June 29th, 2007 by Dr. Val Jones in News
Tags: Complementary And Alternative Medicine, Food and Nutrition, Gastroenterology, Hospitals, Infectious Disease, Milk, Research
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Well, having grown up on a yogurt farm – nothing delights me more than scientific evidence that this fine dairy treat is good for your health. Hats off to my friends at the Imperial College, London who just published a study showing that elderly, hospitalized individuals may use yogurt to avert nasty bacterial infections that cause explosive diarrhea.
Yes, it’s the battle of the bugs at its best – the most common yogurt bacteria: Lactobacillus casei, L. bulgaricus, and Streptococcus thermophilus work together as pretty effective colonic bouncers for enemy bug C. difficile. In this study, elderly patients (n=57) at risk for hospital acquired diarrhea (due to antibiotic use) were given 2 small active culture yogurt drinks/day during the time they received antibiotics and for one week afterwards. Another group (n=56) was given similar drinks, but the yogurt cultures had been sterilized with heat (so there were no actual live bacteria in the yogurt).
And guess what? None of the patients who drank the live yogurt got C. difficile infections, while 9 in the other group did! That means that for every 5 elderly people in the hospital (and taking antibiotics) you could potentially save one from getting a painful gut infection.
So if grandma’s in the hospital on antibiotics, you might want to ask her doctor if she can eat yogurt. It may make the difference between a short stay and a long and unpleasant healthcare experience.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 27th, 2007 by Dr. Val Jones in News
Tags: Internal Medicine, News, Relationships, Research
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Interesting article in the New York Times about doctors talking about themselves too much. Apparently, some doctors spend precious patient interview time talking about unrelated personal information (recent vacation experiences, family members, etc.). In fact, a recent study in the Archives of Internal Medicine suggests that physicians annoy patients with these misguided attempts at building rapport.
We physicians are trained in medical school to be more humanistic and compassionate towards our patients – but we are not given specific direction regarding how to achieve those goals. And let’s face it, we’re kind of geeky in the first place, some of us lack social skills, and we’re under a lot of stress most of the time. The result? Awkward conversations about the most innocuous things we can think of to break the ice – vacations, daily routines, the weather… and perhaps a lot of wasted time.
The research study has its limitations, though. First of all, it only studied physicians in Rochester, New York. Now, my husband is from Rochester – so I dare not say anything unkind… but culturally speaking, the Rochester crew is a little more chatty and casual in their approach to conversations than folks in Manhattan or Boston for example. So there may be a cultural bias at play here in the research.
Second, it’s unclear how much the personal commentary bothers real patients. The conversations were judged by researchers listening to recordings of fake patients who had no previous relationship with the doctor. It’s entirely possible that regular patients might enjoy the personal aspects of the dialogue and actually look forward to hearing how the doctor and his or her family is doing because they have a caring, friendly relationship.
And finally, the study doesn’t address the issue of how to improve the doctor-patient relationship if self-disclosure is so unsuccessful. The poor docs in Rochester are going to be left with a self-conscious uneasiness about idle chatter – and will again not know exactly how to demonstrate humanism as recommended in their medical school training.
But, I must say – that if my doctor spent our entire session talking about herself, I sure would be annoyed, and rightly so. Still, I think I’d like her more if she told me something personal about her own struggles. There’s a balance here – and the complicated interplay of human relationships is hard to measure with standardized patients, audio tapes, and a small geographical location. If your doctor is too chatty, just redirect him/her. You know we do that to YOU all the time. 
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 27th, 2007 by Dr. Val Jones in News, Quackery Exposed
Tags: Complementary And Alternative Medicine, FDA, News, Pharmaceuticals
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Well, hooray for the FDA. On August 24th a new rule will be phased in, requiring all supplement manufacturers to demonstrate that their products contain the ingredients listed on their labels (nothing more, nothing less). This rule will help to reduce contamination issues (some supplements have been found to contain dangerous levels of lead, bacteria, and other contaminants) and false advertising (some supplements don’t contain as much of an ingredient as the label claims).
This is really good news, and better late than never. Although some manufacturers were already conforming to this rule (kudos to them), this will require compliance for the rest of the companies out there who have been misleading the public about the contents of their supplements.
Some say that this rule doesn’t go far enough to ensure the safety and efficacy of the contents of the supplements, and that these bio-active ingredients should undergo the same degree of testing as pharmaceutical products. Unfortunately, studying all the supplements for efficacy would be an enormous and extremely expensive task that is totally cost-prohibitive. At this point, the best we’ve got is NCCAM, and they are slowly grinding their way through a long list of supplements that are purported to be useful for the treatment of various conditions. They are systematically reviewing them to see if indeed they produce the desired effect, without any undesired effects.
