Kids still getting too many antibiotics

If you’re at all concerned that we’re not using our antibiotic appropriately, then this will come as a disturbing report

It was presented at a European conference and it showed that in Belgium, kids under the age of 5 who visit an ER for a sore throat are overwhelmingly likely to get an antibiotic prescription for that complaint, probably because, I’d guess, in a busy ER, where the attention of most doctors is geared to not missing anything important in the seriously ill, it’s much easier to get rid of a cranky kid with a sore throat and his or her worried set of parents with a prescription for something, even if that prescription is useless than it is to sit down with them to delineate the many reasons they really don’t need an antibiotic.

But why is this disturbing?

Couple of reasons at least.

Kids under the age of 5 are very unlikely to be suffering from strep throat, by far the most common reason to give out antibiotics for a sore throat – kids that young are nearly always suffering from a viral infection, for which antibiotics are not only useless, but worse, they also of course can produce significant negative consequences, such as for example, increasing her risk of ending up with a C difficile infection.

Just as disturbing to me, though, was the finding that Dutch residents on call in ER hospitals were even more likely than their Belgian counterparts to be inappropriate dispensers of antibiotics, and the reason that should catch your attention is that if there’s one country where doctors are taught very forcefully to be cautious about using antibiotic prescriptions more cautiously than in the past, it’s Holland, one of the first countries to have raised the red flag of antibiotic overuse.

So if Dutch doctors haven’t really bought  into this precaution, how likely is it that doctors from other countries where such lessons are not taught and re-taught nearly as forcefully will also stop prescribing antibiotics for viral infections?

Not blood likely, I think.

Never believe health headlines in the popular press

Here’s a recent headline in a popular health news web site: Jocks Are Dumber, Research shows.

The study this headline referred to tested cognitive functioning in athletes in contact sports and athletes in non-contact sports both at the beginning of the athletic season and at the end.

The study found that about 1/5 of the athletes (22 %) who’d competed in contact sports i.e. those who’d sustained hits to the head during their athletic season, had significantly lower cognitive scores in some measures at the end of their season compared to the beginning compared to only 4 % of the athletes in non-contact sports.

Ergo the headline.

However, even a person with only rudimentary math skills (me, for example) can figure out that in this study, 78 % of the athletes in contact sports did not have any change in cognitive functions.

In fact, even the lead author of the study noted that “overall, there were few differences in the test results between the athletes in contact sports and the athletes in non-contact sports.”

In other words, yes, a few athletes in contact sports suffered a problem, most did not.

A perfect example of why medical story headlines are meant to attract eyeballs, not to tell the truth.

Being fit benefits every demographic group

Several new reports on exercise and fitness that should catch everyone’s attention.

1)     Women with advanced breast cancer who are fit tend to live longer than women with a similar malignancy who aren’t fit (as an aside, it’s hard to think of a condition where the same advice doesn’t hold, that is, if you have that problem, do more exercise and you’re likely to do better than your buddy with the same condition who doesn’t work out)
 
2)     Nice Swedish study showing that kids who take up physical exercise as part of a new school program tend to have improved school performance as a result of being more active
 
3)     Report from the US Preventive Services Task Force (a group that periodically reviews what we actually know about preventing specific conditions – this is also the group, please note, that has come out with a much-debated recommendation against the use of PSA screening test for prostate cancer, something I happen to agree with although nearly every urologist I’ve spoken to is dead-set against it) that fall prevention for seniors should mean doing regular exercise (as well as making sure of a sufficiently-high blood level of vitamin D).
 
4)     A cute little study showing that Duhh! kids tend to be more active when they hang out with kids who are also more active; best way to become more active is to find a partner to work out with, like, for example,  Tonka, my Rottweiler, who needs 2 (at least) daily walks and who lets me know in his less-than-subtle way when I’ve lingered too long before taking him out
 

Lose some weight- lower your risk of breast cancer

A very neat little study from Seattle showed that post-menopausal women who were also either obese or overweight could lower their risk of some types of breast cancer by losing some of that weight.

