Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine

Lisa Rosenbaum, M.D.,  N Engl J Med 2015; 373:1585-1588 October 22, 2015

A decade ago, a primary care physician I admired seemed to come undone. His efficiency had derived not from rushing between patients but from knowing them so well that his charting was effortless and fast. But suddenly he became distracted, losing his grip on the details of his patients’ lives. He slumped around, shirt half-untucked, perpetually pulling a yellowed handkerchief from his pocket to wipe his perspiring forehead. Everyone worried he was sick. His problem, however, turned out to be the electronic health record (EHR).

Ten years and nearly $30 billion of government stimulus later, the mandate to implement EHRs has spawned many similar stories, some of which Robert Wachter catalogues in The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, which explores the tension between the push to digitize medicine and the sanctity of the doctor–patient relationship.1 Wachter centers his EHR analysis around the story of an 18-year-old given a 39-fold overdose of Bactrim (sulfamethoxazole–trimethoprim) — a near-fatal error partially caused by an EHR. Investigating the root causes, Wachter discovers design flaws, such as defaulting to certain units for medication dosing and alerts rendered meaningless by their sheer number. But he concludes that the mistake stemmed less from the EHR itself than from its effects on our collective psychology. “I realized,” he writes, “that my beloved profession was being turned upside down by technology…”

First, such aspirational narratives beget complacency — and a tendency to dismiss contradictory evidence. The EHR is touted as a cost-saving, quality-promoting tool, though cost-saving projections have been debunked and data on quality are mixed.4,5 Koppel notes that “a seldom voiced barrier” to health IT’s achievement of its promise is our refusal to acknowledge its problems and learn from them: “Researchers and data that do not support the syllogism of health IT equals patient safety, and more health IT equals more patient safety” are ruthlessly attacked.2 Although we’ve made progress in patient safety only by carefully examining our errors, somehow the dangers posed by technology are expected to right themselves…

Second, letting the market shape usability assumes that clinicians are the target users. But EHRs were designed to optimize not workflow or communication but billing — which is increasingly predicated on an ability to document quality…

Which brings us to the third problem: many clinicians know what they want — but haven’t been asked. Wachter describes Boeing’s engineers iteratively improving aviation safety: their industry, committed to “user-centered design,” has pilots test any system changes. Why, Wachter asks, do we do nothing similar in health care? After noting challenges such as the diversity of practice settings and users, he observes, “In the aviation industry, there is an abiding respect, even reverence, for the wisdom of the frontline workers.” Our biggest mistake lies not in adopting clunky systems but in dismissing the concerns of the people who must use them…

In a moving passage, Wachter speaks with a renowned surgeon who once spent his evenings before surgery reading his notes on the next day’s patients. He might have eight hernia repairs scheduled, but one detail — the patient found the hernia bothersome when he played tennis, for instance — would distinguish one case from the next, the patient from the problem. No longer. His notes have been rendered uselessly homogeneous by the tyranny of clicks and auto-populated fields. When he shows up to operate on patients, he says, “It’s like I never saw them before. I can’t even picture their faces.”

What this surgeon and the rest of us need are patient records that communicate meaning and foster understanding of the particular patient in question. The blanks on our screens can be filled with words, but the process of understanding cannot be auto-populated. Perhaps life without the EHR will soon be unimaginable. But the technology will support and improve medical care only if it evolves in ways that help, rather than hinder, us in synthesizing, analyzing, thinking critically, and telling the stories of our patients.

(Edited by me)


Tearing Down the Fetal Tissue Smokescreen

By Raegan McDonald-Mosley, M.D., M.P.H., New England Journal of Medicine, October14, 2015

The ongoing smear campaign against Planned Parenthood focused on the minuscule role that the organization, where I am the chief medical officer, plays in providing postabortion tissue to researchers completely misrepresents the work we do every day. It also fails to acknowledge that our policies in this area have long met and exceeded the applicable legal standards. Our critics have distorted our practices by design, but we are not going to let such distortion continue.

By engaging in fraudulent, unethical, and perhaps illegal behavior, opponents of safe and legal abortion surreptitiously obtained hundreds of hours of video footage of discussions with various Planned Parenthood staff members. Claiming to represent a legitimate tissue-procurement organization working with researchers, these opponents of safe and legal abortion tried for nearly 3 years — and failed — to entrap my colleagues into breaking the law by making money from facilitating the donation of postabortion tissue to research projects. When no wrongdoing occurred and it became clear that none would, they manipulated their footage to sell the story they wanted to tell. My colleagues — national leaders in the field of reproductive health who have been misrepresented by the contrived scenarios and doctored videos — have endured harassment and threats that have no place in a civil society. They have become collateral damage in these attacks, which ultimately harm the women, men, and young people who rely on Planned Parenthood for affordable, specialized, high-quality health care.

