Dr. Bray Links

Saturday, April 7, 2018

Intestinal microbiota as a tetrahydrobiopterin exogenous source

We further confirmed that at least two PTPS-2-producing species, Aldercreutzia equolifaciens and Microbacterium schleiferi, generate BH4 and are present in hph-1 fecal material. In conclusion, intestinal Actinobacteria generate BH4. This finding has important translational significance, since manipulation of the intestinal flora in individuals with congenital biopterin deficiency may allow for an increase in total body BH4 content.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227711/#!po=1.16279

Friday, March 30, 2018

Federal Agency Courted Alcohol Industry to Fund Study on Benefits of Moderate Drinking

It was going to be a study that could change the American diet, a huge clinical trial that might well deliver all the medical evidence needed to recommend a daily alcoholic drink as part of a healthy lifestyle.

That was how two prominent scientists and a senior federal health official pitched the project during a presentation at the luxurious Breakers Hotel in Palm Beach, Fla., in 2014. And the audience members who were being asked to help pay for the $100 million study seemed receptive: They were all liquor company executives.

The 10-year government trial is now underway, and Anheuser Busch InBev, Heineken and other alcohol companies are picking up most of the tab, through donations to a private foundation that raises money for the National Institutes of Health.

The N.I.H., a federal agency, is considered one of the world’s foremost medical research centers, investing over $30 billion of taxpayer money in biomedical research each year. The vast majority of the funding goes to scientists outside the N.I.H., which manages the grants and provides oversight.

The alcohol study is overseen by the National Institute on Alcohol Abuse and Alcoholism, one of 27 centers under the N.I.H. The lead investigator and N.I.H. officials have said repeatedly that they never discussed the planning of the study with the industry. But a different picture emerges from emails and travel vouchers obtained by The New York Times under the Freedom of Information Act, as well as from interviews with former federal officials.
...

https://www.nytimes.com/2018/03/17/health/nih-alcohol-study-liquor-industry.html

Sunday, March 25, 2018

Sodium bisulfite

Sodium bisulfite is also added to leafy green vegetables in salad bars and elsewhere, to preserve apparent freshness, under names like LeafGreen. The concentration is sometimes high enough to cause severe allergic reactions.[12]


https://en.m.wikipedia.org/wiki/Sodium_bisulfite

Saturday, March 17, 2018

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

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

https://www.medscape.com/viewarticle/894032

Thursday, March 15, 2018

'Reinventing Healthcare' Without the People Who Care for Patients

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

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

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

https://www.medscape.com/viewarticle/893790

Arsenic, Lead Found in Popular Protein Supplements - Consumer Reports

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

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

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

https://www.consumerreports.org/dietary-supplements/heavy-metals-in-protein-supplements/

Thursday, March 8, 2018

America's Love/Hate Relationship With Doctors

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

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

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

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

https://www.medscape.com/viewarticle/888837

Wednesday, March 7, 2018

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

Abstract

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

https://www.ncbi.nlm.nih.gov/pubmed/29474822

Tuesday, March 6, 2018

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

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

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

https://www.medscape.com/viewarticle/893421

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

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


http://www.latimes.com/science/sciencenow/la-sci-sn-opioid-painkillers-no-better-20180306-story.html

Sunday, March 4, 2018

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

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

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

http://www.bbc.com/news/health-43246261

Saturday, March 3, 2018

Calcium Supplements Up Risk for Precancerous Serrated Polyps



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

https://www.medscape.com/viewarticle/893319

Wednesday, February 28, 2018

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

Results:

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

https://academic.oup.com/jcem/article/99/11/4346/2836774

Sunday, February 25, 2018

E-cigarettes leak toxic metals, study finds

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

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

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


https://www.medicalnewstoday.com/articles/321006.php

Saturday, February 24, 2018

Nixtamalization

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

https://en.m.wikipedia.org/wiki/Nixtamalization

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

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

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

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

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

http://www.newsweek.com/impact-cleaning-products-lung-health-bad-20-day-cigarette-habit-study-810277

Newly invented eyedrops could replace glasses altogether

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

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

https://www.rt.com/news/419711-eyedrops-invention-israel-glasses/

EHR Time Exceeds Patient Face Time in Family Practice Visits

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

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

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

https://www.medscape.com/viewarticle/893038

Friday, February 23, 2018

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

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


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

http://thehill.com/opinion/healthcare/375348-health-cares-fundamental-problem-your-doctor-doesnt-work-for-you

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

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

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

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

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

https://www.medpagetoday.com/practicemanagement/practicemanagement/71252

Wednesday, February 21, 2018

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

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

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

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

https://mobile.nytimes.com/2018/02/20/well/eat/counting-calories-weight-loss-diet-dieting-low-carb-low-fat.html

Monday, February 19, 2018

Advanced glycation endproducts, dityrosine and arginine transporter dysfunction in autism



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

https://molecularautism.biomedcentral.com/articles/10.1186/s13229-017-0183-3

Acetaminophen Use Alters Sex Hormones, May Cause Birth Defects?



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

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

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

https://www.medscape.com/viewarticle/892824

New C difficile Guidelines Refine Diagnosis, Add FMT

The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have updated the 2010 clinical practice guidelines on Clostridium difficile infection (CDI) in adults.

The update adds recommendations for children, refines combinations and sequences of diagnostic tests, and changes antibiotic choices. It also, for the first time, includes guidance for implementing fecal microbiota transplantation (FMT). The guidelines are published in Clinical Infectious Diseases.

https://www.medscape.com/viewarticle/892813

Ketogenic Drinks Improve Glycemia and Insulin Sensitivity

A ketone supplement, taken as a so-called 'keto drink' half an hour prior to consuming glucose, reduces glycemic response and improves markers of insulin sensitivity without affecting insulin secretion, show data from a small randomized cross-over study in healthy volunteers.

