Archive for the ‘Medical Mythology’Category

Vaccines and Autism: Why the Controversy?

by Tania Houspian, PharmD 2011

VaccineThere is a tried and true medical procedure that is minimally invasive and takes a few seconds to perform. This procedure will help prevent dozens of diseases and aide in making the entire population healthier. The more people that undergo the procedure, the better it is for the health of the entire population. Like any procedure though, it has its risks. Do the benefits outweigh the risks? Would you choose to undergo this procedure?

That’s a question you always have to ask yourself when choosing to undergo any medical procedure. The risks and benefits need to be weighed.  More importantly the true risks and true benefits need to be weighed. Grandma thinks that her blood pressure medicine gives her gas but, as her children and grandchildren can confirm, Grandma had some serious gas long before she began taking blood pressure medication. Just because two things happen at the same time does not mean that one caused the other.  Correlation does not equal causation.

So what was the procedure we referred to above?

Procedure: Vaccinating Children

Benefit: Vaccines are the single best public health measure ever implemented in our society. They have been proven to prevent many diseases that, in the past, were the leading causes of death in young children.  Think Polio, for example.

Risk: Autism?

One in four Americans believes that vaccines cause autism. When anything becomes that engrained in the minds of a society, it warrants deeper examination. There are two main theories that aided in forming this widespread notion.

Theory #1:

Andrew WakefieldThe first mention of vaccines being a possible cause of autism was in 1998 by British gastroenterologist, Andrew Wakefield. Wakefield, along with 12 others, published a paper in which they put forward the theory that the measles virus in the measles, mumps, and rubella vaccine (commonly called the MMR vaccine) caused a “leaky gut.” They concluded that the leaky gut allowed toxic substances into the bloodstream that eventually ended up in the brain. In the paper they recommend separating the three (measles, mumps, and rubella) into separate vaccines. Wakefield called a press conference to let everyone know about his discovery and consequently triggered a panic in Great Britain.

Since then, Wakefield has not exactly been what we would call a respected member of the medical community. Ten of the co-authors on that paper retracted their involvement and have said they do not agree with the conclusions that Wakefield drew in his paper. The General Medical Council is also investigating Wakefield for scientific misconduct, specifically falsifying data.  Oh yeah, and Wakefield also forgot to mention that he was working on introducing a new measles vaccines to the market to compete with the MMR vaccine. Can you say conflict of interest? Hidden motives aside, Wakefield’s research methods have been accused of not only being flawed but also unethical.

Taking into account the fact that Wakefield has been publicly discredited and his paper deemed invalid, you would think this theory regarding the connection between vaccines and autism would have fallen by the wayside…and it hasn’t.  This is because it’s not that simple.  Many people believed Wakefield was on to something even if the science did not match his conclusions. Due to the number of vaccines children receive in the first three years of life (14 vaccines to be exact) many parents felt that there could be a connection.  Once the idea of a risk like this has been introduced, it’s difficult to get the idea out of people’s minds. Simply said, it’s always easier to scare people than to un-scare them.

Theory #2:

MercuryIn 1999 the US government published a report revealing three childhood vaccines (diphtheria, tetanus, acellular pertussis [a combo called DTaP]; Haemophilus influenzae type b (Hib); and hepatitis B) contained higher levels of mercury than previously thought. Thimerosal is the preservative used in these three vaccines and contains 49.6% ethylmercury by weight. An obscure medical journal took this finding and ran with it, publishing an article (without any scientific validity) saying that autism was a form of mercury poisoning.  This, of course, caused a huge uproar in the United States and propaganda like the image and chart included below (again, without scientific support; note the lack of references for the chart’s information).  In response, the Center for Disease Control reviewed numerous studies all finding that there is NO LINK between autism, vaccines, and mercury. Even though the CDC’s findings showed no connection between mercury and autism, the government still requested vaccine manufacturers to remove the mercury component from all childhood vaccines.  Since 2001, no childhood vaccines have contained mercury.  So let’s say the initial theory published by the obscure medical journal linking mercury and autism was correct (even though all the scientific evidence pointed the other way), then autism rates should have dropped dramatically after mercury was removed from all vaccines in 2001…and parents everywhere would be able to breath a sigh of relief. Well, it turns out that the exact opposite has happened. Autism rates have continued to rise since 2001. This simple fact should be enough to put the mercury-autism theory to rest yet many groups out there continue to vilify vaccines and anyone who dares step up to defend them.

