Barefoot running sounding better and better January 28, 2010

Daniel Lieberman, a professor of human evolutionary biology at Harvard University, gives another point to the barefoot team.  His new study shows the differences between those runners who have gone with or without shoes for most of their lives, plus those who have switched to barefoot running after using shoes for a long time.  He asserts that his study backs up claims that the human foot does a better job distributing weight and preventing injuries than our $125 fancy sneakers do, no matter how hard the running surface.  The study demonstrates how the real difference is in the way the foot strikes the ground:  with the ball by barefoot runners and with the heel by their shoe covered counterparts.  The foot has evolved to strike with the ball, whereas heel strikes increase the force exerted on joints, causing more damage.

So my question is, what if keep running in my shoes (to keep my feet nice and girly) but focus on striking with the ball of my foot?  I have yet to see that study, but I’ll remain mindful to not strike with my heels in the meantime.

More proof that handwashing is key January 17, 2010

If you needed any more proof that hand washing is your first major defense against illness, look no further.

Popular Science magazine’s Dec 2009 issue listed HyGreen hand washing tracking system among the top 100 best innovations of the year.  HyGreen is used in hospitals to monitor staff hand washing in order cut down on patient infection rates.  The system detects the presence of  hand sanitizer and alerts a badge worn by the staff member that they are cleared.  The badge then interacts with a monitor on the patient’s bed.  If they are not cleared, a vibration of the badge reminds them to wash their hands.  According the the article, during the product testing at the University of Florida’s medical center “…infection rates dropped to zero.”

That means that our hands get really gross, really fast, and are happy to pass on whatever they are carrying.

Other hand washing monitoring systems exist, including some using RFID technology, others using physical barriers with sensors attached to the sanitizing stations, all with similar promising results.  Now that Medicare now longer pays hospitals to cover expenses related to infections occurring while in the hospital, hand washing tracking systems will become the norm as a way to control infections and cost.

I am reassured that hospitals are taking the necessary measures to prevent infections; and I will be happy to continue washing my hands after I touch money and public doorknobs, ride the bus, and before and after each time I come in contact with a patient.

Green Tea: Drink up January 14, 2010

BBC News reported on their Health website today that a new study demonstrates the efficacy of green tea in preventing lung cancer.

The study explored rates of  lung cancer in smokers versus non-smokers and smokers versus smokers.  The researches observed strong lung protection in the groups that drank at least one cup per day of green tea.  Those smokers and non-smokers who did not drink green tea were five times as likely to develope lung cancer.  Looking at just the smoker groups, the researchers noted that green tea abstainers were twelve times as likely to develope lung cancer.

The researchers made sure to point out that drinking green tea in no way made up for the damage done to the body by smoking and reminded the readers that not smoking is the first step to ensuring healthy lungs.

The BBC article also mentioned earlier meta-analysis and studies that haven given conflicting information to date about the true extent of green tea’s ability to protect against cancers.   Please read more Here.

Another clue to Acupuncture’s method of action December 5, 2009

One of the failings I see in many acupuncture studies is that the “sham” acupuncture is too close to real acupuncture treatment.  Often in such studies the outcomes reflect this similarity showing that both placebo and treatment groups produce similar results.

Today I stumbled across a study from September of this year exploring the difference in the pain reducing mechanisms of both sham and real acupuncture.  This research could help inform future acupuncture research methods, lead to more large scale studies into the method of action found in this study, and shed light on previous confusing or conflicting result data.

The researchers performed eight treatment sessions over a four week period on 20 female fibromyalgia patients.  PET scans were used after the first treatment and again after four weeks.  Both sham and real acupuncture groups reported similar reductions in pain over time; however, the sham group reductions were more consistent with those seen in general placebo groups, while the true acupuncture group showed more significant clinical pain reduction. The scans showed that real acupuncture increased the opiod (the body’s inherent pain killing neurotransmitter) binding potential of the mu-opiod receptors in several key areas of the brain.  The sham acupuncture actually showed a decrease in that potential.  The NCCAM (National Center for Complementary and Alternative Medicine) stated in their review of the study that this would indicate that true acupuncture increases the brain’s ability to effectively use opiods while the sham acupuncture helps signal the brain to simply make more opiods.

The study abstract can be found Here. The NCCAM review can be found Here.

New breast health screening recommendations November 20, 2009

NPR’s All Things Considered broadcast yesterday brought to my attention the US Preventive Services  Task Force’s newly released guidelines for clinical breast screenings and self examinations.

 

According to their webpage on the US Department of Health and Human Services website, the new guidelines change the age recommendation of biennial mammography to

 

50-74 years of age.  They recommend against routine mammography for women 40-49, and eliminate the recommendation to teach women self breast exams.

 

The task force came to these new conclusions based on a meta-analysis of recent research that indicated that routine screening did not statistically decrease mortality rates in women ages 40-49 in relation to the risks associated with those screenings.  They found the greatest impact on mortality rates in the 60-69 age group.   The risks they are referring to are the high number of false positives associated with mammograms and their resulting biopsies or other unnecessary and often expensive interventions.

 

Both guests of the NPR program believed that insurance companies would be more likely to reduce their coverage of screenings for women 40-49 as a way to save money in light of the new guidelines.  The health advocates that disagree with the new guidelines fear that blocking access to screening in this way will have a negative impact on breast cancer mortality.

 

The recommendation against teaching self breast exam is founded on evidence that the exam has not shown to decrease mortality rates from breast cancer.  There were a few reasons given for this finding.  First, evidence shows that women generally do not perform self exams even they are taught how to.  Second, detection of lumps during self exams does not equate to early detection of cancer.  Treatment and prognosis are similar for self screening and clinical screening.  Last, “breast awareness” is more likely to lead to discovery of breast lumps as women already typically become aware of changes in their breasts during normal daily routines, such as showering, putting on clothes, etc…

 

Personally these new guidelines remind me of another recent developement in cancer screening guidelines regarding the PSA test for prostate cancer.  Recommendations came down to reduce or eliminate testing because the test was leading to too many false positives; and the benefits did not outweigh the risks of unnecessary interventions (often life changing).  During the NPR program for this topic doctors stated that they had been, or were in fear of being, sued for not screening by patients with late stage cancers that were found too late.  While the medical evidence showed that the testing did not increase survival statistically, there was plenty of anecdotal evidence showing that many individuals did live longer due to PSA testing catching fast growing cancers (prostate cancer is typically very slow to develop and progress).  I suspect that similar results will show up as these new breast screening recommendations go into effect.

 

Both parties on the NPR program quite eloquently stated each side of the debate on recommending routine mammography screenings for women age 40-49.  From Dr. BARRON LERNER (Internist, Columbia University Medical Center; Author, “Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America”): “…in order to save one life from women in their 40s, you need to screen something like 1,900 women for 10 years…there’s a lot of potential harm along the way to potentially only save one life.”  From Dr. THERESE BEVERS (Medical Director, Cancer Prevention Center, M.D. Anderson Cancer Center):  “In my opinion, my colleagues, other clinicians that see patients – breast cancer patients and screening patients for breast cancer, we’re willing to accept a number of false positives to be able to save one woman’s life.”

 

For me, this is a prime example of why each of us needs to make sure we are fully informed about our health choices.  When I am a 45 year old woman I want to know all of the risks and benefits of receiving early breast screening so that I can decide for myself if it is right for me, taking into account family and personal health history and my lifestyle.  I also want to make sure that my doctors are giving me all the information I need without the bias of insurance reimbursement issues or fear of malpractice lawsuits.

 

To see the transcript of the All Things Considered 11/19/09 program, click Here.