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Sniffing sweat might put you in a better mood?

A small pheromone study made a big splash in the media this week, announcing that male sweat contains a chemical that causes arousal in females.

The media’s sensationalization of the study made me feel dubious about the science behind it. I thought to myself, here we go again – some shoddy research and a lot of hand waving… I was determined enough to get the story straight, that I paid my $15 to the Journal of Neuroscience to get my hands on the original data. And I’m glad I did because my suspicions were NOT confirmed.

Claire Wyart et al. at UC Berkeley designed this study well. They took great pains to control the variables, account for confounders, and provide the appropriate environment for the study. “All testing was performed in a temperature and humidity controlled, stainless-steel-coated, 5 x 8 foot room equipped with HEPA (high-efficiency particulate air) and carbon filtration.” Wyart’s team also made meticulous note of previous research on the subject. They also repeated the study just to make sure that their findings were reproduceable. A total of 48 women participated.

In this double blind, placebo-control study they found that exposure to one of the chemicals in male sweat, androstadienone (AND), produced increased cortisol levels, elevated mood, and increased sexual arousal (when combined with provocative videos) up to an hour after the AND was inhaled.

Now, instead of focusing on the enhanced sexual arousal observation (that triggered the media blitz), Wyart suggested an interesting twist: what if AND could be used as a therapy for those suffering from cortisol deficiency (Addison’s disease)? Current standard therapy requires cortisol replacement which may cause peptic ulcers, osteoporosis, weight gain, mood disorders, and other pathologies. But AND is a potential “natural” solution.

Of course, I’m somewhat skeptical of this alternative since Addison’s is generally caused by an autoimmune attack on the adrenal gland cells – and I’m not sure that stimulating what’s left of them (with AND) would result in enhanced cortisol production. Still, Wyart raises an interesting point: what if we could learn how to positively influence the endocrine system with scent stimulation? Could this be a new method of treatment for women with anxiety, depression, or low libido but with far fewer side effects than our current methods?

Well, it’s too early to tell, but I think Wyart’s on to something. As she notes in her research article, AND is only one of hundreds of chemicals found in human sweat, and it is unclear if it is the most potent chemical in the arousal arena. It will be interesting to see if AND is eventually added to perfumes, cosmetic products, and the like as a means of tricking the body into feeling happier, sexier, and more balanced. Science meets aromatherapy? What do you think?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Patient choice: trust the doctor?

I’ve invited my Revolution colleagues to form a “blog fodder chain” – when we see something interesting on the Internet, or have a difficult question, we forward it to one another as a kind of challenge to write about it in our blogs.

I have to say, though – they keep sending me the hard stuff. Examples of physicians gone bad, morally questionable healthcare practices, and hot topics full of mine fields. I keep hoping for the “which puppy do you think is cutest?” question. But no such luck for Dr. Val…

Our Chief Privacy Officer challenged me again with some powerful food for thought. A recent article in the New England Journal of Medicine reports that some physicians withhold information (about treatment options) from patients if the physician objects to the options on moral or religious grounds.  Med bloggers Kevin MD and Medpundit also have recent posts about this article.

Well, of course this inspires initial indignation. Aren’t physicians supposed to offer all the options, with factual explanations of their pro’s and con’s, and then let the patient decide what they’d like to do?

Well, yes, they are. But the funny thing is that time after time when I’ve tried to do that for patients, they’ve expressed annoyance at me. They say, “you tell me what I should do, you’re the doctor!” And so after hearing this over and over again, I ended up truncating my explanation of options to the most “reasonable” ones and then allowing the patient to ask for more if they’re interested. Am I allowing my personal values to determine the hierarchy of options I present? Yes, probably so.

I’ve noticed that attention spans, even when it comes to important medical decisions, appear to be fairly short. Eyes glaze over when we try to explain all the subtleties of the options, and in the end (if the patient likes you and trusts you as a human being) he or she just wants to know what you’d choose if you were in his/her shoes – and why.

Am I being paternalistic? I hope not. I want patients to choose what’s best for them, but strangely enough their choice is often to let me decide. The power that patients impart to us is an honor and a privilege – and the reason why doctors are held to a higher moral standard than many other professionals. They are right to hold us to that standard. We must not squander their trust.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Relationships and weight gain: Valentine’s Day musings

My friends in the Revolution Weight Management Center asked me to blog about weight and relationships… at first I wondered if they were trying to stage an intervention or something: have I gained that much weight since I started working here? Ha ha. No, I haven’t… but maybe that’s because I have such a skinny husband?