According to the authors, led by Étienne Myette-Côté, PhD candidate, from the University of British Columbia Okanagan, Kelowna, Canada, "ketone monoester supplements could have therapeutic potential in the management and prevention of metabolic disease." The article was published online February 15 in the Journal of Physiology.

https://www.medscape.com/viewarticle/892829

Friday, February 16, 2018

Adult endothelial stem cells can make fully functional blood vessels

"Our findings show that CD157-positive vascular endothelial stem cells give rise to a hierarchy of cell types that can repair vascular injury and maintain the normal blood vessel architecture," Takakura says. "We believe these findings represent an entirely new way of thinking about how blood vessels are formed and, ultimately, how stem cells can be used to treat disorders related to blood vessel malfunction."

https://www.sciencedaily.com/releases/2018/02/180215105734.htm

Thursday, February 15, 2018

Ultra-processed foods 'linked to cancer' - BBC News

What counts as ultra-processed

    Mass-produced packaged breads and buns
    Sweet or savoury packaged snacks including crisps
    Chocolate bars and sweets
    Sodas and sweetened drinks
    Meatballs, poultry and fish nuggets
    Instant noodles and soups
    Frozen or shelf-life ready meals
    Foods made mostly or entirely from sugar, oils and fats

http://www.bbc.com/news/health-43064290

Wednesday, February 14, 2018

Chemicals in packaging, carpets and non-stick pans 'may contribute to obesity'

Chemicals used to make non-stick pots and pans, stain-resistant carpets, and food packaging may contribute to high levels of obesity by disrupting the body's ability to burn calories, scientists say.

Researchers at Harvard University examined the effects of compounds called perfluoroalkyl substances (PFASs), which have already raised concerns among some health experts after animal experiments and other studies linked them to cancer, high cholesterol and immune problems.

In the latest work, Qi Sun, a nutritionist who specialises in the risk factors for diabetes, obesity, and cardiovascular disease, analysed records for 621 overweight and obese people who spent six months dieting. All were part of a clinical trial run in the 2000s to test the effectiveness of different types of diets.


https://www.theguardian.com/science/2018/feb/13/chemicals-in-packaging-carpets-and-non-stick-pans-may-contribute-to-obesity

Monday, February 12, 2018

Prescription Opioids Increase Risk for Serious Infections



Animal studies have shown that some opioid medications have immunosuppressive effects. The drugs interfere with the production of bacteria-killing immune cells, reduce the innate immune response, and inhibit the production of antibodies and cytokines. Previous human studies have shown that opioid medications increase the risk for infection in hospitalized patients after surgery or during treatment for burns or cancer. Other studies suggest an increased risk for serious infections in certain high-risk outpatients.

Now, the new study strengthens the evidence that the immune-suppressing effects of opioids extend to humans.

"[W]e found that current opioid use was strongly and consistently associated with the risk for [invasive pneumococcal disease (IPD),] and that the association was strongest for long-acting and high-potency formulations, opioids previously described as immunosuppressive, and high-dose opioids," write Andrew Wiese, PhD, from the Department of Health Policy at Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues.

https://www.medscape.com/viewarticle/892586

Saturday, February 10, 2018

Inexpensive Technology Can Spot Fake Organic Milk – Will the USDA Look? - Cornucopia Institute

How much fresh grass did the "grass-fed" cows who make your milk eat? A team of scientists from Iowa State University's Leopold Center for Sustainable Agriculture has found a new technique they say can determine exactly that. Their findings, reported in The Journal of Agricultural and Food Chemistry last month, suggest that fluorescence spectroscopy—a relatively cheap and simple form of light measurement—could be a way to assure shoppers about "grass-fed" claims in the supermarket. And it could prove to be an important tool for transparency in the organic dairy sector, where cows are required to spend time foraging outdoors—something critics allege doesn't always happen.


https://www.cornucopia.org/2018/02/inexpensive-technology-can-spot-fake-organic-milk-will-usda-look/#more-44857

Many people take dangerously high amounts of ibuprofen | Fox News

Many adults who use ibuprofen and other so-called nonsteroidal anti-inflammatory (NSAID) drugs take too much, increasing their risk of serious side effects like internal bleeding and heart attacks, a U.S. study suggests.

About 15 percent of adults taking ibuprofen (Motrin, Advil) or other NSAIDs like aspirin, naproxen (Aleve), celecoxib (Celebrex), meloxicam (Mobic) and diclofenac (Voltaren) exceeded the maximum recommended daily dose for these drugs, the study found.

"NSAIDs are among the most commonly used medicines in the U.S. and worldwide," said lead study author Dr. David Kaufman of Boston University.

"These drugs can have serious side effects, including gastrointestinal bleeding and heart attacks, and are often taken without medical oversight because many products are available over-the-counter," Kaufman said by email. "The attitude that users can choose their own dose regardless of label directions, along with poor knowledge of dosing limits, is associated with exceeding the daily limit."

http://www.foxnews.com/health/2018/02/08/many-people-take-dangerously-high-amounts-ibuprofen.html

Zeroing in on FODMAPs - C&EN Global Enterprise

"In healthy individuals, FODMAPs may cause a little more flatulence, but not pain, diarrhea, and bloating," says William Chey, a gastroenterologist at the University of Michigan who studies the low FODMAP diet. FODMAPs also trigger abnormalities in how IBS patients' bowels function, Chey adds. For example, their colons may be hyperactive after a meal, and FODMAPs might exacerbate that activity.
FODMAPs also seem to influence the microbes living inside the gut. Recently, a team led by Chung Owyang, another gastroenterologist at the University of Michigan, reported that FODMAPs promote the overgrowth of Gram-negative bacteria in the gut. These bacteria have cell walls that contain lipopolysaccharides, a group of molecules that can inflame the intestinal lining (J. Clin. Invest. 2017, DOI: 10.1172/JCI92390).
Owyang says his group is now starting to identify the specific Gram-negative bacteria that are richest in lipopolysaccharides. "Perhaps we can come up with ways to decrease the growth of those particular bacteria," he says.
Meanwhile, Chey's patients commonly tell him that ingesting various types of food causes their gastrointestinal (GI) problems. "You would think just logically based upon what patients have been telling us for many, many years that there would be many evidence-based diet strategies for patients with GI problems," he says. "Curiously, that has not been the case until probably the last 10 years or so."
Chey says he first learned about the low FODMAP diet in 2008 after reading a paper from Gibson and the rest of the Monash University team (Clin. Gastroenterol. Hepatol. 2008, DOI: 10.1016/j.cgh.2008.02.058). The following year, Chey gave a talk during a postgraduate course for gastroenterologists in the U.S. and asked how many of the gathered doctors had heard of FODMAPs. "Out of an audience of several thousands, fewer than half a dozen hands went up," he recalls. "People had just never even heard of this concept."
He repeated the informal survey at a similar course in 2017. "Probably 80% of the hands went up," he says. And 60% of the doctors said they were using the low FODMAP diet in their clinical practice. In just nine years, he says, the dietary treatment has become wildly popular.


