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Published on Leave a comment on Is Melanoma Overdiagnosed?

Is melanoma overdiagnosed? I recently wrote about an article on cancer screening where melanoma was discussed as a cancer that was "overdiagnosed". And now an article, with supporting research, from Health News Review  (an excellent site that does "critical thinking about health care") about the issue of overdiagnosis of melanoma during skin screening tests. What? This is definitely news to many.

The following article was written because of a new skin cancer screening test developed using artificial intelligence (AI) that could distinguish between melanomas and benign moles. It turns out that a lot of people have concerns over melanoma being overdiagnosed (and therefore overtreated), including the U.S. Preventive Services Task Force.

But how do we know melanoma is being overdiagnosed? Because even though more and more melanomas are being found (through screening tests) and treated, the death rate from melanoma has stayed the same over the past 40 years (see the graph below).  Just note that what is described here are moles diagnosed as melanoma during screening tests, meaning that small moles just sitting there on the body are examined. It is not talking about moles that are changing in some worrisome way - those should absolutely be checked out. Excerpts from Kevin Lomangino's post at  Health News Review:

Yes, melanoma can be overdiagnosed, but news stories like these don’t discuss it

Many stories, like this U.S. News & World Report piece, suggested that AI “may serve physicians involved in skin cancer screening as an aid in their decision whether to biopsy a lesion or not.” But none of the stories I looked at paused to ask, Is finding more melanoma definitely a good thing?  ...continue reading "Is Melanoma Overdiagnosed?"

Published on Leave a comment on Is A New Organic Label Needed For Farmers Following Traditional Organic Practices?

Something a little different today. For years I've posted studies showing that eating organic foods lowers pesticide levels in the body quickly, eating organic foods is the only way to avoid the presence of the controversial pesticide glyphosate (Roundup) in food, the nutritional profile (especially fatty acids) of meat and milk from grass-fed, pasture raised animals is different and healthier than conventionally raised animals (and even organic animals not raised on pasture), and on and on. In other words, eating organic foods has health benefits. All good.

But meanwhile, the National Organic Program and National Organic Standards Board (which controls the national organic foods certification program) is being influenced by big agriculture lobbying - to the dismay of real organic farmers. Yes - real organic farmers, who farm the way we expect our organic meat and crops to be raised. You know - cows grazing outside, chickens pecking away for insects outside, crops being raised in real soil (and not hydroponics).

But ... Big Agriculture with the mega-farms and lots of chemicals, and animals confined by the thousands indoors, have decided they want a piece of the organic action, and have now influenced the National Organic Program and National Organic Standards Board with the result of weakening of organic standards. But there are other problems too with the organic program as it currently exists.

The Washington Post did a series of articles last year about a huge issue of fraud -  about how so-called organic food from other countries may really not be organic (esp. corn and soybeans), and this mega-influx of fake organic food with lower prices is something real organic farmers in the US can't compete with. Also, how "larger agricultural companies have sought to loosen organic rules in the name of efficiency and affordability". The organic market is a big one, and growing bigger every year (billions of $$). It benefits large corporations and huge mono-crop farms financially to have watered down standards.

Another example: the organic milk that one buys may not really be organic (and the same issue with organic chickens). Organic dairies are supposed to have their dairy cows out grazing in the pasture for a minumum of 120 days per year - it is a requirement. But big dairies that are only organic in name ignore that requirement - such as the huge Aurora Dairy. Yup, they lie.

And in September 2017, the USDA (US Department of Agriculture) didn't punish the 15,000 cow Aurora Dairy - instead they "exonerated the enormous Aurora Dairy CAFO (Confinement Animal Feeding Operation) of any wrongdoing at their Colorado “farm.” This dairy operation was described in detail in one Washington Post article, along with compelling test results to prove the cattle weren’t on pasture." So of course now they and other mega-dairies will just ignore the organic regulations, because they can without any penalty.  ...continue reading "Is A New Organic Label Needed For Farmers Following Traditional Organic Practices?"

Published on Leave a comment on Drinking Baking Soda as a Medical Treatment?

A lot of ifs in this study, but... if it holds up, then a really, really cheap medicine. A study by researchers at Augusta University (in Georgia) found that drinking a little baking soda (sodium bicarbonate or NaHCO3 ) with water tells the spleen to go easy on the immune response. In other words, ingesting the baking soda promotes an anti-inflammatory response by the spleen ("activates splenic anti-inflammatory pathways") - which the researchers found in both rats and humans.