Mercury – Autism Propaganda

Mercury Poisoning

Then why the controversy?

So why is it that, even though all the scientific evidence seems to point away from the connection between vaccines and autism, people still believe vaccines cause autism? Personal experience and temporal associations. One of the main driving forces amongst groups who believe vaccines cause autism are parents with children who have autism, which they begin to notice during the same period of time their children are receiving their 14 recommended vaccinations. Many parents first start to notice signs of autism when their children have developmental delays in speech. The MMR vaccine (which, by the way, never contained thimerosal) is given around 12-15 months of age, which coincides with the age most children begin to speak. So it seems that the most likely explanation is coincidence not causation. There are also many children who exhibit signs of autism prior to any vaccinations, further discrediting the link between vaccinations and autism.

What Now?

No one can belittle how difficult it must be for the parents of autistic children to witness their children’s developmental challenges. These parents need an explanation and, with so many people pointing the finger at vaccines, it’s a tempting to jump on the bandwagon. This approach, however, is not helping anyone. The focus of autism research has been and will continue to be on genetic causes of the disease.  This is the research that needs to be supported and perpetuated in order for real answers to be found and for meaningful interventions to be developed.

UK Measles CasesPeople seem to have become comfortable with how safe vaccines have made our society and forgotten that the illnesses they prevent can kill their children. These viruses continue to exist throughout the world and, without vaccination, we remain vulnerable to the epidemics they can cause. When Wakefield published his paper in 1998, parents in Great Britain stopped vaccinating their kids. The rate of vaccination dropped to 80% by 2003.  That same year, over 1,000 measles cases were reported in Great Britain. Similarly, in the United States there have been outbreaks of measles, pertussis, and Haemophilus influenzae Type B…all diseases that are preventable through vaccination.

References:

Fombonne,E. Thimerosal disappears but Autism Remains. Arch Gen Psychiatry. 2008 Jan;65(1)15-6

Gross L (2009) A Broken Trust: Lessons from the Vaccine–Autism Wars. PLoS Biol 7(5): e1000114. doi:10.1371/journal.pbio.1000114

Immunize.org, http://immunize.org. December 22,2009.

Miller L, Reynolds J. Autism and vaccination- the current evidence. J Spec Pediatric Nursing. 2009 Jul; 14(3): 166-72.

Thimerosal In Vaccines Questions and Answers. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070430#q5. December 26,2009.

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29

12 2009

The Hangover: Make it go away!

by Joshua Goldman, MD/MBA 2010

the-hangover-wallpaperIt’s 9am and you’re cuddling your fire truck-esk alarm as you wake up to realize that you’re already an hour late for work.  You sit up and immediately notice the pounding sensation in your head, reminding you of your alcoholic escapades from the night before.  It’s official, you’re hungover.  The question is “What do you do now?”  We’re here to offer a few suggestions to help mitigate hangovers with some preventive steps before and during drinking, and some hangover-relieving tricks for the morning after.

Rather than accepting a hangover as the unfortunate side effect of a night out, there are a few tricks to help reduce the likelihood of ever becoming hungover.  Here’s our recommendations:

  • Drink slowly (obviously).  Frank the Tank is well on his way to a hangover after beer bong number 3.

  • Eat a full meal before drinking.  One study showed that glucose (which your body gets from food) effectively inhibits the metabolic disturbances induced by ethanol (i.e. a hangover).  The glucose in the meal also helps build up a store of energy so you won’t feel as weak the next day.

  • Drink in moderation. For those of you who aren’t sure what this means, The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day (one drink = a 12-ounce bottle of beer, a 4-ounce glass of wine, or a 1 1/2-ounce shot of liquor).  WaterAlso, the average individual can process one of these alcoholic beverages per hour.  Two drinks in one hour makes you one drink drunk.  Five drinks in two hours make you three drinks drunk.  You follow?

