What causes allergies?
You have an allergy when your body overreacts to things that don't cause
problems for most people. These things are called allergens. Your body's
overreaction to the allergens is what causes symptoms. For example,
sometimes the term "hay fever" is used to describe your body's allergic
reaction to seasonal allergens in the air, such as grass or pollen.
Your family doctor may want to do an allergy skin test to help determine
exactly what is causing your allergy. An allergy skin test puts tiny amounts
of allergens onto your skin to see which ones you react to. Once you know
which allergens you are allergic to, you and your family doctor can decide
the best treatment. Your family doctor may also decide to do a blood test,
such as the radioallergosorbent test (called RAST).
Common Allergy Symptoms:
* Runny nose
* Watery eyes
* Itchy nose, eyes and roof of mouth
* Sneezing
* Stuffy nose
* Pressure in the nose and cheeks
* Ear fullness and popping
* Dark circles under the eyes
* Hives
What are the most common allergens?
Pollen from trees, grass and weeds.
Mold. Mold is common where water tends to collect, such as shower curtains,
window moldings and damp basements. It can also be found in rotting logs,
hay, mulches, commercial peat moss, compost piles and leaf litter. This
allergy is usually worse during humid and rainy weather.
Animal dander. Proteins found in the skin, saliva, and urine of furry pets
such as cats and dogs are allergens. You can be exposed to dander when
handling an animal or from house dust that contains dander.
Dust. Many allergens, including dust mites, are in dust. Dust mites are tiny
living creatures found in bedding, mattresses, carpeting and upholstered
furniture. They live on dead skin cells and other things found in house
dust.
Things that can make your allergy symptoms worse
* Aerosol sprays
* Air pollution
* Cold temperatures
* Humidity
* Irritating fumes
* Tobacco smoke
* Wind
* Wood smoke
How can I avoid allergens?
Pollens. Shower or bathe before bedtime to wash off pollen and other
allergens in your hair and on your skin. Avoid going outside, especially on
dry, windy days. Keep windows and doors shut, and use an air conditioner at
home and in your car.
Mold. You can reduce the amount of mold in your home by removing houseplants
and by frequently cleaning shower curtains, bathroom windows, damp walls,
areas with dry rot and indoor trash cans. Use a mix of water and chlorine
bleach to kill mold. Open doors and windows and use fans to increase air
movement and help prevent mold.
Don't carpet bathrooms or other damp rooms and use mold-proof paint instead
of wallpaper. Reducing the humidity in your home to 50% or less can also
help. You can control your home air quality by using a dehumidifier, keeping
the temperature set at 21 degrees, and cleaning or replacing small-particle
filters in your central air system.
Pet dander. If your allergies are severe, you may need to give your pets
away or at least keep them outside. Cat or dog dander often collects in
house dust and takes 4 weeks or more to die down.
However, there are ways to reduce the amounts of pet dander in your home.
Using allergen-resistant bedding, bathing your pet frequently, and using an
air filter can help reduce pet dander. Ask your veterinarian for other ways
to reduce pet dander in your home.
Dust and dust mites. To reduce dust mites in your home, remove drapes,
feather pillows, upholstered furniture, non-washable comforters and soft
toys. Replace carpets with linoleum or wood. Polished floors are best. Mop
the floor often with a damp mop and wipe surfaces with a damp cloth. Vacuum
regularly with a machine that has a high-efficiency particulate air filter.
Vacuum soft furniture and curtains as well as floors. Install an air cleaner
with a high-efficiency particulate or electrostatic filter. Wash carpets and
upholstery with special cleaners, such as benzyl benzoate or tannic acid
spray. Wash all bedding in hot water (hotter than 130°F) every 7 to 10 days.
Don't use mattress pads. Cover mattress and pillows with plastic covers.
Lower the humidity in your home.
What medicines can I take to help relieve my symptoms?
Antihistamines help reduce the sneezing, runny nose and itchiness of
allergies. They're more useful if you use them before you're exposed to
allergens.
Some antihistamines can cause drowsiness and dry mouth. Others are less
likely to cause these side effects, but some of these require a
prescription. Ask your family doctor which kind is best for you.
Decongestants, such as pseudoephedrine and phenylephrine help temporarily
relieve the stuffy nose of allergies. Decongestants are found in many
medicines and come as pills, nose sprays and nose drops. They are best used
only for a short time. Nose sprays and drops shouldn't be used for more than
3 days because you can become dependent on them. This causes you to feel
even more stopped-up when you try to quit using them.
You can buy decongestants without a family doctor's prescription. However,
decongestants can raise your blood pressure, so it's a good idea to talk to
your family doctor before using them, especially if you have high blood
pressure.
Cromolyn sodium is a nasal spray that helps prevent the body's reaction to
allergens. Cromolyn sodium is more helpful if you use it before you're
exposed to allergens. This medicine may take 2 to 4 weeks to start working.
It is available without a prescription.
Nasal steroid sprays reduce the reaction of the nasal tissues to inhaled
allergens. This helps relieve the swelling in your nose so that you feel
less stopped-up. They come in nasal sprays that your family doctor may
prescribe. You won't notice their benefits for up to 2 weeks after starting
them.
Your family doctor may prescribe steroid pills for a short time or give you
a steroid shot if your symptoms are severe or if other medicines aren't
working for you.
Eye drops. If your other medicines are not helping enough with your itchy,
watery eyes, your family doctor may prescribe eye drops for you.
What are allergy shots?
Allergy shots (also called immunotherapy) contain small amounts of
allergens. They're given on a regular schedule so that your body gets used
to the allergens and no longer overreacts to them.
Allergy shots are only used when the allergens you're sensitive to can be
identified and when you can't avoid them. It takes a few months to years to
finish treatment, and you may need to have treatments throughout your life.
[AAFP]
Monday, October 20, 2008
Tuesday, October 14, 2008
alternative medicine
Alternative Medicine
Peter Saunders, MBBS
General Secretary, UK Christian Medical Fellowship
How should we respond to alternative medicine?
Alternative medicine is rising rapidly up the heathcare agenda. One in four
people use at least one form of alternative medicine and three out of four
people are in favour of alternative therapies.
One study cited by a recent report suggested that there may be millions of
consultations to non-conventional therapists each year, with about 2.5% of
the population receiving treatment. In addition, many doctors have received
some training in alternative medicine. In most member states of the European
Union the practice of medicine by non-recognised health professionals is
illegal.
When one considers the tight controls on the training and practice of
orthodox medical practitioners there is clearly a double standard operating.
If there are no proper controls for alternative medicine practitioners, then
the way is open for charlatans, profiteers and tricksters to operate
alongside those who are genuinely providing service of proven value.
What is alternative medicine?
Problems of definition
The report of the Board of Science and Education's working party,
Complementary Medicine, New Approaches to Good Practice defines
non-conventional therapies as 'those which are not widely used by orthodox
medical professionals nor widely taught at undergraduate level in medical
and paramedical courses' - but some therapies regarded as alternative are
taught formally in medical schools elsewhere.
The three terms complementary, alternative and holistic are used almost
interchangeably - but convey different messages. 'Alternative' implies an
either/or relationship with orthodox medicine; 'complementary' a both/and
relationship while 'holistic' implies that non-orthodox therapies treat the
'whole person'. All these assumptions are controversial.
The Diversity of Therapies
The report says that as many as 160 different forms of non-conventional
therapy have been identified. An A to Z of some of the most common includes:
Acupuncture, Acupressure, Alexander Technique, Aromatherapy, Auricular
Therapy, Bach Flower Remedies, Chiropractic, Crystal Therapy, Herbs,
Homeopathy, Hypnosis, Iridology, Macrobiotics, Massage, Naturopathy,
Osteopathy, Reflexology, Shiatsu, Therapeutic Touch, Transcendental
Meditation (TM), Yoga, Zen and Zone Therapy.
On first glance there seems to be very little similarity between one form of
alternative medicine and another; but what unifies most of them is the idea
of a 'life force' or 'vital energy' which ensures health, becomes disrupted
in disease and can be manipulated by various means.
For example, underlying acupuncture is the belief that there is a vital
force or energy called 'Chi' which flows freely through the body in twelve
meridians or channels. The flow of this energy depends on the balance
between two opposite forces; an active, 'male' force called 'yin' and a
passive, 'female' force called 'yang'. When the flow of the Chi energy is
free and uninterrupted health is ensured but if the balance between yin and
yang is disturbed or if there is any blockage to energy flow then disease
results.
These ideas have their roots in the ancient Chinese religion of Taoism which
has Chi, yin and yang as fundamental concepts.
Ideologies which underly other forms of medicine use different words for the
same general concept of 'life force'. Shiatsu is based on Shintoism and
calls the energy 'Ki'. Yoga and TM are based on Hinduism and call the force
'prana'. Homeopathy uses the term 'vital energy', chiropractic 'innate
intelligence' and Maori medicine terms the life force 'mana'.
The common theme of 'correcting imbalance'
In most alternative therapies health is believed to be restored by relieving
blockage and restoring flow in the 'life force', but the means whereby this
is achieved vary widely as listed below:
Needling: Acupuncture
Homeopathy: Minute doses of diluted medicine
Reflexology: Foot massage
Aromatherapy: Aromatic Oils
Yoga: Adopting Body Postures
Transcendental Meditation: Meditation
Therapeutic Touch: Hovering hands
Macrobiotics: Diet
Why is Alternative Medicine so popular?
There are seven main factors accounting for the rise in popularity of
alternative medicine in the Western World.
1. Changes in the Western worldview
Two hundred years ago in Britain most people had a Christian worldview; they
believed in a creator God who made us, intervened in our world and to whom
we were accountable. But with the publication of Darwin's Origin of the
Species and the rise of biblical criticism, this theistic world view gave
way to an atheistic one.
People began to doubt the existence of God and life after death. Man came to
be seen simply as a clever monkey, the product of matter, chance and time in
a directionless and purposeless universe. Morality became relative ('what's
right for me') rather than absolute.
Now we are seeing another worldview shift from atheism into pantheism.
Pantheism is the ideology which lies behind Eastern religions like Hinduism
and also the New Age Movement. God is an impersonal force of which we are
all simply a part. Death leads to reincarnation, and morality simply means
being in harmony with nature. All is one and all is God. This has meant an
increasing openness to all sorts of non-Christian spiritual belief along
with a scepticism and suspicion about science.
The change of worldview from theism, to atheism and then pantheism has had
profound effects on the way that medicine is practised. While Christian
doctors see human beings as a tri-unity of spirit, soul (or mind) and body
(1 Thes 5:23), atheistic doctors see them as consisting of just body and
mind. By contrast, New Age or alternative medicine practitioners see human
beings as an integrated whole; but from a pantheistic rather than a theistic
perspective.
Much of alternative medicine has its roots in the New Age Movement which in
turn is rooted in Astrology. Exponents believe that for the last 2,000 years
we have been in the age of Pisces (the fishes), but that now we are moving
into the age of Aquarius (the water-carrier). The Age of Pisces was
characterised by rationality, logic, objectivity and black and white
analytical 'left brain' thinking. By contrast the Age of Aquarius is
characterised by intuitional, subjective, grey 'right brain' thinking.
Sociologically the New Age Movement spawned the counterculture of the 1960s
with 'flower-power', peace protests, drug experimentation and the Hippie
movement. Spiritually it paved the way for a wide acceptance of Eastern
religious ideology, Astrology and the Occult. Medically the New Age Movement
has meant an ncreasing disillusionment with and scepticism about scientific
medicine.
As Christians we reject both the atheistic and pantheistic worldviews. They
are quite simply not the way the world is. God does exist. We are made in
his image, yet fallen; and death leads to judgement. We embrace the
scientific method as a gift of God, but we also see human beings as being
more than simply the sum of their parts.
2. Failings of orthodox medicine
There have been great advances in orthodox medicine over the last two
centuries which have led to the eradication and alleviation of many diseases
which were previously neither preventable nor curable: immunisations for
smallpox, antibiotics for infection, anti-psychotics for schizophrenia,
chemotherapy for cancer, drugs for heart failure and surgery for a whole
host of structural and anatomical problems.
But medicine also has its limits. With many illnesses we have a long way to
go. Solid tumours (eg lung, breast and bowel) are in general difficult to
treat if surgery fails. There is still much progress to be made in chronic
diseases like multiple sclerosis and rheumatoid arthritis, and there is
still no orthodox cure for musculoskeletal back pain and the common cold. If
we also consider that 75% of people seeing their doctor do not have any
defined organic illness, it is easy to see why people may decide to consult
alternative practitioners. Patients may also become impatient or
disillusioned with the NHS system of referrals and waiting lists.
With some diseases alternative medicine fares no worse than orthodox
medicine and it is in these areas that alternative medicine thrives.
3. Medical arrogance
Doctors have not always been ready to admit failure; and on occasions may go
on using treatments of doubtful value, or with potential side-effects rather
than being honest that nothing else can be done. The inappropriate use of
some chemotherapeutic agents or radical surgery for advanced cancer, for
instance, may cultivate distrust in patients who then seek other solutions.
4. The side effects of orthodox medicine
Orthodox medicines and surgery can produce side effects and complications
which are sometimes fatal. Examples are often widely publicised by an
unforgiving press. By contrast most alternative medicine has little in the
way of side-effects.
5. Loss of a whole person perspective
Advances in the science of medicine may be at the expense of the art of
medicine. Doctors have less time for the patient, touch patients less often,
and are tempted much more now to treat their patients simply as anatomical
structures or biochemical machines. There is much less in medicine now of
the ritual handshake, pulse-taking, hand on the shoulder etc. Too often the
doctor is now esconced behind his PC and perhaps a formidable desk; while
many alternative therapies involve plenty of 'hands-on' diagnosis and
treatment.
Alternative medical practitioners generally are able to give much more in
terms of time and touch, thereby engendering more trust. Homeopaths, for
example, may spend up to 90 minutes in a first consultation and 45 minutes
on follow up. Patients naturally assume, 'He must know what he is doing
because he spends so much time with me'.
6. Costs of high-tech medicine
High tech medicine is expensive, while often the only cost of alternative
medicine is the therapist's time. This is one feature making alternative
therapies increasingly attractive to health insurance managers looking to
cut costs.
7. Consumer demand
Patients are prepared to pay for therapies which promise what orthodox
medicine has failed to deliver; especially for incurable cancer or chronic
pain. This demand means that there is plenty of room in the market place for
more practitioners.
Why does alternative medicine seem to work?
Why is it that so many people are seeking alternative medicine therapies
when so many of them have been shown not to work in clinical trials? There
are at least eight reasons why.
1. Genuine therapeutic effects
Some alternative medicines genuinely work. Over half of prescription and
over-the-counter drugs originate as natural compounds or are based on them
(eg aspirin, digitalis, morphine, adrenaline, curare, all antibiotics except
the quinolones etc); and the natural world may hold many more therapeutic
treasures.
It is quite conceivable that some alternative medicine practitioners are
using useful compounds or techniques which are not yet known to orthodox
medicine. But if this is the case then we need to discover what they are so
that they can be isolated and given in the correct dose!
2. The placebo effect
If we strongly believe that something (or someone) has the power to help us,
then we are much more likely to experience benefit. It is a fact that one
third of people given an inert compound to relieve a particular symptom will
report relief of that symptom. This is called the placebo effect. In the
same way patients who share the therapist's belief in New Age pantheism or
the existence of 'life force' will be more likely to benefit from their
therapy.
3. Concurrent use of therapies
Belief in an alternative therapy's effectiveness may develop when it is used
concurrently with another more effective orthodox therapy. The effect is
then wrongly ascribed to the alternative therapy.
4. Psychosomatic illness
Many illnesses are psychosomatic; in other words a patient's stress level or
mental state can aggravate the symptoms. Asthma, eczema, peptic ulcer and
rheumatoid arthritis fall in this category. Alternative therapies which
induce relaxation may then improve the symptoms.
5. Spontaneous remissions
Many diseases get better by themselves. Viral infections (eg warts, common
cold) and some tumours (eg malignant melanoma) are examples of conditions
which may spontaneously regress. In such cases people may well then
attribute therapeutic effect to the remedy they were trying at the time of
recovery, when it fact their improvement at that time may just have been
coincidence. This is called the 'post hoc, propter hoc' fallacy; in other
words 'because B followed A, then A must have caused B'.
6. Dietary influences
There is a strong link between diet and health, and many alternative
therapists recommend that patients drink less coffee or alcohol, eat less
fat or more fibre or take vitamins. The resulting improvement may then be
due to the change in diet, rather that the alternative therapy being used
concurrently.
7. Imagined improvement
Some patients, especially if open to suggestion from others that they 'look
better', may simply imagine that they 'feel better'; especially if the
symptoms were of a vague nature in the first place. Alternatively they may
simply get better at tolerating symptoms, and imagine that the symptoms
themselves have diminished.
8. Demonic involvement
There may be real spiritual forces operating to bring healing through
demonic power. Such healings may be the bait that Satan then uses to draw a
person more deeply into the occult, or into accepting a pantheistic
worldview.
How do we assess individual modalities?
It is not possible in this brief review to comment on each and every
alternative therapy; but here are some principles which can be generally
applied.
1. Do the claims fit the facts?
Any new orthodox medicine has to undergo extensive pharmacological testing
to assess its therapeutic potential, side-effects and interactions with
other drugs. Tests are first carried out in animals, then in human
volunteers and only then are short and long term studies carried out on real
patients.
If a drug passes these tests it must then be approved by the Licensing
Authority. This ensures that drugs reaching the public are both safe and
effective.
In the same way medical practitioners must undergo a five year undergraduate
training and then work for a further year before they are registered and
able to practice independently of an institution.
Similar safeguards for alternative medicines and practitioners are largely
absent. There is simply no comparison between the double-blind, randomised,
placebo-controlled cross-over trials which many orthodox drugs undergo and
the subjective anecdotal 'evidence' supporting much alternative medicine.
Furthermore, when proper trials are employed the results are often
unconvincing.
A Department of Complementary Medicine has recently been set up at the
University of Exeter to review trials on alternative and complementary
therapies. The contents pages of their quarterly journal FACT (Focus on
Alternative and Complementary Therapies) are available on the internet and
make interesting reading. Many of the published studies give inconclusive
results.
A 1990 French review of 40 controlled trials on homeopathy concluded that
the majority were flawed by small sample size and subjective measures of
improvement. A 1991 review of 107 trials was similarly inconclusive.
By contrast there is evidence that patients with low back pain treated with
chiropractic derive more benefit and long term satisfaction than those
treated by hospitals; and that, according to a consensus panel of the US
National Institutes of Health, acupuncture is an effective treatment for
nausea and vomiting induced by anaesthesia, pregnancy or chemotherapy.
The biblical injunction to 'enquire, probe and investigate thoroughly' (Dt
13:14ff) must surely be relevant here. We should always ask, 'What is the
evidence that this therapy really works?'
2. Is there a rational scientific basis?
We know how most orthodox drugs work. They may stimulate receptors (eg b
agonists in asthma), modify cell transport (eg probenecid), block enzymes
(eg allopurinol), replace missing compounds (eg vitamin B12) or chelate
toxins (eg penicillamine). The action of any given drug is determined by its
concentration at the site of action; and the actions are understandable in
view of their known biochemical and physiological effects. By contrast the
majority of alternative medicines have no rational scientific basis.
Homeopathy involves diluting an active compound to such a degree that the
resulting 'potency' contains not even a molecule of the original active
ingredient.
Iridology claims to link each area of the iris with a separate part of the
body when it is known that no such anatomical links exist. Reflexology is
based on the belief that there are connections between the sole of the foot
and internal organs; again in the absence of any scientific evidence.
There is similarly no evidence for the existence of the 'meridians' (energy
channels) of acupuncture or the 'chakras' (psychic spinal centres) of yoga.
In some cases an alternative therapy may be working because of some
scientific reason unknown to the therapist. It has been suggested, for
instance that the therapeutic effects of acupuncture could be explained by
the release of endogenous (naturally produced) pain-killers called
endorphins. If this is indeed confirmed, then acupuncture will be shown to
have a scientific basis, but this will not, by any means prove that Taoist
ideology is true or that Chi energy exists.
3. Is it the improvement due to the therapy or some other factor?
Transcendental Meditation lowers blood pressure, but why? Is it because it
enables the Goddess Kundalini to migrate up the spine and unite with Brahman
in the head (as Hindus believe); or is it simply that meditation induces
relaxation and reduces the sympathetic output that raises blood pressure?
