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Published on Leave a comment on New Report About Harms of Endocrine Disruptors

A report released this week by the Endocrine Society states that the list of health problems that scientists can confidently link to exposure to hormone-disrupting chemicals has grown to include: diabetes, cardiovascular disease, obesity, reproductive and developmental problems, thyroid impairment, certain reproductive cancers, and neurodevelopmental problems such as decreased IQ. This statement (report) is based on the summaries of 1300 studies on endocrine disrupting chemicals (EDCs), and it also adds support to the idea that even minute doses of these chemicals can interfere with the activity of natural hormones, which play a major role in regulating physiology and behavior. The statement also stated that most industrial chemicals released into the environment—numbering in the tens of thousands—have never been tested for endocrine-disrupting potential. EDCs include such common chemicals as bisphenol A (BPA), phthalates, parabens, some pesticides (e.g., atrazine), flame retardants, some persistent organic pollutants, and dioxins.

Where are endocrine disruptors found? People are exposed to chemicals with estrogenic effects in their everyday life, because endocrine disrupting chemicals are found in low doses in thousands of products. Many plastic products, including those advertised as "BPA free", have been found to leach endocrine-disrupting chemicals (the substitute chemicals are no better than BPA, and may be worse). Examples: plastic food containers which then leach into foods, linings of metal beverage, formula, and food cans, soft plastic toys, dental sealants, consumer goods, receipts, personal care products that contain parabens or phthalates (e.g., found in lotions,sunscreens, fragrances), household products (such as cleaning products, vinyl shower curtains) , cars (that new car smell in car interiors), etc. Americans love plastics, but there is a serious human health cost.

NOTE: To minimize EDC exposure - try to avoid plastic food and beverage containers. Instead try to use glass, stainless steel, or ceramics. Eat as many unprocessed and fresh foods as possible. Use cloth shower curtains. Read labels and avoid BPA, phthalates, parabens. Avoid fragrances. Don't use or buy non-stick pans, stain and water-resistant coatings on clothing, furniture and carpets. When buying new furniture, check that it doesn't have added fire retardants.

Of course any public discussion of the harms from endocrine disrupting chemicals, as well as the newly released Endocrine Society report, is drawing sharp criticisms from the chemical industry (especially the American Chemistry Council, the largest trade group for the chemicals industry). Of course. We all know that the lobbying efforts by the chemical industry to suppress and deny the evidence of harm to humans from EDCs has been and will continue to be massive. Sadly, but at this point EDCs are found in almost everyone on earth. More about the report, from Science Daily:

Chemical exposure linked to rising diabetes, obesity risk

Emerging evidence ties endocrine-disrupting chemical (EDC) exposure to two of the biggest public health threats facing society -- diabetes and obesity. EDCs contribute to health problems by mimicking, blocking or otherwise interfering with the body's natural hormones. By hijacking the body's chemical messengers, EDCs can alter the way cells develop and grow. Known EDCs include bisphenol A (BPA) found in food can linings and cash register receipts, phthalates found in plastics and cosmetics, flame retardants and pesticides. The chemicals are so common that nearly every person on Earth has been exposed to one or more.  ...continue reading "New Report About Harms of Endocrine Disruptors"

Published on Leave a comment on Shrink Your Brain With An Unhealthy Diet

Over and over studies find that a person's diet is linked to health and diseases, and now a study finds that an unhealthy diet is linked to shrinkage of the brain, specifically the volume of the left hippocampus. The biggest effects on the hippocampus are found with both greater consumption of an unhealthy diet and lower consumption of a healthy diet.  The hippocampus is a brain structure associated with both learning and memory, as well as mood regulation, and is specifically implicated in depression. In dementia and Alzheimer's disease, the hippocampus is one of the first regions of the brain to suffer damage.

