This study joins many other studies and expert opinions published in top-tier medical journals demonstrating no link between cell phones and cancer. Just to drive that point home, here’s a list of only some of the studies showing no link:

Muscat JE et al, Journal of the American Medical Association, 2000

Inskip PD et al, New England Journal of Medince, 2001

Christensen HC et al, American Journal of Epidemiology, 2004

Christensen HC et al, Neurology, 2005

Schoemaker MJ et al, British Journal of Cancer, 2005

Lonn S et al, American Journal of Epidemiology, 2005

Schuz J et al, Journal of the National Cancer Institute, 2006

Schuz J, American Journal of Epidemiology, 2006

Hepworth SJ, British Medical Journal, 2006

Lahkola A, International Journal of Cancer, 2007

The debate isn’t completely over yet, though. The authors of these studies point out that long-term effects can’t be known for certain, given that cell phones have only been widely used for about two decades. Critics of the studies point out some of them have some financial backing from cell phone corporations, and that no high-quality studies have been done in children. Still, if cell phones did cause a large increase in brain cancer, you’d think neurosurgeons would have detected a surge in cases, especially with the four billion phones now in existence. So for those of you who just bought the new Iphone, brain cancer should be the least of your worries.

The post Still No Link Between Cell Phones and Cancer appeared first on The Faster Times.

You’re allergic to bananas. You don’t put them in your cereal, you don’t drink smoothies, you don’t travel to Central America. You even hate monkeys, they like bananas so much. Your whole life, you’ve avoided bananas because your mom told you that your doctor did a test when you were a kid and said bananas could kill you. But maybe it’s not so simple. Maybe, just maybe, a banana won’t kill you after all.

A study published in this week’s Journal of the America Medical Assocation highlights the complexity of diagnosing and treating allergies. The paper is a review of more than seventy other research studies, which the authors summarize as “critically limited by the lack of uniformity for the diagnosis of a food allergy, severely limiting conclusions about best practices for management and prevention.” Basically, the authors came to the clear conclusion that, when it comes to diagnosing food allergies, there is no clear conclusion.

Given the confusion over diagnosing food allergies, the authors believe that of people who have possible allergy symptoms and a positive allergy test, more than 50% of them are not actually allergic. In other words, a lot of people who think they’re allergic to bananas actually are not, even when they have the medical tests to back them up.

There are millions of people in the US with true allergies, including banana allergies. Every year, a few hundred die from anaphylactic reactions. Unfortunately, the seriousness of their condition is diluted by fearful patients and parents who unknowingly exaggerate potential allergic reactions to the point that children with food allergies are a laughing matter. Peanut-free zones in schools are ridiculed, concerned parents are caricatured as over-protective yuppies, and allergy sufferers are painted as histrionic whiners. Too many people cry wolf, to the detriment of everyone who truly experiences serious food allergies.

Why are so many people convinced they or their children are allergic to certain foods, when actually they’re not? First, some people are confused about the difference between a food allergy and food intolerance. An allergy is a specific response from the body’s immune system, involving multiple complex biochemical pathways and mediators such as IgE and histamine. Most forms of food intolerance, such as lactose intolerance, are not the same. Many people who think they’re allergic to a food or medication are not allergic, they’re intolerant. Abdominal cramps and gas after drinking a glass of milk are not a sign of allergy, they’re a sign of lactose intolerance. Hives, lip swelling, and shortness of breath after drinking that same glass of milk are signs of true allergy. The distinction is important, because while the prior is uncomfortable, the latter is sometimes life-threatening. Allergies require specific treatment with anti-histamines, steroids, and epinephrine, while food intolerance does not respond to these measures.

“Ah ha,” you say. “I know the difference between allergy and intolerance. I know I’m allergic to bananas, because I got tested, and the results were positive. I’m truly allergic!”

Well, maybe, maybe not. One of the points this study made was that many allergy tests do not accurately diagnose allergies.

Allergy tests can be blood tests or skin test. Blood tests, known as immunoassays, check your blood for the presence of antibodies to specific foods, medicines, insect venoms, or environmental factors such as dust mites. But the presence of the antibody to bananas is no guarantee that you are actually allergic to bananas. While higher levels of antibodies mean you are more likely to be allergic, many people with antibodies against a certain food have no symptoms when they eat it. So a positive test just means you might be allergic, it does not mean you’re definitely allergic to that food. A negative test, on the other hand, means it’s extremely likely you are not allergic to that particular item.