Similarly, chiropractic has been shown to help low back pain, but is this
because manipulation of the spine alters the flow of 'innate intelligence'
or because it helps to alleviate musculoskeletal trigger points?
In each of these cases it seems to be the methodology rather than the
principle of prana or innate intelligence that brings the therapeutic
effect.
There is thus a world of difference between the GP who makes a diagnosis by
taking a history and doing an examination and the alternative medicine
practitioner who does it by examining an iris or swinging a pendulum. There
is also a huge gulf between the GP who uses acupuncture on the basis of its
proven effectiveness in clinical trials and the practitioner who uses it
because he believes it alters the balance of yin and yang.
4. What is the worldview behind it?
What is the worldview behind the therapy? As mentioned acupuncture has its
roots in Taoism, yoga in Hinduism and therapeutic touch in New Age ideology.
This alone should make us suspicious.
What was the motivation of the therapist who developed the treatment?
Hahnemann, the German physician who developed homeopathy, was a freemason.
Kreger, the New York Nursing Professor who invented therapeutic touch, is a
Buddhist; and her collaborator Kunz was Vice President of the Theosophical
Society and an occultist and psychic. Edward Bach (of 'flower remedy' fame)
was a doctor who trusted his 'spirit self' for knowledge and guidance.
It might be objected here that much orthodox medicine has been developed by
atheists with an atheistic worldview and yet that does not stop us
benefiting from their insights. This is true. We are not saying that
pantheists are unable to discover beneficial treatments which are God-given;
but simply that their worldview should make us wary in assessing their
therapies.
5. Does it involve the occult?
Are occult means of divination used in deciding on diagnosis or treatment?
We should heed the biblical warnings about Mediums and Spiritists (Lv 9:31,
20:6; Acts 16:16-21), Astrology (Is 47:13-15), Magic Charms(Ezk 13:20-23),
Diviner's Wands (Ho 4:12),Sorcery (Acts 19:19), Witchcraft (Gal 5:20), Magic
Arts (Rev 9:21, 21:8, 22:15) and the Occult(Dt 18:10-12) generally.
6. Is it medically safe?
Most alternative therapies have little in the way of side effects, but there
are exceptions. Acupuncture, for example, may cause pneumothaorax or
transmit infection. Chiropractic neck manipulation has been associated with
vertebral artery obstruction and some herbal therapies result in toxicity or
even death. But perhaps the greatest danger is that alternative therapies
can create a false sense of security which leads to delay in diagnosis or in
implementation of effective orthodox medicine.
7. Has it stood the test of time?
This is not a guarantee, as clearly many occult devices stand the test of
time, but we can be equally sure that something which genuinely works or is
of God will stand the test of time.
Applying the tests
As an example of applying the tests above let us consider homeopathy. First,
there is no clear evidence that it actually works. Second, it has no
rational scientific basis; there is no reason known to science why a
solution containing not a single molecule of a given active substance should
have any therapeutic effect. Third, it is based on a pantheistic worldview
with the concept of 'vital energy' playing a prominent role. Fourth,
practitioners will often use occult means (such as pendulums) in diagnosis.
While it does appear to be safe and to have stood the test of time, these
other considerations should make us very wary indeed.
Difficult Questions
Finally let us finish by considering some of the objections which Christians
might raise to the kind of critique I have just given.
1. Weren't many medical treatments initially 'natural' anyway?
This is correct (eg aspirin (willow bark), digitalis (foxglove), Morphine
(poppies)) but the natural ingredient needs to be clearly identified and
given in the right dose. Many useful natural drugs are toxic if given in too
high a dose (eg digitalis, opium).
Decisions about which compound to give must also not be based on occult
practices (eg rituals, spells, charms, astrology, clairvoyance, pendulums,
spirit guides etc) as previously mentioned.
2. How can something be wrong if it actually works?
First, we need to be sure that the given therapy does actually work. Have
there been properly controlled clinical trials carried out showing that it
is better than placebo, or is it supported simply by anecdotal testimony?
Second we need to ask why it works. Is it working as a result of occult
power? (Dt 13:1-6; Ex 7:11,22, 8:7, 18,19; Mt 24:24). If so it may be
leading to the bondage, rather than to the liberation, of the patient. We
must be ready to test everything (1 Thes 5:21).
3. Isn't there some good in it?
It's often objected that we should not throw out the baby with the bath
water; and there is some truth in this... but is the baby and bath water
really a good analogy? It is very easy to see the difference between baby
and bath water but often extremely difficult to separate out the good and
bad in alternative medicine.
A better analogy is the poison mushroom. While poison mushrooms contain
plenty of good fat, carbohydrate and protein we recommend that people don't
eat them because it is impossible to separate out the good and the bad.
Everything that does not proceed from faith is sin; so if we have doubts it
may well be better to abstain (Rom 14:23).
4. How can it be wrong if good Christians I know use it?
Good Christians may be ignorant or deceived or simply have their consciences
blunted from habitual sin. There is no-one with perfect discernment who is
right in all their words, let alone all their beliefs (Jas 3:1). Good
Christians may also have a lot personally invested in a therapy if a friend
or relative is practising in it or has benefited from it and their
objectivity may be accordingly clouded.
Summary
We have reviewed the rapid rise in popularity in alternative medicine, and
seen that while therapies are diverse, there is a pantheistic ideology
behind many of them.
Alternative medicine is popular because of changes in the Western worldview,
the perceived failings, arrogance, costs and side effects of orthodox
medicine, and because it appears to bring a 'whole person' perspective.
While some therapies may genuinely work, apparent improvements are often due
to other reasons such as spontaneous remissions, the use of concurrent
orthodox medicine or the placebo effect.
Each branch of alternative medicine needs to be assessed individually to
determine its effectiveness, scientific basis, mode of action, safety,
underlying worldview and links with the occult.
We should be wary, but we must be careful also that we do not miss genuine
gifts which God has given. The biblical injunction to 'test everything...
hold on to the good... avoid every kind of evil' (1 Thes 5:21,22) is surely
as relevant here as in any other area of the Christian life.
Peter Saunders, MBBS
General Secretary, UK Christian Medical Fellowship
How should we respond to alternative medicine?
Alternative medicine is rising rapidly up the heathcare agenda. One in four
people use at least one form of alternative medicine and three out of four
people are in favour of alternative therapies.
One study cited by a recent report suggested that there may be millions of
consultations to non-conventional therapists each year, with about 2.5% of
the population receiving treatment. In addition, many doctors have received
some training in alternative medicine. In most member states of the European
Union the practice of medicine by non-recognised health professionals is
illegal.
When one considers the tight controls on the training and practice of
orthodox medical practitioners there is clearly a double standard operating.
If there are no proper controls for alternative medicine practitioners, then
the way is open for charlatans, profiteers and tricksters to operate
alongside those who are genuinely providing service of proven value.
What is alternative medicine?
Problems of definition
The report of the Board of Science and Education's working party,
Complementary Medicine, New Approaches to Good Practice defines
non-conventional therapies as 'those which are not widely used by orthodox
medical professionals nor widely taught at undergraduate level in medical
and paramedical courses' - but some therapies regarded as alternative are
taught formally in medical schools elsewhere.
The three terms complementary, alternative and holistic are used almost
interchangeably - but convey different messages. 'Alternative' implies an
either/or relationship with orthodox medicine; 'complementary' a both/and
relationship while 'holistic' implies that non-orthodox therapies treat the
'whole person'. All these assumptions are controversial.
The Diversity of Therapies
The report says that as many as 160 different forms of non-conventional
therapy have been identified. An A to Z of some of the most common includes:
Acupuncture, Acupressure, Alexander Technique, Aromatherapy, Auricular
Therapy, Bach Flower Remedies, Chiropractic, Crystal Therapy, Herbs,
Homeopathy, Hypnosis, Iridology, Macrobiotics, Massage, Naturopathy,
Osteopathy, Reflexology, Shiatsu, Therapeutic Touch, Transcendental
Meditation (TM), Yoga, Zen and Zone Therapy.
On first glance there seems to be very little similarity between one form of
alternative medicine and another; but what unifies most of them is the idea
of a 'life force' or 'vital energy' which ensures health, becomes disrupted
in disease and can be manipulated by various means.
For example, underlying acupuncture is the belief that there is a vital
force or energy called 'Chi' which flows freely through the body in twelve
meridians or channels. The flow of this energy depends on the balance
between two opposite forces; an active, 'male' force called 'yin' and a
passive, 'female' force called 'yang'. When the flow of the Chi energy is
free and uninterrupted health is ensured but if the balance between yin and
yang is disturbed or if there is any blockage to energy flow then disease
results.
These ideas have their roots in the ancient Chinese religion of Taoism which
has Chi, yin and yang as fundamental concepts.
Ideologies which underly other forms of medicine use different words for the
same general concept of 'life force'. Shiatsu is based on Shintoism and
calls the energy 'Ki'. Yoga and TM are based on Hinduism and call the force
'prana'. Homeopathy uses the term 'vital energy', chiropractic 'innate
intelligence' and Maori medicine terms the life force 'mana'.
The common theme of 'correcting imbalance'
In most alternative therapies health is believed to be restored by relieving
blockage and restoring flow in the 'life force', but the means whereby this
is achieved vary widely as listed below:
Needling: Acupuncture
Homeopathy: Minute doses of diluted medicine
Reflexology: Foot massage
Aromatherapy: Aromatic Oils
Yoga: Adopting Body Postures
Transcendental Meditation: Meditation
Therapeutic Touch: Hovering hands
Macrobiotics: Diet
Why is Alternative Medicine so popular?
There are seven main factors accounting for the rise in popularity of
alternative medicine in the Western World.
1. Changes in the Western worldview
Two hundred years ago in Britain most people had a Christian worldview; they
believed in a creator God who made us, intervened in our world and to whom
we were accountable. But with the publication of Darwin's Origin of the
Species and the rise of biblical criticism, this theistic world view gave
way to an atheistic one.
People began to doubt the existence of God and life after death. Man came to
be seen simply as a clever monkey, the product of matter, chance and time in
a directionless and purposeless universe. Morality became relative ('what's
right for me') rather than absolute.
Now we are seeing another worldview shift from atheism into pantheism.
Pantheism is the ideology which lies behind Eastern religions like Hinduism
and also the New Age Movement. God is an impersonal force of which we are
all simply a part. Death leads to reincarnation, and morality simply means
being in harmony with nature. All is one and all is God. This has meant an
increasing openness to all sorts of non-Christian spiritual belief along
with a scepticism and suspicion about science.
The change of worldview from theism, to atheism and then pantheism has had
profound effects on the way that medicine is practised. While Christian
doctors see human beings as a tri-unity of spirit, soul (or mind) and body
(1 Thes 5:23), atheistic doctors see them as consisting of just body and
mind. By contrast, New Age or alternative medicine practitioners see human
beings as an integrated whole; but from a pantheistic rather than a theistic
perspective.
Much of alternative medicine has its roots in the New Age Movement which in
turn is rooted in Astrology. Exponents believe that for the last 2,000 years
we have been in the age of Pisces (the fishes), but that now we are moving
into the age of Aquarius (the water-carrier). The Age of Pisces was
characterised by rationality, logic, objectivity and black and white
analytical 'left brain' thinking. By contrast the Age of Aquarius is
characterised by intuitional, subjective, grey 'right brain' thinking.
Sociologically the New Age Movement spawned the counterculture of the 1960s
with 'flower-power', peace protests, drug experimentation and the Hippie
movement. Spiritually it paved the way for a wide acceptance of Eastern
religious ideology, Astrology and the Occult. Medically the New Age Movement
has meant an ncreasing disillusionment with and scepticism about scientific
medicine.
As Christians we reject both the atheistic and pantheistic worldviews. They
are quite simply not the way the world is. God does exist. We are made in
his image, yet fallen; and death leads to judgement. We embrace the
scientific method as a gift of God, but we also see human beings as being
more than simply the sum of their parts.
2. Failings of orthodox medicine
There have been great advances in orthodox medicine over the last two
centuries which have led to the eradication and alleviation of many diseases
which were previously neither preventable nor curable: immunisations for
smallpox, antibiotics for infection, anti-psychotics for schizophrenia,
chemotherapy for cancer, drugs for heart failure and surgery for a whole
host of structural and anatomical problems.
But medicine also has its limits. With many illnesses we have a long way to
go. Solid tumours (eg lung, breast and bowel) are in general difficult to
treat if surgery fails. There is still much progress to be made in chronic
diseases like multiple sclerosis and rheumatoid arthritis, and there is
still no orthodox cure for musculoskeletal back pain and the common cold. If
we also consider that 75% of people seeing their doctor do not have any
defined organic illness, it is easy to see why people may decide to consult
alternative practitioners. Patients may also become impatient or
disillusioned with the NHS system of referrals and waiting lists.
With some diseases alternative medicine fares no worse than orthodox
medicine and it is in these areas that alternative medicine thrives.
3. Medical arrogance
Doctors have not always been ready to admit failure; and on occasions may go
on using treatments of doubtful value, or with potential side-effects rather
than being honest that nothing else can be done. The inappropriate use of
some chemotherapeutic agents or radical surgery for advanced cancer, for
instance, may cultivate distrust in patients who then seek other solutions.
4. The side effects of orthodox medicine
Orthodox medicines and surgery can produce side effects and complications
which are sometimes fatal. Examples are often widely publicised by an
unforgiving press. By contrast most alternative medicine has little in the
way of side-effects.
5. Loss of a whole person perspective
Advances in the science of medicine may be at the expense of the art of
medicine. Doctors have less time for the patient, touch patients less often,
and are tempted much more now to treat their patients simply as anatomical
structures or biochemical machines. There is much less in medicine now of
the ritual handshake, pulse-taking, hand on the shoulder etc. Too often the
doctor is now esconced behind his PC and perhaps a formidable desk; while
many alternative therapies involve plenty of 'hands-on' diagnosis and
treatment.
Alternative medical practitioners generally are able to give much more in
terms of time and touch, thereby engendering more trust. Homeopaths, for
example, may spend up to 90 minutes in a first consultation and 45 minutes
on follow up. Patients naturally assume, 'He must know what he is doing
because he spends so much time with me'.
6. Costs of high-tech medicine
High tech medicine is expensive, while often the only cost of alternative
medicine is the therapist's time. This is one feature making alternative
therapies increasingly attractive to health insurance managers looking to
cut costs.
7. Consumer demand
Patients are prepared to pay for therapies which promise what orthodox
medicine has failed to deliver; especially for incurable cancer or chronic
pain. This demand means that there is plenty of room in the market place for
more practitioners.
Why does alternative medicine seem to work?
Why is it that so many people are seeking alternative medicine therapies
when so many of them have been shown not to work in clinical trials? There
are at least eight reasons why.
1. Genuine therapeutic effects
Some alternative medicines genuinely work. Over half of prescription and
over-the-counter drugs originate as natural compounds or are based on them
(eg aspirin, digitalis, morphine, adrenaline, curare, all antibiotics except
the quinolones etc); and the natural world may hold many more therapeutic
treasures.
It is quite conceivable that some alternative medicine practitioners are
using useful compounds or techniques which are not yet known to orthodox
medicine. But if this is the case then we need to discover what they are so
that they can be isolated and given in the correct dose!
2. The placebo effect
If we strongly believe that something (or someone) has the power to help us,
then we are much more likely to experience benefit. It is a fact that one
third of people given an inert compound to relieve a particular symptom will
report relief of that symptom. This is called the placebo effect. In the
same way patients who share the therapist's belief in New Age pantheism or
the existence of 'life force' will be more likely to benefit from their
therapy.
3. Concurrent use of therapies
Belief in an alternative therapy's effectiveness may develop when it is used
concurrently with another more effective orthodox therapy. The effect is
then wrongly ascribed to the alternative therapy.
4. Psychosomatic illness
Many illnesses are psychosomatic; in other words a patient's stress level or
mental state can aggravate the symptoms. Asthma, eczema, peptic ulcer and
rheumatoid arthritis fall in this category. Alternative therapies which
induce relaxation may then improve the symptoms.
5. Spontaneous remissions
Many diseases get better by themselves. Viral infections (eg warts, common
cold) and some tumours (eg malignant melanoma) are examples of conditions
which may spontaneously regress. In such cases people may well then
attribute therapeutic effect to the remedy they were trying at the time of
recovery, when it fact their improvement at that time may just have been
coincidence. This is called the 'post hoc, propter hoc' fallacy; in other
words 'because B followed A, then A must have caused B'.
6. Dietary influences
There is a strong link between diet and health, and many alternative
therapists recommend that patients drink less coffee or alcohol, eat less
fat or more fibre or take vitamins. The resulting improvement may then be
due to the change in diet, rather that the alternative therapy being used
concurrently.
7. Imagined improvement
Some patients, especially if open to suggestion from others that they 'look
better', may simply imagine that they 'feel better'; especially if the
symptoms were of a vague nature in the first place. Alternatively they may
simply get better at tolerating symptoms, and imagine that the symptoms
themselves have diminished.
8. Demonic involvement
There may be real spiritual forces operating to bring healing through
demonic power. Such healings may be the bait that Satan then uses to draw a
person more deeply into the occult, or into accepting a pantheistic
worldview.
How do we assess individual modalities?
It is not possible in this brief review to comment on each and every
alternative therapy; but here are some principles which can be generally
applied.
1. Do the claims fit the facts?
Any new orthodox medicine has to undergo extensive pharmacological testing
to assess its therapeutic potential, side-effects and interactions with
other drugs. Tests are first carried out in animals, then in human
volunteers and only then are short and long term studies carried out on real
patients.
If a drug passes these tests it must then be approved by the Licensing
Authority. This ensures that drugs reaching the public are both safe and
effective.
In the same way medical practitioners must undergo a five year undergraduate
training and then work for a further year before they are registered and
able to practice independently of an institution.
Similar safeguards for alternative medicines and practitioners are largely
absent. There is simply no comparison between the double-blind, randomised,
placebo-controlled cross-over trials which many orthodox drugs undergo and
the subjective anecdotal 'evidence' supporting much alternative medicine.
Furthermore, when proper trials are employed the results are often
unconvincing.
A Department of Complementary Medicine has recently been set up at the
University of Exeter to review trials on alternative and complementary
therapies. The contents pages of their quarterly journal FACT (Focus on
Alternative and Complementary Therapies) are available on the internet and
make interesting reading. Many of the published studies give inconclusive
results.
A 1990 French review of 40 controlled trials on homeopathy concluded that
the majority were flawed by small sample size and subjective measures of
improvement. A 1991 review of 107 trials was similarly inconclusive.
By contrast there is evidence that patients with low back pain treated with
chiropractic derive more benefit and long term satisfaction than those
treated by hospitals; and that, according to a consensus panel of the US
National Institutes of Health, acupuncture is an effective treatment for
nausea and vomiting induced by anaesthesia, pregnancy or chemotherapy.
The biblical injunction to 'enquire, probe and investigate thoroughly' (Dt
13:14ff) must surely be relevant here. We should always ask, 'What is the
evidence that this therapy really works?'
2. Is there a rational scientific basis?
We know how most orthodox drugs work. They may stimulate receptors (eg b
agonists in asthma), modify cell transport (eg probenecid), block enzymes
(eg allopurinol), replace missing compounds (eg vitamin B12) or chelate
toxins (eg penicillamine). The action of any given drug is determined by its
concentration at the site of action; and the actions are understandable in
view of their known biochemical and physiological effects. By contrast the
majority of alternative medicines have no rational scientific basis.
Homeopathy involves diluting an active compound to such a degree that the
resulting 'potency' contains not even a molecule of the original active
ingredient.
Iridology claims to link each area of the iris with a separate part of the
body when it is known that no such anatomical links exist. Reflexology is
based on the belief that there are connections between the sole of the foot
and internal organs; again in the absence of any scientific evidence.
There is similarly no evidence for the existence of the 'meridians' (energy
channels) of acupuncture or the 'chakras' (psychic spinal centres) of yoga.
In some cases an alternative therapy may be working because of some
scientific reason unknown to the therapist. It has been suggested, for
instance that the therapeutic effects of acupuncture could be explained by
the release of endogenous (naturally produced) pain-killers called
endorphins. If this is indeed confirmed, then acupuncture will be shown to
have a scientific basis, but this will not, by any means prove that Taoist
ideology is true or that Chi energy exists.