So....you want to protect your hippocampus from shrinkage. The researchers themselves  suggest that the effects may be reversible, and suggest "dietary interventions to promote hippocampal health". Once again, a healthy diet means lots of plant-based foods (for example, a Mediterranean based diet with lots of fruits, vegetables, legumes, nuts, berries, seeds), and decreasing a Western-style diet with highly processed foods, low fiber, lots of meat, fat,  and refined sugars. From Medscape:

Unhealthy Diet May Shrink the Brain

Consumption of an unhealthy Western diet characterized by meat, hamburgers, chips, and soft drinks, may reduce the volume of the left hippocampus, whereas a healthy diet of fresh vegetables and fish may increase hippocampal volume. In a study of more than 250 individuals, investigators found that during a period of 4 years, there was a difference of more than 200 cubic millimeters in hippocampal volume between individuals who ate a healthy diet and those who consumed an unhealthy diet.  ...continue reading "Shrink Your Brain With An Unhealthy Diet"

Published on Leave a comment on Millions of Deaths Annually Due to Air Pollution?

A recent post (Air Pollution Can Kill You) discussed recent research that found that air pollution is linked to an overall increase in death rates, especially cardiovascular disease. But how many deaths each year are linked to air pollution? Recent research suggests that outdoor air pollution, mostly by fine particulate matter with a diameter smaller than 2.5 micrometers (PM2.5), leads to 3.3 million premature deaths per year worldwide, predominantly in Asia. The number one cause  worldwide is residential energy use such as heating and cooking, (India ,China, and the developing world).

But surprisingly agriculture or farming is number 2 worldwide. How can that be? Well, farms produce ammonia from fertilizer and animal waste. That ammonia then combines with sulfates from coal-fired power plants and nitrates from vehicle exhaust to form the soot particles that are the big air pollution killers. The United States had about 54,905 deaths in 2010 from soot and smog. Power plants and traffic (vehicle emissions) are big sources of the air pollution linked to deaths in the USA. From Medical Xpress:

Millions of premature deaths tied to air pollution

Outdoor air pollution leads to more than 3 million premature deaths per year, primarily in Asia, according to a letter published online Sept. 16 in Nature.

Johannes Lelieveld, Ph.D., from the Max Planck Institute for Chemistry in Germany, and colleagues used a global atmospheric chemistry model to investigate the link between premature mortality and seven emission source categories in urban and rural environments. The researchers found that outdoor air pollution, mostly by fine particulate matter with a diameter smaller than 2.5 micrometers (PM2.5), leads to 3.3 million premature deaths per year worldwide, predominantly in Asia. The largest impact on premature mortality globally comes from residential energy use such as heating and cooking, prevalent in India and China. In the United States, emissions from traffic and power generation are important. Agricultural emissions make the largest relative contribution to PM2.5 in the eastern United States, Europe, Russia, and East Asia, with the estimate of overall health impact depending on assumptions regarding particle toxicity. 

...continue reading "Millions of Deaths Annually Due to Air Pollution?"

Published on Leave a comment on Air Pollution Can Kill You

Another study finding negative health effects from air pollution. This year I've posted several studies that found negative effects on the brain (and even cognition) from air pollution for people of all ages. Now this latest study found that in areas with air pollution, long-term exposure to outdoor fine particulate matter (PM2.5),which are fine particles in the air, are linked to an overall increase in risk of death, especially due to cardiovascular disease. The fine particles in the air contribute to the development of potentially fatal heart and lung diseases because they slip past the body's defenses and can be absorbed deep into the lungs and bloodstream. They are not sneezed or coughed out the way larger natural particles, like airborne soil and sand, are removed from the body's airways. From Science Daily:

Link between air pollution, increased deaths and increased deaths from heart disease affirmed

In what is believed to be the largest, most detailed study of its kind in the United States, scientists at NYU Langone Medical Center and elsewhere have confirmed that tiny chemical particles in the air we breathe are linked to an overall increase in risk of death. The researchers say this kind of air pollution involves particles so small they are invisible to the human eye (at less than one ten-thousandth of an inch in diameter, or no more than 2.5 micrometers across).

In a report on the findings, published in the journal Environmental Health Perspectives online Sept. 15, the scientists conclude that even minuscule increases in the amount of these particles (by 10 micrograms per cubic meter of air, for example) lead to an overall increased risk of death from all causes by 3 percent -- and roughly a 10 percent increase in risk of death due to heart disease. For nonsmokers, the risk increase rises to 27 percent in cases of death due to respiratory disease.

