Monthly Archives: May 2014

Five Surprising Ways Oxytocin Shapes Your Social Life

This article shows some interesting uses for oxytocin, the “cuddle ” hormone. I can and have compounded it for some of my patients, in certain circumstance. You may want to discuss this with me at some time.

Five Surprising Ways Oxytocin Shapes Your Social Life

By Jeremy Adam Smith | October 17, 2013 | 4 Comments

New research is finding that oxytocin doesn’t just bond us to mothers, lovers, and friends—it also seems to play a role in excluding others from that bond.

It’s been called the cuddle hormone, the holiday hormone, the moral molecule, and more—but new research suggests that oxytocin needs some new nicknames. Like maybe the conformity hormone, or perhaps the America-Number-One! molecule.

Where does this many-monikered neuropeptide come from? Scientists first found it in mothers, whose bodies flood with oxytocin during childbirth and breastfeeding—which presumably helps Mom somehow decide that it’s better to care for a poopy, colicky infant than to chuck it out the nearest window. And, indeed, one study found a shot of oxytocin more rewarding to rat-mommies than a snort of cocaine. (Don’t worry, Dads: You can get some of that oxytocin action, too.)

As time went on, researchers found oxytocin playing a role in all kinds of happy occasions, from social activities (recognizing faces at a party) to more intimate ones (achieving orgasm with someone you met at that party). Lab tests found that oxytocin made people more trusting, more generous, and more gregarious. Thus oxytocin seemed, for a little while, to deserve its glut of touchy-feely nicknames.

In the past few years, however, new research is finding that oxytocin doesn’t just bond us to mothers, lovers, and friends—it also seems to play a role in excluding others from that bond. (And perhaps, as one scientist has argued, wanting what other people have.) This just makes oxytocin more interesting—and it points to a fundamental, constantly recurring fact about human beings: Many of the same biological and psychological mechanisms that bond us together can also tear us apart. It all depends on the social and emotional context.

The research is ongoing, and scientists are still debating how their findings fit together. But here’s a round-up of recent discoveries about oxytocin, boiled down to five cuddly and not-so-cuddly ways it might shape your social life.

1. It keeps you loyal to your love—and leery of the rest.

Men are dogs, right? They just want one thing, huh? Well, not if they’re jacked up on oxytocin. In fact, if they’re already in a loving relationship, they can become downright unfriendly to the opposite sex, according to a 2012 study in the Journal of Neuroscience.

Fifty-seven hot-blooded, heterosexual German men sprayed either oxytocin or a placebo up their own noses—and were then sent, alone, into a small room with beautiful young woman holding a clipboard. The questions she asked were irrelevant; instead, these scientists were measuring how close the men stood to the temptress as the two talked. (Here’s a tip: When you walk into a lab, never trust an experimental psychologist—those people are liars).

It turned out that if an oxytocin-snorting guy was already in a relationship, boyfriend actually kept his distance from his lovely interlocutor. Partnered guys who sniffed the placebo leaned in a little closer than their partners might have liked. The single guys, meanwhile, were probably too busy staring down her cleavage to hear the questions.

So oxytocin doesn’t simply make you all lovey-dovey, suggests this study. It also keeps you faithful to your partner—and wary of her rivals.

2. It makes us poor winners and sore losers.

Let’s say you’re playing a nice friendly game of poker. You like the people you’re playing with, you’re enjoying yourself. Until you start losing. The bastard on the other side of the table shows four of a kind or a full house every single time, and you can’t even get a pair. Damn him; he must be cheating. But then one hand later, you lay down a straight flush and take all his chips. Are you gracious? Hell, no. You light a cigar and gloat like a goat.

You might be surprised to hear that your posterior pituitary gland was probably secreting oxytocin through every step of that game, from the good feeling to the envy to the taunting. Quite a few studies have found that people dosed with oxytocin are more likely to spite their opponents when playing games of chance, which has led Andrew Kemp of the University of Sydney to argue that oxytocin plays a role in what psychologists call “approach-related” emotions—ones that have to do with wanting something from someone.

What about the friend who lost the game? You may have just lost that particular poker buddy—and again, oxytocin may play a role. If your friend is a mouse, anyway.

Researchers at Northwestern University put three groups of cute, gentle mice in a cage with another pack of crazy, aggressive ones. One of those three groups of mice had their oxytocin receptors removed. The other group had more receptors than usual. The third was normal.

All three groups were equally mauled by the psycho-mice, until the researchers rescued them. Their whiskers twitched, their pink noses happily wiggled—those mice thought they were safe.

But then, six hours later, scientists put the three groups back in the cage with the psycho-mice. (Remember, folks: Never trust an experimental psychologist.) Guess what? The oxytocin-free mice didn’t remember the mauling and didn’t know to run away, poor little guys. The other two groups scattered in fear.

The study, published in July by Nature Neuroscience, suggests that oxytocin strengthens social memories in the lateral septum, which has the highest oxytocin levels in the brains of both mice and humans. Yes, oxytocin is involved with attachment and social bonding, but that neural system can get tangled up in fear and anxiety—it gives us a visceral memory of those who have harmed us, as well as those who have cared for us.

The takeaway? If you beat the pants off your friends at poker and you want to play with them again, don’t gloat—but if you do, be sure to first remove their oxytocin receptors.

3. It makes you cooperative with your group—sometimes a little too cooperative.

Now, say you’re a single male chimpanzee. You enjoy sleeping in trees, attacking rival males, mating with random females, and eating the bugs you find in the fur of your friends.

Those bugs are tasty, but according to a study published in March, there’s at least one more benefit from grooming your chimp buddies: an oxytocin boost. Research finds that this reduces any stress that may have accumulated during a busy day of vying for the alpha male position.

