The Tin Lizard

Downsizing The Big Gulp In The Big Apple

It wasn't at all shocking to hear yesterday morning that New York Mayor Bloomberg's campaign to ban giant-sized (32-ounce) servings of soft drinks was halted in court.  

Well, maybe a little bit surprising -- the judge ruled the new law didn't treat all parties equally, so the shock was to learn that the city had not sought to ban the oversized portions in all types of stores, or to ban large sizes of all caloric drinks. 

The question of whether it's legal to try to regulate the size of portions at all has been left unanswered.  Personally, I think Bloomberg's effort can't stand up to a challenge on that issue.  It may be a health concern, as the Mayor claims, but to what lengths can we go to try to save people from their own bad judgment?  And can't they just buy a larger number of smaller drinks and get around the law that way?

I'm not much of a soft-drink consumer.  Maybe one or two a year.  But I have noticed, when I go to a fast-food place, or a movie, that there typically is no drink small enough for me.  In many such places, 16 ounces is "small."  I might suggest to the Mayor that both health and freedom of choice would be better served if he proposed to require all places serving cold drinks in cups to offer an 8-ounce size so that those who want less, for health or other reasons, have a choice.   Let the people decide if they want to be chubby or not.

Cholesterol And Health

Cardiologist Stephen Sinatra and nutritionist Jonny Bowden have written a book called "The Great Cholesterol Myth."  In it they argue that contrary to what we're often told by doctors (and always told by the purveyors of such medications as Lipitor and other cholesterol-lowering drugs), cholesterol in general is not the cause of heart attacks.

Good and bad cholesterol?  Talk of LDL and HDL has become common in the past 20 years, but Sinatra and Bowden have a persuasive new angle on that too:  There are different types of LDL, one of which - far more common - they say is harmless.  You can get tests now that will analyze your LDL profile to determine if it's mostly Type A (not harmful) or Type B (the really bad stuff).  Only if yours is heavily "B," do the authors recommend statins, absent known heart problems.

Sounds right to me!  I've always supposed this was the case.  I imagine that to the extent it probably arises from a fat-heavy diet, a high cholesterol reading might be a sign of other health problems that could affect the heart, such as obesity.  But I've never been persuaded that cholesterol itself was a villain, so I've turned down suggestions from physicians who hint of prescribing statins for my borderline*  cholesterol, which shows a good percentage of HDL, the "good" version.

*A borderline that, like many another health parameter, keeps moving, inducing further doubt about how meaningful it is. 

I can't say that the views expressed in "The Great Cholesterol Myth" are a great relief to me, because I've never modified my diet much just to reduce cholesterol anyway.  But it is good to see medical thinking coming around to what I consider is a more sensible approach on this topic.

With a little more work, I'm sure they'll eventually get around to vindicating another of my own personal biases:  that high blood pressure is not a cause of heart disease.  I consider that it may be a symptom of something not quite right, so I do take a daily dose of something that's supposed to moderate my blood pressure, but I have no confidence whatsoever that it can really prevent any heart problems. Hypertension is the post hoc, but - as in economics - not the prompter hoc. 

I may never know, since there's no history of heart problems in my family line.  Very possibly, genes are more important than trying to control the uncontrollable.  Meanwhile, I'll continue to gnaw on a sausage now and again ... and again.   

Allergies And Resistance

• Recent research on a small number of patients gives a tantalizing hint that at least some people who suffer from peanut allergy might have their condition ameliorated by exposure to a mild dose of peanuts.
• A recent television news report marveled at the apparently surprising revelation that a large farm family, flourishing in overall good health and free of flu, might  have benefited from its constant exposure on the farm to a variety of livestock, plants, germs and allergens.

What's surprising to me is that these reports should be considered news.  I thought it was fairly common knowledge since at least the days of Edward Jenner that a resistance to a disease can in many cases be developed by exposure to mild or altered forms of that same virus/bacteria. 