3. Is it the improvement due to the therapy or some other factor?
Transcendental Meditation lowers blood pressure, but why? Is it because it
enables the Goddess Kundalini to migrate up the spine and unite with Brahman
in the head (as Hindus believe); or is it simply that meditation induces
relaxation and reduces the sympathetic output that raises blood pressure?
Similarly, chiropractic has been shown to help low back pain, but is this
because manipulation of the spine alters the flow of 'innate intelligence'
or because it helps to alleviate musculoskeletal trigger points?
In each of these cases it seems to be the methodology rather than the
principle of prana or innate intelligence that brings the therapeutic
effect.
There is thus a world of difference between the GP who makes a diagnosis by
taking a history and doing an examination and the alternative medicine
practitioner who does it by examining an iris or swinging a pendulum. There
is also a huge gulf between the GP who uses acupuncture on the basis of its
proven effectiveness in clinical trials and the practitioner who uses it
because he believes it alters the balance of yin and yang.
4. What is the worldview behind it?
What is the worldview behind the therapy? As mentioned acupuncture has its
roots in Taoism, yoga in Hinduism and therapeutic touch in New Age ideology.
This alone should make us suspicious.
What was the motivation of the therapist who developed the treatment?
Hahnemann, the German physician who developed homeopathy, was a freemason.
Kreger, the New York Nursing Professor who invented therapeutic touch, is a
Buddhist; and her collaborator Kunz was Vice President of the Theosophical
Society and an occultist and psychic. Edward Bach (of 'flower remedy' fame)
was a doctor who trusted his 'spirit self' for knowledge and guidance.
It might be objected here that much orthodox medicine has been developed by
atheists with an atheistic worldview and yet that does not stop us
benefiting from their insights. This is true. We are not saying that
pantheists are unable to discover beneficial treatments which are God-given;
but simply that their worldview should make us wary in assessing their
therapies.
5. Does it involve the occult?
Are occult means of divination used in deciding on diagnosis or treatment?
We should heed the biblical warnings about Mediums and Spiritists (Lv 9:31,
20:6; Acts 16:16-21), Astrology (Is 47:13-15), Magic Charms(Ezk 13:20-23),
Diviner's Wands (Ho 4:12),Sorcery (Acts 19:19), Witchcraft (Gal 5:20), Magic
Arts (Rev 9:21, 21:8, 22:15) and the Occult(Dt 18:10-12) generally.
6. Is it medically safe?
Most alternative therapies have little in the way of side effects, but there
are exceptions. Acupuncture, for example, may cause pneumothaorax or
transmit infection. Chiropractic neck manipulation has been associated with
vertebral artery obstruction and some herbal therapies result in toxicity or
even death. But perhaps the greatest danger is that alternative therapies
can create a false sense of security which leads to delay in diagnosis or in
implementation of effective orthodox medicine.
7. Has it stood the test of time?
This is not a guarantee, as clearly many occult devices stand the test of
time, but we can be equally sure that something which genuinely works or is
of God will stand the test of time.
Applying the tests
As an example of applying the tests above let us consider homeopathy. First,
there is no clear evidence that it actually works. Second, it has no
rational scientific basis; there is no reason known to science why a
solution containing not a single molecule of a given active substance should
have any therapeutic effect. Third, it is based on a pantheistic worldview
with the concept of 'vital energy' playing a prominent role. Fourth,
practitioners will often use occult means (such as pendulums) in diagnosis.
While it does appear to be safe and to have stood the test of time, these
other considerations should make us very wary indeed.
Difficult Questions
Finally let us finish by considering some of the objections which Christians
might raise to the kind of critique I have just given.
1. Weren't many medical treatments initially 'natural' anyway?
This is correct (eg aspirin (willow bark), digitalis (foxglove), Morphine
(poppies)) but the natural ingredient needs to be clearly identified and
given in the right dose. Many useful natural drugs are toxic if given in too
high a dose (eg digitalis, opium).
Decisions about which compound to give must also not be based on occult
practices (eg rituals, spells, charms, astrology, clairvoyance, pendulums,
spirit guides etc) as previously mentioned.
2. How can something be wrong if it actually works?
First, we need to be sure that the given therapy does actually work. Have
there been properly controlled clinical trials carried out showing that it
is better than placebo, or is it supported simply by anecdotal testimony?
Second we need to ask why it works. Is it working as a result of occult
power? (Dt 13:1-6; Ex 7:11,22, 8:7, 18,19; Mt 24:24). If so it may be
leading to the bondage, rather than to the liberation, of the patient. We
must be ready to test everything (1 Thes 5:21).
3. Isn't there some good in it?
It's often objected that we should not throw out the baby with the bath
water; and there is some truth in this... but is the baby and bath water
really a good analogy? It is very easy to see the difference between baby
and bath water but often extremely difficult to separate out the good and
bad in alternative medicine.
A better analogy is the poison mushroom. While poison mushrooms contain
plenty of good fat, carbohydrate and protein we recommend that people don't
eat them because it is impossible to separate out the good and the bad.
Everything that does not proceed from faith is sin; so if we have doubts it
may well be better to abstain (Rom 14:23).
4. How can it be wrong if good Christians I know use it?
Good Christians may be ignorant or deceived or simply have their consciences
blunted from habitual sin. There is no-one with perfect discernment who is
right in all their words, let alone all their beliefs (Jas 3:1). Good
Christians may also have a lot personally invested in a therapy if a friend
or relative is practising in it or has benefited from it and their
objectivity may be accordingly clouded.
Summary
We have reviewed the rapid rise in popularity in alternative medicine, and
seen that while therapies are diverse, there is a pantheistic ideology
behind many of them.
Alternative medicine is popular because of changes in the Western worldview,
the perceived failings, arrogance, costs and side effects of orthodox
medicine, and because it appears to bring a 'whole person' perspective.
While some therapies may genuinely work, apparent improvements are often due
to other reasons such as spontaneous remissions, the use of concurrent
orthodox medicine or the placebo effect.
Each branch of alternative medicine needs to be assessed individually to
determine its effectiveness, scientific basis, mode of action, safety,
underlying worldview and links with the occult.
We should be wary, but we must be careful also that we do not miss genuine
gifts which God has given. The biblical injunction to 'test everything...
hold on to the good... avoid every kind of evil' (1 Thes 5:21,22) is surely
as relevant here as in any other area of the Christian life.
Wednesday, September 24, 2008
A Sane Approach to Exercise
Only 20% of people are currently doing enough exercise to get health
benefits from it. A sane approach is easy. A sane approach is just difficult
enough to produce benefits for the heart, lungs and muscles.
Working regular exercise into your busy life takes a real commitment. Even
the greatest enthusiasm does not last for long. So it is good to make a
habit of exercising at the same time of day. Whenever possible, exercise
with others.
Running is not a good choice for exercise because up to four of every ten
adults who run will have an injury to their legs or feet in a year. In the
long run running increases arthritis. Better for most people to walk
regularly...it's something you can do for the rest of your life.
Walk without stopping, use a stationary cycle, or do any continuous activity
for 20 minutes, 3 times a week to make your heart beat a little faster and
to make you breathe a little harder. This activity does not need to be all
at once; it can be spread throughout the day.
How you feel is a better guide for walking than a "target heart rate". If
you can sing, you are walking too slowly. If you are too short of breath to
talk, you are walking too fast.
Slow stretching relaxes muscles and increases flexibility. This is
especially true when muscles are warm with increased blood circulation after
exercise. Gentle movement lubricates joints and reduces pain. Stretching
should be slow and not cause pain. [AAFP]
benefits from it. A sane approach is easy. A sane approach is just difficult
enough to produce benefits for the heart, lungs and muscles.
Working regular exercise into your busy life takes a real commitment. Even
the greatest enthusiasm does not last for long. So it is good to make a
habit of exercising at the same time of day. Whenever possible, exercise
with others.
Running is not a good choice for exercise because up to four of every ten
adults who run will have an injury to their legs or feet in a year. In the
long run running increases arthritis. Better for most people to walk
regularly...it's something you can do for the rest of your life.
Walk without stopping, use a stationary cycle, or do any continuous activity
for 20 minutes, 3 times a week to make your heart beat a little faster and
to make you breathe a little harder. This activity does not need to be all
at once; it can be spread throughout the day.
How you feel is a better guide for walking than a "target heart rate". If
you can sing, you are walking too slowly. If you are too short of breath to
talk, you are walking too fast.
Slow stretching relaxes muscles and increases flexibility. This is
especially true when muscles are warm with increased blood circulation after
exercise. Gentle movement lubricates joints and reduces pain. Stretching
should be slow and not cause pain. [AAFP]
Thursday, August 28, 2008
Acetylsalicylic Acid Linked to Lower Risk of Cancer and Heart Disease
Regular acetylsalicylic acid use may significantly reduce the incidence of
both cancer and heart disease, according to a large new study, but other
nonsteroidal anti-inflammatory drugs, or NSAIDs, have no effect.
Researchers studied 22,507 postmenopausal women, following them for 10
years. All reported their acetylsalicylic acid and NSAID use as part of a
detailed physical and behavioral health questionnaire. None of the women had
cancer or heart disease at the start of the study.
After controlling for age, exercise, diet and other factors, those who used
acetylsalicylic acid had a 16 percent reduced risk of getting cancer, and a
13 percent reduced risk of cancer death, compared with women who never used
it. Acetylsalicylic acid use was also associated with a 25 percent reduced
risk of dying from coronary artery disease and an 18 percent reduction in
all-cause mortality compared with those who never took acetylsalicylic acid.
But use of other NSAIDs like ibuprofen and naproxen had no effect, and there
was no significantly reduced risk among acetylsalicylic acid users who were
currently smoking. The study was published in the Journal of the National
Cancer Institute.
The authors acknowledged that the study was not a randomized trial, that the
questionnaire did not assess duration of acetylsalicylic acid use, and that
the participants were all postmenopausal women, most of whom were white.
"It would be premature at this point to advise women to take acetylsalicylic
acid," said Dr. Aditya Bardia, the lead author.
"The study does produce provocative evidence that acetylsalicylic acid can
reduce mortality, but for now it would be best that women talk to their
health care provider about the risks and benefits of acetylsalicylic acid
use." [AAFP]
both cancer and heart disease, according to a large new study, but other
nonsteroidal anti-inflammatory drugs, or NSAIDs, have no effect.
Researchers studied 22,507 postmenopausal women, following them for 10
years. All reported their acetylsalicylic acid and NSAID use as part of a
detailed physical and behavioral health questionnaire. None of the women had
cancer or heart disease at the start of the study.
After controlling for age, exercise, diet and other factors, those who used
acetylsalicylic acid had a 16 percent reduced risk of getting cancer, and a
13 percent reduced risk of cancer death, compared with women who never used
it. Acetylsalicylic acid use was also associated with a 25 percent reduced
risk of dying from coronary artery disease and an 18 percent reduction in
all-cause mortality compared with those who never took acetylsalicylic acid.
But use of other NSAIDs like ibuprofen and naproxen had no effect, and there
was no significantly reduced risk among acetylsalicylic acid users who were
currently smoking. The study was published in the Journal of the National
Cancer Institute.
The authors acknowledged that the study was not a randomized trial, that the
questionnaire did not assess duration of acetylsalicylic acid use, and that
the participants were all postmenopausal women, most of whom were white.
"It would be premature at this point to advise women to take acetylsalicylic
acid," said Dr. Aditya Bardia, the lead author.
"The study does produce provocative evidence that acetylsalicylic acid can
reduce mortality, but for now it would be best that women talk to their
health care provider about the risks and benefits of acetylsalicylic acid
use." [AAFP]
Monday, August 18, 2008
Vitamins Don't Stop Eye Disease
A healthy diet rich in vitamins and minerals does not protect against the world's leading cause of sight loss, a study has found. Antioxidants have long been thought to help guard against age-related macular degeneration (AMD), a debilitating condition which blurs central vision over time.
Patients don't go blind but the progressive breakdown of light-sensitive cells at the back of the retina makes it increasing impossible to read, drive or carry out daily tasks.
A new international review by researchers has now found that dietary nutrients do nothing to stop a person developing the disease.
This leaves age, genetics and smoking as the only proven factors connected to onset of the disease, which affects one in seven people aged over 50. Most have the slower moving "dry" form of the condition.
Researchers from the Centre for Eye Research analysed evidence from 11 studies involving almost 150,000 people who were tracked for an average of nine years.
The studies looked at intake of various antioxidants such as vitamin C found in fruit, vitamin E in foods such as nuts, zinc found in many meats and carotenoids found in many root vegetables.
The pooled results showed that people with higher intakes of vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, a-carotene, b-carotene, b-cryptoxanthin and lycopene were no more or less likely to develop the condition than those consuming less.
Three of the studies also found little effect if the antioxidants were taken as supplements.
"There is insufficient evidence to support the role of dietary antioxidant supplements for the primary prevention of early AMD," the authors concluded in an article published in the British Medical Journal.
"Cigarette smoking remains the only widely accepted modifiable risk factor for the primary prevention of AMD, and patients seeking advice should be encouraged to stop smoking."
Eye expert Jennifer Evans, from the International Centre for Eye Health, supported the findings but suggested there was still some evidence that antioxidant supplements could be useful to people already in the early stages of the disease.
Blackmores director of research and prevention Philip Daffy said the study had "serious deficiencies".
"Sufferers of macular degeneration who take antioxidant supplements formulated to slow the progression of this disease should not be alarmed by this study," he said.
"The study has some serious deficiencies and only relates to antioxidant intake for the prevention of AMD, not it's treatment."
Blackmores sells products containing antioxidants, which it markets as helping to maintain healthy eyes. [SMH]
Patients don't go blind but the progressive breakdown of light-sensitive cells at the back of the retina makes it increasing impossible to read, drive or carry out daily tasks.
A new international review by researchers has now found that dietary nutrients do nothing to stop a person developing the disease.
This leaves age, genetics and smoking as the only proven factors connected to onset of the disease, which affects one in seven people aged over 50. Most have the slower moving "dry" form of the condition.
Researchers from the Centre for Eye Research analysed evidence from 11 studies involving almost 150,000 people who were tracked for an average of nine years.
The studies looked at intake of various antioxidants such as vitamin C found in fruit, vitamin E in foods such as nuts, zinc found in many meats and carotenoids found in many root vegetables.
The pooled results showed that people with higher intakes of vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, a-carotene, b-carotene, b-cryptoxanthin and lycopene were no more or less likely to develop the condition than those consuming less.
Three of the studies also found little effect if the antioxidants were taken as supplements.
"There is insufficient evidence to support the role of dietary antioxidant supplements for the primary prevention of early AMD," the authors concluded in an article published in the British Medical Journal.
"Cigarette smoking remains the only widely accepted modifiable risk factor for the primary prevention of AMD, and patients seeking advice should be encouraged to stop smoking."
Eye expert Jennifer Evans, from the International Centre for Eye Health, supported the findings but suggested there was still some evidence that antioxidant supplements could be useful to people already in the early stages of the disease.
Blackmores director of research and prevention Philip Daffy said the study had "serious deficiencies".
"Sufferers of macular degeneration who take antioxidant supplements formulated to slow the progression of this disease should not be alarmed by this study," he said.
"The study has some serious deficiencies and only relates to antioxidant intake for the prevention of AMD, not it's treatment."
Blackmores sells products containing antioxidants, which it markets as helping to maintain healthy eyes. [SMH]
Thursday, August 14, 2008
Case for Real Food
Is there more to a carrot than beta carotene? Is lycopene the best we get
from tomatoes? And when we heap our plates with salmon, are we serving up
something other than omega-3s?
For years the scientific community has viewed individual vitamins and
nutrients as the best that food has to offer. Nutrition studies have
isolated beta carotene, calcium, vitamin E and lycopene, among other
nutrients, in order to study their health benefits in the body.
But now, after several vitamin studies have produced disappointing results,
there's a growing belief that food is more than just a sum of its nutrient
parts. In a commentary for the journal Nutrition Reviews, professor of
epidemiology David R. Jacobs argues that nutrition researchers should focus
on whole foods rather than only on single nutrients. "We argue for a need to
return to food as the source of nutrition knowledge,'' writes Dr. Jacobs
with co-author Linda C. Tapsell, a nutrition researcher.
Dr. Jacobs believes that nutrition science needs to consider the effects of
"food synergy,'' the notion that the health benefits of certain foods aren't
likely to come from a single nutrient but rather combinations of compounds
that work better together than apart. "Every food is much more complicated
than any drug,'' said Dr. Jacobs. "It makes sense to want to break it down.
But you get a lot of people talking in the popular press about carbohydrates
and fats in particular as if they were unified entities. They're not. They'
re extremely complicated.''
The narrow focus on the health effects of single nutrients stems from the
earliest days of nutrition research. In 1937, two scientists won a Nobel
Prize for identifying vitamin C as the essential component in citrus fruit
that prevents scurvy. The finding spurred interest by the scientific
community to study other biologically active nutrients in foods.
For as long as observational studies have shown that diets rich in fruits
and vegetables, unsaturated fat and fish, among other things, are associated
with better health, nutrition researchers have been busily deconstructing
these foods to identify the most potent nutrients. For example, vitamin E
has been widely studied as a heart protector.
But attributing the broad health benefits of a diet to a single compound has
proven to be misguided. Several studies have suggested an association
between diets rich in beta carotene and vitamin A, for instance, and lower
risk for many types of cancer. But in a well-known 1994 Finnish study,
smokers who took beta carotene were found to have an 18 percent higher
incidence of lung cancer. In 1996, researchers gave beta carotene and
vitamin A to smokers and workers exposed to asbestos. But the trial had to
be stopped because the people taking the combined therapy showed markedly
higher risks for lung cancer and heart attacks.
Since then, studies of other vitamins, notably vitamins E and B, have also
failed to show a benefit. Manufacturers say the problem is that vitamins are
too often examined in sick people while the real benefit may be in
preventing disease. But Dr. Jacobs notes that the better explanation may
simply be that food synergy, rather than the biological activity of a few
key nutrients, is the real reason that certain diets, like those consumed in
the parts of the Mediterranean and Japan, appear to lower the risks of heart
disease and other health problems.
"People ask me what vitamins they should take,'' said Dr. Jacobs. "I say
'Don't take any. Just make sure you have a nutrient-rich diet.' '' [NYT]
from tomatoes? And when we heap our plates with salmon, are we serving up
something other than omega-3s?
For years the scientific community has viewed individual vitamins and
nutrients as the best that food has to offer. Nutrition studies have
isolated beta carotene, calcium, vitamin E and lycopene, among other
nutrients, in order to study their health benefits in the body.
But now, after several vitamin studies have produced disappointing results,
there's a growing belief that food is more than just a sum of its nutrient
parts. In a commentary for the journal Nutrition Reviews, professor of
epidemiology David R. Jacobs argues that nutrition researchers should focus
on whole foods rather than only on single nutrients. "We argue for a need to
return to food as the source of nutrition knowledge,'' writes Dr. Jacobs
with co-author Linda C. Tapsell, a nutrition researcher.
Dr. Jacobs believes that nutrition science needs to consider the effects of
"food synergy,'' the notion that the health benefits of certain foods aren't
likely to come from a single nutrient but rather combinations of compounds
that work better together than apart. "Every food is much more complicated
than any drug,'' said Dr. Jacobs. "It makes sense to want to break it down.
But you get a lot of people talking in the popular press about carbohydrates
and fats in particular as if they were unified entities. They're not. They'
re extremely complicated.''
The narrow focus on the health effects of single nutrients stems from the
earliest days of nutrition research. In 1937, two scientists won a Nobel
Prize for identifying vitamin C as the essential component in citrus fruit
that prevents scurvy. The finding spurred interest by the scientific
community to study other biologically active nutrients in foods.
For as long as observational studies have shown that diets rich in fruits
and vegetables, unsaturated fat and fish, among other things, are associated
with better health, nutrition researchers have been busily deconstructing
these foods to identify the most potent nutrients. For example, vitamin E
has been widely studied as a heart protector.
But attributing the broad health benefits of a diet to a single compound has
proven to be misguided. Several studies have suggested an association
between diets rich in beta carotene and vitamin A, for instance, and lower
risk for many types of cancer. But in a well-known 1994 Finnish study,
smokers who took beta carotene were found to have an 18 percent higher
incidence of lung cancer. In 1996, researchers gave beta carotene and
vitamin A to smokers and workers exposed to asbestos. But the trial had to
be stopped because the people taking the combined therapy showed markedly
higher risks for lung cancer and heart attacks.
