I’m grateful that I have a home.
I’m grateful that my home has electricity and heating.
I’m grateful that I have work.
I’m grateful that I love what I do.
I’m grateful that I’m healthy enough to attempt a 77 mile bicycle ride this weekend.
I’m grateful that tomorrow I will be gathering with lots of loved ones to eat more than is prudent and to count our innumerable blessings.
I hope you will do the same. Happy Thanksgiving!
Malaria is a life-threatening illness marked by high recurrent fever, shaking chills, and severe headache. Though malaria is now treatable, even with treatment it sometimes progresses to coma and death. Survivors frequently suffer recurrent symptoms and can be debilitated. The World Health Organization estimated that in 2010 there were 216 million people infected with malaria. Hundreds of thousands of them died, though precise estimates are lacking.
Malaria has plagued people for tens of thousands of years. It may have contributed to the decline of the Roman Empire. Very little was known about malaria until the late 1800s when the parasite that infects the red blood cells of malaria patients was first observed under a microscope. Later work discovered that mosquitoes were responsible for transmitting the parasite from person to person. Since that time malaria control has involved a combination of mosquito control, avoidance of mosquito bites, medication to prevent infection, and medication to treat infected patients. Despite advances in all these fronts, malaria remains a tough adversary. It was the most dangerous health hazard faced by U.S. troops in the South Pacific in World War II. As many as half a million troops were infected.
In the second half of the twentieth century as developed nations became more affluent, malaria elimination was a marker of their progress in public health. Mosquitoes were sprayed. Standing water was drained. The U.S eliminated endemic malaria transmission in 1949. Greece did the same in 1974. That doesn’t mean that there were no cases in the U.S. (or Greece) since then, but that all the cases were imported. People who were infected abroad would travel to the U.S. and become ill here, but no one has been infected in the U.S. since 1949.
Well, forty six years later malaria is regaining lost ground. This week the Wall Street Journal reported that endemic malaria transmission has returned to Greece. That means that infected mosquitoes are infecting people in Greece for the first time since the 70s. In the past two years there have been over 50 endemic cases of malaria in Greece and over 100 imported cases. So far there have been no deaths.
Since its economic collapse three years ago, Greece’s public health system and its mosquito eradication efforts have been hard hit. The nation’s ability to care for patients and to prevent infection has been hobbled by worsening scarcity of resources and financial uncertainty. In response, the U.S. Centers for Disease Control and Prevention (CDC) has released an outbreak notice advising travelers to take precautions to prevent mosquito bites when traveling in Greece. Travelers to the agricultural regions of Evrotas should also take prescription medications to prevent malaria.
My friends who were born in the U.S. sometimes think that human progress is inevitable and irreversible, that the human condition can only improve over time as if propelled upward by some natural law, like water flowing downward. I was born in Romania, so I know that this isn’t so. I know that a modern affluent country can be utterly ruined. If you have friends from Iran or Cuba, they’ll tell you the same thing. (If you don’t have friends from Iran or Cuba, make some. Then beg to be invited to their homes for a meal. In both cases, the food is delicious.)
Perhaps the return of malaria in lands from which it was eliminated is a sign of the local cracking of the thin veneer of civilization. Perhaps it is a very late marker of societal collapse or of fiscal profligacy. If that is the case, it may be wise in the next few years to bring insecticide and mosquito nets to Italy, Spain, Portugal, and eventually, to California.
Learn more:
Health Scourge Hits Greece (Wall Street Journal)
Malaria in Greece (CDC Outbreak Notice)
Malaria (Wikipedia)
The stories and pictures from Sandy’s wake are heartbreaking. The loss of life, the destruction of property, and the prolonged disruption of routine seem overwhelming. I’m sure you join me in wishing for the prompt return of electricity, transit, and normalcy to the millions whose lives have been turned upside down.
This is a good time to make sure that we’re prepared for a natural disaster. In California we know with certainty that we’ll be hit with a major earthquake. We just don’t know when, and unlike with severe weather, we won’t get a warning. The Centers for Disease Control and Prevention (CDC) has a very informative web page about how to prepare before an earthquake, what to do during an earthquake, and how to stay healthy after an earthquake. I urge you to take some time to review it.
Before an earthquake, it’s important to assure that there is drinking water and non-perishable food stored for each person in the household for three to five days. Tall heavy furniture (book shelves, bunk beds) should be secured to walls, as should heavy appliances (refrigerators, water heaters).