The researchers thought this could mean that perhaps some day drinking a little baking soda each day could lower the body's inflammation in kidney disease and autoimmune diseases like rheumatoid arthritis. How much baking soda? The researchers tested 2 g of NaHCO3  (less than 1/2 teaspoon) dissolved in 250 ml of bottled water in a small group of healthy adults. More studies need to be done. From Science Daily:

Drinking baking soda could be an inexpensive, safe way to combat autoimmune disease

A daily dose of baking soda may help reduce the destructive inflammation of autoimmune diseases like rheumatoid arthritis, scientists say. They have some of the first evidence of how the cheap, over-the-counter antacid can encourage our spleen to promote instead an anti-inflammatory environment that could be therapeutic in the face of inflammatory disease, Medical College of Georgia scientists report in the Journal of Immunology.  ...continue reading "Drinking Baking Soda as a Medical Treatment?"

Published on Leave a comment on Personal Care Products and Air Pollution

Researchers measured chemicals in the air in 2 cities (Boulder, CO and Toronto, Canada) and found equally high levels of 2 chemicals in the air during morning commute times - benzene (from vehicle exhaust) and a type of siloxane (from personal care products). What? This study's results make a strong case for reading ingredient lists of personal care products (especially lotions, shampoos, deodorants, antiperspirants) - and avoiding those containing siloxane (which emits volatile organic compounds or VOCs!).

If you consider siloxane and fragrances (which can contain a long, long list of chemicals, including VOCs) as significant sources of air pollution, you might not want to breathe it in or put in on your skin to be absorbed.  Bottom line: Read labels! From Science Daily:

Personal care products contribute to a pollution 'rush hour'

When people are out and about, they leave plumes of chemicals behind them -from both car tailpipes and the products they put on their skin and hair. In fact, emissions of siloxane, a common ingredient in shampoos, lotions, and deodorants, are comparable in magnitude to the emissions of major components of vehicle exhaust, such as benzene, from rush-hour traffic in Boulder, Colorado, according to a new CIRES and NOAA study.  ...continue reading "Personal Care Products and Air Pollution"

Published on Leave a comment on Kitchen Cabinet Sealants Can Be A Source of Indoor Air Pollution

Uh-oh, it looks like some (many?) new or fairly new kitchen cabinets are outgassing several types of PCBs from the wood sealants used on the cabinets. PCBs (polychlorinated biphenyls) were banned in the 1970s due to health risks - for example, they are known carcinogens, and some are neurotoxic (also here).

Researchers from the University of Iowa monitored air inside and outside 16 Iowa homes and found 3  types of PCBs (PCB-47, PCB-51, and PCB-68) wafting off the finished kitchen cabinets. They suggest that the PCBs becoming airborne are "unintentional impurities", that is, inadvertent byproducts of polymer sealants (from the common ingredient 2,4-dichlorobenzoyl peroxide) used in modern kitchen cabinetry. They found that unfinished cabinets had no PCB emissions. The concentrations seemed to be dependent on the year the house was built - with higher levels in houses built in the past 5 years (one house had just been completed),  and also in a recently remodeled kitchen (new cabinets!). The cabinets were made by different manufacturers.

So now we have a new source of indoor air pollution to think about. The big questions are: 1) What, if anything, does this mean for human health? 2) How long does this outgassing from sealants go on for? 3) Are there alternative sealers that don't have this problem? By the way, the researchers discuss that household paints emit PCBs (such as PCB 11) as byproducts of paint pigment manufacturing, and yes, they were found both inside and outside houses. We love our plastics, use them in so many products, but there are consequences. From Env. Health News:

Finished kitchen cabinets are emitting toxic PCBs

Researchers tested indoor air at 16 homes and found three types of PCBs are widespread, and finished cabinets are the source of the toxics, according to a study released today. They suspect the PCBs [polychlorinated biphenyls] are byproducts of sealants used on the cabinets. The study, from the University of Iowa, is the first to suggest wood finishing products are a significant source of PCBs to indoor air and finds that, despite federal bans on PCBs, the chemicals are still being released into the environment, including our homes.  ...continue reading "Kitchen Cabinet Sealants Can Be A Source of Indoor Air Pollution"

Published on Leave a comment on Are You Getting Unnecessary Medical Tests?

