gut. The mass and thickness of triple-species (C. tropicalis plus S. marcescens plus E. coli) biofilm were significantly greater than those of single- and double-species biofilms. C. tropicalis biofilms comprised blastospores, while double- and triple-species biofilms were enriched in hyphae. S. marcescens used fimbriae to coaggregate or attach with C. tropicalis/E. coli, while E. coli was closely apposed with C. tropicalis. Specific interkingdom microbial interactions may be key determinants in CD.

IMPORTANCE Here, we characterized the gut bacterial microbiota (bacteriome) and fungal community (mycobiome) in multiplex families with CD and healthy relatives and defined the microbial interactions leading to dysbiosis in CD. We identified fungal (Candida tropicalis) and bacterial (Serratia marcescens and Escherichia coli) species that are associated with CD dysbiosis. Additionally, we found that the level of anti-Saccharomyces cerevisiae antibodies (ASCA; a known CD biomarker) was associated with the abundance of C. tropicalis. We also identified positive interkingdom correlations between C. tropicalis, E. coli, and S. marcescens in CD patients and validated these correlations using in vitro biofilms. These results provide insight into the roles of bacteria and fungi in CD and may lead to the development of novel treatment approaches and diagnostic assays.


Thursday, September 29, 2016

The Bacterial Community in the Gut of the Cockroach

Bacterial community of the colon.We pooled the colon samples of six representative cockroaches (see Fig. S1 in the supplemenatal material) and constructed a clone library of 16S rRNA genes. A total of 265 randomly selected clones were sequenced; 14 were putative chimeras and were excluded from further analysis. The remaining clones were assigned to 132 different phylotypes (>97% sequence similarity). Phylogenetic analysis revealed that the clones represented 11 bacterial phyla. Almost half of the clones belonged to Bacteroidetes (49 phylotypes), followed by Firmicutes (58 phylotypes, mostly Clostridia), and diverse Proteobacteria (12 phylotypes). Three phylotypes clustered among the Planctomycetes, two each among Deferribacteres, Elusimicrobia, and Actinobacteria, and only a single phylotype each among Fusobacteria, Chloroflexi, Synergistetes, and the candidate division TM7. Members of the Spirochaetes and Fibrobacteres, which are consistently found in the gut of termites, were absent from the clone library. Rarefaction analysis indicated that the number of clones analyzed was not sufficient to describe bacterial diversity within the cockroach gut at either genus (95% sequence similarity) or species level (97% sequence similarity) (Fig. S2); however, reasonable coverage was obtained at a sequence similarity threshold of 90%, indicating that the most abundant groups within the six individuals sampled were adequately covered.

Clones assigned to Bacteroidetes.The 120 clones assigned to Bacteroidetes fell mostly within the order Bacteroidales (Fig. 5). The most abundant phylotype was SL41 (5.2% of the library), which clustered together with SL35 (3.2%) and other phylotypes among a group consisting exclusively of termite and Cryptocercus clones in termite group IV of Bacteroidales. They represented a total of 28 clones in the library and were distantly related to bacteria in the genus Parabacteroides (92 to 94% sequence similarity to Parabacteroides distasonis from the mammalian gut). Another abundant group, represented by SL14 (4.0%), was loosely affiliated with clones from other intestinal sources, including Bacteroides cellulosilyticus (90 to 94% sequence similarity). Several phylotypes, with SL20 being the most abundant, formed a large cluster with clones in cluster V of Bacteroidales (4.4% of clones), which consists exclusively of clones from termites and Cryptocercus punctulatus, many of which represent symbionts of gut flagellates from Candidatus Azobacteroides pseudotrichonymphae (33). Phylotypes SL48 to SL51 clustered with sequences originating from the guts of higher termites within Bacteroidales cluster I (50), distantly related (91 to 93% sequence identity) to bacteria in the genus Alistipes.


Fascinating Facts About Cockroaches

Cockroaches get their vitamins from bacteria that live in their bodies.
For millions of years, cockroaches have carried on a symbiotic relationship with special bacteroides carried within their own bodies. The bacteroides live within special cells called mycetocytes, and are passed down to new generations of cockroaches by their mothers. In exchange for living a life of relative comfort inside the cockroach's fatty tissue, the bacteroides manufacture all the vitamins and amino acids the cockroach needs to live. This arrangement allows the cockroach to dine on just about anything it finds, without concern for its lack of nutritional value.


Depression Linked to Hormonal Contraceptives

Women who use oral hormonal contraceptives are at increased risk of developing depression, and adolescents seem most vulnerable, results of a large study suggest.

"Women should generally be informed about this potential side effect with use of hormonal contraception, so they can react appropriately in case of mood changes or even depression development. Likewise, doctors who prescribe hormonal contraception should be aware of this potential risk," Øjvind Lidegaard, MD, Department of Gynecology, Rigshospitalet, Copenhagen, and Faculty of Health Sciences, University of Copenhagen, told Medscape Medical News.

The study was published online September 28 in JAMA Psychiatry.


Tuesday, September 27, 2016

The Scary New Evidence on Tritan Plastics

Eastman, a $7 billion company that was spun off from Eastman Kodak in the 1990s, assured its corporate customers that it had done extensive safety testing on Tritan. But its methods were questionable. According to internal Eastman documents, in 2008 Eastman signed a two-year contract with Sciences International, another product defense firm that had played a key role in the tobacco industry's scientific misinformation campaign. On Sciences' advice, Eastman then commissioned a study that used computer modeling to predict whether a substance contains synthetic estrogens, based on its chemical structure. The model suggested that one of Tritan's ingredients—triphenyl phosphate, or TPP—was more estrogenic than BPA.

Eastman, which never disclosed these findings to its customers, later commissioned another study, this one involving breast cancer cells. Again, the initial results appeared positive for estrogenic activity. In an email to colleagues, Eastman's senior toxicologist, James Deyo, called this an "oh shit moment."


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Antidepressant-Induced Female Sexual Dysfunction

Antidepressant-Induced Female Sexual Dysfunction

Treatment with antidepressant medications can cause difficulty with sexual function in the domains of sexual desire, arousal, and orgasm. Rates of sexual dysfunction with antidepressant use are very high, particularly during the adjustment phase. Medications with the greatest serotonin effect are associated with the highest rates of sexual dysfunction. Determining the cause of the sexual dysfunction (underlying mood disorder vs medication-induced vs other contributing factors, eg, relationship concerns, chronic medical conditions) can be challenging for the clinician. Assessment of sexual functioning is important, not only at the initial visit but also at subsequent visits and can be accomplished with direct inquiry. Treatment options for antidepressant-associated sexual dysfunction include pharmacological strategies such as drug discontinuation or dose reduction but may not be feasible; drug holidays may cause discontinuation symptoms and may lead to nonadherence and relapse. Augmentation, switching to medications with fewer adverse sexual effects, or starting a medication with a better adverse effect profile a priori may be preferable strategies. Behavioral strategies include exercise, scheduling sexual activity, vibratory stimulation, and psychotherapy. Complementary and integrative treatments require additional study but include acupuncture, maca root, saffron, or R demascena oil.

Thursday, September 22, 2016

Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease

Crohn's disease (CD) results from a complex interplay between host genetic factors and endogenous microbial communities. In the current study, we used Ion Torrent sequencing to characterize the gut bacterial microbiota (bacteriome) and fungal community (mycobiome) in patients with CD and their nondiseased first-degree relatives (NCDR) in 9 familial clusters living in northern France-Belgium and in healthy individuals from 4 families living in the same area (non-CD unrelated [NCDU]). Principal component, diversity, and abundance analyses were conducted, and CD-associated inter- and intrakingdom microbial correlations were determined. Significant microbial interactions were identified and validated using single- and mixed-species biofilms. CD and NCDR groups clustered together in the mycobiome but not in the bacteriome. Microbiotas of familial (CD and NCDR) samples were distinct from those of nonfamilial (NCDU) samples. The abundance of Serratia marcescens and Escherichia coli was elevated in CD patients, while that of beneficial bacteria was decreased. The abundance of the fungus Candida tropicalis was significantly higher in CD than in NCDR (P = 0.003) samples and positively correlated with levels of anti-Saccharomyces cerevisiae antibodies (ASCA). The abundance of C. tropicalis was positively correlated with S. marcescens and E. coli, suggesting that these organisms interact in the gut. The mass and thickness of triple-species (C. tropicalis plus S. marcescens plus E. coli) biofilm were significantly greater than those of single- and double-species biofilms. C. tropicalis biofilms comprised blastospores, while double- and triple-species biofilms were enriched in hyphae. S. marcescens used fimbriae to coaggregate or attach with C. tropicalis/E. coli, while E. coli was closely apposed with C. tropicalis. Specific interkingdom microbial interactions may be key determinants in CD.


Combining These Two Polyphenols Inhibits Tumors By 60 Percent

The review highlighted two recent Dr Rath studies which showed a mixture of green tea extract EGCG plus quercetin (EPQ), which also includes vitamin C, l-lysine, l-proline, l-arginine, N-acetyl cysteine, selenium, copper and manganese, was effective in suppressing ovarian cancer growth in mice.

In the first study, dietary intake of EPQ inhibited the weight and burden of tumours by 59.2% and 59.7% respectively.

In the second study, they wrote: "All control mice developed large ovarian tumours, whereas five out of six mice in the EPQ group developed no tumours, and one, only a small tumour. EPQ suppressed tumour growth by 87%."


