March 11th, 2008 by Dr. Val Jones in News
1 Comment »
I was surprised by recent recent findings from the CDC’s National Health and Nutrition Examination Survey– one in four teenage girls (ages 14-19, chosen at random in the US) tested positive for some sort of sexually transmitted disease, most commonly HPV (human papilloma virus) (18%), followed by chlamydia (4%), trichomonas (2.5 %), and herpes (2%).
I asked Revolution Health expert, Dr. Iffath Hoskins, (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) what she thought of this news.
“This relatively high infection rate is cause for concern. We need to increase our education efforts so that teenagers are more aware of the risks of sexually transmitted diseases, especially since women’s reproductive futures are at stake. Chlamydia infections can substantially decrease fertility rates, long after the infection has been fully treated with antibiotics.
As far as the high HPV rates are concerned, I’m not surprised since previous research has estimated that 80-90% of adults have been infected with at least one of 80 subtypes of this very common virus. Only 6 of these 80 are known to predispose women towards cervical cancer. But the HPV vaccine can substantially reduce the risk for contracting those 6, so it’s important to vaccinate young girls against this virus.
No teenage girl should be walking around with chlamydia or trichomonas. They are treatable with antibiotics.”
The study also found racial differences between STD infection rates in teenage girls, with blacks being infected at twice the rate of white or Hispanic girls. The CDC is calling for educational outreach to at-risk groups, and the American Academy of Pediatrics supports confidential teen screening.
I hope that these staggering statistics act as a wake up call to health care providers who may not have thought to screen their teen patients for STDs. Apparently, these infections are more common than we realized.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 11th, 2008 by Dr. Val Jones in Uncategorized
4 Comments »
As many of my faithful readers know, Dr. Val is a big fan of Web 2.0 principles (blogging, online communities, wikis, forums, chats, podcasts, etc.) I’m even leading a weight loss group online, and there are almost 1400 members already. Although I’ve been trying hard to lead by example, I’ve had occasional hiccups in my own weight loss due to the sweet lure of fine dining. Could YOU resist silky, black sesame panna cotta with butter crunch tuile and spicy cranberry compote? Well maybe you could. For me, resistance is futile.
But I digress.
What I really wanted to point out (before my thoughts were derailed by deliciousness), is that research is now confirming what many of us bloggers have known instinctively: social networking can improve the health care experience. In the Journal of the American College of Surgeons, post operative pain and length of stay were reduced for those who had more social support. This means that the more frequent and broad your social contacts, the less likely you are to be bothered by pain, and the more likely you are to get out of the hospital faster. Let’s hear it for using CarePages, FaceBook, and other online support groups while in the hospital, and perhaps as outpatients as well.
And if feeling supported isn’t enough to get you on the right track, more research in the Archives of Internal Medicine suggests that mail reminders can improve post-heart attack medication compliance. Perhaps email reminders would work just as well (and kill fewer trees?) One thing is for sure – Health 2.0 tools can make an impact on peoples lives and I’m excited to be a part of that.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 10th, 2008 by Dr. Val Jones in News, Opinion
2 Comments »
When I eat out at a restaurant I’m inevitably asked whether or not I’d like bottled water with my meal. My answer usually depends upon the city I’m in – New York water tastes great, so I ask for tap water in Manhattan. The water in DC tastes like a swimming pool (at best), so I usually order bottled water at Washington restaurants.
But little did I realize that the water I’ve been drinking (whether from DC, NY or even from the bottle) has small traces of pharmaceutical chemicals in it. A new investigation conducted by the Associated Press suggests that most major urban water supplies are laced with tiny amounts of prescription drugs. How do the drugs get in the water supply?
Remember that water cycle you (or your kids) studied in grade school? Well, the “underground phase” is where the action happens. Drugs that we swallow pass through our bodies and some is released in our urine and stool. We flush that down the toilet and the fluid debris is treated in a sewage plant and then the water portion is released back into the water supply. Sewage plants and water filters are not designed to remove trace chemicals like heart medicines and anti-depressants, so they remain in the drinking water. Kind of disturbing, right?