Humans generally engage in other kinds of affiliative behaviors. I like to see movies with my human friends—but, hey, if you like eating bugs off yours, I for one will not judge you. Because just like other primates, studies find that oxytocin plays a critical role in helping us become more relaxed, extroverted, generous, and cooperative in our groups.

Sounds utopian, doesn’t it? Perhaps a little too utopian. Mirre Stallen and colleagues dosed Dutch study participants with either oxytocin or a placebo, and then divided them into groups of six. Each group watched a series of images and the individuals in the group voted for which ones they found most attractive. The results: The oxytocin-influenced participants tended to go with the flow of their group, while the placebo-dosed participants hewed to their own individualistic path.

The implication: Oxytocin is great when you’re out with friends or solving a problem with coworkers. It might not be so great when you need to pick a leader or make some other big decision that requires independence, not conformity.

4. It makes you see your group as better than other groups (to a point).

So far, dear reader, I’ve cast you in the roles of a hot-blooded lover, a poker-playing sore loser, and a chimp. Now let’s pretend you’re Dutch.

If a group of researchers in the Netherlands dosed you with oxytocin, you might find yourself developing a sudden affection for windmills, tulips, totally legal soft drugs and prostitution, and tall, blonde, multilingual bankers. You might also decide that the life of a Dutch person is more valuable than that of, say, a Canadian.

That’s exactly what Carsten De Dreu found in 2011. His study was sternly criticized for overstating its effects—and yet it’s not the only one to find that oxytocin seems to make us really, really, really like our own groups, even at the expense of other groups.

But loving our own groups doesn’t necessarily lead to hating other groups. Paul Zak’s lab at Claremont Graduate University has taken blood samples from members of campus groups like ROTC cadets and dance troupes. Then the groups perform some typical ritual—the cadets march, the dancers learn new steps together—and Zak and his minions draw more blood.

Zak isn’t a vampire. He’s not even an experimental psychologist; he’s actually an economist, so obviously you can trust him (right?). Being an economist means that his experiments always come down to money. He had those cadets and dancers play a series of trust and sharing games that ultimately earned them an average of $56 in real money. At the end, they could donate money to their own group or to a random charity.

That’s where things get nuanced. Yes, performing that ritual increased oxytocin counts by about 10 or 11 percent, but did cadets start favoring their team more than others? Across all 400 participants in his studies—this number of blood samples must make Zak the bloodiest economist in history—the increased oxytocin did not predict where they donated their money.

But there are some caveats. The more marginalized a group felt on campus, the more likely they were to circle their wagons and favor their own in-group (presumably, the band nerds weren’t as generous as frat boys to other groups). The effects of oxytocin could also change depending on what else was happening in the body: If Zak’s lab induced stress or acted to jack up testosterone, participants could, in fact, become more aggressive toward out-groups.

Which leads us to our final item…

5. It does make us trusting—but not gullible.

The research I’ve described so far probably sounds pretty great. If you’re a dictator. Or Don Draper—think about all the defective products you could sell by blowing oxytocin into the air.

Face it, we all want to rule the world sometimes, and I can certainly understand the desire to keep everyone else docile, compliant, and hostile to out-groups. The drug “soma” from Aldous Huxley’s Brave New World probably contained some oxytocin. The two-minutes hate in Orwell’s 1984 probably got the oxytocin pumping as well.

But before you start getting excited, you wanna-be dictator, there’s one more bit of new research you should know about: Studies find that we can cognitively override oxytocin-driven impulses.

Several experiments suggest that while oxytocin makes us more generous and trusting, it does not make us more gullible. If we have evidence that someone is deceiving us, we can withdraw trust and resources no matter how high we are on oxytocin. If we think someone doesn’t have our best interests at heart, we can end the relationship with a person or a group.

But the effects go beyond self-interest. We may like being part of a group so much that we’re willing to hurt others just to stay in it. The desire to belong can compromise our ethical and empathic instincts. That’s when the conscious mind needs to come online and put the brakes on the pleasures of social affliliation.

Your mom was right about keeping good company, says Paul Zak: “We do have to be in the right environment to be virtuous.” That might be the bottom line with oxytocin—and, indeed, any neural system that bonds us to other people: The impulse to join and conform in a group is always very strong in human primates, and so the key lies in choosing the right group—and then not getting carried away.

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About The Author

Jeremy Adam Smith is Web Editor of the Greater Good Science Center and a 2013 fellow with the Institute for Justice and Journalism. He is also the author or coeditor of four books, including The Daddy Shift, Rad Dad, and The Compassionate Instinct. Before joining the GGSC, Jeremy was a 2010-11 John S. Knight Journalism Fellow at Stanford University. You can follow him on Twitter!

PathoLOLgical testing.

29 October 2013, 2.40pm AEST

PathoLOLgical testing. Actually it’s not so funny.


A second opinion about health care and medical science


Michael Vagg

Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

Friends of Science in Medicine (to whose goals I am a signatory) has gotten together with the Royal College of Pathologists of Australasia (RCPA) to produce some excellent and sensible advice about dodgy health tests. I applaud the RCPA for being involved in defending the borders of its professional responsibilities as the ‘learned college’ responsible for pathology testing. It is heartening to see a professional body whose mission is largely the training and ongoing maintenance of standards for pathologists take on more of a consumer protection role in this way.

Some tests that get abused are legitimate tests which may be done by unaccredited laboratories with poor quality control, and with misleading interpretations of the results. Much of the online genetic testing that is available falls into this category. Respectable genetic testing involves trained genetic counsellors who explain the ethics and ramifications of doing the tests beforehand, and help to interpret the result afterwards. Overly simplistic ideas about genetic influences of disease are superficially appealing, but cheap and cheerful genetic testing is an ethical and legal minefield that needs an experienced guide. I was pleased to see there is advice about this in the document.

