Monday, February 10, 2025

Cannabis and health

Marijuana, now most often called cannabis, use is growing. In recent years, almost 20% of the U.S. population have used cannabis, with 4% using it daily or almost daily. What is the impact on the health of regular users?

Advocates describe better sleep, less pain and less anxiety. Unfortunately, these benefits come at a price.

Multiple studies have examined the association of regular cannabis use with symptoms and illness.

I can get the good news out of the way quickly. Regular users are less likely to report nasal congestion than non-users, unlike tobacco users who report more nasal and sinus issues.

Unfortunately, on the key major illness side, the news is not good. Regular cannabis users have more heart attacks and strokes than non-users, with even higher risk among those who use it daily or near-daily.

Regular cannabis smokers also have dramatically more (3-4 times) head and neck cancers than non-users. The highest risk was for laryngeal cancer, but higher rates of mouth and tongue cancer are also seen.

Middle-aged and older adults are increasingly using cannabis-based therapies (CBT) for symptoms, and this population suffers from many CBT-related side effects, including dry mouth, dizziness, balance problems, drowsiness and confusion.

Motor vehicle accident rates rose an average of 15% in states after recreational cannabis use was legalized, and the best evidence we have suggests that regular cannabis use is associated with a roughly 50% greater chance of having an accident and a 30% increase in fatal accidents.

Finally, there is the concern about cannabis’ effects on the developing brain. Cannabis use by mothers during pregnancy has been linked to problems with attention, memory, problem-solving skills, and behavior in their children.

Using cannabis before age 18 may affect how the brain builds connections for functions like attention, memory, and learning.

So, no, cannabis is not harmless. If you use it, do so with the knowledge that you may pay a price beyond the cost of the drug.



Prescription for Bankruptcy. Buy the book on Amazon

Sunday, February 2, 2025

What do we know about bird flu?

There are many influenza viruses. A and B are the main causes of seasonal flu outbreaks and while B only infects humans, influenza A can infect many bird and animal species.

A given influenza virus is identified by two proteins found on its surface, H and N. The common viruses causing winter influenzas are H1N1 and H3N2. The “bird flu” is H5N1.

When bird flu first appeared, it was thought to be a risk primarily to birds and was felt unlikely to infect people. Infecting birds is bad enough: the current outbreak among chickens has been a major cause of diminishing supply and increasing price of eggs. The infected flock must be slaughtered, so chicken also becomes scarcer and more expensive.

The story has gotten worse. H5N1 can clearly spread readily to dairy cattle; there have been major herd outbreaks around the U.S. It can also spread to cats, both wild and domestic and other animals.

From cattle, there has been spread to humans, so far rare and sporadic. Since 1997, there have been about 1000 proven human cases world-wide, reported from 23 countries. More than half of these have died, and this number is clearly an undercount, since testing for H5N1 is not routinely done.

In the U.S. since the start of 2024 there have been 66 proven cases of bird flu, most in dairy workers, and one death. One 13-year-old girl required life support but recovered.

So far, no human-to-human spread has been seen, but as we have learned, viruses mutate, and it would not be a shock for a mutation to appear that would allow this to happen.

Oseltamivir (“Tamiflu”) has been approved to treat H5N1 based on very little data. This drug has been available since 1999 to treat seasonal flu but is not that effective for most patients. Studies have shown that it shortens symptoms of influenza by a day. It does have benefit in very sick influenza patients, reducing the death rate by almost half.

A vaccine is available, but there are only a few million doses stockpiled and if the H5N1 mutates to spread human-to-human, the vaccine may need to be modified.

What should you do?

Avoid raw milk, which transmits H5N1 (as well as many other nasty infections!) and raw meat, and do not feed raw meat to your pets. Pasteurized milk is safe, as is properly-cooked meat.

Do not touch sick birds; call your animal control officer, who will know how to safely handle them.



Prescription for Bankruptcy. Buy the book on Amazon

Sunday, January 26, 2025

I heard about this new drug....

