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Published on 2 Comments on Five Years of Sinusitis Treatment Success

It's official. This month is 5 whole years being free of chronic sinusitis and off all antibiotics! Yes, that's correct - 5 whole years for all 4 family members, and our sinuses feel great!

Back in February 2013 - first I, and then the rest of my family, started using easy do-it-yourself sinusitis treatments containing the probiotic (beneficial bacteria) Lactobacillus sakei. Now we only treat with a L. sakei  product when occasionally needed - and it still works great. In fact, the best way to use Lactobacillus sakei is to use only when there are sinusitis symptoms, and not when feeling well. The whole process still feels miraculous.

After reading the original ground-breaking research on sinusitis done by Abreu et al (2012), it led to me trying L. sakei as a sinusitis treatment. Of course, there is an entire community of microbes (bacteria, fungi, viruses) that live in healthy sinuses - the sinus microbiome - but L. sakei seems to be a key one for sinus health. Since that original 2012 study, other studies have also found that in people with chronic sinusitis, the sinus microbial community is out of whack (dysbiosis). 

The one thing different this past year is that our sinus microbial community (sinus microbiome) seems better. If we need to treat (for example, after a virus that goes into sinusitis, or when sliding toward sinusitis for whatever reason), then all four of us noticed that we need to use much less of a product than in the past. Incredibly little. So it seems that our sinus microbial community has definitely improved over time.

The post The One Probiotic That Treats Sinusitis (originally posted January 2015 and with many updates since then) contains information using my family's experiences (lots of self-experimentation!) and all the information that people have given me over the years. Thanks everyone! The post has a list of brands and products with L. sakei, treatment results, as well as information about some other promising probiotics (beneficial bacteria).

Thank you all who have contacted me  - whether publicly or privately. Please keep writing and tell me what has worked or hasn't worked for you as a sinusitis treatment. If you find another bacteria or microbe or product that works for you - please let me know. It all adds to the sinusitis treatment knowledge base. I will keep posting updates. 

(NOTE: I wrote our background story - Sinusitis Treatment Story back in December 2013, there is a  Sinusitis Treatment Summary page with the various treatment methods quickly discussed, and the latest information on The Best Probiotic For Sinus Infections. One can also click on SINUSITIS under CATEGORIES to see more posts about what is going on in the world of sinusitis research.)

Published on Leave a comment on Eating Yogurt Associated With Lower Risk of Heart Attack and Stroke

Another study finding health benefits from eating yogurt - that men and women with hypertension who eat at least 2 servings or more per week of yogurt were at a lower risk of having a heart attack (myocardial infarction) and stroke. Women also had a lower risk of a revascularization procedure (such as a coronary artery bypass). The strongest association between yogurt consumption and lower risk of cardiovascular disease was among those with higher DASH (Dietary Approaches to Stop Hypertension) diet scores.The DASH diet is considered a healthy diet, one rich in fruits, vegetables, nuts, whole grains, beans (legumes), etc.

The major thing to keep in mind is that high blood pressure is a major cardiovascular disease risk factor. So anything that helps lower risk of heart attack or stroke is good. Note that in this large study they did not randomly assign people to different groups - so the higher yogurt intake people also tended to have a healthier lifestyle. But other studies have had similar findings to this one. For example, eating dairy products regularly is linked to lower rates of cardiovascular disease and high blood pressure, while eating yogurt regularly is linked to lower rates of hypertension and type 2 diabetes.

Also note that the types of yogurt (whole-fat, low-fat, non-fat) eaten were not looked at, as well as the types of probiotics added to yogurts. Some research suggests that beneficial effects are from whole fat dairy products rather than low-fat dairy products - which is different than DASH diet recommendations. From Science Daily:

Eating yogurt may reduce cardiovascular disease risk

A new study in the American Journal of Hypertension, published by Oxford University Press, suggests that higher yogurt intake is associated with lower cardiovascular disease risk among hypertensive men and women. .... High blood pressure affects about one billion people worldwide but may also be a major cause of cardiovascular health problems. Higher dairy consumption has been associated with beneficial effects on cardiovascular disease-related comorbidities such as hypertension, type 2 diabetes, and insulin resistance.

For the current analyses, participants included over 55,000 women (ages 30-55) with high blood pressure from the Nurses' Health Study and 18,000 men (ages 40-75) who participated in the Health Professionals Follow-Up Study.

