health

Small Towns Face Rising Suicide Rates (www.nytimes.com)

Rural adolescents commit suicide at roughly twice the rate of their urban peers, according to a study published in the May issue of the journal JAMA Pediatrics. Although imbalances between city and country have long persisted, “we weren’t expecting that the disparities would be increasing over time,” said the study’s lead author, Cynthia Fontanella, a psychologist at Ohio State University.

“The rates are higher, and the gap is getting wider.”

Suicide is a threat not just to the young. Rates over all rose 7 percent in metropolitan counties from 2004 to 2013, according to the Centers for Disease Control and Prevention. In rural counties, the increase was 20 percent.

The problem reaches across demographic boundaries, encompassing such groups as older men, Native Americans and veterans. The sons and daughters of small towns are more likely to serve in the military, and nearly half of Iraq and Afghanistan veterans live in rural communities.

This is what inadequate heath care looks like. This is what a system that puts profits over treatment looks like. Right-wingers will say this $10 million settlement shows the need for tort reform; sane people will say that the fact that a toddler lost her feet, left hand, and part of her right hand because of delayed emergency room care shows the need to real health care reform.

From http://news.yahoo.com/girl-10m-amputations-er-delay-185910406.html:

The family of a California toddler whose feet, left hand and part of her right hand were amputated because of a lengthy emergency room delay has agreed to a $10 million malpractice settlement.

...

The hospital instead told them to continue waiting, and it was five hours before Malyia was first seen by a doctor, the document said.

"Ryan Jeffers and Leah Yang saw their daughter get weaker and sicker hour after hour as (hospital workers) chose to delay treatment," the complaint said. "They saw the bruising on her body increase, affecting her legs, arms and face. They were afraid she would die in the waiting room."

The New York Times printed my letter to the science editor. (Any New York friends still have Tuesday's paper around and willing to hold page D4 for my scrapbook?) They trimmed it, of course, cutting out the good parts; the original version is below.

Amusing that some sort of automatic system apparently tagged "wasting" as related to muscle atrophy when they posted it to the web.

Re: "Gun Query Off Limits for Doctors in Florida" (August 9):

I'm fairly certain that firearms safety was not part of my doctor's medical training, and if she brought the topic up at my next appointment I'd be concerned about why she was wasting time on a minor threat to my health. More than four times as many people die in fires each year than in firearms accidents, yet I don't hear anyone calling matches a "public health issue".

So long as people like Dr. Marcus conflate murders and suicides by firearm with accidental deaths, people who understand the statistics will feel that they are being treated as potential murderers or suicide cases when doctors ask prying questions about firearms ownership. Firearms are just one of many potentially dangerous items in a home, and excessive focus on gun accidents reveals either ignorance of the facts or a political agenda.

Tom Swiss
Baltimore

I recently mentioned a study showing that dietary intake of fiber from grains was strongly tied to lowered risk of death from cardiovascular, infectious, and respiratory diseases, and also protective against cancer deaths in men. (That intake would have to be mostly from whole grains, since the whole point of refining grains is to remove the fiber-rich bran.) And I mentioned that this was another strike against the "paleo" diet, which strongly discourages consumption of grains, as well as legumes and tubers.

Followers of the paleo fad argue that their diet is optimal because it represents what humans ate before the development of agriculture. But as it happens, for years we've had evidence that consumption of wheat and barley -- and perhaps even grain-flour bread -- goes back at least 23,000 years. (And there are hints that it might go back as far as 105,000 years, but that's still very speculative.)

And more recently, in an analysis published in the Proceedings of the National Academy of Sciences researchers from George Washington University and the Smithsonian Institution examined phytoliths (microscopic bits of silica or other minerals from plants) and starch grains found on Neanderthal teeth dating back 36,000 to 46,000 years. Their research shows that these most iconic cavemen (who have been recently shown to be part of our ancestry and not just an evolutionary dead-end, as was argued for some years) were not only eating legumes and grains like barley, but were cooking these carb-rich foods to improve their digestibility. (Full article here, though it may be hit by the copyright cops at some point.)

Yet again, a scientific study shows that if you don't want to die, plant-based nutrition is the way. A study published in the Archives of Internal Medicine shows that intake of dietary fiber -- which comes only from vegetables, fruits, legumes, nuts, seeds, and grains, and is not found in meat, eggs, or dairy products -- was associated with a lowered risk of death from cardiovascular, infectious, and respiratory diseases in both men (24% to 56% lower) and women (34% to 59% lower). Fiber was also found to be protective against cancer in men, though a significant effect was not found in women -- perhaps because men are more likely to die from cancers with a strong dietary link, such as esophageal cancer.

Putting yet another nail in the coffin of the psudeoscientific "paleo" diet fad, the results showed that fiber from grains (discouraged in paleo diets) was most strongly tied to lowered risk.

The study, conducted by the National Institutes of Health and AARP, included more than 388,000 people ages 50 to 71. Diet was self-reported by a questionnaire that asked participants to estimate how often they ate 124 food items. After nine years, more than 31,000 of the participants had died, and national records were used to find out who died and the cause of death.

