Rotavirus is the leading cause of severe diarrhea in infants and children worldwide, leading to more than half a million deaths each year in children under the age of 5. Before the introduction of the rotavirus vaccine, almost all children in the US were infected by the age of 5, and rotavirus infections were responsible for 400,000 doctor visits, 200,000 ER visits, 55,000-70,000 hospitalizations, and 20-60 deaths each year. The first rotavirus vaccine, RotaShield, was found to have an association with intussusception. Two newer vaccines, Rotateq and Rotarix, were thought not to carry that risk, but two new trials have shown that they do. Still, the risk is small and the benefits of the vaccines are great.
What is intussusception?
Intussusception is a “telescoping” of the intestine where one section slides inside another section. This can cut off the blood supply, block the intestine, and cause tears, infections, and death. Most cases are in young children. They have severe abdominal pain (intermittent at first), and pass blood in the stool, typically mixed with mucus and having the appearance of currant jelly. A barium enema can confirm the diagnosis and simultaneously treat it. Sometimes surgery is needed. (more…)
Too Much Texting?
The United Chiropractic Association has warned that using mobile phones for texting could cause poor posture that could shorten your life. They claim that poor posture is as big a health risk as obesity and that it increases the risk of an early death, especially in elderly people. Chiropractors have said a lot of silly things, but this ranks right up there among the silliest. They are just making stuff up and using scaremongering as a practice-building technique.
They say these claims are based on research studies. They aren’t. They are fanciful imaginings built around a tiny grain of truth that is just large enough to confuse a medically naive public. When people text, they usually bend their head forward; and if you hunch over for long periods, your back is likely to hurt. I have to keep reminding myself not to sit at the computer too long in one position. (more…)
Note: I had just finished writing this article when I discovered Dr. Jones had beat me to the punch with his March 28th article on the same subject. He did an excellent job, and of course reached the same conclusions I did (it’s not that great minds think alike, but that we base our conclusions on the same body of evidence). Rather than let my efforts go to waste, I decided to go ahead and publish my shorter, more idiosyncratic article. If it’s worth saying, it’s worth saying twice; and different approaches may appeal to different readers.
“Humani nihil a me alienum puto.”
Nothing human should be alien to me, and I can understand why people do most of the strange things they do, but water birth is something I have really had difficulty with. Why would anyone want a baby to be born underwater? Why would they want to buy a special pool, set it up in the living room, fill it with water, keep the water at the right temperature, and then have to deal with emptying the pool and cleaning up afterwards? I read about it and tried to understand, and now I have some insight into their reasons; but I think they are poor reasons, and the whole concept remains pretty alien to my mind.
I found a fuzzy feel-good rationale on the Waterbirth International website. Mothers feel it is the gentlest of gentle births. Warm, luxurious water cradles you and gives you complete freedom to move during the greatest achievement of your life. “The women who have experienced the support and comfort of water for their labors and held their newborns in their arms speak more than any scientific article or paper on the subject.” In other words, “We don’t need no stinkin’ science!” (more…)
A bit of good news for a change: a “Perspective” article in the New England Journal of Medicine describes how point-of-care ultrasound devices are being integrated into medical education. The wonders of modern medical technology are akin to science fiction. We don’t yet have a tricorder like “Bones” McCoy uses on Star Trek, but we are heading in that direction, and the new handheld ultrasound devices are a promising development.
The stethoscope has become iconic, a symbol of medical expertise draped proudly around the neck by doctors and other medical personnel. Before it was invented, doctors could only try to listen to a patient’s heart by direct application of ear to chest. In 1816, Laennec interposed a tube of rolled paper between ear and chest, and the stethoscope was born. It quickly became an essential tool, allowing us to hear the distinctive murmurs produced by different heart valve abnormalities, to take blood pressures, to detect the wheezing of asthma or the collapse of a lung , to hear the bruits caused by atherosclerotic narrowing of blood vessels, to detect intestinal obstructions by listening for borborygmi (I love that onomatopoeic word!).
The stethoscope allows us to hear sounds produced by the body, but sound also allows us to see inside the body. Diagnostic ultrasound has a multitude of uses. With prenatal sonograms, we can determine the sex of a fetus, watch it suck its thumb, and even take its picture for the family album. With echocardiography we can evaluate heart valves, see fluid accumulation in the pericardium, observe the thickness and motion of the heart wall, and even quantify the efficiency of the pumping process. Ultrasound lets us see clots in blood vessels and stones in the gallbladder, evaluate abdominal organs, detect cysts, screen for carotid artery narrowing and abdominal aortic aneurysms, and guide needles into the body for therapeutic and diagnostic purposes. (more…)
For those who dismiss advocates of the “natural” as ignorant of science and deluded by the logical fallacy that natural = best, Nathanael Johnson’s new book is an eye-opener: All Natural: A Skeptic’s Quest to Discover if the Natural Approach to Diet, Childbirth, Healing, and the Environment Really Keeps Us Healthier and Happier. If nothing else, it is a testament to the ability of the human mind to overcome childhood indoctrination in a belief system, to think independently, and to embrace science and reason.
Nathanael Johnson was brought up by hippie parents who subscribed to every “natural” belief and fad. His mother nearly died of a postpartum hemorrhage when he was born at home (he weighed 11 pounds!). His parents didn’t report his birth, and he didn’t have a birth certificate. He co-slept with his parents, never wore diapers (imagine the clean-up!), was allowed to play in the dirt and chew on the snails he found there, was fed a Paleolithic diet, was never allowed any form of sugar, didn’t know there was such a thing as an Oreo cookie, was home-schooled, and did not know that public nudity was taboo until he and his brother shocked the folks at a church picnic by stripping naked to go swimming in the lake. Nudity was customary in his home, and he was encouraged to “let his balls breathe.”
