The American Clean Energy and Security Act of 2009, the House bill sponsored by Rep. Henry Waxman, was passed by the House last June. The Senate bill, called The Clean Energy Jobs and American Power Act, sponsored by Sen. John Kerry, has been languishing in the Senate since its introduction last September. Now that health care has passed, we may see some action.

Steven Pearlstein, writing in the Washington Post, points out that the passage of health care reform may have convinced Democrats that the perfect really isn't the enemy of the good (a Voltaire phrase now associated with Ted Kennedy). Republicans may be ready to acknowledge that if they attempt to kill another piece of important and historic legislation simply to be ornery, they will miss out on significant concessions they could have won. Pearlstein puts the chances of passage at only 50-50, however.

I try to resist writing about health advice, since most health news is designed to increase anxiety unnecessarily. But here's something I found that's quite sensible and helpful. It's a post by Dr. Edward Pullen on over-the-counter (OTC) medications at KevinMD.

Scarring, stuffy noses, headaches, and sleep aids

You might think that products sold without a prescription would have no harmful side effects. Or at least that they'd be useful. That's not always the case.

The New England Journal of Medicine (NEJM) published a study back in 2006 that showed glucosamine and chondroitin worked no better than a placebo for knee pain. But patients still swear by the supplements for pains in the back or knees.

Consumers spent $838 million on glucosamine and chondroitin in 2008, which was a one percent increase above the previous year.

The lead researcher for the GAIT study [the Glucosamine/Chondroitin Arthritis Intervention Trial], Dr. Daniel Clegg, a rheumatologist, talked about this paradox with The Washington Post:

Clegg says both glucosamine and chondroitin are broken down during digestion and there's no evidence that they are incorporated into the deteriorating cartilage that is characteristic of the disease [osteoarthritis, the most common type of arthritis]. ...

When Texas nurse Anne Mitchell accused a doctor of unethical conduct, she had no idea how much trouble was in store. First of all, her complaint was anonymous, and second, she believed she was doing the right thing. When she was accused of harassment and faced a ten-year prison term, her reaction, according to the New York Times, was: "It was surreal. ... I said how can this be? You can't go to prison for doing the right thing."

The relationship between nurses - a predominantly female occupation - and doctors - still dominated by males in the more highly paid specialties - has not always been an easy one. Nurses have less power, not to mention fewer financial resources, which makes it less safe to blow the whistle.

Following the 2008 discovery in China of melamine-laced milk - an event that left six babies dead, 300,000 sickened, and over 50,000 hospitalized -- the Chinese government ordered all contaminated products to be burned or buried. The government was not directly involved in the destruction, however. That was left to those who had produced and distributed the tainted products.

Much of the contaminated milk was simply repackaged and shipped from the south (Guangdong province) to the northeastern part of the country. The government is aware of 170 tons of tainted milk powder, which were recalled earlier this week. The government also knows of another 100 tons that can't be located. Melamine-tainted candy is still being sold to children.

Melamine in milk is in the news again. Is this totally inexcusable or what?

Products from three Chinese companies were removed from shelves in southern China after they tested positive for melamine. Products included not just milk, but candy that used milk as an ingredient. Two of the companies had been cited in the last melamine scandal of 2008. That event was responsible for the deaths of six children and illness for 300,000 others.

It appears that milk contaminated with melamine in 2008 was not destroyed and was subsequently repackaged and sold. According to Reuters, "[H]ealth officials have continued to crack down on distributors who sell melamine-tainted milk to stores, but some distributors, wrongly assuming that the government has scaled back its crackdown, continue to sell it."

The Food and Drug Administration (FDA) has a new video on health fraud awareness. A worthy topic. It touches on weight loss products, HIV scams, cures for cancer and diabetes. What's noteworthy about the video is that it's SO boring. The inflections of the voiceover are totally inauthentic. It has the pacing of a 1970s newscast. There's almost no music. It's not sufficiently interesting to grab and hold anyone's attention.

News - and not just TV news -- has become infotainment. I would be the first to complain that this is a tragedy with major implications. But it's also a reality. To compete for attention, you need some creativity. The chances that this video had any input from a decent ad agency are slim.

Source: Sacramento for Democracy

Climate change

Copenhagen climate summit: Five possible scenarios for our future climate (The Guardian)
Concise summary of what we can expect for each increase of one degree Celcius (1.8 degrees Fahrenheit) in global temperature. Here are a few of the health implications.

1C: "Most of the world's corals will die, including the Great Barrier Reef. Glaciers that provide crops for 50m people with fresh water begin to melt and 300,000 people are affected every year by climate-related diseases such as malaria and diarrhoea."