I was surprised to learn that what we should do during an earthquake has changed somewhat since I learned these instructions. I’m quite phobic about earthquakes, so my typical behavior when a mild 2.0 magnitude earthquake shakes me awake in the middle of the night is to leap out of bed, stand in a doorway, and scream “EARTHQUAKE!” like a panicked child. This annoys my wife who would have slept through the whole thing, but also, apparently, doesn’t even protect me. In modern buildings doorways are no safer than anywhere else.
During an earthquake, if you are inside do not run outside or to other rooms during the shaking. Drop down to your hands and knees. Cover your head and neck (or your whole body if possible) under a sturdy table or desk or next to low-lying furniture. Hold on to the furniture that you’re sheltering under until the shaking stops.
If you are outside during an earthquake, stay outside and avoid buildings and utility wires.
After the earthquake, avoiding spoiled food and contaminated water is critical. Also, power outages and disrupted natural gas lines will lead to people using camping stoves or charcoal grills for cooking or heating. Remember never to use camping stoves, outdoor grills, or electrical generators indoors. Several people have died of carbon monoxide poisoning on the East Coast this week because of poorly ventilated combustion sources.
The CDC website has much more detailed information. You owe it to your family to make preparations now.
Learn more:
Earthquakes (CDC Emergency Preparedness and Response)
During an Earthquake (CDC Emergency Preparedness and Response)
Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer who survived and is no longer ill.
Chemotherapy is still occasionally used in such cases and sometimes can prolong life by a few months. Chemotherapy might also help temporarily alleviate some of the symptoms caused by the cancer. But what chemotherapy never does in these cases is cure the disease. The distinction is important because chemotherapy itself frequently has serious and uncomfortable side effects and patients who are considering undergoing it should understand the benefits they may gain.
A disturbing study in this week’s issue of The New England Journal of Medicine suggests that many terminally ill patients misunderstand why they are receiving chemotherapy. The study was a survey of over 1,100 patients with a recent diagnosis of stage IV lung or colon cancer who had opted to receive chemotherapy. The survey asked several questions about their expectations of chemotherapy. One such question was “After talking with your doctors about chemotherapy, how likely did you think it was that chemotherapy would cure your cancer?” Response options were “very likely,” “somewhat likely,” “a little likely,” “not at all likely,” and “don’t know.”
“Not at all likely” is the only response that conveys an accurate understanding of what chemotherapy can do for these patients. Yet 69% of patients with lung cancer and 81% of colon cancer patients chose one of the first three responses, reflecting mistaken expectations of their treatment. Though previous studies suggested that some patients are mistakenly optimistic in the face of a terrible prognosis, the very high fraction of patients in these studies who apparently believed they might be cured was surprising.
What could account for this? An accompanying editorial ponders the possibilities. Might the oncologists not be giving patients an honest explanation of their prognosis? Prior studies show that most oncologists give bad news honestly, so that is not likely to account for the majority of patients misunderstanding the goals of treatment. Perhaps patients actually know that a cure is impossible and have discussed this with their doctors and their families but are reluctant to share this painful realism with a researcher who is a stranger. Perhaps many patients heard the bad news and chose not to believe it.
Certainly some selection bias is involved. The study, after all, interviewed only patients who chose to undergo chemotherapy. That would include whichever patients were most likely to ignore bad news or exaggerate the possible benefits of treatment. Those who were mostly likely to accept bad news and minimize the possible benefits of treatment were the most likely not to have pursued chemotherapy and would not have been included in the study.
The distressing possibility is that many of the patients surveyed are fooling themselves. In other facets of life self-deception might be beneficial, or at least harmless. (“I look terrific.” “I think I’ll do great in this interview.”) But in this case patients with limited time are choosing to spend that time in healthcare facilities experiencing side effects instead of at home (or on vacation) with loved ones.
One final worrisome finding is that the patients who reported better scores for how well their physician communicated with them were less likely to give accurate responses for the goals of chemotherapy. That means that patients who best understood that chemotherapy could not cure them reported that their physicians were worse communicators than patients who misunderstood their likelihood of cure. Does telling bad news inevitably strain the physician-patient relationship? Do patients bond best with physicians who misinform them with optimism or allow them to misunderstand important aspects of their care?
As patient satisfaction surveys begin to play a larger role in physician compensation we may ironically find that doctors will be increasingly paid to cater to patients’ unstated desire for misinformation.