Sunday, September 18, 2016

Domestic violence against men hits record levels as numbers treble in past decade

John Mays, the chairman of the Parity, which campaigns for equal rights for men and women, said: "In 30 to 40 percent of domestic violence cases men are the victims and in many cases the injuries sustained are very severe.

"One of the great tragedies of male victim domestic violence is that there are very few safe houses for men who are seeking refuge with their children while there are over 9,000 for women.

"This is a problem which needs to be urgently addressed."


Some Generic Drugs See Huge Price Increases


The prices of generic drugs covered under the Medicare Part D program dropped overall from 2010 to 2015, but a group of 315 drugs saw extraordinary price increases during that period, according to a new report from the US Government Accountability Office (GAO). The study was requested by members of Congress who were concerned about reports of spiking generic drug prices.


Friday, September 16, 2016

Could Ancient Remedies Hold the Answer to the Looming Antibiotics Crisis? - NYTimes.com

By analyzing ancient medical texts and more than 2,000 herbal remedies, the phytochemist Tu Youyou and her team identified a plant supposedly brimming with antimalarial compounds: sweet wormwood (Artemisia annua), a member of the daisy family that looks a bit like chamomile. Upon initial testing, the plant did not perform well. But a fourth-century handbook of prescriptions provided a vital insight: To extract the plant's medicinal properties, it should be steeped in relatively cold water, rather than boiled like tea. Subsequent research identified wormwood's primary active compound, which was eventually developed into artemisinin, one of the most successful treatments for malaria in history. In 2015, Tu received the Nobel Prize in Physiology or Medicine.


Thursday, September 15, 2016

Moderate drinking: Heart health benefits challenged in new study

AF risk increased with every 10 grams of alcohol consumed daily

Over 6 years of follow-up and more than 17,600 ECG scans, the researchers identified 1,088 cases of AF, and long-term alcohol intake was found to raise the risk for this condition.

Results of the analysis revealed that the more alcohol participants consumed, the greater their risk of AF; each 10 grams of alcohol consumed each day (just under one drink daily) was linked to a 5 percent greater risk of new-onset AF.

The researchers say this increased risk of AF is likely down to enlargement of the heart's left atrium as a result of alcohol intake; each additional 10 grams of alcohol consumed daily was associated with a 0.16 millimeter increase in size of the left atrium.

What is more, around 24 percent - and up to 75 percent in some cases - of the relationship between regular alcohol intake and risk of AF could be explained by enlargement of the heart's left atrium, the team reports.


Sweet Deceptions from 1960s Reverberate Today

An exposé published online this week in JAMA Internal Medicine provides a glaring example of why many Americans are distrustful of those who claim to speak for the public good.

Papers found in Harvard University archives provide smoking-gun evidence that the sugar industry in the 1960s conspired and paid academics at the prestigious school (about $50,000 in today's dollars) to publish skewed research reviews in The New England Journal of Medicine that obfuscated and downplayed the linkage of sugar and coronary heart disease.

"The Sugar Research Foundation had a very sophisticated understanding for the time of the potential health risks associated with sugar use," said Stanton Glantz, PhD, one of several authors of the exposé, and a professor of medicine at the University of California – San Francisco, in an interview accompanying the JAMA story.

"They reached out to some well-known professors at Harvard University and funded them to write a review of the available literature on dietary determinants of heart disease. In the review, the Harvard authors really downplayed the evidence linking sugar and triglycerides and heart disease and emphasized the evidence linking fat intake with heart disease."


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Wednesday, September 14, 2016

Emissions from Electronic Cigarettes: Key Parameters Affecting the Release of Harmful Chemicals

Use of electronic cigarettes has grown exponentially over the past few years, raising concerns about harmful emissions. This study quantified potentially toxic compounds in the vapor and identified key parameters affecting emissions. Six principal constituents in three different refill "e-liquids" were propylene glycol (PG), glycerin, nicotine, ethanol, acetol, and propylene oxide. The latter, with mass concentrations of 0.4–0.6%, is a possible carcinogen and respiratory irritant. Aerosols generated with vaporizers contained up to 31 compounds, including nicotine, nicotyrine, formaldehyde, acetaldehyde, glycidol, acrolein, acetol, and diacetyl. Glycidol is a probable carcinogen not previously identified in the vapor, and acrolein is a powerful irritant. Emission rates ranged from tens to thousands of nanograms of toxicants per milligram of e-liquid vaporized, and they were significantly higher for a single-coil vs a double-coil vaporizer (by up to an order of magnitude for aldehydes). By increasing the voltage applied to a single-coil device from 3.3 to 4.8 V, the mass of e-liquid consumed doubled from 3.7 to 7.5 mg puff–1 and the total aldehyde emission rates tripled from 53 to 165 μg puff–1, with acrolein rates growing by a factor of 10. Aldehyde emissions increased by more than 60% after the device was reused several times, likely due to the buildup of polymerization byproducts that degraded upon heating. These findings suggest that thermal degradation byproducts are formed during vapor generation. Glycidol and acrolein were primarily produced by glycerin degradation. Acetol and 2-propen-1-ol were produced mostly from PG, while other compounds (e.g., formaldehyde) originated from both. Because emissions originate from reaction of the most common e-liquid constituents (solvents), harmful emissions are expected to be ubiquitous when e-cigarette vapor is present.


Consumer Product Chemicals in Indoor Dust: A Quantitative Meta-analysis of U.S. Studies

Indoor dust is a reservoir for commercial consumer product chemicals, including many compounds with known or suspected health effects. However, most dust exposure studies measure few chemicals in small samples. We systematically searched the U.S. indoor dust literature on phthalates, replacement flame retardants (RFRs), perfluoroalkyl substances (PFASs), synthetic fragrances, and environmental phenols and estimated pooled geometric means (GMs) and 95% confidence intervals for 45 chemicals measured in ≥3 data sets. In order to rank and contextualize these results, we used the pooled GMs to calculate residential intake from dust ingestion, inhalation, and dermal uptake from air, and then identified hazard traits from the Safer Consumer Products Candidate Chemical List. Our results indicate that U.S. indoor dust consistently contains chemicals from multiple classes. Phthalates occurred in the highest concentrations, followed by phenols, RFRs, fragrance, and PFASs. Several phthalates and RFRs had the highest residential intakes. We also found that many chemicals in dust share hazard traits such as reproductive and endocrine toxicity. We offer recommendations to maximize comparability of studies and advance indoor exposure science. This information is critical in shaping future exposure and health studies, especially related to cumulative exposures, and in providing evidence for intervention development and public policy.


Cumulative Phthalates Exposure with Implications for Identifying Racial/Ethnic Disparities among U.S. Reproductive-Aged Women in NHANES 2001–2012

Phthalates are ubiquitous chemicals linked to hormonal disruptions that affect reproduction and development. Multiple antiandrogenic phthalates exposure during fetal development can have greater impacts than individual exposure; thus, the National Academy of Sciences (NAS) recommends them for cumulative assessment. Using National Health and Nutrition Examination Survey data (NHANES, 2001–2012), we developed a potency-weighted sum of daily intake (∑androgen-disruptor; μg/kg/day) of di-n-butyl phthalate (DnBP), diisobutyl phthalate (DiBP), butyl benzyl phthalate (BBzP), and di(2-ethylhexyl) phthalate (DEHP) based on NAS recommendations, and included diethyl phthalate (DEP) and diisononyl phthalate (DiNP) in additional metrics (2005–2012). We compared racial/ethnic differences in ∑androgen-disruptor among 2842 reproductive-aged women. In sensitivity analyses, we assessed the influence of potency assumptions, alternate urine dilution adjustment methods, and weighting phthalate metabolites directly rather than daily intake estimates of parent compounds. We found that DEHP contributed most to ∑androgen-disruptor (48–64%), and that ∑androgen-disruptor decreased over time. Black women generally had higher cumulative exposures than white women, although the magnitude and precision of the difference varied by model specification. Our approach provides a blueprint for combining chemical exposures linked to common adverse outcomes, and should be considered in future exposure, risk, and epidemiological studies.


Children exposed to potentially toxic chemicals daily in household dust - Medical News Today

In the first-of-its-kind meta-analysis, published in Environmental Science & Technology, the researchers discovered that the number one chemical identified in household dust was DEHP, which belongs to a hazardous class of chemicals called phthalates that are used in everything from household cleaners to food packaging to cosmetics, fragrance, and personal-hygiene products.

Household dust was found to have phthalates in the highest concentration - with a mean of 7,682 nanograms per gram of dust - an amount that was several orders of magnitude above the other chemicals.

Phenols, chemicals used in cleaning products and other household items, were the second on the list of highest concentrations, followed by flame retardants and highly fluorinated chemicals that are used to make non-stick cookware.

"Our study is the first comprehensive analysis of consumer product chemicals found in household dust," says lead author Ami Zota, Sc.D., M.S., assistant professor of Environmental and Occupational Health at Milken Institute School of Public Health. "The findings suggest that people, and especially children, are exposed on a daily basis to multiple chemicals in dust that are linked to serious health problems," she adds.

Potentially toxic chemicals from consumer products are released into air and amalgamate with dust that settles on household furniture and the floor. Families are then exposed to the toxic dust composite through inhaling or ingesting small particles, while some minor amounts can be absorbed through skin.


The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.

Age-standardized years of life lost due to premature mortality (YLLs) rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of years lived with disability (YLDs) in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of disability-adjusted life-years (DALYs) than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use.


