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Are Plastic Products Safe? Educational Webinar Reviews The Science

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Concerns about plastic safety have been growing over the years, and the media has stepped up its efforts to expose potential dangers associated with plastic compounds such as bisphenol A (BPA) and phthalates. The problem is – there is very little scientific evidence linking plastic to human harm, and no credible evidence that our current typical exposures to BPA poses any health risks at all (so say the health agencies of the United States, Canada, the European Union, and Japan). But that’s not a very exciting story, is it?

Instead, what we often hear in the news is that microwaving our plastic containers or drinking from plastic water bottles could be dangerous to our health… and that BPA-free containers are better for baby. But where did the media come up with these ideas? I asked Dr. Chuck McKay, a toxicologist and emergency medicine physician at the University of Connecticut, to explain how safe levels of exposure (to various chemicals) are determined, and how to know if news reports are based on scientific evidence. I hope you’ll listen in to this educational Webinar.

Some of my favorite take-home messages from the Webinar include what I call “just becauses”:

1. Just because you can find a substance in your urine doesn’t mean it’s harmful. (Asparagus anyone?)

2. Just because an animal reacts to a substance, doesn’t mean that humans will. (How often have you caught a cold from your dog?)

3. Just because extreme doses of a substance can cause harm, doesn’t mean that tiny doses also cause harm. (Consider radiation exposure from riding in an airplane versus being near ground zero of a nuclear strike).

4. Just because something has a theoretical potential to harm, doesn’t mean it will. (Will you really be attacked by a shark in 2 feet of water at your local beach?)

5. Just because someone conducted a research study doesn’t mean their findings are accurate. (Do you really believe the Cosmo polls? There’s a lot of junk science out there!)

For an excellent review article of the high-quality science behind plastic safety, please check out this link. In the end, there are far more important health concerns to worry about than potential exposure to plastic compounds. And throwing out all your plastic containers may not even reduce your exposure to BPA anyway… A recent study found that people had higher concentrations of BPA in their urine when they followed a plastic-free, organic diet! Their exposure was actually traced to ground cinnamon, coriander, and cayenne pepper. Who knew?

Do Childless Couples Have An Increased Risk Of Death And Mental Illness?

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I hate scientific studies that don’t investigate the assumptions on which they’re based.  They do harm.  The findings slither around and get into the heads of people who treat people for the issues the research purports to understand.  And the misconceptions become protocol.  Here’s one example:

The Journal of Epidemiology and Community Health published an article declaring a connection between childlessness and increased risk of death and mental illness.

Among the findings:

  • Having a child cut the risk of early death, particularly among women.
  • The early death rate from circulatory disease, cancers, and accidents among childless women was four times as high as that among those who gave birth to their own child, and 50% lower among women who adopted.
  • Similarly, rates of death were around twice as high among men who did not become parents, either biologically or through adoption.
  • The prevalence of mental illness in couples who adopted kids was around half that of other parents.

What the study states but doesn’t investigate is that for their research they used:  “population-based health and social registers, we conducted a follow-up study of 21 276 childless couples in in vitro fertility treatment.”

Do you hear the sound of “WHAT!??!” beginning to reverberate?

Might it be that couples who have been living in the infertility system for months, maybe years and have had their original life script expectations erased, have had doctors and drugs and timetables invade their intimate time, have spent gobs of money, and have had repeated cycles of devastating disappointment may be in a very different state than couples who have CHOSEN not to have children?

And let me state my assumption up front.  Choosing not to have children is not dysfunctional.  It’s not a psychological condition.  It’s not an ethical/moral lapse.  It’s not a sign of immaturity or selfishness.  It’s a legitimate choice.

It may be that the researchers’ findings do apply to couples who undergo infertility treatment in order to have a child.

But there is harm in assuming that all couples who don’t have children are at higher risk for death and mental illness.

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This post originally appeared at Barbara’s blog, In Sickness As In Health.

