Harm Reduction

Two articles in the last few weeks caught my eye, the first, once again looking at predicting disease based on our genes, the modern-day equivalent to reading animal bones; the second a cautionary analysis of how labels frame our medical conversations. While they seem disparate, they are linked, are genome-wide studies clinically useful and if they are, what should we be telling or not telling our patients?

Genetic Predictions

The first study again delves into the UK Biobank, quickly becoming the go-to source of genome-wide association studies (GWAS) or polygenic scores. A brief refresher for those a little late to the party, GWAS look for genomic alterations to identify genomic segments associated with various diseases which can then be used to predict...

In the year of using condoms not how they were intended, the Centers for Disease Control and Prevention (CDC) felt compelled to raise public awareness about why they exist in the first place and remind people how they should actually be used. Given that the condom challenge was a thing earlier this year where people filmed themselves as they snorted condoms through their nose and pulled them out of their mouth for the purpose of more likes on social media, health officials deemed it necessary to remind us that condoms can only prevent the spread of sexually transmitted diseases and pregnancy when correctly placed on the penis (while unexpired, new for single use and not tampered...

Congratulation to the state of Massachusetts for raising the legal age to purchase tobacco products and cigarettes to 21, from 18. Gov. Charlie Baker, a Republican, signed the bill into law late last week, and the new law will take effect in five months, on New Year's Eve.

The measure also includes added restrictions on e-cigarette purchase and use. The Bay State becomes the sixth state in the U.S. to raise its legal age to 21, joining California, Hawaii, Maine, New Jersey and Oregon.

In addition to the age change, the bill also prohibits the sale of tobacco products from pharmacies that offer health services, a move that will make Massachusetts...

Transcatheter aortic valve replacement, TAVR, is a far-less invasive means of replacing the heart valve connecting the heart with the aorta, the body’s main artery. It will, in no small degree, replace the traditional surgical repair, SAVR, over the next few years. How to diffuse its use across the US while maintaining its value, in both, functional outcome and fewer complications is a concern for the government, industry, physician and patient advocates. The question is, does size matter?

TAVR’s journey from the lab to the bedside

TAVR is a triumph of technology [1], and the story of its initial clinical use is fairly typical. Manufacturers of TAVR devices collaborate with academic centers that have both highly specialized/skilled physicians and a “...

For those of us who cook, a cast-iron skillet is an early acquisition, they hold heat well and evenly, and best of all they are cheap. But food sticks to cast-iron unlike those more expensive non-stick, tri-metal $200 pans, so most cooks are told to “season” the pan, coating it with olive oil and baking it. Over time, it develops a non-sticky, if not non-stick surface. As it turns out, unbeknownst to the cooks in our life, seasoning a pot also reduces bacterial contamination. A group of researchers in Toronto reports how an industrial version of seasoning may help reduce bacterial contamination that causes food poisoning.

Stainless steel, rather than cast-iron, is commonly used for food processing. And this equipment is thoroughly cleaned and disinfected between batches of...

Complementary medicine (CM) runs the gamut in its healing claims from offering authentic stress relieving massage and well-meaning, but expensive placebo to outright spurious declarations. Due to superior marketing efforts often targeted to the most vulnerable and the lucrative nature of the multibillion-dollar industry, academic centers have even jumped on board allowing extensions of their facilities to include CM wellness centers as another avenue for patient and financial pipelines. Typically armed with anecdotes, buzzwords like “revolutionary” and “world-renowned,” or thinly veiled and weak “studies” to support their assertions, CM therapies are often not vetted by meaningful scientific rigor or evidence. So, a team of researchers decided to apply some by investigating CM’s impact...

Everyone has one, something they find disgusting; whether it is a crawling insect, body odor, or a bruised banana. But setting aside, for the moment, the actual source of disgust, why is that such a universal experience? As it turns out, understanding the thinking behind disgust has a long scientific history, a recent paper in Philosophical Transactions of the Royal Society sought to determine whether disgust protected us from infection.

In the last 100 years, disgust has been categorized in many ways, from Freud’s defense against inappropriate behavior to more generalized belief that disgust might be protective against disease. There is some evidence that disgust upregulates our immune system and women in their first trimester of pregnancy, a vulnerable period, show heighten...

For fair-skinned folks, the results of a new study can be taken as some worthy advice: applying sunscreen alone doesn't provide enough protection from sunburn.

Instead, multiple protection methods are needed for those with pale skin to keep the threat of skin cancer at bay.

That's the summer takeaway message from researchers at the National Cancer Institute in Bethesda, Maryland, after analyzing over 28,500 responses from the 2015 National Health Interview Survey. Of those, among the replies from roughly 16,000 who considered themselves fair or sun-sensitive, 62 percent who say they applied sunscreen – and took no other protective measures – had the highest incidence of sunburn.

“The most surprising and counterintuitive finding," according to Kasey Morris, who led...

Dogs get poisoned, not “just stoned” from marijuana exposure. And, the rates are increasing with the dedicated veterinary services Pet Poison Helpline experiencing a 448% increase in calls over the past 6 years. This trend is in parallel with legalization efforts by various states. Animals, especially dogs due to their curious nature and ability to access what they sniff, are being poisoned by pot from second-hand smoke, ingestion of edibles or consumption of the actual supply. Whether irresponsibly tossed on the street or positioned in the home, the impact on canines is more dangerous than conventional wisdom asserts.

The American Society for the Prevention of Cruelty to Animals...

It is difficult to make care decisions when you are entrusted by a family member whose dementia is so advanced that it now requires the continuous care of a nursing home. And even with planning, the phone call informing you that they have broken a hip brings a new reality to those choices. Do you have the surgeons repair the fracture or do you treat it with bedrest allowing the fracture to heal for itself? A study from JAMA Internal Medicine concerning our decisions and their subsequent outcomes for all family members has a lot to teach.

The study

The data is retrospective, obtained from what is termed the Minimum Data Set, a comprehensive (400 variable) assessment of nursing home patients done on admission and quarterly after that. The...