August 20th, 2007 by Dr. Val Jones in News
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There has been some recent buzz about the health risks of nail salon workers. Two studies suggest that constant exposure to nail product fumes might impact cognition in both nail salon workers and their unborn babies. Although the workers’ exposure is estimated at 1200 times that of the average American, it does make one wonder if any woman who frequents these places may be at some risk.
The first study involved neuropsychological testing of 33 female salon workers and comparing their results to 35 women matched controls. The researchers found that the salon workers did worse on tests of attention span and mental processing speed and their sense of smell was decreased. This study was too small and non-specific to tease out which chemicals might be the culprits, but the observations were concerning.
The second study involved cognitive testing of children born to 32 mothers who were exposed to organic solvents when they were in utero. Compared to a control group, the children (whose moms had been exposed to chemicals) performed more poorly on IQ tests and various other cognitive tests. Interestingly, the participants in this study were not nail salon workers – they held jobs ranging from funeral home embalming technicians to hair stylists, to dry cleaners.
The Environmental Protection Agency issued some guidelines for nail salons, and based on my experience I’d be surprised if salons adhere to even 1/3 of these guidelines on average. If you scroll to page 12 of the brochure, you’ll see that the EPA recommends wearing a “organic vapor cartridge respirator” which looks like something out of a HAZMAT video. I doubt that any nail salons provide these for their staff… and if they did, what would clients make of it?
And so I think these small studies raise an interesting question: how safe is it to be exposed to organic solvents at all? We need to do more research to tease out the exact risks of each individual chemical, and at which concentrations. As for me, I’d urge pregnant women to minimize their exposure wherever possible, and strongly consider avoiding salons that offer acrylic nail services. Until we know exactly how harmful these chemicals are – the best thing to do is to avoid them wherever possible. The potential for solvent-related cognitive decline is worrisome enough – but allergies and asthma exacerbations are far more common. For a full list of chemicals known to be harmful (and their side effects) please review the EPA brochure, pages 4-5.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 20th, 2007 by Dr. Val Jones in Opinion
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I returned from Trader Joe’s with several bags full of
organic produce and frozen goods today.
It cost me substantially more than it would have at a regular grocery
store, but I figured it was worth it since the food was probably of higher
quality. It also seemed that I might be
helping small farmers by purchasing goods there, which pleased me. And yet I had this nagging feeling that maybe
this was a marketing ploy… that the “experience” of Trader Joe’s was what I was
really buying.
Dr. Clark
directed me towards this interesting, if not controversial blog about organic foods. In it, the author explains the “real story”
behind Trader Joe’s:
Trader Joe’s is a
supermarket chain specializing in organic, vegetarian, and alternative foods
with hundreds of locations throughout the United
States, centered in organic-happy Southern
California. Shoppers appreciate its image of healthful food in a
small-business family atmosphere. Really? In 2005 alone, Trader Joe’s racked up
sales estimated at $4.5 billion. The company is owned by a family trust set up
by German billionaire Theo Albrecht, ranked the 22nd richest man in the world
by Forbes in 2004. He’s the co-founder and CEO of German multi-national ALDI,
with global revenue in grocery sales at $37 billion. According to Business
Week, the decade of the 1990’s saw Trader Joe’s increase its profits by 1000%.… Trader Joe’s customers are willing to pay
their premium prices to get that healthful image. But they should not kid
themselves that they’re striking a blow at big business and supporting the
little guy.
Ok, so maybe I’m not
helping the little guy. But isn’t it
healthier to eat organic food?
From Canada’s
Department of Agriculture (hat tip to Moof for finding this reference):
· Some studies have shown traces of pesticide
residues in both food sources, regardless of production method.
· Nutritional value of plants depends on
genetics, availability of water, amount of sunlight, maturity when picked, how
long it took to come to market and whether it was properly handled and
refrigerated. Numerous laboratory tests have not found any substantial
nutritional differences in organically and conventionally grown produce.
· In blind taste tests, consumers generally
cannot differentiate between organically and conventionally grown food.
· Organic produce is marketed as pure and
healthy. Conventionally produced goods are equally safe and nutritious due to
strict regulations and guidelines.
In a recent
article in the Chicago Tribune, raw foods were not found to be as healthy
as initially suspected. The natural
sprouted plant enzymes that are supposed to be really good for you are actually
destroyed by stomach acid and never absorbed in the body. A raw food diet lacks Vitamin B12, which can
cause dangerous deficiencies.