As it turns out, research suggests that married couples are influenced by one another’s dietary habits. If you marry a person with poor eating habits, you are much more likely to adopt them yourself. Also, they say that marriage leads to more regular (read frequent), larger meals and increased financial pressures, stress levels and decreased exercise frequency.

Well, I guess choosing the right spouse has never been more important for weight control? Marriage doesn’t automatically lead to weight gain, but you should eye your boyfriend/girlfriend/fiancé(e) with suspicion at the dinner table. When I was dating my husband I noticed that he ate small portions, never finished his plate, and didn’t like dessert. He liked to run, had good sleeping habits, drank in moderation, and wouldn’t notice a super model if she fell in his lap. Sound too good to be true? I still ask myself that every day. They don’t make too many like Steve, I’ll tell you!

Anyway, I must confess that before our wedding I was in the best shape of my life, running about 20-25 miles a week, shunning all products containing high fructose corn syrup, and taking good care of my health. Now I exercise irregularly, sneak in rich dining experiences, and skip meals. I weigh about the same, but have (I’m sure) exchanged fat for muscle.

What do I make of this? Well, I need to force myself to go running again with my husband (he patiently runs at my pace as I lumber along next to his gazelle-like frame) and be more mindful of my eating habits. This is a never-ending battle for me, but it is made so much easier by having a supportive spouse who never deviates from good health practices.

So as Valentine’s Day approaches, observe your loved one’s eating and exercise habits with a critical eye. You are likely to be influenced by them more than you know. And for those of you who have a “Steve” in your life, thank your lucky stars, put down the box of chocolates, and show him how much he’s appreciated!

P.S. Steve would like to tell you that he (thanks to me) now enjoys dessert and craves ice cream from time to time. I guess my influence on him hasn’t been as positive.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Medical errors – apologies required

Our Chief Privacy Officer sent me an interesting article today about how hospitals are promoting “disclosure and apology” (by physicians to patients or their families) when a medical error is committed.  The report suggests that less money will be spent in malpractice suits if physicians fess up to their mistakes instead of trying to hide them.

Another study suggests that 99% of physicians believe that it is morally right to confess errors to patients and family members, but that only about 33% report doing so.  The article says that the number one reason why they don’t report errors is fear of being sued.

While these statistics don’t reflect well on physicians, I think there’s some murkiness here that’s worth reviewing.  First of all, what constitutes an error?  When a young resident physician performs a procedure in an inferior manner due to lack of experience, is that an error?  When a code team is not called soon enough because a patient doesn’t appear gravely ill initially, is that an error?  If an unconscious patient arrives in the ER and is treated with a medicine that causes a life-threatening allergic reaction, is that an error?  I think that many times physicians perceive some “errors” as unfortunate and regrettable aspects of the natural practice of medicine and don’t report them formally.

Another reason why physicians may not report errors is because it’s unclear that the error has a specific adverse effect – perhaps a patient’s Tylenol was given at the wrong time of day.  That’s an error – but is it worthy of formally reporting it to the patient?  What about when the lab loses the tube of blood drawn from a patient?  Should the patient be told about it or should the labs be added to the next day’s scheduled draw?

The majority of “errors” that I’ve witnessed are in the realm of sub-optimal care due to inexperience, inattentiveness, or misinterpretation of test results.  However, errors of the sort that result in death and serious harm appear to be alarmingly frequent (some studies argue that there are 40-90 thousand of these errors per year).

I think that physicians should always tell patients the truth about their care, the risks associated with certain procedures, and the full range of choices that are available to them.  I do believe that patients value (and deserve) to know the truth - even when it makes the physician or hospital seem less than perfect.  In the cases of errors that result in serious consequences – honesty is the best (and only) policy.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Understanding introverts

Here’s an excerpt from a timeless essay in the Atlantic Monthly about understanding and appreciating introverts. For the full article, click here.

“Extroverts are energized by people, and wilt or fade when alone. They often seem bored by themselves, in both senses of the expression. Leave an extrovert alone for two minutes and he will reach for his cell phone. In contrast, after an hour or two of being socially ‘on,’ we introverts need to turn off and recharge. My own formula is roughly two hours alone for every hour of socializing. This isn’t antisocial. It isn’t a sign of depression. It does not call for medication. For introverts, to be alone with our thoughts is as restorative as sleeping, as nourishing as eating. Our motto: ‘I’m okay, you’re okay—in small doses.’”


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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