Health for my Mom

Not Wired that Way

February 4, 2010 · Leave a Comment

So we’ve done our third installment of Doctor’s Orders with ABC, this time on addiction science.

I got the idea when one of our reporters, Ed Susman, said he lost weight in a clinical trial of a drug that worked partially through a behavioral modifier. Not only did he drop 50 pounds; he also kicked his nail-biting habit. I had to know more about how addictions and compulsions worked.

I found researchers at a national laboratory on Long Island who actually conducted brain scans of drug addicts, alcoholics, and obese patients. Eerily, function decreased in the same areas of the brain in all three groups.

Seeing how deeply habits are wired into our brains has made me a bit less self-critical about the little compulsions I just can’t shake.

ABC did their own segment, but the story I wrote appeared on both ABCNews.com and MedPageToday.com. The latter also includes the video I worked on with Bjoern Kils. Enjoy!

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On Bedside Manner

February 3, 2010 · Leave a Comment

My inner ear was itchy. In the split second before I reached for the Q-tip, I had an argument with myself. This isn’t a good idea, the more rational part of me said. The other side said, I can handle this. Nothing will happen. And it won.

So I swabbed. I scratched. And then, my hearing was muffled.

I knew that was going to happen.

I dialed my doctor in shame. The next day, in his office, he teased me. “Now what did we learn in grade school about shoving things in our ears?”

“I’m especially ashamed, as a medical reporter, that I did this,” I replied.

What he said next will probably stick with me forever. He could have lectured me, he could have played almighty doctor pandering to the lowly patient. But his response shows just how exceptional of a physician he is.

“We’re all human,” he said. “Whatever we do as our ‘thing’ — your reporting, my white coat — first, we are human.”

It’s wonderful to have a doctor who acknowledges this. And it encourages me, in my writing, to emphasize those human details. To converse, rather than to list. To have a confident voice, not just confidence intervals. Because a story can be peppered with statistics, but will lack significance if it ignores our least common denominator — humanity.

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On the Couch or On the Computer?

January 18, 2010 · Leave a Comment

When I tell my friends that I’m covering the American Psychoanalytic Association meeting, they often respond, “Psychoanalysis? That still exists?”

Few of them can dissociate the practice from an image of Sigmund Freud, pen and pad in hand, saying, “ja, tell me more,” to a patient laying down on a couch.

Their perception may not be completely off base. There seems to be a rift between conservative and progressive approaches to analysis.

Some believe that the couch is an absolutely essential part of the psychoanalytic process, and that the analyst should never inject him- or herself into the consultation. I met quite a few from this more traditionalist set at the meeting, and heard some German accents among white-haired men.

Others welcome a seated patient, and prefer creating a dynamic between consultee and doctor to garner relevant information. The most progressive members were even open to Skype sessions with their patients.

For a field that doesn’t rely heavily on scientific research, the progressives are certainly re-testing hypotheses and adjusting their theories accordingly. They’re doing service to a discipline that some have come to consider irrelevant.

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Coping with School Shootings

January 7, 2010 · Leave a Comment

Tis (almost) the season for school shootings.

I don’t mean to sound so sanguine, but many psychiatrists say springtime can bring out the manic in bipolar disorder. For those with other social problems, the increased community activity sparked by longer days could be a reminder of painful exclusion.

Schools have to be prepared for these kinds of traumatic events. Administrators are quick to offer one-on-one or group therapy sessions. But researchers reporting in the Canadian Medical Association Journal say the kind of “psychological debriefing” that involves a child re-living a traumatic event may do more harm than good.

In adults, some studies have shown that debriefing could increase the risk of posttraumatic stress disorder.

Researchers have yet to do similar studies in children, but some are taking the adult data as a warning.

Christopher Thomas, MD, of the University of Texas Medical Branch in Galveston, said having a child relive a trauma may “work against natural processes of handling trauma and grieving,” and forcing someone to recall painful memories before they’re emotionally able to handle it can be damaging.

Check out the full story on medpagetoday.com, and comment about the resources you think schools should provide after traumatic events.

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The Challenges of Eating Well

December 29, 2009 · Leave a Comment

This was originally published on MedPageToday.com.

On Christmas, I couldn’t eat anything.

No, it wasn’t the flu. And it wasn’t because of some fad diet.

It was a film.

A couple days earlier, I watched Food, Inc., a revealing documentary on big-business agriculture, co-produced by Eric Schlosser author of Fast Food Nation, and starring Michael Pollan, a leading expert on food and food policy from the University of California Berkeley.

It covered a range of the related issues: Cattle crammed together in industrial farms, feeding on fodder made from reprocessed beef. Sick chickens made top-heavy by hormones to enlarge their breasts that can’t even stand up in dark, cramped coops. Crops genetically engineered by one dominant company to be resistant only to that company’s pesticide.

