Cyclosporiasis - what you need to know

The outbreak of diarrheal illness caused by the parasite cyclospora is still making headlines. What do you need to know?

Many organisms can cause acute diarrhea, including viruses such as the norovirus, bacteria such as salmonella, and parasites. Viruses have no specific treatment while bacteria and parasites have specific treatments available.

The current culprit, cyclospora, is a microscopic parasite that can contaminate fresh food or water, and typically leads to severe watery diarrhea, along with bloating, loss of appetite and fatigue. Untreated, the diarrhea can last for many weeks to a few months. Treatment with the antibiotic trimethoprim-sulfa for a week relieves the symptoms within a few days.

There are outbreaks of cyclosporiasis in the US every summer, but rarely on the scale of the current outbreak. The worst hit have been the upper mid-west states, with Michigan the epicenter, but 45 states have reported at least some cases. As of July 31, 20,374 cases have been reported to the CDC. More than 10,000 of these cases have been in Michigan. The real number of cases is almost certainly much higher, with many not reported.

The source of the current outbreak seems to be contaminated lettuce from Mexico. Prior outbreaks have been linked to snap peas, raspberries and fresh herbs, as well as romaine lettuce.

Avoidance is better than treatment! Know where your produce comes from. This may be a good time to buy your produce from local farmers’ markets. I’d avoid packaged “pre-washed” lettuce. Remove the outer leaves and carefully wash all produce. Cooking kills the parasite and is the safest way to get your veggies.

Should you develop diarrhea that last more than a day or two, get medical help. The diagnosis can be made from a stool sample, and treatment clearly helps.

p.s. - Remind your senators and reps that public health should never be a partisan issue - red or blue, we are all at the same risks from such outbreaks!


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Why do women live longer than men?

As of 2024, while the average life expectancy in the U.S. climbed to 79, there was a striking and persistent gap between men and women. Women lived an average of 81.4 years, men 76.5. This five-year difference has been consistent over recent decades.

Why do women live so much longer than men?

Some of the difference is biologic and not anything men can change. Women have two X chromosomes, men one. This means that women have “backup” for loss of X chromosome gene deletions or losses. There is some animal data suggesting that the male Y chromosome has deleterious effects.

Women have stronger immune responses, letting them better fight off infections (but also making them more prone to auto-immune diseases like lupus).

Women have much more circulating estrogen than men, which seems to delay the onset of coronary disease, though women “catch up” after menopause when their estrogen levels drop.

There are many factors over which men do have control. Men are more likely than women to smoke and drink heavily, both negative factors for longevity.

Men are more likely to work in hazardous occupations (construction, fishing , forestry, police and fire, etc.) than women. Men also engage in more risky behaviors such as speeding in cars, fighting and extreme sports.

Women are much better than men at looking after their health – getting regular checkups, seeing a doctor if something seems wrong. Men tend to avoid doctors until forced to.

Women generally have much better social networks, a consistent factor promoting longevity. Men’s friendships tend to be less intense and less personal.

So, while we cannot (yet) engraft a second X chromosome into men, there are a lot of things men can do to emulate women and hopefully add a few years to their lives.


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TrumpRx - what is it good for?

In February, with much fanfare, TrumpRx was launched, claiming the ability to save US residents money on prescription drugs. Does it do so? Are there better ways to save money?

If you go to trumprx.gov, you are greeted by a glossy picture and a claim that “TrumpRx is rewriting the script, bringing major savings on essential medications to all Americans.”

Reality is less impressive than the rhetoric.

The site does not sell medications. Rather it directs you to manufacturers’ websites where you can (with a prescription) buy the medications directly from the companies, for cash – no insurance accepted. The list price is contrasted with the lower “TrumpRX” price.

43 medications are listed. All are brand name drugs. At least 18 are old-timers with much cheaper generic versions available at your local drug store, not only far cheaper than the list price but even cheaper than the discounted price offered.

An example: Protonix, an acid-suppressing medication, is shown with “an original price” of $497.28 for 30 tablets and a TrumpRx price of $200. Sounds good, no? Almost 60% off. It sounds good until you go to Amazon and see you can get the generic version, 30 tablets for $11.60.

Even for drugs where there is no generic yet available, you may well pay less at your pharmacy than the supposed savings offered via TrumpRx. Moreover, at the pharmacy you can use your health insurance, while using TrumpRx does not allow any insurance.