https://pubs.acs.org/doi/full/10.1021/cen-09606-cover?ref=PubsWidget

Friday, February 9, 2018

Bacteriophages Plentiful in Women’s Bladders

 The researchers identified more than 450 possible phage sequences within the majority of the nearly 200 bacterial genomes that they examined. More than half of these viral sequences were not found in any databases, suggesting that they could be phages unique to the urinary tract.

"We find this time and time again," James says. "In all of the niches, there's so little known about viruses that every time you sequence any viral community, there's always a massive amount of novelty. It highlights how much we still don't know."

https://mobile.the-scientist.com/article/51548/bacteriophages-plentiful-in-women-s-bladders

Think Beyond the Bladder for Interstitial Cystitis/Bladder Pain Syndrome

PVD can result from hormonal changes, inflammation, neurological factors, and hypertonic pelvic floor muscles. Deficiency in testosterone is especially common, mostly in younger women receiving oral contraceptives and in menopausal women. Pelvic muscle health is also a big factor. When pelvic floor muscles are tight and overactive, pain can be referred to the vestibule, and this can mimic bladder pain symptoms, she said.

"The pelvis is a bowl of muscles holding the bladder up. If it's irritated, it causes the bladder 'next door' to sense pain," she said. "But it's not actually the bladder that has problem; it's the tissue around and nearby the bladder that's the problem."

https://www.medscape.com/viewarticle/887862

Thursday, February 8, 2018

Mental health: Living with Borderline Personality Disorder - BBC News

A psychiatrist I was referred to then diagnosed Borderline Personality Disorder, otherwise known as emotional instability.

I had never heard of this, but when I looked up the symptoms, I had them all.

They included struggling to maintain stable relationships, having suicidal thoughts and intense emotions that would change rapidly.

Then there was acting impulsively, feeling paranoid and suffering intense outbursts of anger. 

http://www.bbc.com/news/uk-wales-42861224

Food may influence cancer spread - BBC News



There is mounting evidence the food on your plate can alter cancer's growth and spread, say Cambridge scientists.

Animal research, published in the journal Nature, showed breast tumours struggled without the dietary nutrient asparagine.

It is found in the foodies' favourite asparagus, as well as poultry, seafood and many other foods.

In the future, scientists hope to take advantage of cancer's "culinary addictions" to improve treatment.

Asparagine is an amino acid - a building block of protein - and takes its name from asparagus. 

http://www.bbc.com/news/health-42976851

Wednesday, February 7, 2018

Largest Animal Study of Cell Phone Radiation and Cancer Risk

Specifically, exposure to Global System for Mobile Communications (GSM)–modulated or to Code Division Multiple Access (CDMA)–modulated cell phone RFR was associated with an increase in the incidence of malignant schwannoma in the heart of male rats.

There was also a significant increase in incidence of right ventricular cardiomyopathy in both male and female rats exposed to 3 watts per kilogram (W/kg) and 6 W/kg of GSM-modulated RFR, and in male rates exposed to 6 W/kg of CDMA-modulated RFR.

The researchers also observed other, albeit weaker, effects for both modulations that included malignant glioma in the brain, adenomas in the pituitary gland (pars distalis), and pheochromocytomas of the adrenal medulla.

In addition, marginal effects were seen for GSM-exposed male rats in the prostate gland and in pancreatic islets, and granular cell tumors of the brain were observed. Such effects were not observed in CDMA-exposed rats. Conversely, liver effects were noted only in CDMA-exposed male rats, although the relationship between these responses and exposure to GSM or CDMA RFR remains unclear.

https://www.medscape.com/viewarticle/892346

Vitamin D improved asthma symptoms and reduced exacerbations - PulmCCM

Multiple randomized trials have suggested that vitamin D supplementation might improve asthma control and reduce severity of asthma attacks. A new meta-analysis bolsters that hypothesis, and may encourage more physicians and people with asthma to consider vitamin D supplements for low vitamin D levels.

In a study in Lancet Respiratory Medicine, authors analyzed the experience of 955 asthma patients previously enrolled in seven randomized controlled trials testing vitamin D versus placebo.

Supplementation with vitamin D was associated with a 50% reduction in asthma attacks severe enough to require hospitalization or emergency department visit (3% vs 6%), compared to placebo. Vitamin D use was also associated with a 30% reduction in asthma attacks necessitating 

https://pulmccm.org/asthma-review/vitamin-d-improved-asthma-symptoms-reduced-exacerbations/

Acetaminophen in pregnancy: Is it really safe?

The research team — from the University of Edinburgh in the U.K. — showed that three daily doses of acetaminophen over 7 days caused the levels of testosterone in male mouse babies to drop by nearly half.

Last week, a review of studies looking at the effects of acetaminophen use and fertility in female offspring concluded that the last weeks of the first trimester may be a critical time window.

Data obtained from rodent studies indicate that acetaminophen may disrupt normal development of the female reproductive organs, causing symptoms similar to premature ovarian insufficiency syndrome in humans.

Data from three independent studies, cited in the review, revealed that when rodents received acetaminophen, their offspring produced fewer eggs.

https://www.medicalnewstoday.com/articles/320584.php

Allergens present in most homes: study

Alert your immune system: More than 90 percent of homes contain three or more detectable indoor allergens, while 73 percent harbor at least one allergen at an elevated level, according to a recent study from the National Institutes of Health.

Using the 2005-2006 National Health and Nutrition Examination Survey, researchers analyzed data from nearly 7,000 homes. They examined bedroom levels of cat, dog, cockroach, mouse, rat and mold allergens, as well as levels of two types of dust mite allergens.

