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General health problems such as ear infections, pink eye and influenza affect nearly every person eventually. Rod Moser, PA, PhD, shares information and advice here on the most common general health disorders, their symptoms, treatments, and prevention.

Friday, October 16, 2009

Dueling Medical Studies - Who to Believe?
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People who primarily get their health information from the evening news, the local newspaper, or non-medical Internet sites are in big trouble. The amount of conflicting information about the risks or benefits of just about anything is staggering. I guess I am particularly troubled by television news. I use coffee as an example:
"New Study Shows that Coffee Consumption Linked to Breast Cancer"

This was a story that I heard over 30 years ago (before the Internet!). It was so shocking at the time, that women stopped drinking coffee all over the country. In one, highly-publicized study, coffee was blamed for fibrocystic breast disease and tentatively linked to breast cancer. This alarming coffee/breast cancer link was later disproven, but that news never seemed to make it to the media. This is really like having your neighbor hauled off by police as a possible child molester. The evening news shows him being put into a police car. The police quickly realize that they got the wrong man, apologize, and release him. All your neighbors really remember is that there is a child molester that lives in that house. The news that this was a mistaken identity doesn't really filter down. The accusation of being a child molester, even after being vindicated, is reason enough to move away. Capturing a child molester is a big story. The man not being a child molester is boring news.

A doctor in a nearby community was accused of fondling his patient's breasts. He was arrested in his office and put in jail. It made the evening news top story and the front page of the newspaper for weeks. After spending tens of thousands of dollars to defend his medical license and good name, he was finally exonerated after the victim admitted to lying. She had made up the entire story. What was once front-page news, complete with pictures, was now a tiny write-up on page seven. Most of his patients never saw that he had been exonerated. His practice and reputation was ruined by the news media jumping to sensationalism. People are supposed to be considered innocent until proven guilty, but the media can prematurely imply guilt.

Coffee has been vindicated, too. As a matter of fact, coffee has completely recovered from that story that it causes breast cancer. Coffee is now considered medically beneficial, assuming of course, that those recent studies were not funded by Maxwell House or Starbucks. People spend billions of dollars every year on this valuable commodity, so having a safe reputation is essential. According to WebMD there have been 19,000 studies that have examined coffee's impact on health. It appears that the benefits of coffee greatly outweigh any hazards.

Coffee contains a significant amount of caffeine, about 85 mg. - a potent stimulant. It can zip you up when you are tired, boost your concentration, but it can also raise your pulse and blood pressure, and make you a bit jittery, at least until it wears off. If you are not used to drinking strong coffee, those effects can be frightening.

When my daughter was in high school, she worked part-time at a neighborhood coffee shop. I worked for a university at the time, with a remote campus about ninety miles away. At the time, I was not a coffee drinker. I was a coffee virgin. Since I had to leave very early, I thought that I would try drinking coffee to keep me awake on the long, boring drive, so I ordered mocha. I assumed this was primarily chocolate. The guy behind the counter asked me if I wanted a "single or double". I figured this referred to the size of the cup. It was a long drive, so I said "double". I had absolutely no idea that he was referring to two shots of espresso. In about twenty minutes, the palpitations of my heart were so severe that I had to pull off of the highway. Now, my entire coffee consumption is just one cup in the morning - no double shots of anything. When driving non-stop back from Mexico, I did drink one of those new "energy drinks" heavy in caffeine. I definitely felt those effects and remained alert while driving the last six hours of an 18 hour journey.

As parents, we typically don't let children drink coffee, perhaps because we feel that kids are zippy enough without it. Believe it or not, no studies have shown that coffee is harmful to kids. Even if it is safe, I am not going to ever suggest that parents give their kids a cup of joe before heading off to school. With teenagers dozing off in math and social studies on a regular basis, perhaps coffee would not be a bad idea for them. Of course, we all worry about "complimentary behaviors" in coffee drinkers. I just can't picture a five-year sipping on a cup of coffee in one hand, a cigarette in the other, and looking for the newspaper. Okay, I know this is a bad stereotype, but you get the idea. Maybe coffee is a gateway drug? Perhaps we need a study.

Studies have now concluded the coffee is good for us; or most of us, at least. Coffee drinkers are less likely to develop Parkinsonism, decreased the risk of colon cancer, less chance of gallstones, and even less dental cavities. There is even evidence that asthmatics who are also coffee drinkers, have less asthma attacks. Coffee appears to be a good diuretic, too. There are just some of the positive health benefits that have been linked to coffee, if we are to believe those studies.

People are more likely to believe the last thing that they read in the newspaper, magazine, or on television news. We tend to quickly forget that a conflicting story may have been highlighted a few weeks prior, or even a rebuttal or disclaimer announced later. Once we glom on to a story, it becomes part of our belief system - one that we will freely share with others.

Every day in my clinic, I am defending vaccinations and dispelling junk-science about their presumed hazards. Once a parent is convinced that vaccinations may be harmful to their child, perhaps causing autism, it is very difficult for a medical provider to convince them otherwise. For some, holding on to those beliefs are like a religion - they are deep and personal.

I watched an anti-smoking documentary the other day that effectively used the Scared Straight technique. The anti-smoking lecture was given by a surgically-deformed cancer survivor who had most of his face removed. Those kids were listening. I think it would be a good idea to get a group of survivors of vaccine-preventable diseases, like polio, meningitis, or mumps, to have a talk with some of these parents.

Until I hear otherwise, from a well-designed, scientifically-controlled medical study, I am going to continue to promote vaccines, and of course, drink my one cup of coffee in the morning. Let the fools continue to smoke, avoid seat belts, drink booze, drive crazy, take drugs, have unsafe sex, and believe that vaccines are a government plot to control and harm us. Nature has some unique ways of dealing with them.