Learn more:
Many Terminal Cancer Patients Mistakenly Believe A Cure Is Possible (NPR Shots)
Study: We overestimate how much medicine can do (Washington Post, Wonkblog)
Patients’ Expectations about Effects of Chemotherapy for Advanced Cancer (New England Journal of Medicine)
Talking with Patients about Dying (New England Journal of Medicine editorial)
My regular readers already know my deep skepticism about the benefit of vitamin supplements in well-nourished healthy people. My post last year summarized the available studies about many vitamins and ran under the headline “A Reminder to Dump Your Multivitamin”. Thus far, large randomized studies about vitamins have tended to study a single vitamin at a time usually in fairly high doses. That makes a lot of sense. If you want to figure out if vitamin E prevents heart attacks, design a trial in which lots of people get either vitamin E or placebo. (It doesn’t prevent heart attacks.)
This week the Journal of the American Medical Association published the results of the first large randomized trial to study the effects of a multivitamin. The trial began in 1997 and enrolled 14,641 male US physicians aged 50 years or older. It randomized the men to a daily multivitamin or a placebo. The multivitamin used was the same formulation as the formulation of Centrum Silver at the time, which has 30 different vitamins and minerals. The men were followed for an average of 11 years. New diagnoses of cancer (except non-melanoma skin cancer) and deaths were counted for both groups.
It’s important to note that this was part of a larger study to test the effects of a multivitamin on cancer, cardiovascular disease, eye disease, and cognitive decline. The current results publish only the cancer findings. The effects on cardiovascular disease, eye disease, and cognitive decline will be published separately.
Especially to a skeptic like me, the results were interesting. The multivitamin group had slightly fewer new cancer diagnoses than the placebo group. The media is reporting the decrease as an 8% lower risk, which is true, but I don’t think gives us a clear mental image of the magnitude of the benefit. Imagine two groups each of 769 older men. If one group took the multivitamin for a year and the other group took the placebo for a year, the vitamin group would have 13 new cases of cancer and the placebo group would have 14. So for every 769 men taking a multivitamin for a year one new diagnosis of cancer is prevented.
Total mortality and mortality due to cancer were the same in both groups. The study was too small to detect differences in occurrence rates of specific types of cancers (i.e. lung cancer, colon cancer, etc.).
Two objections demand to be raised. First, why would you test 30 different vitamins and minerals together? It’s conceivable that some of the ingredients have synergistic effects and work differently in combination than they do individually, but it seems that the scientific method suggests the opposite approach. First figure out the effects of each ingredient, then test some combination. The current results leave us completely mystified about which of the ingredients (or combination of ingredients) is responsible for the effect. The authors state that the trial studied the effects of multivitamins because so many people take them, but I am left wondering whether the trial was designed to raise our understanding or increase Centrum Silver sales. (Pfizer which sells Centrum Silver, supplied the placebo and the multivitamin for the trial, though it did not design or conduct the study. The study was funded by the NIH.)
The other objection is that the difference between the cancer incidences in the two groups barely rose to the level of statistical significance. Bear with me while I delve into the statistics briefly. Statisticians use a measure called a p value to decide whether a measured difference between two groups might have been due to chance alone and not due to the intervention being studied. The p value answers this question: If the intervention being studied is actually irrelevant (in this instance, if the multivitamin and the placebo have equivalent health effects) how likely is it that the two groups would show such different numbers (in cancer incidence, in this case) by chance alone? By convention, any p value less than 0.05 is considered statistically significant. That is an arbitrary choice agreed on by statisticians, but there is no math or science behind that number. We just need some cut-off point, so we decided that 0.05 is statistically significant and 0.06 is not. That still means that for all the randomized trials we do, if the null hypothesis is true (meaning, if the medicine is just like the placebo) 1 time in 20 we’ll get a result that shows that the two are different in a statistically significant way, meaning we’ll get a false result by chance. The p value in this trial for the difference in cancer incidence for the two groups was 0.04. Yes, that’s statistically significant, but just barely.
So what can we conclude?
First of all, this teaches us nothing about multivitamins in women or in men under 50.
Second, the design of the trial is very solid. It was randomized and blinded. So we should take the result at face value – that for men over 50 taking a multivitamin daily makes a small decrease in the risk of cancer (but not in dying of cancer). This effect is much smaller than quitting smoking. So it makes a lot of sense to quit smoking before you try to figure out whether or not to take a multivitamin.
My suggestion for now is to wait for the rest of the results from the trial. For example, if the cardiovascular results are even slightly negative, suggesting that the multivitamin increases stroke or heart attack risk by a small amount, that may overwhelm the cancer benefit.