Higher intakes of yogurt were associated with a 30 percent reduction in risk of myocardial infarction among the Nurses' Health Study women and a 19 percent reduction in the Health Professionals Follow-Up Study men. There were 3,300 and 2,148 total cardiovascular disease cases (myocardial infarction, stroke, and revascularization) in the Nurses' Health Study and the Health Professionals Follow-Up Study, respectively. Higher yogurt intake in women was associated with a 16 percent lower risk of undergoing revascularization.

In both groups, participants consuming more than two servings a week of yogurt had an approximately 20 percent lower risks of major coronary heart disease or stroke during the follow-up period. When revascularization was added to the total cardiovascular disease outcome variable, the risk estimates were reduced for both men and women, but remained significant. Higher yogurt intake in combination with an overall heart-healthy diet was associated with greater reductions in cardiovascular disease risk among hypertensive men and women.  [Original study.]

Published on Leave a comment on Viewing Cancers As Birds, Rabbits, and Turtles

This article by academic physician and cancer researcher H. Gilbert Welch about viewing cancers as a barnyard pen of animals (birds, rabbits, and turtles) is a way to explain why some early screening tests haven't really reduced the rate of deaths from certain cancers, such as breast cancer (here and here). Or another way of looking at it is that some cancers are really "bad" and aggressive (birds that have already flown away to distant points at earliest cancer diagnosis), while others are "good" (rabbits or cancers that are slowly spreading and that can be treated, or turtles - that are such slow growing cancers that they would never cause a problem).

Interesting and thought-provoking reading. Excerpts from an editorial by H.Gilbert Welch from Breast Cancer Research and Treatment:

The heterogeneity of cancer

Cancer used to be so simple. It started as a wayward cell that then underwent a stepwise progression: from in situ to local, local to regional and, finally, regional to distant disease. At least, that is what I was taught in medical school…some (gulp) 40 years ago. Narod and Sopik suggest a wildly different paradigm. Local growth and distant metastasis are independent phenomena. Local control of cancer (e.g., efforts to minimize local recurrence) has no effect on its tendency to metastasize. If a cancer is destined to spread to distant sites, it will have already done so.

Call it the “bad cancers are bad” model. Or, alternatively, “good cancers are good.” Oddly enough, in 1955 a cancer surgeon at the Cleveland clinic—George Crile Jr.—foretold this complexity on the pages of Life magazine: In clinical practice to say that a person has cancer gives as little information about the possible course of his disease as to say that he has an infection. There are dangerous infections that may be fatal and there are harmless infections that are self-limited or may disappear. The same is true of cancers. Cancer is not a single entity. It is a broad spectrum of diseases related to each other only in name. 

..... The conventional model has been that large tumors are more likely to metastasize because they have a large pool of cancer cells to disseminate. Narod and Sopik instead suggest that these tumors became large because they are more aggressive cancers and thus are more likely to metastasize. Large, late-stage, node positive lesions are simply valuable markers for “badness.” The corollary is that small, early-stage, node negative lesions are valuable markers for “goodness.” But not always.

Which brings us to the conundrum of DCIS. It would be simplest if all DCIS was pseudodisease— cancer not destined to ever cause problems for our patients. Most DCIS is pseudodisease, but as Narod documented in earlier work , about 3% of women with DCIS will die from breast cancer in the next 20 years. Over half of these women did not experience an in-breast invasive recurrence prior to death. In other words, bad breast cancers are bad—from the get go.

This phenomenon explains the limited ability of mammography to reduce breast cancer mortality. The lack of value in finding microscopic breast cancers (like DCIS) is one of the least well-recognized findings from the ten randomized trials of mammography. Only one trial addressed this important question, the second Canadian trial ..... Given the finding of no difference in breast cancer mortality between the two groups, the lesson is clear: there is no obvious value to finding breast cancers that are so small they cannot be felt (such as most DCIS).

Overdiagnosis is made possible by cancers at the other end of the spectrum. Overdiagnosis is the detection of cancers that are very good – so good that patients would be better of not having them detected. Overdiagnosis doesn’t limit the ability of mammography to reduce breast cancer mortality—instead it’s a side-effect of the effort.

Such heterogeneity in cancer poses huge challenges for our effort to catch the disease early. It’s been described as the “barnyard pen of cancers” (an analogy that likely originates with Crile). We are trying to catch birds, rabbits, and turtles.