None of these practices shocked me, in theory. I had heard them all before. Here at MedPage Today, I’ve covered several disease outbreaks linked to foods contaminated by deadly strains of E. Coli or Salmonella. Five years ago, after a Mad Cow Disease scare that was traced to farms that fed their cattle reprocessed beef parts, I wrote a feature on a farmer in New Jersey who refused to feed his beef cattle anything but grass — the diet cows and other ruminants are adapted to.

But after the film’s visualization of these issues, it was hard not to see the feces-smeared fur of industrial cattle every time I looked at the steak on the Charlie Brown’s gift certificate I bought a relative for Christmas.

As soon as the movie ended, I resolved to make a greater effort to learn where my food comes from.

And what better time to start than Christmas, when family shoves one baked or processed good after another onto your plate.

Luckily, we follow the tradition of our Italian heritage with the “Seven Fishes” dinner on Christmas Eve, a slightly healthier choice to begin with than meat, right?

Well, one of the sillier scenes in Food, Inc., was on a fish farm where tilapia were routinely fed corn — which was perhaps genetically modified. Or grown in soil full of super-resistant strains of bacteria from industrial cattle manure.

What about pasta — my uncle’s famous spaghetti with garlic and oil. Lots of healthy grain, no antibiotics necessary to grow it.

But there could be a pesticide issue. And any health benefits from grain are likely gone with the grinder — our spaghetti was made from refined grains.

Shrimp? Mercury. Fruits from the chocolate fondue spread? Pesticides. Venetian cookies? Forget about it. I wouldn’t bore myself attempting to read that ingredient list, but I’d bet my Christmas gifts it contained several processed, corn-based products.

So what can the omnivore do? The movie doesn’t answer that, other than by offering some suggestions to eat local. But that raises a whole host of issues in itself.

I doubt local farmers are using fertilizer that doesn’t come from the manure of industrial cattle, with traces of hormones. And they aren’t barred from using pesticides — unless they’re trying to get classified as “organic.”

Still, the organic label is vague. I’ll always remember from my grass-fed beef interviews that the organic label is awarded if the farm has enough space for the cattle to graze. True, it restricts hormone use. But it doesn’t require that the cows be kept outdoors all the time, and doesn’t restrict grain or other fodder that’s not indigenous to a cow’s diet.

Even if local farmers don’t use pesticides on their veggies, and feed their cattle only grass, one still has to take into consideration the farmer’s land — and this is particularly relevant for New Jersey, which is infamous for its amount of Super Fund sites. Contaminated soil and groundwater could easily find their way onto your dinner plate.

And now it’s also fashionable to calculate the carbon footprint of your food. More questions to add to my list next time I go to the local Paterson, N.J. farmers’ market — how much methane do your cattle expel into the atmosphere annually? How many thousands of miles does your topsoil travel before it’s spread on your fields?

After a couple of visits, the farmers would probably start closing up their booths as soon as they see me.

Several family members heard my arguments for eating better, but said attempts to know where food actually came from would be futile.

Rather than feeling resigned to continue the same old diet, I did some research and found a couple helpful resources. Not all of them address every single issue I’ve raised here, but they are a springboard.

The Centers for Science in the Public Interest recently published a book in conjunction with Food, Inc., on improving your diet. The chapter on “Making Change” is particularly helpful. If you’re attached to eating meat and dairy, it recommends eating beef from non-industrial farms, eggs from uncaged hens, milk from cows that graze on grass. Don’t eat foods, of course, from animals that have been given hormones.

Fruits are trickier, since almost all have been exposed to pesticides. Generally, experts say to eat only fruits that are in season. And be wary of fruits grown in other countries, which may not have the same pesticide regulations as the U.S.

I’d never been convinced of a need to stay away from “genetically modified” foods, because in some ways this practice can be beneficial. Golden rice, for example, can reduce vitamin A deficiencies. And flood-resistant rice can prevent hunger in developing nations.

But watching Monsanto bully farmers into growing only soybeans that were genetically altered only to be resistant to a Monsanto pesticide was infuriating.

I’ve always been a disciplined eater, so imposing a few more restrictions shouldn’t be too challenging. Although it’s now approaching lunch time and I’m wondering who, exactly, in the cafeteria I can talk to about where they grow the produce that I’ll be having in my salad.

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Science Still Says Climate Change is Real

December 5, 2009 · 1 Comment

Perhaps this is a bit of a break from a direct health or medicine story, but climate change will undoubtedly have effects on human health in terms of disease outbreaks and epidemics.

So I feel it’s important to reaffirm that, despite all this talk of ‘ClimateGate,’ human-induced climate change is indeed happening, according to prominent scientific organizations.