For the time being I’m still not recommending a multivitamin for healthy adults, or taking one myself.
Learn more:
Multivitamin Cuts Cancer Risk, Large Study Finds (Wall Street Journal)
Daily multivitamin appears to slightly lower cancer risk in older men (Los Angeles Times Booster Shots)
Multivitamin Use Linked to Lowered Cancer Risk (New York Times)
Multivitamins in the Prevention of Cancer in Men, The Physicians’ Health Study II Randomized Controlled Trial (Journal of the American Medical Association)
A Reminder to Dump Your Multivitamin (my post from last year reviewing the current studies about vitamin supplements, with links to my prior posts about vitamins)
This week you’ll have to learn a little medical jargon, and I know that you love that. The meninges (men-IN-jees) are the membranes that line the brain and spinal cord. Meningitis is inflammation of those membranes, usually caused by an infection. Meningitis can lead to brain damage, deafness, and sometimes death. Meningitis is usually caused by viruses or bacteria. OK? That wasn’t so bad.
Recently an outbreak of meningitis has come under the attention of investigators. 170 patients in the last few months have been diagnosed with meningitis due to a fungus. This is strange because fungi are a very rare cause of meningitis. Investigators tracked the infection to contaminated vials of a steroid medication (methylprednisolone) prepared by New England Compounding Center (NECC), a Massachusetts compounding pharmacy.
The medication is used to administer epidural injections – injections into the spine intended to relieve back pain. This presumably introduced the contaminating fungus directly into the spinal fluid and resulted in meningitis.
Three lots of potentially contaminated medication have been recalled by NECC. Health officials have determined that about 14,000 people may have been injected with the medication since May 21. About 12,000 of the patients have already been contacted and informed. As of yesterday 14 have died of fungal meningitis. Two different fungus species have been isolated from sick patients, Exserohilum (pictured above) and Aspergillus.
Some of the medication was also used to inject painful joints, and one fungal ankle infection was found in a patient who earlier received an injection into that ankle.
There are four facilities in California which received medication from NECC that was later recalled: Cypress Surgery Center in Visalia, Encino Outpatient Surgicenter in Encino, Ukiah Valley Medical Center in Ukiah, and Universal Pain Management in Palmdale. (The complete list of facilities across the nation is here.)
Fungal meningitis and fungal joint infections are not transmissible from person to person. So if you have not received a steroid injection into your spine (epidural) or joint from a recalled medication lot since May 21 you have nothing to worry about.
If you have received such an injection, be aware that meningitis or joint infections can occur 1 to 4 weeks after the injection, or perhaps even later. These 14,000 exposed patients are being asked to be vigilant for symptoms, and to report symptoms immediately to their physician. Symptoms of fungal meningitis are fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, slurred speech, and increasing pain, redness or swelling at the injection site. Symptoms of an infected joint are fever, increased pain, redness, warmth, or swelling in the joint or at the injection site.
How the medication became contaminated is still being investigated.
Learn more:
Fungal meningitis outbreak: Death toll hits 14; Idaho reports case (Los Angeles Times)
CDC: Meningitis outbreak growing, 14 people dead (Associated Press)
Meningitis Deaths Increase (Wall Street Journal)
Frequently Asked Questions For Patients: Multistate Meningitis Outbreak Investigation (CDC)
… or Reflections on Yom Kippur
“My heart is blighted like grass, and withered, for I forget to eat my bread.”
— A patient’s prayer, Psalm 102
[None of the anecdotes in this post are descriptions of any specific patient. They are amalgams of many patients. Specific details have been distorted or invented to preserve anonymity.]
I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone’s life. More often, I just reassure them that they’re going to be OK. Or I give them advice about what they need to do to live healthier. But what I do has limits, and people frequently bring me problems that are well beyond my ken.
A business man comes to me for chest pain. He feels guilty because he has been misleading his business partner in a negotiation.
A wife has vague urinary symptoms after her affair of several years ends.
A middle aged man comes to me for insomnia. His endless work responsibilities have caused him to miss important events with his kids.
Of course, they each believe they may have a medical problem, so I examine them and order the appropriate tests. I rule out coronary disease, and infections, and hormonal problems. I call them with the good news. The tests are all normal. But they are not relieved. Their symptoms persist or even worsen.
I think I must be missing something. I send the business man to a cardiologist, the wife to a urologist, the father to a sleep specialist. More diagnostic tests are ordered. They are all normal. Good news, right? No. They are not reassured. Their symptoms continue and with every unrevealing test result they seem to give their symptoms more attention.
