Brief News & Comments From the CMO

Mr. Spock’s Last Lesson     

Leonard Nimoy died recently. He was famous world-over for his portrayal of Mr. Spock in Star Trek. He had previously announced that he had COPD – Chronic Obstructive Pulmonary Disease. 

COPD is caused almost entirely by one thing – smoking (tobacco and Marijuana). COPD is usually emphysema and chronic bronchitis combined. Breathing becomes increasingly difficult and cough eventually becomes exhausting.

As he appeared in public wearing oxygen to breathe, Nimoy was quoted by the LA Times:

"I quit smoking 30 years ago. Not soon enough. I have COPD. Grandpa says, quit now!! LLAP," the living legend tweeted, adding his signature abbreviation for the half-Vulcan's "live long and prosper" motto.

Tobacco diseases are progressive. At some point they reach the point of no return – lung cancer, COPD and much else will continue to worsen even after stopping smoking cigarettes, cigars, marijuana and anything else.

Best to listen to Mr. Spock – if you smoke anything, stop now, before it is too late, so you too can live long and prosper!

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 Is coffee good or bad for you?

It seems that there is a new study on coffee every week, and the stories swing from it is good for you to it is bad for you. A recent study says it reduces the risk of multiple sclerosis. Previous ones said it caused some harms. Still others said it lengthens life. What is the poor coffee lover to think?

All of those studies are just about associations. Such studies, called observational, compare equally matched groups, one with the factor in question and one without. If there is something different between the two groups, who are otherwise supposed to be the same, then perhaps that means that the factor in question is causing the difference. If two things occur together, that does not mean that one necessarily causes the other to happen.

Be careful about what you read

Observational studies are useful to identify things needing further research. Such studies pointed the way to recognizing the risks of high blood pressure, high cholesterol, smoking and many other things that were later confirmed by further research. While some association observational studies have been very helpful, many others, widely publicized, turn out to be false leads, but, when they do, that does not make the news.

Association studies are only meant to identify things for future study. Unfortunately, the media report them constantly as if they were proof of cause and effect. Association is not cause. Hemlines of women’s skirts go up and down with the stock market, but you would probably lose your shirt (or skirt) buying or selling stocks based on that.

Look for meaningful results

Furthermore, in most of the studies the differences are in the range of ten to fifty percent. That is even less reliable proof. If something were fully twice the risk or more, then there is likely a real effect there, but anything less than that could well be due to other factors the researchers could not figure in or know about. For example, the story might say that people who eat a certain food are twenty percent less likely to get cancer. That is a meaninglessly small difference and not one you should be bothered by. Maybe it is true or maybe not, but no need to drive ourselves crazy over these endless, poorly reported stories.

Smokers are many times more than twice as likely to get lung cancer as non-smokers are (and non-smokers rarely get lung cancer), so smoking is very clearly and unequivocally the cause of lung cancer.  However, suppose you read that people who drink smoothies made purely from vegetables and fruit with no added sugar or fat are thirty-percent healthier. You might think you should start drinking them, too.  You are probably right, since vegetables have been proven in many ways to be really good for you, but in this study, it is possible that the people who chose the veggie smoothies were also very health conscious in other ways and thus healthier because of that and not because of the smoothies. You might also wonder by what measure they judge ‘healthiness’?

In many things reported in the media the results are even less certain. Reporters are not scientists or doctors and lack the ability in many cases to recognize and analyze the limits and problems of scientific research. Science really works - it has sent men to the moon and helped people live much longer and healthier, but the scientific process getting there looks messy and uncertain if you do not understand it.

So beware all those news stories and wait for clear-cut conclusive further research. Get the information you need from your doctor, from reliable websites like the National Institutes of Health, major medical school sites and the like and from JIB Medical. Our handouts and website are all based on careful scientific analysis and long experience.

So what about your coffee? Like anything, it has its advantages and disadvantages. 

On the good side, there is some suggestion (not proof!) that it might slightly reduce the risk of multiple sclerosis and Parkinson’s Disease, but much more research is needed.

On the bad side, coffee, with or without caffeine, is the strongest stimulant of stomach acid there is, so best to be avoided in people with acid problems.  Too strong a brew might raise cholesterol (bad). A cup of coffee can have between 100-450 milligrams of caffeine per cup, depending on size and maker (http://www.cspinet.org/new/cafchart.htm). For comparison, a No-Doz tablet, which people use to keep awake, contains 200 milligrams of caffeine. Caffeine in moderation probably has some beneficial effects and feels good, but it is a stimulant and too much can cause blood pressure to go up, heart to race and even more serious problems in those with certain genetic defects or advanced heart disease. If you are used to heavy caffeine use, sudden stopping can cause bad headaches.

So what is the answer? As in most things, the best strategy is moderation.  Enjoy your coffee in limited amounts. Use only skim milk to avoid the unhealthy milk fats. Ask your doctor about it if you have any medical problems or if you are or might soon be pregnant.

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Concerns about Diclofenac and other NSAID’s

Diclofenac is a widely used NSAID (non-steroidal anti-inflammatory drug). NSAID’s are pain medications that also reduce inflammation a little. Common examples are Aleve, an over-the-counter form of Naproxen and various brands for Ibuprofen, such as over-the-counter Advil and Motrin. NSAID’s are used for acute aches and pains and for various kinds of arthritis.

Diclofenac is sold under various brand names, including Voltaren, Cataflam, Zorvolex, Zipsor, and as topical gels (Voltaren Gel, Flector Patch, Pennsaid, Solaraze). It is very popular among orthopedists and is the primary NSAID used topically (on the skin).

All NSAID’s are about equally effective and mostly similar in safety, other than Diclofenac’s higher risk of liver injury. Aspirin is also an NSAID, but differs in some way in its effects and risks. Aspirin can reduce the risk of heart attacks when used in appropriate cases but can increase the risk of bleeding and stomach damage.

Diclofenac has a clearly higher risk of liver injury.  According to the National Institutes of Health, it is among the top ten medicines causing liver injury (http://livertox.nih.gov/Diclofenac.htm#insert). The problems can come on within a week or over a much longer time. Some of the cases have been quite severe, including fatality.

Since the other NSAID’s have a lower liver risk but are just as effective, it is unclear why Diclofenac is still used.

Since NSAID’s are sold over the counter, many people think they must be totally safe and use them without hesitation or precautions. Actually, they are far more powerful medicines than most realize. They are very good for aches and pains and, under a doctor’s direction, for more serious problems, but must be used with knowledge and caution.

Risks of NSAID’s other than aspirin are uncommon but include increased risk of heart disease in some people, damage to stomach and esophagus, kidney damage, liver damage (much less common in non-Diclofenac types) and increased bleeding.

NSAID’s can cause serious interactions with some medications.

Consider alternatives to Diclofenac and discuss with your doctor how and when you can use all NSAID’s safely and effectively. They can be very helpful and worth using, but they are serious medicines, so do not pop them like candy, as unfortunately too many people do.

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