Specifically, the women in this study who were able to lose 5 % of their body weight (and surprisingly, most women in this study managed to do that; in fact, many lost 10 % of their body weight, which is remarkable) also ended up reducing their blood levels of some types of estrogen, and that in turn should lower their ultimate risk of developing an estrogen-sensitive breast malignancy, which is the most common type of breast cancer.

Hard to do, but it is doable.

And it is worth it. 

It's not just what you eat

An old and sage adage has it that you should eat a huge breakfast, a good-sized lunch and a tiny dinner.

Why?

The reason for a big breakfast is easy.

Breakfast sets the “metabolic table” for the day and because the more energy you start the day with, the more likely it is that you will produce more during the day, as well as the more likely that you will have the energy and discipline to do the exercise you need to do every day.

A good-sized lunch just adds to those benefits since you will still be active for at least 8 or 10 hours after lunch.

A small dinner is also easy to rationalize: your body “slows” at night so you really don’t need much in the way of calorie intake as evening sets in.

Unfortunately, nearly everyone follows exactly the opposite of that adage and for most of us breakfast is the smallest meal, dinner the largest.

To prove why that’s probably the least healthy way to live, a study on rats has shown that rats who ate a high-fat diet yet had their unlimited food intake restricted to only 7 hours of the day gained no weight from their high-fat, high-calorie diet and also had much better hormonal and metabolic measures than did the rats who were fed a high-fat diet but were allowed to eat whenever they wanted to.

Ergo: it’s not just what you eat but also when you eat that matters.

A thought for all parents to consider

Here’s an email I got in response to an item I did on TV encouraging parents to vaccinate their kids.

Dear Dr. Hister;

Thank you so much for voicing a strong advocation for childhood vaccinations.

I am an RN at BCCH (BC Children’s Hospital) and in my (many) years of pediatric nursing I have never seen nor heard of a child being admitted for a vaccine reaction.

Sadly however; I have looked after several children seriously affected by a vaccine preventable illness.

Something that any parents opposed to vaccines to ponder.

If you have high blood pressure

Several recent studies of importance for nearly everyone with high blood pressure, and even for most of  those who don’t have it – yet.

Reason I say “yet” is that HBP is increasing faster than nearly any other condition around the world.

And no surprise why, of course: HBP is closely related to excess weight and poor diet more sedentary lifestyle, which is affecting a rapidly increasing population even in third world countries.

So, first, a study has shown that that there may be a gender difference in how HBP affects us, that is, compared to men, in this study, women were more likely to get complications from HBP – strokes, heart attacks, and (the Yikes! one ) sudden death  - at lower blood pressure levels than men.

More specifically, to significantly lower their risk of complications from HBP, men needed to get to only 135/85 but women needed to get to 120/80.

Why does this matter?

Because it gets harder to achieve lower BP levels the lower you set the standard.

In other words, women may require more drugs to get to the level they need to than men may need, which also means, of course, that women may – likely will - suffer more side effects and complications from their BP therapy than their other-gender spouse might suffer.

Second, an interesting study showed that the music a person is listening to when they get their blood pressure checked may affect their BP reading.

In this study, patients getting their BP measured who listened to Mozart actually had a small but significant drop in their average BP, people listening to rock music (a song from Queen) had a spike in their average BP.

All of which has wider implications that it seems because what this highlights is that lots of factors – yes, the music on your Ipod, but also the personality – or lack of same - of your doctor, the receptionist’s attitude, how long you’ve been kept waiting, what you have to get to after you leave the office – may affect your BP reading in a doc tor’s office, so try to get it done in as neutral a state as you can, not always easy to do in a strange environment like that.

So a better idea if you can manage it is to get your BP measured on your own time, preferably on a machine you buy to use at home: that’s a way more accurate measure of your “true” BP than a one or even two-off in your doctor’s office.

But whatever you do, there is one clear implication from this study: when waiting to get your BP done, pick Mozart or Mahler over Megadeath.

A third study to note concerned people with a high genetic risk for HBP, specifically people in whom both parents suffered from high blood pressure.

In this study, people with that high pre-disposing risk were very nicely able to counter-act it by doing – you guessed it! I’m sure – lots of exercise.