Skin prick testing, or SPT, is an alternative to blood testing to diagnose allergic reactions. After stopping any anti-allergy medicines, your skin is pricked with small needles, each containing a minute amount of a different potential allergen. If you are allergic to the substance, you will develop a hive at the site you were pricked. SPT is risky if you have had a severe allergic reaction called anaphylaxis; a blood test is much safer. Similar to the blood test, a positive result on the skin test does not guarantee you are allergic to that substance. Many people have skin reactions to the test but do not have any allergic reaction when they actually eat the specific food.

So the bottom line is, medical testing over-diagnoses allergies, and many people are needlessly worried about their reaction to a peanut butter and banana sandwich. On the other hand, some do have legitimate concern as true allergies do exist.

What group are you in? If you’ve had a serious allergic reaction to a food, and not just a positive blood test, it’s obvious: you should avoid the trigger and talk to a doctor about whether you need an epi-pen. But if you think you’re allergic only due to results from a blood or skin test, chances are you might be missing out on some tasty meals for no good reason. Talk with an allergy specialist about doing a test called an oral food challenge (OFC).

OFCs expose people to the food which they believe they are allergic to. In a safe medical setting, you will eat gradually increasing amounts of the food over several hours to determine whether you truly are allergic. OFCs are not recommended for people who have previously experienced a life-threatening allergic reaction called anaphylaxis. Given they do carry a small risk of a severe allergic reaction, OFCs are also not recommended for foods that are easily avoidable. In general, less than half of patients have positive reactions in OFCs-implying that most people who think they are allergic to a food actually are not, even if they had a positive blood or skin prick test.

While many people definitely have serious food allergies, a large number-perhaps a majority-of people who think they have allergies actually do not.

Photo Credit: Jason Gulledge

The post Maybe We’re Not Allergic to Everything After All appeared first on The Faster Times.

Here’s the deal. Health insurance is not health care. We have a health care problem in the United States, not just a health insurance problem. Yes, America does have a shamefully high number of citizens who don’t have insurance, and I hope this legislation will help them. But there are hundreds of millions of Americans who already have health insurance–and as they know, we still have a problem.

Our real health care problem is not a lack of insurance; it’s a lack of trust. Doctors don’t trust patients, and patients don’t trust doctors. This is why we spend about twice as much of our GDP on health care as any other country, without any notable improvement in our health. Fixing this problem requires much more fundamental change than expanding insurance coverage.

Doctors Don’t Trust Patients

In residency, one of my professors told me about an ER physician sued by a patient with a broken nose. While walking into the hospital, the patient collapsed from a heart attack. He fell forward and smashed his face. His heart had stopped beating, so the ER doctor shocked him back into life and admitted him into the hospital. I don’t think the doctor expected flowers for saving the patient’s life, but I don’t think he expected a lawsuit for damages sustained while walking into the ER–the broken nose. The story might be apocryphal, but it’s believable and it changed how I practiced medicine. Doctors can’t trust patients, even after saving their lives.

While there are plenty of lawsuits that shouldn’t happen, there are also plenty of lawsuits that should happen but don’t. Malpractice attorneys turn away a large percentage of cases, some because they don’t have merit, but some because the injury simply isn’t severe enough to be worth the attorney’s time. These injured patients deserve compensation but can’t get it. So patients, not just doctors, suffer from a broken malpractice system.

Our capricious medical malpractice system leads to defensive medicine, with doctors performing excessive testing and treatment in order to protect themselves. Think about every normal test you’ve ever had–every normal chest x-ray, every normal blood test, every normal ultrasound. If those tests hadn’t been performed, would your treatment-or more specifically, lack of treatment-be any different? While some normal test results do affect treatment decisions, in many cases they have no impact. Doctors order many tests to protect themselves in case a plaintiff’s attorney starts flipping through a patient’s chart, not for their patient’s benefit.