2C: "The heatwaves seen in Europe during 2003, which killed tens of thousands of people, will come back every year. ... More than 60 million people, mainly in Africa, would be exposed to higher rates of malaria. Agricultural yields around the world will drop and half a billion people will be at greater risk of starvation. ... Glaciers all over the world will recede, reducing the fresh water supply for major cities including Los Angeles."

When did we start calling the whole day before Christmas "Christmas Eve?" I thought Christmas Eve was the evening before Christmas. But no. Senators voted on health care reform at 1:00 AM on Thursday December 24th. To me, that's still Wednesday night, but it was widely reported as happening on Christmas Eve. Perhaps publishers want to save ink. Or we live in such fast times that it takes too long to say "The day before Christmas."

Anyway, here's a flock of interesting stories I've come across recently.

Aging, end-of-life, and death

The Breadth of Hope, Selling Hope, and More on Quelling Thanatophobia, (Pallimed: A Hospice & Palliative Medicine Blog)
One unspoken message behind the "sell hope for a cure" ads is "we will not only cure your cancer so that you can avoid death, but we'll also make it so it's a non-issue in your life so that you can return to the way things were before. It'll kind of be like getting your car's air conditioner recharged."

A decibel (abbreviated dB) measures the intensity of a sound. The zero point of the decibel scale is called "near total silence." As long as we're living and breathing on the earth, we're never going to experience absolute, total silence.

If you scan the increasing decibel levels of familiar sounds, the numbers may seem to rise gradually enough. But they pack more punch than their size suggests. That's because the decibel scale grows logarithmically. A 20 dB sound (a whisper) isn't 20 times louder than near total silence. It's 100 times louder.

Let's look at the facts. Global warming inevitably leads to a global health crisis. Health and disease are the province of the medical profession. Shouldn't doctors be speaking out on the health crisis of global warming?

Last month the two leading British medical journals - The Lancet and the British Medical Journal -- published an open letter to doctors on climate change. In the US, the Journal of the American Medical Association also published a commentary on this subject. Both the US and UK arguments drew on the same evidence and made the same dire predictions.

The US commentary concluded with an appeal to the public health profession: "This is a critical time for public health advocates to demand that political leaders safeguard the health of the world's population, with particular attention to the survival needs of the most disadvantaged."

The British publications appealed directly to doctors: "Doctors are still seen as respected and independent, largely trusted by their patients and the societies in which they practise. ... We call on doctors to demand that their politicians listen to the clear facts that have been identified in relation to climate change and act now to implement strategies."

Climate change is a more serious problem than we thought it was just a few years ago. A big rise in global temperature may not happen for another 40 years, but other changes are "imminent," according to Science magazine. A permanent drought, with Dust Bowl-like conditions, could become the "new climatology" of the American Southwest in a matter of years.

Next December, 190 countries will meet in Copenhagen to discuss a solution. It's very difficult for politicians, who represent the financial interests of the status quo, to tackle the problems of climate change. As Paul Krugman said recently, a response to global warming would "shuffle the economic deck, hurting some powerful vested interests even as it created new economic opportunities. And the industries of the past have armies of lobbyists in place right now; the industries of the future don't."

There's an unfortunate parallel between the politics of climate change and the politics of US health care reform. They differ in scale -- global vs. domestic. But consider this: Who suffers the most from the lack of universal health care in the US? The poor and unemployed. Who will suffer the most from climate change? The poor and unemployed. There are many reasons for this, but largely it's a matter of where the poor live: the tropics, underdeveloped countries, overcrowded slums.

The world's poorest populations will be the first to suffer from climate change. When they can no longer survive where they currently live, they will leave their homes and migrate. The Indian government is presently constructing a seven-foot-high fence made of double-thickness razor wire and steel. It will be 2,800 miles long (4500 km) and line the entire border between India and Bangladesh. Its purpose? To keep out terrorists, yes, but according to the BBC, it's also meant to keep out immigrants who will flee the impact of climate change.

Like the appendix , collateral circulation is another part of our anatomy that was more useful to our ancestors. Collateral circulation refers to systems of veins and arteries that allow blood to continue flowing when the main pathway is blocked or damaged.

These extra vessels sometimes develop in response to a circulation blockage. But certain parts of the body - the elbows, knees, shoulders - are equipped with these redundant vessels right from the start.

We're not born with collateral circulation in those really important places like the brain and the heart. Why would we have these surplus vessels in the elbows, but not in the places that keep us alive?