Circadian Light - Key Discoveries

The problem is that the 440-470nm blue light emission spike of these widely sold blue-pump LEDs causes maximum stimulation of the melanopsin retinal ganglion cell receptors and the non-visual pathways controlling the circadian timing system and pineal. Because of these spectral characteristics these conventional blue-pump LEDs are much more potent suppressors of pineal melatonin with its attendant disruptive health effects. With LED lighting projected to replace over 50% of the workplace lighting by 2020 we have an impending catastrophic collision between technological advance and human health and well-being.

Florida Muscadine Grapes ... Full of Health Promoting Polyphenols

As muscadine grapes are notable for their highly pigmented, thick skins in which the content of polyphenols is known to be high, research interest in describing these phytochemicals is significant.

One early report had indicated that muscadine grapes contained high concentrations of resveratrol, but subsequent studies have found no or little resveratrol in muscadine grapes. It appears that the initial report overestimated the amount of resveratrol because it relied on a less precise method, which could not distinguish resveratrol from ellagic acid, another polyphenol found in higher concentration in muscadine grapes.

Resveratrol is a polyphenol produced by many plants (including grapes) as a natural antifungal, and is widely thought to be health-promoting. Red wine typically contains between 0.2 and 5.8 mg/L, depending on a range of factors, while white wine has much less. This is because most of the resveratrol in grapes is located in the skin of the grape, and red wine is fermented with the skins of the grape included, allowing the wine to absorb it; by contrast, white wine is fermented after the skins have been removed.

Other muscadine polyphenols include:

  • anthocyanins such as delphinidin and petunidin
  • tannins
  • quercetin
  • flavan-3-ols (catechins, particularly in seeds)
  • gallic acid
  • ellagic acid (particularly in skin)
  • ellagic acid glycosides
  • ellagitannins
  • myricetin (particularly in leaves)
  • kaempferol

The rank order of total phenolic content among muscadine components was found to be seeds >> skins > leaves >> pulp


Massive heavy metals poisoning problem in the dietary supplements industry

Why U.S. supplements are the most toxic in the civilized world
Because poisoning people with toxic supplements is legal in America -- high heavy metals are outlawed in Canada, the EU, Japan and most other civilized nations -- there are quite a few companies in the industry that routinely sell heavily contaminated products to U.S. consumers. (Some are even certified organic.)

In fact, one rather disturbing trend I've noticed is that products which are too toxic to sell overseas are "dumped" in the USA where there are no restrictions on heavy metals. In other words, when a raw material is too toxic to be legally sold for human consumption in the EU, it's bought up by U.S. manufacturers who legally sell contaminated products to the U.S. market.

While the FDA has recently sought to shut down a few contaminated products -- such as lead-contaminated turmeric -- for the most part, both the FDA and the supplements industry remain in total denial about the heavy metals problem. Everybody pretends in simply doesn't exist, and until I achieved ISO 17025 accreditation for my laboratory, the industry's response to my own scientific analysis was often something like, "He doesn't really have a lab, he's making this up, there's no lead in our product..." and so on.

Instead of cleaning up their products, in other words, they were far more interested in destroying the messenger and trying to sweep their heavy metals problems under the rug. But now, they're facing a huge problem: Public transparency. Thanks to Natural News and my independent laboratory, product manufacturers can no longer hide behind a veil of lies and deceptions. Now, the truth about the real composition of foods, supplements and natural health products cannot be withheld from the public.

The dietary supplements industry has a heavy metals problem
At this point, it can no longer be denied: The dietary supplements industry has a heavy metals problem. And yes, the industry is in denial about this problem. Right now, there are millions of health conscious consumers who are buying contaminated products that will contribute to kidney damage, liver damage and brain damage. Many of these products are labeled "organic" or even "better than organic." (For the record, I am 100% pro organic, and I strongly recommend buying organic over everything else. But you should know that organic doesn't cover heavy metals, which is why organic products can still be contaminated with lead, mercury, cadmium and so on. In other words, "organic" isn't enough! It's got to be organic plus heavy metals tested...)

Sadly, consumers around the world are being hoodwinked and poisoned by contaminated health products sold almost everywhere. Many such consumers suffer horrendous side effects as a result of consuming contaminated products, and retailers like Amazon.com and even Whole Foods seem to be more than happy to keep selling toxic products regardless of their heavy metals composition.


A novel nutrition medicine education model: the Boston University experience.

Most deaths in the United States are preventable and related to nutrition. Although physicians are expected to counsel their patients about nutrition-related health conditions, a recent survey reported minimal improvements in nutrition medicine education in US medical schools in the past decade. Starting in 2006, we have developed an educational plan using a novel student-centered model of nutrition medicine education at Boston University School of Medicine that focuses on medical student-mentored extracurricular activities to develop, evaluate, and sustain nutrition medicine education. The medical school uses a team-based approach focusing on case-based learning in the classroom, practice-based learning in the clinical setting, extracurricular activities, and a virtual curriculum to improve medical students' knowledge, attitudes, and practice skills across their 4-y period of training. We have been using objectives from the NIH National Academy Awards guide and tools from the Association of American Medical Colleges to detect new areas of nutrition medicine taught at the medical school. Although we were only able to identify 20.5 h of teaching in the preclerkship years, we observed that most preclerkship nutrition medicine objectives were covered during the course of the 4-y teaching period, and extracurricular activities provided new opportunities for student leadership and partnership with other health professionals. These observations are very encouraging as new assessment tools are being developed. Future plans include further evaluation and dissemination of lessons learned using this model to improve public health wellness with support from academia, government, industry, and foundations.


Monday, September 12, 2016

Neonatal gut microbiota associates with childhood multisensitized atopy and T cell differentiation : Nature Medicine

Gut microbiota bacterial depletions and altered metabolic activity at 3 months are implicated in childhood atopy and asthma1. We hypothesized that compositionally distinct human neonatal gut microbiota (NGM) exist, and are differentially related to relative risk (RR) of childhood atopy and asthma. Using stool samples (n = 298; aged 1–11 months) from a US birth cohort and 16S rRNA sequencing, neonates (median age, 35 d) were divisible into three microbiota composition states (NGM1–3). Each incurred a substantially different RR for multisensitized atopy at age 2 years and doctor-diagnosed asthma at age 4 years. The highest risk group, labeled NGM3, showed lower relative abundance of certain bacteria (for example, Bifidobacterium, Akkermansia and Faecalibacterium), higher relative abundance of particular fungi (Candida and Rhodotorula) and a distinct fecal metabolome enriched for pro-inflammatory metabolites. Ex vivo culture of human adult peripheral T cells with sterile fecal water from NGM3 subjects increased the proportion of CD4+ cells producing interleukin (IL)-4 and reduced the relative abundance of CD4+CD25+FOXP3+ cells. 12,13-DiHOME, enriched in NGM3 versus lower-risk NGM states, recapitulated the effect of NGM3 fecal water on relative CD4+CD25+FOXP3+ cell abundance. These findings suggest that neonatal gut microbiome dysbiosis might promote CD4+ T cell dysfunction associated with childhood atopy.


It may be time to abandon dreaded digital rectal exam, research shows -- ScienceDaily

"The evidence suggests that in most cases, it is time to abandon the digital rectal exam (DRE)," said Ryan Terlecki, M.D., a Wake Forest Baptist urologist who recently published an article on the topic in Current Medical Research and Opinion. "Our findings will likely be welcomed by patients and doctors alike."

Terlecki said the DRE, referred to by some urologists as a "clinical relic," subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain. In addition, it may deter some men from undergoing any test for prostate cancer.

The issue Terlecki's team explored was whether the DRE is needed when another more accurate test that measures prostate-specific antigen (PSA) in the blood is available. PSA is a protein that is often elevated in men with prostate cancer.

"Many practitioners continue to perform DRE in attempts to identify men with aggressive prostate cancer who could die from the disease," said Terlecki. "In the era of PSA testing, we wanted to explore whether it's time to abandon the digital exam."


How the Sugar Industry Shifted Blame to Fat - NYTimes.com

The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.

The internal sugar industry documents, recently discovered by a researcher at the University of California, San Francisco, and published Monday in JAMA Internal Medicine, suggest that five decades of research into the role of nutrition and heart disease, including many of today's dietary recommendations, may have been largely shaped by the sugar industry.

"They were able to derail the discussion about sugar for decades," said Stanton Glantz, a professor of medicine at U.C.S.F. and an author of the JAMA paper.

The documents show that a trade group called the Sugar Research Foundation, known today as the Sugar Association, paid three Harvard scientists the equivalent of about $50,000 in today's dollars to publish a 1967 review of research on sugar, fat and heart disease. The studies used in the review were handpicked by the sugar group, and the article, which was published in the prestigious New England Journal of Medicine, minimized the link between sugar and heart health and cast aspersions on the role of saturated fat.

Even though the influence-peddling revealed in the documents dates back nearly 50 years, more recent reports show that the food industry has continued to influence nutrition science.

Last year, an article in The New York Times revealed that Coca-Cola, the world's largest producer of sugary beverages, had provided millions of dollars in funding to researchers who sought to play down the link between sugary drinks and obesity. In June, The Associated Press reported that candy makers were funding studies that claimed that children who eat candy tend to weigh less than those who do not.