A study by the Center for Global Food Issues found that
although organic foods make up about 1 percent of America’s diet, they also account
for about 8 percent of confirmed E. coli cases.
For a long list of organic food contaminations, check out the Canada Free Press.
What about hormones
given to animals to increase milk production or bulk them up?
In theory, this is the most concerning and potentially
convincing reason to preferentially select organic meats. I could imagine that eating animals pumped
with hormones could have a negative impact on humans – though the research I
found from the WHO and Cornell
University did not support my initial fears. They write:
Studies indicate that
if correct treatment and slaughter procedures are followed, the levels of these
hormones may be slightly higher in the treated animal’s meat or milk, but are
still within the normal range of natural variation known to occur in untreated
animals.
FDA scientists have
concluded that eating foods with slightly higher levels of rbGH would not
affect human health. This is because the amount of rbGH that is in milk or milk
products as a result of treatment of the animals is insignificant compared to
the amount of growth hormone that is naturally produced by our bodies. Also,
rbGH is a protein hormone and is digested into smaller fragments (peptides and
amino acids) when eaten. The rbGH hormone used on dairy cattle is effective in
promoting growth in cows, but does not work in humans. Scientists know that
rbGH is not recognized as a hormone by human cells.
Well, isn’t organic
farming better for the environment?
The Canadian Department of Agriculture states that organic
farming methods lead to increased soil erosion, lower crop yields (which
require more acres to produce the same amount of food), and require more
pesticides. Although regular farming
methods use different pesticides than the organic variety, neither types of
pesticides are particularly safe for humans.
Organic pesticides such as
rotenone may be a risk factor for developing Parkinson’s Disease – though
more research is needed to fully elucidate this risk.
So should you go
organic?
If you enjoy the flavor or the food quality of certain
produce (and don’t care about price) then purchase it gladly. Make sure you wash it well (organic or not)
and peel the skin if you have any doubts about remaining pesticides. Buy food directly from local farmers when you
can, support free range farming (it’s so much kinder to the animals), and don’t
believe the hype about organic foods automatically being healthier or more
nutritious for you.
Conclusions: organic food is not necessarily more
nutritious, it still may contain harmful pesticides, it is more likely to
contain harmful bacteria, there’s no convincing evidence to suggest that
hormones or antibiotics given to cattle have a negative impact on meat eaters,
and one thing’s for certain: organic food costs at least 20% more than
non-organic.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 19th, 2007 by Dr. Val Jones in News
1 Comment »
Thanks to MedGadget for bringing this to my attention. Did you know that as many as 1 million fake diabetes test strips (manufactured in China but imported via Canada) made it onto the US market? About 10 million Americans use the One Touch Ultra system for measuring their glucose and titrating their insulin doses. Bloomberg news had this to say:
“Growth in counterfeit medicines and devices is probably
the biggest health threat besides infectious disease,” says
Peter Pitts, director of the Center for Medicines in the Public
Interest in New York and formerly an FDA official investigating
knockoff drugs.
The court filings disclose, for the first time, that China
is the source of about one million phony test strips that have
turned up in at least 35 states and in Canada, Greece, India,
Pakistan, the Philippines, Saudi Arabia, and Turkey.”
The test strips don’t measure glucose levels reliably and could result in patients dosing their insulin incorrectly. So be careful out there, folks… make sure that the test strips you use are not counterfeit. Check the lot number on your package to make sure it’s not one of these fake numbers.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 18th, 2007 by Dr. Val Jones in Health Policy, Medblogger Shout Outs
4 Comments »
Emergency departments are splitting at the seams, uninsured patients fill the waiting rooms, and Emergency Medicine physicians are crying “uncle” on a national level. We assume that gaps in health insurance coverage force patients to seek treatment in the ED, but the reality is that many insured patients seek treatment there as well. Why? Because the ED is a crowded, but one-stop shop whose convenience cannot be denied. PandaBearMD explains why one well-insured patient (who has a regular PCP) still chose to see him in the ED:
“As my patient related to me, in order to see his doctor he has to
make an appointment which is often weeks to months in the future. On
the day of his appointment, even if he shows up on time he will usually
have to wait an hour or two because the doctor is always running late.