This post is about an issue that I've covered before - the issue of unnecessary medical tests and care, which has been documented by many, especially Dr. H. Gilbert Welch (here and here). In the past I've focused on research documenting physical and emotional harms resulting from overuse of some medical tests and procedures, especially some types of cancer screening, but today's post is about the financial harms of unnecessary medical tests and procedures.

We're talking about medical tests or services that are overused, perhaps done "routinely" when there are no symptoms or real reasons to do the test. The cost of unnecessary tests and services can be financially devastating to the person receiving the bill(s). But this "waste" has also been estimated  at $765 billion a year by the National Academy of Medicine. This is about a fourth of all the money spent each year on health care! Wow. The following article by Marshall Allen is co-published on both ProPublica and NPR. Excerpts from NPR:

Unnecessary Medical Care: More Common Than You Might Imagine

It's one of the intractable financial boondoggles of the U.S. health care system: Lots and lots of patients get lots and lots of tests and procedures that they don't need. Women still get annual cervical cancer testing even when it's recommended every three to five years for most women. Healthy patients are subjected to slates of unnecessary lab work before elective procedures. Doctors routinely order annual electrocardiograms and other heart tests for people who don't need them.

That all adds up to substantial expense that drives up the cost of care for all of us. Just how much, though, is seldom tallied. So, the Washington Health Alliance, a nonprofit dedicated to making care safer and more affordable, decided to find out. The group scoured the insurance claims from 1.3 million patients in Washington state who received one of 47 tests or services that medical experts have flagged as overused or unnecessary. What the group found should cause both doctors, and their patients, to rethink that next referral. In a single year:

  • More than 600,000 patients underwent a treatment they didn't need, treatments that collectively cost an estimated $282 million.
  • More than a third of the money spent on the 47 tests or services went to unnecessary care.
  • 3 in 4 annual cervical cancer screenings were performed on women who had adequate prior screenings – at a cost of $19 million.
  • About 85 percent of the lab tests to prep healthy patients for low-risk surgery were unnecessary — squandering about $86 million.
  • Needless annual heart tests on low-risk patients consumed $40 million.

Susie Dade, deputy director of the alliance and primary author of the report released Thursday, said almost half the care examined was wasteful. Much of it comprised the sort of low-cost, ubiquitous tests and treatments that don't garner a second look. But "little things add up," she said. "It's easy for a single doctor and patient to say, 'Why not do this test? What difference does it make?'"

ProPublica has spent the past year examining how the American health care system squanders money, often in ways that are overlooked by providers and patients alike. The waste is widespread – estimated at $765 billion a year by the National Academy of Medicine, about a fourth of all the money spent each year on health care.

Dr. H. Gilbert Welch, a professor at The Dartmouth Institute who writes books about overuse, said the findings come back to "Economics 101." The medical system is still dominated by a payment system that pays providers for doing tests and procedures. "Incentives matter," Welch said. "As long as people are paid more to do more they will tend to do too much."

Published on Leave a comment on Furniture Can Be A Cause of Indoor Air Pollution

I recently read a nice article discussing indoor air pollution, which can be worse than outdoor air, even that of cities. Yes, that's true! In past posts I've discussed problems (and health issues) with air fresheners, fragrances, incense, dryer sheets, scented candles, synthetic rugs, "stain-proofing", and flame retardants in upholstery, but this article is about furniture and how it can emit various chemicals ("outgassing"), especially when new. Think of all the stains, glues, paints, etc. used in making furniture.

The article points out that when buying new furniture, can look to see if it is certified by Greenguard or SCS Global Services as having low or no emissions of  hazardous chemicals. Another thing to do is avoid particle board, engineered wood, or pressed wood (frequently emits formaldehyde, a carcinogen). But in the mean time - it's generally a good idea to frequently get fresh air in your residence by opening windows for a while. Excerpt's from E. Leamy's article in the Washington Post:

Your furnishings could be causing indoor air pollution

We feel safe in our homes, but that can be a false sense of security. The threat I’m talking about is something we can’t see: indoor air pollution. The air in our homes and workplaces can be more polluted than outdoor air in the most industrialized cities, according to the Environmental Protection Agency. The EPA says the problem is compounded by the fact that Americans spend 90 percent of their time indoors. Many different things can cause indoor air pollution, and they have a cumulative effect on our health.

Let’s look at one of those possible sources: our furnishings. Yes, your new carpet or cabinet could be subtly poisoning you with chemicals such as benzene, ethylene glycol or formaldehyde. It’s called “off-gassing.” Four of the top 10 chemicals emitted from furnishings are considered “acute” hazards, or irritants. “Poor indoor air quality can cause or contribute to the development of infections, lung cancer and chronic lung diseases such as asthma,” according to the American Lung Association.

