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Should Circumcision Become Public Health Policy?
Tweet Share on Facebook August 31, 2009 Comment (78)The Centers for Disease Control and Prevention caused quite a stir last week when word slipped out that the agency was considering, for the first time, making public health recommendations concerning circumcision. In terms of a woman's health, circumcision makes sense because it lowers a man's risk of getting infected with HIV and other sexually transmitted diseases and, thus, decreases his likelihood of transmitting them to his female partner. That's probably why the editorial board of the San Francisco Chronicle has come out supporting recommendations, expected to be issued by the CDC next year, in favor of circumcision to "curb the spread of HIV and other infections." But those vehemently opposed to circumcision—who call themselves "intactivists"—have expressed outrage that the government is thinking about recommending that all newborn boys be circumcised. They contend it's a form of mutilation that destroys a man's ability to fully experience sexual pleasure.
I'm wondering why the CDC is choosing to tackle this controversial cultural issue at this particular time, when Americans' tempers are already flaring over healthcare reform, and rumors of so-called death panels that will determine whether you live or die just won't go away even though there's no mention of them in the legislation. There's just as much potential here for the spreading of misinformation. Case in point: One headline today reads "CDC Proposing Manditory [sic] Circumcision for Newborn Babies."
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Can You Avoid Arthritis Knee Pain by Building Thigh Muscles?
Tweet Share on Facebook August 28, 2009 Comment (8)Millions of older women suffer the pain and stiffness of arthritis, especially in their knee joints, which can severely curtail everyday activities like climbing stairs or getting out of a car. It turns out there may be a way to protect our knees and avoid the discomforts of aging: strong thigh muscles. That's according to a University of Iowa study published this week, which found that women who had the strongest thigh muscles were about 50 percent less likely to develop knee pain compared with those with the weakest muscles. (The study didn't find the same association in men.)
Previous research has shown that strong quadriceps muscles (located in the upper half of the leg) help protect against cartilage loss behind the kneecap and also provide crucial support for the joint. However, strong thigh muscles don't appear to actually prevent osteoarthritis in the knee; about 10 percent of the female participants developed knee arthritis over the 2½-year study, according to X-rays. Even those without symptoms still had signs of arthritis. "But I think these women wouldn't have otherwise known they had arthritis," says study author Neil Segal, "since they wouldn't have gone to doctor with symptoms." The study wasn't designed to see whether building thigh muscles actually prevents painful knee arthritis, but Segal says it's reasonable to assume that it may.
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Swine Flu Advice for Pregnant Women and New Moms
Tweet Share on Facebook August 27, 2009 Comment (13)Government officials are continuing their public relations campaign to get us to care about the H1N1 virus (aka swine flu) without scaring us out of our wits. That has proven to be tricky: On Monday, the White House estimated that up to 90,000 Americans could die of swine flu this year. And today, the Centers for Disease Control and Prevention reported that children were at greatest risk of being infected with H1N1 (14 times more likely than adults over age 60) and that babies and toddlers were most likely to be hospitalized with severe complications.
At the same time, the CDC is telling us not to panic, with the agency director, Thomas Frieden, saying he doesn't believe the White House death estimates will prove accurate unless the virus mutates into a deadlier form. And this afternoon, the Department of Health and Human Services hosted a webcast to give pregnant women and new moms sensible advice—rather than scary news—about preparing for H1N1.
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Why You Should Think Twice Before Using Alli or Other Weight Loss Aids
Tweet Share on Facebook August 25, 2009 Comment (20)When it comes to losing weight, we'd all love that quick fix: a pill, shake, heck, even surgery to ease our efforts. Unfortunately, weight-loss aids—even when approved by the Food and Drug Administration—come with risks as well as benefits. Yesterday, the FDA announced an investigation into reports of liver problems thought to be related to an over-the-counter weight loss pill, Alli, and the prescription version, Xenical. This came after the agency received information on 32 cases of serious liver injury, including six cases of liver failure, in those using either product, which contain different doses of the drug orlistat. (The reports spanned 10 years.)
The FDA hasn't determined yet whether these liver problems are related to orlistat since overweight individuals—who are most likely to use these drugs—tend to have a higher risk of developing liver failure because of a condition called nonalcoholic fatty liver disease. The agency is not putting a warning label on these drugs and hasn't advised doctors to change their prescribing practices. Still, the FDA is telling folks to see a doctor if they're experiencing signs of liver problems like jaundice (yellowing of the skin or whites of the eyes), brown urine, weakness, or abdominal pain.
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Advice for Parents on Gardasil Vaccine for HPV
Tweet Share on Facebook August 21, 2009 Comment (29)Last month, U.S. News posted the first in a set of vaccine videos that my colleague Bernadine Healy, M.D., and I made with leaders at the American Academy of Pediatrics. The first roundtable discussion dealt with vaccines and autism, and the second (below) addresses Gardasil, a vaccine that protects against the cervical-cancer-causing human papillomavirus.
The government recommends this vaccine for all 11- and 12-year-old girls to make sure they get protected early from the virus, which is sexually transmitted. Still, the vaccine is relatively new, and the full details about its safety risks aren't known, as I wrote yesterday. For this reason, I decided to delay giving it to my own teenage daughter. We asked AAP President David Tayloe and President-elect Judith Palfrey to weigh in on this issue and whether it's wise for parents to proceed cautiously when it comes to Gardasil.
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Gardasil Side Effects Tough to Monitor
Tweet Share on Facebook August 20, 2009 Comment (71)This week Gardasil, the vaccine that protects against the cervical-cancer-causing human papillomavirus, got a bit of a smack-down from two studies published in the Journal of the American Medical Association detailing safety risks associated with the vaccine and promotional tactics used by medical organizations to convince women and girls to get the vaccine. An editorial that accompanied the studies concluded that "the net benefit of the HPV vaccine is uncertain" since most women infected with HPV won't develop cervical cancer and thus should "be willing to accept only a small risk of harmful effects from the vaccine."