Ersatz sciencey-looking tests are a potentially excellent money spinner for alt-medders. They are advertised to the ‘professionals’ concerned (usually but not exclusively naturopaths) as such. Many of the testing devivces are completely discredited but continue to be sold and used by people who are either too lazy or too poorly trained to find out the truth about them. One excellent example of this category is Vega testing. This is a device which had its origins in made-up quackery and was widely marketed with claims about its ability to diagnose allergies amongst other problems. It was actually put into clinical trials, and was unable to tell those with allergies from those without. It has been debunked and condemned for more than 20 years by the medical experts in the field. In 2010, the importer of Vega devices into Australia finally had its listing withdrawn from the Australian Register of Therapeutic Goods (ARTG). This meant it could no longer be sold in Australia for healthcare purposes.

It did NOT however mean that it couldn’t still be used, or that retractions of all the claims had to be made. It’s as if a magic yeti tooth importer got busted for selling cow teeth and just agreed to no longer import them. The magic yeti tooth retailers are still free to go around continuing to report the miracles their products have performed, and people keep getting fooled into buying them. Check out what happened in the comments section when The Conversation’s own Dr Rachael Dunlop blogged about it (a full year before the ARTG cancellation in 2010) if you want to see for yourself the level of mistaken belief Vega supporters have in their equipment.

It’s now clearly a breach of the TGA Advertising Code to make any claims at all for the Vega machine, given that its sponsors couldn’t provide any supporting evidence of effectiveness when TGA asked them to. Product sponsors affirm when registering with the ARTG that they hold evidence that their product can do what it claims to do, by the way. Despite this minor regulatory hurdle, I found a friendly local practitioner just a couple of streets away from my office who could sort me out for some Vega testing action. You can take it from me that the secondhand Vega market seems pretty healthy as well, based on my browsing of some of the professional natural therapy classifieds.

Vega testing is just one example of the sort of flaky testing that many naturopaths espouse. Live blood analysis is another popular pseudoscientific test at the moment. According to my search of one of the larger natural therapy sites, there are at least 66 practitioners in Melbourne alone offering it. Amount of valid research supporting it as a diagnostic service? None. Have a look at the Wikipedia page. It has been scientifically debunked, and practitioners have been disciplined for making the sort of claims you see any day on the internet. One wonders how such a thoroughly discredited service could possibly be offered by any practitioner in good faith.

I think I know how it can happen. First, you need to create an environment where credible, sensible advice such as that offered by FSM and RCPA (or by Sense About Science in the UK) can be construed as propaganda in a turf war. Do this by producing testimonials. Fictional or not, a breathless story is always compelling. It helps to have toothless regulators whose legal powers have been carefully constrained by lack of money and staff. No matter how forbidding they look on paper, they won’t have the resources to pursue any more than a couple of fringe operators, while the rest of the industry pretend that nothing has happened. If pushed, blame the scapegoats as ‘rogue operators’ but under no circumstances should any natural practitioner attempt to address the logical and scientific howlers that underpin the whole enterprise. Finally, get sympathetic academics to write wordy papers which claim that trying to stop consumers getting ripped off and harmed is actually just a medico-fascist activity carried out by a powerful yet shady cabal trying to suppress free speech and ‘patient choice’. Stop me if any of this sounds familiar….

So my advice is to insist that any blood test you may have should be covered by Medicare, unless it is a highly specialised test that a relevant specialist recommends. If it’s not Medicare rebatable, the test should at least be done by a laboratory that is accredited by RCPA and the National Association of Testing Authorities (NATA). The logo should be on the test request slip.

It’s challenging enough to wisely order lab tests and interpret them without having pseudomedical wannabes stealing the lab coats and performing zombified versions of them.

Trust me, I’m a doctor… of sorts

13 December 2013, 6.43am AEST

Trust me, I’m a doctor… of sorts


It seems anyone can call themselves a doctor these days. Bart/Flickr

Qualifications and their associated titles allow for quick identification of appropriately trained or recognised experts within a given field. They bestow legitimacy on the information provided to people looking for expert advice.

But how does the average person decide who to reasonably trust when it seems anyone can call themselves a doctor?

Traditionally, the title doctor was reserved for medical doctors, or scholars who’d completed postgraduate training to a doctoral level, and were recognised by their peers as an expert in their field.

Indeed, a number of dictionary definitions appear to support these two categories.

Free for all

But doctor creepage has been hastening with extraordinary stealth over the last few years, particularly within health care.

I can clearly remember assuming as an adolescent that chiropractors were doctors who specialised in a particular medical domain (back care) because the title Dr preceded their name.

It wasn’t until much later that I realised that Dr Chiropractor or Dr Osteopath or Dr Vet were all equally deceptive for implying that people using the title are either medical doctors, or substantially more qualified than an undergraduate degree.

To be fair, most medical doctors also have an undergraduate degree, but that involves six or seven years of tertiary training, similar to that undertaken in total by a doctor of philosophy degree.

And I’m not suggesting that members of the aforementioned professions haven’t undergone university training suited to their practice (I’ll come to that substantially more serious problem later), but there appears to be no legal impediment to a number of bachelor degree graduates using the title doctor.

In fact, I couldn’t easily find the answer to the question of whether there’s any legal reason why plumbers, hairdressers or retired beekeepers can’t use the title!

Surely this situation is confusing because most people would assume a particular type of training (medical), or level of training (recognised expert in their field) goes hand-in-hand with this title.