Why Pumping Iron Is Great For Brain Cells

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In my last post I told you that I would reveal the one thing you can do to have a significant, positive and lasting effect on your brain health as you get older. See if you can spot it in the following list:

a) Learn to dance Gangnam style
b) Join a choir
c) Catch a wave
d) Pump some iron

Ok, that was a trick question. All of these answers are somewhat correct, but I was looking for the “most” correct answer (flashbacks to undergrad, anyone?): Pump some iron.

I realize I sound like a broken record – I’ve already written about how aerobic exercise can promote healthy aging here and here, and I’ve even already written about resistance training, or lifting weights, here.

So why am I at it again? Because it’s important!

I’m fresh out of the 2012 Aging and Society Conference, where researchers came together to discuss what works and what doesn’t when it comes to healthy aging. It turns out everyone pretty much agrees that exercise is hands down the most effective intervention to keep your brain cells happy into old(er) age. All sorts of different types of exercise, ranging from simply walking to attending resistance training classes, are associated with different types of improvements in cognition, memory, and even brain size.

Of course, there are different levels of effort involved with different types of exercise, or even when talking about a single form of exercise. When my friend Jess asks me to go for a walk, she means a power walk: it usually involves going up hills, sweating like a pig (even though pigs, ironically, don’t sweat much), and barely having enough breath for girl talk (though somehow we always seem to find it). When my friend Al and I go for a walk, what he means is a “mosey”: we stop to look at the view, pet the dog, chit chat with strangers, and have more than enough breath for lengthy discussions about life, work, and the possibility of alien lifeforms. When it comes to brain health, whether you’re walking or pumping iron, a little sweating and effort can go a long way. For example, resistance training has been proven to be most effective when the load, or how much weight you are working with, increases over time. So kick the intensity up a notch: there will still be plenty of time for chit chat around a post-exercise, antioxidant-rich mug of matcha (my new obsession – stay tuned).

Now that the obvious has been (re)stated, I want to take this opportunity to discuss the idea that perhaps lifestyle interventions such as exercise could be prescribed by your doctor. We know that exercise can improve cognition in aging but also conditions like depression. Should physicians prescribe lifestyle changes? Or are diet, exercise, and other lifestyle activities choices we should make ourselves? How would you feel if your doctor prescribed you exercise instead of pills? Would you be more motivated to exercise if the prescription came from your doctor instead of from your friendly Internet science blogger? Your thoughts in the comments!

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Dr. Julie Robillard is a neuroscientist, neuroethicist and science writer. You can find her blog at scientificchick.com.

Should You Get A Mammogram?

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A recent mammogram study in the New England Journal of Medicine was so controversial that the authors (Drs. Welch and Bleyer) decided to make a YouTube video to defend and explain their conclusions. Now that’s a first, isn’t it? Well kudos to the study authors for their creative approach to getting ahead of a controversy. However, their video (created for the “general public”) is still a bit too technical in my opinion. I’d like to take a crack at distilling it further.

A question on most women’s minds (as they turn 40 and beyond) is whether or not they should get a screening mammogram (x-ray of the breasts). If you have found a lump in your breast or you have a family history of breast cancer the answer is yes. No need to read any further. However, for the majority of us lumpless, family-history-free women, a screening mammogram is far more likely to expose us to unnecessary follow up testing than it is to catch a tumor early.  Dr. Welch explains that screening mammograms aren’t very good at identifying aggressive breast cancer early enough to make a difference in whether one lives or dies anyway. That’s very disappointing news.

Dr. Welch goes on to explain that most of the gains we’ve made in breast cancer survival have been because of improved breast cancer treatments, not because of early detection with mammograms. He estimates that every year in the U.S. 1.3 million women are “over-diagnosed” with breast cancer because of screening mammograms, subjecting women to unnecessary biopsies, surgical procedures, and further follow up studies. In the video, Dr. Welch doesn’t explain exactly what these “over diagnosed” cancers end up being exactly (Cysts? Benign calcifications? Early non-aggressive cancers that the immune system kills on its own?) But suffice it to say that they don’t contribute to the cancer death rates.