All primary care doctors see lots of these cases. These patients are seeking care in the wrong marketplace. They don’t have a medical problem. Their conscience is bothering them. They’re not sick; they’re guilty. They do not require medicine. They seek absolution.
But I have no prescription for that, no advice for attaining forgiveness, for undoing wrong deeds. Perhaps I should send them to a psychologist. I ask some questions looking for symptoms of depression or anxiety disorder. I come up empty. They’re mentally healthy, yet they are miserable.
What’s the medical specialty that helps people who’ve done wrong? What’s the service industry that undoes guilt? I’m no expert, but as far as I can tell, the only methodical approaches to this are in organized religions. My colleagues and friends who are psychologists and psychiatrists may object. But it seems to me that mental health professionals can only clarify the patient’s goals and feelings, clarify if the ethical damage can be undone, and work through the feelings. That’s a lot, but it doesn’t strike me as what these patients are craving. They want to atone. Organized religions have a formula for that.
I’m not here to tell you to go to church. And I’m certainly not going to delve into theology or suggest that any religion’s recipe for forgiveness is true in a fundamental or exclusive sense. I’m just suggesting that if you know you’ve done something wrong, and you feel terribly about it, maybe you don’t need a doctor. Maybe you need a minister, a priest, or a rabbi.
Like I said, I love what I do. I can fix some medical problems, and I can help prevent others. I can help you live more days and make those days healthier. But there is more to life than that. Sometimes there is also wrongdoing, and guilt, and redemption. For that, I have no training. Forgive me.
Learn more:
Forgiveness (Wikipedia)
In 1993 in the Four Corners region of the US Southwest a woman developed a cough and progressive shortness of breath and died shortly thereafter. A few days later, her fiancée, a young physically fit man developed similar symptoms was rushed to a hospital and also died. A series of laboratory tests failed to identify any known infectious agent. The Centers for Disease Control and Prevention (CDC) Special Pathogens Branch was notified. Further testing revealed a previously unknown strain of hantavirus. The new strain would eventually be named Sin Nombre hantavirus (perhaps the most paradoxical name I’ve ever encountered).
In Asia and Europe hantavirus infections in people cause a very different illness marked by hemorrhagic fever and kidney failure. This new illness in the US marked by progressive respiratory failure was named Hantavirus Pulmonary Syndrome (HPS). HPS has early symptoms that are very similar to the flu: fever, fatigue, and muscle aches in the thighs and back. About half the patients also experience headaches, chills, nausea, vomiting, and diarrhea. Four to 10 days after the initial symptoms a cough and progressive shortness of breath develop. The lungs fill with fluid. About one third of patients with HPS die.
Since 1993 there have been very few (587) cases of HPS nationwide. The hantavirus strains in the US, like elsewhere, are carried by rodents. Sin Nombre hantavirus is carried mostly by the deer mouse in the western and central US and Canada. People are infected with hantavirus through contact with infected rodents, or their urine and droppings. Hantavirus in the US cannot be transmitted from person to person.
This summer hantavirus claimed the spotlight because of a number of cases linked to Yosemite National Park. Nine visitors to Yosemite have become sick from hantavirus, the most recent this week. Most of them camped in tent cabins in Curry Village in early July. These cabins have since been closed. Three of the nine have died.
The park, along with state and national health agencies, have attempted to contact all campers who have visited Yosemite this summer to advise them to seek care promptly if they develop flu-like symptoms. There is no specific treatment for hantavirus, but prompt admission to intensive care can help support patients on ventilators until the illness resolves. The patients who have survived seem to have recovered completely.
For those of us who haven’t been to Yosemite recently, the CDC advises that the best way to avoid hantavirus is to keep your home and nearby structures (garages, sheds) free of rodents. The links below have some common-sense suggestions.
Our family’s rodent control strategy involves an attractive feline named Pancho. Perhaps we should make her available to the National Park Service.
Finally, with Rosh Hashannah a few days away, I wish my readers a year of prosperity and joy, and no exposures to dangerous untreatable viruses.
Learn more:
Hantavirus in Yosemite: Ninth case reported in another visitor (LA Times)
August 2012 – Yosemite National Park Outbreak Notice (CDC)
Hantavirus (CDC information page)
Tracking a Mystery Disease: The Detailed Story of Hantavirus Pulmonary Syndrome (CDC)
“It’s not what you don’t know that hurts you,
it’s what you know that isn’t so.”