We can’t catch the birds early, because they have already gone—these are the most aggressive cancers, those that have already spread by the time they are detectable. We are able to catch the rabbits—the more slowly progressive cancers— but their earlier detection may not help much, because they weren’t destined to metastasize anyway. And then there are the turtles. There’s no need catch them, because they’re not going anywhere anyway.

Published on Leave a comment on Too Much Cancer Screening Has Misled Us About Risk Factors?

H. Gilbert Welch has written extensively about the issue of "overdiagnosis" and resulting  "overtreatment" of cancers. Cancer screening can cause the problem of overdiagnosis (finding small tumors that may never cause problems) and lead to overtreatment (treating unnecessarily, which can cause harm).

But now Welch and coauthor Otis Brawley discuss the issue of how too much screening and diagnostic testing of people thought to be "high risk"  for certain cancers results in more being found - thus the risk factors are "self-fulfilling". And it occurs the most in "scrutiny dependent cancers" - which are cancers that the more you look, the more you find, and the more of what you find is harmless. Many are referred to as slow-growing, indolent, subclinical, or even as precancerous. Prostate cancer, thyroid cancer, breast cancer, melanoma, and  lung cancer are  examples of "scrutiny-dependent" cancers.

Looking so hard and then finding cancer gives a false impression of an increased incidence of some cancers. The authors also said that risk factors in determining  who should be screened should not be cancer diagnosis (e.g. in a family member), but death from cancer. From STAT News:

Too much screening has misled us about real cancer risk factors, experts say

The best-known downside of cancer screening, such as PSA tests for prostate cancer and mammograms for breast cancer, is that they often flag cancers that pose no risk, leading to overdiagnosis and unnecessary, even harmful, treatment. But widespread screening for “scrutiny-dependent” cancers — those for which the harder you look the more you find, and the more of what you find is harmless — causes another problem, two leading cancer experts argue in a paper published on Monday: increasing the apparent incidence of some cancers. That in turn is misleading doctors and the public about what increases people’s risk of developing cancers — or at least the types of cancer that matter.

“Detecting cancers that would never become apparent is screwing up our understanding of risk factors,” said Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, co-author of the analysis in Annals of Internal Medicine. The problem is especially clear in prostate, breast, and thyroid cancers, all of which are scrutiny dependent.

Men whose relatives developed prostate cancer are more likely to get PSA and other screening tests, either because they request them or because their physicians, noting their family histories, order them. Men with no such family history are less likely to be screened. .... (More than half of such cancers are so slow-growing that they don’t affect health or longevity.) Men who don’t get screened are less likely to have biopsies and so are less likely to be diagnosed with prostate cancer — not because they develop the disease at a lower rate but because they get screened at a lower rate. What you don’t look for, you don’t find.

“If we biopsied men without a family history of prostate cancer at the same rate that we biopsy men with a family history, we’d find more prostate cancer in them as well,” Welch said. “Family history influences how hard we look for prostate cancer and therefore how much we find. The risk factor becomes a self-fulfilling prophecy.”

A 2016 study of increased prostate cancer screening in men with a family history of the disease concluded that the risk due to family history has been overestimated by nearly half. “The risk factor of family history is spuriously strengthened because men with a family history are exposed to greater scrutiny,” write Welch and Dr. Otis Brawley, chief medical officer of the American Cancer Society, in the Annals report.

Wealthier, better educated women are, however, more connected to the health care system and therefore get more mammograms, breast ultrasounds, and MRIs. The more scrutiny, the more likely that harmless cases of breast cancer are found. (The idea of “harmless” breast cancer sounds like an oxymoron, but an estimated one-half of breast cancers detected by screening would never cause problems even if undetected and untreated.)

Breast tumors found by imaging are much more likely to be harmless than those discovered by women or their physicians finding a breast lump. Income and education are therefore less likely to be a true risk factor for breast cancer and more likely to be a “risk factor” for undergoing screening. If poorer, less educated women were screened for breast cancer at the same rate as wealthier, better educated women, the socioeconomic risk factor would likely vanish.

Thyroid cancers are also scrutiny dependent, which is why when countries launch screening programs the incidence of the disease skyrockets (but death rates don’t, showing that what’s being found is a false epidemic). 

Welch and Brawley call for less focus on risk factors for developing cancers, since those numbers both determine and reflect who gets screened, and more on risk factors for death from cancer.