So, given the fact that you are more likely to suffer through a false alarm than to discover a cancer early (and even if you do find it early, if it’s the “bad” kind you may not survive) are you willing to undergo a screening mammogram? That’s a personal question that we each have to answer for ourselves. As time goes on, however, I suspect that the answer will be made for us since health insurance companies (whether public or private) will begin to balk at paying for tests that do more harm than good overall. I think this issue is really at the heart of the controversy (the perception of rolling back a health benefit that women currently “enjoy”). Eventually screening mammograms may become an out-of-pocket expense for women who simply prefer the peace of mind that a normal test can give – even at the risk of going through a false alarm.

That being said, it sure would be great if we could find a screening test that identifies breast cancer early – especially the aggressive kind. Perhaps a blood test will do the trick one day? At least it is comforting to know that we have made great strides on the treatment side, so that fewer women than ever before die of breast cancer. More research is needed on both the screening and treatment sides of course.

As for me, I do regular breast self exams – though because I have no family history of breast cancer I’ve opted out of screening mammograms because I feel the cost/benefit ratio is not in my favor. I certainly hope that a better screening test is developed before I face a potential diagnosis. I respect that other women will disagree with me – and I think they have the right to be screened with the only option we currently have: the mammogram. I’m not sure how long it will continue to be covered by insurance, but at a price point of about $100, most of us could still afford to pay for it out-of-pocket if desired.

The bottom line of this controversial research study is that screening mammograms don’t actually catch death-causing breast cancers early enough to alter their course. Even though it makes intuitive sense to be screened, long term observations confirm that overall, mammograms do more harm than good. So now we wait for a better test – while some of us continue with the old one (as the National Cancer Institute recommends), and others (like me) don’t bother.

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Thanks to ePatient Dave and Susannah Fox who brought the issue to my attention on Facebook. Isn’t social media grand?

Is It More Important To Make Patients Happy Or To Heal Them?

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One would think that happiness and healing are inextricably linked in healthcare, but the Happy Hospitalist (HH) raises an interesting question: is modern medicine’s emphasis on patient satisfaction (and shared decision-making) sacrificing our quality of care? A recent study found that patients who preferred their physicians to take the lead in their medical decision-making had shorter, less costly hospital stays.

HH argues that if physicians are expected to perform like airline pilots, reliably choosing/performing the best course of action for those depending on them, then patients should behave like passengers. In other words, passengers don’t tell the pilot how to fly the plane, nor should patients override a physician’s clinical judgment with personal preferences.

I think this analogy misses the mark because patients are rarely interested in making decisions about how a physician accomplishes her task, but rather which tasks she undertakes. Flight passengers aren’t interested in quibbling about the timing of landing gear, they are interested in the selection of their destination city. And so they should be.

While there may be a correlation between physician-led decision-making and shorter hospital stays, I’m not convinced that this translates to improved care quality. For the study subjects, discharge could have been delayed because the “empowered” patients insisted on ensuring that a home care plan was in place before they left the hospital. Or perhaps they wanted to get their prescriptions filled before going home (knowing that they couldn’t get to their home pharmacy over the weekend)? The study did not assess whether or not the discharge delays reduced readmission rates, nor did it seek to determine the cause of prolonged stays. This study alone is insufficient to draw any conclusions about the relative value of the patient empowerment movement on health outcomes.

While I certainly empathize with HH about the excessive focus on patient satisfaction surveys over true quality care, I strongly believe that an educated, participatory patient is our best ally in the practice of good medicine. There are simply too many cogs and wheels turning at once in the healthcare system to be able to ensure that the right care is provided at the right time, every time. We need all the help we can get to monitor our care plans in order to avoid medical errors, compliance problems and missed opportunities.

If you see something, say something. That principle applies to healthcare as much as it does to flight safety.

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