For doctors to trust patients, the medical malpractice system has to be reformed. It has to be a rational system, one where patients who suffered injuries due to negligence have recourse even if they can’t pay for an attorney. It has to be a system where doctors know they will be judged by experienced individuals based on the medical standard of care, not by a naïve jury swayed by a sympathetic plaintiff and a polished expert witness who’s in it for the money, not justice. It has to be a system where the majority of the award goes to the patient, not attorneys and the legal system. We do not have that system, and are nowhere closer to that system after this recent legislation.

The closest we have to malpractice reform is a caps system, in which some states cap awards for ‘pain and suffering’ to prevent headline-grabbing multimillion dollar payouts. While this helps–I would probably never practice medicine in a state without malpractice caps–it doesn’t change a fundamentally broken system.

One solution is to set up health courts, where experienced judges who understand health care get opinions from expert witnesses who aren’t selling out to the highest bidder. Doctors need to know they won’t be sued for broken noses that are beyond their control. A reliable system where doctors felt they could trust their patients would limit the billions of dollars spent on defensive medicine.

Patients Don’t Trust Doctors

You visit a doctor for a sore throat, but you’re overweight and you have high blood pressure. You know the sore throat isn’t such a big deal, and you’re hoping to get some advice, or at least some cajoling, about your overall health concerns. He spends about twenty minutes with you, most of which is focused on your sore throat. He starts to ask you about your high blood pressure, when the nurse knocks on the door to notify the doctor that all the equipment has been set up to remove the ingrown toenail of the patient next door. The doctor encourages you to get your blood pressure rechecked and rushes out the door to see the patient with the ingrown nail. He never mentions your weight. The next day, you barely remember the doctor’s name, and you’re certain he has already forgotten yours.

There’s no way you would trust this doctor. He didn’t spend any time getting to know you and your health issues. Even if the doctor did everything medically appropriate, correctly diagnosing and treating your sore throat, and advising you to recheck your blood pressure, there was still no chance for you to form a bond with the physician and develop a trusting relationship.

Speaking from experience, I guarantee you a doctor, if given a choice, would pick a friendly conversation about your longterm health instead rushing out of the room to clean the lint out between someone’s toes before hacking off their nail. So why doesn’t this happen? Not surprisingly, it boils down to money.

Physicians are paid via a complex system based on RVUs: relative value units. Researchers at Harvard, in conjunction with the American Medical Association and a few other interested parties, have assigned a numerical value called an RVU to every single task a doctor does, from anogenital exams to zygoma tumor excision. The more complicated the task, the higher the RVU and the higher the corresponding payment. For example, placing an IV has a work RVU of 1.09, lancing a boil has an RVU of 2.17, and a heart transplant operation has an RVU of 89.5.

Back to our example. The work RVU for a twenty minute visit with your doctor in his office is 0.48. The RVU for the ingrown toenail removal next door is 0.74. So the doctor gets paid around 50% more to remove a toenail than to have a discussion with you about your high blood pressure and weight issues.

The RVU system ends up encouraging procedures and discouraging conversations. It favors specialists, who tend to be procedure oriented–colonoscopies, angiograms, skin biopsies–over primary care doctors, who tend to be conversation oriented. Doctors aren’t paid to talk with you, they’re paid to do things to your body. No wonder trust in physicians has eroded over the past few decades.

The RVU system needs to be transformed, if not completely eliminated and replaced with a new model. Physician performance should be a factor in payments-if two doctors offer the same service, but one does it better, the better doctor should be paid more. Preventative counseling should be emphasized, and expensive, over-utilized procedures should be devalued. In the end, doctors need to be paid for giving patients what they want: an honest, thoughtful conversation with compassionate advice.

Fixing the Health Care System

Those are the fundamentals of health care reform. In order for doctors to trust patients, we need major tort reform–health courts, not just caps on monetary payouts. In order for patients to trust doctors, we need to pay doctors to spend time talking with people, rather than doing things to their bodies. To the tens of millions of people who will be getting health care insurance over the next few years, congratulations. Now that you’re joining the rest of us who are lucky enough to already be insured, maybe we’ll finally have the critical mass needed to tackle the real health care problems facing the country.

The post Health Insurance Reform Is Not Health Care Reform appeared first on The Faster Times.