Well, the good news (if there is any) is that the amounts of chemicals in the water are pretty small – we’re talking parts per trillion. Just to put that in perspective, that’s more than 1000 times smaller than the minimum amount needed for therapeutic effect from the fluoride added to the water system. And the concentration is far below the therapeutic threshold in the bloodstream for these drugs. But how do we know that tiny amounts of drug exposure isn’t harmful in some cumulative way?
Research into the potential long term effects of these chemicals in the water supply has focussed mostly upon the presence or absence of the drugs, and the concentrations at which they’re present. Animal studies (such as the “feminization” of fish exposed to environmental estrogens) and cell culture research suggest that exposure to larger concentrations of these drugs can cause negative outcomes, but to my knowledge there are no long term studies of the potential impact of very small concentrations on human health. But before we become outraged at this apparent lack of investigation, let’s think about why it’s so difficult to gather this kind of information.
First of all, concentration-wise, pharmaceuticals represent a small fraction of the thousands of man-made chemicals in the environment, including everything from pesticides to personal care products. So it’s very difficult to prove a cause and effect for any one drug’s influence – we are each exposed to a very dilute cocktail of chemicals in our daily lives, whether through the water we drink, the food we eat, or the air we breathe. How can we tease out the potential damage of one chemical over another?
Secondly, it’s pretty likely that any potential harm (from chemicals at such small doses) would take many years of exposure before a clinically measurable threshold is reached. It’s very difficult and expensive to study large groups of people over time – and it’s hard to know what their lifestyle choices may contribute to their overall chemical exposure. Over time people change jobs, change what they eat or drink, change where they live… the complex interplay of environmental factors make it hard to interpret exposures and effects.
And finally, how do we know what outcomes to look at? It’s possible that these small doses of pharmaceutical products could affect our bodies in fairly subtle ways – which again makes it difficult to measure. It’s hard enough to study cancer rates in populations, but how would we study differences in physical or mental performance? Or slight changes in mood or heart function?
Since there’s no easy way to prove a connection between drugs in our water system and our general health and wellbeing, we are likely to be left with far more questions than answers. I think we all agree that we’d rather not be exposed to trace amounts of any chemicals in our water supply, but unfortunately the cost of filtering all potential contaminants from the water is exceedingly high. Reverse osmosis (a process currently used to reclaim fresh water from the sea) can cost as much as $1-18/gallon depending on the system in place and the country using it. While reverse osmosis could guarantee a chemical-free drinking water supply, we couldn’t afford to supply it to all Americans. And in the end, it’s still unclear if solving that part of the puzzle would improve our overall health.
I hope that we’ll find ways to reduce the chemical load on our environment, and that advanced water purification technology will become more affordable in the future. Unfortunately, trace amounts of chemicals, drugs, and pesticides are more ubiquitous than we’d like to believe. The impact they may have on our health is difficult to measure, and largely unknown at this point. Perhaps the bottom line is that we’re all connected to one another through our environment – so that granny’s heart medicines may yet live on (albeit in trace amounts) in your bottled water. All the more reason for Americans to pull together to live healthy lifestyles, control our weight, and try to prevent the diseases that are requiring all these drugs in the first place.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 9th, 2008 by Dr. Val Jones in True Stories
3 Comments »
It was really cold in NYC this weekend. Most of the little Upper East Side dogs were decked out in full coats that matched their collars, some even had booties. I spotted a couple of Italian
Greyhounds looking forlorn and trembling on their leashes. They weren’t
interested in a walk in the park on this day – they just wanted to go home to
their warm condos.
But cold as I was, I didn’t have the option to retreat. I
had come to run in the Colon Cancer Challenge with my friend Seton – a lifelong
marathon runner just finishing her second round of chemotherapy. She was in
high spirits – and laughed at my joke that this was the first race in which I’d
have a “snowball’s chance” of keeping up with her. You see, I’d always wished I could be an
athlete – but the best my genes could do is prepare me to pull the plow. So I
plod along, hoping for the day when I’ll be invited to join a caber toss – and
actually have a chance of doing something I might be good at.
But I digress.
So thousands of runners took to the 4 mile course – and as I
looked around I doubted that too many of them were actively taking chemotherapy
like Seton. She was bound and determined to run at least half of the way, and
had been training for it between IV infusions of very toxic drugs.
