Entries for January 2009

By Bernadine Healy, M.D.

Estrogen is living up to its long-held reputation as the memory molecule. It gets soaked up by the brain and promotes nerve connections in all manner of species—from man to ape, rodent to songbird. But, paradoxically, it is also a molecule that can shrink an older women's brain, accelerating its demise into the dark night of Alzheimer's disease. In research from the Women's Health Initiative released this week, brain scans helped explain why some women show deterioration when given hormone replacement therapy (HRT) begun in their older years.

The two new MRI studies from the NIH and Wake Forest University found, surprisingly, that the primary problem is neurodegenerative—that is, the destruction of neurons—not indirect damage caused by ministrokes, as researchers had anticipated. They identified a small amount of brain shrinkage and loss of working tissue in the brain's memory center and in higher brain regions typical of what's seen in Alzheimer's.

By Bernadine Healy, M.D.

There is nothing worse for any physician than to find a dangerous medical problem in a patient and feel powerless to help. That's how the whole country seems to feel as it hears about gloomy statistics on teen pregnancy released this month from the Centers for Disease Control and Prevention. The findings show a 3 percent jump in teens having babies, following 14 years of decline. Many adults seem to have given up even trying to influence teen sexual behavior, and the statistics on teen sex have incited plenty of finger-pointing at sex-education programs as if they are the central solution to this very complex problem. This is the wrong reaction to what is a major public health issue.

Viewing this as a nonpartisan, nonideological, teen health issue—which also affects some 435,000 babies born into woefully disadvantaged circumstances—what emerges in all fairness is that the 3 percent jump between 2005 and 2006 (the most recent analyzed) in births among teens between 15 and 19 years of age equals the 3 percent increase in birthrates for all women. The year 2006 was an especially fertile one in America. And one good trend is that births among girls under 15 actually fell a bit. But, parents, heed this: The birthrate among all unmarried women rose an astounding 7 percent to almost 40 percent of all births—accounting for 1,641,946 little ones. Thus, out-of-wedlock births are a trend in society at large. In fact, the birthrate for all unmarried women has risen almost without interruption for 60 years. In the 1940s, when the first baby boomers were being born, it was closer to 4 percent.

By Bernadine Healy M.D.

Though Barack Obama has not spoken, it appears that his transition team has confirmed that Sanjay Gupta, the chief medical correspondent for CNN, is the president-elect's top choice to be U.S. surgeon general. Gupta, a surgeon and assistant professor of neurosurgery at Emory University (where he still cares for patients), would bring to the White House and the Department of Health and Human Services unique talents unrivaled by any of the prior 17 surgeons general going back to 1871. Among them are his truly outstanding health communication skills and the fact that he is already a trusted figure in many people's living rooms on all matters of health and disease—particularly on the major national heath problems that are within the domain of the surgeon general.

Gupta's leadership of CNN's "Fit Nation," a broad initiative targeting obesity (including the hazards of obesity in children), for example, meshes well with a similar initiative forged by former Surgeon General David Satcher, who back in 2002 called for the nation to recognize obesity as both a disease and a national epidemic that requires communities—not just individuals—to take action. Gupta's extensive reporting on AIDS readies him to take on that epidemic with the same vigor C. Everett Koop displayed. Gupta is similarly ready for tobacco, which has been a major focus of most surgeons general since Luther Terry. In 1964, Surgeon General Terry initiated the long, drawn-out war against the evil weed with the most famous and enduring of the many surgeon general's reports that connect tobacco use to lung cancer and other diseases.

Speaking as a physician, I have no doubt that teens need to be thoroughly educated about sex: why and how to avoid it when it's of no benefit to their physical or emotional well-being (virtually always) and how to maximally protect themselves if they do get sexually involved (all too often).

At a public-health level, there is no such thing as virginity-only teaching—if only because it doesn't serve close to half of all teens, who are already sexually active. Actually, it's a wonder it's not more. We live in an anything-goes society in which Sex and the City has become a cultural icon, half of 18-year-olds using social network sites like MySpace clutter them with the joy of risky behaviors that include sex and drug abuse, and grown-ups seem to be more worried about what the kids are divulging than what they are doing.

Prevention is not working. Despite a flood of health information, U.S. surgeons generals' reports, and the Healthy People 2010 health promotion and disease prevention agenda laid out by the federal government, we are still falling short. It's not that most people don't know their diet is awful or their waistline is bulging or they're having risky sex. It's that they don't take it to heart.

As dedicated as public-health efforts have been in making prevention a national goal, it's fair to say that making it happen needs a major boost. What's missing, I think, is an all-out effort to mobilize moms. Mothers—not doctors or public-health experts—are the nexus of prevention. However weighty a burden this may seem, Mom is the figure everywhere in the world best positioned to influence the behavior of those she loves, and that's the influence we need to reverse the dismal trend in America's health status.