First, be ready to quit. Quitting is often a tough process, and there’s no point in starting if you know it won’t work. If you’re not ready to quit, figure out why not. Consider what you enjoy about smoking–an escape from the office, companionship, the comfort of a familiar habit. Start weighing those factors against what you don’t enjoy–the cost, the health effects, the holier-than-thou attitude from those yuppies in that Prius speeding by you.

Use these to play mindgames with yourself. Each time you light up, remember how bad it makes you smell. Or think what you could do instead with all the money you’ve spent in the past month on cigarettes. Or if you’re inclined to the macabre, follow the advice of one of my patients who quit a pack-a-day habit. He made a list of twenty diseases linked to smoking (see the end of the article) and mentally labeled each cigarette in the pack with the name of one disease as he smoked it. If you consistently link smoking to something negative, you’ll be more prepared to give up the habit.

Once you’re ready to quit, learn about your options. Get information from a health care provider, online, or call 1-800-QUIT-NOW. Use their support to develop a plan that combines three elements: lifestyle changes, a quit program, and medications.

When it comes to changing your lifestyle, focus on eliminating your triggers and reinforcing a smoke-free life. Ask friends not to smoke around you. Avoid places, people, and frothy beverages that make you smoke. When cravings hit, have sugarfree gum or low calorie snacks in your home, office, and car. Get support from the people closest to you. You changed your relationship status on Facebook after your last breakup, why not publicly announce that you’re finally getting out of an abusive relationship with nicotine? Tweet it to the world.

Next, line up a quit program and start the program before you actually quit smoking. Options range from a simple one-time phone conversation to multiple intensive sessions with a trained expert. Two free, easily accessible resources are 1-800-QUIT-NOW and online chats at LiveHelp. Your community might have a Nicotine Anonymous group or a local health care organization that provides a quit program. In general, the more intensive the program, the more likely it is to help you succeed. People pay to have experts design a workout program, a healthy diet, a polished resume. It makes sense to get an expert on your side when it comes to quitting smoking, especially when it’s free.

In addition to lifestyle changes and quit programs, medications are an effective tool to help you quit. The three most commonly used medications are nicotine, buproprion, and varenicline.

Nicotine replacement therapy with patches, gum, inhalers, or sprays doubles the success rate of quitting. Probably the most effective way to use nicotine substitutes is to wear the patch and then have an additional agent, such as the gum, to combat breakthrough cravings. If you smoke less than 25 cigarettes a day, you should chew the 2mg dose of gum; if you smoke more than that, use the 4mg dose. The gum is more effective the less you chew it and the more you park it between your gum and cheek, like dipping tobacco. People sometimes worry that they’re replacing one bad habit (cigarettes) with another (nicotine), but the negative health effects from smoking come primarily from all the other toxins in the smoke, not nicotine. The patch, gum, and other nicotine products are safe when used as prescribed.

Buproprion, also called Wellbutrin and Zyban, is as effective as nicotine replacement in helping people quit smoking. The drug acts on multiple neurotransmitters in the brain to decrease the cravings for a cigarette. It’s usually taken twice a day for three months, starting one week before the quit date. The most common side effect is insomnia, and the most dangerous side effect is an increase in suicidality, especially in adolescents.

Varenicline, also called Chantix, appears to be more effective than either nicotine or buproprion, tripling the success rate of quitting. It binds to the nicotine receptors in your brain, decreasing the withdrawal symptoms and blunting any buzz from a cigarette you might smoke during a moment of weakness. Like buproprion, it is taken twice daily for three months. While it’s a safe drug, like buproprion, there is a concern for an increased risk of suicidality. People taking this medication need to do so under a doctor’s supervision, and they and their families should pay attention to any symptoms of depression or unusual behavior.

There’s no clear best method for combining these three medications. But one medication strategy recommended by experts is to use varenicline and a nicotine patch daily, with an additional nicotine fix–gum or spray–for when a craving really hits you.

Once you’ve determined your best strategy, and lined up medications, counseling, and the support of your friends and family, pick a quit day. Your odds of quitting smoking are best if you go cold turkey rather than winding down over a period of days to weeks. Remember that if it’s your first try, it might not be your last. Don’t be discouraged if you start smoking again, a relapse just puts you one step closer to the day when you finally quit.