The Harvard scientists and the sugar executives with whom they collaborated are no longer alive. One of the scientists who was paid by the sugar industry was D. Mark Hegsted, who went on to become the head of nutrition at the United States Department of Agriculture, where in 1977 he helped draft the forerunner to the federal government's dietary guidelines. Another was Dr. Fredrick J. Stare, the chairman of Harvard's nutrition department.

In a statement responding to the JAMA report, the Sugar Association said that the 1967 review was published at a time when medical journals did not typically require researchers to disclose funding sources. The New England Journal of Medicine did not begin to require financial disclosures until 1984.


National Weight Loss Registry

James O. Hill, Ph.D. is Professor of Pediatrics and Medicine at the University of Colorado Health Sciences Center in Denver, Colorado. Dr. Hill also serves as the Director of the Center for Human Nutrition, a nutrition center funded by the National Institutes of Health. He holds a B.S. degree from the University of Tennessee and M.S. and Ph.D. degrees from the University of New Hampshire in Physiological Psychology. He has served on numerous government panels, including the National Institutes of Health (NIH) Taskforce on the Prevention and Treatment of Obesity. He is a past chair of the NIH Nutrition Study Section. He served as Chair of the World Health Organization Consultation on Obesity in 1997. He is a past president of the North American Association for the Study of Obesity (NASSO) and is a current regional vice-president of the International Association for the Study of Obesity (IASO). He was also a member of the Expert Panel on Obesity of the National Institutes of Health that developed U.S guidelines for the treatment and prevention of obesity. Dr. Hill has published more than 200 scientific articles and book chapters in the area of obesity. His research in the obesity field involves the study of lifestyle factors that affect body weight regulation. Dr. Hill is co-founder of America on the Move, a national weight gain prevention initiative that aims to inspire Americans to make small changes in how much they eat and how much they move to prevent weight gain. He established The Colorado Weigh, a behavioral weight management program that is offered to the public. He is the author of the Step Diet Book, published in June 2004. Dr. Hill is a co-founder with Dr. Rena Wing of the National Weight Control Registry. He has received numerous awards including a prestigious MERIT award from the NIH.


Sunday, September 11, 2016

SugarScience.org | SugarScience

SugarScience.org is designed as an authoritative source for the scientific evidence about sugar and its impact on health. Developed by a team of health scientists from the University of California, San Francisco (UCSF), the site reflects an exhaustive review of more than 8,000 scientific papers that have been published to date, with a focus on the areas where the science is strongest – specifically, on diabetes, heart disease and liver disease. The goal of SugarScience is to take this information out of medical journals and make it available to the public, to help individuals and communities make healthy choices.

SugarScience enables you to:

    Explore the latest, evidence-based research on the health effects of sugar overconsumption;
    Ask the SugarScientists questions to clear up confusion or learn more about sugar's impact on our health;
    Download flyers, posters or graphics from the SugarScience Resource Kit to post on your refrigerator, share with friends or family, or use in presentations to your community and schools;
    Stay connected through our newsletter, SugarScience Alerts, featuring new science and expert perspectives, and follow us on social media.


President Obama Signs DARK Act Into Law | Food & Water Watch

While campaigning for president eight years ago, Obama promised to label GMOs. Now he's struck a blow to our right to know what's in our food.

By Christian Detisch

On Friday, President Obama signed into law a bill best described as the Denying Americans the Right to Know (DARK) Act, striking down Vermont's popular, democratically enacted law requiring clear, easy to read GMO labels on food packaging. The bill also pre-empts labeling laws in Connecticut, Maine, Alaska and seed labeling laws in Vermont and Virginia while also preventing other states from adopting similar legislation in the future.

Over 90% of Americans support clear mandatory GMO labeling, but President Obama signed this giveaway to the Big Food industry, despite promising Americans he would label GMOs as part of his 2008 presidential run. The DARK Act, supported by Senators Pat Roberts (R-Kan.) and Debbie Stabenow (D-Mich.), as well as trade groups representing the Big Food industry like the Grocery Manufacturers Association and biotech companies such as Monsanto, is an unfortunate example of how powerful corporations and moneyed interests have taken over our democracy.


The Human Experiment

The Human Experiment lifts the veil on the shocking reality that thousands of untested chemicals are in our everyday products, our homes and inside of us. Simultaneously, the prevalence of many diseases continues to rise. From Oscar® winner Sean Penn and Emmy® winning journalists Dana Nachman and Don Hardy, The Human Experiment tells the personal stories of people who believe their lives have been affected by chemicals and takes viewers to the front lines as activists go head-to-head with the powerful and well-funded chemical industry. These activists bring to light a corrupt system that's been hidden from consumers... until now.


Can Being Toxic Make Me Fat? - Dr. Mark Hyman

These toxins, which include plastics, pesticides, phthalates, bisphenol A, flame retardants, mercury, lead, arsenic or any one of the 80,000 chemicals introduced into our world since the industrial revolution, can interfere with your metabolism and cause weight gain even when you stick with a normal-calorie diet.

That "new car smell" provides a great example.  That "scent" that you are breathing in daily is most likely formaldehyde, which has been shown to cause adverse health effects, and even cancer.

Why We Should Avoid Obesogens!

We call these environmental toxins obesogens, or foreign chemical compounds that disrupt fat metabolism and create weight gain.

Obesogens are more prevalent than you might imagine. Stop and consider the average newborn has 287 chemicals in his or her umbilical cord blood. Since they are brand new to the world, you can see that exposure only gets worse from there.

Studies show early-life exposure to environmental toxins can play a major role in predisposing animals to insulin resistance, hormone disruptions and obesity. Toxins promote weight gain in many ways, including affecting your metabolism, your hormones and your brain function.

As we become more toxic, we get fatter. Obesity rates continue to rise in the US and abroad. Almost 70 percent of Americans are overweight. The latest study from the Centers for Disease Control and Prevention (CDC) shows about 35 percent of Americans are obese.

Even animals and lab rats are getting fatter, suggesting an environmental aspect independent of calorie intake and energy expenditure. And in fact, animal studies show toxic chemicals can cause weight gain independent of any change in calorie intake or exercise.

Where do these toxins come from? They lurk in your cosmetics, skincare products, soaps, shampoos, deodorant, food, water, air, household cleaners, plastic food storage containers, furniture, mattresses, and carpets.

Maybe you carry a plastic water bottle and Tupperware to work every day. These products contain chemicals that leach into our water and food. These and other toxins can really wreak havoc on your health.


The Biggest “Drug” to Reverse or Prevent Heart Disease Isn’t a Medication - Dr. Mark Hyman

The "EPIC" study published in the Archives of Internal Medicine studied how 23,000 people adhered to four simple behaviors: Not smoking, exercising 3.5 hours a week, eating a healthy diet and maintaining a healthy weight. Adhering to those four behaviors alone prevented 93 percent of diabetes, 81 percent of heart attacks, 50 percent of strokes, and 36 percent of all cancers.

Likewise, the INTERHEART study, published in the Lancet in 2004, followed 30,000 people in 52 countries. Researchers found changing lifestyle could prevent at least 90 percent of all heart disease.

Other research shows lifestyle intervention becomes more effective than almost any other traditional medical intervention to reduce cardiovascular disease, hypertension, heart failure, stroke, cancer, diabesity and deaths from all causes.

Your environment, in turn, changes gene expression, subsequently modulating inflammation, oxidative stress and metabolic dysfunction. These are the reasons we get sick and develop heart disease along with other problems.

That's actually good news. Addressing and fixing the root causes benefits most chronic disease. These modifications will make you feel alive and healthy without the side effects of medication.

Occasionally, I will use medications if I feel a patient shows a strong genetic predisposition for heart disease or if significant heart disease already exists. Under those circumstances, I carefully weigh a medication's risks and benefits.

At the same time, most patients can achieve the benefits of most medications through lifestyle changes.

Dr. David Jenkins from the University of Toronto compared treatment with statin drugs (the number one cholesterol medication) with a diet rich in viscous fiber, almonds, soy and plant sterols. Researchers in this study found that, while they created almost equal benefits, diet became more effective to lower inflammation and homocysteine (a risk marker for heart disease).


Friday, September 9, 2016

Migraine Prevention: Is There a Link to Vitamin Deficiency?

Past research demonstrated an association between adults and children with migraine disorders and vitamin deficiencies. However, there have been other studies that discounted this connection.13

The team, led by Dr. Suzanne Hagler, a headache medicine fellow in the division of neurology at Cincinnati Children's Hospital, evaluated over 7,400 participants.

Researchers took baseline levels of riboflavin, vitamin D, folate and coenzyme Q10 (CoQ10). A high percentage of the children, teens and young adults had mild CoQ10, vitamin D and riboflavin deficiencies.14

Interestingly, they found young women and girls were more likely to experience a CoQ10 deficiency and boys were more likely to suffer from vitamin D deficiency.15

Additionally, they discovered an association in women between migraines and cardiovascular disease and mortality. Participants suffering from chronic migraines at regular intervals had an increased risk of CoQ10 and riboflavin deficiency, compared to those with episodic migraines occurring at infrequent intervals.

Many of the patients in this study were also prescribed preventative therapy and too few were given just supplements for the researchers to determine if supplementation alone was enough to prevent migraines.16

The researchers found that an alarming 16 to 51 percent of participants had below average levels of vitamins depending on the vitamin tested.17


Thursday, September 8, 2016

Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance | The BMJ

Enhanced liver fibrosis (ELF) blood test

The ELF test is a blood test used to measure liver damage. The test uses an algorithm of three serum biomarkers found in the blood to calculate an ELF score:

    Hyaluronic acid

    Procollagen III amino terminal peptide

    Tissue inhibitor of metalloproteinase 1.