Homes with pets and pests often had high allergen levels, study results showed, as did older homes, mobile homes, rental homes and homes in rural areas. Age, sex, race, ethnicity and socioeconomic levels influenced individual exposure levels.

"Elevated allergen levels can exacerbate symptoms in people who suffer from asthma and allergies, so it is crucial to understand the factors that contribute," Darryl Zeldin, senior author and National Institute of Environmental Health Sciences scientific director, said in a Nov. 30 press release.

NIH offers several tips for reducing exposure to indoor allergens and irritants

    Vacuum carpets and upholstery weekly.
    Wash sheets and blankets in hot water weekly.
    Cover mattresses, pillows and box springs in allergen-impermeable material.
    Keep indoor humidity levels below 50 percent.
    Remove pets from home or limit bedroom access.
    Seal potential entry points for pests, and remove nesting places as well as food and water sources.

The study was published online Nov. 30 in the Journal of Allergy and Clinical Immunology.

http://www.safetyandhealthmagazine.com/articles/16571-allergens-present-in-most-homes-study

Acetaminophen in pregnancy: Is it really safe?

These results are in line with a study we covered in 2016 that showed that acetaminophen use was linked to behavioral problems. The team — from the University of Bristol and Cardiff University, both in the United Kingdom — found that when mothers took acetaminophen at 18 weeks of pregnancy, their children were more likely to have conduct problems and symptoms of hyperactivity.

When the drug was used later on in pregnancy — at 32 weeks — these same traits were observed, but the risk of emotional symptoms and total behavioral difficulties was also higher.

https://www.medicalnewstoday.com/articles/320584.php

Saturday, February 3, 2018

The Fragile Generation

In free play, ideally with kids of mixed ages, the children decide what to do and how to do it. That's teamwork, literally. The little kids desperately want to be like the bigger kids, so instead of bawling when they strike out during a sandlot baseball game, they work hard to hold themselves together. This is the foundation of maturity.

The older kids, meanwhile, throw the ball more softly to the younger ones. They're learning empathy. And if someone yells, "Let's play on just one leg!"—something they couldn't do at Little League, with championships (and trophies!) on the line—the kids discover what it means to come up with and try out a different way of doing things. In Silicon Valley terms, they "pivot" and adopt a "new business model." They also learn that they, not just grown-ups, can collectively remake the rules to suit their needs. That's called participatory democracy.

https://www.zerohedge.com/news/2018-02-02/fragile-generation

Wednesday, January 31, 2018

Inspired Medicine: Getting Patients to Make Healthy Changes

The business of medicine puts its emphasis on the treatment of people who are already very sick. As an orthopedic surgeon, I got training mostly in how to repair damaged bones, joints, and flesh, and that's what I'm paid to do. But by the time someone has torn a ligament, suffered a heart attack, or lost a kidney, their lives will most likely be shorter no matter how sophisticated the drugs or surgery we have to offer.

...

We can't force our patients to stop smoking, exercise, eat well, get plenty of sleep, or receive vaccines. We can't grab the guns out of their hands if they've made up their minds to shoot themselves. But we can inspire them to take care of themselves.

... 

There's a reason why the lifespans in places like Monaco and Japan are so much longer than ours, and it's not superior DNA. It has a lot to do with culture, and as physicians, we must lead the change.

https://www.medscape.com/viewarticle/891885

Sunday, January 28, 2018

Want to Reduce Burnout? Tackle System Problems, Experts Say



In exchange for time spent on such tasks as mentoring, serving on committees, and covering shifts for other providers, Stanford's pilot program allowed faculty members to receive work- and home-related services: meal delivery, cleaning services, or grant-writing support, for instance, New England Journal of Medicine national correspondents Alexi A. Wright, MD, MPH, from Harvard Medical School and the Dana Farber Cancer Institute, and Ingrid T. Katz, MD, MHS, from Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, explain.

The initiative was successful, particularly among female faculty members, who in a survey conducted by the school were most likely to report feeling unsupported or undersupported in their career development. "Though this initiative was meant for all physicians and basic scientists, women used these services more frequently than men, and the number of female faculty members who reported 'feeling supported' had nearly doubled by the end of the pilot program," the authors write.

Programs such as time banking signify an important cultural shift in medicine, according to Tait Shanafelt, MD, who joined Stanford Medicine in September 2017 as the organization's chief wellness officer. Stanford is the first academic medical center in the country to create an executive-level position of this kind focused specifically on clinician well-being. But many more will likely follow as the true cost of burnout — medical errors, poor clinical outcomes, high turnover, low engagement — becomes increasingly obvious, Dr. Shanafelt said in an interview with Medscape Medical News. "Physician burnout is eroding the soul of medicine. Organizations need to constantly gauge the well-being of providers and develop and implement research-based interventions to address the practice considerations that contribute to clinician suffering."


https://www.medscape.com/viewarticle/891849

Lab-Confirmed Flu Virus Linked to Imminent Risk for Acute MI

Patients with laboratory-confirmed influenza were about six times as likely to be admitted for acute MI in the following 7 days compared with the period comprising the prior and subsequent years, results of a cohort study show.[1]

The risk was especially pronounced in older patients and was independent of flu vaccination status or history of MI hospitalization. There was also a signal that other forms of respiratory infection can similarly raise the risk for MI admission.

https://www.medscape.com/viewarticle/891823

Thursday, January 25, 2018

Dr. Greger's Daily Dozen

In the years of research required to create the more than a thousand evidence-based videos on NutritionFacts.org, Michael Greger, MD, FACLM, has arrived at a list of what he considers the most important foods to include in a healthy daily diet. Yes, greens are good for you, but how much should we try to eat each day? Dr. Greger's Daily Dozen details the healthiest foods and how many servings of each we should try to check off every day. He explains his rationale in his book How Not to Die (http://NutritionFacts.org/book). All his proceeds from his books, DVDs, and speaking engagements is all donated to charity.

NutritionFacts.org is a non-commercial, nonprofit, science-based public service provided by Dr. Greger, providing free daily updates on the latest in nutrition research via bite-sized videos. He has nearly a thousand videos on every aspect of healthy eating, with new videos and articles uploaded every day. Like this app, everything on the website is both free of ads and free of charge.