"Our data add to a growing body of evidence that particulate matter is really harmful to health, increasing overall mortality, mostly deaths from cardiovascular disease, as well as deaths from respiratory disease in nonsmokers," says lead study investigator and health epidemiologist George Thurston, ScD, a professor of population health and environmental medicine at NYU Langone. "Our study is particularly notable because all the data used in our analysis comes from government- and independently held sources."

According to Thurston, fine particles can contribute to the development of potentially fatal heart and lung diseases because they slip past the body's defenses and can be absorbed deep into the lungs and bloodstream. They are not sneezed or coughed out the way larger natural particles, like airborne soil and sand, are removed from the body's airways. Moreover, Thurston says, fine particles are usually made of harmful chemicals such as arsenic, selenium, and mercury, and can also transport gaseous pollutants, including sulfur and nitrogen oxides, with them into the lungs.

For their research, Thurston and his colleagues evaluated data from a detailed health and diet survey conducted by the National Institutes of Health (NIH) and the American Association of Retired Persons (AARP). The NIH-AARP study involved 566,000 male and female volunteers, ages 50 to 71, from California, Florida, Louisiana, New Jersey, North Carolina, Pennsylvania, and the metropolitan areas of Atlanta and Detroit. Analyzing information gathered about the participants between 2000 and 2009,....

Indeed, the team did not find any significant difference in the effect of particulate matter exposure between different sexes or age groups or by level of education. The researchers also noted that limiting the analysis to only the state of California, which has the most rigorous controls on air pollution, did not produce a different overall level of risk; instead, they found the same association between particulate matter exposure and increase in risk of death from all nonaccidental causes and from cardiovascular disease.

Published on Leave a comment on How Many Healthy Years Do You Have Left?

The following article posted average life expectancies for both men and women in countries throughout the world. But what was interesting is that it also gave the average years that a person would be healthy and also unhealthy (which is typically the last years of life). And no matter which country one looks at and the average life expectancy of men and women, it turns out that on average people spend about one eighth of their life in a disabled or unhealthy state. Or between 10 to 20% of their life disabled or unhealthy.

So looking at the United States, it is expected that the average women will live 81 years, but about 13 of those years will be in poor health. Men in the USA will live on average 76 years, but of that about 11 years will be unhealthy. Which means, don't wait until retirement to travel and do all those things you want to do, because you may have health issues preventing you from doing those things - so get out there NOW and DO IT ALL. The "bucket list" should be started now. (Note: I only copied information for 5 countries, but the actual chart has 188 countries. Do go check it out.) From NPR News:

Check Out Life Spans Around The World — And Likely Years Of Ill Health

How Long Will You Live — And How Many Of Those Years Will Be Healthy?

Here are the life expectancies in 188 countries — and the number of unhealthy years a person faces. No matter where you live, the range for years of healthy life is 80 to 90 percent.

Life expectancy compared with global average:

COUNTRY       MALE    UNHEALTHY YEARS       FEMALE       UNHEALTHY YEARS

GLOBAL            68                  8                                     74                       10

CANADA           79                 10                                     83                       12

CHINA               73                   8                                     79                         9

MEXICO             72                  9                                      78                       11

RUSSIA               65                 7                                       76                       10

USA                    76                 11                                      81                       13


Credit: Christopher Groskopf and Alyson Hurt/NPR     Notes: — Life expectancies are estimated for individuals born in 2013.  

Source: Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

It's one of those good news/bad news stories. A study in the medical journal The Lancet found that people around the world — in countries rich, poor and in the middle — are living longer. But here's the rub. You can't count on living those extra years in good health.

In the first of what will be an annual look at health along with life span around the world called the Global Burden of Disease Study, researchers found that between 1990 and 2013, life expectancy rose by 6.2 years. The average life span at birth across the globe is now 71.5 years, though rates vary tremendously by region. People live the longest, according to the Lancet study, in Andorra, in southwestern Europe, or an average of 83.9 years. People die the youngest, an average of 48.3 years, in Lesotho, in Africa.

But regardless of socioeconomics, geography or total number of years lived, the study shows what appears to be a universal part of the human condition: people live an average of one-eighth of their lives in a disabled or unhealthy state.