Wednesday, September 7, 2016

Patients' memory for medical information

Memory for medical information is often poor and inaccurate, especially when the patient is old or anxious. Patients tend to focus on diagnosis-related information and fail to register instructions on treatment. Simple and specific instructions are better recalled than general statements. Patients can be helped to remember medical information by use of explicit categorization techniques. In addition, spoken information should be supported with written or visual material. Visual communication aids are especially effective in low-literacy patients, but video or multimedia techniques do not improve memory performance or adherence to therapy.


Diet and Physical Activity for Cardiovascular Disease Prevention - American Family Physician

Cardiovascular disease (CVD) is the leading cause of death in the United States.1 From 2008 to 2010, CVD accounted for 272,668 deaths annually in persons younger than 80 years. Nearly one-third of deaths from CVD are considered potentially preventable.1 The American Heart Association (AHA) has published recommendations defining ideal cardiovascular health. Recommendations for physical activity in adults are at least 150 minutes of moderate-intensity aerobic activity or at least 75 minutes of vigorous-intensity aerobic activity per week.2  Ideal cardiovascular health also includes adhering to at least four of five components of a diet consistent with the Dietary Approaches to Stop Hypertension (DASH) eating plan (Table 1).2


Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding | JAMA Pediatrics | JAMA Network

Conclusions and Relevance  Children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties, and the associations do not appear to be explained by unmeasured behavioral or social factors linked to acetaminophen use insofar as they are not observed for postnatal or partner's acetaminophen use. Although these results could have implications for public health advice, further studies are required to replicate the findings and to understand mechanisms.


New Review Offers Providers and Researchers Evidence-Based Information on Complementary Health Approaches for Pain | NCCIH

Today, Mayo Clinic Proceedings published a review, "Evidence-based Evaluation of Complementary Health Approaches for Pain Management in the United States," which I authored, along with several NCCIH colleagues.

We know that while most pain is acute and improves within a short time, millions of Americans suffer from more persistent pain that may become chronic and debilitating over time.

Medications may not completely relieve chronic pain or can produce unwanted side effects. As a result, many people may turn to complementary health approaches to help manage their pain. Our overall goal was to summarize the evidence-base on what is safe and effective when it comes to complementary approaches for pain.


Vitamin B12 as Protection for the Aging Brain - NYTimes.com

European researchers have also shown that giving B12 to people deficient in the vitamin helped protect many of the areas of the brain damaged by Alzheimer's disease. In a two-year study at the University of Oxford of 270 people older than 70 with mild cognitive impairment and low B12 levels, Dr. Helga Refsum, a professor of nutrition at the University of Oslo, found reduced cerebral atrophy in those treated with high doses of the vitamin.

"A B12 vitamin deficiency as a cause of cognitive issues is more common than we think, especially among the elderly who live alone and don't eat properly," Dr. Rajarethinam said.

The academy estimates that between 10 percent and 30 percent of people older than 50 produce too little stomach acid to release B12 from its carrier protein in foods, and as the years advance, the percentage of low-acid producers rises.


What’s the Value of Exercise? $2,500 - NYTimes.com

For people still struggling to make time for exercise, a new study offers a strong incentive: You'll save $2,500 a year.

The savings, a result of reduced medical costs, don't require much effort to accrue — just 30 minutes of walking five days a week is enough.

The findings come from an analysis of 26,239 men and women, published today in the Journal of the American Heart Association. Researchers from a number of universities and hospitals around the country, including Baptist Health South Florida, Yale, Johns Hopkins, Emory and Baylor, decided to see if they could determine what being active or inactive costs each of us annually in health care spending.

Scientists and health policy experts have known for some time that inactivity is expensive at the public health level. Sedentary people are more likely than physically fit people to develop a number of diseases.


Methylation plays role in prostate cancer

Background: Prostate cancer development is initially steroid hormone dependent. Estrogen receptors (ERs), androgen receptors (ARs), and progesterone receptors (PRs) have been identified in normal and cancerous prostate tissues. We investigated whether the promoter regions of these steroid receptor genes are methylated and inactivated in prostate cancer cells and tissues. Methods: The expression and promoter methylation status of three ERα isoforms (ERα-A, ERα-B, and ERα-C), ERβ, two PR isoforms (PR-A and PR-B), and AR were investigated in five prostate cancer cell lines (ND1, DU145, PC3, LNCaP, and DUPro) and in pairs of normal and cancerous prostate tissues from 38 patients with prostate cancer. Methylation-specific polymerase chain reaction, reverse transcription–polymerase chain reaction, and 5` rapid amplification of complementary DNA ends were used. All statistical tests were two-sided. Results: ERα-C was expressed in all cell lines, but ERα-A and ERα-B were not expressed in any cell line. ERα-A and ERα-B promoters were methylated, but ERα-C was unmethylated. Promoters for ERβ, AR, PR-A, and PR-B were methylated and thus inactivated in some cell lines but not in others. Treating cells with the demethylating reagent 5-aza-2`-deoxycytidine restored expression of all steroid receptor genes with previously methylated promoters. All 38 pairs of cancer and normal tissues had unmethylated ERα-C promoters. Thirty-six (95%) of 38 cancers had methylated ERα-A, 35 (92%) of 38 cancers had methylated ERα-B, but all normal tissues had unmethylated ERα-A and ERα-B (both P<.001). ERβ was methylated in 30 (79%) of 38 cancers but unmethylated in all normal tissues. AR was methylated in three (8%) of 38 cancers but unmethylated in all normal tissues. PR-A and PR-B were unmethylated in all tissues. Conclusion: Certain steroid receptor genes appear to be inactivated by CpG methylation in prostate cancer tissue and cell lines.


High quality evidence suggests Vitamin D can reduce asthma attacks

A new Cochrane Review, published in the Cochrane Library today, has found evidence from randomised trials, that taking an oral vitamin D supplement in addition to standard asthma medication is likely to reduce severe asthma attacks.

Asthma is a common chronic disease affecting about 300 million people worldwide. The symptoms of asthma include wheezing, coughing, chest tightness and shortness of breath.

Low blood levels of vitamin D have been linked to increased risk of asthma attacks in children and adults with asthma. There has been a growing interest in the potential role of vitamin D in asthma management because it might help to reduce upper respiratory infections, (such as the common cold) that can lead to exacerbations of asthma. Several clinical trials have tested whether taking vitamin D as a supplement has an effect on asthma attacks, symptoms and lung function in children and adults with asthma.

The team of Cochrane researchers found seven trials involving 435 children and two studies, involving 658 adults. The study participants were ethnically diverse, reflecting the broad range of global geographic settings, involving Canada, India, Japan, Poland, the UK, and the U.S. The majority of people recruited to the studies had mild to moderate asthma, and a minority had severe asthma. Most people continued to take their usual asthma medication while participating in the studies. The studies lasted for between six and 12 months.

The researchers found that giving an oral vitamin D supplement reduced the risk of severe asthma attacks requiring hospital admission or emergency department attendance from 6% to around 3%.They also found that vitamin D supplementation reduced the rate of asthma attacks needing treatment with steroid tablets. These results are based largely on trials in adults. They also found that vitamin D did not improve lung function or day-to-day asthma symptoms, and that it did not increase the risk of side effects at the doses that were tested.

The Cochrane Review's lead author, Professor Adrian Martineau from the Asthma UK Centre for Applied Research, Queen Mary University of London, said, "We found that taking a vitamin D supplement in addition to standard asthma treatment significantly reduced the risk of severe asthma attached, without causing side effects."

He added, "This is an exciting result, but some caution is warranted. First, the findings relating to severe asthma attacks come from just three trials: most of the patients enrolled in these studies were adults with mild or moderate asthma. Further vitamin D trials in children and in adults with severe asthma are needed to find out whether these patient groups will also benefit. Second, it is not yet clear whether vitamin D supplements can reduce risk of severe asthma attacks in all patients, or whether this effect is just seen in those who have low vitamin D levels to start with. Further analyses to investigate this questions are on-going, and results should be available in the next few months."

The findings of this Cochrane Review are to be presented at the ERS (European Respiratory Society) Congress in London on Tuesday 6th September.


Monday, September 5, 2016

What's With Wheat - What's With Wheat

Why have we become so wheat intolerant?

'What's With Wheat?' documentary investigates the growing epidemic of wheat intolerance and why after eating wheat for thousands of years, it has been linked to so many health problems.


Air Fresheners Are Toxic And What You Perceive As Pleasant Is Not Worth The Damage To Your Health

The use of chemical air fresheners either in our cars, home or exposure to them at the office, restaurants, health clubs or any other indoor location may be causing long-term health damage to our lungs which may not even be noticeable in the short-term. Headaches, earaches, depression, an irregular heart beat, and diarrhea are just a few of many health challenges that have been linked to regular use of synthetic air fresheners. Indoor air quality is a serious pollution threat and all artificially scented products and fragrances, regardless of the type are major contributors to the problem.
We spend 90 percent of our time indoors, but have you ever thought about the purity of the air that you are breathing as you sit inside?

Indoor air quality is considered to be the fourth greatest pollution threat to Americans by the Environmental Protection Agency (EPA). Even if you can never see, and can't always smell, the chemicals inside your home, they are there. It comes from cleaning products, drycleaning chemicals, plastic products like computer keyboards, furniture, paint, carpeting and more. However, air fresheners are one of the biggest sources of voluntary pollution we place on ourselves.