This app was developed thanks to the volunteer efforts of John Slavick.


https://play.google.com/store/apps/details?id=org.nutritionfacts.dailydozen

Nonpharma Intervention Cuts Dementia Risk by a Third

Participants were randomly assigned to one of three types of cognitive training — memory, reasoning, or speed of processing — or to a control group that received no cognitive training.

Each training arm consisted of ten 60- to 75-minute sessions over 5 to 6 weeks. The memory and reasoning training took place in a classroom format with pencil-and-paper types of exercises.

"The memory training taught people strategies they can use to better remember lists of information, and the reasoning training taught strategies to recognize patterns to be able to better solve problems," said Dr Edwards.

The speed of processing training was the only computerized intervention. This training targets "mental quickness," which, said Dr Edwards, declines with age.

https://www.medscape.com/viewarticle/888747

Green Leafy Vegetables Linked to Slower Cognitive Decline

Eating one serving of green leafy vegetables per day may help to slow cognitive decline with aging, a new study suggests.

In the prospective study of an older US community population, consumption of green leafy vegetables was linearly associated with slower cognitive decline.

The rate of decline among those who consumed one to two servings per day was the equivalent of being 11 years younger compared with those who rarely or never consumed green leafy vegetables, the researchers say.

Investigation of the nutrients for which green leafy vegetables are a rich or primary source indicated that higher food intakes of folate, phylloquinone, and lutein were each linearly associated with slower cognitive decline and appeared to account for the protective correlation of green leafy vegetables to cognitive change.

https://www.medscape.com/viewarticle/891051

New Stroke Treatment Guidelines - What's Hot at ISC 2018?

DEFUSE 3: This National Institutes of Health–funded trial is looking to expand the therapeutic window for thrombectomy out to 16 hours from time of stroke onset. "The DEFUSE 3 trial is seen as complementary to the recently reported DAWN trial, which showed a benefit of thrombectomy when used out to 24 hours in patients selected by clinical mismatch," Dr Ovbiagele commented. "DEFUSE differs in that the patients were selected for inclusion using imaging techniques to identify those who had a large potentially salvageable area of brain. It will be interesting to see if the results are different with these different ways of selecting patients."  

https://www.medscape.com/viewarticle/891558

Acupuncture for Chronic Pain: Unprecedented Advances



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

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

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

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

Wednesday, January 24, 2018

Obesity is contagious, new research finds

"The social influence component is an important component, and too much attention may have been focused just on the built environment," said Ms. Datar, a senior economist at the Dornsife Center for Economic and Social Research at the University of Southern California. "That doesn't seem to be where the answer is, that you can build all these parks and things. There's the social influence aspect that has to be addressed as well."

Ms. Datar, with co-author Nancy Nicosia of the Rand Corp., set out on a study that evaluated how location influences obesity rates in military families, who often move around the country because of where they are needed and not by personal choice.

"To be honest with you, we were not expecting to find a social contagion," said Ms. Datar, adding that the study originally was meant to look at how the built environment influenced obesity rates in neighborhoods.

https://m.washingtontimes.com/news/2018/jan/24/obesity-contagious-new-research-finds/

Lazy lifestyles to cause surge in serious illness

More than two million older people will have at least four serious illnesses within 20 years because of the increase in obesity and lazy lifestyles, a large study warns.

Those in middle age are so unhealthy that as they get older two thirds of over-65s are forecast to have at least two conditions such as cancer, dementia or arthritis, up from half today.

Experts believe that past estimates of the rising cost of treating an ageing population are too low because they do not take into account this increasing level of sickness.

https://www.thetimes.co.uk/edition/news/lazy-lifestyles-to-cause-surge-in-serious-illness-630qftw22

Tuesday, January 23, 2018

APOE4 Carriers Also Reap Cognitive Benefits of Healthy Lifestyle Changes

In subgroup analyses of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, the cognitive benefits of the multipronged intervention targeting diet, exercise, cognitive training, and vascular risk factors did not significantly differ between apolipoprotein E (APOE) ε4 carriers and noncarriers and might actually be more pronounced in APOE ε4 carriers.

"This is good news for people who worry that genetic risk factors for dementia may somehow hinder potential benefits from healthy lifestyle changes," Alina Solomon, MD, PhD, from the Institute of Clinical Medicine/Neurology, University of Eastern Finland in Kuopio, told Medscape Medical News.

https://www.medscape.com/viewarticle/891667

Saturday, January 20, 2018

What's the Best 'Breathing Retraining' for Uncontrolled Asthma?

A recent trial[1] compared two methods of breathing retraining: self-taught, using a video; or three face-to-face sessions with a respiratory therapist. The training focused on diaphragmatic breathing, nasal breathing, and slow breathing, as well as controlled breath holds and simple relaxation exercises.

Compared with usual care, both methods of breathing retraining improved asthma-related quality of life. Although the interventions didn't change measures of airway inflammation or obstruction, patients reported increased control over breathing and reduced need for medication. They also felt more relaxed.

So, for your patients struggling with their asthma, consider adding breathing retraining to their treatment. Even patients who don't have easy access to respiratory therapists can benefit from the self-taught video training. It's a simple, low-cost option.

https://www.medscape.com/viewarticle/891195

The Doctor Of The Future: Prescribing Lifestyle As Medicine | Mark Rowe | TEDxUCD

Thursday, January 18, 2018

Five-foot long tapeworm came 'wiggling out' of man's body after he ate sushi

The emergency room physician was initially skeptical when the man insisted to residents at Community Regional Medical Center, "I really want to get treated for worms" until he saw for himself the disgusting proof.

After being unraveled, the tapeworm ended up being 5.5 feet long. The patient said he felt the worm "wiggling out" and then, began to remove the worm, which started moving.

http://www.foxnews.com/health/2018/01/18/five-foot-long-tapeworm-came-wiggling-out-mans-body-after-ate-sushi.html

This new blood test can detect early signs of 8 kinds of cancer

Scientists have developed a noninvasive blood test that can detect signs of eight types of cancer long before any symptoms of the disease arise.

The test, which can also help doctors determine where in a person's body the cancer is located, is called CancerSEEK. Its genesis is described in a paper published Thursday in the journal Science.