"What's interesting is that wherever you go around the world, about seven-eighths of life expectancy is healthy," says Peter Byass, professor of global health at UmeaUniversity in Sweden. "I'm not sure we totally understand why.We probably can't do a lot about decreasing this part of life that's not healthy," he adds. "That pretty much appears to be a part of being human."

Healthy life — the measure researchers used, called HALE, or healthy life expectancy years — ranged from a high of 73.4 years in Japan to a low, again in Lesotho, of 42 years. Not much is known about when those years of ill health occur. "A lot of the unhealthy stuff is around end of life," says Byass.

Spending more money on health care doesn't seem to reduce the proportion of life spent in ill health. The study was based on regional data and showed that in high-income North America, men live an average of 76.64 years, but only 66.17 of those years are healthy; women live an average of 81.62 years, but experience good health in only 68.85 of those years. The United States, which spends more on health care than any other country, is part of that high-income region. "This is seen even in places where there's a high investment in health care," says Byass, who wrote a commentary accompanying the Lancet study.

Countries where people die the youngest have the highest rates of communicable diseases like AIDS, malaria and tuberculosis as well as high rates of maternal and childhood mortality and malnutrition. "If we want to have a healthier global population, more equal health, the world has got to invest in getting rid of those avoidable problems in poorer countries, mainly in Africa," says Byass.

Published on Leave a comment on Nearly 70% of Prostate Cancers Can Just Be Watched?

The issue of overdiagnosis and overtreatment has recently been in the news, especially when discussing breast cancer, prostate cancer, and thyroid cancer. Meaning too much unnecessary treatment with harms, when the best approach would have been to do nothing, as studies have suggested or actually shown. Now here is an article in Medscape suggesting that rather than be quick to operate or treat, the best approach for nearly 70% of prostate cancers may be just "watching".

The U.S. Preventive Task Force, which analyzes the value of screening tests, in May 2012 recommended AGAINST routine prostate-specific antigen (PSA)-based screening for prostate cancer for all age groups. According to them, studies do not show that benefits of routine screening of asymptomatic prostate cancer and the resulting treatment outweigh the harms of treatment (e.g., surgical complications including death from surgery, erectile dysfunction, urinary incontinence, bowel dysfunction, and bladder dysfunction), or that prostate cancer treatment even reduces mortality (deaths).

They point out that: "There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. There is also convincing evidence that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man's lifetime. The terms "overdiagnosis" or "pseudo-disease" are used to describe both situations." (NOTE: others have argued against this recommendation)

When reading the full Medscape article, it was pointed out that in the study being discussed, one person who was offered active surveillance but declined and was treated with an immediate radical prostatectomy, still died of metastatic prostate cancer. This was an example of a case where when the disease is truly aggressive, it may have spread "like a bird" throughout the body (in Dr. H. Gilbert Welch's terms in his books Overdiagnosed and Less Medicine, More Health) from the very beginning, and may be unstoppable no matter what is done.

I have also noticed reading other prostate cancer studies that a certain percentage of prostate cancers regress from the point of diagnosis (the PSA test and biopsy). In other words, researchers are finding that cancer can have different paths: regresses, stays the same, grows slowly (and can be treated when symptoms appear), or grows very quickly and is so aggressive and unstoppable that it goes through the body "like a bird". And we don't know which will be the aggressive ones when we first find them, thus the controversies over what to do: screen or not?, and treat or not?  ...continue reading "Nearly 70% of Prostate Cancers Can Just Be Watched?"

Published on

Again, more benefits of vitamin D. Think of it as the sunshine vitamin, but supplements also work, especially vitamin D3 (rather than D2). This time higher levels of vitamin D in the blood (as measured by the vitamin D biomarker, 25-hydroxyvitamin D [25(OH)D) are linked to lower incidence of macular degeneration among those women genetically prone to it.

Macular degeneration is thought to have both genetic (inherited) and environmental components. Currently macular degeneration is the leading cause of vision loss and affects about 2.07 million Americans (this is according to the National Eye Institute). Note that this number is very different than that given by the American Macular Degeneration Foundation in the article. From Medical Xpress:

Vitamin D may play key role in preventing macular degeneration

Vitamin D has been studied extensively in relation to bone health as well as cancer. Now, a team led by a researcher at the University at Buffalo has discovered that vitamin D may play a significant role in eye health, specifically in the possible prevention of age-related macular degeneration, or AMD, among women who are more genetically prone to developing the sight-damaging disease.

