Author Archives: drcharles

Exfoliating Soap is Full of Plastic. Seriously.

I feel ignorant.

I’ve been buying, using, and recommending Dove Exfoliating Soap as an affordable and low maintenance facial cleanser. Doctor-recommended. In general my skin has liked the stuff. But a friend recently made me aware of the fact that most of these mass-produced exfoliating soaps contain “microbeads” of plastic. These tiny globules of polyethylene act as a gentle abrasive that exfoliates dead skin, but the synthetic grit then washes down our drains and into our watersheds and oceans where it accumulates, gets eaten by sea creatures, and damages our ecosystems. Plastic beads, made from petroleum products, in my soap. Really?

Whether created by the mechanical pounding of waves upon larger pieces of plastic, or formed intentionally as exfoliating microbeads, these little bits of plastic add up. We’ve all seen plastic bottles and junk floating in ponds and rivers, but how much is there that we can’t see? One study found that up to 85% of plastic by weight in some estuaries is microscopic, invisible to the unaided eye, creating a hidden suspension of toxic materials. Many of the synthetic beads are so small that most sewage treatment systems allow them through. From a Slate.com article on the subject:

The thing about plastic exfoliating beads is that they don’t need to break down in order to end up in the stomachs of marine life from otters to octopi. “As this debris occupies the same size range as sand grains and planktonic organisms, it is available to a wide range of invertebrates near the base of the food chain,” says Mark Browne, a scientist at the Centre for Ecological Impacts of Coastal Cities at the University of Sydney who has studied the consequences of microscopic plastic in marine habitats.

… a range of bottom-of-the-food-chain critters—including mussels, barnacles, lugworms, and tiny crustaceans called amphipods—will ingest the particles, which may then remain in their digestive tracts or migrate to other body tissue. New research also suggests that polyethylene is an excellent transporter of phenanthrene, a byproduct of fossil fuel burning that’s a dangerous ocean pollutant.

Is all that plastic (and the many chemicals attached to it, read on) making its way up the food chain, as larger organisms like us devour smaller ones, potentially creating a process not unlike mercury toxicity in our seafood? I’m not qualified to say, except that this sounds plausible.

An environmentally-oriented blog in the Yahoo network has compiled a list of soaps to avoid. You will find, and rub your face with, plentiful polyethylene beads in these brands:

Aveeno Skin Brightening Daily Scrub
Clean & Clear’s line of scrubs
Dove Gentle Exfoliating Foaming Facial Cleanser
Neutrogena’s line of scrubs
Noxzema’s line of scrubs
Olay’s line of scrubs
Phisoderm Nurturing Facial Polish
Scrubs and Beyond coupons

Look for “polyethylene” in the label’s ingredient list. You can double-check on a site like drugstore.com, where it’s often easier to read the full ingredient list. You might also question terms like “microbeads” or “microcrystals” that aren’t explained.

I’m not an expert, but you can probably find suitable alternative soaps without polyethylene at places like Whole Foods and Trader Joe’s.  As a New Year’s resolution I picked up a bar which lists oatmeal as the sole exfoliant. Here are a few good name brands mentioned in the same Yahoo article, with their more natural exfoliating ingredients in parentheses:

Avalon Organics Exfoliating Enzyme Scrub (ground walnut & flax)
Burt’s Bees line of scrubs (ground peach stones, almond, & oats)
Freeman Feeling Beautiful Salt Body Scrub (salt)
Freeman Feeling Beautiful Sugar Body Scrub (sugar)
Nature’s Gate Revitalizing Facial Scrub (ground willow bark, walnut, & corn meal)
Queen Helene Natural Facial Scrub (ground walnut)
Skin Milk Facial Scrub, Exfoliate (oat flour & almond meal)
*St. Ives Apricot Scrub (ground apricot kernels)
And don’t forget the good, old-fashioned loofah sponge for exfoliating your skin.

*A lot of the blogs mentioned this name brand as a favorite, but I don’t know.