Training and expertise

But there’s an even more serious related problem here, and that involves the questionable practice of representing certain kinds of “tertiary training” as comparable to university-level qualifications.

This practice is also becoming increasingly rampant in the health-care field.

Representing certain kinds of ‘tertiary training’ as comparable to university-level qualifications has become rampant in health care.

I was intrigued recently by a workshop reported by the press as being run by a “world renowned expert” allegedly “recognised as one of the foremost experts in the biochemistry of ADHD and ASD” (attention deficit hyperactivity disorder and autism spectrum disorders).

I wanted to discover more about this presenter, whose name was followed by the letters CNC.

After consulting the individual’s website, I discovered that CNC stood for Certified Nutrition Consultant, a qualification I had not previously heard.

And here’s a tip from that experience for punters: if you type the name of a qualification into Google, and the first site in the list is Quackwatch, you’re probably justified in being suspicions about the validity of that certification.

In this case, I was unable to find any mention that the person in question had engaged in any university-level education whatsoever. Although, to be fair, perhaps she has but chooses not to clearly advertise her education on her website.

While this particular CNC-qualified expert has written a couple of books and frequently appeared in the media, I couldn’t find any trace of her authoring a published study, review, or even having presented a basic scientific overview of her “research” in any kind of peer-reviewed journal.

When I tried to find out how one obtains registration as a CNC, I eventually found myself at its supposed credentialing website, which appeared to have some sort of requirement for tertiary training, but not necessarily at university-level.

Are you qualified?

This brings me to my final point: a number of qualifications, such as naturopathy, cannot be obtained from a public university because, quite frankly, these institutions won’t touch them.

Indeed, training in a number of alternative health domains is not even vaguely scientific or evidence-based, despite the pretence of being so. This has led to a variety of colleges popping up offering all sorts of questionable “qualifications”.

Now, I’m not suggesting that there’s anything wrong with people seeking alternative health options. But I dare say there’s very deliberate confusion being created by credentialing practices by these colleges, that attempt to mimic traditional markers of university-level training or expertise, presumably for personal or professional gain.

For those seeking a specific type or level of recognised expertise, the inflation of qualifications via the appropriation of the title Dr is at best unhelpful, and, at worst, deliberately disingenuous.

And those seeking a particular basis of advice (alternative versus scientific, for instance) have the unhappy task of navigating a conflation of scientific and alternative health qualifications from questionable tertiary training colleges.

Apart from the confusion this creates, it suggests level of insecurity among some health-care practitioners who may be attempting to establish their legitimacy through stealth and deceit.

Limits of Vitamin D Supplements

Limits of Vitamin D Supplements
The New York Times, 12/13/2013

A large review of studies has found that vitamin D supplements have little or no benefit beyond the low levels required for bone health. The meta–analysis, published in The Lancet Diabetes & Endocrinology, combined data from 290 observational studies and 172 random trials. All the studies used blood levels of vitamin D to measure outcomes. Dosages varied, but most trials used 800 units or more. The observational studies generally found an association of lower vitamin D levels with increases in cardiovascular disease, lipid concentrations, glucose levels, weight gain, infectious disease and mood disorders. But random trials showed little or no effect of vitamin D supplements on any of these problems. The authors conclude that low vitamin D levels are almost surely an effect of these diseases, and not a cause. Current guidelines recommend supplements for anyone with a blood level under 30 nanograms per milliliter, but the lead author, Dr. Philippe Autier, said that only at levels of 10 or less would there be a risk to skeletal health. Less than 10 percent of Americans, he estimates, fall into this category. Dr. Autier is a researcher at the International Prevention Research Institute in Lyon, France.

Health Check: is it safe to cut mould off food?

3 February 2014, 2.30pm AEST

Health Check: is it safe to cut mould off food?

The short answer is that it’s a lot safer than not cutting it off. Some moulds make and release poisons, called mycotoxins, into the food that could, over time, make you very sick. Why they do it is not…

Good news for vintage cheddar lovers. TheeErin

The short answer is that it’s a lot safer than not cutting it off.

Some moulds make and release poisons, called mycotoxins, into the food that could, over time, make you very sick. Why they do it is not especially well understood but that doesn’t make it any safer.

Some mouldy foods should simply be discarded (ideally, to compost). For others, though, you can salvage and use the unaffected parts without exposing yourself to a health risk. That’s good if your mouldy food is an expensive, vintage cheddar cheese!

The life of moulds

Moulds are fungi. They’re related to mushrooms, and the yeasts we use to make bread, or convert sugars to alcohol. They are heterotrophs, meaning they can’t make their own food (unlike plants). Instead, they degrade complex organic molecules in their environment into smaller molecules they can absorb to meet their energy and nutrient needs.

In nature, mould’s ability to break down detritus (waste) ensures that dead matter doesn’t accumulate. It also enables the release of minerals that are chemically tied up in detritus to the plants that need them for their primary production.

Moulds are single-celled organisms and, individually, are microscopic. When water and nutrients are available (such as in semi-perishable foods) they grow in number: to procreate, mould cells simply make copies of all essential cell components, and then divide into two new (genetically identical) “daughter” cells.

When moulds divide the two cells stay connected and when they divide again and again, they form a long chain of cells, called a hypha. The hyphae can branch and collectively form a complex matrix called a mycelium that, when big enough, can be seen with an unaided eye. This is the furry growth we can see, for example, on crumpets, berries, jam, tomato paste, cheese, and so on.

Not all moulds on foods will produce mycotoxins, or produce them at harmful levels. Sleepy Gonzales

The growing tips of the hyphae release enzymes into the environment to degrade complex organic molecules into usable nutrients. The tips of the hyphae also release the mycotoxins which are probably released to ward off competitors.