“The vast preponderance of evidence, based on years of research conducted by a wide array of different investigators at many institutions, clearly indicates that global climate change is real, it is caused largely by human activities, and the need to take action is urgent,” Alan I. Leshner, chief executive officer of the American Academy for the Advancement of Science, said in a statement.

You can read the rest of the statement here. Also check out some of the resources and interesting responses to the story on the NY Times’ climate change blog, DotEarth.

Of course the e-mail hackers could not have timed their break-in any better, in these days leading up to an international discussion about the issue in Copenhagen. Luckily, most Americans still think Sen. Jim Inhofe is a joke.

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Faith in Statistics

November 21, 2009 · Leave a Comment

I have some empathy for those who are suspicious of recent recommendations pushing back screening ages for breast and cervical cancer.

Nothing, for example, can stop my pre-flight anxiety. And try as my boyfriend may, he will never convince me to go skydiving. It may be a “calculated risk,” as he says, but it just feels unnatural and, well, “risky.”

So I can sympathize with women who say, ‘that one person saved from breast cancer out of 2,000 others could have been me.’

Highly, highly unlikely. But however unluckily so, it could have been.

Humans tend to see things in 50-50 odds, in terms of this outcome or that. Either my plane lands safely or it doesn’t. My chute opens, or I pummel into the earth. It takes a lot more to think in terms of numbers, odds, risk.

That’s why public health experts do it for us. They’re trained to pit the risks of screening (radiation exposure and anxiety from false-positives for breast cancer, for example) against its benefits (how many lives does it really save?) and calculate sound advice.

It’s called evidence-based medicine, and it’s what doctors like to practice best.

But we don’t see the epidemiologists’ thought processes, their methodology, or their rationale, which could explain why there’s so much skepticism in the general public. As Paul Raeburn jokes in a recent Knight Science Journalism Tracker item, we can’t just consult our healthcare epidemiologist to tell us what to do and why.

But we can try to think like one. It’s as simple as searching the New York Times. These numbers are from a fantastic news analysis by reporter Kevin Sack:

According to their review, the U.S. Preventive Services Task Force found that one cancer death is prevented for about every 2,000 women ages 40 to 49 who are screened for 10 years.

For women ages 50 to 59, one death is prevented for every 1,300 women screened.

Looking very broadly at those numbers, your risk almost doubles when you hit 50. Starting to see their thought process?

The screen works even more efficiently for women ages 60 to 69, preventing one death for every 377 ladies. Based on those numbers, no one would deny screening at that age. That’s a huge difference from 1 in 2,000 — your risk is increased almost five times from when you were 40.

I don’t know the exact statistics, but it would also be worthwhile to factor in your risk of cancer from being exposed to radiation once a year from 40 to 49.

I surely wouldn’t be able to calculate that. As a rookie health reporter, I’m just beginning to understand risk. If I’m around it every day and am still no expert, I can imagine how challenging it must be for the lay reader.

And your doctor may not be able to offer much help, either, as Raeburn notes in his commentary. Physicians learned of the recommendations at the same time we readers did. And they are certainly not epidemiologists. Their last statistics course may have been during their undergraduate training.

So what can you do? Well, know your risks. Know that the new guidelines exempt women who have genetic risks for breast cancer. (And bear in mind that the new guidelines are only one set of recommendations. Other medical organizations, like the American Cancer Society, have not changed their policies yet.)

And do a bit of rationalizing on your own. If you’re not in the at-risk population, but you’re not comfortable relying on the numbers, then compromise. Get screened every three or five years during your 40s if that puts your concerns at ease. It may be statistically unnecessary, but at least you will have peace of mind.

Just like I do when I pray to the deity of statistics before takeoff.

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Such is Science

November 14, 2009 · 3 Comments

Remember that blog post in which I blasted folks on airplanes and in Broadway theaters for wearing surgical masks to guard against H1N1?

When I said, “the science says that surgical masks do nothing to keep the flu from getting into you — they just keep it from getting out of you.”

Well, a reporter is only as good as her sources, and my sources — and the CDC’s sources — got it wrong.

Last week at the Infectious Diseases Society of America meeting in Philadelphia, the researchers retracted their study that showed N95 respirators were effective against flu transmission, while surgical masks weren’t.

Apparently their statistics were off, and their peer reviewers pointed it out.

So, now, taken altogether, the data show that there’s no difference between N95 respirators and surgical masks in terms of flu protection (a study published in JAMA — that means it was peer-reviewed — already came to this conclusion last month).

Perhaps that’s what we get for taking science reported at meetings for gospel (the study was originally reported at ICAAC). This kind of work tends to be published only as abstracts — which are rarely up-to-date — and seldom scrutinized by anyone other than the study’s authors.

On the other hand, this was a good confirmation that both science and the peer review system work. Science continues to re-evaluate its stance until it comes to an acceptable answer. Peer-reviewers are a big driver in that process.