The authors said the new work represents the first noninvasive blood test that can screen for a range of cancers all at once: cancer of the ovary, liver, stomach, pancreas, esophagus, colon, lung and breast.

Together, these eight forms of cancer are responsible for more than 60% of cancer deaths in the United States, the authors said.

http://www.latimes.com/science/sciencenow/la-sci-sn-blood-test-cancer-20180118-story.html

Tuesday, January 16, 2018

Are Meta-Analyses a Form of Medical Fake News? | Circulation

How many dreadful manuscripts describing the results of a meta-analysis are submitted to and rejected from journals each year? We cannot know, but many published meta-analyses do not use appropriate methods or contribute meaningfully to medical thought or patient care. Some journals avoid all meta-analyses, whereas others pride themselves on publishing only the best; still others are delighted to have anything to print in an era where the number of opportunities to publish greatly exceeds the number of valid observations.

Many have critically examined the methodology of meta-analysis, and others have set standards for their execution. Despite such guidance, meta-analyses continue to proliferate, but we should ask: do they really contribute? Esteemed organizations regard the conclusions of a well-executed meta-analysis as a higher level of evidence than a single well-done clinical trial. This commentary explains why this cannot possibly be true.

http://circ.ahajournals.org/content/136/22/2097.long

Nora Gedgaudas The Silent Autoimmunity Explosion

Monday, January 15, 2018

Engineered commensal microbes for diet-mediated colorectal-cancer chemoprevention | Nature Biomedical Engineering

Chemoprevention—the use of medication to prevent cancer—can be augmented by the consumption of produce enriched with natural metabolites. However, chemopreventive metabolites are typically inactive and have low bioavailability and poor host absorption. Here, we show that engineered commensal microbes can prevent carcinogenesis and promote the regression of colorectal cancer through a cruciferous vegetable diet. The engineered commensal Escherichia coli bound specifically to the heparan sulphate proteoglycan on colorectal cancer cells and secreted the enzyme myrosinase to transform host-ingested glucosinolates—natural components of cruciferous vegetables—to sulphoraphane, an organic small molecule with known anticancer activity. The engineered microbes coupled with glucosinolates resulted in >95% proliferation inhibition of murine, human and colorectal adenocarcinoma cell lines in vitro. We also show that murine models of colorectal carcinoma fed with the engineered microbes and the cruciferous vegetable diet displayed significant tumour regression and reduced tumour occurrence.

https://www.nature.com/articles/s41551-017-0181-y

L-carnitine for hyperthyroidism?

Old studies in animals and unblinded studies in a few hyperthyroid patients suggested that L -carnitine is a periferal antagonist of thyroid hormone action at least in some tissues. This conclusion was substantiated by our recent observation that carnitine inhibits thyroid hormone entry into the nucleus of hepatocytes, neurons, and fibroblasts. In the randomized, double-blind, placebo-controlled 6-month trial reported here, we assessed whether 2 or 4 g/d oral L-carnitine were able to both reverse and prevent/minimize nine hyperthyroidism- related symptoms. We also evaluated changes on nine thyroid hormone-sensitive biochemical parameters and on vertebral and hip mineral density (bone mineral density). Fifty women under a fixed TSH-suppressive dose of L -T(4) for all 6 months were randomly allocated to five groups of 10 subjects each. Group 0 associated placebo for 6 months; groups A2 and A4 started associating placebo (first bimester), substituted placebo with 2 or 4 g/d carnitine (second bimester), and then returned to the association with placebo. Groups B2 and B4 started associating 2 and 4 g/d carnitine for the first two bimesters, and then substituted carnitine with placebo (third bimester). Symptoms and biochemical parameters worsened in group 0. In group A, symptoms and biochemical parameters worsened during the first bimester, returned to baseline or increased minimally during the second bimester (except osteocalcin and urinary OH-proline), and worsened again in the third bimester. In group B, symptoms and biochemical parameters (except osteocalcin and urinary OH-proline) did not worsen or even improved over the first 4 months; they tended to worsen in the third bimester. In both the A and B groups, the two doses of carnitine were similarly effective. At the end of the trial, bone mineral density tended to increase in groups B and A (B > A). In conclusion, L-carnitine is effective in both reversing and preventing symptoms of hyperthyroidism and has a beneficial effect on bone mineralization. Because hyperthyroidism depletes the body deposits of carnitine and since carnitine has no toxicity, teratogenicity, contraindications and interactions with drugs, carnitine can be of clinical use.

https://www.ncbi.nlm.nih.gov/pubmed/11502782


The present pilot study has shown that L-Carn + Se significantly reduced symptoms associated with SHyper, improving QoL of patients, without significant modifications of their endocrine profile. In addition, it is noteworthy that the extension of treatment seems necessary to prevent symptoms reappearance. Prospective randomized controlled trials are needed to address clinicians to define the appropriate treatment-settings for this disorder.'

https://www.ncbi.nlm.nih.gov/pubmed/28537653

Saturday, January 13, 2018

Over-the-counter mouthwash use and risk of pre-diabetes/diabetes - ScienceDirect

Over-the-counter mouthwash comprises part of routine oral care for many; however, potential adverse effects of the long-term daily use have not been evaluated. Most mouthwash contain antibacterial ingredients, which could impact oral microbes critical for nitric oxide formation, and in turn predispose to metabolic disorders including diabetes. Our aim was to evaluate longitudinally the association between baseline over-the-counter mouthwash use and development of pre-diabetes/diabetes over a 3-year follow-up.

http://www.sciencedirect.com/science/article/pii/S1089860317301532

Thursday, January 11, 2018

Perverse Incentives: Do You See What I See? - PulmCCM

Recently, a 91-year-old relative had a serious intracerebral hemorrhage, but recovered miraculously. It is really hard for him to get around, but he always goes for an annual checkup. His stroke wasn't going to stop him from his routine.

During the visit, his physician told him that the office x-ray equipment wasn't working, and that he needed to return in 2 weeks for his routine annual chest x-ray (which was normal during his recent stroke). When I heard the story, I told him that the x-ray wasn't needed. He didn't need to make special arrangements to return to the office.