So, wherever the mycelia go in search of nutrients, toxins may also be found. The extent of spread of the mycelium is not always visible, however, and herein lies the problem.

What to do?

Many moulds can grow on, and spoil, our foods. Among those we are likely to encounter on foods in our homes are Penicillium (“cousins” of those used to make antibiotics, or to ripen some cheeses), Aspergillus, and on fruits, Botrytis.

You’re unlikely to experience any immediate symptoms from ingestion of mycotoxin-contaminated foods. Ongoing exposure increases the chances of a range of diseases including include kidney, liver and immune system damage, increased risk of a range of cancers and neurological symptoms; though these worst-case scenarios are rare.

Not all moulds on foods will produce mycotoxins, or produce them at harmful levels, but without a microscope and laboratory its hard to distinguish the dangerous and harmless ones. Given the risk to your health its best to take a very cautious approach to visible mould growth on any food with some exceptions.

A good rule of thumb to judge whether a mouldy food can be “saved” is its moisture content or firmness. Foods with a high moisture content such as cooked casseroles, soft fruit and vegetables, pastes/sauces and soft cheeses can have invisible hyphae growing below the surface and producing mycotoxins.

Time for composting. Jo Naylor

The same is true for porous foods such as bread and cakes where the hyphae can penetrate. All of these foods should be discarded if you see mould on the surface.

Conversely a cheddar, or a salami, or carrot, that have dense structure are less likely to have extensive hyphal growth away from the visible mycelium. In these cases the mycelium can be cut away (to a centimetre or two depth) and the remaining food consumed with little risk.

The United States’ Department of Agriculture’s website is a good source of advice for dealing with mould contamination on a wide variety of foods.

We Are Giving Ourselves Cancer

We Are Giving Ourselves Cancer



Launch media viewer
Ben Jones

DESPITE great strides in prevention and treatment, cancer rates remain stubbornly high and may soon surpass heart disease as the leading cause of death in the United States. Increasingly, we and many other experts believe that an important culprit may be our own medical practices: We are silently irradiating ourselves to death.

The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. Our resulting exposure to medical radiation has increased more than sixfold between the 1980s and 2006, according to the National Council on Radiation Protection & Measurements. The radiation doses of CT scans (a series of X-ray images from multiple angles) are 100 to 1,000 times higher than conventional X-rays.

Of course, early diagnosis thanks to medical imaging can be lifesaving. But there is distressingly little evidence of better health outcomes associated with the current high rate of scans. There is, however, evidence of its harms.

The relationship between radiation and the development of cancer is well understood: A single CT scan exposes a patient to the amount of radiation that epidemiologic evidence shows can be cancer-causing. The risks have been demonstrated directly in two large clinical studies in Britain and Australia. In the British study, children exposed to multiple CT scans were found to be three times more likely to develop leukemia and brain cancer. In a 2011 report sponsored by Susan G. Komen, the Institute of Medicine concluded that radiation from medical imaging, and hormone therapy, the use of which has substantially declined in the last decade, were the leading environmental causes of breast cancer, and advised that women reduce their exposure to unnecessary CT scans.

CTs, once rare, are now routine. One in 10 Americans undergo a CT scan every year, and many of them get more than one. This growth is a result of multiple factors, including a desire for early diagnoses, higher quality imaging technology, direct-to-consumer advertising and the financial interests of doctors and imaging centers. CT scanners cost millions of dollars; having made that investment, purchasers are strongly incentivized to use them.

While it is difficult to know how many cancers will result from medical imaging, a 2009 study from the National Cancer Institute estimates that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed. Given the many scans performed over the last several years, a reasonable estimate of excess lifetime cancers would be in the hundreds of thousands. According to our calculations, unless we change our current practices, 3 percent to 5 percent of all future cancers may result from exposure to medical imaging.

We know that these tests are overused. But even when they are appropriately used, they are not always done in the safest ways possible. The rule is that doses for medical imaging should be as low as reasonably achievable. But there are no specific guidelines for what these doses are, and thus there is considerable variation within and between institutions. The dose at one hospital can be as much as 50 times stronger than at another.

A recent study at one New York hospital found that nearly a third of its patients undergoing multiple cardiac imaging tests were getting a cumulative effective dose of more than 100 millisieverts of radiation — equivalent to 5,000 chest X-rays. And last year, a survey of nuclear cardiologists found that only 7 percent of stress tests were done using a “stress first” protocol (examining an image of the heart after exercise before deciding whether it was necessary to take one of it at rest), which can decrease radiation exposure by up to 75 percent.

In recent years, the medical profession has made some progress on these issues. The American College of Radiology and the American College of Cardiology have issued “appropriateness criteria” to help doctors consider the risks and benefits before ordering a test. And the insurance industry has started using radiology benefit managers, who investigate whether an imaging test is necessary before authorizing payment for it. Some studies have shown that the use of medical imaging has begun to slow.

But we still have a long way to go. Fortunately, we can reduce the rate of medical imaging by simply avoiding unnecessary scans and minimizing the radiation from appropriate ones. For example, emergency room physicians routinely order multiple CT scans even before meeting a patient. Such practices, for which there is little or no evidence of benefit, should be eliminated.

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Better monitoring and guidelines would also help. The Food and Drug Administration oversees the approval of scanners, but does not have regulatory oversight for how they are used. We need clear standards, published by professional radiology societies or organizations like the Joint Commission or the F.D.A. In order to be accredited for CT scans, hospitals and imaging clinics should be required to track the doses they use and ensure that they are truly as low as possible by comparing them to published guidelines.

