As anyone with seasonal allergies to tree pollen knows, allergy season has begun. Aside from the sneezing, itchy eyes, nasal congestion, and general sense of being ill, is there anything good about this springtime immune system dysfunction? I came across some evidence that might slightly relieve that annual sense of “suffering” – having allergies of any kind seems to reduce the risk of glioma, including malignant brain tumors, by up to 40%.

Asthma, eczema, and hay fever seem to all have this “protective” effect. Multiple observational, case-control studies have shown that allergic conditions are associated with a lower risk of glioma, and this has been confirmed by a larger, systematic meta-analysis. One prospective study found a 25% lower risk of gliomas in subjects with high IgE levels. When women alone were analyzed, those with the highest IgE levels had up to a 50% reduced risk of gliomas. IgE is the type of antibody most often found abnormally high in those with allergic/atopic conditions.  It is not known why women seems to have greater protection than men.

It is postulated that a general immune system activation with heightened immune surveillance explains this cancer reduction phenomenon among those with allergies.  An activated, vigilant immune system may destroy central nervous system cancer cells.

Ironically, the most common treatments for allergies, antihistamines, contain precursors of n-nitroso compounds which have been found to be potent neurocarcinogens. Some think these chemicals, which are also found in cured meats and bacon, may increase the risk of brain cancer by 2-3 fold. More recent studies, however, have been done prospectively and show no clear association between n-nitroso compounds and glioma.

And so while the nuisance of allergies as a medical problem cannot be compared with the profound suffering of those with malignant brain tumors, it seems as though all the sniffles, wheezes, and congestion may have at least one potential benefit.

References:
1, 2, 3, 4

There was an article in the New York Times recently about the importance of cultivating a family narrative to instill a sense of identity, control, and resilience in children. The more children know about their family story, the better equipped they are to handle stresses that would shake their foundation. Is it possible that, in the realm of personal health and well being, the cultivation of an affirmative family medical narrative might bolster one’s constitution?

Family narratives tend to follow one of three arcs. First there is the ascending motif: your grandfather came to this country as a peasant, his son became a teacher, and now you are in medical school. The second theme is the descending one: we used to have it all but now everything is falling apart. And the third narrative, which seems to be the most edifying, is the nuanced one: your father was a great business man, but he sometimes drank too much. Your grandmother was an excellent piano player, but her brother was in trouble with the law. No matter what, they stuck together as a family.

Children with the most confidence seem to possess an inter-generational self, a sense of identity that is part of something bigger. They can recall past chapters of hardships overcome by other family members, and get to work writing such stories of resilience when life presents new setbacks and sorrows.

Is it possible that in order to create a healthier, adaptive sense of well being we should set out to tell stories of good health and sanguine habits, and at the same time revere the tales of medical adversities overcome? Often we cannot control what medical ailments come our way, and many are utterly devastating. But as a family doctor I have seen family ailments that are less a genetic predisposition than an inherited legacy of symptom comprehension and behavior.

I hope to incorporate the strength of my great grandfather, who built his own house in the forest and chopped wood well into his eighties. I recall and regret that my grandmother smoked for fifty years, addicted as most of her generation was to nicotine. Yet I honor and hope to emulate her courage in the face of chemotherapy when it is my turn – may I have the strength of character to still make it to church and the farmer’s market on Sundays, holding my bald head high and keeping my exhausted eyes open to fight another day.

We should tell our medical histories, both good ones and bad ones, to our children – with hopeful, brave, and steadfast themes of endurance and vigor. It might just save or comfort a life.

You’ve probably watched the Super Bowl as I have many times, faithfully, elevating the occasion to some kind of macabre family tradition. It is a spectacle of athletic agility, drama, and struggle; the pinnacle of American sporting contests.

Despite the heavy onslaught of commercialism, faux halftime culture, and evident violence on the field, we suspend our awareness that this event may not be a magical moment worth our time and validation, even as its winners call out to some magical disney kingdom. Here are 7 points to consider:

7.) Obesity and cardiovascular disease

Up to 45% of youth participating in football are overweight or obese. The nature of the sport favors, and increasingly demands, a large body size. The physique acquired in adolescence often persists into adulthood.

According to a 2007 study of 653 boys ages 8-14 playing football in Michigan, 20% were overweight and another 25% were obese, as defined by body mass index. Studies have shown that linemen have high early mortality rates, and for all professional players who have played 5 years or more, life expectancy is less than 60.

6.) MRSA infections and abscesses

• Quarterbacks Tom Brady and Peyton Manning have suffered from it.
• In 2003, five members of the St. Louis Rams developed large abscesses due to methicillin-resistant Staphylococcus aureus.
• In 2002, two members of the USC football team were hospitalized, with one requiring multiple surgeries and skin grafts. The following year USC football reported 17 players contracting MRSA infections requiring incision and drainage.
• A 2007 survey of collegiate football players found an infection rate of 6.7%.
• Three studies completed by the Texas Department of State Health Services found that at least 276 high school football players in Texas were infected with MRSA between 2003-2005, at a rate that was 16 times higher than the national average.