Published on Leave a comment on How Many Children Have Fetal Alcohol Disorders?

As many (most?) people know nowadays - drinking alcohol during pregnancy can have negative effects on the developing baby. Drinking a lot of alcohol can result in fetal alcohol syndrome, but drinking smaller amounts (frequently or binge drinking now and then) can also have negative effects, even though not as severe. The effects from alcohol are called fetal alcohol spectrum disorders - because the effects are along the spectrum from major to minor effects. Currently they're called  fetal alcohol syndrome, partial fetal alcohol syndrome, or alcohol related neurodevelopmental disorder. Effects are generally determined by the child's facial features, physical growth, neurobehavioral development, and prenatal alcohol exposure (esp. by interviewing the mother).

A recent study tried to determine how common are fetal alcohol spectrum disorders in the United States. The researchers screened 6639 first grade children in 4 communities from different areas of the US, and fully evaluated about 3000 children for fetal alcohol spectrum disorders. They found that the disorders ranged from 1.1% to 5% in the communities studied - and they felt that this is a conservative estimate. Interestingly, almost all of these newly diagnosed children had not been diagnosed with fetal alcohol spectrum disorders before the study. So it's easy to miss, and to misdiagnose- thus a "hidden problem".

How to avoid this problem? Don't drink alcohol during pregnancy. But unfortunately many women don't realize that they are pregnant in the first trimester, especially if the pregnancy is unplanned. The Centers for Disease Control (CDC) says on its site (official advice) that women should: "Stop drinking alcohol if they are trying to get pregnant or could get pregnant." What about men who drink alcohol and then conceive a child? There is also some research (mainly animal research) that alcohol can have negative effects on the father's sperm and the resulting fetus. Not fetal alcohol spectrum disorders, but perhaps other health effects which are still being determined.

From  journalist Pam Belluck's article at the NY Times: Far More U.S. Children Than Previously Thought May Have Fetal Alcohol Disorders

More American children than previously thought may be suffering from neurological damage because their mothers drank alcohol during pregnancy, according to a new study. The study, published Tuesday in the journal JAMA, estimates that fetal alcohol syndrome and other alcohol-related disorders among American children are at least as common as autism. The disorders can cause cognitive, behavioral and physical problems that hurt children’s development and learning ability.

The researchers evaluated about 3,000 children in schools in four communities across the United States and interviewed many of their mothers. Based on their findings, they estimated conservatively that fetal alcohol spectrum disorders affect 1.1 to 5 percent of children in the country, up to five times previous estimates. About 1.5 percent of children are currently diagnosed with autism.

The range of fetal alcohol spectrum disorders (also called FASDs) can cause cognitive, behavioral and physical difficulties. The most severe is fetal alcohol syndrome, in which children have smaller-than-typical heads and bodies, as well as eyes unusually short in width, thin upper lips, and smoother-than-usual skin between the nose and mouth, Dr. Chambers said. A moderate form is partial fetal alcohol syndrome. Less severe is alcohol-related neurodevelopmental disorder, in which children have neurological but not physical characteristics and it is known that their mothers drank during pregnancy.

Then there is the stigma that often makes mothers reluctant to acknowledge alcohol consumption. “When you identify a kid with FASD, you’ve just identified a mom who drank during pregnancy and harmed her child,” said Susan Astley, director of the Fetal Alcohol Syndrome Diagnostic and Prevention Network at the University of Washington, who was not involved in the study. While Dr. Astley, a longtime expert in the field, said she admired the researchers’ hard work, she said the reliability of the study’s numbers was hampered by several factors. For example, only 60 percent of eligible families in the schools allowed their children to be evaluated and more than a third of those children’s mothers declined to answer questions about drinking during pregnancy.

The authors of the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, acknowledged the study’s limitations and tried to partly compensate by providing a conservative estimate (of 1.1 percent to 5 percent) that is likely low and another estimate (of 3.1 percent to 9.9 percent) that is likely high. Dr. Chambers also said the results might not generalize across the country because although the four communities were diverse, they did not include a large, high-poverty urban area or certain rural or indigenous communities that struggle with high rates of alcoholism. The locations, which are not named in the publication, include small-to-midsize cities in the Midwest and Rocky Mountains, a Southeast county and a Pacific Coast city the authors identified in interviews as San Diego. [Original study.]