And so at this point, let the buyer beware – supplements may or may not be as helpful as the manufacturer claims, and they may not be as side-effect free as they suggest either. But soon you’ll at least be able to know that they don’t contain toxic chemicals, heavy metals, or dangerous bacteria – and that’s a giant step in the right direction for public safety.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 25th, 2007 by Dr. Val Jones in Expert Interviews, News
Tags: Breast Cancer, Cancer, News, Obstetrics And Gynecology, Oncology, Research
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This is the weird correlation of the week: women who suffer with symptoms of morning sickness during their pregnancies may be less likely to develop breast cancer later on in life. A group of epidemiologists in Buffalo recently reported this finding at a scientific meeting (Society for Epidemiologic Research). No one is sure what this means, and I dare not speculate… but perhaps there’s some kind of link between a woman’s hormone levels produced during pregnancy, the nausea they cause, and the hormonal milieu that is the background for breast cancer? Or maybe this study has turned up a false association. Only time – and a lot more research – will tell. Of course, if anyone should speculate on this, it’s the breast cancer oncologists like Dr. Gluck. So I dropped him an email to ask him what he thinks.
Dr. Gluck said that first of all, the association between morning sickness and decreased breast cancer risk is relatively weak. So here’s what the numbers mean: For the average 50 year old woman, the standard risk for developing breast cancer is about 2% (one in
50). According to this study, that same woman (if she had severe morning sickness at some point during pregnancy), is about 1.4% (~30%
less).
Dr. Gluck speculates (and this is quite fascinating) that women with morning sickness are subjected to a hormonal milieu that may result in permanent alterations in their breast tissue. The breast tissue (having been exposed to surges of hormones, insulin, and changing blood pressure and blood sugar levels) might be less vulnerable to the genetic mutations that cause cancer.
We’ve known for a long time that women who have children are at lower risk for breast cancer than women who don’t… now it seems that there might be something about women who are really sick when they’re pregnant and decreased risk of breast cancer as well.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 21st, 2007 by Dr. Val Jones in News, Opinion
Tags: Complementary And Alternative Medicine, Pain Management
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An interesting meta-analysis was recently published in the Annals of Internal Medicine. It showed that acupuncture for knee arthritis can reduce pain, but its effects are likely due to the placebo effect. The placebo effect is nicely described in Wikipedia:
A so-called placebo effect occurs when a patient’s symptoms are altered
in some way (i.e., alleviated or exacerbated) by an otherwise inert
treatment, due to the individual expecting or believing
that it will work. Some people consider this to be a remarkable aspect
of human physiology; others consider it to be an illusion arising from
the way medical experiments are conducted.
Because of the mind-body connection, we humans can actually alter our experience of pain if we will ourselves to do so. We experience more intense pain when we’re depressed or particularly fixated upon it (via boredom for example). And we experience less pain when we’re happy (take women immediately after giving birth – they barely even notice the Ob as she sews up their tears).
When it comes to pain management, there are many non-medical techniques that can improve the experience of pain, even if it doesn’t affect the physiology of it. And so if we can find ways to put ourselves in a frame of mind that minimizes the pain sensations, that can be really valuable.
But as far as the physiology of acupuncture is concerned, we have not yet been able to explain exactly how it works. I’ve often wondered if it may be due to the fact that the sharp pain fibers (stimulated by acupuncture needles in different locations) travel along slightly different nerve pathways than the fibers from the actual painful area for which one is getting the acupuncture. The pain input might subconsciously distract the mind from the duller (or more chronic) pain input from the arthritic joint (or other pain generator). This might explain why sham acupuncture works (meaning, putting the needles anywhere, rather than in certain specified meridians).
I’m sure some of you will disagree with this – and it’s only a theory. But it does seem that inserting tiny sharp needles into the skin improves pain sensations in knee arthritis – no matter where the needles are put. How do we explain this placebo effect? I’m not sure – but if the treatment is quite harmless, and seems to decrease pain, how important is it to have an explanation?
And by the way, I was just about to post this when I found another interesting article about acupuncture in the journal Circulation. In this study, they found that acupuncture (when performed 3-5 times a week for 30 minutes each time) was able to reduce blood pressure by about the same amount as a low dose ACE inhibitor pill. Interestingly, though, in this case the needles placed according to Traditional Chinese Medicine (in certain meridians) rather than sham acupuncture (random placement) decreased blood pressure significantly more. I wonder if the TCM placements are activating the autonomic nervous pathways in this case?
At this point the jury’s still out on how all this works. But acupuncture does have measurable effects – even if they’re due to the placebo effect and/or stimulation of the autonomic nervous system. The real question is: would you rather pop a pill each day or travel to and from an acupuncturist’s office 3-5 times a week for 30 minute treatment sessions?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