A report that was released in September of 2007 by the Natural Resources Defense Council found that 12 of 14 brands of common household air fresheners contained phthalates . Phthalates are chemicals that are used to prolong the length of time that scented products maintain their fragrance. Regular exposure to phthalates can increase your risk of experiencing endocrine, reproductive, and developmental problems. Amazingly, some of the brands that tested positive for phthalates did not include phthalates on their lists of ingredients; some of these brands were even labeled as being "all-natural" and "unscented." Other often contain napthelene and formaldehyde.

Most air fresheners mask odors with a synthetic fragrance or numb your sense of smell with chemical anesthetics. But, they do nothing to eliminate the source of the odor. Also, aerosol air fresheners spew out tiny droplets of chemicals that are easily inhaled into the lungs.


Sunday, September 4, 2016

Blood Test for Colorectal Cancer: The Last Resort?

Despite recommendations, many Americans in the target age group are not getting screened for colorectal cancer.

However, a new blood-based screening test may help boost those rates because of its simplicity and convenience for the patient.

The downside is that the new test is not as sensitive or accurate as a colonoscopy or the other recommended screening approaches.

Approved in April 2016, the Epi proColon (Epigenomics AG) is the first blood-based colorectal screening test to get a thumbs-up from the US Food and Drug Administration (FDA).

This molecular test detects methylated Septin 9 DNA in plasma, which is increased in colorectal cancer and can be found in tumor DNA that has been shed into the bloodstream from both colon and rectal sites. This makes it a differential biomarker for the early detection of colorectal cancer, according to the manufacturer.

Available in Europe since 2012, it is also being marketed in other countries, including China.

The question now facing healthcare providers is, Where does this new test fit in the current armamentarium of screening options?

"It's the new kid on the block, another alternative, and one that isn't as highly recommended as the current options that are available," said Andrew Chan, MD, an associate professor of medicine at Harvard Medical School and a practicing gastroenterologist at Massachusetts General Hospital in Boston.

The major advantage of the Epi proColon is that because it is fast, easy, and noninvasive, it may appeal to individuals who have shunned other screening approaches.


The Vegan RD | Plant Protein: A Vegan Nutrition Primer

a lentils and a bowlProtein is often a big worry for people contemplating a vegan diet. It's important after all. We need it for muscles, bones, hormones, digestive enzymes, absorption of nutrients and to rebuild and replenish all kinds of cells. So knowing a little about sources of protein and recommendations for vegans can be helpful and reassuring.

Protein and Amino Acids

Proteins in foods and in the human body are composed of 20 amino acids. We humans can synthesize eleven of these as long as we get sufficient nitrogen from our diets. (Nitrogen is a component of every amino acid.)

The other nine amino acids—called essential amino acids (EAAS)—have to come from food since we can't make them. So our need for protein is actually a need for these nine essential amino acids plus enough nitrogen to manufacture the other eleven.

Every plant protein contains all nine of the EAAs. They aren't missing any of them, but (with the exception of soy protein) they are always a little low in one or two EAAs. As a result, the amino acid patterns in plants are a less precise match to human protein needs.

At one time, nutrition experts thought the answer to this was to combine proteins from different plant foods. Since grains and beans have complementary strengths and weaknesses in their EAA patterns, eating them together produced a "complete" amino acid pattern—that is, a pattern that mimics patterns found in human body proteins. And that wasn't really a big deal, because historically, it's the way most people have eaten: black beans and rice, lentil soup with bread, pinto beans with corn tortillas, hummus with pita bread.

Careful protein combining has turned out to be unnecessary, though. This is because the body maintains a reserve pool of amino acids from various sources for later use. Basically, your body can do its own "complementing" with the amino acids in a meal (1). The evidence also suggests that protein consumed at one meal can combine with protein consumed later in the day.

Protein combining is now considered an old-fashioned idea that isn't relevant in vegan or vegetarian diets.


Vegan Diets and Irritable Bowel Syndrome: The FODMAP Approach | The Vegan RD

Vegan Diets and Irritable Bowel Syndrome: The FODMAP Approach
By Ginny Messina on March 8, 2016

One of the most frequent questions I get through this website is about the low-FODMAP diet. This popular approach to easing symptoms of irritable bowel syndrome (IBS) eliminates (at least initially) many plant foods. It's definitely a bit of a challenge for vegans, but may be worth it if you suffer from IBS.


IBS affects as much as 15% of the population in North America, so it is no small problem. And while it's not life-threatening, it can have a significant effect on quality of life.

The idea behind the low-FODMAP diet is that certain fermentable short-chain carbohydrates contribute to symptoms in people with IBS. Some of these carbs are poorly digested and some are not digested at all. Others, like lactose in milk or the sugar fructose, are digested by some but not all people.

Since they aren't digested, these carbs aren't absorbed. Instead, they travel to the colon where they are fermented by bacteria, resulting in gas production. They can also pull water into the lower intestines, creating an uncomfortable feeling of distension. For most people, these effects are not a problem or at least, they are felt to only a minor degree. But people with IBS may be hypersensitive to the effects of water and gas in their lower intestines.

The FODMAP approach limits these fermentable carbs for several weeks to see if IBS symptoms improve. If you feel better after avoiding these foods, the next step is to determine which type of fermentable carbs are responsible for your symptoms. This is achieved by gradually adding foods back one at a time.

Some research suggests that about 75 percent of people with IBS may be helped with the FODMAP approach.


Plant Protein May Help Offset Unhealthy Habits

After accounting for lifestyle factors such as smoking, drinking, obesity and physical inactivity, each 3 percent increase in calories from plant protein was associated with a 10 percent lower risk of death during the study period.

In contrast to the benefits seen with plants, each 10 percent increase in the proportion of calories from animal protein was associated with a 2 percent higher risk of death from any cause and an 8 percent increased risk of death from cardiovascular disease during the study period.

This association between animal protein and mortality was even stronger for people who were obese or heavy drinkers, researchers report in JAMA Internal Medicine, online August 1.


Saturday, September 3, 2016

Atrazine Herbicide - The Forgotten Toxin

    "Syngenta, which is set to be acquired by Chinese state-owned ChemChina, said atrazine is safe and that the EPA report 'contains numerous data and methodological errors and needs to be corrected.' If the EPA's report is finalized as written, it could cause label restrictions so severe that they would 'effectively ban the product from most uses,' the Iowa Corn Growers Association said."

Curious Conflict of Interest

Like Monsanto, Syngenta produces patented genetically engineered (GE) seeds, designed to tolerate the pesticides they sell. This is a clear conflict of interest, as their seed business is little more than a means to sell more pesticides.

Another particularly curious conflict of interest raised by Hayes relates to the fact that, up until the year 2000, Syngenta not only produced atrazine, which induces aromatase that causes overproduction of estrogen — an effect that could raise your risk of breast cancer — but the company also produced another chemical, letrozol, which has the converse effect.

It's an aromatase inhibitor that blocks estrogen production, and letrozol was, and still is, a commonly used as treatment for breast cancer.

    "[T]he company was simultaneously, in 2000, making a chemical that induced estrogen and promoted breast cancer, and making a chemical that blocked estrogen production and was used to treat breast cancer. So there's a clear conflict of interest there."


ACS by Plaque Erosion? No Stent, Dual Antiplatelets May Be Enough

ROME, ITALY — A small, 1-month pilot study hints that patients who arrive in the emergency department with ACS caused by plaque erosion, not plaque rupture, may not need to have a stent implanted. Instead, conservative treatment with antithrombotic therapy alone may be enough to restore flow at the thrombus site[1].

The study found that one in four patients with ACS had plaque erosion, which agrees with what was seen in pathology studies, according to the researchers, but it also showed for the first time that plaque erosion can be distinguished from plaque rupture by optical coherence tomography (OCT) in living patients. If confirmed, such patients might be spared from having a stent, plus any stent-related complications, they say.


F.D.A. Bans Sale of Many Antibacterial Soaps, Saying Risks Outweigh Benefits

Where is triclosan found?
It’s nearly ubiquitous in liquid hand soap and dishwashing detergent, but those aren’t the only products it’s in. Triclosan is also a common ingredient in toothpaste, facewash, deodorant, a host of personal care products, and even mattresses, toothbrushes and shoe insoles. A U.S. FDA advisory committee has found that household use of antibacterial products provides no benefits over plain soap and water, and the American Medical Association recommends that triclosan not be used in the home, as it may encourage bacterial resistance to antibiotics.

What problems are associated with triclosan?
Triclosan is linked to liver and inhalation toxicity, and low levels of triclosan may disrupt thyroid function. Wastewater treatment does not remove all of the chemical, which means it ends up in our lakes, rivers and water sources. That’s especially unfortunate since triclosan is very toxic to aquatic life.


WASHINGTON — The Food and Drug Administration banned the sale of soaps containing certain antibacterial chemicals on Friday, saying industry had failed to prove they were safe to use over the long term or more effective than using ordinary soap and water.

In all the F.D.A. took action against 19 different chemicals and has given industry a year to take them out of their products. About 40 percent of soaps — including liquid hand soap and bar soap – contain the chemicals. Triclosan, mostly used in liquid soap, and triclocarban, in bar soaps, are by far the most common.

The rule applies only to consumer hand washes and soaps. Other products may still contain the chemicals. At least one toothpaste, Colgate Total, still does, but the F.D.A. says its maker proved that the benefits of using it — reducing plaque and gum disease — outweigh the risks.