Since then, studies of other vitamins, notably vitamins E and B, have also
failed to show a benefit. Manufacturers say the problem is that vitamins are
too often examined in sick people while the real benefit may be in
preventing disease. But Dr. Jacobs notes that the better explanation may
simply be that food synergy, rather than the biological activity of a few
key nutrients, is the real reason that certain diets, like those consumed in
the parts of the Mediterranean and Japan, appear to lower the risks of heart
disease and other health problems.
"People ask me what vitamins they should take,'' said Dr. Jacobs. "I say
'Don't take any. Just make sure you have a nutrient-rich diet.' '' [NYT]
Tuesday, August 12, 2008
Experts Recommend Eat Fish While Pregnant
Pregnant and breast-feeding women should eat at least 340 grams of fish and
other seafood a week because the benefits for infant brain development
outweigh any worries about mercury contamination, a group of experts said.
The recommendations contradict warnings that these women should consume no
more than 340 grams of fish and other seafood weekly due to concerns that
mercury -- which can harm the nervous system of fetuses -- might exist in
trace amounts in this food.
But the group of 14 obstetricians and nutritionists said the threat of
mercury poisoning remains only theoretical, while the warnings have scared
many pregnant women into not eating fish at all, robbing them and their
babies of vital nutrients like omega-3 fatty acids, known to help brain
development.
The nutrients in fish and seafood are important for brain and motor skill
development in children and can help prevent postpartum depression in
mothers, the experts said.
No Case of Fetal Mercury Toxicity
The coalition said it received $60,000 from a seafood industry trade group,
but the experts defended the independence of their work.
"There has been no case of fetal mercury toxicity due to fish consumption
reported," said one of the experts, Dr. Ashley Roman, a professor of
obstetrics and Gynecology.
The group urged that women who want to become pregnant, are pregnant or are
breast-feeding should eat a minimum of 340 grams per week of fish like
salmon, tuna, sardines and mackerel and seafood like shrimp, lobster and
clams.
That amounts to about two to three servings a week. It did not state a
recommended upper limit for consumption.
"There are some fish that have been shown to be higher in mercury and in
other important trace elements such as shark and swordfish," Roman said.
"Those might be sources of fish women still might want to stay away from.
But the vast majority of fish out there present in the diet, those are
generally very healthy fishes."
"We're not saying that women should eat 21 meals a week of fish. That's not
the message here," added nutritionist Thomas Brenna, another member of the
group.
The experts cited a study published in the Lancet medical journal finding
that children whose mothers ate more fish and other seafood while pregnant
were smarter and had better developmental skills than those whose mothers
ate less or none.
It looked at children of 8,000 British women to see how children fared if
their mothers ate more than 340 grams a week.
The Food and Drug Administration and Environmental Protection Agency issued
advisories telling women who were pregnant, breast-feeding or trying to
become pregnant, as well as young children, to eat no more than 340 grams
weekly of some types of fish due to mercury concerns.
Estimates on the dangers posed by mercury come from people exposed in
chemical spills. No major studies have shown that mercury from food or
vaccines has caused brain damage to mothers or children.
"While it's recognized that fish is an important source of protein,
especially for pregnant women, this new emphasis on eating more than 12
ounces of fish per week, without mention of the need to avoid
mercury-contaminated fish, appears to throw the baby out with the bath
water," Michael Bender, director of the Mercury Policy Project advocacy
group that believes mercury exposure has damaged children, said in a
statement. [RT]
other seafood a week because the benefits for infant brain development
outweigh any worries about mercury contamination, a group of experts said.
The recommendations contradict warnings that these women should consume no
more than 340 grams of fish and other seafood weekly due to concerns that
mercury -- which can harm the nervous system of fetuses -- might exist in
trace amounts in this food.
But the group of 14 obstetricians and nutritionists said the threat of
mercury poisoning remains only theoretical, while the warnings have scared
many pregnant women into not eating fish at all, robbing them and their
babies of vital nutrients like omega-3 fatty acids, known to help brain
development.
The nutrients in fish and seafood are important for brain and motor skill
development in children and can help prevent postpartum depression in
mothers, the experts said.
No Case of Fetal Mercury Toxicity
The coalition said it received $60,000 from a seafood industry trade group,
but the experts defended the independence of their work.
"There has been no case of fetal mercury toxicity due to fish consumption
reported," said one of the experts, Dr. Ashley Roman, a professor of
obstetrics and Gynecology.
The group urged that women who want to become pregnant, are pregnant or are
breast-feeding should eat a minimum of 340 grams per week of fish like
salmon, tuna, sardines and mackerel and seafood like shrimp, lobster and
clams.
That amounts to about two to three servings a week. It did not state a
recommended upper limit for consumption.
"There are some fish that have been shown to be higher in mercury and in
other important trace elements such as shark and swordfish," Roman said.
"Those might be sources of fish women still might want to stay away from.
But the vast majority of fish out there present in the diet, those are
generally very healthy fishes."
"We're not saying that women should eat 21 meals a week of fish. That's not
the message here," added nutritionist Thomas Brenna, another member of the
group.
The experts cited a study published in the Lancet medical journal finding
that children whose mothers ate more fish and other seafood while pregnant
were smarter and had better developmental skills than those whose mothers
ate less or none.
It looked at children of 8,000 British women to see how children fared if
their mothers ate more than 340 grams a week.
The Food and Drug Administration and Environmental Protection Agency issued
advisories telling women who were pregnant, breast-feeding or trying to
become pregnant, as well as young children, to eat no more than 340 grams
weekly of some types of fish due to mercury concerns.
Estimates on the dangers posed by mercury come from people exposed in
chemical spills. No major studies have shown that mercury from food or
vaccines has caused brain damage to mothers or children.
"While it's recognized that fish is an important source of protein,
especially for pregnant women, this new emphasis on eating more than 12
ounces of fish per week, without mention of the need to avoid
mercury-contaminated fish, appears to throw the baby out with the bath
water," Michael Bender, director of the Mercury Policy Project advocacy
group that believes mercury exposure has damaged children, said in a
statement. [RT]
Monday, August 11, 2008
Get Natural Sugar High
These juicy orbs of tropical delight are available, so make the most of
them. As you sink your teeth into the luscious orange flesh, rest assured
that you will benefit from all that Mangifera indica has to offer in the
form of nutrition - a good source of dietary fibre and vitamins B6, A and
C - plus low levels of saturated fat, cholesterol and sodium.
Eating a mango au naturel is one of life's great pleasures, but this
versatile fruit of Indian origin also adds a touch of class to sweet and
savoury dishes.
Use it with cos lettuce and avocado and a slightly sweet dressing of olive
oil and a sticky balsamic vinegar, then top with coriander or mint. Terrific
on a hot night.
Make a salad of mignonette lettuce (or oak), avocado and sliced mango, layer
slices of marinated, barbecued chicken or prawns over it, then top with
generous dollops of curry mayonnaise and lime slices. Great for a crowd.
Mango goes well with ginger, lemongrass, cucumber and diced red pepper and
makes a great smoothie and salsa.
Store unripe fruit at room temperature for a few days, then once ripe it can
be stored in the refrigerator for about three days, but not in a plastic
bag. Mangoes freeze really well either sliced, bagged or pureed into ice
cube trays.
To choose a mango, make sure it has the characteristic sweet aroma and that
it gives to gentle pressure at the stem. A handsome tree, it needs a
frost-free climate and, once established, will produce a profusion of white
flowers. Only a small percentage of these set fruit. [SMH]
them. As you sink your teeth into the luscious orange flesh, rest assured
that you will benefit from all that Mangifera indica has to offer in the
form of nutrition - a good source of dietary fibre and vitamins B6, A and
C - plus low levels of saturated fat, cholesterol and sodium.
Eating a mango au naturel is one of life's great pleasures, but this
versatile fruit of Indian origin also adds a touch of class to sweet and
savoury dishes.
Use it with cos lettuce and avocado and a slightly sweet dressing of olive
oil and a sticky balsamic vinegar, then top with coriander or mint. Terrific
on a hot night.
Make a salad of mignonette lettuce (or oak), avocado and sliced mango, layer
slices of marinated, barbecued chicken or prawns over it, then top with
generous dollops of curry mayonnaise and lime slices. Great for a crowd.
Mango goes well with ginger, lemongrass, cucumber and diced red pepper and
makes a great smoothie and salsa.
Store unripe fruit at room temperature for a few days, then once ripe it can
be stored in the refrigerator for about three days, but not in a plastic
bag. Mangoes freeze really well either sliced, bagged or pureed into ice
cube trays.
To choose a mango, make sure it has the characteristic sweet aroma and that
it gives to gentle pressure at the stem. A handsome tree, it needs a
frost-free climate and, once established, will produce a profusion of white
flowers. Only a small percentage of these set fruit. [SMH]
Thursday, August 7, 2008
Sterilization
Sterilization involves making a person incapable of reproduction.
Sterilization should always be considered permanent. However, an operation
that reconnects the appropriate tube (reanastomosis) can be performed to
restore fertility. Reanastomosis is less likely to be effective in men than
in women. For couples, pregnancy rates are 45 to 60% after reanastomosis in
men and 50 to 80% after reanastomosis in women.
Vasectomy is performed to sterilize men. It involves cutting and sealing the
vasa deferentia (the tubes that carry sperm from the testes). A vasectomy,
which is performed by a doctor in the office, takes about 20 minutes and
requires only a local anesthetic. Through a small incision on each side of
the scrotum, a section of each vas deferens is removed and the open ends of
the tubes are sealed off. A man who has had a vasectomy should continue
contraception for a while. Usually, he does not become sterile until about
15 to 20 ejaculations after the operation, because many sperm are stored in
the seminal vesicles. A laboratory test can be performed to be sure that
ejaculates are free of sperm.
Complications of vasectomy include bleeding (in fewer than 5% of men), an
inflammatory response to sperm leakage, and spontaneous reopening (in fewer
than 1%), usually shortly after the procedure. Sexual activity, with
contraception, may resume as soon after the procedure as the man desires.
Fewer than 1% of women become pregnant after their partner is sterilized.
Tubal ligation is used to sterilize women. It involves cutting and tying or
blocking the fallopian tubes, which carry the egg from the ovaries to the
uterus. More complicated than vasectomy, tubal ligation requires an
abdominal incision and a general or regional anesthetic. Women who have just
delivered a child can be sterilized immediately after childbirth or on the
following day, without staying in the hospital any longer than usual.
Sterilization also may be planned in advance and performed as elective
surgery.
Sterilization for women is often performed by laparoscopy. Working through a
thin tube inserted through a small incision in the woman's abdomen, a doctor
cuts the fallopian tubes and ties off the cut ends. Or a doctor may use
electrocautery (a device that produces an electrical current to cut through
tissue) to seal off about 1 inch of each tube. The woman usually goes home
the same day. After laparoscopy, up to 6% of women have minor complications,
such as a skin infection at the incision site or constipation. Fewer than 1%
have major complications, such as bleeding or punctures of the bladder or
intestine. About 2% of women become pregnant during the first 10 years after
they are sterilized. About one third of these pregnancies are mislocated
(ectopic) pregnancies that develop in the fallopian tubes.
Various mechanical devices, such as plastic bands and spring-loaded clips,
can be used to block the fallopian tubes instead of cutting or sealing them.
Sterilization is easier to reverse when these devices are used because they
cause less tissue damage. However, reversal is successful in only about
three fourths of the women.
Surgical removal of the uterus (hysterectomy) results in sterility. This
procedure is usually performed to treat a disorder rather than as a
sterilization technique. [Merck]
Sterilization should always be considered permanent. However, an operation
that reconnects the appropriate tube (reanastomosis) can be performed to
restore fertility. Reanastomosis is less likely to be effective in men than
in women. For couples, pregnancy rates are 45 to 60% after reanastomosis in
men and 50 to 80% after reanastomosis in women.
Vasectomy is performed to sterilize men. It involves cutting and sealing the
vasa deferentia (the tubes that carry sperm from the testes). A vasectomy,
which is performed by a doctor in the office, takes about 20 minutes and
requires only a local anesthetic. Through a small incision on each side of
the scrotum, a section of each vas deferens is removed and the open ends of
the tubes are sealed off. A man who has had a vasectomy should continue
contraception for a while. Usually, he does not become sterile until about
15 to 20 ejaculations after the operation, because many sperm are stored in
the seminal vesicles. A laboratory test can be performed to be sure that
ejaculates are free of sperm.
Complications of vasectomy include bleeding (in fewer than 5% of men), an
inflammatory response to sperm leakage, and spontaneous reopening (in fewer
than 1%), usually shortly after the procedure. Sexual activity, with
contraception, may resume as soon after the procedure as the man desires.
Fewer than 1% of women become pregnant after their partner is sterilized.
Tubal ligation is used to sterilize women. It involves cutting and tying or
blocking the fallopian tubes, which carry the egg from the ovaries to the
uterus. More complicated than vasectomy, tubal ligation requires an
abdominal incision and a general or regional anesthetic. Women who have just
delivered a child can be sterilized immediately after childbirth or on the
following day, without staying in the hospital any longer than usual.
Sterilization also may be planned in advance and performed as elective
surgery.
Sterilization for women is often performed by laparoscopy. Working through a
thin tube inserted through a small incision in the woman's abdomen, a doctor
cuts the fallopian tubes and ties off the cut ends. Or a doctor may use
electrocautery (a device that produces an electrical current to cut through
tissue) to seal off about 1 inch of each tube. The woman usually goes home
the same day. After laparoscopy, up to 6% of women have minor complications,
such as a skin infection at the incision site or constipation. Fewer than 1%
have major complications, such as bleeding or punctures of the bladder or
intestine. About 2% of women become pregnant during the first 10 years after
they are sterilized. About one third of these pregnancies are mislocated
(ectopic) pregnancies that develop in the fallopian tubes.
Various mechanical devices, such as plastic bands and spring-loaded clips,
can be used to block the fallopian tubes instead of cutting or sealing them.
Sterilization is easier to reverse when these devices are used because they
cause less tissue damage. However, reversal is successful in only about
three fourths of the women.
Surgical removal of the uterus (hysterectomy) results in sterility. This
procedure is usually performed to treat a disorder rather than as a
sterilization technique. [Merck]
Wednesday, August 6, 2008
Monitoring Your Blood Sugar at Home
Why should I monitor my blood sugar at home?
Monitoring your blood sugar at home helps you and your family doctor make
good choices about treating your diabetes. Controlling it can help lower the
risk of problems with your heart, kidneys, eyes, and nerves.
How do I monitor my blood sugar at home?
There are many easy-to-use blood sugar meters available. You can buy them at
most drug stores and medical supply stores. When choosing a meter, you
should think about features you want, like test time, sample size, and
memory, and whether the meter can test somewhere other than your fingertips.
Be sure you read the directions on how to use the meter before using it.
How often should I check my blood sugar?
This depends on several things, such as the type of medicines you are taking
and how well your diabetes is controlled. Your family doctor will tell you
how often to check your blood sugar.
What should my blood sugar level be?
Your family doctor will tell you what your goals should be. Ask your family
doctor what to do if your blood sugar is above or below your goal. [AAFP]
Monitoring your blood sugar at home helps you and your family doctor make
good choices about treating your diabetes. Controlling it can help lower the
risk of problems with your heart, kidneys, eyes, and nerves.
How do I monitor my blood sugar at home?
There are many easy-to-use blood sugar meters available. You can buy them at
most drug stores and medical supply stores. When choosing a meter, you
should think about features you want, like test time, sample size, and
memory, and whether the meter can test somewhere other than your fingertips.
Be sure you read the directions on how to use the meter before using it.
How often should I check my blood sugar?
This depends on several things, such as the type of medicines you are taking
and how well your diabetes is controlled. Your family doctor will tell you
how often to check your blood sugar.
What should my blood sugar level be?
Your family doctor will tell you what your goals should be. Ask your family
doctor what to do if your blood sugar is above or below your goal. [AAFP]
Inflammatory Bowel Disease
Inflammatory Bowel Disease
J.F. del Rosario
Digestive problems are among the most common conditions affecting people
today. There are many different types of digestive problems, from
gastrointestinal infections that make a person miserable but pass quickly to
long-term illnesses like inflammatory bowel disease (IBD). IBD is a general
term that refers to illnesses that cause chronic inflammation in the
intestines. If you're having diarrhea, stomach cramps, and other symptoms
that make you question your digestion, you may want to learn more about the
digestive system and IBD, as well as other digestive conditions.
What Is IBD?
The digestive system is the set of organs that digest food and absorb the
important nutrients your body needs to stay healthy and grow. Two of the
major parts of the digestive system are the small and large intestines. Just
like other organs in your body, the intestines can develop problems or
diseases.
IBD (which is not the same thing as irritable bowel syndrome, or IBS), can
cause more serious problems than just diarrhea and pain. IBD may also cause
a delay in puberty or growth problems for some teens with the condition,
because it can interfere with a person getting nutrients from the foods he
or she eats.
The two major types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease occurs when the lining and wall of the intestines becomes
inflamed and ulcers develop. Although Crohn's disease can occur in any part
of the digestive system, it often occurs in the lower part of the small
intestine where it joins the colon. The intestine becomes inflamed, meaning
the lining of the intestinal wall reddens and swells. It can become
irritated, causing it to bleed and preventing it from properly absorbing the
nutrients from digested food.
People with Crohn's disease usually have these symptoms:
* abdominal cramps or pain
* diarrhea, sometimes with blood in the stool (bowel movements)
* fever
* weight loss
These symptoms often cause people with Crohn's disease to feel tired and
lose their appetites.
Some people with Crohn's disease have minor symptoms and hardly any
discomfort or pain. Their symptoms may only flare a few times. But others
may experience frequent diarrhea, intestinal ulcers, and problems in other
parts of their bodies, such as inflammation of the joints, skin rashes, and
eye problems. Crohn's disease can cause a person's intestines to become
blocked by swelling and scar tissue. People with the condition may also be
more susceptible to infections and developing abscesses in and around their
intestines.
In ulcerative colitis, the large intestine becomes inflamed and ulcers may
develop. Ulcerative colitis affects only the large intestine. The
inflammation begins in the rectum (the last few inches of the large
intestine where feces are stored before they leave the body) and can affect
only the rectum or the part of the large intestine that joins it. However,
most kids and teens who have ulcerative colitis have the condition
throughout their large intestines.
The most common symptoms of ulcerative colitis are abdominal pain and bloody
diarrhea. But some people also experience these symptoms:
* tiredness
* weight loss
* loss of appetite
* nausea
Some people with ulcerative colitis may experience periods of time when they
are free of symptoms (this is called remission) and other times when they
feel sick (called relapse).
Like Crohn's disease, ulcerative colitis can be associated with problems in
other parts of the body. These problems may include inflammation of the
joints, eye problems, and anemia due to blood loss.
Who Gets IBD?
IBD is most likely to occur in people in their late teens and twenties.
However, kids as young as 5 years old have been known to develop IBD. It
affects both guys and girls.
The exact cause of IBD is not known. Because it often runs in families,
genetic factors are probably involved. About 15% to 30% of people with IBD
have a relative with the disease. Research is being done to find out if a
certain gene or group of genes makes a person more likely to get the
disease.
What Do Family Doctors Do?
If you have any of the symptoms of IBD, it's important to see your family
doctor. In addition to doing a physical examination, the family doctor will
ask you about any concerns and symptoms you have, your past health, your
family's health, any medications you're taking, any allergies you may have,
and other issues. This is called the medical history.
After hearing your symptoms, if your family doctor suspects IBD, he or she
may suggest certain tests. Blood tests may be done to determine if there are
signs of inflammation in your body, which are often present with IBD. The
family doctor may also check for anemia and for other causes of your
symptoms, like infection.
The family doctor will examine your stool for the presence of blood. He or
she may look at your colon with an instrument called an endoscope, which is
a long, thin tube attached to a TV monitor. The tube is inserted through the
anus. This procedure is called a colonoscopy, which allows the family doctor
to see inflammation, bleeding, or ulcers on the wall of your colon. A family
doctor may also do a test called an upper endoscopy to check the esophagus,
stomach, and upper small intestine for inflammation, bleeding, or ulcers.
During the exam, the family doctor may perform a biopsy, which involves
taking a small sample of tissue from part of the colon so it can be viewed
with a microscope or sent to a laboratory for other kinds of analysis.