It took somewhat longer for us to begin to understand allergies in the same way.  Nevertheless, by the 1960s the idea of taking injections to counter a range of allergens was in full-blown fad mode.  (I took some myself, for allergies to grass and pollens; they had little effect on me but reportedly did a lot of good for some people.)

Then came some kind of reversal.  On the allergy side, doctors apparently began advising people to keep their infants away from all allergens, while on the contagious disease front, people began widely to believe (incorrectly) that immunization can cause disease.

The field of medicine is not immune to an occasional sneeze of fad or fashion.  With luck, we may be moving back toward what seems to be a commonsense and generally effective approach on allergy.   

 

 

Let Us Not Get Over-Joyed!

Here's an interesting Christmas tale: Imagine contracting norovirus, bringing destructive insects into your home, getting lice, and suffering from food poisoning during your Christmas holiday.  Too much to bear?  There's more!

Indeed, the Washington Post ran a very strange "health" article yesterday, appropriately entitled "Creepy-crawly holidays," which, like somebody's old granny, details every possible health hazard that might arise as a side effect of Christmas celebrations.  There are nine in all, including the few I mentioned above, but not including some other well-known ones, like getting run over by Santa's reindeer, for example, being caught flirting around at the office Christmas party by your jealous wife.

Seriously, though, it's hard to imagine what weird bug possessed The Post and its health columnists to rain on the seasonal parade this way.  And if young children are traumatized by the shootings at Newtown, do they really need this piled on too?  Most of the hazards mentioned are with us at all times of the year, Christmas or not, so why make a special effort to dampen the spirit of the season?  

I'm reminded of going to a dermatologist a few years ago to have a few moles checked out.  Along with the doc, as a sort of package deal, came a doomsday harpy who fluttered around the exam room muttering incantations like " w-e-e-a-a-r a hat in the sun,"  "o-o-o-oh, always put on long sleeves!" and "b-e-e sure to protect your eyes with sun glasses at all times."  It was a performance worthy of a Greek play, but I never went back to that doctor.   

Some people take their health too seriously and like to nag others about it.  Enough is enough. 

 

The Parable Of The Fatted Calf - A Math Problem

The latest non-news on this evening's ABC-TV "news" was a fluffy report on an already-known topic:  How outward indications on your body (your fingernails, for example) may reflect certain things about your health.

In this case, Daffy Diane was all agog over a physician's "revelation" that certain external features may reflect a greater danger of heart disease.   According to the helpful diagram presented, if your calves are less than thirteen inches in diameter, it could be an indication of greater heart attack risk.

Wait.... diameter?  Did that say diameter?   I played it back.  Yes!  Diameter!   I tried to imagine a 13-inch-diameter calf.   To help me feature it, I took a photo which I am also sharing with you, dear reader, if you have the stomach for it.  Here:

In the photo, 13 inches is the distance from the left end of the ruler to my thumb.  Gee, I must be at really severe risk!  How counterintuitive!  I would think that anyone with calves that huge would be the one who's got a serious risk of heart attack.

Well, of course, it's just a little math problem.  They didn't mean diameter, they meant circumference.  And that's what they say in the accompanying voice-over:  "calves less than 13 inches around."   So I guess I'm OK after all; mine measures nearly 16 inches.

Still, my ninth-grade geometry teacher (whose calves were surely no more than maybe ten inches in diameter) would be appalled; and she probably would thwack the ABC news editors with that ruler to lay down a marker about the deterioration of basic education.

Generic Drugs

The morning news summarizes a new Consumer Reports look at generic medicines.  The focus is on how generics are required to be the "same as" the brand name products, but also on how generics can be different.

The underlying message is that even with the required same amounts of active ingredients, generics may create slightly different levels of medication in the body.  Also, the inactive ingredients in the medicine may be different from maker to maker.

I'm fortunate not to have to take a lot of medicines, but I humor my doc by taking something for my blood pressure.  Once or twice during the past 10 years, we've experimented twice with taking a generic.  But in one instance the new pill caused near-constant diarrhea, and in the other, my blood pressure go so low it felt like I was going to have a heart attack any time I exerted myself a bit.   These weren't side effects I read about on the package and then experienced; they appeared shortly after I started taking the new medicine, and ceased as soon as I went back to the regular one.