In other words, and this also goes for other important inherited risks such as a tendency to obesity, for example – healthy lifestyle choices trump genetic risks, so work out, eat right, and live longer.

A fat old brain may be a dull old brain

A study published in the Annals of Neurology found that the more saturated fat the women in this study (all of whom were over the age of 65) ate, the worse their cognitive functioning.

Conversely, the more "good" fat (mono-unsaturated fat from e.g. olive oil, avocados, etc ) they ate, the better their cognition.

2 things: there’s really no reason to assume that similar results wouldn’t occur in younger women as well as men, ergo, it makes sense to me that a diet high in saturated fat – at whatever age - may be linked to progressive deterioration in cognitive functioning.

That said, it may not be the saturated fat that’s the culprit in the drop in cognitive powers.

In fact, I think it’s more likely that the high-saturated fat intake is a marker for a poorer overall lifestyle, that is, women (and men) who eat lots of red meat and butter (which are the major sources of saturated fat for American adults, and this study was done in the US) are also, I think, less likely to eat lots of veggies, do a bit of exercise, etc., and it’s really that overall poorer lifestyle, I think, that’s to blame for the cognitive drop.

In other words, I will not stop using using butter to fry my eggs and to eat lots of cheese.

Chocolate instead of lipitor?

In a small, terrific study for which I would have volunteered instantly, 31 people were assigned (over 2 weeks) randomly to consume a daily serving (about a whole bar) of either two forms of dark chocolate (70% cocoa), or white chocolate (0% cocoa, so it’s more of a candy than chocolate).

Those lucky people who got to eat the real thing had – and I’d like to trumpet this - lower blood glucose, lower LDL levels, and TA DA - higher HDL levels.

All of which would make chocolate a better lipid “drug” than even the most powerful statins.

Now clearly, chocolate has downsides – lots of it is made with too much sugar, it can add lots of calories to your daily intake, but you need your healthy treats, and a few hits of chocolate a week is not only a delight, it might also be very healthy for you.  

Diet for ADHD

A group of scientists from the University of Copenhagen in Denmark claim that there is some evidence in the literature to support trying dietary changes in kids with ADHD.

According to professor Kim Fleischer Michaelsen, “There is a lot to suggest that by changing their diet, it is possible to improve the condition for some ADHD children."

I’d love to believe this is true.

And I also think it never hurts to try a dietary manipulation to see if there’s any positive change in behaviour, but I wouldn’t hold my breath waiting for that to occur.

Seems to me that to evaluate the benefit – or lack of same – in kids with ADHD, what we first need is a much more accurate way to diagnose the condition in. 

Cancer survivors need to do the same as people without cancer

According to what are being called new guidelines, the American Cancer Society says that cancer survivors should exercise and eat right in order to reduce the risk of the cancer recurring, prompting me to ask “why in the world would these guidelines be considered as new?”

Isn’t this what we’ve always told cancer patients?

And if we didn’t shouldn’t we have been doing so?

One other point the ACS makes that’s also worth underlining: there is absolutely no evidence that supplements offer any additional benefits over a healthy diet to a cancer patient.

Amen to all that.

Should everyone be on statins?

A provocative study published in the Lancet argues that everyone over the age of 50 should be taking statin drugs to lower their risk of “cardiovascular events”, the common euphemism for heart attacks, strokes, cardiac arrhythmias, and sudden death from cardiovascular problems.

In this study, the researchers claim that even people with no major added risks of heart problems, the so-called “low-risk” individuals experienced small but significant drops in their risk for a heart attack or other cardiovascular event if they were taking a statin compared to low-risk people who weren’t taking these drugs.

It’s hard to know what to do with that advice.

Overall, despite what you may read in chat rooms where people who are unhappy for some reason are generally way over-represented, statins are pretty easy drugs to tolerate, and so far (this could change in an instant), their long-term risks seem to be minimal at worst.

However, taking a drug for life – and this is where this advice would lead you to – when you are well to begin with is an issue we have little experience with.

As always, it comes down to you and your preferences: there is no road map to follow, just a series of suggestions, and you have to decide for yourself which suggestions to follow.