  • Drink a glass of water in between alcoholic drinks. This will help you drink less alcohol while simultaneously hydrating you (remember that a large part of your hangover is dehydration).

We realize that these tips are not ideal for those of you looking to get a little wild during your night out on the town.  As such, here are some additional tips to help mitigate the pounding in your head that you will experience the next morning once the hangover has set in:

  • Replace all the fluids and electrolytes you lost. If you remember, alcohol is Rehydrating with Electrolyte Drinkdehydrating and, unfortunately, you lose a lot of electrolytes along with the fluid (mainly sodium, potassium, and magnessium).  There are a number of great electrolyte drinks (pedialyte, Gatorade Performance, Powerade, Smart Water, etc.) that can replace both water and electrolytes simultaneously.  If you prefer a more natural approach, water plus bananas and a salty snack can help replenish your fluids as well as the missing sodium and potassium.  You can also take a multivitamin to rapidly (and thoroughly) get all your needed minerals back on board.

  • Replenish your energy stores. Consume foods and drinks that contain fructose (such as fruit juice or honey). There is some evidence that fructose will help your body break down and eliminate the alcohol faster.  Also, remember that alcohol inhibits your body’s production of glucose (your body’s form of gasoline).  When you wake up the next morning, your body is in desperate need of glucose replenishment.  A healthy carbohydrate-rich meal will quickly replenish these glucose stores.  Add some protein (think eggs) to breakfast and you can simultaneously boost your body’s cysteine level which will help counteract the brutal effects of alcohol’s metabolites.

  • Stock up on Vitamin C. Vitamin C has been shown to increase your body’s level of glutathione, the chemical needed to breakdown alcohol that becomes depleted in hangovers (1).  Vitamin C also neutralizes free radicals (which are formed at an increasing rate during drinking) that can cause damage to your body in the aftermath of a night out.  Oranges or those tasty chewable Vitamin C tablet will both do the trick.

  • Get your liver back on track. In addition to Vitamin C, milk thistle is an excellent way to replace your liver’s glutathione stores (which you need to process all the alcohol you consumed).  You can also find glutathione in asparagus and spinach.  Eggs are rich in cysteine which is a building block of glutathione.  Vitamin B6, riboflavin, and selenium are required in the manufacture of glutathione (they can be found in most multivitamins) and are essential to getting your body back to normal.

  • Upset StomachBe gentle on your stomach. You spent a good portion of last night dumping the equivalent of battery acid into your digestive track.  It’s understandable that it’s not feeling so hot the next morning.  The alcohol you consume irritates the lining of your digestive track much like the way it is irritated with very spicy foods.  This irritation causes you to feel nauseous and makes it hard to eat.  To help your stomach heal, eat bland foods the next day and save the spicy peppers and chili sauce for another day.  If your upset stomach is sucking your will to live, try Pepto-Bismol (it acts as a temporary stomach lining protecting your irritated gut from its natural acid while it heals…yes, the picture on the pink bottle is true).

  • Get plenty of rest. Alcohol inhibits your ability to reach your most deep and restful phase of sleep.  As such, you will be tired regardless of the number of hours you spent in bed.  Try to take a midday nap to allow your body time to catch up on some much needed deep sleep.

  • Take an aspirin. Aspirin (as well as ibuprofen and naproxen) has been proven to be effective in minimizing the pain in many types of headaches including a hangover headache.  Avoid taking any medications for your hangover that contain acetaminophen (such as Tylenol), because it may cause liver damage when combined with alcohol.  Your liver is already angry; no need to push it over the edge with Tylenol.