Seton’s husband was beaming with pride as he photographed
her at the start gate. I had vowed not to leave her side, no matter what the
pace… She had about 20 other friends who had joined the race as well and a
small handful stayed with us for the entire time. Amazingly, Seton was able to
run 3 of the 4 miles, her hands cramping in the cold, her thin legs carrying
her tingling feet past familiar landmarks. She held her head high, and never
complained – though it must have been hard for a former track star to watch people
of lesser abilities passing her on the trail. Her friends called her cell
phone every 10 minutes to find out how she was feeling/doing. They didn’t know
that it was so hard for her to even open the phone.
As Seton crossed the finish line, she held her arms up in
the air, as if she were breaking through winning tape. Cameras flashed, people
cheered, and I saw tears well up in her eyes as she tried not to show her
exhaustion. She gathered her friends around her and gave this short speech:
“I want to thank all of you for coming out and supporting me
and the fight against colon cancer today. I can’t tell you how much it means to
me to see all of your smiling faces… Although I certainly had some unlucky news
recently, I want you all to know that when I look at you, my dear friends and
family, I feel like the luckiest woman alive. I am so glad to have you all in
my life. I am truly blessed, and I’m going to beat this cancer with you all by
my side.”
There wasn’t a dry eye among us.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 6th, 2008 by Dr. Val Jones in Expert Interviews
3 Comments »
I must admit that I was a bit skeptical of the conclusions drawn by the media about the latest analysis of the Women’s Health Initiative (WHI) data. The WHI study has generated many different spin-off articles about hormone replacement therapy and its potential link to breast cancer. This latest review suggests that the increased risk for cancer persists up to five years after stopping HRT treatment for menopausal symptoms. I asked Revolution Health expert and past president of the American College of Obstetricians and Gynecologists, Dr. Vivian Dickerson, to help us put this new article into context.
Dr. Val: What does this new study contribute to our understanding of the risks of HRT?
Dr. Dickerson: First of all the women in this study were not on estrogen alone (the usual treatment for women who have had hysterectomies). Their HRT consisted of a combination of Premarin (estrogen) and Provera (progesterone). The original study indicated a slightly higher (barely statistically significant) increased risk for cardiovascular disease (CVD) and a statistically significant increased risk in breast cancer (but relative risks were less than 1.5 for both, which is very small).
Now all this new analysis tells me is that the CVD risk appears to extinguish or become negligible after three years though there is still an increase in breast cancers (compared to placebo) but the difference was not statistically significant. This is interesting in that it does add some plausibility to the claim that the reason breast cancer rates declined so significantly in the year(s) after WHI is because of all the women who quit taking HRT. It doesn’t prove anything, but just more grist for the mill. (Unfortunately I don’t see sub-group analyses of the women who chose to continue HRT after the end of WHI and those who quit from the treatment group.)
The study authors used some fancy math to demonstrate that there was a statistically significant increase in all-cause mortality (including breast cancer) for the women in the HRT group. Since the relative risk is so low, all they can say is that there is no reason to use HRT as a protective or primary preventive measure against heart disease, which we’ve known for many years now.
Dr. Val: Would you change your HRT recommendations based on this new analysis of the WHI data?
Dr. Dickerson: I wouldn’t change a thing that I am doing or counseling. These data are weak and the differences are not robust in any parameter.
***
So there you have it, ladies. No need for heightened alarm based on this analysis of the WHI data, especially if you have never been on the Premarin/Provera cocktail. It would be really helpful to compare breast cancer rates in women who stopped HRT versus those who continued it after the initial WHI data were released. Let’s keep our fingers crossed that this subgroup analysis is next up for publication.
Addendum: My friend and HRT expert, Dr. Avrum Bluming, kindly wrote me an email to further underscore the dubious nature of this study’s findings. Here’s what he said:
“The paper reads more like a lawyer’s presentation then a scientific article (i.e. it makes points followed by the disclaimer that the findings represented are not statistically significant—but the points have been registered). Instead of concluding that the very small increased risk of harm associated with estrogen and progesterone combination therapy (reported in the original studies, which were of questionable significance in the first place) are not found 2+ years after HRT was stopped, they find new risks (lung cancer) to allow them to conclude that administration of HRT results in delayed increased risks.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