A family doctor may also order a barium study of the intestines. This
procedure involves drinking a thick white solution called barium. The barium
shows up white on an X-ray film, allowing a family doctor to get a better
look at what's going on in a person's intestines.
How Is IBD Treated?
There are a number of ways to manage the symptoms of IBD. Some treatments
include:
Nutritional Therapy
It is important for people with IBD to eat healthy foods and drink plenty of
fluids to replace those lost through diarrhea. People with IBD should work
with a family doctor or a dietitian to come up with an eating plan that is
best for their individual situation and symptoms.
For example, some people are told to cut down on the amount of fiber or
dairy products in their diets, whereas others find that their symptoms
improve if they cut back on foods that are high in fat or sugar. If you've
been diagnosed with IBD, your family doctor might ask you to keep a food
diary so that you can find out which foods make your symptoms worse.
If you're having trouble maintaining or gaining weight, your family doctor
may recommend that you take nutritional supplements or special drinks or
shakes that contain needed vitamins, minerals, and calories.
More Sleep and Less Stress
Besides watching the types of foods they eat, people with IBD need to get
enough sleep. It's also helpful to manage stress in a positive way. When you
get stressed out, your intestinal problems can flare. Some people find that
learning breathing and relaxation exercises can help.
Medications
Medications are also used to treat IBD. Anti-inflammatory drugs, including
corticosteroids, may be used to decrease the inflammation caused by IBD. If
symptoms don't go away after taking anti-inflammatory drugs, your family
doctor may prescribe other medications called immunosuppressants or
immunomodulators to reduce the inflammation.
Family doctors may prescribe antibiotics to prevent or treat bacterial
infections associated with Crohn's disease, and antidiarrheal drugs may be
prescribed for someone who has diarrhea a lot.
Surgery
Sometimes surgery is necessary to control the symptoms of IBD and to remove
damaged sections of the intestines. For people with Crohn's disease, surgery
may need to be performed more than once because the disease can involve
other parts of the intestine over time.
Removal of the large intestine can cure the bowel problems in people with
ulcerative colitis. However, this surgery is usually only done if medicines
have failed or if a person develops a perforation (a hole in the intestine),
uncontrollable bleeding, or has developed intestinal cancer.
Although it can be challenging and difficult to deal with the symptoms of
IBD, many people with IBD find that they are able to feel well and have few
symptoms for long periods of time. Talk to your family doctor about ways
that you can feel better during the times you have flares. If you feel sad
or anxious about your symptoms, it may also help to talk to a therapist or
other mental health professional.
If you don't get medical treatment, IBD can put a serious cramp in your
daily life. The good news? Getting treatment for IBD, managing your
symptoms, and keeping a positive attitude can help get you back on the fast
track. [AAFP]
J.F. del Rosario
Digestive problems are among the most common conditions affecting people
today. There are many different types of digestive problems, from
gastrointestinal infections that make a person miserable but pass quickly to
long-term illnesses like inflammatory bowel disease (IBD). IBD is a general
term that refers to illnesses that cause chronic inflammation in the
intestines. If you're having diarrhea, stomach cramps, and other symptoms
that make you question your digestion, you may want to learn more about the
digestive system and IBD, as well as other digestive conditions.
What Is IBD?
The digestive system is the set of organs that digest food and absorb the
important nutrients your body needs to stay healthy and grow. Two of the
major parts of the digestive system are the small and large intestines. Just
like other organs in your body, the intestines can develop problems or
diseases.
IBD (which is not the same thing as irritable bowel syndrome, or IBS), can
cause more serious problems than just diarrhea and pain. IBD may also cause
a delay in puberty or growth problems for some teens with the condition,
because it can interfere with a person getting nutrients from the foods he
or she eats.
The two major types of IBD are Crohn's disease and ulcerative colitis.
Crohn's disease occurs when the lining and wall of the intestines becomes
inflamed and ulcers develop. Although Crohn's disease can occur in any part
of the digestive system, it often occurs in the lower part of the small
intestine where it joins the colon. The intestine becomes inflamed, meaning
the lining of the intestinal wall reddens and swells. It can become
irritated, causing it to bleed and preventing it from properly absorbing the
nutrients from digested food.
People with Crohn's disease usually have these symptoms:
* abdominal cramps or pain
* diarrhea, sometimes with blood in the stool (bowel movements)
* fever
* weight loss
These symptoms often cause people with Crohn's disease to feel tired and
lose their appetites.
Some people with Crohn's disease have minor symptoms and hardly any
discomfort or pain. Their symptoms may only flare a few times. But others
may experience frequent diarrhea, intestinal ulcers, and problems in other
parts of their bodies, such as inflammation of the joints, skin rashes, and
eye problems. Crohn's disease can cause a person's intestines to become
blocked by swelling and scar tissue. People with the condition may also be
more susceptible to infections and developing abscesses in and around their
intestines.
In ulcerative colitis, the large intestine becomes inflamed and ulcers may
develop. Ulcerative colitis affects only the large intestine. The
inflammation begins in the rectum (the last few inches of the large
intestine where feces are stored before they leave the body) and can affect
only the rectum or the part of the large intestine that joins it. However,
most kids and teens who have ulcerative colitis have the condition
throughout their large intestines.
The most common symptoms of ulcerative colitis are abdominal pain and bloody
diarrhea. But some people also experience these symptoms:
* tiredness
* weight loss
* loss of appetite
* nausea
Some people with ulcerative colitis may experience periods of time when they
are free of symptoms (this is called remission) and other times when they
feel sick (called relapse).
Like Crohn's disease, ulcerative colitis can be associated with problems in
other parts of the body. These problems may include inflammation of the
joints, eye problems, and anemia due to blood loss.
Who Gets IBD?
IBD is most likely to occur in people in their late teens and twenties.
However, kids as young as 5 years old have been known to develop IBD. It
affects both guys and girls.
The exact cause of IBD is not known. Because it often runs in families,
genetic factors are probably involved. About 15% to 30% of people with IBD
have a relative with the disease. Research is being done to find out if a
certain gene or group of genes makes a person more likely to get the
disease.
What Do Family Doctors Do?
If you have any of the symptoms of IBD, it's important to see your family
doctor. In addition to doing a physical examination, the family doctor will
ask you about any concerns and symptoms you have, your past health, your
family's health, any medications you're taking, any allergies you may have,
and other issues. This is called the medical history.
After hearing your symptoms, if your family doctor suspects IBD, he or she
may suggest certain tests. Blood tests may be done to determine if there are
signs of inflammation in your body, which are often present with IBD. The
family doctor may also check for anemia and for other causes of your
symptoms, like infection.
The family doctor will examine your stool for the presence of blood. He or
she may look at your colon with an instrument called an endoscope, which is
a long, thin tube attached to a TV monitor. The tube is inserted through the
anus. This procedure is called a colonoscopy, which allows the family doctor
to see inflammation, bleeding, or ulcers on the wall of your colon. A family
doctor may also do a test called an upper endoscopy to check the esophagus,
stomach, and upper small intestine for inflammation, bleeding, or ulcers.
During the exam, the family doctor may perform a biopsy, which involves
taking a small sample of tissue from part of the colon so it can be viewed
with a microscope or sent to a laboratory for other kinds of analysis.
A family doctor may also order a barium study of the intestines. This
procedure involves drinking a thick white solution called barium. The barium
shows up white on an X-ray film, allowing a family doctor to get a better
look at what's going on in a person's intestines.
How Is IBD Treated?
There are a number of ways to manage the symptoms of IBD. Some treatments
include:
Nutritional Therapy
It is important for people with IBD to eat healthy foods and drink plenty of
fluids to replace those lost through diarrhea. People with IBD should work
with a family doctor or a dietitian to come up with an eating plan that is
best for their individual situation and symptoms.
For example, some people are told to cut down on the amount of fiber or
dairy products in their diets, whereas others find that their symptoms
improve if they cut back on foods that are high in fat or sugar. If you've
been diagnosed with IBD, your family doctor might ask you to keep a food
diary so that you can find out which foods make your symptoms worse.
If you're having trouble maintaining or gaining weight, your family doctor
may recommend that you take nutritional supplements or special drinks or
shakes that contain needed vitamins, minerals, and calories.
More Sleep and Less Stress
Besides watching the types of foods they eat, people with IBD need to get
enough sleep. It's also helpful to manage stress in a positive way. When you
get stressed out, your intestinal problems can flare. Some people find that
learning breathing and relaxation exercises can help.
Medications
Medications are also used to treat IBD. Anti-inflammatory drugs, including
corticosteroids, may be used to decrease the inflammation caused by IBD. If
symptoms don't go away after taking anti-inflammatory drugs, your family
doctor may prescribe other medications called immunosuppressants or
immunomodulators to reduce the inflammation.
Family doctors may prescribe antibiotics to prevent or treat bacterial
infections associated with Crohn's disease, and antidiarrheal drugs may be
prescribed for someone who has diarrhea a lot.
Surgery
Sometimes surgery is necessary to control the symptoms of IBD and to remove
damaged sections of the intestines. For people with Crohn's disease, surgery
may need to be performed more than once because the disease can involve
other parts of the intestine over time.
Removal of the large intestine can cure the bowel problems in people with
ulcerative colitis. However, this surgery is usually only done if medicines
have failed or if a person develops a perforation (a hole in the intestine),
uncontrollable bleeding, or has developed intestinal cancer.
Although it can be challenging and difficult to deal with the symptoms of
IBD, many people with IBD find that they are able to feel well and have few
symptoms for long periods of time. Talk to your family doctor about ways
that you can feel better during the times you have flares. If you feel sad
or anxious about your symptoms, it may also help to talk to a therapist or
other mental health professional.
If you don't get medical treatment, IBD can put a serious cramp in your
daily life. The good news? Getting treatment for IBD, managing your
symptoms, and keeping a positive attitude can help get you back on the fast
track. [AAFP]
Should You Give Informal Medical Advice?
Here's a familiar scenario: You're at a dinner party or a community meeting
and an acquaintance walks over to you and asks you to take a look at a
bothersome rash, or wants to know whether the headaches he's been
experiencing are anything to worry about. You wonder: (1) should you offer a
professional opinion? and (2) could you be held liable if the advice is
wrong?
The answer to question 1 is, only if you proceed very carefully and follow
the guidelines listed below. The answer to question 2 is, Yes, you could be
held liable. Once medical advice is proffered whether in the office, over
the e-mail/phone, or in a friend's dining room, a doctor-patient
relationship is established, as is a duty of care. That duty is what makes
you a potential defendant.
The second element in a malpractice case is departure from the standard of
care, which requires you to act as a "reasonable physician in your
specialty." The standard of care rule applies whether the advice is formal
or informal, and whether or not you charge a fee. (Standard of care criteria
are less stringent if you're acting as a Good Samaritan. But even then you
have to be careful not to leave the patient in worse condition than you
found him.)
If you think a friend or relative won't sue you, think again. Court records
are full of such cases. To reduce the likelihood that a casual request for
medical help will come back to bite you:
* Treat relatives and friends who need clinical advice with the same
professional expertise and judgment as any other patient. That is, use
similar diligence, knowledge, and research.
* Document the encounter. If a record doesn't already exist, create one. In
most medical liability lawsuits, a complete medical record is your best
defense. You'll also need a record of your actions if the friend or relative
complains to your licensing board.
* Ask the person to come to your office if you need to review records or
examine him/her.
* If you agree to supply a second opinion, first get a compliant request to
obtain, review, and evaluate records of prior treating physicians.
To bill or not to bill? That's up to you. If you want to waive payment as a
gesture of friendship, fine. But most patients who are covered by health
plans will be happy to give you their insurance information.
If you're not comfortable with the idea of treating acquaintances or friends
due to social, financial, liability, and other considerations, you might
consider drafting an office policy that all people whom you know socially
must be treated by other members of your group. Practitioners can tell
informal advice seekers that they'll be glad to recommend physicians in the
community. This is especially wise if the query is outside your area of
specialization. [ME]
and an acquaintance walks over to you and asks you to take a look at a
bothersome rash, or wants to know whether the headaches he's been
experiencing are anything to worry about. You wonder: (1) should you offer a
professional opinion? and (2) could you be held liable if the advice is
wrong?
The answer to question 1 is, only if you proceed very carefully and follow
the guidelines listed below. The answer to question 2 is, Yes, you could be
held liable. Once medical advice is proffered whether in the office, over
the e-mail/phone, or in a friend's dining room, a doctor-patient
relationship is established, as is a duty of care. That duty is what makes
you a potential defendant.
The second element in a malpractice case is departure from the standard of
care, which requires you to act as a "reasonable physician in your
specialty." The standard of care rule applies whether the advice is formal
or informal, and whether or not you charge a fee. (Standard of care criteria
are less stringent if you're acting as a Good Samaritan. But even then you
have to be careful not to leave the patient in worse condition than you
found him.)
If you think a friend or relative won't sue you, think again. Court records
are full of such cases. To reduce the likelihood that a casual request for
medical help will come back to bite you:
* Treat relatives and friends who need clinical advice with the same
professional expertise and judgment as any other patient. That is, use
similar diligence, knowledge, and research.
* Document the encounter. If a record doesn't already exist, create one. In
most medical liability lawsuits, a complete medical record is your best
defense. You'll also need a record of your actions if the friend or relative
complains to your licensing board.
* Ask the person to come to your office if you need to review records or
examine him/her.
* If you agree to supply a second opinion, first get a compliant request to
obtain, review, and evaluate records of prior treating physicians.
To bill or not to bill? That's up to you. If you want to waive payment as a
gesture of friendship, fine. But most patients who are covered by health
plans will be happy to give you their insurance information.
If you're not comfortable with the idea of treating acquaintances or friends
due to social, financial, liability, and other considerations, you might
consider drafting an office policy that all people whom you know socially
must be treated by other members of your group. Practitioners can tell
informal advice seekers that they'll be glad to recommend physicians in the
community. This is especially wise if the query is outside your area of
specialization. [ME]
Thursday, July 31, 2008
Pleural Effusion
Pleural effusion is the abnormal accumulation of fluid in the pleural space.
Normally, only a thin layer of fluid separates the two layers of the pleura.
An excessive amount of fluid may accumulate for many reasons, including
heart failure, cirrhosis, pneumonia, and cancer. Depending on the cause, the
fluid may be either rich in protein (exudate) or watery (transudate). Family
doctors use this distinction to help determine the cause.
Blood in the pleural space (hemothorax) usually results from a chest injury.
Rarely, a blood vessel ruptures into the pleural space when no injury has
occurred, or a bulging area in the aorta (aortic aneurysm) leaks blood into
the pleural space. Because blood in the pleural space does not clot fully,
it is usually easy for a family doctor to remove using a large-bore needle
or a chest tube.
Pus in the pleural space (empyema) can accumulate when pneumonia or a lung
abscess spreads into the space. A wide range of bacteria as well as certain
fungi and mycobacteria (especially the mycobacterium that causes
tuberculosis) are the most common organisms causing pleural effusion.
Empyema may also complicate an infection from chest wounds, chest surgery,
rupture of the esophagus, or an abscess in the abdomen.
Milky fluid in the pleural space (chylothorax) is caused by an injury to the
main lymphatic duct in the chest (thoracic duct) or by a blockage of the
duct by a tumor.
High-cholesterol fluid in the pleural space results from a long-standing
pleural effusion caused by a condition such as tuberculosis or rheumatoid
arthritis.
Symptoms & Diagnosis
The most common symptoms, regardless of the type of fluid in the pleural
space or its cause, are shortness of breath and chest pain. However, many
people with pleural effusion have no symptoms at all.
A chest x-ray, which shows fluid in the pleural space, is usually the first
step in making the diagnosis. Computed tomography (CT) more clearly shows
the lung and the fluid and may show evidence of pneumonia, a lung abscess,
or a tumor. An ultrasound may help a family doctor determine the position of
a small accumulation of fluid.
A specimen of the fluid is almost always removed for examination using a
needle, a procedure called thoracentesis. The appearance of the fluid may
help a family doctor determine its cause. Certain laboratory tests evaluate
the chemical composition of the fluid and determine the presence of
bacteria, including the bacteria that cause tuberculosis. The fluid specimen
is also examined for the number and types of cells and for the presence of
cancerous cells.
If these tests cannot identify the cause of the pleural effusion, a biopsy
of the pleura may be needed, which can detect cancer and tuberculosis. Using
a biopsy needle, a family doctor removes a sample of the outer layer of the
pleura for analysis. If the specimen is too small for an accurate diagnosis,
a tissue sample must be taken through a small incision in the chest wall, a
procedure called an open pleural biopsy. Sometimes, a sample is obtained
using a thoracoscope (a viewing tube that allows a family doctor to examine
the pleural space and obtain samples.
Occasionally, bronchoscopy (a direct visual examination of the airways
through a viewing tube) helps the family doctor find the cause of the fluid.
In about 20% of people with pleural effusion, the cause is not obvious after
initial testing, and in some people a cause is never found, even after
extensive testing.
Common Causes of Pleural Effusion
Abscess under the diaphragm
Cirrhosis
Coccidioidomycosis and other fungal infections
Drugs such as hydralazine, procainamide, isoniazid, phenytoin,
chlorpromazine, nitrofurantoin, bromocriptine, dantrolene, procarbazine
Heart failure
Heart surgery
Improper placement of feeding tubes or intravenous catheters
Injury to the chest
Low protein levels in the blood
Pancreatitis
Pneumonia
Pulmonary embolus
Rheumatoid arthritis
Systemic lupus erythematosus
Tuberculosis
Tumors
Treatment
Small pleural effusions may require treatment of only the underlying cause.
Larger pleural effusions, especially those that cause shortness of breath,
may require drainage of the fluid. Usually, drainage dramatically relieves
shortness of breath. Often, fluid can be drained using thoracentesis. An
area of skin between two lower ribs is anesthetized, then a small needle is
inserted and gently pushed deeper until it reaches the fluid. A thin plastic
catheter is often guided over the needle into the fluid to lessen the chance
of puncturing the lung and causing a pneumothorax. Although thoracentesis is
usually performed for diagnostic purposes, a family doctor can safely remove
as much as 1.5 liters of fluid at a time using this procedure.
When larger amounts of fluid must be removed, a tube (chest tube) may be
inserted through the chest wall. After numbing the area by injecting a local
anesthetic, a family doctor inserts a plastic tube into the chest between
two ribs. Then the family doctor connects the tube to a water-sealed
drainage system that prevents air from leaking into the pleural space. A
chest x-ray is taken to check the tube's position. Drainage can be blocked
if the chest tube is incorrectly positioned or becomes kinked. If the fluid
is very thick or full of clots, it may not flow out.
An accumulation of pus from an infection (empyema) requires intravenous
antibiotics and drainage of the fluid. Tuberculosis or fungal infections
such as coccidioidomycosis require prolonged treatment with antibiotics or
antifungal drugs. If the pus is very thick or if it has formed within
fibrous compartments, drainage is more difficult. Sometimes drugs called
fibrinolytics are instilled into the pleura space to help drainage, which
may avoid the need for surgery. If surgery is needed, it can be performed by
a procedure called video-assisted thorascopic debridement or by thoracotomy.
During surgery, a thick peel of fibrous material is removed from the lung
surface to allow the lung to expand normally.
Fluid accumulation caused by tumors of the pleura may be difficult to treat
because fluid tends to reaccumulate rapidly. Draining the fluid and giving
antitumor drugs sometimes prevents further fluid accumulation. But if fluid
continues to accumulate, sealing the pleural space (pleurodesis) may be
helpful. All fluid is drained through a tube, which is then used to
administer a pleural irritant, such as a doxycycline solution or a talc
mixture, into the space. The irritant seals the two layers of pleura
together, so that no room remains for additional fluid to accumulate.
If blood has entered the pleural space, usually drainage through a tube is
all that is needed-as long as the bleeding has stopped. Drugs that help
break up blood clots, such as streptokinase and urokinase, are occasionally
administered through the drainage tube if a substantial portion of the clot
remains in the pleural space. Caution should be taken because these drugs
can trigger rebleeding. If the bleeding continues or if the accumulation of
fluid cannot be removed adequately with a tube, surgery may be needed.
Treatment of chylothorax focuses on repairing the damage to the lymphatic
duct. Such treatment may consist of surgery, chemotherapy, or radiation
treatment for a cancer that is blocking lymph flow. [AAFP]
Normally, only a thin layer of fluid separates the two layers of the pleura.