House Call, MD’s Hypothetical Hangover Remedy:

In simplified terms, this is our best (scientifically supported) guess at what can get you back on track:

  1. A carbohydrate-rich breakfast with eggs on the side (but remember to keep it bland)

  2. Electrolyte-enhanced fluids…lots of them

  3. A multivitamin (make sure it has Vit B6, B12, riboflavin, and selenium)

  4. Vitamin C – Consume any way you’d like (OJ or oranges will kill two birds with one stone)

  5. Aspirin – One dose in the AM is probably all you need

  6. Rest - Try an afternoon nap…you look like you need it.

References:
1. Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in healthy adults. Am J Clin Nutr 58:103-5, 1993
2. Kera Y, Ohbora Y, Komura S (1989). “Buthionine sulfoximine inhibition of glutathione biosynthesis enhances hepatic lipid peroxidation in rats during acute ethanol intoxication”. Alcohol Alcohol. 24 (6): 519–24.

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09

10 2009

Urine: Nectar of the Gods?

GladiatorIt has been fabled since the days of Gladiators in Rome that drinking one’s own urine while training for battle  provided special nutritional value to the fighters in training. Fighters such as Lyoto Machida, who claims to swill his pee every morning, is one example.  These individuals profess that their urine is full of nutrients that their body could not absorb on the first pass. But is there any medical validity to this ancient practice?

Dr. Johnny Benjamin, sports columnist and renowned orthopedic surgeon shared the truth behind this myth with us, “Urine is 95 percent water, 2.5 percent urea, and a 2.5 percent mixture of minerals, salts, hormones, enzymes and non-toxic waste products.

“The practice of drinking urine is certainly not new or limited to a few modern practitioners of combat sports such as world champions Lyoto Machida in MMA and Juan Manuel Marquez in boxing. China, India, the Middle East and Rome all have ancient and modern writings that discuss the willful consumption of urine.

“I recently viewed an HBO 24/7 episode with Mr. Marquez sipping a steaming glass of his golden nectar in preparation for an upcoming fight with Floyd Mayweather Jr. I have the utmost respect for Marquez as a champion, but apparently the thought of a potential ass whipping will drive a man to consider a great many things.

“Although the potential benefits and healing capacities of drinking urine have been encouraged for centuries by many cultures, there is no credible medical literature or studies that support these beliefs.

Urine and Straw“Urine has been consumed to combat dehydration in extreme survival situations for its 95-percent water content. Also, water is reclaimed from urine, purified and filtered for consumption on the International Space Station.

“Drinking your own urine may reclaim a small bit of water, but if the body didn’t want the other five percent (waste products and the like) during the first time, why would it want it the second time around?  Wouldn’t it be easier (and probably considerably tastier) to just sip a tall refreshing glass of H20 and take a multivitamin?”

In addition, proteins are not present in a healthy individual’s urine.  Loss of proteins in urine is a sign of kidney problems and necessitates further medical investigation.  If you’re looking for extra protein in your diet, we recommend a hearty chicken breast or protein shake after your workout.

As Juan Manuel Marquez says in his HBO clip, he drinks his urine because “that’s where a lot of proteins and vitamins are, part of your vitamin intake, and why not drink them again instead of wasting them?”  That’s an interesting question, Dr. Marquez.  Our thoughts are that 1) it’s pretty disgusting, and 2) you can consume infinitely superior “proteins and vitamins” from any number of other non-urine-based sources.  Are we supposed to believe that hot urine contains super-nutrients that you can’t find at the GNC, and the body is flushing them out of your system?  No disrespect to our beloved light-heavyweight champion, but is it possible that the athletes who swear by urine-drinking just enjoy drinking pee?  Maybe it simply serves as means of intimidation to the opponent.  After all, we wouldn’t fight him.

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16

09 2009

Auto-Cleaning Ear Wax

How many times did your mom tell you to clean your ears growing up?  If you’re like most of us, it was part of a daily mantra chanted by our parents.  Walk into any personal bathroom in America and there’s a 75% chance you’ll find a fancy little container of Q-Tips sitting on the counter reminding you to clean your ears.  The only problem is that your ears don’t actually need cleaning.Q-Tip Cleaning

