Monthly Archives: March 2014

Should doctors be environmentalists/advocates for the environment?

One thing that sometimes crosses my mind is whether physicians and other health care workers should also be environmentalists. After all the environment does play a role in people’s health. Contaminated water lead to outbreaks of water born diseases (John Snow, a London physician in the mid 1800’s is credited [at least in part] for ending a Cholera outbreak  by convince authorities to block use of a water pump at the center of the outbreak).  The cholera outbreak following the earthquake in Haiti several years ago is another example. Polluted air leads to increased respiratory disease.

Though in the U.S. and other developed nations with functioning governments, the chances of contaminating water with sewage is low. The one exception could be when severe weather overloads the septic systems in an area. However even in the Northeast U.S. where I live, beaches are monitored for coliform bacteria (this is a generic term for bacteria that live in our guts) and closed when the counts are too high.

Air quality effects health of populations – there were reduced hospitalizations in parts of Ireland after there were bans placed on burning coal.  When lead was taken out of gas (well, actually prevented from being put in gasoline…), blood levels of lead dropped. It’s a neurotoxin and high blood levels can affect brain development in children (hence the ban of lead in paint in the U.S.), and function in adults. For water, it’s not just bacterial contamination/pollution that is important. Chemical pollution can also affect health. Toxins can build up in the food chain – this is part of the reason why it’s suggested that pregnant women limit their intake of certain fish, for example. Mercury builds up in fish at the top of the food chain, such as in Tuna, and can adversely affect people neurologically and adversely affect developing brains. Studies continue to show an association between air pollution and respiratory  deaths.

Given the number of of medications that are derived in whole or part from the plant and animal world (aspirin, reserpine, taxol, digoxin, penicillin, streptomycin, are all plant and fungal products), an argument could be made that making sure plant and animal species don’t become extinct because it might affect future drug discovery. Before you say “but wait,….” think of this: heparin is derived from the linings of Pigs. ACE inhibitors were discovered through research on snake venom. There are some newer medications for Type 2 Diabetes which are derived/grew out of research on saliva from a lizard known as the Gila monster.

 

Men’s Health

My previous post was about women’s health. In this post I am going to review a couple of aspects of Men’s health. Most of the things men should be doing are things  people of both genders should be doing to stay healthy: stop smoking, exercising, eating a healthy diet, maintaining a healthy weight (or loosing weight if overweight).  Staying up to date with immunizations, such as yearly flu vaccination, is also important. Getting screened yearly for hypertension is important. Skin cancer screening is also important, though this might only need to be done every 2 years depending on whether you have any suspicious moles or lesions, prior history, you and your dermatologist’s comfort levels for yearly vs every other year screening. Cholesterol screening at appropriate intervals is important (a healthy male in his 20’s with no risk factors for heart disease only needs his cholesterol checked every 5 years or so. Older men and those with risk factors require monitoring more frequently and perhaps yearly if risk factors are present or if on treatment to lower cholesterol). I won’t get into more details about screening or other issues covered already in other posts.

Perhaps the biggest controversy in mens health is prostate cancer screening. The U.S. Preventive Services Task Force actually recommends against routine screening for prostate cancer in healthy men of all ages. Even the American Urological association recommends against screening for prostate under the age of 64 and in men with life expectancy of less than 10 years. For screening, a conversation with your primary care doctor is warranted before getting the test. The main reason it is controversial is that one runs the risk of finding a prostate cancer which is indolent (slow growing), non aggressive that one is likely to die with than of – meaning one is likely to die of some other disease before the prostate cancer becomes a problem. At this time we don’t have enough information to know what low grade/early prostate tumors are going to become aggressive and turn into problems. One therefor runs the risk of over treating something that would not be a problem.

Occasionally I’ve had patients ask for testosterone levels and had to talk to patients about testosterone replacement. Testosterone levels are not something  routinely checked unless there is a clinical reason (if there is loss of libido, erectile dysfunction, and so forth, then it’s worth getting). Testosterone replacement has been associated with an increased risk of heart disease so replacement benefits needs to be worth the increased risk.

Although I probably run the risk of repeating myself by saying this, but reducing the risk of heart disease, lung cancer, colorectal cancer by exercising, watching what one eats and getting appropriate screening applies to men’s health as well.

Random Thoughts on Women’s health

I’m dividing this post into two parts. The first is on the recommendations for screening in females. The other part is some general thoughts on women’s health in general (and are somewhat generalizable to anyone’s health, male or female). The recommendations are taken from USPSTF related sites.

If you’ve read any or all of my earlier posts, you know I’m into screening and catching diseases early, especially if there is treatment for the particular disease.

Women should get pap smears every 3-5 years with HPV testing. The frequency depends on a woman’s age, whether the pap smear is negative and the results of HPV testing. It is important that the HPV testing be done via one of the five tests that are FDA approved: the unapproved tests from what I understand are more prone to error. Ask your doctor if he or she knows whether the lab he or she uses is FDA approved.

Screening for STIs (sexually transmitted infections) is suggested. This includes syphilis and HIV in high risk individuals.

Breast cancer screening (mammography) is done every 1-2 years starting at 50 (the old recommendations were every two years starting at 40, then yearly after age 50). BRAC testing should only be done if there is a family history of breast, ovarian, peritoneal cancer.

Bone density should be done at least once after age 64. However one can consider doing bone densitometry at an earlier age.

As much time and energy that people put into screening for breast cancer, cervical cancer, etc I think there a tendency forget about screening for heart disease and colorectal cancer, things I think people tend to see as “a man’s disease”.   However in 2010, 23.5% of deaths in women were due to heart disease,  and 22.1% were due to cancer deaths (this includes all cancer deaths, not just breast cancer).  Lung cancer killed 70,000 women whereas breast cancer killed 40,000 women that same year. These are  for the most part “lifestyle diseases” in as much as most lung cancer is caused by smoking; diet, lack of exercise, obesity contribute to heart disease. These are all things that are modifiable to a  great extent.