The study of safety risks, conducted by researchers at the Centers for Disease Control and Prevention, concluded that Gardasil still has a good safety profile. It did, however, find that the vaccine caused an increased risk of fainting and a slightly increased risk of blood clots, based on more than 12,000 adverse events reports filed with the government's Vaccine Adverse Event Reporting System database by patients, doctors, and Merck, the vaccine's manufacturer.
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Breast-Feeding Lowers Breast Cancer Risk for Some
Tweet Share on Facebook August 10, 2009 Comment (6)We all know that breast-feeding is good for the baby. It provides much-needed antibodies to lower a baby's risk of diarrhea, ear infections, and bacterial meningitis, as well as preventing overfeeding, which could stave off obesity later in life. But is it good for moms? That's a difficult question to answer. Some studies suggest it may help prevent bone loss later in life and possibly lower the risk of ovarian cancer by delaying the onset of menstruation after pregnancy. Now, an intriguing new study out today in the Archives of Internal Medicine shows that it could help some women avoid breast cancer early in life. Breast-feeding conferred nearly a 60 percent lower risk of premenopausal breast cancer on women who had a family history of the disease.
There are, though, a lot of caveats to this study. First of all, it shows a protective effect only against breast tumors that develop before menopause. Yet the vast majority of breast cancers occur well beyond a woman's 40s. What's more, the study of 60,000 nurses who had given birth found that the protective effect extended only to women already at elevated risk of breast cancer—namely, those who had a close relative (mother, sister, grandmother) who'd been diagnosed with the disease. Women with no family history of breast cancer didn't get any extra protection by breast-feeding.
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Schools Won't Close for Swine Flu, Putting Pregnant Teens at Risk
Tweet Share on Facebook August 7, 2009 Comment (8)The government issued a bit of good news today with regard to swine flu: Most schools with outbreaks won't need to be shuttered this fall. Last spring, more than 100 school systems in 14 states temporarily shut their doors, leaving 160,000 kids home and working moms scrambling for babysitter coverage. There's no longer any reason to shutter schools because the H1N1 virus that causes swine flu is not as deadly as was feared. "Most U.S. cases have not been severe and are comparable in severity to seasonal influenza," the Centers for Disease Control and Prevention stated in its new recommendations, released today. "At this time, CDC recommends the primary means to reduce spread of influenza in schools and child care programs focus on early identification of ill students and staff, staying home when ill, and good cough and hand hygiene etiquette." Sick individuals shouldn't return to school for at least 24 hours after their fever breaks, the CDC adds.
It also says that local authorities should determine when and if any schools should be closed; for example, they may want to consider closing schools where pregnant students make up the majority of the population because pregnant women are more at risk of severe complications from H1N1 infections.
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How Much Vitamin D Should You Be Taking?
Tweet Share on Facebook August 5, 2009 Comment (46)Quick quiz: What vital nutrient may protect against cancer, heart disease, stroke, bone fractures, and a host of other diseases? Experts on vitamin D are quick to answer, and, by their reckoning, many Americans are sorely lacking in the nutrient. Just this week, new data from a government-run health and nutrition survey found that most kids weren't getting enough vitamin D and that those with the lowest levels were more likely to have high blood pressure, high blood sugar, and low levels of "good" HDL cholesterol. At a meeting convened Tuesday by the Institute of Medicine, leading vitamin D researchers mentioned this study and many others as they tried to convince an IOM committee to raise the daily recommended intake (DRI) for the nutrient.
[How Much Vitamin D Is Enough?]
"When [the U.S. government] set the DRI in 1997, the amount of vitamin D recommended was based on the prevention of rickets," said Robert Heaney of Creighton University in Omaha. Rickets, a bone malformation condition, has long been linked to severe vitamin D deficiency, as Heaney knows from studying the effects of the vitamin on bones. Vitamin D-fortified milk now gives most people protection from rickets, but we may not be getting enough of the nutrient to benefit from its protective effects against cancer, stroke, and other diseases. Experts like Heaney consider the current recommendations—200 international units for children and adults up to age 50, 400 IUs for ages 50 to 70, and 600 IUs for those 70 and older—to be way too low to help us stay healthy. In fact, they say, most Americans are deficient, especially during the winter, when many Northerners don't get the exposure to the sun that lets their bodies make vitamin D.
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How to Break Your Addiction to Tanning
Tweet Share on Facebook August 3, 2009 Comment (22)Indoor tanning fanatics got some disheartening news last week when the International Agency for Research on Cancer moved tanning beds to its highest cancer risk category, calling them "carcinogenic to humans." That means that there's now enough evidence showing beyond a doubt that tanning beds can cause skin cancer and should be avoided. While tanning salons won't be outlawed, they could eventually have restrictions placed upon them: for example, prohibiting their use in those under 18. Unfortunately, all those warnings may not keep some folks—especially young women—away.
That's because indoor tanning can be a tough habit to break. Researchers have identified some specific causes for tanning addiction—or tanorexia. A 2006 study from Wake Forest University found that frequent tanners actually experience withdrawal symptoms—like nausea or jitteriness—when they stop using tanning beds. The ultraviolet light rays emitted by the beds appear to trigger the release of "feel good" brain chemicals called endorphins, says Wake Forest researcher Steven Feldman. Our bodies can become dependent on these endorphin surges—also produced from mild opiates or after an intense bout of running—which is why we feel lousy when we're deprived. "Those who tan infrequently for a wedding or other special occasion may not have a problem quitting, but others who do it regularly might," Feldman says.