Risk factors including weight, education level, smoking and health status were accounted for in the statistical analysis, but the protective effect of fiber remained.

To regs@dhmh.state.md.us:

Dear Ms. Phinney:

It has been brought to my attention that that Board of Chiropractic and Massage Therapy Examiners is considering changes to Maryland's massage therapy regulations. As a Licensed Massage Therapist I find the elements of the proposal dealing with continuing education to be deeply disturbing.

The most troubling change is that which requires the State Board of Chiropractic and Massage Therapy Examiners to pre-approve all continuing education courses. Under this plan, the board will no longer accept courses that are approved by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) -- even though NCBTMB certification is the dominant credential used for licensing in the first place. (Certification from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is also recognized for licensure, and as an Asian Bodywork Therapist I believe that is very important.)

This will reduce the quality of continuing education available to LMTs in Maryland. I have received much of my continuing education at the national conventions of the American Organization for Bodywork Therapies of Asia (AOBTA), traveling as far as California to receive instruction from the best teachers available. AOBTA is an NCBTMB certified provider, but if each individual state were to require approval of continuing education courses, such national providers would find it difficult or impossible to continue.

The proposal states that it "has no economic impact" and "has minimal or no economic impact on small businesses." This is a stunningly inaccurate statement. Many, if not most, massage therapists work for small businesses or are sole proprietors themselves, and continuing education makes up a significant outlay. And this proposal would heavily impact continuing education providers both in Maryland and across the nation.

This proposal is not in the best interests of the public, and I strongly urge DHMH to reject it. Thank you.

Very truly yours,

Tom Swiss
Dipl. A.B.T. (NCCAOM), AOBTA-CP, LMT
tms@EarthTouchShiatsu.com

Sure, you can lose weight on a junk food diet, since when it comes to weight loss, "it's the calories, stupid" should be the mantra. But if your goal is to live long and prosper, then (like the vegetarian Mr. Spock), you need to eat your vegetables. Yet more evidence for this comes from a study in the Archives of Internal Medicine, which looked at data from the Third NHANES Follow-up Study and found that people who consumed the highest levels of alpha-carotene (found in yellowish-orange vegetables like carrots, sweet potatoes, and pumpkins, and in dark green ones like broccoli, spinach, and lettuce) had the lowest death rates from cardiovascular disease, from cancer, and from all other causes put together.

The alpha-carotene intake was measured by blood serum levels, and the relationship was dose-dependent -- meaning, the higher the alpha-carotene level, the lower the risk. Those with a serum level of 9 µg/dL or higher had a relative risk of death that was only 61% that of those whose level was 0 to 1 µg/dL.

Alpha-carotene is chemically similar to the famous beta carotene, but seems to be more protective against certain types of cancer.

The good news is that something as simple and inexpensive as eating more fruits and vegetables can lower your risk of disease. The bad news: the CDC estimates that only 32.5% of American adults get two or more servings of fruit per day, and just 26.3% get three or more vegetables a day.

Chinese herbal medicines are well-known for often containing rare animal ingredients like tiger bone. In my opinion, a lot of this probably originated more from social/political pressure to make remedies for the Emperor or nobility from rare ingredients than from any increase in efficacy over plant materials, but regardless of the origin it's a common feature of Chinese herbal formulas, and most practitioners seem to accept it without question.

So I was pleased to stumble on this excerpt from the work of Sun Simiao. Sun was a Tang dynasty physician born around 581; he wrote the classic herbalism treatise Prescriptions for Emergencies Worth a Thousand Gold and is so highly regarded in the history of Chinese medicine that he has been worshiped as the "King of Medicine". He wrote:

From early times famous persons frequently used certain living creatures for the treatment of diseases, in order to thus help others in situations of need. To be sure, it is said: "Little esteem for the beast and high esteem for man," but when love of life is concerned, man and animal are equal. If one's cattle are mistreated, no use can be expected from it; object and sentiments suffer equally. How much more applicable is this to man!

Whoever destroys life in order to save life places life at an even greater distance. This is my good reason for the fact that I do not suggest the use of any living creature as medicament in the present collection of prescriptions.

What can you do when your product gets a bad reputation? Rename it! That's the plan the Corn Refiners Association has for high fructose corn syrup, a substance linked with high blood pressure, insulin resistance, and high blood cholesterol levels. They want to rename the stuff "corn sugar".

(It's unclear how different the effects of fructose are from sucrose -- it may just be that fructose is cheap so we eat more sugar in general now -- and exercise, as usual, mitigates the effects.)

New research published in the Annals of Internal Medicine uses data from the Nurses' Health Study and the Health Professionals' Follow-up Study to compare the overall mortality effects -- i.e., how likely something is to help you to your death -- of two different sort of low-carb diets: those based on animal products, and those based on plant foods.

Unsurprisingly, overall low-carb diets were associated with an increase in overall mortality. But what's interesting is that when they broke it down by plant-based versus animal-based diets, people consuming animal-based low-carb diets had higher mortality overall and also from cardiovascular disease and cancer, while vegetable-based low-carb diets were actually associated with lower all-cause and cardiovascular disease mortality.