Plastics can take thousands of years to degrade, with some types persisting almost indefinitely. The scope of the problem is immense.  Try to live one day without encountering plastic. It is impossible. We’ve made such a mess of the world that the polyethylene exfoliating beads are just a recent example of our brash disregard. Ever heard of the Great Pacific Garbage Patch?  Discovered in 1997 by Captain Charles Moore, it is the size of Texas:

Captain Moore had wandered into a sump where nearly everything that blows into the water from half the Pacific Rim eventually ends up, spiraling slowly toward a widening horror of industrial excretion. For a week, Moore and his crew found themselves crossing a sea the size of a small continent, covered with floating refuse. It was not unlike an Arctic vessel pushing through chunks of brash ice, except what was bobbing around them was a fright of cups, bottle caps, tangles of fish netting and monofilament line, bits of polystyrene packaging, six-pack rings, spent balloons, filmy scraps of sandwich wrap, and limp plastic bags that defied counting.

Not limited to the Pacific, there are 6 other garbage patches in the oceans of the planet.  All this plastic clogs the digestive tracts of animals that mistake it for food. (Addendum – thanks to a heads up from a reader, you can view some horrific photos of dead albatrosses with stomachs filled by plastic junk, taken by photographer Chris Jordan).  It can also adsorb a lot of other toxic chemicals onto its surface. What health problems is it already causing in humans?  In one report:

…free-floating toxins from all kinds of sources—copy paper, automobile grease, coolant fluids, old fluorescent tubes, and infamous discharges by General Electric and Monsanto plants directly into streams and rivers—readily stick to the surfaces of free-floating plastic.

One study directly correlated ingested plastics with PCBs in the fat tissue of puffins. The astonishing part was the amount. Takada and his colleagues found that the plastic pellets eaten by the birds concentrated poisons to levels as high as 1 million times their normal occurrence in seawater.

We’ve got a lot of work to do, in addition to changing our exfoliating soaps.  Try to avoid buying anything with plastic packaging or that’s made of plastic and you’ll be reminded of how ubiquitous the stuff is. I hope the plastic I recycle actually gets recycled, but I digress.

Review the ingredients in the things you buy, and spend the extra dollar on those products that are made, packaged, and distributed in a responsible way when you can. Without exploding this idea to all that is wrong with our consumption, at least beware of the polyethylene microbeads in exfoliating soaps.

I doubt there will ever be such a discovery as The Great Ground Apricot Kernel Patch and Cornmeal Slick floating in the Pacific Ocean.

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Top Medical Stories of 2009

What did we learn in 2009?

The editors of Journal Watch, a publication of The New England Journal of Medicine, have compiled a top ten list for the most important clinical pearls of 2009. These stories and findings are consequential and should effect the daily practice of physicians. Although patients may sometimes be frustrated to learn that once-sage advice can be rendered obsolete with new evidence, it is good that modern medicine keeps striving for proof that what we practice is beneficial to health.

Here are the editors’ choices for top medical stories of 2009.
[Hopefully Journal Watch won’t mind that I’ve reproduced them here, since I find great value in my $99 subscription and encourage other clinicians to join, too!]

Continue reading

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Medical Advance of the Decade?

What has been the top medical advancement of the 2000’s?

As the first decade of the 21st century comes to an end, it is interesting to look back and reflect on the most significant medical advances we’ve seen. I’ve presented 12 medical advances that I consider to have been the most important over the past decade, added one from commenters’ suggestions, and then narrowed the field down to just 10 finalists. Now I’d like to ask you, the wider world, to vote:

(brief descriptions below; you can vote for up to 3 choices; polls close New Year’s Eve; winner gets the most votes)




So, here is a list with brief explanations:
Continue reading

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Hypochondriacal Heroism

diceIt’s morning, and in the shower he reaches a trembling hand up towards his face and strokes his jugular lymph node chain, searching for any indications that the small lumps palpable within might have gotten larger. He feels the same familiar bumps, rolls them like jelly beans inside a package, and wonders if at least one lymph node is rotting with cancer.