An excessive amount of fluid may accumulate for many reasons, including
heart failure, cirrhosis, pneumonia, and cancer. Depending on the cause, the
fluid may be either rich in protein (exudate) or watery (transudate). Family
doctors use this distinction to help determine the cause.
Blood in the pleural space (hemothorax) usually results from a chest injury.
Rarely, a blood vessel ruptures into the pleural space when no injury has
occurred, or a bulging area in the aorta (aortic aneurysm) leaks blood into
the pleural space. Because blood in the pleural space does not clot fully,
it is usually easy for a family doctor to remove using a large-bore needle
or a chest tube.
Pus in the pleural space (empyema) can accumulate when pneumonia or a lung
abscess spreads into the space. A wide range of bacteria as well as certain
fungi and mycobacteria (especially the mycobacterium that causes
tuberculosis) are the most common organisms causing pleural effusion.
Empyema may also complicate an infection from chest wounds, chest surgery,
rupture of the esophagus, or an abscess in the abdomen.
Milky fluid in the pleural space (chylothorax) is caused by an injury to the
main lymphatic duct in the chest (thoracic duct) or by a blockage of the
duct by a tumor.
High-cholesterol fluid in the pleural space results from a long-standing
pleural effusion caused by a condition such as tuberculosis or rheumatoid
arthritis.
Symptoms & Diagnosis
The most common symptoms, regardless of the type of fluid in the pleural
space or its cause, are shortness of breath and chest pain. However, many
people with pleural effusion have no symptoms at all.
A chest x-ray, which shows fluid in the pleural space, is usually the first
step in making the diagnosis. Computed tomography (CT) more clearly shows
the lung and the fluid and may show evidence of pneumonia, a lung abscess,
or a tumor. An ultrasound may help a family doctor determine the position of
a small accumulation of fluid.
A specimen of the fluid is almost always removed for examination using a
needle, a procedure called thoracentesis. The appearance of the fluid may
help a family doctor determine its cause. Certain laboratory tests evaluate
the chemical composition of the fluid and determine the presence of
bacteria, including the bacteria that cause tuberculosis. The fluid specimen
is also examined for the number and types of cells and for the presence of
cancerous cells.
If these tests cannot identify the cause of the pleural effusion, a biopsy
of the pleura may be needed, which can detect cancer and tuberculosis. Using
a biopsy needle, a family doctor removes a sample of the outer layer of the
pleura for analysis. If the specimen is too small for an accurate diagnosis,
a tissue sample must be taken through a small incision in the chest wall, a
procedure called an open pleural biopsy. Sometimes, a sample is obtained
using a thoracoscope (a viewing tube that allows a family doctor to examine
the pleural space and obtain samples.
Occasionally, bronchoscopy (a direct visual examination of the airways
through a viewing tube) helps the family doctor find the cause of the fluid.
In about 20% of people with pleural effusion, the cause is not obvious after
initial testing, and in some people a cause is never found, even after
extensive testing.
Common Causes of Pleural Effusion
Abscess under the diaphragm
Cirrhosis
Coccidioidomycosis and other fungal infections
Drugs such as hydralazine, procainamide, isoniazid, phenytoin,
chlorpromazine, nitrofurantoin, bromocriptine, dantrolene, procarbazine
Heart failure
Heart surgery
Improper placement of feeding tubes or intravenous catheters
Injury to the chest
Low protein levels in the blood
Pancreatitis
Pneumonia
Pulmonary embolus
Rheumatoid arthritis
Systemic lupus erythematosus
Tuberculosis
Tumors
Treatment
Small pleural effusions may require treatment of only the underlying cause.
Larger pleural effusions, especially those that cause shortness of breath,
may require drainage of the fluid. Usually, drainage dramatically relieves
shortness of breath. Often, fluid can be drained using thoracentesis. An
area of skin between two lower ribs is anesthetized, then a small needle is
inserted and gently pushed deeper until it reaches the fluid. A thin plastic
catheter is often guided over the needle into the fluid to lessen the chance
of puncturing the lung and causing a pneumothorax. Although thoracentesis is
usually performed for diagnostic purposes, a family doctor can safely remove
as much as 1.5 liters of fluid at a time using this procedure.
When larger amounts of fluid must be removed, a tube (chest tube) may be
inserted through the chest wall. After numbing the area by injecting a local
anesthetic, a family doctor inserts a plastic tube into the chest between
two ribs. Then the family doctor connects the tube to a water-sealed
drainage system that prevents air from leaking into the pleural space. A
chest x-ray is taken to check the tube's position. Drainage can be blocked
if the chest tube is incorrectly positioned or becomes kinked. If the fluid
is very thick or full of clots, it may not flow out.
An accumulation of pus from an infection (empyema) requires intravenous
antibiotics and drainage of the fluid. Tuberculosis or fungal infections
such as coccidioidomycosis require prolonged treatment with antibiotics or
antifungal drugs. If the pus is very thick or if it has formed within
fibrous compartments, drainage is more difficult. Sometimes drugs called
fibrinolytics are instilled into the pleura space to help drainage, which
may avoid the need for surgery. If surgery is needed, it can be performed by
a procedure called video-assisted thorascopic debridement or by thoracotomy.
During surgery, a thick peel of fibrous material is removed from the lung
surface to allow the lung to expand normally.
Fluid accumulation caused by tumors of the pleura may be difficult to treat
because fluid tends to reaccumulate rapidly. Draining the fluid and giving
antitumor drugs sometimes prevents further fluid accumulation. But if fluid
continues to accumulate, sealing the pleural space (pleurodesis) may be
helpful. All fluid is drained through a tube, which is then used to
administer a pleural irritant, such as a doxycycline solution or a talc
mixture, into the space. The irritant seals the two layers of pleura
together, so that no room remains for additional fluid to accumulate.
If blood has entered the pleural space, usually drainage through a tube is
all that is needed-as long as the bleeding has stopped. Drugs that help
break up blood clots, such as streptokinase and urokinase, are occasionally
administered through the drainage tube if a substantial portion of the clot
remains in the pleural space. Caution should be taken because these drugs
can trigger rebleeding. If the bleeding continues or if the accumulation of
fluid cannot be removed adequately with a tube, surgery may be needed.
Treatment of chylothorax focuses on repairing the damage to the lymphatic
duct. Such treatment may consist of surgery, chemotherapy, or radiation
treatment for a cancer that is blocking lymph flow. [AAFP]
Monday, July 28, 2008
Menopause
What is menopause?
Menopause is the time in a woman's life when her periods stop and she can't
have children anymore. This happens because as a woman ages, her ovaries
stop making enough of the female hormones estrogen and progesterone.
When does menopause occur?
The average age for women to have their last period is about 50. But it's
normal for menopause to occur any time from age 41 to 59. A woman often goes
through menopause at about the same age as her mother.
Women who have both ovaries removed will go through "surgical menopause" at
the time of their surgery. If the uterus is taken out but the ovaries are
left, a woman won't have periods but she will only go through menopause when
her ovaries stop making estrogen.
If you stop having periods early--before age 40--your family doctor can do a
blood test to see if you're going through menopause.
Menopause is a gradual process that can take several years. You're not
really through menopause until you haven't had a period for 12 months.
(During this time, keep using birth control if you don't want to become
pregnant.)
Talk to your family doctor if you have:
A change in your monthly cycle
Heavy bleeding
Bleeding that lasts longer than usual
Bleeding more often than every 3 weeks
Bleeding after sexual intercourse
Any blood staining between periods
What are the common signs and symptoms of menopause?
Some women just stop having periods. Others experience symptoms, such as the
following:
A change in your menstrual cycle. This is one of the first signs of
menopause. You may skip periods or they may occur closer together. Your flow
may be lighter or heavier than usual.
Hot flashes. Hot flashes are the most common symptom of menopause.
When you have a hot flash, you'll feel warm from your chest to your head,
often in wave-like sensations. Your skin may turn red and you may sweat. You
may feel sick to your stomach and dizzy. You may also have a headache and
feel like your heart is beating very fast and hard.
Thinning of your vagina and vulva (the area around your vagina). The skin of
your vagina and vulva becomes thinner with menopause. Your vagina also loses
its ability to produce as much lubrication (wetness) during sexual arousal.
These changes can lead to pain during sex.
You can use an estrogen cream (put in and around your vagina) or a
water-based lubricant (such as K-Y Jelly) to make sex less painful.
Urinary tract problems. You're more likely to have bladder and urinary tract
infections during and after menopause. Talk to your family doctor if you
have to go to the bathroom often, feel an urgent need to urinate, feel a
burning sensation when urinating or are not able to urinate.
Headaches, night sweats, trouble sleeping and tiredness are other symptoms.
Trouble sleeping and feeling tired may be caused by hot flashes and night
sweats.
Does menopause have emotional symptoms?
Many women experience emotional symptoms during menopause. These symptoms
may include sadness, anxiety and loss of sleep. For some women, symptoms can
be severe. If you find that you're having emotional problems, talk to your
family doctor.
What is hormone replacement therapy?
Hormone replacement therapy (HRT) involves taking estrogen alone or estrogen
combined with another hormone, progestin. Some women have found that HRT can
relieve symptoms such as hot flashes, vaginal dryness and some urinary
problems. However, HRT is not for everyone. New information from recent
studies suggests that for many women, the risks of using HRT may outweigh
the benefits. Talk to your family doctor about the risks and benefits of
HRT.
Are other treatments available?
Yes. Medicines such as estrogen cream, antidepressants, soy products and
certain herbal supplements may help ease some menopausal symptoms. Discuss
these options with your family doctor.
Help for hot flashes
Turn your thermostat down. Sleep in a cool room.
Dress in layers, so you can remove clothing when you get too warm.
Wear cotton and other natural fabrics that "breathe" so you don't get
overheated. Use cotton sheets on your bed.
Drink cool water or other beverages when a hot flash starts.
Avoid alcohol. [AAFP]
Menopause is the time in a woman's life when her periods stop and she can't
have children anymore. This happens because as a woman ages, her ovaries
stop making enough of the female hormones estrogen and progesterone.
When does menopause occur?
The average age for women to have their last period is about 50. But it's
normal for menopause to occur any time from age 41 to 59. A woman often goes
through menopause at about the same age as her mother.
Women who have both ovaries removed will go through "surgical menopause" at
the time of their surgery. If the uterus is taken out but the ovaries are
left, a woman won't have periods but she will only go through menopause when
her ovaries stop making estrogen.
If you stop having periods early--before age 40--your family doctor can do a
blood test to see if you're going through menopause.
Menopause is a gradual process that can take several years. You're not
really through menopause until you haven't had a period for 12 months.
(During this time, keep using birth control if you don't want to become
pregnant.)
Talk to your family doctor if you have:
A change in your monthly cycle
Heavy bleeding
Bleeding that lasts longer than usual
Bleeding more often than every 3 weeks
Bleeding after sexual intercourse
Any blood staining between periods
What are the common signs and symptoms of menopause?
Some women just stop having periods. Others experience symptoms, such as the
following:
A change in your menstrual cycle. This is one of the first signs of
menopause. You may skip periods or they may occur closer together. Your flow
may be lighter or heavier than usual.
Hot flashes. Hot flashes are the most common symptom of menopause.
When you have a hot flash, you'll feel warm from your chest to your head,
often in wave-like sensations. Your skin may turn red and you may sweat. You
may feel sick to your stomach and dizzy. You may also have a headache and
feel like your heart is beating very fast and hard.
Thinning of your vagina and vulva (the area around your vagina). The skin of
your vagina and vulva becomes thinner with menopause. Your vagina also loses
its ability to produce as much lubrication (wetness) during sexual arousal.
These changes can lead to pain during sex.
You can use an estrogen cream (put in and around your vagina) or a
water-based lubricant (such as K-Y Jelly) to make sex less painful.
Urinary tract problems. You're more likely to have bladder and urinary tract
infections during and after menopause. Talk to your family doctor if you
have to go to the bathroom often, feel an urgent need to urinate, feel a
burning sensation when urinating or are not able to urinate.
Headaches, night sweats, trouble sleeping and tiredness are other symptoms.
Trouble sleeping and feeling tired may be caused by hot flashes and night
sweats.
Does menopause have emotional symptoms?
Many women experience emotional symptoms during menopause. These symptoms
may include sadness, anxiety and loss of sleep. For some women, symptoms can
be severe. If you find that you're having emotional problems, talk to your
family doctor.
What is hormone replacement therapy?
Hormone replacement therapy (HRT) involves taking estrogen alone or estrogen
combined with another hormone, progestin. Some women have found that HRT can
relieve symptoms such as hot flashes, vaginal dryness and some urinary
problems. However, HRT is not for everyone. New information from recent
studies suggests that for many women, the risks of using HRT may outweigh
the benefits. Talk to your family doctor about the risks and benefits of
HRT.
Are other treatments available?
Yes. Medicines such as estrogen cream, antidepressants, soy products and
certain herbal supplements may help ease some menopausal symptoms. Discuss
these options with your family doctor.
Help for hot flashes
Turn your thermostat down. Sleep in a cool room.
Dress in layers, so you can remove clothing when you get too warm.
Wear cotton and other natural fabrics that "breathe" so you don't get
overheated. Use cotton sheets on your bed.
Drink cool water or other beverages when a hot flash starts.
Avoid alcohol. [AAFP]
Sunday, July 27, 2008
Acute Bronchitis
What is acute bronchitis?
Acute bronchitis is an infection of the bronchial (say: "brawn-kee-ull")
tree. The bronchial tree is made up of the tubes that carry air into your
lungs. When these tubes get infected, they swell and mucus (thick fluid)
forms inside them. This makes it hard for you to breathe. You may cough up
mucus and wheeze (make a whistling sound when you breathe).
What causes acute bronchitis?
Acute bronchitis is almost always caused by viruses that attack the lining
of the bronchial tree and cause infection. As your body fights back against
these viruses, more swelling occurs and more mucus is made. It takes time
for your body to kill the viruses and heal the damage to your bronchial
tubes.
In most cases, the same viruses that cause colds cause acute bronchitis.
Research has shown that bacterial infection is a much less common cause of
bronchitis than we used to think. Very rarely, an infection caused by a
fungus can cause acute bronchitis.
How do people get acute bronchitis?
The viruses that cause acute bronchitis are sprayed into the air or onto
people's hands when they cough. You can get acute bronchitis if you breathe
in these viruses. You can also get it if you touch a hand that is coated
with the viruses.
If you smoke or are around damaging fumes (such as those in certain kinds of
factories), you are more likely to get acute bronchitis and to have it
longer. This is because your bronchial tree is already damaged.
How is acute bronchitis treated?
Most cases of acute bronchitis will go away on their own after a few days or
a week. It's a good idea to get plenty of rest, drink lots of noncaffeinated
fluids (for example, water and fruit juices) and increase the humidity in
your environment.
Because acute bronchitis is usually caused by viruses, antibiotics
(medicines that kill bacteria) usually do not help. Even if you cough up
mucus that is colored or thick, antibiotics probably won't help you get
better any faster.
If you smoke, you should cut down on the number of cigarettes you smoke, or
stop smoking altogether. This will help your bronchial tree heal faster.
For some people with acute bronchitis, family doctors prescribe medicines
that are usually used to treat asthma. These medicines can help open the
bronchial tubes and clear out mucus. They are usually given with an inhaler.
An inhaler sprays the medicine right into the bronchial tree. Your family
doctor will decide if this treatment is right for you.
How long will the cough from acute bronchitis last?
You should call your family doctor if:
* You continue to wheeze and cough for more than 2 weeks, especially at
night or when you are active.
* You continue to cough for more than 2 weeks and sometimes have a
bad-tasting fluid come up into your mouth.
* You have a cough, you feel very sick and weak, and you have a high fever
that doesn't go down.
You cough up blood.
* You have trouble breathing when you lie down.
* Your feet swell.
Sometimes the cough from acute bronchitis lasts for several weeks or months.
Usually this happens because the bronchial tree is taking a long time to
heal. However, a cough that doesn't go away may be a sign of another
problem, like asthma or pneumonia.
How can I keep from getting acute bronchitis again?
One of the best ways to keep from getting acute bronchitis is to wash your
hands often to get rid of any viruses.
If you smoke, the best defense against acute bronchitis is to quit. Smoking
damages your bronchial tree and makes it easier for viruses to cause
infection. Smoking also slows down the healing, so it takes longer for you
to get well. [AAFP]
Acute bronchitis is an infection of the bronchial (say: "brawn-kee-ull")
tree. The bronchial tree is made up of the tubes that carry air into your
lungs. When these tubes get infected, they swell and mucus (thick fluid)
forms inside them. This makes it hard for you to breathe. You may cough up
mucus and wheeze (make a whistling sound when you breathe).
What causes acute bronchitis?
Acute bronchitis is almost always caused by viruses that attack the lining
of the bronchial tree and cause infection. As your body fights back against
these viruses, more swelling occurs and more mucus is made. It takes time
for your body to kill the viruses and heal the damage to your bronchial
tubes.
In most cases, the same viruses that cause colds cause acute bronchitis.
Research has shown that bacterial infection is a much less common cause of
bronchitis than we used to think. Very rarely, an infection caused by a
fungus can cause acute bronchitis.
How do people get acute bronchitis?
The viruses that cause acute bronchitis are sprayed into the air or onto
people's hands when they cough. You can get acute bronchitis if you breathe
in these viruses. You can also get it if you touch a hand that is coated
with the viruses.
If you smoke or are around damaging fumes (such as those in certain kinds of
factories), you are more likely to get acute bronchitis and to have it
longer. This is because your bronchial tree is already damaged.
How is acute bronchitis treated?
Most cases of acute bronchitis will go away on their own after a few days or
a week. It's a good idea to get plenty of rest, drink lots of noncaffeinated
fluids (for example, water and fruit juices) and increase the humidity in
your environment.
Because acute bronchitis is usually caused by viruses, antibiotics
(medicines that kill bacteria) usually do not help. Even if you cough up
mucus that is colored or thick, antibiotics probably won't help you get
better any faster.
If you smoke, you should cut down on the number of cigarettes you smoke, or
stop smoking altogether. This will help your bronchial tree heal faster.
For some people with acute bronchitis, family doctors prescribe medicines
that are usually used to treat asthma. These medicines can help open the
bronchial tubes and clear out mucus. They are usually given with an inhaler.
An inhaler sprays the medicine right into the bronchial tree. Your family
doctor will decide if this treatment is right for you.
How long will the cough from acute bronchitis last?
You should call your family doctor if:
* You continue to wheeze and cough for more than 2 weeks, especially at
night or when you are active.
* You continue to cough for more than 2 weeks and sometimes have a
bad-tasting fluid come up into your mouth.
* You have a cough, you feel very sick and weak, and you have a high fever
that doesn't go down.
You cough up blood.
* You have trouble breathing when you lie down.
* Your feet swell.
Sometimes the cough from acute bronchitis lasts for several weeks or months.
Usually this happens because the bronchial tree is taking a long time to
heal. However, a cough that doesn't go away may be a sign of another
problem, like asthma or pneumonia.
How can I keep from getting acute bronchitis again?
One of the best ways to keep from getting acute bronchitis is to wash your
hands often to get rid of any viruses.
If you smoke, the best defense against acute bronchitis is to quit. Smoking
damages your bronchial tree and makes it easier for viruses to cause
infection. Smoking also slows down the healing, so it takes longer for you
to get well. [AAFP]
Wednesday, July 23, 2008
Occupational Exposure to Lead
How might I be exposed to lead?
Lead can get into your body in two ways: inhalation (breathing it in) and
ingestion (eating it). You might breathe in lead dust or lead fumes without
even knowing it. You can swallow lead dust if it gets in your food or drink.
You might even swallow lead dust if you eat without washing your hands
first.
What problems does lead cause?
Once lead gets into your body, it stays there for a long time. It builds up
over time even if you're exposed to only small amounts of it. As lead builds
up in your body, it can damage your brain, kidneys, nerves and blood cells.
This is called lead poisoning.
As a general rule, the more lead you have in your body, the more likely it
is that you'll have health problems. Your chance of having health problems
goes up the longer you have a high level of lead in your body. We don't know
just how much lead causes health problems because the effects of lead are
different for everyone.
What are the signs of lead poisoning?
These are some of the early signs of lead poisoning:
* Tiredness
* Irritability
* Muscle and joint pain
* Headaches
* Stomachaches and cramps
What is my employer's responsibility for lead in the workplace?