MRSA infections can be fatal. Football is a particularly risky sport for contracting MRSA due to skin abrasions, potentially contaminated turf, sharing of towels, poor hygiene, and high antibiotic use (in the case of the St. Louis Rams study, players were given antibiotics at 10x the rate of the general community).

5.) Heat illnesses

CDC researchers analyzed cases of dehydration, heat exhaustion, and heat stroke among players of 9 types of sports at 100 high schools. 70% of illnesses occurred among football players, many of whom were overweight or obese. This translates into roughly 6,400 annual heat-related illnesses resulting in at least one day of athletic participation lost.

4.) Spectator heart attacks

The most vivid anecdote of this phenomenon may be the story of a Pitttsburgh Steelers fan who went into ventricular fibrillation, a lethal heart rhythm, as he watched Jerome Bettis fumble while crossing the goal line.

A German study found that cardiac emergencies were over 3 times as likely in men, and almost 2 times as likely for women, during days the German national football (soccer) team played in the 2006 World Cup.

3.) Concussions

The violent shaking of the brain against the skull causes a flood of neurotransmitters and discharged neural circuits in the brain, leading to varying degrees of confusion, blurry vision, nausea, dizziness, headache, memory loss, imbalance, and sometimes unconsciousness. Repeated concussions lead to permanent brain injury and long term degenerative brain disease as listed below.

2.) Musculoskeletal gore

Athletes become paralyzed from vicious collisions, accidental and malicious. During some games it seems there are more pauses for injuries than forward passes. Microphones capture the crunching sounds, cracking joints, and juice-filled meat poundings of each hyperintense collision.

How often can the mob watch breathlessly as another football player lies motionless on the ground, hoping for a twitch to assuage the collective guilt of a blood thirsty audience?

If the sum total of all the torn cartilage, tendons, muscle, skin, and fat were placed in an abattoir-worthy heap it would tower into the sky like an oozing, fetid, bacchanalian monument to human misery. Need references for that claim?

1.) Chronic Traumatic Encephalopathy

CTE is thought to be caused by repeated blows to the head. It has been implicated as a cause of depression, completed suicide (football players such as Ray Easterling, Junior Seau, and Dave Duerson), and dementia in untold others.

Even mild but repetitive impacts have been associated with long term brain damage, and increasingly attention is being focused towards the negative consequences of the sum total of head trauma.

Perhaps George Will said it best in an editorial in the Washington Post last summer:

In the NFL, especially, football is increasingly a spectacle, a game surrounded by manufactured frenzy, on the grass and in the increasingly unpleasant ambiance of the fans in the stands. Football on the field is a three-hour adrenaline-and-testosterone bath. For all its occasional elegance and beauty, it is basically violence for, among other purposes, inflicting intimidating pain.

So join me in boycotting the Super Bowl and its grandiose commercialism, entertaining violence, and sad risks for the health of its gladiators. Create art, have a conversation with your kid, get a colonoscopy… there are much more edifying pursuits than tolerating, nay worshipping, the violent tendencies within.

I’ve been feeling a bit more skeptical of the supposed benefits of “organic” foods lately. It’s hard to imagine any greater purity as I watch this fruit in a bowl on my kitchen counter top – a sad modern still life, festooned with brand name stickers. The high grocery bills I’ve been racking up combined with a few recent studies casting doubt over the differences between conventionally grown versus organically grown foods have given me pause.

A large systematic review concluded that organic foods in general are no more nutritious than conventionally produced foods, but did find less antibiotic resistant organisms and pesticide residues on organic foods. More studies are needed to determine if this has any clinical significance for our health.

This echoed a previous analysis published in 2009 which concluded that the nutritional advantage of organically produced food is doubtful when compared to conventional.

The American Academy of Pediatrics recently published guidance on the advantages and disadvantages of organic foods.

The foods that seem to be worth buying organic have been ranked here by Environmental Working Group (EWG) and include apples, celery, sweet bell peppers, peaches, strawberries, nectarines, grapes, spinach, lettuce, cucumbers, blueberries, potatoes, green beans and kale.

EWG has also compiled a list of other vegetables that are low in pesticides anyway, and might not be worth buying organic (simply in terms of personal pesticide exposure). One should also consider the harms to the environment that are inherent in mass conventional produce production.

But I guess the bottom line is that a bowl full of “organic” fruits labeled, tracked, and defined by logo stickers is less than inspiring. The great still lifes hanging in the museums of the world recount a much more sensuous experience of food – exchanged hand to hand at markets, grown from the sweat and care of human toil, and I would imagine savored like rare treasures from the earth, instead of the consumed inputs of someone’s minimum 5 fruits a day.

Dr. Andrew Weil delivered the keynote address at the 2012 American Academy of Family Physicians Scientific Assembly.  I admit that I don’t know much about him or his wellness empire, but apparently Time Magazine has anointed him one of the top 25 visionaries in the world.  Here is the gist of his keynote address, as heard by someone with a relatively unbiased unfamiliarity.