Through close coordination with federal and state politicians who want to make abortion illegal, these doctored videos have been used to try to block people from getting their care from Planned Parenthood and to further restrict access to safe and legal abortion throughout the United States. In the month of September alone, the U.S. Congress voted six times to restrict women’s health care — as many times as the previous Congress did so over its entire 2-year session. Five congressional committees are currently investigating Planned Parenthood. We have cooperated with these investigations, providing more than 25,000 pages of documents; the time of our physicians to brief committee staff; and that of our president, Cecile Richards, who gave 5 hours of testimony before one committee.

Nonetheless, as the chair of that committee conceded1 and the minority staff of another committee reported in a memorandum,2 there is no evidence of wrongdoing. Yet states in just about every region of the country — many of which have already enacted numerous restrictions on family planning and abortion that have either been blocked by state and federal courts or are having demonstrably negative health effects on women seeking to safely end a pregnancy or prevent unintended pregnancy in the first place — are using these videos to double down on their interference with women’s health care…

It is the dignity I see in every patient I’ve ever treated — and the chilling memory of what it was like to see women die needlessly from unsafe abortions — that steels my resolve to ride out this latest smear campaign, the 15th this organization has experienced in the past 10 years. It is the remembrance of the women I treated abroad and the gratitude of my patients every day that gives me the faith I need to know that at the end of all this, Planned Parenthood and the millions of people who rely on us will ultimately triumph.

The Strange Laws That Dictate What Your Doctor Tells You

By Olga Khazan

Across the country, states are passing laws that determine what doctors can and cannot discuss with their patients, according to a new reportfrom a coalition of four nonprofit organizations. Doctors might be prevented from asking patients about politically sensitive topics, like guns or fracking, or they might be forced to give patients medically inaccurate information, in the case of abortion.


According to the report, written jointly by the National Partnership for Women & Families, National Physicians Alliance, Natural Resources Defense Council, and the Law Center to Prevent Gun Violence, more than 15 million Americans live within a mile of a fracking well that was recently drilled.

Numerous studies have linked fracking—the process of injecting water into rock in order to extract natural gas—to health risks, and some patients see doctors for illnesses they believe might be related to fracking-chemical exposure. However, the report notes, some states require doctors to sign confidentiality agreements with fracking companies before they can learn what chemicals are used in their we In some cases, these agreements might prevent doctors from discussing those chemicals with other doctors, the patients’ families, and potentially the patients themselves. When Pennsylvania’s law, called a “gag rule” by opponents, was passed in 2012, NPR described how it might tie the hands of doctors who treat patients near fracking sites:

Plastic surgeon Amy Pare practices in suburban Pittsburgh where she does reconstructive surgeries and deals with a lot of skin issues. She tells me about one case, a family who brought in a boy with strange skin lesions.

“Their son is quite ill — has had lethargy, nosebleeds,” Pare says. “He’s had liver damage. I don’t know if it’s due to exposure.” …

Pare’s first step was to figure out what chemicals the [local] drillers were using. But that information isn’t easy to get. In this case, Pare says, the patient’s family had a good lawyer who helped them find out what kind of chemicals the gas company was using.

“If I don’t know what [patients] have been exposed to, how do I find the antidote? We’re definitely not clairvoyant,” she says.

Two lawsuits brought by doctors to challenge Pennsylvania’s laws have so far been unsuccessful.


Among the record number of abortion restrictions states have passed in the past five years are laws requiring doctors to give abortion patients information that many obstetricians say is false. According to the report, 12 states force doctors to tell women that their fetus can feel pain, even though evidence is weak that fetuses can feel pain in the first two trimesters, the cutoff for abortions. Other states require doctors to tell patients—falsely, according to ACOG and other doctors’ groups—that abortion negatively impacts their future fertility, that abortion is linked to breast cancer, or that an abortion can be reversed.

Some states also require doctors to perform ultrasounds on abortion-seeking patients and describe what they see. The report quotes one doctor as saying, “Sometimes I find myself apologizing for what the state requires me to do, saying, ‘You may avert your eyes and cover your ears.’”These laws impact roughly 40 million women of reproductive age. Statistically, 30 percent of them will seek an abortion by age 45.