Among developed countries, only the U.S. and New Zealand allow direct-to-consumer advertising by pharmaceutical companies and boy, do they take advantage of this opportunity! You cannot watch television without seeing ads for pharmaceutical products.

The FDA relaxed its guidelines on radio and television advertising in 1997, and the boom took off. In 2012, spending on traditional media (mostly TV) advertising by the pharmaceutical industry was $3.2 billion and by 2024 it hit $7.5 billion.

As eyeballs turned from broadcast TV to social media, pharmaceutical advertising followed. In addition to the $7.5 billion spent on traditional broadcast media, pharma ads on social media hit $19.5 billion in 2024.

Why do they spend so much money on these ads? Because they work. People hear about new “wonder drugs” and ask their doctors about them.

Product claim ads, the majority, give the drug’s brand name (in large print) along with its generic name, the condition it treats and its benefits and risks. The benefits are up front and emphasized while the risks typically go by rapidly at the end. Cost is never mentioned.

Not surprisingly, there is no obligation for the ad to specify how the drug works or if there are competing drugs for the same condition that are safer or cheaper.

A fascinating study published in the Journal of the American Medical Association two years ago found that advertising expenses were much higher for drugs of limited benefit than for those with greater clinical benefit.

What should you do? If you think you have the condition the drug is supposed to help, it is perfectly OK for you to ask your doctor about it. They are in the best position to know if the drug might benefit you, if it is safe for you given any other medical conditions you have and medicines you are taking, whether there are better and/or cheaper drugs to use instead and if you can avoid the need for any drug by making lifestyle changes.

I must note that doctors are also heavily marketed by big pharma and not immune to the siren call of glossy ads and free lunches brought by pharma’s marketing representatives.

Remember, the purpose of any advertisement is to sell products. This is as true for pharmaceutical ads as it is for ads for cars or vacation time-shares. The primary goal of pharmaceutical advertising is not to help you but to sell more drugs, so take the claims with a large grain of salt.



Prescription for Bankruptcy. Buy the book on Amazon

Monday, January 20, 2025

It is OK to "Talk Dirty" to your doctor

As toddlers, nothing is off-limits. We are fascinated by the whole world, including our bodies and the things that come out from them.

As we get older, we are socialized to regard many topics as not to be discussed, and this often colors the way we present ourselves to doctors and nurses, sometimes to our detriment.

It is said that 70% of the information a doctor needs to make a diagnosis comes from the history. This assumes the history given is accurate.

One good example is our bowels. While I agree that discussing one’s bowel habits at a dinner party would not be appropriate, the same does not hold true in the doctor’s office. If there has been a change in your frequency or the appearance of your movements, this may indicate disease and so should not be kept secret.

Ditto urination. Increased frequency of urination, loss of bladder control or change in urine color may all need to be addressed, but this will only happen if you tell your doctor about these things.

Your sexual habits may put you at higher risk for certain illnesses and may suggest certain tests be done, but these will only be ordered if the doctor is aware of the need.

Do you drink more than you let on? Do you use injectable drugs? These habits clearly increase your risk of liver disease and other conditions, and it is important that your doctor know about these behaviors.

Just as a Catholic going to confession feels safe in admitting their behaviors to the priest, a patient seeing their doctor should feel safe in discussing topics they would never bring up in any other situation.

Unless your doctor has limited their practice to convents, you will not be telling them anything they have not heard before, so there is no reason to be embarrassed. Knowing these behaviors and habits will get you more effective care than will keeping them secret.

While there is doctor-patient confidentiality, in an era of electronic medical records you may justifiably worry about privacy. If this is a concern, you can ask the doctor specifically not to put what you are telling them in their note. Since, in the U.S., you are entitled to see your medical visit notes, you can verify they have followed your request.

A well-informed doctor will give you better care. Nothing you say will shock them, so be open!



Prescription for Bankruptcy. Buy the book on Amazon

Sunday, January 12, 2025

Alcohol: how bad is it?