Twenty diseases linked to smoking: asthma, blindness, bladder cancer, breast cancer, chronic bronchitis, congestive heart failure, deep vein thrombosis, diabetes type 2, emphysema (COPD), esophageal cancer, heart attacks, impotence, infertility, lung cancer, pancreatic cancer, pulmonary embolism, oral cancer, osteoporosis, stroke, ulcers.

The post How You–and Obama–Can Quit Smoking appeared first on The Faster Times.

It might seem surprising that a non-radioactive, tobacco-less, industrial waste-free product could cause cancer. Sure, it makes you fat and gives you cavities, but cancer? The theory is that the mega-doses of sugar contained in these beverages trigger our bodies to release higher levels of insulin, the hormone that regulates sugar levels. Insulin is created in the pancreas and triggers pancreatic cells to divide. Each time a cell divides, the chances of its offspring developing a cancer-causing mutation increase. So more sugar causes more mutations in pancreatic cells, which leads to more pancreatic cancer.

That’s the theory, but the research into the link between soft drinks and pancreatic cancer is contradictory–some studies confirm a link, some studies refute it, and some studies go so far as to find that even fruit juices are linked to pancreatic cancer. This particular Singaporean study was well-designed and its conclusion is believable. It is not, however, as dire as headlines make it sound.

While the study did find that soft drinks increased the rate of cancer, let’s look at that increase. The people who didn’t drink soft drinks had a rate of about 3 in 10,000 cases of pancreatic cancer per year. The 85 percent increased risk this study found means that soft drinks increase the annual rate of pancreatic cancer among soda drinkers to about 5 in 10,000. Not particularly dramatic. Furthermore, the researchers did not find that fruit juice, which contains about as much sugar as soft drinks, was linked to pancreatic cancer.

So, should you stop drinking soda? Yes, but not because of the risk of pancreatic cancer. You should mostly stop drinking soda, as this video shows, because it’s just incredibly disgusting how much sugar there is in a can of coke. Don’t let nutrition labels deceive you, “carbohydrates” means sugar, and a “single serving” is sometimes only two-thirds of what’s in the can. So a Coca-Cola Classic label advertising 27 grams of carbohydrates per serving actually contains about 40 grams of sugar in a 12 ounce can. That’s the equivalent of ten of the sugar packets you’d put in your coffee.

Replacing sodas with fruit juice doesn’t solve the problem. Even completely natural fruit juice, made from pesticide-free fruits picked by free-range hippies with the dawn’s pure dew still glistening on their skins, contains about as much sugar as soft drinks. A single glass of fruit juice combines the sugar from several fruits, usually without the fiber that helps make whole fruit so healthy. And despite that, manufacturers still add sugar. Their labeling can be confusing: fruit juice means 100 percent of the contents come from fruit, while fruit drinks, fruit beverages, and fruit cocktails contain added ingredients–usually sugars and fortifiers. A juice box (8.45 ounces) of unsweetened apple juice contains 25 grams of sugar. That’s about the same amount in an identical volume of Coca-Cola Classic, 28 grams of sugar.

I was surprised to find the American Academy of Pediatrics has a policy on fruit juice (and on trampolines and ATVs! Sounds like some fun committee meetings). They state children under six months shouldn’t drink any fruit juice, children from six months to six years should drink less than six ounces (the volume of half of a can of soda), and children older than six years should drink less than twelve ounces of fruit juice a day (the same volume as a full can of soda). They worry that the amount of sugar in fruit juices can contribute to childhood obesity, as well as malabsorption syndromes, chronic diarrhea, and cavities.

Ironically, sports drinks and vitamin water, which are marketed specifically for their health benefits, aren’t much better when it comes to sugar content. That bottle of Gatorade (602g) you drink after kickboxing class contains 32 grams of sugar–about eight of the sugar packets you’d add to your coffee. No wonder it’s so hard to lose weight at the gym. For a typical workout, water and a healthy diet give you all the hydration and electrolytes you need. You’re shooting yourself in the foot if you’re trying to lose weight through exercising, and then drink a sports drink afterwards.