As he dresses for work he follows the sinews of his neck down to his thyroid gland, a bowtie beneath his skin. The right side is larger than the left, and this asymmetry surely indicates a malignancy. He’s read that thyroid cancers are actually quite curable, unless he has one of the rare kinds, which he almost certainly does. Three years to go before death, full of surgeries and chemo, if he’s lucky.

At work he’s had a headache for the past week, which is unusual. It is centered above his right eye, and seems to increase in intensity every few minutes. He rubs his forehead to assuage the dull ache, careful not to rub too hard because that might trigger the underlying aneurysm to explode, reducing him to a jiggling heap of jelly on the floor. Conversely, the headache might be a brain tumor.

Driving home he notices an ache in his right shin, most likely from running into the dresser last week. Less likely but still possible is osteosarcoma. The treatment for that sort of thing involves removing the entire lower leg.

After dinner he is reminded that his bowels have been loose of late. Crohn’s Disease, parasitic infection, and colon cancer (probably metastatic) are all possible. Blood in the stool would be a late finding of invasive colon cancer, and when it shows up he’ll know his days are severely numbered.

He knows his thoughts are ridiculous. They are exhausting.

There is no way he could have five distinct cancers at once, yet a feeling of dread lingers. His hands are clammy, his heart beats quickly, and he’s fearful most of the day. He laments the absurd vulnerability of his human condition, rages against the body that would betray his spirit. Sighing deeply and shaking his head he attempts to move on with the rest of the evening.

He’s distracted from reading his book as he runs through the list of today’s symptoms in his mind, and ponders their possible mortal significance. It is somehow calming for him, like thumbing the beads of a rosary while reciting grave prayers.

By bedtime the headache has lifted. The pain from a brain tumor would be constant, he thinks with a measure of elation. Despite the constant fear and anxiety about illness, there is one good thing about his worrying. He’s overcome at least a hundred types of cancer, and averted multiple catastrophic heart attacks, strokes, and seizures. He is perhaps the world’s most resilient being.

At night he smiles as he lays his head down on the soft pillow of his bed. He thinks to himself that there is something gloriously brave about having cheated Death every precarious day of his life.

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The Top Ten Preventive Services, Ranked by Bang for the Buck

doctor appleWith all the controversy about the utility of mammography, optimal Pap smear intervals, and risks of prostate cancer screening, you have to ask yourself – what are the most beneficial and cost effective preventive services we should be focusing on?

Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.”  For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61

{The Top Ten}:

Discuss Daily Aspirin Use
This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but rather that individuals at moderate to high risk should weigh with their doctors the risks of bleeding and ulcers against the benefits of reducing cardiovascular disease. Heart attacks, strokes, and peripheral arterial disease accounts for over 900,000 deaths in the United States each year. According to Up To Date, net benefits of aspirin have been proven in secondary prevention for those who’ve already suffered a heart attack, occlusive stroke, TIA, angina, or coronary bypass surgery. Acute ischemic syndromes such as acute MI, unstable angina, and acute occlusive stroke also benefit.

Aspirin use for primary prevention of a first cardiovascular disease event is the most controversial, with recent trends favoring only using aspirin for those found to be at moderate to high risk. The National Commission estimates that “Physicians advising all high-risk adults to consider taking aspirin would save 80,000 lives annually and result in a net medical cost savings of $70 per person advised.”

The discussion with a doctor if aspirin is appropriate for you is very tricky, and is currently undergoing some changes based on new evidence, but the discussion may save your life, either way. Continue reading

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Astronomical Medicine

Beautiful, humbling, unfathomable vistas to contemplate during fretful times:

A digital, zoomable panorama of over 3,000 images stitched together, capturing the highest resolution view of our galactic night sky ever created:
http://galaxy.phy.cmich.edu/~axel/mwpan2/

A crescent phase Earth, as seen by the departing Rosetta spacecraft as it makes its 5 year journey to rendezvous with a comet:
http://antwrp.gsfc.nasa.gov/apod/ap091123.html

No worries.

crescentearth_rosetta

(Thanks to obeythepurebreed for the link)

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