How do researchers know that some furnishings emit harmful gaseous chemicals? Greenguard, a division of UL Environment, has developed a way of testing furniture to find out. In a ­generic-looking office park outside Atlanta, researchers heft furniture into giant, airtight chambers. .... Greenguard developed the testing method so manufacturers who wanted to sell low-emission furniture could prove their products were healthier. UL awards its Greenguard certification to furniture that emits low or no levels of hazardous chemicals. 

Manufacturers don’t have to state what chemicals they use in their furnishings. The EPA singles out engineered wood — otherwise known as particleboard — as being particularly prone to emitting formaldehyde, a probable carcinogen. UL Environment adds that products that are applied wet, such as glues and paints, often off-gas while they are curing. Sometimes a strong industrial odor is a good hint that a piece of furniture is emitting chemicals. If you develop a headache while inside a building where paints, stains or glues are being used, that’s another clue. 

However, it is possible to know whether harmful chemicals are not present, because more and more furnishings are being certified as having low emissions. Here are certifications you can look for and other steps you can take to reduce your exposure to indoor air pollution from your furnishings: 

1. Check certifications. Look for an indoor-air-quality certification, such as the one offered by Greenguard. Another firm that certifies low-emission furniture is SCS Global Services. 2. Air out. .... 3. Paint first. If you’re renovating your house, paint it and air it out before installing carpeting and curtains, because they can absorb chemical fumes from the paint..... 4. Buy used. Off-gassing diminishes over time, so buying older furniture can be better. ....5. Avoid particleboard. This material is also called pressed wood, engineered wood and MDF. The glues used to hold the material together often contain harmful chemicals such as formaldehyde. Alternatively, look for certified particleboard products. 6. Choose unscented. .... 7. Beyond furnishings. Other products frequently used in homes can also off-gas and cause indoor air pollution. 

Published on Leave a comment on Fetus, Science, Evidence

The words and phrases science-based, evidence-based, fetus, and vulnerable are all important words in science and medicine, and are frequently used on this site when I post about new health studies. Medical treatment is based on science, and it is evidence-based (that's why studies are done - to test hypotheses, and to see what the evidence shows). The effects of viruses (e.g. Zika virus, measles), nutrition, and environmental pollutants (e.g. BPA, lead, mercury, pesticides, air pollution) all have effects on the developing fetus. Fetuses, children, the elderly, and immunocompromised individuals are all especially vulnerable to the effects from pollutants. See how important and powerful those words are?

The Washington Post reported Friday (December 15, 2917) that the Trump administration is prohibiting officials at the Centers for Disease Control and Prevention (CDC) from using a list of 7 words or phrases in official documents when preparing next year's budget proposals. The seven words are: science-based, evidence-based, fetus, vulnerable, diversity, transgender, and entitlement.

The CDC is the nation's top health agency and staffed with many scientists working on diseases throughout the world, including the Zika virus (which has an effect on the developing fetus),  and working on ways to prevent sexually transmitted diseases among transgender people. This is an agency with more than 12,000 employees and a $7 billion budget that works on all sorts of health issues - including food and water safety, heart disease and cancer, antibiotic resistance, and censorshipways to prevent epidemics. Their work is based on science, and it looks at all the evidence. Yup - those pesky words are an integral part of the function of the CDC, and of science..

Of course scientists are outraged by this censorship of science. So should you.

Published on Leave a comment on Disinfectant Use By Nurses Linked to COPD

There are a number of professions where there is an elevated risk for getting chronic obstructive pulmonary disease (COPD) from all the vapors, gases, dust, fumes, and chemicals (all irritants) that one inhales - such as welders, coal miners, cotton textile workers, construction, farmers, even hairdressers. Now a study suggests that nurses who use disinfectants at least once a week are also at higher risk for COPD. The specific disinfectants associated with COPD are glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quats (quaternary ammonium compounds).

From Medscape: Exposure to Disinfectants Linked to COPD

The risk for chronic obstructive pulmonary disease (COPD) is higher in those who use disinfectants at least once a week than in those who do not, a preliminary observational study of a large cohort of female nurses in the United States reveals. 