The agency is also studying the safety and efficacy of hand sanitizers and wipes, and has asked companies for data on three active ingredients — alcohol (ethanol or ethyl alcohol), isopropyl alcohol and benzalkonium chloride — before issuing a final rule on them.

Public health experts applauded the rule, which came after years of mounting concerns that the antibacterial chemicals that go into everyday products are doing more harm than good. Experts have pushed the agency to regulate antimicrobial chemicals, warning that they risk scrambling hormones in children and promoting drug-resistant infections.

“It has boggled my mind why we were clinging to these compounds, and now that they are gone I feel liberated,” said Rolf Halden, a scientist at the Biodesign Institute at Arizona State University, who has been tracking the issue for years. “They had absolutely no benefit but we kept them buzzing around us everywhere. They are in breast milk, in urine, in blood, in babies just born, in dust, in water.”

The agency first proposed the rule in 2013, when it told companies that unless they could prove that chemicals like triclosan and triclocarban did more good than harm, they would have to remove the products that contained them from the market. On Friday, the agency said that it was not convinced.

The F.D.A. has given industry more time to prove that an additional three chemicals are safe and effective — benzalkonium chloride, benzethonium chloride and chloroxylenol. Products with those chemicals can stay on the market for now.

The American Cleaning Institute, a trade group, opposed the rule, saying the agency “has in its hands data that shows the safety and effectiveness of antibacterial soaps.” The group said manufacturers were continuing to work to provide even more science and research “to fill data gaps identified by the F.D.A.”

But some of the largest companies have already started removing the chemicals, in part a reaction to rising consumer concerns. Both Johnson & Johnson and Procter & Gamble announced their intention to phase out the chemicals in their products before the rule was made final, said Dr. Theresa Michele, the director of the division of nonprescription drug products at the F.D.A.’s Center for Drug Evaluation and Research.

Studies in animals have shown that triclosan and triclocarban can disrupt the normal development of the reproductive system and metabolism, and health experts warn that their effects could be the same in humans. The chemicals were originally used by surgeons to wash their hands before operations, and their use exploded in recent years as manufacturers added them to a variety of products, including mouthwash, laundry detergent, fabrics and baby pacifiers. The Centers for Disease Control and Prevention found the chemicals in the urine of three-quarters of Americans.

Dr. Halden began publishing findings on what appeared to be risks of triclocarban in 2004. He said it is an older chemical, part of the family of organochlorines, like DDT and hexachlorophene, some of which were eventually banned. Newer chemicals are much lighter on the environment, he said, but triclocarban takes a very long time to disappear. In one study in New York City, for example, his team found traces of it that dated back to the 1960s.

“It was still sitting there in Jamaica Bay near J.F.K. Airport,” he said. “This stuff makes no sense.”


FDA: No Soap For You!

The Food and Drug Administration has banned antibacterial soaps containing the chemicals triclosan and triclocarban, and more bans could be on the way. NBC's Mark Barger reports.


Is Butter Really Back? - Mark Hyman MD

“Dr. Hyman, I have been so confused about saturated fat,” writes this week’s house call. “The government still says to limit saturated fat, yet I read in the news how maybe it’s not really connected to heart disease? Is butter really back?”

I understand why there is so much confusion around butter and saturated fat. The diet debates have America spinning.  Some advocate for putting dollops of butter in coffee, while others shun avocados and nuts as harmful, heart-disease-promoting and fattening foods.  What’s the average eater to do?

Three recent studies add to an increasing body of evidence that saturated fat is not the evil, heart-disease-producing substance we once thought. A recent large review of the research found that the higher the saturated fat intake in the population, the lower the risk of stroke.

Another study of 3,333 people over 15 years led by Dr. Dariush Mozaffarian of Tufts, examined not dietary history but actual blood levels of fats, and found that those with the highest level of dairy fat (essentially, butter in the blood) had up to a 44 percent lower risk of developing diabetes compared to those who had the lowest levels of dairy fat in their blood.

And a third study, just published after 40 years, looked at 9,400 people residing in mental hospitals who were fed either butter and saturated fats or corn oil (omega-6 fats).  The researchers found surprising results. The corn oil group had a much greater reduction in LDL cholesterol (30 mg/dl vs. 5 mg/dl) but a higher risk of heart attacks than the saturated fat group.

Is butter a health food? Probably not. Should it be shunned? For sure not. A review of the literature and a growing consensus among a large group of leading scientists suggest that we, for far too long, have unfairly maligned butter and saturated fats.

America first went low-fat in earnest in 1980, when our government told us to cut the fat. That message was then reinforced with the USDA’s infamous food pyramid, which encouraged us to eat 6 to 11 servings of bread, rice, cereal and pasta a day.

Eleven servings of bread a day? That sounds a little crazy now. But back then, most Americans took that advice. As a result, we are now fatter and sicker than ever, with nearly 70 percent of us overweight and one in two with pre-diabetes or type 2 diabetes. And while death rates from heart disease are declining due to better treatments, the percent of the population developing heart disease is increasing significantly.

What happened to our diet over the last century?  According U.S. Department of Agriculture records, our intake of saturated fats, eggs and meat decreased — butter from 9 to 4.6 pounds, lard and tallow from 10.5 to 6.0 pounds, red meat 71 to 60 pounds per person, per year. Egg consumption dropped from 374 to 250 per year. But our intake of refined vegetable oils increased from 9.8 to 35.2 pounds per person, per year, chicken by 57 percent, sugar by 39 percent and grains by 45 percent.

While our total calorie consumption has increased (we eat more of everything), our fat consumption has decreased from 40 to 30 percent of our diet, and our sugar and carbohydrate consumption has increased dramatically.  And yet, obesity, diabetes and the incidents of heart disease are all increasing.

Today, we know some things we didn’t know back when we originally received all that low-fat dietary counsel. First, review after review after independent review of the research shows that there seems to be very little link between saturated fats and heart disease. In the absence of refined (starchy) carbs and sugars, and in the presence of adequate omega-3 fats, saturated fat itself is in no way linked to heart disease.

So why all the mixed messages? Well, the fact is, dietary saturated fat raises total and LDL cholesterol. But not all cholesterol is created equal. In fact, saturated fat improves the quality of the LDL cholesterol by increasing the less harmful large fluffy LDL particles, while also lowering triglycerides and raising your levels of good HDL cholesterol. A low-fat, high-carb diet, meanwhile, makes cholesterol quality worse.

Total cholesterol, and especially LDL-C cholesterol, is not the best predictor of heart disease risk. What matters is the total-cholesterol-to-HDL ratio, and the LDL particle number and size. These are the factors that are the most predictive of heart disease. Eating more fat (except trans fats) and lowering sugar and refined carbs is one of the best ways (in addition to eating more non-starchy vegetables) to improve the quality of your cholesterol.

In fact, small LDL particles (from low-fat, high-carb diets) are associated with three times the risk of heart attacks compared to total LDL cholesterol. Saturated fat and fat in the context of a lower sugar and refined carbohydrate diet increases the LDL particle size (which is a good thing). Evidence also suggests that a bigger predictor of the extent of cardiac disease is the triglyceride-to-HDL ratio, not total or LDL cholesterol. That ratio is also improved by a higher total and saturated-fat diet, and worsened by refined carbs and sugars.  The evidence tying higher-fat diets to greater weight loss and improvements in cardiovascular risk factors has been repeated in many other studies.

What about all the calories in fat (gram for gram, it has more than twice as many calories as carbs and proteins)? Shouldn’t we cut out fat to lose weight?  While a shrinking number of health professionals still suggest that low-fat diets are best for weight loss, the overwhelming scientific consensus no longer supports the conclusion that total fat causes obesity.

In a recent review of 53 high-quality, randomized, controlled trials, comprising research that compared low-fat to high-fat diets, lasting at least a year, researchers found that in more than 68,128 people, the high-fat diets led to greater weight loss than the low-fat diets. The researchers included only the best quality studies (53 out of 3,517 studies).

This is why the 2015 Dietary Guidelines removed its previous limits on total dietary fat. They also removed the previous limits on dietary cholesterol, saying it was “no longer a nutrient of concern.”  After reviewing the evidence, the USDA Dietary Guidelines Advisory Committee concluded: “Reducing total fat (replacing total fat with overall carbohydrates) does not lower CVD [cardiovascular disease] risk.… Dietary advice should put the emphasis on optimizing types of dietary fat and not reducing total fat.”

So is butter really back?  In a word. Yes.


Is Academic Medicine for Sale? - NEJM

"The combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion) [in 2002]. Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself." - Dr. Angell

In 1984 the Journal became the first of the major medical journals to require authors of original research articles to disclose any financial ties with companies that make products discussed in papers submitted to us.1 We were aware that such ties were becoming fairly common, and we thought it reasonable to disclose them to readers. Although we came to this issue early, no one could have foreseen at the time just how ubiquitous and manifold such financial associations would become. The article by Keller et al.2 in this issue of the Journal provides a striking example. The authors' ties with companies that make antidepressant drugs were so extensive that it would have used too much space to disclose them fully in the Journal. We decided merely to summarize them and to provide the details on our Web site.