Published on Leave a comment on Chronic Diseases Raise Cancer Risk, and Exercise Lowers It

A new observational study from Taiwan found that having one of eight chronic diseases, such as heart disease or diabetes, or their markers (e.g. high cholesterol levels as a marker for heart disease), also significantly raises the person's odds of developing cancer or dying from cancer. The study estimated that these diseases or markers accounted for about 20% of all new cancers and 39% of all cancer deaths. That's about the risk of 5 lifestyle factors combined (smoking, alcohol consumption, obesity, unhealthy diet, and lack of exercise) contributing to cancer development and death.

The eight chronic diseases and markers were: cardiovascular disease (markers for which include blood pressure, total cholesterol, and heart rate), diabetes, chronic kidney disease (markers for which include proteinuria and glomerular filtration rate), pulmonary disease, and gouty arthritis (for which uric acid is a marker). The higher the chronic disease and marker score, the higher the risk of developing cancer and cancer death (a dose-response). Chronic diseases and markers were associated with a shortened lifespan -  about 13.3 years in men and 15.9 years in women.

But the good news is that regular physical exercise lowers the risk of developing cancer by about 48% and the risk of cancer death by 27%. That's huge!  So physical exercise and activity could be viewed as "cancer prevention" strategies. The researchers pointed out that additional cancer prevention strategies are avoiding smoking (very important), avoiding excessive alcohol consumption, maintaining healthy weight, and a healthy diet. From Science Daily:

Substantial impact of chronic diseases on cancer risk

Several common chronic diseases together account for more than a fifth of new cancer cases and more than a third of cancer deaths, finds a study published by The BMJ today. The findings show that the cancer risks from common chronic diseases, such as heart disease and diabetes, are as important as those from five major lifestyle factors combined.

A team of researchers based in the US and Taiwan therefore set out to investigate the combined effect of eight common chronic diseases or disease markers (for example, high blood pressure as a marker of heart disease) on cancer risk compared with lifestyle factors. They also explored whether physical activity could reduce the cancer risk associated with chronic diseases and disease markers. The study involved 405,878 men and women in Taiwan with no history of cancer .... underwent a series of medical tests between 1996 and 2007. .... Participants were followed for an average of 8.7 years.

The researchers found that cardiovascular disease markers, diabetes, chronic kidney disease markers, pulmonary disease, and gouty arthritis marker were individually associated with risk of developing cancer or cancer death. Higher chronic disease risk scores based on these diseases or markers were linked with an increased risk of developing cancer and cancer death, with the highest level associated with a more than twofold increase in risk of developing cancer and a fourfold increase in risk of cancer death.

High chronic disease risk scores were also associated with substantial reduction in life span. The highest scores were associated with 13.3 years of life lost in men and 15.9 years of life lost in women. Together, these chronic diseases and markers accounted for more than one fifth of all new cancers and more than one third of all cancer deaths in this study population, which was similar to the contribution of five major lifestyle risk factors combined -- smoking, insufficient physical activity, insufficient fruit and vegetable intake, alcohol consumption, and obesity.

The researchers also found that physical activity was associated with a nearly 40% reduction in the excess risks of cancer and cancer death associated with chronic diseases and markers. [Original study.]

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Published on 1 Comment on A Little Alcohol Daily May Be Beneficial

Interesting new research found health benefits to the brain from daily low intake of alcohol (equivalent to about 2 1/2 drinks per day). The University of Rochester (in New York) researchers found that while low daily (chronic) levels of alcohol were beneficial to the brain's glymphatic system, higher daily levels or binge drinking was not. And the low daily levels of alcohol intake was also better for the glymphatic system than no alcohol at all (the control group). In 2015 this same research team described the glymphatic system as not just the brain’s “waste-clearance system,” but as potentially helping fuel the brain by transporting glucose, lipids, amino acids, and neurotransmitters.

I'm sure this study will be greeted by many as great news, but remember it was done with MICE, and not humans, so one should be cautious in generalizing the results. But the researchers think that it does apply to humans, and may explain why some studies find some health benefits to low levels of daily alcohol intake, even better than no alcohol, and many negative effects to higher levels of alcohol intake - thus the J-shaped curve of effects seen in studies. [NOTE: Studies also find that alcohol consumption can cause cancer, and this is dose related. Studies find the Mediterranean diet (which includes low to moderate levels of alcohol) beneficial for brain health.]