So he asked: "Why would a physician ask me to return for a test that I didn't need?"

Good question. Why do physicians check the serum cholesterol in women who have advanced ovarian cancer?

Too many physicians order tests and recommend procedures primarily because they can be paid to do them.

Many healthcare practices -- and entire health systems -- focus on generating revenues in every possible way. The goal is to eke out every dollar from every patient interaction. In many instances, it means encouraging patients to undergo tests and procedures that are not needed but will be reimbursed.

This obsession with revenues is destroying medicine.

https://pulmccm.org/policy-ethics-education-review/warning-physicians-perverse-incentives-may-impair-vision/

Pfizer to Halt Alzheimer’s and Parkinson’s Drug Research | The Scientist Magazine(R)

 US pharmaceutical corporation Pfizer announced plans this week to abandon research of new drugs to treat Alzheimer's and Parkinson's diseases. The decision will result in about 300 layoffs in the company's neuroscience discovery and early development programs, which are located in Massachusetts and Connecticut, according to a statement emailed to journalists.

"We have made the decision to end our neuroscience discovery and early development efforts and reallocate funding to those areas where we have strong scientific leadership and that will allow us to provide the greatest impact for patients," the company says in the statement (via Reuters).

https://mobile.the-scientist.com/article/51264/pfizer-to-halt-alzheimer-s-and-parkinson-s-drug-research

Monday, January 8, 2018

US child mortality ranks worst among 20 wealthy countries, study finds - CNN

The United States has the worst overall child mortality rate compared with those of 19 other wealthy nations in the Organisation for Economic Co-operation and Development.
That's according to a study published in the journal Health Affairs on Monday.
The study examined child mortality rates between 1961 and 2010 in the US and comparable nations in the OECD, a group of 35 countries, founded to improve economic development and social well-being around the world. It found that mortality rates were not evenly distributed.

"This study should alarm everyone. The US is the most dangerous of wealthy, democratic countries in the world for children," said Dr. Ashish Thakrar, lead author of the study and an internal medicine resident at Johns Hopkins Hospital and Health System in Baltimore.

http://www.cnn.com/2018/01/08/health/child-mortality-rates-by-country-study-intl/index.html

Hospital Medicine: Better, or Less Personal, Care?

"As the number of physicians caring for a patient increases, the depth of the relationship between patient and physician tends to diminish — a phenomenon of particular concern to those who regard the patient–physician relationship as the core of good medical care."

More physicians involved in a patient's care may result in miscommunication and discoordination of care, especially at admission and discharge.

"From the patient's point of view, it can be highly disconcerting to discover that the physician who knows you best will not even see you at your moment of greatest need — when you are in the hospital, facing serious illness or injury," Dr Gunderman explains. "The patient–physician relationship is built largely on trust, and levels of trust are usually lower among strangers."

Community physicians are also at risk for less professional and personal fulfilment when they do not oversee their patients' hospitalizations. Potential disadvantages for the medical profession include increased fragmentation of patient care, faster burnout, and less knowledge sharing and camaraderie.

Hospitalists may suffer from lack of outpatient experience, becoming less accountable to nonhospitalized patients and their communities, and therefore less effective advocates for comprehensive medical care. Their employment by hospitals may shift their loyalty away from patients and their profession.

https://www.medscape.com/viewarticle/867409

Mortality Lower When Inpatients See Their Own PCP in Hospital

Unadjusted 30-day mortality was lowest among patients cared for by PCPs, followed by the rates in those cared for by hospitalists and other generalists (8.6%, 10.8%, and 11.0%, respectively; test of difference, P < .001).

"These findings persisted in adjusted analyses for PCPs (AOR, 0.94; 95% CI, 0.91 - 0.97; P < .001) and other generalists (AOR, 1.09; 95% CI, 1.07 - 1.12; P < .001), with hospitalists as the reference group," the authors write.

This pattern also remained significant in a sensitivity analysis that accounted for the complexity of the admission and patient disease burden. "For example, patients cared for by PCPs had the lowest 30-day mortality across all 3 physician groups at all quantiles of DRG complexity and patient comorbidities," the authors write.

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

Many Adults With Arthritis Not Receiving Exercise Counseling

"[T]he prevalence of counseling remains low for a self-managed behavior (exercise) with proven benefits and few risks, especially among those who are inactive. Various strategies such as health care provider education and training in exercise counseling and electronic medical record prompts might increase health care provider counseling for exercise among adults with arthritis," Jennifer Hootman, PhD, from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues write.

Approximately 54 million Americans have arthritis. Many of these people also have common comorbidities, such as diabetes, heart disease, and obesity, for which exercise is recommended to improve disease control.  However, arthritis pain can be a barrier to exercise for people with these conditions.

At the same time, exercise can decrease the pain of arthritis. The American College of Rheumatology recommends exercise as first-line nonmedication therapy for managing osteoarthritis symptoms. One of the goals of the Healthy People 2020 initiative is to increase counseling about the benefits of exercise for people with arthritis.

https://www.medscape.com/viewarticle/891015

Ibuprofen linked to male infertility, study says - CNN

Ibuprofen has a negative impact on the testicles of young men, a study published Monday in the journal Proceedings of the National Academy of Sciences found. When taking ibuprofen in doses commonly used by athletes, a small sample of young men developed a hormonal condition that typically begins, if at all, during middle age. This condition is linked to reduced fertility.
Advil and Motrin are two brand names for ibuprofen, an over-the-counter pain reliever. CNN has contacted Pfizer and Johnson & Johnson, the makers of both brands, for comment. 

http://www.cnn.com/2018/01/08/health/ibuprofen-male-fertility-study/index.html

Sunday, January 7, 2018

Targeting the Warburg effect for Cancer Treatment: Ketogenic Diets for Management of Glioma