As he grew up, he started to question some of the dogmas he had learned from his parents. He had been taught that good health resulted from forming connections with nature, but he found that nature “generally wanted to eat me.” Now an adult and a journalist, he understands science and how to do research. He tried to read the scientific literature with an unbiased mindset, asking questions about the subjects in his book’s title rather than looking for evidence to support any prior beliefs, and he arrived at pretty much the same conclusions we science-based medicine folks did. But he still appreciates that a natural approach has value, and he seeks to reconcile nature with technology. He calls his book a comfortable refuge from people who are driven to extremes. (more…)
I wrote about ASEA in August, 2012. To quote the company’s website, “ASEA is trillions of stable, perfectly balanced Redox Signaling Molecules suspended in a pristine saline solution—the same molecules that exist in the cells of the human body.” Molecules that supposedly have all kinds of antioxidant benefits for health and for athletic performance through “redox signalling.” They claim it is “a mixture of 16 chemically recombined products of salt and water with completely new chemical properties.” But they never specify exactly which molecules those are, what they mean by balanced, or how they can determine that they remain stable. The product label only lists salt and water. If those 16 recombined molecules are really in the product, the FDA can and should act against them for false labeling.
An ASEA distributor (part of the company’s multi-level marketing cadre) recently wrote an e-mail, not to me, and not to the editors of SBM, but to an assistant editor, to demand that my article be taken down, or that at least the comments for that article be re-opened. Since the e-mail was not sent to me, and I don’t have the writer’s permission, I won’t name him or quote him directly but will paraphrase what he said. He said my article had prevented thousands of people from benefitting from the health effects of ASEA. Thousands? I don’t think I’m that influential; I only wish I were! Anyway, it has not been established that ASEA offers any health benefits. He complains that I don’t have any evidence that ASEA doesn’t work, and of course I don’t. The burden of proof is not on me to prove it doesn’t work, but on those making the claims to prove it does.
He says there is real scientific evidence showing that it does work. My article said there was nothing about ASEA listed in PubMed, and he countered that there are 102 mentions. I was skeptical, so I checked for myself. What I found left me rolling on the floor in paroxysms of laughter. (more…)
You may have noticed that men and women are different. I hope you have noticed. As the French say, vive la différence! It’s not just that one has dangly bits and the other has bumpy chests. Or that one has to shave a beard and doesn’t like to ask for directions while the other has menstrual periods and likes to discuss feelings. There are differences in physiology and in the incidence of various diseases. For instance, normal lab values for hemoglobin are higher for men than for women, and autism is more prevalent in males while multiple sclerosis is more prevalent in females.
In the past, women have been underrepresented in clinical studies; when the first studies of aspirin for cardiovascular prevention came out, we knew it was effective for men, but we didn’t have enough evidence to recommend it for women. This is changing; researchers today are more aware of the need to include women in their studies. Now the American Heart Association/American Stroke Association (AHA/ASA) has issued the first evidence-based guidelines for reducing the risk of stroke in women. (more…)
Depression affects approximately 10% of Americans. It can be fatal; I found estimates of suicide rates ranging from 2-15% of patients with major depression. When it doesn’t kill, it impairs functioning and can make life almost unbearably miserable. It is a frustrating condition because there is no lab test to diagnose it, no good explanation of its cause, and the treatments are far from ideal.
Jonathan Rottenberg is a psychologist and research scientist who began to study depression after his own recovery from a major depressive illness. He teaches psychology at the University of South Florida, where he is the director of the Mood and Emotion laboratory. He has launched the Come Out of the Dark campaign to start a better, richer national conversation about depression. In a new book The Depths: The Evolutionary Origins of the Depression Epidemic, he reviews insights from recent experiments and asks a number of difficult questions, such as why humans evolved to be subject to incapacitating depressions. He comes up with some startling hypotheses, including the idea that evolution favored depression because of its survival value and that depression is essentially a good thing. He offers his ideas as the basis of a paradigm shift. (more…)
I’ve always thought of Tylenol (AKA acetaminophen in the US and paracetamol in the UK) as one of the safest drugs around, with essentially no side effects when used as directed. But it has been in the limelight lately. Several SBM articles have addressed it here, here, and here. We know there is a risk of liver damage and death with acetaminophen overdose or accidental ingestion (458 deaths a year in the US). Since it is included in many other products (painkillers, cold and cough remedies, etc.) consumers may not realize how much they’re taking. The FDA has addressed this problem, and reformulations and lower daily dose recommendations are being implemented; but there is still no guarantee that consumers will realize that their “non-aspirin pain reliever,” pain pills like Vicodin, and many cold, sinus, and cough remedies have the same ingredient as Tylenol.
We have gradually become aware of other dangers not associated with overdose. Acetaminophen has been associated with kidney damage (especially with long-term use), gastrointestinal symptoms, and cardiovascular events. Combining the recommended dose with alcohol ingestion can lead to liver failure. It can also interact with some other drugs, for instance isoniazid. Allergic reactions can occur, and 7% of patients who are allergic to aspirin or NSAIDs also react to acetaminophen. It is excreted in breast milk, but in very low concentrations. The manufacturer’s professional product information includes detailed listings of reported reactions, drug/drug interactions, and safety studies in patients with various diseases. There is no need to adjust dosage for the elderly or for those with liver or kidney disease. For most patients, including those with chronic disease, acetaminophen is the pain-reliever of choice due to its low risk. But recently a draft recommendation from the UK’s NICE (National Institute of Health and Care Excellence) has warned us against using it, at least to treat the pain of osteoarthritis. (more…)