If the only compositional differences between brands and generics are their "inactive" ingredients, it doesn't make sense that side effects could exist.  Yet clearly they do, and they are my reason for not trying generics more often.

 

Breaking Down Barriers

I was impressed and surprised by the story of Kathrine Switzer as reported by the Washington Post yesterday.  Switzer was the first woman to run officially in the Boston marathon.  At the time there was no specific prohibition on female runners but none had actually tried it.  Perversely, that run in Boston in 1967 caused a backlash ban on women in marathons, which wasn't overcome until 1972.  Nevertheless, she effectively opened the sport for women, and helped make the marathon an Olympic sport. 

I'm not a runner (not since my army boots wore out) and certainly never did marathons, so it came as a surprise to me to learn that women had ever not been permitted to run.  (Pro football, maybe but running?)   But when you think about it, that was the conventional thinking of the time:  Women were "the weaker sex."  And the attitude of the Boston marathon coordinator, Jock Semple, who tried to stop her when he discovered there was a woman in "his" race, was also typical. 

Switzer, who is now in her 70s, had the last laugh.  She has a wikipedia page; Semple does not.        

 

Juice And Old Lace

Everyone seems to be getting excited about arsenic content in commercial fruit juices.  Consumer Reports has put out a report; news media have propagated their study.  Not that we shouldn't expect this news.  Arsenic is not only present in nature - our air, our water - naturally, just as the juice bottlers maintain, but it's also a component of insecticides.

Juice has other disadvantages.  It's usually relatively caloric, because (for example) a typical glass of orange juice contains the juice and calories of at least three oranges.  It's also sweet; naturally, to some extent, but also often excessively so due to the addition of more sugars.   And finally, it's adulterated.  Many juices labeled as a fruit (cranberry juice, cherry juice, apricot juice) contain only a limited percentage of the juice of that fruit, and a large percentage of apple juice.  No doubt this is because apple juice adds sweetness, and because it's cheap.  But it's not what you're paying for.

I was surprised to learn that many mothers are giving infants juice in bottles, several times a day.  Wow.  I suppose they think of it as "natural," but besides the various indignities inflicted upon pure juice by the folks who bottle it, it's useful to keep in mind that drinking juice isn't "natural" at all.  Cavemen, I feel pretty certain, didn't squeeze the juice out of their fruit into some rudimentary stone bowl and drink it.  The ATE THE FRUIT.

So:  Save your kids.  Drink water.  Eat fruit. 

 

Normal Bleeding

A recent commercial message for a pharmaceutical potion warns that if you experience "abnormal bleeding," you should consult a doctor.  This begs the question:  What would "normal bleeding" be?   Wouldn't you interpret most bleeding as "abnormal"?  Does this mean there are people who bleed all the time and might have to be on the lookout for an unexpected uptick in their bleeding?    

Air Travel And Surgery - Are There Differences?

It popped into my head just now that air travel, which has become increasingly unpleasant over the past couple of decades, is now very similar to having surgery.  I'm not currently planning either of these "adventures" for myself, but I note that both experiences:

• have an end benefit that's a bit uncertain: arrival at a destination, or a state of better health; you need to have hope, you can't be certain!
• include an element of danger - it makes no sense to travel by air or to have surgery if it isn't essential
• are priced similarly, i.e., by accretion:  Want an extra bag? That'll be extra.  Want the anaesthesia?  That, and the anaesthesiologist, will be separate on your bill.
• have a long lead-up that takes longer than the process itself, and is generally more unpleasant -- consider hospital check-in forms, restricted diet, and prep for surgery, or getting to the airport and making your way through security.

I think air travel probably has a somewhat better survival rate than surgery but even if that's not the case, if I were facing both experiences, I'd always do the air travel first.  A flight that goes wrong might eliminate the need for surgery, but even a surgery that goes right can't eliminate the need for truly necessary travel.