In a paper published today (Aug. 27) in JAMA Ophthalmology online, Amy Millen, associate professor of epidemiology and environmental health in UB's School of Public Health and Health Professions, and her team found that women who are deficient in vitamin D and have a specific high-risk genotype are 6.7 times more likely to develop AMD than women with sufficient vitamin D status and no high risk genotype.

Macular degeneration is characterized by the deterioration of the macula, a small part of the central retina where the eye's photoreceptors (rods and cones) are most highly concentrated. The leading cause of legal blindness, macular degeneration affects more than 10 million Americans—more than cataracts and glaucoma combined—according to the American Macular Degeneration Foundation. The disease affects a person's central vision, which is needed for common tasks such as reading and driving. The effect is similar to that of a rain drop on the center of a camera lens.

Researchers analyzed data compiled on 1,230 women ages 54 to 74 who participated in the Carotenoids in Age-related Eye Disease Study (CAREDS),..... CAREDS was conducted among participants at three of the centers: University of Wisconsin (Madison), the University of Iowa (Iowa City) and the Kaiser Center for Health Research (Portland, Oregon). Researchers were able to determine participants' vitamin D status by analyzing serum samples for a vitamin D biomarker, 25-hydroxyvitamin D [25(OH)D], which provided a glimpse into vitamin D intake through all sources: diet, supplements and sunlight.

Human skin can synthesize vitamin D when exposed to ultraviolet light, Millen explains. However, for many people, 15 to 30 minutes a day with 10 percent of their skin exposed might be sufficient. In winter months, when there is a lower solar angle, sun exposure may not be not sufficient to maintain blood level for people who live north of a line from about Washington, D.C., to Los Angeles. At these times and locations, dietary intake may be needed. Dietary sources of vitamin D include fortified foods such as milk and foods that naturally contain vitamin D such as fatty fish like salmon and mackerel.

"Macular degeneration has been found to be strongly associated with genetic risk," Millen says. Among many genes linked to AMD, one of the strongest is a specific genetic variant (Y402H) in the complement factor H gene, called CFH for short. This gene codes for the CFH protein that is involved in the body's immune response to destroy bacteria and viruses. Inflammation is believed to be involved in the development of macular degeneration.  "People who have early stage AMD develop drusen, lipid and protein deposits that build up in the eye. Your body sees this drusen as a foreign substance and attacks it, in part via the complement cascade response," explains Millen.

Vitamin D shows promise for protecting against because of its anti-inflammatory and antiangiogenic properties; antiangiogenic refers to slowing the growth of new blood vessels, often seen in late stages of AMD."Our message is not that achieving really high levels of vitamin D are good for the eye, but that having deficient vitamin D levels may be unhealthy for your eyes," Millen says. 

Although the odds of having AMD was higher in women who were deficient for vitamin D, with 25(OH)D levels below 12 ng/mL (30 nmol/L), increasing vitamin D levels beyond 12 ng/mL did not further lower the odds of AMD to any meaningful extent, she explains.

Published on

Several recent studies have found that constant exposure to high levels of air pollution has negative effects on the brain. The last post described negative effects on the gray matter in brains (resulting in smaller brain volumes) of elderly women from air pollution, but this study found negative effects (lower grade point averages) in young children from high air pollution. From Environmental Health News:

Bad air means lower grade point averages in Texas

Fourth and fifth graders in El Paso, Texas, are more likely to have lower grade point averages if heavily exposed to contaminated air at home, according to a new study.It bolsters a growing body of evidence that air pollution can impair success in school.

They found that for all types of air pollution sources, more exposure corresponded with lower grade point averages. Only one type of pollution—point sources such as factories—was not significantly linked to lower grade point averages.University of Texas at El Paso researchers analyzed the grade point averages of 1,895 children and, using their home location, estimated their exposure to air toxics—such as benzene, arsenic, lead, mercury, hydrochloric acid, toluene, vinyl bromide, xylenes, and diesel particulate matter—using federal data.