The architect of the human body was brilliant and built an auto-cleaning function into our ears. Our bodies naturally produce ear wax (what doctors call cerumen) to trap dust particles that find their way into the ear canal.  Ear wax also collects all the dead cells from your ear canal that naturally desquamate (the doctor word for “die and slough off”) each day as well as some antibacterial properties.  Without this wax, your ears would have been completely blocked with dirt and cells by about age 3.  So how does the wax get out?  The portion of your ear canal where wax is produced (the outer 1/3 of the canal) is lined by tiny hair cells (cilia) which are constantly brushing in the outward direction.  The repetitive movement of these hair cells pushes the wax and dust particles out of your ears all by themselves…no Q-Tips needed.  When left alone, your ears are an amazing self-cleaning wonder.  So what’s the problem with using a Q-Tip to help this process along (perhaps before a hot date or your next yearly check up)?

There are two hazards to using Q-Tips:

1. Ear Drum PerforationYou could perforate (i.e. poke a hole in) your eardrum.  We’re all aware of this danger and have adjusted our ear cleaning techniques appropriately after the one time we dug a bit too deep and couldn’t hear for the rest of the morning.  Luckily your ear drum (called the tympanic membrane) is one of the fastest regenerating tissues in your body.  Thus, a perforation will be able to heal itself relatively quickly and you will regain normal hearing.

2. When you use a Q-Tip, the wax that you aren’t able to sweep out gets pushed deeper into the ear canal, beyond the region of the canal where the hair cells are able to push it out.  This wax remains in your ear and slowly accumulates with each successive Q-Tip “ear cleaning.”  Over time, you will build up your own Great Wall of ear wax and begin to notice a change in your hearing as you occlude the canal and coat the ear drum.  This is the point at which you go see your doctor to find out what’s going on with your hearing, resulting in a vigorous in-office ear flushing (yes, we realize this is both gross and uncomfortable).  If you’re already at the point of auditory-impairing wax build-up, you don’t necessarily need to go to the doctor to have it cleaned out.  The American Academy of Otolaryngology (i.e. Ear Doctors) recommends mineral oil or hydrogen peroxide treatments in the ear combined with rinsing in the shower to help soften up the wax and wash it out.  If the problem persists, go see your doctor for some cleaning assistance.  If you  insist that something be done on a regular basis for your wax, feel free to continue the mineral oil regimen at your leisure.  No harm in helping the natural cleaning process in a clinically-proven way!

Because of both of these dangers, Q-Tips are not actually intended for use when cleaning the ear canal.  The marketers of Q-Tip are aware of this and will never show a person cleaning their ear canal with Q-Tips during their commercials.  Instead, you’ll find lots of clips of women removing their makeup, wiping away the gunk around babies eyes, and people cleaning the outside portion of their ear (called the pinna)…but no deep ear cleaning.  For more information about earwax, visit The American Academy of Otolaryngology

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02

03 2009

Medical Mythology: The Bloody Nose

Medical Myth: To stop a nosebleed, tilt your head back while pinching your nose.

Fifty percent of this medical myth is true, while 50% can actually be relatively dangerous. Think of a nosebleed like a cut on your finger. What would you do to stop the bleeding? Pressure, pressure, pressure! The key to stopping any bleeding is pressure over the wound. The same theory applies in your nose. The bleed is caused by injury to an exposed blood vessel inside your nose as a result of trauma (i.e. the ever-sexy nose picking we all try to hide). To apply pressure, squeeze your nose firmly over the cartilaginous part (the softer part more towards the tip of your nose rather than the bony part closest to your face) and hold it for 5 minutes. Do not scrape away your newly-formed scab in your nose because this will simply restart your bleed. Now the myth: Tipping your head back does NOT stop the bleeding. All it does is allow the blood to flow down the back of your throat causing an upset stomach and an increased risk of choking on blood going down the wrong pipe…not a good idea. In children, the risk of aspiration (getting fluid, in this case blood, in your lungs) is even higher. The take home: Keep your head level or lean forward. Some people argue that applying an ice pack over your nose and brow helps constrict the blood vessels and slow down the bleed as well but this has never been proven Unlike tipping your head back, this can’t hurt so if you’re fond of the forehead icepack, there’s no harm in trying.

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22

02 2009