The gall bladder is another useful but expendable organ (see recent posts on the appendix and the spleen). Unlike losing your spleen, living without a gall bladder is not detrimental to your health, though it may be inconvenient at times.

The gall bladder is located under the liver, on the right side of the body. It's a small sac, about three inches long and 1 ½ inches wide when it's full. It can hold a little under two ounces of bile (less than a quarter of a cup).

Bile is produced in the liver and stored in the gall bladder until it's needed to digest fats. Fats need to be broken down (emulsified) before they can used by the body. When they're not broken down, they pass right through the digestive track. That's what can be inconvenient about not having a gall bladder. If you eat foods rich in fats, you may need to stay close to a restroom.

While some anatomical organs are dismissed as totally unnecessary (see Still useful after all these years: The appendix), others are considered useful but dispensable. Consider the spleen.

Located on the left side of the body, under the ribs and behind the stomach, the spleen is about five to six inches long and one and a half inches thick. It weighs about six ounces (the weight of a can of tuna).

Until recently, we thought the spleen was limited to filtering out red blood cells and supporting the immune system.

What we already knew the spleen did for us

Red blood cell gets old, tired and damaged after 120 days or so, at which point we make new replacement cells. The spleen filters out the old blood cells. Not only does the spleen remove the aging cells. It recycles them. It breaks down the hemoglobin so the liver can use it for bile, and it makes the iron in hemoglobin available for the manufacture of new red blood cells.

You can live without an appendix, true, but you should no longer think of this "vestigial" organ as a useless part of your anatomy. The appendix is finally getting the respect it deserves.

We have ten times as many bacteria in the body as we have cells (and we have 10,000,000,000,000 cells). The human digestive system runs on bacteria, where they're called gut flora. The appendix turns out to be a storage container for the beneficial bacteria that digest our food. When an illness such as cholera empties the contents of the digestive track too rapidly, we lose bacteria. The appendix reboots the digestive track by repopulating the intestines with the bacteria stored in its little pouch.

The downside of an overly hygienic society

Why did it take so long to appreciate the appendix? "It's hard to figure out what the appendix does when you're studying superclean animals and people," according to Bill Parker, a Duke professor of surgery. The appendix evolved when lifestyles were much dirtier and were plagued with parasites. People got sick with diarrheal diseases much more often.

The idea that drinking eight glasses of water a day is the healthy thing to do has been around since the 1940s. It's not true, but at this point it's a widely held myth.

On a site called Optimum Health, for example, I found this statement: "The average person needs 8-10 glasses of water daily to PREVENT DEHYDRATION. At Optimum Health we encourage our clients to become properly hydrated. If you want to ... allow you body to function beautifully ... you must give it a whole lot more water!"

How the eight glasses myth got started

Chinese medicine teaches that people should drink when they're thirsty. The Chinese find it strange that Westerners strive to drink so much water. Public health recommendations in the West have now come to the same conclusion.

There's an email that makes the rounds on the Internet about three signs for identifying a stroke: Can the person smile, raise both arms, and speak a simple sentence.

"The Smile Test" was originally presented at a conference hosted by the American Stroke Association (ASA) in 2003. The ASA makes a point of not endorsing this test as a way to identify stroke. The research that came up with these three signs was based on a very small study.

Stick out your tongue

Since 2006 there's been an additional sign of stroke circulating in emails: Ask the person to stick out their tongue and see if comes out straight or if it's "crooked," that is, if it deviates to one side. This is a less reliable indicator of stroke simply because "crooked" is open to interpretation.

My mother was decidedly vain her whole life. She'd been exceptionally good looking in her youth, which made it especially difficult to accept the slow physical decay of aging.

Surely it must be easier in our culture to accept the wrinkles, sags and bulges that come with advancing age if one has never thought of oneself as particularly attractive. Or if one has cared little about appearances. Admittedly, this is an increasingly rare point of view in contemporary Western societies.

My mother slept in her wig. She didn't want anyone to see her bald spot, in case she died in her sleep. The bald spot was caused by the wig, which she wore because her hair had turned gray.

Scientists have not yet discovered that vanity is transmitted through the genes. Macular degeneration, on the other hand, is genetically transmitted. When my mother died of a heart attack at age 91, the doctor told her children she was about to be declared legally blind. She had macular degeneration and had never mentioned it to anyone.

Does swearing decrease pain? Definitely, according to a recent study from Keele University. Here are a few details most reports didn't cover.