“Effects appear to be insidious, since they are mild, unlikely to be perceived, and, hence, unlikely to be addressed in any way … seemingly trivial effects on children’s development may translate into substantial impacts throughout the life course in terms of physical and mental health and personal success,” the authors wrote.The researchers did control for some other things that can affect children’s grades such as poverty, mother’s age, education and ability to speak English, and the child’s race and sex.

Still, the study doesn’t prove that dirty air makes kids do worse in school. It does, however, suggest children’s developing bodies are more susceptible to air pollution, which can harm their respiratory systems and brain.Air pollution might hamper kids’ grades via two primary ways: Illnesses, mostly respiratory, that would make them miss school, and developmental problems resulting from long-term exposure, said Sara Grineski, an associate professor of sociology at The University of Texas at El Paso and co-author of the new study.

Others have found similar links between air pollution and academic performance. Three months ago Columbia University's Perera and colleagues reported that New York City children born to mothers in poverty and exposed to certain air toxics during pregnancy had lower IQs.  Perera, tracking the mothers and children since before birth, said the pollution exposure prior to birth is more strongly linked to learning and behavioral problems. 

In the current study it’s unclear if the children were exposed in their mothers’ womb—an exposure window that is critical to brain development, Perera said....Other studies support this—in February Calderón-Garcidueñas and colleagues reported Mexico City smog was linked to impaired short-term memory and IQ in children.

The city is more than 80 percent Hispanic....Previous studies have shown that El Paso’s minorities are disproportionately impacted by toxics, Grineski said. The city of 675,000 is one of the worst when it comes to particulate matter—a mix of substances emitted by combustion sources, including cars, trucks, industrial plants and wood burning—especially coarse particulates, PM10, those between 2.5 and 10 micrometers (from about 25 to 100 times thinner than a human hair, according to the EPA). El Paso’s 24-hour PM10 average is about 233 micrograms per cubic meter of air, according to the latest EPA data from 2013, which was eighth highest among more than 500 U.S. cities. El Paso, along with Laredo, has the highest carbon monoxide levels in Texas.

Published on

Several recent studies found that air pollution has a negative effect on the brain. This study of elderly women in North Carolina found that long-term exposure to higher levels of air pollution (specifically fine particulate matter smaller than 2.5 micrometers (called PM2.5) resulted in smaller brain volumes (especially the brain's white matter). They studied elderly women (aged 71 to 89), but the findings should be of concern to everyone exposed to high levels of air pollution.  White matter connects brain regions (with nerve fibers that pass signals throughout the brain) and determines how information is processed in the brain. The researchers pointed out that other recent studies reported that high air pollution is linked to cognitive decline and accelerated brain aging. From Futurity:

AIR POLLUTION MAY SHRINK BRAIN’S WHITE MATTER

Exposure to air pollution may have a negative impact on how the brain’s white matter ages. Older women who lived in geographic locations with higher levels of fine particulate matter in ambient air had significantly smaller white matter volumes across a wide range of brain areas, new research shows.

Fine particulate matter is smaller than 2.5 micrometers and is known as PM2.5, a form of pollution that easily enters the lungs and possibly the bloodstream. White matter connects brain regions and determines how information is processed in the brain....“Our study provides convincing evidence that several parts of the aging brain, especially the white matter, are an important target of neurotoxic effects induced by long-term exposure to fine particles in the air.”

The study found that older women ages 71 to 89 who had lived in places with greater PM2.5 exposures had significantly smaller volumes of white matter and that this could not be explained by the geographic region where they lived, their race or ethnic background, socioeconomic status, lifestyle, or medical conditions that may also influence brain volumes.

The researchers performed brain magnetic resonance imaging scans of 1,403 women who are part of the Women’s Health Initiative Memory Study (WHIMS), a nationwide report based at Wake Forest Baptist Medical Center in Winston-Salem, NC. The researchers also used residential histories and air monitoring data to estimate the participants’ exposure to air pollution in the previous six to seven years.

White matter contains nerve fibers and connects brain regions with each other by traveling deep within and passing nerve signals throughout the brain. Gray matter is primarily composed of neuronal cell bodies, dendrites, glial cells, and capillaries. The study did not find impacts from exposure to air pollution in participants’ gray matter.