The news media have been filled with reactions to the U.S. Surgeon General’s recent pronouncement that alcohol was a major cancer risk, and that alcoholic beverages should carry a cancer warning label like that on cigarette packages. (Ireland currently requires such warning labels.)

The World Health Organizations estimates that about 4% of cancers worldwide are alcohol-related.

The long-touted heart protective effects of alcohol have been questioned.

What should you believe?

First, some definitions. A “standard” drink is defined as 5 ounces of wine, 12 of beer and 1.5 ounces of liquor.

Women metabolize alcohol differently than men, and so have higher blood levels than men from the same amount consumed.

Almost all studies of the effects of alcohol on health are flawed.

First, they depend on self-reported consumption. Since many, if not most, people know that heavy drinking is not good, there is a strong tendency to under-report what you drink.

Second, they are observational: groups are followed and their health outcomes studied. We know that this type of study is prone to bias. People who drink alcohol may have many other habits that non-drinkers do not share, such as smoking.

Alcohol consumption has been linked to higher incidences of head and neck cancer, liver cancer, colorectal cancer, esophageal cancer and breast cancer.

Even the most toxic of substances only cause harm at threshold doses, and for most toxins, the more, the worse. Consistent with this, the National Academy of Medicine estimated that 2 drinks/week would shorten your life by less than a week, 7 drinks/week would shorten your life by 2.5 months while 5 drinks/day would shorten it by over two years.

A recent study from Spain shed fascinating light on wine and the heart. Rather than ask subjects how much they drank, they took urine samples and measured metabolites of wine to objectively estimate how much they drank. They found that light-to-moderate drinkers (from ½ to 1 glass/day) had 50% fewer cardiac events over 6 years of follow-up. This protective effect disappeared in those who drank more than 1 glass/day.

My take-aways:

If you do not drink, there is no reason to start. There are no net health benefits to drinking.

If you drink heavily (more than 2 drinks/day for men, 1/day for women), please cut down. You are harming yourself.

If you enjoy a glass of wine a few times a week, relax. The slight increased cancer risk is probably balanced by less heart disease.

The Greeks had it right: all things in moderation.



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Sunday, January 5, 2025

Norovirus - what you need to know

There are many gastrointestinal infections that spread person-to-person, including E. coli, salmonella and listeria, but by far the most common is the norovirus.

Norovirus typically infects some 20 million people in the U.S. every year, and this winter has seen an increase in reported outbreaks.

The virus is highly transmissible, resistant to alcohol (the active ingredient in most hand sanitizers) and heat, and persists for many days on surfaces such as counters.

Places where people are in close quarters and sharing food preparation are particularly prone to outbreaks: cruise ships, nursing homes, schools and day care centers.

The symptoms: nausea, vomiting, cramps and diarrhea, usually begin very abruptly – you feel fine one minute and then all the symptoms hit you. If there is a fever, it is usually low-grade. The symptoms generally only last 2-3 days and most people recover uneventfully.

There is no specific treatment; antibiotics are of no use. The most important therapy is fluids to prevent dehydration. Adults can drink plain water, tea, sports drinks or light fruit juices. Children will benefit from pediatric-tailored electrolyte solutions.

While most healthy people will do fine at home taking frequent small amounts of fluid, an ER visit or even hospitalization may be needed if you cannot keep down liquids.

A persistent fever of 101 or more is unusual and warrants at least a call to your doctor. Blood in the stool is also not expected and should prompt medical attention.

The best way to avoid catching norovirus is good hand-washing before you eat or prepare food, and cleaning surfaces with bleach if they may have been exposed to virus particles.

Note that virus may be shed in the stool for up to two weeks, long after you have recovered, so be careful if you have had such symptoms to wash well after using the toilet and you had best not handle food.

Norovirus has also spread via shellfish and other food. Cook shellfish to an internal temperature of over 145 F and wash all fresh fruits and vegetables.

If you do catch it, remember that “this too shall pass.”



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