Similarly, vitamin water is actually sugar water. Sure, there are a few sprinkles of additional vitamins, but that’s like the parsley that comes on the side of the jumbo burger deluxe with French fries. You don’t need those extra vitamins if you’re eating a healthy diet. While a bottle of vitamin water might only advertise 13 grams of sugar per serving, realize that there are 2.5 servings in a bottle. That’s as bad as a bottle of sports drink, and almost as bad as a can of soda.

Regardless of your feelings about a slight increase in your risk of pancreatic cancer, there are plenty of good reasons to quit drinking sugary beverages–not just sodas, but fruit juice and other supposedly healthy drinks. Combine the possible risk of pancreatic cancer with the known negative impacts of sugar on much more common diseases-obesity, diabetes, cavities-and you’ve got a really good reason to put down that bottle. The real message about soft drinks, fruit juices, and other sugary drinks is that while they might slightly increase your risk of pancreatic cancer, they’re unhealthy for much more common reasons.

The post Will This Soda Give Me Pancreatic Cancer? appeared first on The Faster Times.

Media have widely reported that seasonal flu epidemics kill about 36,000 Americans a year, so I was surprised to see this low death count for the 2009-2010 H1N1 pandemic. The CDC’s flu-tracking website shows that pediatric death rates from H1N1 are double to triple the rates from seasonal flu earlier this decade, and this year’s number of doctor visits and hospitalizations for flu is higher than it has been in previous years. While I didn’t expect a huge increase, I certainly wasn’t expecting 25,000 fewer flu deaths this year!

Why is the 2009-2010 H1N1 pandemic less deadly than prior flu pandemics? Is it a statistical fluke, given how difficult it is to estimate every single person who died from flu and flu-related complications? Or is the H1N1 pandemic truly less lethal than prior epidemics?

Some might argue the lower death rate is because the epidemic has not yet run its course, and many more people will die this spring. However, we have seen a peak and cases are now declining dramatically. So while early reporting might inaccurately exclude a few thousand later deaths, the CDC’s estimates are not entirely premature for the purpose of comparison to peaks in prior years.

One possible factor lowering the death rate is the surprising finding that H1N1 spares the elderly. Flu typically strikes people over the age of 65 the hardest, but not this year. The majority of H1N1 cases are in people younger than 65, and deaths are unusually skewed towards younger patients. In most years, 90% of flu-related deaths are in people older than 65, but this year, they only account for 10% of the deaths.

One study found that about a third of people older than 60 already had antibodies to H1N1, compared to only 6% of young adults. This suggests adults were exposed to a virus similar to H1N1 in the 1950’s and retain lifelong immunity, thus limiting the overall mortality. A large portion of the missing 25,000 deaths could be immune older adults who survived the flu season without a sniffle.

Another possibility to explain the lower death count is the vagaries of number-crunching. It’s difficult to estimate the number of people who die from flu. There is no accurate and complete nationwide flu-tracking system, the CDC uses data from only ten states to develop their estimates. Educated guesswork accounts for underreporting, and data from these states is extrapolated the entire nation.

Flu cases and deaths are under-reported, as it’s difficult to define what a flu-related death actually is. If someone is weak from the flu, falls out of bed striking their head, and dies from a bleed in their brain, does that count as a flu-related death? What about a person who catches the flu and has a heart attack? (Flu is known to increase the risk of heart attacks, just like everything else.) A doctor might only record heart attack on the death certificate, unaware that the patient had been suffering from the flu. Assuming the doctor does report the patient died of flu, this information can be recorded in different places—for example, the death certificate or the patient’s chart.

Given these difficulties, statisticians have access to imperfect data and have to make several assumptions. The data used and assumptions made will vary from study to study. The study that determined 36,000 annual deaths from flu used data from the National Center for Health Statistics, which compiles death certificate information from previous years but not the current year. The current CDC estimate of 11,000 deaths uses rawer data from the Emerging Infections Program. Given the different methodologies, perhaps comparing these two numbers is like comparing apples to oranges.

Whatever the cause, I’m glad to see 25,000 fewer deaths this year, but it’s not a reason for public health officials to let down their vigilance or for the public to ignore the disease. The virus is still circulating, and 11,000 deaths is still a lot of people. If you’re sick, stay home from work, cough into your shoulder instead of your hand, and wash your hands frequently. If you’re well, the vaccine could help you stay that way and you should talk to your doctor about whether it’s appropriate for you.