The Lead Standard is a federal and state regulation (law) that requires
employers to follow guidelines to protect workers from harmful lead
exposure. An important part of this standard says that lead in the air of a
workplace shouldn't be more than 50 µg (micrograms) per meter, averaged over
8 hours. Under the Lead Standard, workers have the right to the following:
* To receive a copy of the Standard.
* To receive a copy of air monitoring results.
* To receive medical evaluation and monitoring if they are exposed to
airborne lead levels above 30 µg per meter for more than 30 days a year. If
this occurs, the employer must provide workers with a medical surveillance
program. This program would include blood testing, a lead-specific medical
exam, treatment (if needed), removal from further exposure to lead if health
is at risk and medical clearance for use of a respirator. In some
circumstances, workers can be transferred to jobs that don't expose them to
lead without loss of pay or benefits.
Who can help me understand my blood lead test?
Your family doctor and your company safety officer can help if you're
worried about lead exposure. Your family doctor can test your blood for
lead.
Your family doctor can also help you understand your lead level and the
effects it might have on your health. It's important for your family doctor
to know that you are exposed to lead at work even if you don't notice any
health problems.
How can I protect myself from lead exposure?
The company safety officer can help you find out whether your work area has
been checked for high levels of lead in the air. He or she can also help you
avoid exposure by giving you protective equipment.
You can protect yourself and your family with these basic safe work
practices:
* Wear separate work clothes and shoes or boots while at work.
* Don't wear your work clothes and shoes or boots home from work, and don't
wear them when you aren't at work.
* Wash and dry your work clothes separately. Don't mix your work clothes
with clothes from other people in your family when the laundry is done.
* Wash your hands and face before you eat, drink or smoke.
* At work, eat, drink or smoke only in areas that are free of lead dust and
fumes.
* Avoid stirring up lead-containing dust with dry sweeping; wet cleaning is
safer.
* If you wear a respirator at work, make sure it fits well.
What about lead in my home?
Lead is present in lead-based paint and in lead-contaminated soil and water.
The older the home, the greater the chance lead-based paint was used. Lead
from paint can enter your body through dust or paint chips. The soil around
your home can pick up lead from sources such as exterior paint. Lead can
enter your drinking water through your plumbing. If you think the plumbing
in your house may contain lead, use only cold water for drinking and cooking
and run water for 30 seconds before using it. You may also need to replace
the pipes that supply water to the faucets in your home.
You can check your home for lead by having a professional inspect your paint
or assess any possible sources of lead. [AAFP]
Lead can get into your body in two ways: inhalation (breathing it in) and
ingestion (eating it). You might breathe in lead dust or lead fumes without
even knowing it. You can swallow lead dust if it gets in your food or drink.
You might even swallow lead dust if you eat without washing your hands
first.
What problems does lead cause?
Once lead gets into your body, it stays there for a long time. It builds up
over time even if you're exposed to only small amounts of it. As lead builds
up in your body, it can damage your brain, kidneys, nerves and blood cells.
This is called lead poisoning.
As a general rule, the more lead you have in your body, the more likely it
is that you'll have health problems. Your chance of having health problems
goes up the longer you have a high level of lead in your body. We don't know
just how much lead causes health problems because the effects of lead are
different for everyone.
What are the signs of lead poisoning?
These are some of the early signs of lead poisoning:
* Tiredness
* Irritability
* Muscle and joint pain
* Headaches
* Stomachaches and cramps
What is my employer's responsibility for lead in the workplace?
The Lead Standard is a federal and state regulation (law) that requires
employers to follow guidelines to protect workers from harmful lead
exposure. An important part of this standard says that lead in the air of a
workplace shouldn't be more than 50 µg (micrograms) per meter, averaged over
8 hours. Under the Lead Standard, workers have the right to the following:
* To receive a copy of the Standard.
* To receive a copy of air monitoring results.
* To receive medical evaluation and monitoring if they are exposed to
airborne lead levels above 30 µg per meter for more than 30 days a year. If
this occurs, the employer must provide workers with a medical surveillance
program. This program would include blood testing, a lead-specific medical
exam, treatment (if needed), removal from further exposure to lead if health
is at risk and medical clearance for use of a respirator. In some
circumstances, workers can be transferred to jobs that don't expose them to
lead without loss of pay or benefits.
Who can help me understand my blood lead test?
Your family doctor and your company safety officer can help if you're
worried about lead exposure. Your family doctor can test your blood for
lead.
Your family doctor can also help you understand your lead level and the
effects it might have on your health. It's important for your family doctor
to know that you are exposed to lead at work even if you don't notice any
health problems.
How can I protect myself from lead exposure?
The company safety officer can help you find out whether your work area has
been checked for high levels of lead in the air. He or she can also help you
avoid exposure by giving you protective equipment.
You can protect yourself and your family with these basic safe work
practices:
* Wear separate work clothes and shoes or boots while at work.
* Don't wear your work clothes and shoes or boots home from work, and don't
wear them when you aren't at work.
* Wash and dry your work clothes separately. Don't mix your work clothes
with clothes from other people in your family when the laundry is done.
* Wash your hands and face before you eat, drink or smoke.
* At work, eat, drink or smoke only in areas that are free of lead dust and
fumes.
* Avoid stirring up lead-containing dust with dry sweeping; wet cleaning is
safer.
* If you wear a respirator at work, make sure it fits well.
What about lead in my home?
Lead is present in lead-based paint and in lead-contaminated soil and water.
The older the home, the greater the chance lead-based paint was used. Lead
from paint can enter your body through dust or paint chips. The soil around
your home can pick up lead from sources such as exterior paint. Lead can
enter your drinking water through your plumbing. If you think the plumbing
in your house may contain lead, use only cold water for drinking and cooking
and run water for 30 seconds before using it. You may also need to replace
the pipes that supply water to the faucets in your home.
You can check your home for lead by having a professional inspect your paint
or assess any possible sources of lead. [AAFP]
Monday, July 21, 2008
Bad Reaction to Diet
Vogue made the proposal, but was it indecent?
Last September, Kate and Laura Mulleavy, the sibling designers of Rodarte,
received a phone call from a Vogue editor who suggested that they see a
trainer and go on a diet. The sisters, who said they wanted to be healthier
and balance their stress levels, agreed, accepted four months of personal
training and a meal delivery service paid for by the magazine, lost a
combined 50 pounds and kept a journal of their experiences, which appears in
the April issue.
"Kate and I have decided we have to do this program in a realistic way,"
Laura Mulleavy wrote in an Oct. 22 entry. "We'll have wine when we feel like
it and cheat on holidays."
Reactions to the issue have been blistering. Dozens of objections were
posted to an entry about the diet on the blog Jezebel.
Nonetheless, Cynthia M. Bulik, a professor of eating disorders, defended the
offer as it was presented in the magazine, noting that the designers had
written that a doctor had also told them to get in shape. She said she was
surprised by the controversy, given that Anna Wintour, in her editor's
letter, had challenged designers to use healthier looking models.
"I saw more of an emphasis on healthy eating and healthy fitness than an
order, 'You've got to lose weight,' " Dr. Bulik said.
The magazine has a track record of chronicling the diets of its staff, and
in 1998, Oprah Winfrey acknowledged that she had agreed to lose 20 pounds in
order to appear on its cover.
On top of this, Vogue has also been accused of racial stereotyping in its
cover: a black male athlete posing ferociously with his arm around a
skipping-to-my-lou supermodel. Some media critics compared the pose
unfavorably to images of King Kong and Fay Wray.
"We thought it was a strong and beautiful photo shoot," said Abigail Walch,
a senior editor at Vogue, who said the pose happened naturally. The Rodarte
article, she said, was intended to inspire women who have trouble
incorporating fitness into their hectic schedules. On subjects like weight
and shape, she added, dissension is to be expected.
"It's a hot topic that people love to talk about," Ms. Walch said. [NYT]
Last September, Kate and Laura Mulleavy, the sibling designers of Rodarte,
received a phone call from a Vogue editor who suggested that they see a
trainer and go on a diet. The sisters, who said they wanted to be healthier
and balance their stress levels, agreed, accepted four months of personal
training and a meal delivery service paid for by the magazine, lost a
combined 50 pounds and kept a journal of their experiences, which appears in
the April issue.
"Kate and I have decided we have to do this program in a realistic way,"
Laura Mulleavy wrote in an Oct. 22 entry. "We'll have wine when we feel like
it and cheat on holidays."
Reactions to the issue have been blistering. Dozens of objections were
posted to an entry about the diet on the blog Jezebel.
Nonetheless, Cynthia M. Bulik, a professor of eating disorders, defended the
offer as it was presented in the magazine, noting that the designers had
written that a doctor had also told them to get in shape. She said she was
surprised by the controversy, given that Anna Wintour, in her editor's
letter, had challenged designers to use healthier looking models.
"I saw more of an emphasis on healthy eating and healthy fitness than an
order, 'You've got to lose weight,' " Dr. Bulik said.
The magazine has a track record of chronicling the diets of its staff, and
in 1998, Oprah Winfrey acknowledged that she had agreed to lose 20 pounds in
order to appear on its cover.
On top of this, Vogue has also been accused of racial stereotyping in its
cover: a black male athlete posing ferociously with his arm around a
skipping-to-my-lou supermodel. Some media critics compared the pose
unfavorably to images of King Kong and Fay Wray.
"We thought it was a strong and beautiful photo shoot," said Abigail Walch,
a senior editor at Vogue, who said the pose happened naturally. The Rodarte
article, she said, was intended to inspire women who have trouble
incorporating fitness into their hectic schedules. On subjects like weight
and shape, she added, dissension is to be expected.
"It's a hot topic that people love to talk about," Ms. Walch said. [NYT]
Protein Keeps Hunger at Bay
Diets high in protein may be the best way to keep hunger in check,
researchers have said in a study that offers insight into how diets work.
They found that protein does the best job at keeping a hunger hormone in
check, while carbohydrates and fats may well deserve their current nasty
reputation.
The study, which will appear in the Journal of Clinical Endocrinology &
Metabolism, looked at the effectiveness of different nutrients at
suppressing ghrelin, a hormone secreted by the stomach that stimulates
appetite.
"Suppression of ghrelin is one of the ways that you lose your appetite as
you begin to eat and become sated," said Dr. David Cummings of the
University of Washington in Seattle, who worked on the study.
The researchers gave 16 people three different beverages, each with varying
levels of carbohydrates, fats, and proteins. They took blood samples before
the first beverage, then every 20 minutes for six hours afterward, measuring
ghrelin levels in each sample.
"The interesting findings were that fats suppress ghrelin quite poorly,"
Cummings said in a telephone interview. They fared the poorest overall.
"Proteins were the best suppressor of ghrelin in terms of the combination of
the depth and duration of suppression," he said. "That is truly satisfying
because high proteins are essentially common to almost all of the popular
diets."
They also found that eating carbohydrates resulted in a strong ghrelin
suppression at first, but ghrelin levels rebounded with a vengeance, rising
to an even higher level.
Basically, the carbohydrates eventually made people even hungrier than
before they had eaten.
Cummings said the findings may aid in future research on the effectiveness
of different diets.
And the study likely means that nightly bowl of ice cream is out. "That is a
bad idea no matter what," he said. [RT]
researchers have said in a study that offers insight into how diets work.
They found that protein does the best job at keeping a hunger hormone in
check, while carbohydrates and fats may well deserve their current nasty
reputation.
The study, which will appear in the Journal of Clinical Endocrinology &
Metabolism, looked at the effectiveness of different nutrients at
suppressing ghrelin, a hormone secreted by the stomach that stimulates
appetite.
"Suppression of ghrelin is one of the ways that you lose your appetite as
you begin to eat and become sated," said Dr. David Cummings of the
University of Washington in Seattle, who worked on the study.
The researchers gave 16 people three different beverages, each with varying
levels of carbohydrates, fats, and proteins. They took blood samples before
the first beverage, then every 20 minutes for six hours afterward, measuring
ghrelin levels in each sample.
"The interesting findings were that fats suppress ghrelin quite poorly,"
Cummings said in a telephone interview. They fared the poorest overall.
"Proteins were the best suppressor of ghrelin in terms of the combination of
the depth and duration of suppression," he said. "That is truly satisfying
because high proteins are essentially common to almost all of the popular
diets."
They also found that eating carbohydrates resulted in a strong ghrelin
suppression at first, but ghrelin levels rebounded with a vengeance, rising
to an even higher level.
Basically, the carbohydrates eventually made people even hungrier than
before they had eaten.
Cummings said the findings may aid in future research on the effectiveness
of different diets.
And the study likely means that nightly bowl of ice cream is out. "That is a
bad idea no matter what," he said. [RT]
Online Social Networks Are Powerful & Ineffectual All At Once
Nothing demonstrates the wildfire spread of online social networks such as
MySpace and Facebook better than the experience 73 students had last fall.
They were enrolled in the computer science course Creating Engaging Web
Applications Using Metrics and Learning on Facebook-and did they ever
engage. At a public session held at the Alumni Center toward the end of the
quarter, 500 people heard how "10 million [users] in 10 weeks" were expected
to have installed the students' free applications, some of which were
reportedly generating enough ad revenue to pay tuitions.
Most of the apps resemble party games or amusements-ScribbledPhotos lets
users draw graffiti on Facebook photos; with KissMe, members can bestow
kisses-although some focus on generating useful information. But
co-instructor BJ Fogg, an experimental social psychologist whose Persuasive
Technology Lab studies how computer technology changes people's beliefs and
behaviors, dismisses critics like one blogger who called the applications
"monumental drivel." The point was for students to learn how to think, using
psychology and metrics to make their applications more appealing. And by
quarter's end, 10 million proved an underestimate: "What other class in the
history of the world created student projects that reached 16 million people
in 10 weeks?" asks Fogg.
It's that kind of dramatic result that has a growing number of academics
starting to look at how online social networks function and what they
deliver compared with traditional, offline connections. Fogg can envision
revolutions; others are not so sure.
Students and teachers in the Facebook class share in the credit, of course,
but much of their success must be attributed to the intrinsic power of
Facebook-which Fogg proclaims "the No. 1 persuasive technology and maybe of
all time." Online social networks are inherently "viral," built through
overlapping circles of friends, relatives, colleagues or acquaintances. In
most other businesses, referrals and positive word of mouth come from good
service. But to make almost any use of a networking site, you first must be
connected to people. So new users quickly start "friending," or inviting,
others, in effect shilling for the site before they've really tried it
themselves. Because the major sites enable users to import their e-mail
contact lists, it's easy to invite everybody you know with one click. True,
the invited must accept to join, but joining is free and declining or
ignoring a friend request can feel awkward.
As a site reaches critical mass, bandwagon-like "network effects" feed
further growth: since new users want to be where others are, numbers can
grow with epidemic speed. Today, hundreds of millions of people worldwide
belong to at least one online social network, making MySpace (with 110
million members) and Facebook (70 million) among the web's top 10 sites.
Beside these behemoths are many others, each with its own slant. LinkedIn,
for example, is generally regarded as the most popular professional network,
with 20 million users.
Such hyper-connectedness sets today's social networks apart from the online
communities that have been around since the dawn of the Internet, where
people gather to share common interests from hobbies to rare medical
problems. The newer networks offer enough services-and entertainment-to keep
users glued to the screen for hours a day. For some, MySpace and Facebook
are integral to their lives and identities: users can endlessly spruce up
their profile pages; share photos and videos; play games; compare tastes in
books, movies and music; keep up to date on the goings-on of friends (and
strangers); buy and sell through classified ads. On Facebook, users can
engage in more civic-minded pursuits, too-rallying around political causes,
supporting charities, coordinating blood drives and even lending money.
But all these activities aren't Facebook's main draw, Fogg concludes from
his survey of students. "It's mainly about connecting with others in a
convenient way," he says-keeping in touch with old friends, building new
relationships and expressing your identity and views. "The games are an
excuse to do these other things." MySpace, Fogg observes, is more about
entertainment and playing with identities.
On the all-business LinkedIn, less colorful and time-consuming by design,
users can tap into their networks for job leads, employees or vendors; try
to get the inside scoop on job candidates or prospective bosses; introduce
one person in their network to another; ask questions or build their
reputations by answering questions; or just put up their profiles in hopes
that opportunity knocks.
How much does all this differ from what people do offline? Not very, some
observers say. "Social networking is an intrinsically human activity that
goes a long way back and is closely tied to what we consider progress and
civilization-as well as nastier things like organized warfare," says Howard
Rheingold, a lecturer in communication and the author of The Virtual
Community (Basic Books, 1993) and Smart Mobs (Basic Books, 2002), among
other books about the Internet's social effects. He says that social
networking technology has merely lowered distance barriers to communication,
much the way the printing press did in its time.
Bernardo Huberman, a consulting professor of applied physics, concurs. He
also is director of the Social Computing Lab at HP Laboratories and is the
author of The Laws of the Web (MIT Press, 2001). "The main effect of the
sites has been the immense collapse of distance and cost," he says, likening
the situation to what happened after the cost of telephone calls fell.
"Twelve to 15 years ago, a long-distance call was expensive. Even though you
may have had friends in London, you didn't call your friends in London every
day."
Online social networks also let you broadcast information to everyone at
once. Establishing and perhaps maintaining a relationship is much easier
online than in the so-called real world, says anthropology lecturer and
academic technology specialist Claudia Engel, who has taught classes on
digital ethnography. "The cost-benefit balance changes dramatically." It's
not just about dollars and cents, either. "Sweaty palms, fear of
rejection-all that disappears online," Huberman notes.
Much of this is true of e-mail, too, which-at the worst extreme-lets users
spam millions of others at shockingly low cost to the spammer. But computer
scientist Ashish Goel, associate professor in management science and
engineering, says there's something more intriguing about social networks
than pushing information out-namely, pulling in information from diverse
sources. On LinkedIn, for example, you can quickly find out who in your
network knows a particular individual. "It's very hard to call all 250 of
your friends and ask, 'Do you know this person?'" Goel observes.
Getting a promising job lead, for example, "is not dependent on your cousin
remembering who they might have worked with a couple years ago in
Cincinnati," says Ingrid Erickson, a graduate student at the Center for Work
Technology & Organization in the department of management science and
engineering. LinkedIn, in which users' public profiles are essentially
résumés, provides an up-to-date record of skills, experience and
connections. "There's a bit of a knee-jerk reaction that face-to-face is the
gold standard," Erickson says. She argues that online exchanges sometimes
can be better. Because your online profile remains accessible, you can make
a stronger, longer-lasting impression-and perhaps connect in person later.
Conference attendees, for example, can learn about each other beforehand,
making their face-to-face networking more targeted and effective than in the
days of exchanging business cards around the punch bowl.
No one disputes the exponentially greater accessibility of information and
connections online, but opinions vary on how genuine or effective online
relationships can be.
Some critics point to the meaninglessness of amassing online "friends" the
way you might collect baseball cards. The sites themselves are partly to
blame, Fogg suggests. "A thousand connections-on LinkedIn, that's a status
marker," he says, noting that the interface was clearly designed to display
everybody's number. "And given that it was used in Silicon Valley first,
among competitive people, that number became like a video-game score."
"There has to be a trade-off between the volume of connections and the
quality," says economics professor Matthew O. Jackson, author of the
forthcoming book Social and Economic Networks (Princeton University Press).
He points out that having quick, easy access doesn't ensure strong
possibilities for trust to develop and valuable transactions to occur.
"There's informational value, but ultimately how valuable a particular
relationship becomes depends on how much people interact."
Fogg agrees. "At the beginning, the label 'friend' suggests you're going to
watch each other's back," he says, "but after you get 60 connections or
whatever your social capacity is, it doesn't mean you'll travel the world
and ring in the new year together." We have room for only so many
relationships in our lives, which is why the costs of real networking-not
exchanging virtual gifts on Facebook or inviting your former co-workers to
join your LinkedIn network, but helping others as you hope they may one day
help you-stay stubbornly high.
There's another way in which online networks are a poor approximation of an
offline network: they take a crude, binary view of human connection. On the
sites, someone is either your friend or not, and early attempts to let users
subdivide friends (such as Facebook's Friend List feature) still seem
robotic and inadequate. That lack of nuance leads to a host of problems,
Fogg says. "If somebody sees that Felix is my friend, and let's say Felix is
[really] an acquaintance or stranger, they're going to make assumptions
about Felix that he's a great guy-and that gets into problems of trust and
credibility."