Then he will spend a brief ten to fifteen minutes with his doctor who
will order a slew of tests and imaging studies, many of which will have
to be completed at a different location. He may, for example, have to
drive across town for a CT scan and it is usually scheduled for a
different day, often weeks in the future.
Then, as my patient explained, he must wait several weeks for his
next appointment where his physician will explain the results and
finally initiate either definitive treatment or, as is often the case,
referral to another specialist who will repeat the time consuming
process…
My patient also confided to me that even getting the results of studies
and imaging was not guaranteed. Although we are all quick to relay bad
news, apparently follow-up is not that pressing to many physicians if
the results are normal…
Consider now a visit to the Emergency Department. First, my patient did
not need an appointment. While it is true that he was triaged to a low
acuity and had to wait a while, at certain times of the day the waiting
times are not that much longer than the typical wait for his delayed
primary care physician. Second, the lab tests he needed were drawn on
the spot and the results reported within an hour even though he was a
low acuity patient. Our goal, you understand, is to discharge or admit
as fast as possible. Likewise his imaging studies were obtained, read,
and reported quickly. Finally, if anything serious has been discovered
he would have been admitted within hours. More importantly to my
patient, since everything was all right he knew fairly quickly instead
of biting his nails for a couple of months.”
This is a perfect illustration of how Americans value convenience over cost, and how health insurance can be an enabler for inappropriate ER use. The solution here is in IT. Primary Care Physicians need the tools to automate a lot of what they do, thus making care more convenient for their patients and themselves. A common, secure PHR-EMR, synched with online scheduling, radiology suites and laboratories, health news alerts, care pages and vibrant community, chronic disease management tools, and comprehensive, credible, patient education will go a long way to keeping people out of the ER. Revolution Health is working on such a system, and we have high hopes that the creation of America’s first integrated, digital medical home will improve the quality of life of patients and physicians alike. Achieving this goal will require cooperation and patience from all sectors in healthcare. I hope we’ll find a way to work together as rapidly as possible or else the PCPs and ER docs are going to crack. Hang in there, guys – help is on the way, though it might be a few years out…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 17th, 2007 by Dr. Val Jones in True Stories
3 Comments »
I was pleased to receive an email invitation from Dr. Jon Mikel from Unbounded Medicine to blog about surgery. He writes,
“Please feel free to post anything related to surgery,
like surgical procedures, mistakes during surgery or during your training,
lessons learned, tips, first operation done solo, memorable operations,
memorable patients, jokes, your point of view about surgery, or even why you dislike surgery or surgeons (if that is the case).”
As my mind wandered through all the possible posts I could prepare, I settled on a touching story that highlights the life of a wonderful surgeon named John Schullinger. Dr. Schullinger was the surprised recipient of one advanced case of intussusception in a 10 month old baby girl. The baby was shipped to him from a distant general hospital where they didn’t have any pediatric surgeons to take the case. On arrival the baby was moribund – septic and seizing, with an abdomen distended with gangrene.
Dr. Schullinger explained the gravity of the baby’s condition to her mom, promised not to give up on the baby, and took her to the O.R. for a bowel resection. Against all odds – and having to resect everything from the terminal ileum to the sigmoid colon – the baby made it through. A jubilant mother thanked the surgeon, and promised to keep in touch, though the family would be moving out of the country.
Every Christmas, the baby’s mom sent Dr. Schullinger a card from Canada – detailing her daughter’s growth and accomplishments and thanking him again for saving her life. Each Christmas he responded with a hand written note, expressing his pleasure with the child’s progress.
This ritual continued each year for 25 years until one day the young woman went to visit the surgeon and thank him in person. She was interviewing for medical school at Columbia, the same institution where Dr. Schullinger had saved her life nearly a quarter century earlier. It was a tearful reunion and touching for both surgeon and patient – because they could see how operations can change lives, and how babies that you operate on can grow up to be physicians who help other babies.
Dr. Schullinger saved my life – but his influence reached far beyond his technical skills in the O.R. His compassion and faithful follow up responses to my mom showed me what being a doctor is all about. My fondest hope is that I’ll live up to his example.
So for all you surgeons out there… you work longer hours than most others on this planet, you sacrifice your lifestyle to serve others, and yet you rarely see how your work impacts families long term. I am here to thank you on behalf of all those who can’t or don’t – please take courage from this story. You never know if the patient you operate on will come back and take over the scalpel for you one day…
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