The post How Deadly is H1N1 Influenza? appeared first on The Faster Times.

Neti pots are small containers with a nozzle designed for easy insertion into your nostril. Fill the pot with lukewarm saltwater, made with non-iodized salt instead of table salt–such as pickling salt, or salt sold by neti pot suppliers online or in health stores. Stand over the sink, tilt your head to the side, and insert the nozzle into the upper nostril. Pour the saltwater in, and let it drain out of your lower nostril into the sink. Avoid looking at yourself in the mirror if your dignity is important to you. Check out this link for an entertaining music video starring the neti pot.

Theoretically, rinsing your sinuses breaks up thick mucus and cleans out germs and allergens, thereby improving your health. Several studies have examined nasal saline irrigation (NSI), as neti pots and similar devices are called in the medical literature. The data do show benefits in people who suffer from sinus-related symptoms such as stuffy nose, cough, and facial pressure. These studies are small and vary in quality, but generally show that NSI is safe and improves symptoms in many patients who have acute and chronic rhinosinusitis. The research also suggests that NSI reduces the need for steroid nasal sprays. These findings led this review to conclude that NSI can play a role in the treatment of chronic sinus disease.

However, a more recent study presented last month showed that long-term neti pot use might actually make people sicker. A team led by Dr. Nsouli, an allergist, followed 68 people with chronic sinus problems who were using neti pots. The researchers asked them to stop using NSI and counted how many sinus infections they had. Compared to the prior year, the group suffered 62.5% fewer cases of sinusitis during the year they didn’t use neti pots. Compared to a different group of 24 patients who continued using neti pots into the second year, the group suffered 50% fewer cases of sinusitis. I asked Dr. Nsouli why he thought neti pots might increase rates of sinusitis. “NSI will deplete the nose from its immune elements,” he wrote, “resulting in chronic sinus disease.” By rinsing sinuses every day, not only are you washing out allergens and bacteria, you’re also washing out proteins such as immunoglobulins that help protect the nose and sinuses. These findings are preliminary and the study has yet to be published in a peer-reviewed journal. However, they suggest that further research is needed before neti pots should be unreservedly recommended.

So what’s the bottom line? In the short term, using a neti pot for a few days will probably not do any harm, and it’s likely to help relieve the symptoms of acute sinusitis and nasal congestion. However, current medical research does not provide a clear answer about long-term use, and it is possible that daily use of a neti pot over several months can do more harm than good.

The post Do Neti Pots Really Work? appeared first on The Faster Times.

You might find the calculator useful, but don’t substitute it for common sense. Remember that most cases of the flu resolve on their own, with or without a doctor’s visit and prescription for Tamiflu, but that rarely people can have serious complications. Pay attention to what your body is telling you, not an Internet calculator or this website.

I wrote a column about the H1N1 vaccine. And while I’m engaged in blatant self-promotion, check out my column about a cocaine vaccine–I think this is one of the most interesting advances in medicine this year, with fascinating implications for the legal, educational, and public health care systems.

The post H1N1 Update: Microsoft Knows if You Have Swine Flu appeared first on The Faster Times.

Some of this could soon come true, and unfortunately, it’s not the flying cars. Researchers just published a study of a new anti-cocaine vaccine, which shows promise that future addicts might be immunized against drugs of abuse.

The researchers gave about 50 cocaine abusers a vaccine against the drug. About half had a strong immune response, while the remainder only responded weakly to the vaccine. Those with a strong immune response continued to use cocaine, but at a decreased rate when compared to the weak responders and the placebo group. Certainly this initial version of the vaccine is no cure for cocaine addiction, but the study is proof of concept that a vaccine can limit drug abuse.

The vaccine itself is a molecule of a cocaine derivative, called succinylnorcocaine, linked to a piece of the bacteria that causes cholera. The patient’s immune system recognizes the cholera component, and develops antibodies to the cocaine-cholera complex. The next time the patient uses cocaine, the antibodies recognize the cocaine and neutralize it. No drug reaches the brain, and the user doesn’t get high.

