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Do Chronic Diseases Begin In Utero?

Heart disease. Stroke. Diabetes. Asthma. Osteoporosis. These common scourges are often pegged to genes, pollution, or the wear and tear caused by personal choices like a poor diet, smoking, or too little exercise. David Barker, a British physician and epidemiologist, has a different and compelling idea: these and other conditions stem from a developing baby’s environment, mainly the womb and the placenta.

Barker was the invited speaker at this year’s Stare-Hegsted Lecture, which is a big deal at the Harvard School of Public Health. In just over an hour, he covered the basics of what the British Medical Journal used to call the Barker hypothesis. It has since come to be known as the developmental origins of chronic disease. (You can watch the entire talk here.)

It goes like this: During the first thousand days of development, from conception to age 2, the body’s tissues, organs, and systems are exquisitely sensitive to conditions in their environment during various windows of time. A lack of nutrients or an overabundance of them during these windows programs a child’s development and sets the stage for health or disease. Barker and others use low body weight at term birth is a marker for poor fetal nutrition.

When a fetus is faced with a poor food supply, it Read more »

*This blog post was originally published at Harvard Health Blog*

Research Provides Further Justification For Women To Avoid Smoking

Women who smoke begin menopause a year earlier than nonsmokers, researchers concluded, adding that earlier menopause is associated with osteoporosis and heart disease.

Researchers conducted a meta-analysis of the available data about smoking and menopause, finding 11 studies comprising about 50,000 women, using age 50 as a threshold for early or late age at natural menopause (ANM). Results appeared in Menopause.

In five studies, participants were classified as Read more »

*This blog post was originally published at ACP Internist*

Vaccine For HPV May Prevent More Than Cervical Cancer

Oropharyngeal cancers caused by the human papillomavirus (HPV) are on the rise in the United States since 1984, as changes in sexual habits further the virus’ spread. But the focus of the HPV vaccine will remain on preventing genital warts and cervical cancer.

Reuters reported one clinician’s opinion that throat cancer linked to HPV will become the dominant cause of the disease, ahead of tobacco use.

To study the issue, researchers determined HPV-positive status among 271 of all 5,755 oropharyngeal cancers collected by the three population-based cancer registries in Hawaii, Iowa and Los Angeles from the Surveillance, Epidemiology, and End Results (SEER) program from 1984 to 2004. Prevalence trends across four calendar periods were estimated by using logistic regression. The study appeared online Oct. 3 in the Journal of Clinical Oncology.

HPV prevalence Read more »

*This blog post was originally published at ACP Internist*

Rethinking Old Truisms: Menopause And Heart Disease

The idea that heart disease mortality rises dramatically at menopause has been one of the truisms of medicine that spawned a generation of hormone use by women and led to the rise and subsequent fall of Prempro in the Women’s Health Initiative, the end-all-be-all study that failed to prove the truism. The truism is still so strongly believed that research to prove it right continues, using different hormone formulations and different cohorts of women, in the hopes that the hormonal fountain of youth was just misbranded and given to the wrong aged cohort.

Now comes a landmark study that suggests that what we’ve thought all along about heart disease and menopause may actually be wrong.

Dhananjay Vaidya and colleagues at Johns Hopkins and the University of Alabama have re-analyzed mortality data on men and women in the UK and US and concluded that, contrary to popular belief, heart disease rates and mortality do not increase dramatically with menopause, but rather rise more gradually as a function of age in both men and women.

Our data show there is Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Researchers Identify Faulty Gene Associated With Ovarian Cancer Development

British researchers identified a faulty gene associated with a one-in-11 chance of developing ovarian cancer, and they think drugs for breast cancer might also work in these women.

Ovarian carcinoma, from ACP's book Practical GynecologyResearchers from England’s Institute of Cancer Research reported that they compared DNA from women from 911 families with ovarian and breast cancer and to a control group of 1,060 people from the general population.

They found eight gene faults in theRAD51Dgene in women with cancer, compared with one in the control group. TheRAD51Dgene repairs damaged DNA, and when it’s faulty, cells are more likely to turn cancerous.

Results appear Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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