Just as in the offline world, social networks rely on trust-but trust online
doesn't always work the way users expect. For example, I asked LinkedIn's
co-founder and VP of product strategy Allen Blue, why I might have trouble
getting hold of somebody who on LinkedIn is a connection of a connection.
"Every person within the system acts as a gatekeeper for everybody else in
the system," he told me. "There's no assurance that any of those gates are
going to work at any given time. You rely on the quality of the relationship
you have with somebody, and that person relies on the quality of the
relationship they have with somebody else."
Sociology professor Karen Cook, whose current research centers on trust in
social relations and networks, says that even if all the relationships in
the chain are strong, trust goes only so far. And to be worthy of our trust,
someone must be both competent and well-meaning. "I may trust my husband
with a child," explains Cook, "because he's highly motivated to take care of
the child, but not trust him with a checkbook-but that's more about
competence."
We have room for only so many relationships in our lives, which is why the
costs of real networking stay stubbornly high.
What's more, trust is not transitive. As Rheingold puts it, borrowing from
the writer Clay Shirky, "I may trust my friend's friend, but I don't trust
my friend's friend's crack dealer." Trust decays across the network, Cook
explains, because the farther removed someone is, the less we know about why
and how much others in the chain trust that person.
Still, there is at least a theoretical basis for thinking that online
networks might trump narrower offline connections, especially for business
purposes. Sociology professor Mark Granovetter wasn't thinking about online
networks when he coined the phrase "the strength of weak ties." It was the
1970s, and Granovetter was studying how people found employment. The most
fruitful connections for job leads, he found, were not close friends and
family, but more tenuous contacts-weak ties. That's because people close to
you are privy to more or less the same information you are; those outside
your inner circle will know of opportunities that you and your friends
don't. With the rise of online social networks, where people can maintain
many more weak ties, Granovetter's idea took on new legs.
So did the even older theory, popularly known as "six degrees of
separation," that any two people in the world are connected by at most a
few intermediaries. The idea gained traction following Stanley Milgram's
Small World Experiment. Milgram aimed to discover how many steps it would
take for a package-sent by one person to an acquaintance who in turn would
send it to a friend, and so on-to reach the hands of a total stranger.
Over the years, the popular imagination has distorted Milgram's results, as
psychologist Judith Kleinfeld uncovered more than 30 years later. The
endpoints of Milgram's original experiment were not random strangers around
the globe, but a small sample of Americans in Massachusetts and Nebraska.
Moreover, Milgram's six degrees was an average, not a maximum. In fact, the
overwhelming majority of packets never reached their targets.
Yet the legend of six degrees persisted, and online social networks added
credibility. We're comforted to know that it's a small world after all, and
it's nice to think we can connect to opportunities through people we already
know. The defunct SixDegrees.com made this promise explicit, but other
networks at least hint at the same possibility.
Certainly, social networks exhibit the "small-world property." Some
individuals know many more people than the rest-think politicians, agents,
hairstylists-and because of these well-connected hubs, it takes far fewer
jumps from node to node to connect any two individuals on a social graph
than if social ties were distributed evenly. But mere connection isn't
enough: many of Milgram's subjects didn't so much as mail a packet forward
in the chain. The mathematical sociologist Duncan Watts, author of Six
Degrees: the Science of a Connected Age (Norton, 2003), has been replicating
Milgram's study on a large scale, using e-mail, and has found the same
problem with messages not reaching their targets.
Software like LinkedIn's can lessen that problem by revealing the shortest
path between you and another individual in the network. But there's a
greater obstacle that databases can't overcome. Small-world networks work
through hubs, but most of the hubs' ties are, almost by definition, weak.
And, as Graduate School of Business professor of organizational behavior
Hayagreeva Rao puts it, "Typically, you get information from weak ties, but
you can't count on them to get anything done." This is true online and off.
"It's costless to add a connection," Rao says, "but when the person asks for
an actual favor that implies trust or some hassle, you're going to say,
'Wait a minute.'"
Granovetter's research suggests the same thing. People he studied didn't
find jobs through chains longer than one or two-either a friend or a friend
of a friend. "Beyond that point, it's no longer more effective than the
newspaper," he says. Interestingly, a quarter of LinkedIn's revenue comes
from newspaper-style job listings.
In 2004, three years before Facebook became a household word, Peter Thiel
invested $500,000 in the fledgling social networking site. Thiel, learned
about the investment opportunity from his close friend and former PayPal
colleague Reid Hoffman, himself a co-founder of LinkdIn. Hoffman had found
out about the Facebook opportunity almost by chance. Its founder, Mark
Zuckerberg, had moved from Boston to Palo Alto and became housemates with
the Internet entrepreneur Sean Parker. "I knew Sean, and I liked Sean a
lot," Hoffman told a San Jose Mercury News reporter. Hoffman thought highly
of Facebook, too, so he introduced Zuckerberg to Thiel. Today, Thiel's stake
in Facebook, at least on paper, is worth about $1 billion, and everyone else
in this chain has reaped benefits, too.
Yet online networking played no role in matching up these online networking
insiders. "The vast majority of economically significant networks are not
online, they're offline," says Graduate School of Business assistant
marketing professor Harikesh Nair, who studies economic implications of
social networks.
Granovetter, who has been studying Silicon Valley networks, says that
high-level VCs "are going to avoid those social networking sites like the
plague. Their whole stock-in-trade is their network, but they're never going
to manage those networks online: it's too democratic." For them, the costs
of belonging-notably loss of privacy-presumably do not justify any possible
benefits. (However, several online social networks restricted to VIPs have
sprung up; time will tell their effect on offline life.)
The economic benefits of online networking are hard to determine-in part
because any tangible payoff occurs offline. "I don't think we have good
studies of it," Granovetter says, "but as far as I can tell, online social
networking hasn't made any substantial difference in how people find jobs."
That could change, as job search sites like Jobster and CareerBuilder link
up with Facebook and members increasingly use the site to network for jobs
instead of purely socializing.
But for BJ Fogg, the important thing is that technology can lead to
interpersonal persuasion on a massive scale, and his lab's next initiative
is a lofty one. Peace Innovation aims to inspire international peacemaking
experiments using YouTube, Flickr or other second-generation web services.
The ultimate goal: world peace in 30 years. Fogg knows that sounds
ambitious, even a bit crazy. "But I think it's crazier to not try," he says.
"The world's in pretty bad shape, but we have some amazing tools to connect
and change people. We're not going to sell laundry detergent with them."
[SM]
MySpace and Facebook better than the experience 73 students had last fall.
They were enrolled in the computer science course Creating Engaging Web
Applications Using Metrics and Learning on Facebook-and did they ever
engage. At a public session held at the Alumni Center toward the end of the
quarter, 500 people heard how "10 million [users] in 10 weeks" were expected
to have installed the students' free applications, some of which were
reportedly generating enough ad revenue to pay tuitions.
Most of the apps resemble party games or amusements-ScribbledPhotos lets
users draw graffiti on Facebook photos; with KissMe, members can bestow
kisses-although some focus on generating useful information. But
co-instructor BJ Fogg, an experimental social psychologist whose Persuasive
Technology Lab studies how computer technology changes people's beliefs and
behaviors, dismisses critics like one blogger who called the applications
"monumental drivel." The point was for students to learn how to think, using
psychology and metrics to make their applications more appealing. And by
quarter's end, 10 million proved an underestimate: "What other class in the
history of the world created student projects that reached 16 million people
in 10 weeks?" asks Fogg.
It's that kind of dramatic result that has a growing number of academics
starting to look at how online social networks function and what they
deliver compared with traditional, offline connections. Fogg can envision
revolutions; others are not so sure.
Students and teachers in the Facebook class share in the credit, of course,
but much of their success must be attributed to the intrinsic power of
Facebook-which Fogg proclaims "the No. 1 persuasive technology and maybe of
all time." Online social networks are inherently "viral," built through
overlapping circles of friends, relatives, colleagues or acquaintances. In
most other businesses, referrals and positive word of mouth come from good
service. But to make almost any use of a networking site, you first must be
connected to people. So new users quickly start "friending," or inviting,
others, in effect shilling for the site before they've really tried it
themselves. Because the major sites enable users to import their e-mail
contact lists, it's easy to invite everybody you know with one click. True,
the invited must accept to join, but joining is free and declining or
ignoring a friend request can feel awkward.
As a site reaches critical mass, bandwagon-like "network effects" feed
further growth: since new users want to be where others are, numbers can
grow with epidemic speed. Today, hundreds of millions of people worldwide
belong to at least one online social network, making MySpace (with 110
million members) and Facebook (70 million) among the web's top 10 sites.
Beside these behemoths are many others, each with its own slant. LinkedIn,
for example, is generally regarded as the most popular professional network,
with 20 million users.
Such hyper-connectedness sets today's social networks apart from the online
communities that have been around since the dawn of the Internet, where
people gather to share common interests from hobbies to rare medical
problems. The newer networks offer enough services-and entertainment-to keep
users glued to the screen for hours a day. For some, MySpace and Facebook
are integral to their lives and identities: users can endlessly spruce up
their profile pages; share photos and videos; play games; compare tastes in
books, movies and music; keep up to date on the goings-on of friends (and
strangers); buy and sell through classified ads. On Facebook, users can
engage in more civic-minded pursuits, too-rallying around political causes,
supporting charities, coordinating blood drives and even lending money.
But all these activities aren't Facebook's main draw, Fogg concludes from
his survey of students. "It's mainly about connecting with others in a
convenient way," he says-keeping in touch with old friends, building new
relationships and expressing your identity and views. "The games are an
excuse to do these other things." MySpace, Fogg observes, is more about
entertainment and playing with identities.
On the all-business LinkedIn, less colorful and time-consuming by design,
users can tap into their networks for job leads, employees or vendors; try
to get the inside scoop on job candidates or prospective bosses; introduce
one person in their network to another; ask questions or build their
reputations by answering questions; or just put up their profiles in hopes
that opportunity knocks.
How much does all this differ from what people do offline? Not very, some
observers say. "Social networking is an intrinsically human activity that
goes a long way back and is closely tied to what we consider progress and
civilization-as well as nastier things like organized warfare," says Howard
Rheingold, a lecturer in communication and the author of The Virtual
Community (Basic Books, 1993) and Smart Mobs (Basic Books, 2002), among
other books about the Internet's social effects. He says that social
networking technology has merely lowered distance barriers to communication,
much the way the printing press did in its time.
Bernardo Huberman, a consulting professor of applied physics, concurs. He
also is director of the Social Computing Lab at HP Laboratories and is the
author of The Laws of the Web (MIT Press, 2001). "The main effect of the
sites has been the immense collapse of distance and cost," he says, likening
the situation to what happened after the cost of telephone calls fell.
"Twelve to 15 years ago, a long-distance call was expensive. Even though you
may have had friends in London, you didn't call your friends in London every
day."
Online social networks also let you broadcast information to everyone at
once. Establishing and perhaps maintaining a relationship is much easier
online than in the so-called real world, says anthropology lecturer and
academic technology specialist Claudia Engel, who has taught classes on
digital ethnography. "The cost-benefit balance changes dramatically." It's
not just about dollars and cents, either. "Sweaty palms, fear of
rejection-all that disappears online," Huberman notes.
Much of this is true of e-mail, too, which-at the worst extreme-lets users
spam millions of others at shockingly low cost to the spammer. But computer
scientist Ashish Goel, associate professor in management science and
engineering, says there's something more intriguing about social networks
than pushing information out-namely, pulling in information from diverse
sources. On LinkedIn, for example, you can quickly find out who in your
network knows a particular individual. "It's very hard to call all 250 of
your friends and ask, 'Do you know this person?'" Goel observes.
Getting a promising job lead, for example, "is not dependent on your cousin
remembering who they might have worked with a couple years ago in
Cincinnati," says Ingrid Erickson, a graduate student at the Center for Work
Technology & Organization in the department of management science and
engineering. LinkedIn, in which users' public profiles are essentially
résumés, provides an up-to-date record of skills, experience and
connections. "There's a bit of a knee-jerk reaction that face-to-face is the
gold standard," Erickson says. She argues that online exchanges sometimes
can be better. Because your online profile remains accessible, you can make
a stronger, longer-lasting impression-and perhaps connect in person later.
Conference attendees, for example, can learn about each other beforehand,
making their face-to-face networking more targeted and effective than in the
days of exchanging business cards around the punch bowl.
No one disputes the exponentially greater accessibility of information and
connections online, but opinions vary on how genuine or effective online
relationships can be.
Some critics point to the meaninglessness of amassing online "friends" the
way you might collect baseball cards. The sites themselves are partly to
blame, Fogg suggests. "A thousand connections-on LinkedIn, that's a status
marker," he says, noting that the interface was clearly designed to display
everybody's number. "And given that it was used in Silicon Valley first,
among competitive people, that number became like a video-game score."
"There has to be a trade-off between the volume of connections and the
quality," says economics professor Matthew O. Jackson, author of the
forthcoming book Social and Economic Networks (Princeton University Press).
He points out that having quick, easy access doesn't ensure strong
possibilities for trust to develop and valuable transactions to occur.
"There's informational value, but ultimately how valuable a particular
relationship becomes depends on how much people interact."
Fogg agrees. "At the beginning, the label 'friend' suggests you're going to
watch each other's back," he says, "but after you get 60 connections or
whatever your social capacity is, it doesn't mean you'll travel the world
and ring in the new year together." We have room for only so many
relationships in our lives, which is why the costs of real networking-not
exchanging virtual gifts on Facebook or inviting your former co-workers to
join your LinkedIn network, but helping others as you hope they may one day
help you-stay stubbornly high.
There's another way in which online networks are a poor approximation of an
offline network: they take a crude, binary view of human connection. On the
sites, someone is either your friend or not, and early attempts to let users
subdivide friends (such as Facebook's Friend List feature) still seem
robotic and inadequate. That lack of nuance leads to a host of problems,
Fogg says. "If somebody sees that Felix is my friend, and let's say Felix is
[really] an acquaintance or stranger, they're going to make assumptions
about Felix that he's a great guy-and that gets into problems of trust and
credibility."
Just as in the offline world, social networks rely on trust-but trust online
doesn't always work the way users expect. For example, I asked LinkedIn's
co-founder and VP of product strategy Allen Blue, why I might have trouble
getting hold of somebody who on LinkedIn is a connection of a connection.
"Every person within the system acts as a gatekeeper for everybody else in
the system," he told me. "There's no assurance that any of those gates are
going to work at any given time. You rely on the quality of the relationship
you have with somebody, and that person relies on the quality of the
relationship they have with somebody else."
Sociology professor Karen Cook, whose current research centers on trust in
social relations and networks, says that even if all the relationships in
the chain are strong, trust goes only so far. And to be worthy of our trust,
someone must be both competent and well-meaning. "I may trust my husband
with a child," explains Cook, "because he's highly motivated to take care of
the child, but not trust him with a checkbook-but that's more about
competence."
We have room for only so many relationships in our lives, which is why the
costs of real networking stay stubbornly high.
What's more, trust is not transitive. As Rheingold puts it, borrowing from
the writer Clay Shirky, "I may trust my friend's friend, but I don't trust
my friend's friend's crack dealer." Trust decays across the network, Cook
explains, because the farther removed someone is, the less we know about why
and how much others in the chain trust that person.
Still, there is at least a theoretical basis for thinking that online
networks might trump narrower offline connections, especially for business
purposes. Sociology professor Mark Granovetter wasn't thinking about online
networks when he coined the phrase "the strength of weak ties." It was the
1970s, and Granovetter was studying how people found employment. The most
fruitful connections for job leads, he found, were not close friends and
family, but more tenuous contacts-weak ties. That's because people close to
you are privy to more or less the same information you are; those outside
your inner circle will know of opportunities that you and your friends
don't. With the rise of online social networks, where people can maintain
many more weak ties, Granovetter's idea took on new legs.
So did the even older theory, popularly known as "six degrees of
separation," that any two people in the world are connected by at most a
few intermediaries. The idea gained traction following Stanley Milgram's
Small World Experiment. Milgram aimed to discover how many steps it would
take for a package-sent by one person to an acquaintance who in turn would
send it to a friend, and so on-to reach the hands of a total stranger.
Over the years, the popular imagination has distorted Milgram's results, as
psychologist Judith Kleinfeld uncovered more than 30 years later. The
endpoints of Milgram's original experiment were not random strangers around
the globe, but a small sample of Americans in Massachusetts and Nebraska.
Moreover, Milgram's six degrees was an average, not a maximum. In fact, the
overwhelming majority of packets never reached their targets.
Yet the legend of six degrees persisted, and online social networks added
credibility. We're comforted to know that it's a small world after all, and
it's nice to think we can connect to opportunities through people we already
know. The defunct SixDegrees.com made this promise explicit, but other
networks at least hint at the same possibility.
Certainly, social networks exhibit the "small-world property." Some
individuals know many more people than the rest-think politicians, agents,
hairstylists-and because of these well-connected hubs, it takes far fewer
jumps from node to node to connect any two individuals on a social graph
than if social ties were distributed evenly. But mere connection isn't
enough: many of Milgram's subjects didn't so much as mail a packet forward
in the chain. The mathematical sociologist Duncan Watts, author of Six
Degrees: the Science of a Connected Age (Norton, 2003), has been replicating
Milgram's study on a large scale, using e-mail, and has found the same
problem with messages not reaching their targets.
Software like LinkedIn's can lessen that problem by revealing the shortest
path between you and another individual in the network. But there's a
greater obstacle that databases can't overcome. Small-world networks work
through hubs, but most of the hubs' ties are, almost by definition, weak.
And, as Graduate School of Business professor of organizational behavior
Hayagreeva Rao puts it, "Typically, you get information from weak ties, but
you can't count on them to get anything done." This is true online and off.
"It's costless to add a connection," Rao says, "but when the person asks for
an actual favor that implies trust or some hassle, you're going to say,
'Wait a minute.'"
Granovetter's research suggests the same thing. People he studied didn't
find jobs through chains longer than one or two-either a friend or a friend
of a friend. "Beyond that point, it's no longer more effective than the
newspaper," he says. Interestingly, a quarter of LinkedIn's revenue comes
from newspaper-style job listings.
In 2004, three years before Facebook became a household word, Peter Thiel
invested $500,000 in the fledgling social networking site. Thiel, learned
about the investment opportunity from his close friend and former PayPal
colleague Reid Hoffman, himself a co-founder of LinkdIn. Hoffman had found
out about the Facebook opportunity almost by chance. Its founder, Mark
Zuckerberg, had moved from Boston to Palo Alto and became housemates with
the Internet entrepreneur Sean Parker. "I knew Sean, and I liked Sean a
lot," Hoffman told a San Jose Mercury News reporter. Hoffman thought highly
of Facebook, too, so he introduced Zuckerberg to Thiel. Today, Thiel's stake
in Facebook, at least on paper, is worth about $1 billion, and everyone else
in this chain has reaped benefits, too.
Yet online networking played no role in matching up these online networking
insiders. "The vast majority of economically significant networks are not
online, they're offline," says Graduate School of Business assistant
marketing professor Harikesh Nair, who studies economic implications of
social networks.
Granovetter, who has been studying Silicon Valley networks, says that
high-level VCs "are going to avoid those social networking sites like the
plague. Their whole stock-in-trade is their network, but they're never going
to manage those networks online: it's too democratic." For them, the costs
of belonging-notably loss of privacy-presumably do not justify any possible
benefits. (However, several online social networks restricted to VIPs have
sprung up; time will tell their effect on offline life.)
The economic benefits of online networking are hard to determine-in part
because any tangible payoff occurs offline. "I don't think we have good
studies of it," Granovetter says, "but as far as I can tell, online social
networking hasn't made any substantial difference in how people find jobs."
That could change, as job search sites like Jobster and CareerBuilder link
up with Facebook and members increasingly use the site to network for jobs
instead of purely socializing.
But for BJ Fogg, the important thing is that technology can lead to
interpersonal persuasion on a massive scale, and his lab's next initiative
is a lofty one. Peace Innovation aims to inspire international peacemaking
experiments using YouTube, Flickr or other second-generation web services.
The ultimate goal: world peace in 30 years. Fogg knows that sounds
ambitious, even a bit crazy. "But I think it's crazier to not try," he says.
"The world's in pretty bad shape, but we have some amazing tools to connect
and change people. We're not going to sell laundry detergent with them."
[SM]
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