A promising approach to cancer control is to develop interventions to slow or halt progression of early stages of carcinogenesis to invasive disease as indicated by biomarkers of disease progression as well as related symptom burden. Our goal is to utilize a broad-spectrum approach targeting multiple signaling pathways that result in modulation of apoptosis, proliferation, inflammation and related pathologies, relevant to progression in early stage disease to advanced cancers. The metabolic pathways which support rapid growth of tumors represent a promising therapeutic target for cancer. Ketogenic therapies in the form of a KD and/or pharmacological modulators using exogenous KAs represent one potential tool to exploit the metabolic vulnerabilities of tumors. A number of distinct yet interrelated effects of ketosis may be implicated in the potential anti-tumor effects of ketosis (Fig. 2). Ketogenic therapy for CNS tumors, including glioma, extends far beyond the originally proposed mechanism of reducing glucose availability, and may work through multiple and yet distinct mechanisms such as reducing inflammation, altering in oxidative stress, enhancing anti-tumor immunity, altering gene expression, sensitizing tumors to standard of care and adjuvant therapies, among others (Fig. 5). Some of these mechanisms may depend directly on ketone signaling, supporting the notion that an elevation in blood ketones is a significant component of ketogenic therapy for CNS tumors. To date, case reports and pilot projects have reported moderate success evaluating KD in patients with advanced stage disease (HGG). However, it is important to acknowledge that advanced stage disease, including GBM, display significant increases in genomic complexity and a variety of cell-signaling redundancies. Thus, clinicians face multiple patient-related (due to illness, compliance and other co-morbidities) and metastatic disease- related challenges. It is possible that the KD would be more effective in earlier stage disease (LGG) and provide an opportunity to potentially increase the likelihood of pinpointing targets for transformational therapies. However, to date, there continues to be a paucity of research that exploits these mechanisms and systematically examines interventions such as the ketogenic diet, relevant to tumor progression in glioma. If successful, these novel treatments could provide a non-toxic, cost-effective adjuvant therapy to standard of care in a disease currently with a grim prognosis.

http://www.sciencedirect.com/science/article/pii/S1044579X17301244

Saturday, January 6, 2018

DNA Damage May Underlie Alcohol Link to Cancer Risk



In the Cancer Research UK Science Blog, Dr Patel stated that in mice that lacked the enzyme that breaks down acetaldehyde, he and his colleagues "saw huge amounts of DNA damage" after just one dose of ethanol. Acetaldehyde is the main metabolic product of alcohol.

"Bits of DNA were deleted, bits were broken, and we even saw parts of chromosomes being moved about and rearranged," he added.

https://www.medscape.com/viewarticle/890929

Friday, January 5, 2018

Depo birth control shot linked to risk of HIV infection | Endocrine Society

In addition to these clinical studies, the review's authors examined animal, cell and biochemical research on the form of progestin used in DMPA—medroxprogesterone acetate, or MPA. The analysis revealed MPA acts differently than other forms of progestin used in contraceptives. MPA behaves like the stress hormone cortisol in the cells of the genital tract that can come in contact with HIV.

"The increased rate of HIV infection among women using DMPA contraceptive shots is likely due to multiple reasons, including decreases in immune function and the protective barrier function of the female genital tract," Hapgood said. "Studying the biology of MPA helps us understand what may be driving the increased rate of HIV infection seen in human research. These findings suggest other forms of birth control should rapidly replace DMPA shots."  

https://www.endocrine.org/news-room/current-press-releases/common-birth-control-shot-linked-to-risk-of-hiv-infection

The Big Vitamin D Mistake

Since 2006, type 1 diabetes in Finland has plateaued and then decreased after the authorities' decision to fortify dietary milk products with cholecalciferol. The role of vitamin D in innate and adaptive immunity is critical. A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the previously presumed U-shape curve of mortality associated with vitamin D levels. Since all-disease mortality is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L, we call public health authorities to consider designating as the RDA at least three-fourths of the levels proposed by the Endocrine Society Expert Committee as safe upper tolerable daily intake doses. This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280

Wednesday, January 3, 2018

Unfiltered Fervor: The Rush to Get Off the Water Grid - NYTimes.com

 At Rainbow Grocery, a cooperative in this city's Mission District, one brand of water is so popular that it's often out of stock. But one recent evening, there was a glittering rack of it: glass orbs containing 2.5 gallons of what is billed as "raw water" — unfiltered, untreated, unsterilized spring water, $36.99 each and $14.99 per refill, bottled and marketed by a small company called Live Water.

"It has a vaguely mild sweetness, a nice smooth mouth feel, nothing that overwhelms the flavor profile," said Kevin Freeman, a shift manager at the store. "Bottled water's controversial. We've curtailed our water selection. But this is totally outside that whole realm."

https://mobile.nytimes.com/2017/12/29/dining/raw-water-unfiltered.html

Monday, January 1, 2018

Risk Factors for Hospital-Onset C difficile Identified

The authors found that carbapenems, third- and fourth-generation cephalosporins, metronidazole, and piperacillin/tazobactam all increased the risk for CDI. However, the risk dropped with use of clindamycin, macrolides, and tetracyclines.

"The clindamycin findings are somewhat surprising in that clindamycin has been classified as a high risk for development of a CDI in both the hospital and in the community," the authors write. "This finding may be due to reduced use of clindamycin over time." The results suggesting a possible protective effect from tetracycline and macrolide match up with previous research findings, they write.

https://www.medscape.com/viewarticle/890746

Arthritis in Chikungunya Patients Not Due to Persistent Virus

"The finding of chronic joint pain in one fourth of the patients infected with CHIKV approximately 2 years after initial infection has important implications for prediction of the magnitude of disability and health system costs after the Latin American epidemic," the authors write in an article published online December 20 in Arthritis & Rheumatology. "Prior predictions had over-estimated the expected frequency of CHIKV-related joint pain in Latin America indicating 48% of CHIKV-infected people were predicted to have chronic chikungunya arthritis 20 months after acute infection."

https://www.medscape.com/viewarticle/890729

Hospitalist Tackles Chronic Disease With Food Pharmacies

Inspired by programs in other parts of the country, Dr Nguyen worked to establish at her hospital a food pharmacy, a program that allows physicians to prescribe healthy food to patients and gives them affordable access to those foods. Today, she is a chronic disease specialist with the San Francisco Department of Public Health and a leader of the San Francisco Health Network's Food Pharmacy program. She continues to see patients as a hospitalist about 2 weeks of the year.

https://www.medscape.com/viewarticle/890431