So, can you really save money on prescriptions? Yes, by following some commonsense rules.

First, always ask your prescriber if a generic is available for your condition. There are a few illnesses for which only one or a limited number of branded products will work, but such conditions are rare. For common conditions there are usually generic versions that are similarly effective.

Beware of manufacturer coupons that claim to let you pay little or nothing for a new branded drug – these have a limited lifetime, and when the promotion runs out you will be on an expensive medication for a long time.

Check the Mark Cuban Cost-plus Pharmacy (costplusdrugs.com). This has a large and growing number of medications at very reasonable prices.

Look for savings coupons on GoodRx.com.

If you have a condition for which only a very expensive drug will work, and your share will be financially stressful even using your insurance, call the manufacturer directly. Many have patient assistance programs that will lower your cost.

For a few items, including fertility drugs and weight loss drugs, TrumpRx may save you money – it does not take much time to look.


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Of Mice and Men - reading about medical "breakthroughs"

Researchers want people to appreciate their work and to get funding for more research, so they and the institutions for which they work want favorable publicity.

Reporters want to get bylines and publishers want readers, because more readers mean more advertising dollars. Thus, news outlets have every incentive to trumpet research results as big news, breakthroughs that will attract “eyeballs.”

Combine these aligned incentives with the fact that very few reporters have much background in science and you have a recipe for over-hyping minor advances or preliminary results as big news.

How can you critically read a story about a supposed major medical advance and know if it is truly important?

First, accept that mice are not humans. What works in mice may or may not work in people. Some 5% of initial promising results in lab rodents end up being similarly effective in humans. Even those that do cross over take a very long time before being useful – an average of 17 years between the first trial in mice and an approved human product.

What about human studies?

Be VERY skeptical of association as proving causation: the observational trial Researchers live in a “publish or perish” world and look for associations between habits or exposures and diseases or longevity that can form the basis of a published paper.

Good medical science depends on a controlled clinical trial, in which people are randomly assigned to the treatment being studied and are generally otherwise very similar. Observational trials may suggest linkages but almost never prove them.

The fact is that people who do one thing, like drink coffee, may do many other things differently. Coffee drinkers may be more likely to smoke, or eat donuts or work in offices than those who do not drink coffee. Unless the researchers have been able to match the people who do the thing studied with those who don’t, and can be sure that is the ONLY difference between them, the outcome may be due to something completely different.

Good trials, in addition to randomly assigning people to the treatment(s) being studied are double blinded. This means that neither the people being studied nor the researchers know which treatment or placebo they are getting. Other than death, few outcomes of a trial are absolutes. There is a strong placebo effect for most conditions, and if people know they are getting the active drug, many will feel better for that reason.

If researchers are heavily invested (emotionally or financially) in drug A being better than drug B, they will be tempted to ignore side effects or encourage feeling better in the group given A.

Finally – be careful not to assume that “statistically significant” is always the last word. Statisticians devise ways to tell if trial results are purely due to chance. This is given as a “P value.” A P of 0.05 means there is only a 5% chance that the results were just luck; the lower the P value, the more likely there really was a difference between groups.

Small differences in outcome may be called statistically significant when their clinical significance is minor. When a study result says that people given A lived significantly longer than those given B, look carefully to see how much longer.

This is particularly common with trials of new cancer drugs. You may read a headline saying that cancer patients given X lived significantly longer than those given Y. Buried deep in the story may be the facts that those given X lived 6.5 months and those given Y lived 5.3 months – and that those given X had many more side effects and had to pay $50,000 more out of pocket. It is not so clear that you would always want to choose X.


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The last diet advice you need to read

Paleo, Keto, Carnivore, Intermittent Fasting , Whole30 – each diet purporting to solve all your health problems. None are terribly healthy and none solve all your health problems.

What do we know, based on lots of observation and backed by science, about what constitutes healthy eating?

First, make plants the foundation of your diet. Whole grains, fresh fruits and fresh (or frozen) vegetables should make up much of your food intake. Use legumes as a healthy source of protein. Use nuts or minimally-processed nut butter as a snack food. A plant-heavy diet reduces inflammation, reduces coronary disease and cuts your cancer risk.

Eat fatty fish, preferably wild-caught, 2-3 times a week to get more protein and omega-3.

Use red meat sparingly and do not eat processed meats such as bacon, hot dogs or salami. Despite the new USDA guidelines, heavy consumption of red meat adds to coronary risk and may be carcinogenic.