Patients have a part to play as well. Consumers can go to the Choosing Wisely website to learn about the most commonly overused tests. Before agreeing to a CT scan, they should ask: Will it lead to a better treatment and outcome? Would they get that therapy without the test? Are there alternatives that don’t involve radiation, like ultrasound or M.R.I.? When a CT scan is necessary, how can radiation exposure be minimized?

Neither doctors nor patients want to return to the days before CT scans. But we need to find ways to use them without killing people in the process.

Rita F. Redberg is a cardiologist at the University of California, San Francisco Medical Center, where Rebecca Smith-Bindman is a radiologist.

Estrogen After Menopause May Blunt Stress’ Effects on Memory

This is one of many studies (see my post of Dec 13th 2012) showing the benefits of oestrogen to women’s brain function. See also under Menopause recommendations on this web-site.  Some of the cautions below are mainly applicable to the use of the synthetic, one size fits all HRT used by most doctors. To reduce the risks of HRT substantially, Bio-identical, individually adjusted  doses and transdermal delivery is essential.

Estrogen After Menopause May Blunt Stress’ Effects on Memory

In small study, older women with higher hormone levels didn’t show memory decline

By Kathleen Doheny
HealthDay Reporter

SUNDAY, Nov. 10 (HealthDay News) — Estrogen therapy after menopause may help reduce the memory problems associated with stress in some older women, a small new study suggests.

“Those higher levels of estrogen are related to less release of stress hormone after a stressful event,” said study researcher Alexandra Ycaza, a doctoral candidate in psychology at the University of Southern California.

Ycaza is scheduled to present the findings Sunday at the annual meeting of the Society for Neuroscience, in San Diego.

The use of hormone-replacement therapy after menopause declined sharply in the United States after a clinical trial looking at estrogen and progestin therapy was halted in 2002. The researchers found that the benefits (reductions in colon cancer, hot flashes and hip fractures) were outweighed by the risks (heart attack, stroke and blood clots).

Many experts recommend women in menopause take the lowest dose of hormone therapy possible for the briefest time only if they are having bothersome symptoms.

For the study, Ycaza evaluated women who were part of a larger study that looked at the differences between taking hormone-replacement therapy soon after menopause versus later, as well as the therapy’s effect on the cardiovascular system. That study assigned women to one of two groups — those taking hormone replacement and those not — and then followed them for nearly five years. For her research, Ycaza focused on 42 of these women.

In random order, she exposed them either to a stressful situation — putting their hand in ice water for three minutes — or a non-stressful situation. During each of the sessions, she measured levels of estrogen and the stress hormone cortisol.

After each situation, the women took tests to gauge their working memory, such as remembering lists of words while reading sentences and making decisions on whether sentences were grammatically correct.

Ycaza looked at the performance and then looked to see if estrogen and cortisol levels were a factor. “Our women in the bottom level [of estrogen] showed a decrease in the number of words they could remember after the stress [situation],” she said.

They remembered about 50 percent of the words after being stressed. “If they are not being stressed, they remember about 60 percent.”

The higher-estrogen women remembered 55 percent of the words each time, whether stressed or not before the test.

The cortisol levels of the lower-estrogen women doubled from before the stressful exposure to after. The cortisol levels in the higher-estrogen women increased very little after the stressful exposure.

It wasn’t known in the new study which women were taking hormone-replacement therapy. The research did not prove a cause-and-effect relationship between a woman having higher hormone levels and not having a reduction in memory.

Older women can turn to other approaches besides hormone therapy to protect memory, said Dr. James Burke, director of the Memory Disorders Clinic at Duke University Medical Center, in Durham, N.C. Burke was not part of the study.

“Research generally supports daily exercise, intellectual stimulation, social engagement and a Mediterranean diet,” Burke said.

“The results are intriguing, but the study was small,” he said. The ice-water plunge, he added, “is not the same as real-life stressors.”

Another expert said hormone treatment would only be viable for certain women.

“The established risks of hormone-replacement therapy for the average post-menopausal woman are not worth the potential benefits,” said Dr. Gary Kennedy, director of geriatric psychiatry at the Montefiore Medical Center in New York City, who reviewed the study findings. “However, for that minority of women who are experiencing severe symptoms, it is worth the risk to maintain function.”

Exercise would help women withstand the effects of stress, he said.

The study received funding from the U.S. National Institute on Aging. Because it was presented at a medical meeting, the conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

To learn more about hormone therapy studies, try the U.S. National Institutes of Health.

SOURCES: Alexandra Ycaza, Ph.D. candidate in psychology, University of Southern California, Los Angeles; Gary Kennedy, M.D., director, geriatric psychiatry, Montefiore Medical Center, New York City; James Burke, M.D., Ph.D., director, Memory Disorders Clinic, Duke University Medical Center, Durham, N.C.; Nov. 10, 2013, presentation, Society for Neuroscience annual meeting, San Diego

Last Updated: Nov. 11, 2013

Copyright © 2013 HealthDay. All rights reserved.

No Sex, Please, We’re on Medicare

This is my 400th blog !!. Please give me feedback on the posts you like, and those you don’t. This will help me in choosing topics of value.  I will be away for the whole of December, so please plan ahead if you need to see me in Nov, Dec or Jan. Book early.
February 6, 2014, 12:54 pm

No Sex, Please, We’re on Medicare


What could be more likely to draw international headlines, and jokes on late-night talk shows, than a government report that includes both an alleged waste of Medicare money and erectile dysfunction?

Even without dopey jokes about swelling costs and rising whatevers, this story was bound to get attention: The federal Department of Health and Human Services dispatched its Office of Inspector General to review Medicare payments for vacuum erection systems, less formally known as penis pumps. Its recent report revealed that Medicare was paying “grossly excessive” prices for these devices (which draw blood into the penis, creating an erection that allows a man to have intercourse).