Finding an editorialist to write about the article presented another problem. Our conflict-of-interest policy for editorialists, established in 1990,3 is stricter than that for authors of original research papers. Since editorialists do not provide data, but instead selectively review the literature and offer their judgments, we require that they have no important financial ties to companies that make products related to the issues they discuss. We do not believe disclosure is enough to deal with the problem of possible bias. This policy is analogous to the requirement that judges recuse themselves from hearing cases if they have financial ties to a litigant. Just as a judge's disclosure would not be sufficiently reassuring to the other side in a court case, so we believe that a policy of caveat emptor is not enough for readers who depend on the opinion of editorialists.

But as we spoke with research psychiatrists about writing an editorial on the treatment of depression, we found very few who did not have financial ties to drug companies that make antidepressants. (Fortunately, Dr. Jan Scott, who is eminently qualified to write the editorial,4 met our standards with respect to conflicts of interest.) The problem is by no means unique to psychiatry. We routinely encounter similar difficulties in finding editorialists in other specialties, particularly those that involve the heavy use of expensive drugs and devices.

In this editorial, I wish to discuss the extent to which academic medicine has become intertwined with the pharmaceutical and biotechnology industries, and the benefits and risks of this state of affairs. Bodenheimer, in his Health Policy Report elsewhere in this issue of the Journal, 5 provides a detailed view of an overlapping issue — the relations between clinical investigators and the pharmaceutical industry.

The ties between clinical researchers and industry include not only grant support, but also a host of other financial arrangements. Researchers serve as consultants to companies whose products they are studying, join advisory boards and speakers' bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in the companies.

Although most medical schools have guidelines to regulate financial ties between their faculty members and industry, the rules are generally quite relaxed and are likely to become even more so. For some years, Harvard Medical School prided itself on having unusually strict guidelines. For example, Harvard has prohibited researchers from having more than $20,000 worth of stock in companies whose products they are studying.6 But now the medical school is in the process of softening its guidelines. Those reviewing the Harvard policy claim that the guidelines need to be modified to prevent the loss of star faculty members to other schools. The executive dean for academic programs was reported to say, “I'm not sure what will come of the proposal. But the impetus is to make sure our faculty has reasonable opportunities.”7

Academic medical institutions are themselves growing increasingly beholden to industry. How can they justify rigorous conflict-of-interest policies for individual researchers when their own ties are so extensive? Some academic institutions have entered into partnerships with drug companies to set up research centers and teaching programs in which students and faculty members essentially carry out industry research. Both sides see great benefit in this arrangement. For financially struggling medical centers, it means cash. For the companies that make the drugs and devices, it means access to research talent, as well as affiliation with a prestigious “brand.” The time-honored custom of drug companies' gaining entry into teaching hospitals by bestowing small gifts on house officers has reached new levels of munificence. Trainees now receive free meals and other substantial favors from drug companies virtually daily, and they are often invited to opulent dinners and other quasi-social events to hear lectures on various medical topics. All of this is done with the acquiescence of the teaching hospitals.

What is the justification for this large-scale breaching of the boundaries between academic medicine and for-profit industry? Two reasons are usually offered, one emphasized more than the other. The first is that ties to industry are necessary to facilitate technology transfer — that is, the movement of new drugs and devices from the laboratory to the marketplace. The term “technology transfer” entered the lexicon in 1980, with the passage of federal legislation, called the Bayh–Dole Act,8 that encouraged academic institutions supported by federal grants to patent and license new products developed by their faculty members and to share royalties with the researchers. The Bayh–Dole Act is now frequently invoked to justify the ubiquitous ties between academia and industry. It is argued that the more contacts there are between academia and industry, the better it is for clinical medicine; the fact that money changes hands is considered merely the way of the world.

A second rationale, less often invoked explicitly, is simply that academic medical centers need the money. Many of the most prestigious institutions in the country are bleeding red ink as a result of the reductions in Medicare reimbursements contained in the 1997 Balanced Budget Act and the hard bargaining of other third-party payers to keep hospital costs down. Deals with drug companies can help make up for the shortfall, so that academic medical centers can continue to carry out their crucial missions of education, research, and the provision of clinical care for the sickest and neediest. Under the circumstances, it is not surprising that institutions feel justified in accepting help from any source.
I believe the claim that extensive ties between academic researchers and industry are necessary for technology transfer is greatly exaggerated, particularly with regard to clinical research. There may be some merit to the claim for basic research, but in most clinical research, including clinical trials, the “technology” is essentially already developed. Researchers are simply testing it. Furthermore, whether financial arrangements facilitate technology transfer depends crucially on what those arrangements are. Certainly grant support is constructive, if administered properly. But it is highly doubtful whether many of the other financial arrangements facilitate technology transfer or confer any other social benefit. For example, there is no conceivable social benefit in researchers' having equity interest in companies whose products they are studying. Traveling around the world to appear at industry-sponsored symposiums has much more to do with marketing than with technology transfer. Consulting arrangements may be more likely to further the development of useful products, but even this is arguable. Industry may ask clinical researchers to become consultants more to obtain their goodwill than to benefit from their expertise. The goodwill of academic researchers is a very valuable commodity for drug and device manufacturers. Finally, it is by no means necessary for technology transfer that researchers be personally rewarded. One could imagine a different system for accomplishing the same purpose. For example, income from consulting might go to a pool earmarked to support research or any other mission of the medical center.

What is wrong with the current situation? Why shouldn't clinical researchers have close ties to industry? One obvious concern is that these ties will bias research, both the kind of work that is done and the way it is reported. Researchers might undertake studies on the basis of whether they can get industry funding, not whether the studies are scientifically important. That would mean more research on drugs and devices and less designed to gain insights into the causes and mechanisms of disease. It would also skew research toward finding trivial differences between drugs, because those differences can be exploited for marketing. Of even greater concern is the possibility that financial ties may influence the outcome of research studies.

As summarized by Bodenheimer,5 there is now considerable evidence that researchers with ties to drug companies are indeed more likely to report results that are favorable to the products of those companies than researchers without such ties. That does not conclusively prove that researchers are influenced by their financial ties to industry. Conceivably, drug companies seek out researchers who happen to be getting positive results. But I believe bias is the most likely explanation, and in either case, it is clear that the more enthusiastic researchers are, the more assured they can be of industry funding.

Many researchers profess that they are outraged by the very notion that their financial ties to industry could affect their work. They insist that, as scientists, they can remain objective, no matter what the blandishments. In short, they cannot be bought. What is at issue is not whether researchers can be “bought,” in the sense of a quid pro quo. It is that close and remunerative collaboration with a company naturally creates goodwill on the part of researchers and the hope that the largesse will continue. This attitude can subtly influence scientific judgment in ways that may be difficult to discern. Can we really believe that clinical researchers are more immune to self-interest than other people?

When the boundaries between industry and academic medicine become as blurred as they now are, the business goals of industry influence the mission of the medical schools in multiple ways. In terms of education, medical students and house officers, under the constant tutelage of industry representatives, learn to rely on drugs and devices more than they probably should. As the critics of medicine so often charge, young physicians learn that for every problem, there is a pill (and a drug company representative to explain it). They also become accustomed to receiving gifts and favors from an industry that uses these courtesies to influence their continuing education. The academic medical centers, in allowing themselves to become research outposts for industry, contribute to the overemphasis on drugs and devices. Finally, there is the issue of conflicts of commitment. Faculty members who do extensive work for industry may be distracted from their commitment to the school's educational mission.

All of this is not to gainsay the importance of the spectacular advances in therapy and diagnosis made possible by new drugs and devices. Nor is it to deny the value of cooperation between academia and industry. But that cooperation should be at arm's length, with both sides maintaining their own standards and ethical norms. The incentives of the marketplace should not become woven into the fabric of academic medicine. We need to remember that for-profit businesses are pledged to increase the value of their investors' stock. That is a very different goal from the mission of medical schools.
What needs to be done — or undone? Softening its conflict-of-interest guidelines is exactly the wrong thing for Harvard Medical School to do. Instead, it should seek to encourage other institutions to adopt stronger ones. If there were general agreement among the major medical schools on uniform and rigorous rules, the concern about losing faculty to more lax schools — and the consequent race to the bottom — would end. Certain financial ties should be prohibited altogether, including equity interest and many of the writing and speaking arrangements. Rules regarding conflicts of commitment should also be enforced. It is difficult to believe that full-time faculty members can generate outside income greater than their salaries without shortchanging their institutions and students.

As Rothman urges, teaching hospitals should forbid drug-company representatives from coming into the hospital to promote their wares and offer gifts to students and house officers.9 House officers should buy their own pizza, and hospitals should pay them enough to do so. To the argument that these gifts are too inconsequential to constitute bribes, the answer is that the drug companies are not engaging in charity. These gifts are intended to buy the goodwill of young physicians with long prescribing lives ahead of them. Similarly, academic medical centers should be wary of partnerships in which they make available their precious resources of talent and prestige to carry out research that serves primarily the interests of the companies. That is ultimately a Faustian bargain.
It is well to remember that the costs of the industry-sponsored trips, meals, gifts, conferences, and symposiums and the honorariums, consulting fees, and research grants are simply added to the prices of drugs and devices. The Clinton administration and Congress are now grappling with the serious problem of escalating drug prices in this country. In these difficult times, academic medicine depends more than ever on the public's trust and goodwill. If the public begins to perceive academic medical institutions and clinical researchers as gaining inappropriately from cozy relations with industry — relations that create conflicts of interest and contribute to rising drug prices — there will be little sympathy for their difficulties. Academic institutions and their clinical faculty members must take care not to be open to the charge that they are for sale.