While the lay person might recoil in having to admit that she is wrong, a scientist is not a scientist if they claim to know everything. Real science is about advancing knowledge — which may sometimes contradict previous knowledge.

As Michael Smith, my colleague who reported the mask stories, so aptly puts it, “science is the only field willing to admit its mistakes.”

I’d gladly buy any scientist a couple rounds to wash down any pride.

→ 3 CommentsCategories: H1N1 Flu
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Thought We Were Over H1N1 Vaccine Hazards

November 4, 2009 · Leave a Comment

I got an email from a friend early this morning about how three pediatricians refused to give another friend’s newborn the swine flu vaccine.

“Many doctors are coming out and saying that you have  a much higher risk of dying from the vaccine than from dying from swine flu itself,” she said.

I cringed the way I do when I watch that obviously-faux Fox News report on the cheerleader who got “dystonia” from a seasonal flu vax.

No physician would claim that. I wrote a response-to-all that I want to share here, to allay any kinds of false concerns over the vaccine:

“As a medical reporter, I feel I should weight in on this. I have to say that statistic about risk of death is blatantly wrong. More kids in the U.S. have died from the swine flu — 114 since April — than from the vaccine. Actually, NO kids have died as a result of having the vaccine. We now have almost two months’ worth of data (not to mention data from early, albeit rushed, clinical trials) on the swine flu vaccine and there have been no deaths, no serious adverse events. And that’s among the entire U.S. population (over 500 U.S. adults died from swine flu between April and August, and I don’t know how many more by now).

The swine flu vaccine is nearly identical to the seasonal flu vaccine. It just contains one different protein — DNA from the H1N1 strain, rather than the typical seasonal flu virus. But incorporating new proteins into the vaccine happens every year, since different strains become the “dominant” seasonal flu. Next year, for example, your seasonal vaccine will likely incorporate, or fully become, the swine flu vaccine.”

My friend also had concerns about other ingredients in the vaccine, including formaldehyde. I thought it was just a really terrible rumor, but on further analysis this is what I found and wrote to her:

“This is the FDA’s H1N1 ingredient list:
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm186102.htm

And here is the makeup of Sanofi’s vaccine:
Influenza A (H1N1) 2009 Monovalent Vaccine is formulated to contain 15 mcg hemagglutinin (HA) of influenza A/California/07/2009 (H1N1) v-like virus per 0.5 mL dose. Gelatin 0.05% is added as a stabilizer. Each 0.5 mL dose may contain residual amounts of formaldehyde (not more than 100 mcg), polyethylene glycol p-isooctylphenyl ether (not more than 0.02%), and sucrose (not more than 2.0%).

Apparently formaldehyde is used to kill live virus. If it’s in the vaccine, it’s trace amounts — 100 micrograms is incredibly small. Not something I would personally worry about.”

This is how I signed off the email:

“Apologies if I sound stern about this, but part of my job is to keep abreast of all of this information, and ask hard questions of officials — doctors, government administrators, researchers — if something really is amiss. Since April, I really haven’t had any major reason to do so.”

I also sent her a couple of links. Check them out if you have any other remaining questions:

Here is a good myth-buster piece on the H1N1 vaccine: http://www.nytimes.com/2009/10/12/opinion/12offit.html?_r=1

And here is one with regard to the virus itself: http://www.nytimes.com/2009/09/08/health/08well.html

Also, the FDA and CDC have great swine flu landing pages. I like the FDA’s better: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm150305.htm

And here is the CDC’s: http://www.cdc.gov/H1N1FLU/

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A Better ‘Position’ to Deal with Disease

November 1, 2009 · Leave a Comment

In pop culture, yoga gets a bad rap as a frou-frou hobby of rich housewives or yuppies.

But recently, researchers — mostly psychologists — have been taking a hard look at its potential as a complementary therapy for patients with all kinds of disorders. Cancer. Cardiovascular disease. Asthma. ADHD.

Many have found that it has positive effects on quality of life, and reduces stress and anxiety. Makes sense, since the Ayurvedic therapy is comprised of stretching (read: exercise) and breathing and meditation (relaxation/stress relief).

Studies on possible physiological effects of yoga are still underway. Some say it may reduce levels of cortisol, the body’s stress hormone.

Of course, no researcher would ever ask whether yoga can actually TREAT disease. It’s clear that yoga is a complementary therapy, not an alternative one. Though those terms are often paired, they mean very different things.

I go into more detail in a story I wrote for Good Morning America Weekend on ABC and Medpage Today. We just launched a new monthly segment together called “Doctor’s Orders,” and the yoga story was the first in the new partnership.

After you watch the ABC video, check out our video on MedPage Today, produced by Bjoern Kils.

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