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Posted by: Rod Moser_PA_PhD at 7:48 AM

Friday, May 22, 2009

The Media and the Worried Well
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Every morning I watch the local news to see what kind of medical problems and issues I will be discussing that day. If there is a story about a new case of West Nile Fever in the area, I will be getting calls as soon as the phones open. A Lyme disease case was diagnosed thirty miles from here, so I will get a few of those calls, too. These calls come from a large group of media-inflamed people called the "Worried Well" - well people that think they might be ill, or at least, exposed.

A rash that would have been otherwise ignored is now a target lesion characteristic of Lyme. A fever that would have been previously attributed to a viral infection is now the H1N1 (swine) flu. I saw two, perfectly-well boys, ages 7 and 9, last evening because the father felt they had swine flu. Apparently, they had a particular rare type of swine flu - one that had no symptoms. They have not traveled to Mexico, although they were in Venezuela last year to visit relatives. They had no contact with others who were ill at school; and there were no reported cases in that particular school or city. The answers to all of the H1N1 medical screening was a flat negative. No symptoms. No contacts. Well kids. I literally had to argue with the parents that a screening test was not only not indicated, the Health Department would refuse to run it.

This recent influenza pseudo-pandemic is a prime example of media hype, not unlike yelling "Fire" in a crowded theater. I really can't fault the CDC and the Health Departments for going on alert, even high-alert, but the media fed the fires of fear that drove people into a frenzy. Tents were set up to screen people outside of standing-room-only emergency rooms. People, whose only contact was with a cooked pork chop, demanded to be tested and treated. A local Catholic school was closed after one case was found (not a bad idea), but several more schools were closed in neighboring communities "just in case". There were no firm guidelines on school closures. Each hour, I would get an email from our lab or from the Health Department on how to collect and store the viral swabs and where we should send them. Our clinic ended up sending several dozen cultures of suspected cases over the last two weeks. We have yet to hear about any of them.

If this potential pandemic was a test of our public health system's response to a biological emergency, I am not sure we passed. The first day that I sent the proper viral swabs to the local health department, they were closed due to budget constraints! Millions of doses of Tamiflu - an antiviral flu medication - were sent to the border states for possible public distribution. The federal government had bought tons of these expensive drugs during the last flu scare - the bird flu - when it was assumed that we would see millions of cases of a deadly strain spread by birds along their migratory routes. It didn't happen, obviously. It was sure financially-convenient to have this new swine flu emerge since those medications were due to expire anyway. I had two courses of Tamiflu in my medicine cabinet from the bird flu that I didn't take; it was expired, too. Oh, by the way, the companies that make Tamiflu and Relenza (another anti-flu medication) are ecstatic.

This morning, I had a heated thirty-minute counseling session with a mother who did not want to give her healthy five-year old any more vaccines in preparation for kindergarten for fear that he would get autism. Yes, autism exists, and yes it is being diagnosed more and more in the U.S. (Although not so often in other countries where the exact, same vaccines are used.). There is absolutely no scientific evidence that autism is directly or indirectly caused by any of the vaccines, or combination of vaccines, or the preservatives in the vaccines (which, incidentally, no longer exists). Of course, these medical claims vindicating the vaccines, made from years of controlled studies, reviewed by experts in their respective fields, must be wrong. Why? Because someone disputed it on the Internet claiming that the studies are wrong - motivated by vaccine-manufacturer's greed and profit, or a neighbor told her that she had a cousin that got autism from the vaccine. Rumors, anecdotal claims, and unsubstantiated personal testimonials appear to have more credibility than a published study in the New England Journal of Medicine. In the end, the mother agreed to get the MMR vaccine, but did not want to get the other three required, school-entry vaccines at this time. Okay, one vaccine (three, actually) is better than none at all.

I feel sorry for the media. Unless they have a good story, no one will watch the news or read the paper. If readership goes down and people stop watching, advertisers will not buy time or space. If advertisers stop advertising; newspapers and television stations will go under. It has already happened with the economic downturn.

There are some days, when I am getting my morning "Disease of the Day" briefing on television, that there are no good stories. They may have a "breaking news" story about a new meat-slicer at the local market that is safer than the older, finger-amputating model. A few years ago, I turned on the news to see live helicopter footage of a local swimming pool. Someone (unnamed) had pushed the wrong button to automatically chlorinate the pool, and several people had become sick from the chlorine fumes, while others had bleached-out Speedos. I could see ambulances with light flashing. Paramedics ran dragging gurneys with people on oxygen. It was chaos. Two hours later at work, I saw an endless dance of potential chlorine victims. A few hours after that, it was determined that the chlorine levels in the pool were really not that high; certainly not toxic.

About 12 years ago, when I was teaching in Michigan, another chlorine incident happened. The people doing the laundry at the Indian Casino used concentrated chlorine instead of Clorox. The fumes wafted through the casino, much to the horror of the semi-drugged gamblers. Some became nauseated. A few vomited. The rest fled in a wild panic. The rumor was that there was a terrorist, nerve gas attack. The local fire department quickly set up a make-shift decontamination area for the many victims before transporting them to the local emergency room. Totally-naked gamblers stood in the freezing weather and were systematically hosed down with even colder water. Once they were blue and placed in paper gowns, they were sent to the ER. I can tell you that this was big news for Mt. Pleasant, Michigan. I was puzzled all day why anyone would think that terrorists or a disgruntled loser would consider an Indian casino in Mt. Pleasant to be a target.

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Posted by: Rod Moser_PA_PhD at 8:18 AM

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