Avoid highly-processed foods. If you look at the label and see items you cannot pronounce and that are not found in normal kitchens, don’t buy it or eat it.

Get adequate dairy for calcium. Best are fermented dairy products such as yogurt, kefir and cheese.

Limit your alcohol intake. Modest (1-2 drinks/day for men, 1/day for women) alcohol intake probably reduces heart disease a bit and increases cancer a bit – sort of a wash. If you enjoy an occasional glass of wine, you do not have to stop, but you certainly do not have to drink for health reasons.

For coffee-drinkers, the news is good – 2-3 cups/day may lower dementia risk, reduces the risk of atrial fibrillation and seems to have no harmful effects. Do not drink it at night if it causes insomnia. Regular or green tea (but not herbal) probably has similar benefits.

Finally, loosen up occasionally. Very few foods are dangerous in small quantities; it is the day-to-day that matters. If you are taking your grandchildren to an amusement park, have an ice cream cone. If your boss has you over for a cook-out and serves hot dogs, eat one. You can get back on your normal healthy diet tomorrow.


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Supplements - What are they good for?

Supplements are a multi-billion-dollar business. Pushed by TikTok influencers and TV personalities, they cover everything from vitamins and minerals to a variety of gummies, powders and pills.

Supplements are not regulated the way pharmaceutical drugs are, meaning the FDA does not assess them for efficacy or safety before they are marketed. Only if serious side effects show up does the FDA get involved.

An important consequence of this lack of regulation is that many of these products do not contain what they claim to contain, and there have been many reports of seriously tainted products. A popular protein powder was found to contain lead.

While touted to solve all human ills, no supplement has been found in a scientific trial to prolong life. Resveratrol was all the rage until trials showed no benefit.

Many of the products pushed on-line or on-TV are expensive. I know of people spending hundreds of dollars monthly on supplements, most of which were useless.

Are there any that you should consider taking?

A standard multi-vitamin is safe and inexpensive. There is evidence that it has a modest effect on reducing dementia. The B12 and D included in multivitamins can make up for the reduced B12 absorption that is common is older adults and the lack of sunshine-produced Vitamin D that is common in winter.

Omega-3 is healthy for the circulatory system. The best way to get this is by eating fatty fish 2-3 times a week. If you don’t eat fish, an omega-3 capsule may be useful.

Even safe and useful products can be harmful in large doses. Vitamin D in excess causes elevated serum calcium, which in turn can cause nausea, constipation, kidney stones and bone pain. While 1 multivitamin daily may be good, 5 or 10 are likely to be bad.

When you see a product pushed by a celebrity or “influencer,” remember that they are usually either selling the product or being paid to tout its benefits. Keep your money in your pocket.


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Can we make healthcare affordable?

On January 15, President Trump announced a “great healthcare plan” that seemed to have three components. It would formalize his push for pharmaceutical companies to lower their prices, send funds to individuals to help pay their insurance premiums and mandate price transparency for any hospital or other provider who participates in Medicare.

Will this do any good? Given the sparsity of details, analyzing this “plan” is analyzing air, but probably not much.

Going back to President Nixon, U.S. presidents have decried the high cost of medical care. In 1971 Nixon pronounced health costs as a crisis when healthcare consumed 7% of the Gross Domestic Product (GDP). In 1992 President Clinton said that “healthcare costs are increasing at unsustainable rates.”

Well, here we are in 2026, and healthcare now consumes 18% of the U.S. GDP, roughly double the cost in peer-countries.

In 2025, the average premium for a family plan was $26,993 - roughly 40% of the average worker’s salary. Even though much of this cost is borne by the employer (for those lucky enough to work for a company that offers health insurance), workers contributed an average of $6850 towards the cost.

Moreover, as insurance costs have skyrocketed, employers have tried to slow this by offering plans with high co-pays and deductibles, meaning that out-of-pocket costs have risen dramatically.

Keeping drug costs down is a start, but drug costs make up only 9-10% of healthcare spending.

When it costs $27,000, sending people $2000 to buy health insurance would not allow most lower income people to come anywhere near being able to afford it.

We have had mandated price transparency in law since 2021, and hospitals have proven very adept at making prices visible only to those with a PhD in computer science.

Yes, we MUST make healthcare affordable to all Americans, but this will require bold steps, with some pain for those currently getting rich off our dysfunctional, adminstration-burdened system, not “a concept of a plan.”


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