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 The following article supported what I have been reading over the past few years: that medical tests and treatments also have downsides, that it is possible to "know too much", that more harm than benefits can occur from certain tests, procedures, and medicines, and lifestyle changes (eat a less processed more plant-based diet, move more, and don't smoke) can be better than some medicines or certain procedures. The doctor mentioned in this article (Dr. H. Gilbert Welch) recently published a book aimed at the general public which I just read and highly recommend: Less Medicine, More Health. Dr. Welch is an academic physician, a professor at Dartmouth Medical School, and a nationally recognized expert on the effects of medical testing. In 2012 he published the well regarded and more technical and in-depth book on this issue: Overdiagnosed: Making People Sick in the Pursuit of Health. From The Atlantic:

The Downside of Medical Screening

If you had a disease, and you could find out sooner rather than later, why wouldn’t you?Medicine has long focused on early detection of diseases as part of a move toward preventive care. But imperfect tests, false positives, and overdiagnosis mean that sometimes the tests do more harm than good, and in recent years, there have been more recommendations to reduce some kinds of screening, including pap smears, colonoscopies, mammograms, and even annual pelvic exams.

“This is something we all need to understand, the two sides of early detection. It does help people, but it’s almost guaranteed to harm others,” said H. Gilbert Welch, a professor of medicine, public policy, and business administration at Dartmouth College, and author of the book Should I Be Tested for Cancer? (He reveals his answer in the book’s subtitle: “Maybe not.”)

The more you look for disease, the more you find it. And in the case of cancer, it’s hard for doctors to know if what they find is dangerous and needs to be addressed, or if it’s just a small tumor that won’t grow and poses no threat. “We can’t be sure which is which, so we treat everybody,” Welch explained at the Aspen Ideas Festival’s Spotlight Health session. “That means we’re treating people who will never experience problems from their disease.”

But they may experience problems from the treatment.The panel gave the example of prostate cancer, which is very common in men—one in seven American men will be diagnosed with it in their lifetimes. “But it turns out a lot of these cancers are very indolent,” said Jessica Herzstein, a preventive-medicine consultant and member of the U.S. Preventive Services Task Force. Around 30 to 40 percent of men who’ve been treated for prostate cancer likely had “slow-growing tumors that would never have become a threat to the man’s lifespan or health,” according to the Prostate Cancer Foundation.

In other words, “you’re going to die with them, not of them,” Herzstein said, “and the treatments are very very harmful.” Radiation therapy, for example, can cause incontinence and erectile dysfunction, and hormone therapy can cause osteoporosis and depression.

The possibility of a false positive is another downside. Not only could it lead to more invasive follow-up tests or treatments that aren’t needed, but it can also give patients unnecessary anxiety.“If we resolve the test by saying ‘The test was wrong, you’re fine!’, that’s one thing,” Welch said. “But most false alarms aren’t resolved that way. [It’s more like] ‘You don’t have cancer, but you have some abnormality that possibly puts you at a higher risk for cancer, but we’re not going to do anything about it. I think that’s where there can be [mental] harm.”

Ultimately, it comes down to a weighing of the benefits and the harms, and, in the absence of clear evidence, the preferences of the patient. The U.S. Preventive Services Task Force helps identify which tests are beneficial by evaluating and grading them. It gives tests an A if there’s a high certainty of substantial benefit, a B if there’s moderate certainty of substantial benefit, a C if there’s moderate certainty of a small benefit, a D if there’s moderate or high certainty of no benefit, and an I if the evidence is just too insufficient to say.

The task force gave prostate cancer screening a D. HIV screening got an A. For breast cancer screening, an always-controversial topic, the results vary. Breast self-exams got a D. Mammograms got a B, but only for women between 50 and 74 years old. For women in their 40s, the grade is a C, meaning the task force recommends patients and physicians discuss and decide together.

Before getting a screening test, patients should think about what would happen if they get a positive result, and if they’d be ready for it, Welch advised. “If I were to go through this, and have this diagnosis, would I want to have this surgery?” Herzstein asked, posing a hypothetical. Would you want to undergo the biopsy, the chemo, whatever treatments come next? “Maybe you don’t even want to go there if there is no treatment for the disease,” she added. Welch gives an example. “With Alzheimer’s disease that’s a fundamental question: What are you going to do with a positive result?” he asked.