By the way - no, the mice didn't receive wine as the press release from the Univ. of Rochester says. The mice actually received "intraperitoneal injections of low, intermediate, and high doses of ethanol" or just plain saline (the control group). From Science Daily:

In wine, there's health: Low levels of alcohol good for the brain

While a couple of glasses of wine can help clear the mind after a busy day, new research shows that it may actually help clean the mind as well. The new study, which appears in the journal Scientific Reports, shows that low levels of alcohol consumption tamp down inflammation and helps the brain clear away toxins, including those associated with Alzheimer's disease.

"Prolonged intake of excessive amounts of ethanol is known to have adverse effects on the central nervous system," said Maiken Nedergaard, M.D., D.M.Sc., co-director of the Center for Translational Neuromedicine at the University of Rochester Medical Center (URMC) and lead author of the study. "However, in this study we have shown for the first time that low doses of alcohol are potentially beneficial to brain health, namely it improves the brain's ability to remove waste." The finding adds to a growing body of research that point to the health benefits of low doses of alcohol. While excessive consumption of alcohol is a well-documented health hazard, many studies have linked lower levels of drinking with a reduced risk of cardiovascular diseases as well as a number of cancers.

Nedergaard's research focuses on the glymphatic system, the brain's unique cleaning process that was first described by Nedergaard and her colleagues in 2012. They showed how cerebral spinal fluid (CSF) is pumped into brain tissue and flushes away waste, including the proteins beta amyloid and tau that are associated with Alzheimer's disease and other forms of dementia. Subsequent research has shown that the glymphatic system is more active while we sleep, can be damaged by stroke and trauma, and improves with exercise.

The new study, which was conducted in mice, looked at the impact of both acute and chronic alcohol exposure. When they studied the brains of animals exposed to high levels of alcohol over a long period of time, the researchers observed high levels of a molecular marker for inflammation, particularly in cells called astrocytes which are key regulators of the glymphatic system. They also noted impairment of the animal's cognitive abilities and motor skills.

Animals that were exposed to low levels of alcohol consumption, analogous to approximately 2 ½ drinks per day, actually showed less inflammation in the brain and their glymphatic system was more efficient in moving CSF through the brain and removing waste, compared to control mice who were not exposed to alcohol. The low dose animals' performance in the cognitive and motor tests was identical to the controls.

"The data on the effects of alcohol on the glymphatic system seemingly matches the J-shaped model relating to the dose effects of alcohol on general health and mortality, whereby low doses of alcohol are beneficial, while excessive consumption is detrimental to overall health" said Nedergaard. "Studies have shown that low-to-moderate alcohol intake is associated with a lesser risk of dementia, while heavy drinking for many years confers an increased risk of cognitive decline. This study may help explain why this occurs. Specifically, low doses of alcohol appear to improve overall brain health." [Original study. Especially interesting is the Introduction & Discussion sections.]

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 A Curcumin Supplement That Actually Has Health Benefits?

The spice turmeric is a very popular supplement nowadays, believed to have all sorts of health benefits due to the curcumin in it (e.g. that it is anticancer, anti-Alzheimer's, anti inflammatory). And yes, studies in the lab (in vitro and in vivo) look very promising. However, a large 2017 review of existing studies also found evidence that "curcumin is unstable under physiological conditions and not readily absorbed by the body, properties that make it a poor therapeutic candidate". In other words, the hype for curcumin supplements is not matching the reality, especially or probably because it is so poorly absorbed by humans. But researchers keep trying. And keep in mind that turmeric has other compounds in it also - it is not just curcumin and nothing else.

A "double-blind, placebo-controlled clinical trial" is the best evidence for something being effective. That means a study where people are randomly assigned to groups, no one actually knows who is getting what, and there is a placebo group that is getting a "sham" treatment. A recent study did exactly that in testing a new formulation of curcumin (Theracurmin) that was easily absorbed (bioavailable) by the persons participating in the study.

And yes - they found health benefits, specifically improvements in memory and attention in those persons taking the curcumin supplements over a 18 month period (as compared to those taking a placebo and whose memory and attention deteriorated over that time). The subjects (who were between 50 and 90 years of age) did not have dementia at the start of the study, but were showing signs of "normal aging" or had mild neurocognitive disorder. Brain scans (before and after treatment) suggested that the behavioral and cognitive benefits from curcumin were associated with "decreases in plaque and tangle accumulation in brain regions moduating mood and memory" - so it had anti-inflammatory and/or anti-amyloid brain effects.