From 2006 through 2011, the investigators found, Medicare paid on average $451 per pump. Medicare beneficiaries were responsible for a $90 co-pay; Medicare put up the remaining $361. That was more than twice what the Department of Veterans Affairs paid per pump: $186. Searching online, the investigators found that consumers could buy similar pumps for even less.

And Medicare paid for a whole lot of these items — more than 473,000 pumps over six years. Had it paid what others paid, the Inspector General’s report concluded, taxpayers could have saved more than $14 million and beneficiaries almost $4 million each year.

Those are paltry sums in the general scheme of Medicare, which spends hundreds of billions of dollars annually. But anyone who wants Medicare to continue to provide health care for older and disabled Americans, and avoid death by a thousand budget cuts, had to shudder at the waste.

The Centers for Medicare and Medicaid Services pointed out that it had made significant progress in reducing overpayments for durable medical equipment (which is what a vacuum erection system is) with its competitive bidding program. But the agency needs Congressional authorization to add pumps to that program, as the Inspector General suggested. Officials said they would consider seeking it.

Aside from the price tag issue, though, there is rumbling about whether Medicare should cover penis pumps at all.

According to Reuters, a senior fellow at the Heartland Institute (which advocates “free market solutions”) pointedly noted that retiring boomers will strain the Medicare budget and asked if politicians shouldn’t “be focusing this entitlement program on real, life-saving treatment and equipment to service the health needs of seniors?” For men who wanted a pump, he added, “just buy it yourself — you don’t need to send the bill to your fellow Americans.”

The comments on mainstream news sites were predictably nastier, with contemptuous references to “geezers” and “old goats.”

“We are a laughable bunch as we spend that sort of money to allow sexually dysfunctional men to have erections they have no business having,” read one of the milder comments on the NBC site.

There is an ageist current here, a result of our deep discomfort with the idea of older people’s sexuality. Can’t we insist that Medicare not get ripped off by device manufacturers without sneering at the idea that an older man — perhaps feeling the effects of diabetes or the side effects of prostate cancer treatment –- and his partner might want to have intercourse?

Most private health insurers cover vacuum pumps, and many also cover drugs like Viagra, Levitra and Cialis to treat erectile dysfunction. Why should that approach change on someone’s 65th birthday?

“The general concept is that older people are asexual, that they don’t have, or shouldn’t have, any thoughts about sex,” said Ann Christine Frankowski, associate director of the Center for Aging Studies at the University of Maryland, Baltimore County, whose research has included sexual behavior and policies in assisted living. “There’s a bias against it.”

In 2006 Congress barred Medicare from covering medications like Viagra under the Part D drug plan. The bill’s chief sponsor scoffed at “Grandpa’s recreational sex” — his language suggesting that if he couldn’t avoid paying for seniors’ health care, he at least wanted to be sure they didn’t have any fun.

In fact, beneficiaries’ increased use of vacuum pumps for impotence may well be a response to the fact that Medicare won’t cover the pharmaceutical treatments, which are considered “first-line” therapies. “They’re the most patient-friendly,” said Dr. Ira Sharlip, a urologist at the University of California, San Francisco.

The pumps, by contrast, are “a little awkward, a little inconvenient and not very romantic,” Dr. Sharlip said. “But they do work pretty well, and a lot of patients rely on them.”

Medicare covers many things that don’t save lives but do enhance health, as it should. And of all the things it doesn’t cover, we might rank dental care well ahead of penis pumps or erectile dysfunction drugs in importance.

But it is hardly ridiculous to think people over age 65 are doing it. In fact, as a recent New York Times opinion piece by Dr. Ezekiel Emanuel pointed out, more than half of men and 40 percent of women over age 60 are sexually active (and, sadly, not using condoms regularly enough to prevent sexually transmitted diseases).

My two cents (and I’m eager to read yours): Sexual health is part of health. And you can spare us the ageist claptrap about Grandpa and his recreation, sonny.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.

When does fertility decline?

20 January 2014, 2.30pm AEST

Health Check: when does fertility decline?

It’s said that “40 is the new 30” and “50 is the new 40”. But, when it comes to female fertility, 40 is still 40, and the likelihood of successful pregnancy and childbirth has notably decreased from age…

Women’s ability to conceive and give birth to healthy babies starts to decline before the age of 30. Image from

It’s said that “40 is the new 30” and “50 is the new 40”. But, when it comes to female fertility, 40 is still 40, and the likelihood of successful pregnancy and childbirth has notably decreased from age 30. By the time a woman reaches 50, her capacity to conceive and give birth to her own genetic child is near to nil, even with the assistance of fertility treatment.

It has long been recognised that very few babies are born to women over 40 years of age. This is true across societies, including populations in which there is no use of effective birth control methods. So, the lower birth rate of older women is not simply a consequence of family planning decisions.

In fact, female fecundity – the ability to conceive and give birth to live offspring – starts to decline before the age of 30, and the rate accelerates after about age 35. This decline is due to a continuous and immutable decrease in both the quantity and quality of eggs with increasing female age. Although the rate of egg decline varies among women, it is universally experienced and nothing, yet, can be done to slow its progress.

On the other hand, factors such as cigarette smoking, radiation to the pelvis and chemotherapy hasten the loss of ovarian follicles which contain eggs, while obesity is also linked to poorer egg quality, potentially compounding age-related effects.

Male fertility

While a female’s natural childbearing potential ceases absolutely at menopause, males retain the ability to produce sperm throughout life and with that, the prospect of late-age fatherhood.