— attributed variously to Mark Twain and to Will Rogers
Many popular ideas are popular not because they’re right but because of a widespread failure of skepticism. For example, in the 1970s the idea that wide lapels really make you look great was widely adopted without rigorous testing.
Organic food has grown to a $26 billion industry in the last couple of decades largely on public good will. This industry was perfectly poised at the intersection of several of our irrational biases – our fear of “chemicals”, our assumption that natural is better than artificial, and our suspicion of technology that alters living things. Surely our food must be healthier without all those industrial “chemicals”, we told ourselves as we spent sometimes twice as much for organic produce.
My regular readers know that I’ve written previously (links below) that there is no proof whatsoever that organic food is healthier than conventional food. In the current issue of the Annals of Internal Medicine, the question is finally given some rigorous examination.
Since the adjective “organic” is sometimes bandied about carelessly, we should have a general consensus about what it means. Organic plants are grown without synthetic pesticides or fertilizers and are not genetically modified. Organic livestock is raised without growth hormones or routine (i.e. preventive) antibiotics. Organic livestock is fed organically produced feed and is provided access to the outdoors and freedom of movement. Organic food is also generally manufactured without additives or irradiation.
The authors of the paper retrieved every peer-reviewed study that compared either organically and conventionally grown food or the people eating these foods. 240 of these studies were found and their findings were reviewed. The results were strikingly blah, prompting a flurry of media coverage (links below).
The studies found no difference in health outcomes between people eating organic and conventional food. Two studies found higher pesticide levels in the urine of children eating conventional food compared to organic food, but these levels were well below those that cause health problems. There were also no consistent meaningful differences in nutrient levels between the two groups.
I have long been suspicious that organic produce has higher risks for bacterial contamination since the alternative to synthetic fertilizer is fertilizer from animal waste. This also turns out to be unfounded. Bacterial contamination of food was similar in both groups.
There was one small but tantalizing difference. Bacterial contamination of meat was similar in frequency in both farming methods, but bacterial contamination with bacteria resistant to three or more antibiotics was significantly more common in traditionally grown chicken and pork than organically grown animals. That doesn’t prove that the humans who eat that meat are more likely to get sick or that their illnesses would be harder to treat, but it suggests that routine use of antibiotics in livestock has risks which require further study.
There may be lots of other good reasons to buy and eat organic food. Some people think organic food tastes better, and of course that is best left to each one’s palate. Others assert that organic farming practices are better for the environment. But organic farming consumes more resources and uses much more land per food produced, so if most of us ate organic food much more of the environment would be taken up for farming than is currently. There are also ethical reasons to refrain from supporting farming practices that treat animals cruelly. I’m not suggesting that we should not eat organic food, only that we should not do it with the expectation that it is healthier.
So for now, I’ll take my apple with pesticides. Oh, and those lapels are still groovy, no matter what other people say.
Learn more:
Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review (Annals of Internal Medicine)
Why Organic Food May Not Be Healthier For You (NPR Morning Edition)
Study Questions How Much Better Organic Food Is (Associated Press)
Organic food no more nutritious than non-organic, study finds (NBC News)
My previous posts about organic food:
When the Stool Hits the Sprouts
Would You Like Some Salmonella With That?
For a very informative description of the benefits of modern farming, as well as other technical revolutions that make modern life possible, I highly recommend “The Rational Optimist: How Prosperity Evolves” by Matt Ridley.
Tangential Miscellany
Dr. Kevin Pho, the very well known physician blogger and outspoken advocate of social media in medicine, published my post about the coming flood of newly-insured patients. If you didn’t read it when I posted it three weeks ago, you might want to take a look. Check out the comments, too. Many of them are, shall we say, vigorously opposed to my point of view.
Temperatures are dropping. Children are returning to school. (Parents are elated.) Families are planning a last summer outing on Labor Day. It must be time for flu shots.
This season’s influenza vaccine has shipped from manufacturers. Our office just received them. So it’s a good time to remind ourselves that the flu can be fairly nasty and that the most reliable way to protect yourself is the influenza vaccine.
The flu shot is recommended for everyone over six months of age. It’s especially important for the groups below.
The following groups should not receive the vaccine.
Follow the links below to learn more about the flu. And get the shot now, before the flu season starts.
Learn more:
Seasonal Influenza (Centers for Disease Control and Prevention page)
Key Facts About Seasonal Flu Vaccine (Centers for Disease Control and Prevention page)
Google Flu Trends