So...  Stay tuned. Meanwhile, perhaps frequent eating of foods containing turmeric may also have beneficial effects, as some studies suggest. From Science Daily:

Curcumin improves memory and mood

Lovers of Indian food, give yourselves a second helping: Daily consumption of a certain form of curcumin -- the substance that gives Indian curry its bright color -- improved memory and mood in people with mild, age-related memory loss, according to the results of a study conducted by UCLA researchers. .... Found in turmeric, curcumin has previously been shown to have anti-inflammatory and antioxidant properties in lab studies. It also has been suggested as a possible reason that senior citizens in India, where curcumin is a dietary staple, have a lower prevalence of Alzheimer's disease and better cognitive performance.

The double-blind, placebo-controlled study involved 40 adults between the ages of 50 and 90 years who had mild memory complaints. Participants were randomly assigned to receive either a placebo or 90 milligrams of curcumin twice daily for 18 months. All 40 subjects received standardized cognitive assessments at the start of the study and at six-month intervals, and monitoring of curcumin levels in their blood at the start of the study and after 18 months. Thirty of the volunteers underwent positron emission tomography, or PET scans, to determine the levels of amyloid and tau in their brains at the start of the study and after 18 months.

The people who took curcumin experienced significant improvements in their memory and attention abilities, while the subjects who received placebo did not, Small said. In memory tests, the people taking curcumin improved by 28 percent over the 18 months. Those taking curcumin also had mild improvements in mood, and their brain PET scans showed significantly less amyloid and tau signals in the amygdala and hypothalamus than those who took placebos. The amygdala and hypothalamus are regions of the brain that control several memory and emotional functions. [Original study.]

Published on Leave a comment on Can There Be Negative Effects From Retirement?

Many people look forward to retirement, thinking of all the wonderful things they will finally be able to do.  However, what no one expects is that retirement can have a negative effect on their cognitive functioning. This is what a long-term study carried out by researchers Baowen Xue etal at the University of London in the United Kingdom found. The study tracked 3,433 civil servants for the 14 years before retirement, and then another 14 years afterward. The participants were given periodic examinations to assess their cognitive functioning (verbal memory, abstract reasoning, etc.).

The researchers found that when people did eventually retire, they experienced decline in their verbal memory 38 percent faster than before they stopped working. They concluded that the act of retirement significantly accelerates verbal memory decline. They also found that a higher employment grade was protective against verbal memory decline while people were still working, but this ‘protective effect’ was lost when individuals retired, resulting in a similar rate of decline after retirement across the different employment grades.

The researchers pointed out that the adverse effect of retirement on verbal memory is consistent with the results of other studies. That's why they stress how important it is to continue undertaking mentally stimulating activities after retirement in order to prevent this decline. The researchers felt that the study results supported the ‘use it or lose it’ hypothesis regarding verbal memory function. But the good news was that retirement seemed to have little impact on other domains of cognitive functions, such as abstract reasoning and verbal fluency. They just showed normal age-related declines over time.

From European Journal of Epidemiology: Effect of retirement on cognitive function: the Whitehall II cohort study

According to the ‘use it or lose it’ hypothesis, a lack of mentally challenging activities might exacerbate the loss of cognitive function. On this basis, retirement has been suggested to increase the risk of cognitive decline, but evidence from studies with long follow-up is lacking. We tested this hypothesis in a cohort of 3433 civil servants who participated in the Whitehall II Study, including repeated measurements of cognitive functioning up to 14 years before and 14 years after retirement. Piecewise models, centred at the year of retirement, were used to compare trajectories of verbal memory, abstract reasoning, phonemic verbal fluency, and semantic verbal fluency before and after retirement.

We found that all domains of cognition declined over time. Declines in verbal memory were 38% faster after retirement compared to before, after taking account of age-related decline. In analyses stratified by employment grade, higher employment grade was protective against verbal memory decline while people were still working, but this ‘protective effect’ was lost when individuals retired, resulting in a similar rate of decline post-retirement across employment grades. We did not find a significant impact of retirement on the other cognitive domains. In conclusion, these findings are consistent with the hypothesis that retirement accelerates the decline in verbal memory function. This study points to the benefits of cognitively stimulating activities associated with employment that could benefit older people’s memory.