The concept behind the anti-cocaine vaccine can be applied to other drugs of abuse such as nicotine, meth and heroin. However, such vaccines will not work against alcohol, which is too simple a molecule. NicVAX, an investigational anti-nicotine vaccine, shows some promise in reducing smoking rates. While the anti-nicotine and anti-cocaine vaccines are exciting advances, no anti-drug vaccine will be ready for several years. Still, it is realistic to expect that vaccines will be a legitimate future treatment option for drug abuse, likely in combination with behavioral counseling.

What will happen once we do have effective vaccines against drugs of abuse? The implications are fascinating. People convicted of drug-related crimes might be ordered to go to vaccine clinics instead of prison. Parents of teenagers abusing drugs might force their children to get the vaccine. Health care agencies, recognizing that drug abuse burdens society as much as measles, mumps, and rubella, might recommend that you take your two-year old to get an anti-cocaine shot along with those routine immunizations. Universities seeking to curb recreational drug use might require the vaccine for incoming freshmen. Insurance companies could lower premiums for those who receive the vaccine. The airline industry or health care industry, recognizing the potential dramatic impact of a coke-snorting pilot or physician, might mandate that their employees get vaccinated.

Once an effective vaccine against drug abuse is here, who should and should not be required to get it? Share your thoughts below.

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To understand the safety issues, here’s a little background. Common estimates are that at baseline about 1 women in 10,000 will have a blood clot this year; that number increases to about 3 women in 10,000 if they’re taking BCPs. (Compare this to the fact that more than 50 women in 10,000 will get a blood clot due to pregnancy.) Since this is true for many BCPs, what’s so special about Yaz and Yasmin?

Like many BCPs, Yaz and Yasmin use both estrogens and progestins to prevent ovulation. However, unlike other BCPs, Yaz and Yasmin use a new progestin called drospirenone. The research on drospirenone is contradictory: one study sponsored by the manufacturer found no increased risk in blood clots, while two studies by independent researchers found a slight increase in blood clots from drospirenone.

Let’s take a closer look at these studies that show an increased risk. A Danish study by Lidegaard, published in the British Medical Journal, examined women taking different types of oral contraceptives. As expected, they found that the pill increases the risk of blood clots, from an annual rate of 3 per 10,000 women to 6 per 10,000 women. What did they find specifically about drospirenone? Comparing drospirenone to levonorgestrel (a progestin found in other BCPs such as Alesse and Nordette), they found that annually, 5.5 women out of 10,000 on levonorgestrel BCPs had blood clots, while about 8 women out of 10,000 on drospirenone had blood clots. A similar increase was also found when other progestins (desogestrel and gestodene, found in OrthoCept, Mircette, and others) were compared to levonorgestrel.

The second study, done in the Netherlands by van Hylckama Vlieg, found similar results. Patients taking BCPs had higher rates of blood clots: in patients aged 30-40 years old, the annual rate of blood clots was 2 per 10,000 women in patients who didn’t use BCPs, and 10 per 10,000 women who did use BCPs. It was lower in women younger than 30 and slightly higher in women older than 40. While the authors don’t report their results in the same manner as the previous study, extrapolation from their data shows that drospirenone has an annual rate of 12 blood clots per 10,000 women aged 30-40. Desogestrel BCPs also had similar increased rates compared to baseline.

The bottom line from these studies: Yaz and Yasmin, which use drospirenone, have a slightly higher risk of blood clots than BCPs using levonorgestrel. This risk is not dramatically higher. Furthermore, other BCPs containing desogestrel and gestodene also have a slightly increased risk of blood clots compared to levonorgestrel.

If you’re weighing the risks and benefits of birth control, remember that BCPs decrease the risk of getting ovarian and endometrial cancer. Also they definitely decrease the medical risks associated with pregnancy! To counter those benefits, there are some risks in smokers–people who smoke face increased risks of breast cancer and heart attacks if they use BCPs. There is debate whether non-smokers have an increased risk of breast cancer and heart attacks while using BCPs, currently there is no consensus on these issues.

So what should you do if you’re on Yaz or Yasmin? There’s no immediate cause for serious worry, but please use the information in this post to have an informed conversation with your health care provider about the best option for your individual situation. There might be a levonorgestrel-based BCP that’s better for you.

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