My first impression of him was influenced by a Santa Claus-worthy white beard. He decried our “disease management system” that masquerades as a health care system.  A true sentiment, yet all the better intentions in the world will not change the fact that there are a lot of diseases to manage.

Dr. Weil scolded the medical profession for its over reliance on medications. Instead, he is a proponent of Integrative Medicine, a concept that emphasizes the body’s own ability to heal, and incorporates such things as botanicals.  I’m not sure how much he promotes supplements or chiropractic, but there is a slippery slope here. On the other hand he is absolutely correct that physicians and patients have come to expect that a pill can cure many problems without the more arduous attention needed to improve our lifestyles. He feels direct to consumer advertising by the pharmacy industry is wrong. It’s hard to disagree with that as well.

He is a proud General Practitioner, and has created an active education curriculum for residents, physicians, medical students to promote his integrative approach. He emphasized the lack of training in nutrition during medical school, and that most courses look more like biochemistry. Dr. Weil stated that his is an evidence-based curriculum (yet later downplayed the importance of evidence based medicine).

He feels we don’t need more rigorous studies of St Johns Wort, but we do need more outcomes studies showing his integrative, lifestyle medicine approach works better.  

His lofty goal is to make his curriculum a standard part of the education of every physician.

He called for a grassroots movement among doctors and patients to reform healthcare outside of government, and feels both political parties offer few inspiring solutions. I would certainly agree with this sentiment, but to build any consensus on what a utopian health care system might look like seems impossible to me.

He blames government subsidies of corn and soy for having made the least nutritious foods the cheapest.  He calls for subsidies for vegetables and fruits instead. Sounds good. Dr. Weil beleives one small step that would create a major positive impact would be eliminating or even outlawing sugary beverages like soda.  

He stated that many people have no idea of the difference between fruit and fruit juice.  Dr. Weil believes we should tell patients they are drinking soda when counseling them about juice. If you compare grams of sugar this is often true. Most breads labeled as “whole grain”  are still pulverized and have an unhealthy glycemic index.

The grand finale of his keynote address was the demonstration of a breathing technique which he touted as a kind of panacea.  By doing this breathing, the voluntary nervous system sets the tone for the involuntary autonomous systems.  He went on to actually demonstrate this breathing technique with elaborate counting, breath holding, and forceful exhaling.  According to Dr.Weil, we must do this twice a day “religiously.” He claims it is almost impossible to have a panic attack while doing these exercises, and cites 5 cases of this technique correcting atrial fibrillation.

While I think the idea of breathing exercises is excellent, and there is good evidence we can reduce stress, anxiety, and the downstream health effects of tension, he inflated this power to curative proportions. I think of breathing exercises as a coping mechanism with beneficial physiologic and health effects, but his method came off as proprietary and ritualistic, admittedly derived as it is from a kind of Yoga.

He ended his speech by pointing out that the word “conspiracy” is derived from the root “breathing together.”

At best I think his heart is in the right place, and his talk has at least piqued my interest in learning more about his integrative curriculum. There are a lot of things wrong with the institution of medicine, and the fight against a robotic system that relies on technology and ignores our own innate capacity to improve our health is righteous. However it seemed from his talk that he glorified the placebo effect, the anecdote, and the wisdom of accumulated clinical experience.  He downplayed the primacy of evidence based medicine, and the authority of the randomized double blind placebo controlled clinical trial – methods which have been invaluable in elevating medicine above the shaman. I think the art of medicine is derived from a continuum spanning rigorous science and respect for our desire to believe, but must always be informed by the scientific method as the best arbiter of truth.

Again, I don’t really know much about Dr. Weil. I do respect the medical blogger ORAC, and he wrote this scathing post about the selection of Dr. Weil as a keynote speaker. The Dr. Weil who showed up here certainly knew his audience, and tempered his more magical thinking, allowing just a hint of quackery to shine through. Thanks ORAC.

While picking up some diapers at the pharmacy I noticed the adjacent, ironic placement of condoms in the same aisle.

I suppose as a medical professional who does his fair share of counseling about safe sex I should appreciate the not-so-subtle juxtaposition of products rimmed for pleasure and fitted for maximum absorption. Yet I couldn’t help feeling that I was being manipulated.

If I were buying condoms, would I feel that the smiling, freely pooping images of children staring back at me were a reinforcement of my good judgement to control fertility? Or might I think that despite my free choice to protect myself, some pharmacy overlord is righteously asserting the proper function of sex as a procreative process, the success or failure thereof determined by a higher power?

As a purchaser of diapers, should I chuckle at the implied commiseration of someone who thinks that maybe I should rethink my ability to raise a second child? Or should I frown, sensing that beautiful, smiling babies on the packaging have been cynically labeled as co-producers of unwanted bodily fluids?

I really don’t know what to think, except that somebody certainly wants me to think something.

What do you think?