For their study, Dr Dumas and her colleagues analyzed data from the Nurses' Health Study II. From 2009 to 2017, participants completed a survey every 2 years. ..... And they used the job-task exposure matrix to evaluate seven major disinfectants: formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds (or quats), and enzymatic cleaners.

In the cohort of 55,185 women who were nursing in 2009, 663 reported incident physician-diagnosed COPD during the follow-up period. The team found an association between incident COPD and high-level exposure to glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quats. Of the nurses diagnosed with COPD, 37% reported the weekly use of disinfectants to clean surfaces, and 19% reported weekly use to clean instruments. Regression models demonstrated that the risk for COPD was 22% higher for nurses who cleaned instruments, and 32% higher for nurses who cleaned surfaces.

We've been aware of the association between disinfectants and asthma for some time, she told Medscape Medical News.... There's no easy solution, Dr Dumas acknowledged. "Protection from infection is important, but so is the health of workers." Green products might be one solution, "but we're not sure of their effect on health either. Just because they're natural, doesn't mean they're safe; they can have allergens." Another solution could be ultraviolet light, as previously reported by Medscape Medical News.

This was a "well-performed study," said Lidwien Smit, PhD, from the University of Utrecht in the Netherlands. "I just wonder about the pathology, and how it influences the microbiome. Disinfectants are meant to kill off bacteria, but if you're exposed to large concentrations, you're also inhaling them, which could affect your airway microbes," she explained. In fact, disinfectants could play a role in killing off bacterial communities in the airways that are responsible for "immune homeostasis" and keep users healthy, she added. If that immune balance gets disturbed, it might have an influence on a person's reaction to pathogens or inflammation. 
Chest X-ray of person with COPD. Credit: Wikipedia

Published on Leave a comment on Could A Vitamin Supplement Help Those With Asthma?

An interesting possibility - that taking supplements of  a type of vitamin E known as gamma tocopherol may reduce the inflammation of the airways common in asthma patients – eosinophilic inflammation.

Note that these findings were from a preliminary study of 15 people with mild asthma, done by researchers at the Univ. of North Carolina. Now larger and longer studies need to be done, especially to make sure that side-effects and an increased risk for hemorrhagic stroke won't occur with gamma tocopherol, as it does for the other form of vitamin E (alpha tocopherol) commonly found in supplements. From Medical Xpress:

Can asthma be controlled with a vitamin supplement?

The shortness of breath experienced by the nearly 26 million Americans who suffer from asthma is usually the result of inflammation of the airways. People with asthma typically use albuterol for acute attacks and inhaled steroids to limit chronic inflammation. Both medications come with side effects. But what if it was possible to keep asthma under control by changing one's diet or taking a vitamin supplement? It may happen sooner than you think.

Preliminary research results from the UNC School of Medicine indicate that a type of vitamin E known as gamma tocopherol may reduce eosinophilic inflammation – a kind of airway inflammation common in asthma patients. The results were published in the Journal of Allergy & Clinical Immunology.

"We started looking into vitamin E because epidemiologic data suggested that people with high amounts of vitamin E in their diet were less prone to asthma and allergic disease," said Michelle Hernandez, MD, professor of pediatrics and senior author of the study.  There are several different isoforms of vitamin E. The type commonly found in vitamin supplements – alpha tocopherol – has been studied previously, but the results suggested that alpha tocopherol was not particularly effective. Even worse, the alpha isoform seemed to be associated with an increased risk for hemorrhagic stroke.

So UNC researchers took a different tack and asked whether the kind of vitamin E being used might have an effect on the outcome. They began looking more closely at gamma tocopherol, the type of vitamin E commonly found in a diet rich in nuts and nut oil. .... "While the alpha isoform does have antioxidant activities, gamma tocopherol has both an antioxidant and a very unique anti-inflammatory action as well," she said "That anti-inflammatory effect is what we think made the difference in this study."

Participants in the study were randomized into two groups that received either gamma tocopherol supplement or a placebo for two weeks. At the end of that period, they were asked to cough up sputum..... After a three week "washout period" where they took nothing, subjects were placed in the other group: if they took the supplement for the first two weeks, they took a placebo for the second period.

"The advantage of a cross-over design like this is that we are able to compare the subjects to themselves," said Burbank. "And what we found is that when people were taking the vitamin E supplement, they had less eosinophilic inflammation." In addition to decreased inflammation, those who were taking vitamin E were also found to have lower levels of proteins called mucins, which affect the stickiness of mucus. Mucins are often elevated in asthmatics.