Study volunteers were able to hold their non-dominant hand in a bucket of ice water (41° F) for two minutes while swearing, but for only one minute and 15 seconds while refraining from the use of expletives.

Before subjecting themselves to pain, the volunteers were asked to come up with five words they might use if they hit their thumb with a hammer. One test subject had to be eliminated because none of his words were curse words. Since the study was in England, a common choice was "bullocks."

It's not clear why swearing helps relieve pain. The author of the study, Richard Stephens, speculates that it activates the fight-or-flight response, which produces physiological changes.

He suggests it might be a good idea to refrain from swearing in casual, non-painful situations. "Swearing is emotional language but if you overuse it, it loses its emotional attachment."

Here's a good companion thought to HRT and the incredible shrinking brain. It's from Dr. Alicia White, an employee of Bazian, the evidence-based medicine firm in Great Britain. Bazian does research for the health news on Behind the headlines, the National Health Service site I recommend as a source of health news.

If you've just read a health-related headline that has caused you to spit out your morning coffee ("Coffee causes cancer" usually does the trick), it's always best to follow the Blitz slogan: "Keep Calm and Carry On". On reading further, you'll often find the headline has left out something important, such as, "Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumours eventually. (Study funded by The Association of Tea Marketing)".

The most important rule to remember is: don't automatically believe the headline. It is there to draw you into buying the paper and reading the story. Would you read an article called, "Coffee pretty unlikely to cause cancer, but you never know"? Probably not.

There was a widely reported story today about hormone replacement therapy (HRT) and a decrease in the size of women's brains. The headlines were predictably but needlessly sensational. In fact, the study did not measure a decrease in the brain size of any individual woman.

First, the headlines. There were 27 stories listed when I checked Google news this afternoon. 19 of these (70 percent) used the word "shrink," definitely a frightening choice of words when talking about one's brain. Five stories (18.5 percent) used a less provocative descriptor: brain-tissue loss... reduced brain size... reduction in brain volume... affects brain mass... loss of brain tissue... You get the idea. Three stories (11 percent) elected not to refer to brain size in the headline. But two of those talked about brain "shrinkage" in the first paragraph, another waited until the third. So all of these stories led you to believe that the brains of women on HRT got smaller.

The rush of stories was based on two papers published in the January 13 issue of Neurology. The primary paper analyzed brain scans for abnormal tissue (lesions) in blood vessels. The second paper analyzed MRIs of the brain and reported:

Much to our surprise, we found a small but significant decrease in the hippocampal and frontal volumes, and a nonsignificant trend towards reduced total brain volume in women who had been randomized to hormone therapy.

I haven't had an opportunity to see the original study, but none of the quotations I have seen use the word "shrink."

The Journal of Nutrition published a study on chocolate this month that was immediately picked up by the press. The headline of choice was "Dark Chocolate Prevents Heart Disease." Slightly more discriminating publications were willing to say "Dark Chocolate May Prevent Heart Disease." A marginally more accurate but still flawed headline: "Dark chocolate linked to lower risk of heart disease."

The title of the original journal article is "Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population." OK. Medical journalists need to translate dense, academic prose into everyday language. But there really is a big difference between saying you can prevent heart disease by eating chocolate and saying there's a correlation between chocolate consumption and a medical marker associated with the risk of heart disease.

The first implies a cause and effect relationship. With the second, you have no way of knowing if the correlation is a coincidence and some other factor actually explains what you're observing. You need to look at more than one study and the right type of study. Jumping to the headline "Chocolate prevents heart disease" is simply a quick way to get attention. That's why you need to beware of health news.

As promised in the last post, I have a recommendation for a source of health news. It's a site called Behind the Headlines. It comes from the National Health Service (NHS), the publicly funded health care system of the United Kingdom, and it's available on the Internet at Behind the Headlines.

The information in Behind the Headlines articles comes from Bazian, a company that provides evidence-based information to publications and healthcare systems. I won't go into all the pros and cons of evidence-based medicine (EBM) in this post. Just a brief overview, and why it's useful in analyzing the news. (EBM has a poor reputation in the US because some insurance companies have used it to deny benefits to patients.)

Do you eat trans fats and high-fructose corn syrup? If you know the ingredients of what you're eating, you can choose to avoid certain foods. But what about the consumption of health news? There is an enormous appetite for the latest medical findings, but no labels to tell us the ingredients: how are the stories selected, what are the sources of information, how accurate is the reporting. If we knew the ingredients, would we choose to avoid the majority of stories on medical research and health? In this post, I'll discuss the ingredients of health news and, in the next post, I'll suggest a reliable source.