Smoking may affect sperm production. Image from

Nevertheless, there is evidence that semen quality (sperm count and motility) is reduced in males over 40 years and older male age is associated with lower pregnancy rates, increased risk of miscarriage and more health risks in children.

Lifestyle factors such as cigarette smoking and obesity also negatively affect sperm production and function, potentially adding to any age-related effects.

Lack of fertility knowledge

Despite the evidence, there is a general lack of knowledge among women and men about age-related fertility decline and the risks of delaying childbearing.

A recent Australian study of 462 women and men aged 18 to 45 who were planning a future pregnancy found that only 31% of women and 20% of men were aware that female fertility starts to decline before age 35.

Of concern, almost one-third of men either believed that female fertility did not decline until after age 45 or responded that “age doesn’t matter” or “don’t know”.

In vitro fertlisation

Even when couples are aware of the age effects on fertility, there is often the belief that assisted reproduction treatments such as IVF will overcome any age-related fertility problems. The statistics, however, show otherwise.

Among Australian and New Zealand women aged 40 to 44 seeking IVF or related treatment in 2011, only 6.6% of initiated treatment cycles in which women used their own eggs resulted in live birth, and the majority of these occurred in women aged less than 43 years.

For women aged 45 or more, there was only one live birth from every 100 treatments started.

For comparison, the live birth rate per initiated treatment was 26.6% for women aged less than 30 years, 25.3% for women aged 30 to 34 years and 16.9% for women aged 35 to 39 years.

IVF is not a panacea for age-related fertility problems. Image from

These figures are not surprising when we consider that IVF requires eggs capable of normal fertilisation and subsequent development, and that neither the drugs nor the laboratory procedures used during IVF can improve the quality of aged eggs.

The importance of egg-age on IVF success rate is further highlighted by the fact that the live birth rate for women aged 45 and over is much improved (18% vs 1%) by using eggs donated from a younger woman. But egg donors are in short supply.

IVF is not a panacea for age-related fertility problems and while living a healthy lifestyle will improve general health and fertility prospects it does not slow the effects of age.

How a fake surgical device was registered

Professor Andreas ObermairMDVIE, FRANZCOG, CGO

How a fake surgical device was registered

Posted by on 20 November 2013 | 0 Comments

Tags: ,

I was wondering for a long time how stringent the requirements are to register a surgical device.

It is common knowledge that surgical devices only need to be tested for “Safety”. For example you need to prove that a surgical device does not explode or go up in flames all by itself in theatre. Safety in this context does not necessarily mean “safe for patients beyond the day of surgery”.

Safety is different from efficacy. Efficacy addresses if the surgical devices actually does what it promises. An adhesion barrier to prevent the formation of adhesions; a haemostatic agent to stop bleeding, etc.

As surgeons we normally assume that devices such as adhesion barriers, haemostatic agents, mesh or sutures will need to prove that they are safe for patients and actually work; we assume that they are tested prior to being used on real patients. The actual fact is that many of these devices are not tested at all. They are not tested because there are no legal requirements for them to be tested.

There is no need for an adhesion barrier to prove that it prevents adhesion formation. It would even be possible that an adhesion barrier actually increases the formation of adhesions and cause actual harm to patients.

There is no need for haemostatic agents to prove that they stop bleeding. It would even be possible that a “haemostatic” agent has no effect whatsoever. It is even possible that the “haemostatic” agent causes adverse events to the patient and no one would pick it up.

There is no need for a mesh to prove that it strengthens human tissues. It is even possible that meshes cause harm, erode into human tissues and cause adverse effects on those patients who had it implanted.

There is no need for a new suture to prove that it holds tissues together. It would be even possible that the new suture does harm to patients but no one would pick it up.

The new suture – like any “novel” device – only needs to prove that it is strikingly similar to what is registered at present already. The new suture does not need to prove that it is better than the suture we use at present. Companies will claim it is (far) better – but that is only a claim made by Reps to surgeons. In order to avoid clinical testing the official claim to TGA is that it is “equivalent” and “strikingly similar”. So far, this is the Australian situation.

The editor of the BMJ together with a journalist from the Daily Telegraph set out to test Europe’s system to register new surgical devices.

For the sake of this experiment they invented a fake hip prosthesis that only existed on paper. It was modelled on a prosthesis that was one of the biggest surgical disasters in orthopaedic surgery history. A prostheses that had to be recalled from market and legal action apparently is pending.

For the sake of this experiment the two authors claimed to have set up a company (in reality that company was never registered anywhere) and created a (pretend) fake hip prosthesis (that was never created) solely on paper.

The team of authors obtained quotes from European “notified bodies”, which are in charge of registering surgical devices in Europe. At the time there were approximately 70 such notified bodies, many of them have set up a practice in former Eastern Europe.

Those companies seem to compete for business with each other. Registering as quickly as possible with the least inconvenient enquiries, detailed paperwork, at the lowest cost differentiates those notified bodies. These companies proud themselves that no surgical device has ever been refused registration and all surgical devices applying for certification get through the approval process.

It is obvious that the standards of registrations vary. The fake hip prosthesis got registered without hassles. No one ever needed to show the actual prosthesis, confirm that it actually existed or show any data confirming its safety to patients or even that it has been tested in any way.

No original studies had to be completed about its potential for adverse effects, infection rates, levels of metal ions in the body, etc. prior to use in humans.

Apparently the European Certificate is critical to companies for an application to the Australian TGA. In Europe, the US or in Australia surgical devices do not need to prove their efficacy. Until efficacy data become available, patients have no chance knowing how safe surgical prosthesis and devices are that we as surgeons introduce into our patients pelvis.

Class action against surgical corporates will be the logical consequence of not testing surgical devices properly or suppressing inconvenient test results obtained in properly conducted test series.