Having a gun in the home is strongly correlated with both suicide and accidental shootings. The report authors say 1.7 million children live in homes with unsafe gun practices. About 7,400 children are hospitalized each year due to gunshot wounds, according to a 2014 study in Pediatrics.Naturally, many pediatricians ask parents whether they have a gun at home, much as they might ask whether their swimming pool is fenced in. When doctors counsel patients about how to store their guns safely, the patients listen—the majority improve their firearm-storage practices, according to some studies. In 2011, Florida passed a law—which is now likely headed to the U.S. Supreme Court—that severely curtailed doctors’ ability to discuss guns with patients, citing the privacy rights of gun-owners. Fourteen states have introduced similar legislation since then, though none as restrictive as Florida’s have been enacted, the report authors write…



OKC doctor: Planned Parenthood defunding would curtail reproductive care options

BY ELI RESHEF, M.D. • Published: August 16, 2015 Oklahoman

Wars are not deliberately waged against defenseless beings. Victims of wars, however, are primarily the defenseless. While the expression “war on women” is most irritating to those who claim ownership of “life” in the abortion debate, it is the unintended consequence of an impassioned conflict.


Not many doubt the passion in Sen. James Lankford’s speech on the Senate floor, as he fought off tears while introducing legislation to cut off federal funds to Planned Parenthood (PP) following the “expose” of controversial fetal tissue practices. Sadly, by waging war against PP, Lankford misdirected his wrath at millions of American women, potentially limiting their access to reproductive care. As unintentional as it may be, it bolsters that onerous campaign.

Lankford says many other clinics can assume the role that PP is playing in reproductive care, and that contraception and STD testing are widely available elsewhere. The facts are different.

According to statistics, health care clinics for low-income women outnumber PP clinics 13-1. So where are they in our city? Where are the theoretical 40 clinics in Oklahoma City that can provide comprehensive, efficient and inexpensive reproductive health care to women comparable to Planned Parenthood? Excellent services to low-income patients by
VarietyCare, the City-County Health Department, the University of Oklahoma and a handful of others are no match to the expertise, efficiency and professionalism of PP.

Ask any woman in Oklahoma City if she or any of her acquaintances have ever used PP services. One in five has, while in college, without income, or in their teens to receive contraception, or as elderly to receive cancer screening and referrals. Why? Because unlike the recent demonization campaign, PP is mostly staffed by compassionate and caring professionals who have at least as much passion to help women as Lankford has to protect the unborn. And women in need recognize that.

What’s the retail cost of a single pack of oral contraceptives? Often more than $150! An uninsured woman can get that at a fraction of the cost at PP. While some health clinics may allow same-day STD testing, how many of them also provide other reproductive services such as annual examinations, PAP smears, breast exams and contraception?

Nationwide, 40 percent of PP funding is from federal sources. Before diverting these funds to other providers of reproductive care, let’s honestly ask ourselves what the unintended consequences of such action would be for access to quality care for low-income women.

Efforts to shut down PP are as sensible as permanently shutting down an interstate after a bad accident — unintended consequences that are worse than the triggering event.

Hurting Planned Parenthood, a reputable institution steeped in tradition of professional reproductive care, amounts to disrespect for low-income women propagated, intentionally or not, by some who forgo the helpless living in favor of the unborn. Access to quality care means short appointment times, low cost, confidentiality and medical professionalism. Let’s preserve it for low-income women.

Reshef is a reproductive endocrinologist and infertility specialist in Oklahoma City

The Toxins in Feminine Hygiene Products

How perfumed toiletries—particularly douches—lead to dangerously high levels of chemicals in the body
OLGA KHAZAN, The Atlantic,  JUL 20, 2015 (

In a 2010 ad, feminine-hygiene purveyor Summer’s Eve seemed to suggest that using its products will lead to getting a raise. The next year, the company sparked an outcry when a series of its commercials featured stereotypically black and Latina voices—the latter actually cried, “Ay-yai-yai!”

Douche-makers might be running out of ways to make American women want to irrigate their nether regions. By now, the science is clear that shooting scented water into your ladyparts doesn’t prevent or treat infections. In fact, it only promotes yeast or bacterial overgrowth because it disturbs the normal vaginal ecosystem. The practice has also been linked to infertility and a greater risk of STDs.

Fortunately, douching is in decline: In 2002, a third of women between the ages of 15 and 44 did it, but just one-fifth did so by 2013. But the practice is still common among some women—particularly African Americans and Hispanics. The reason seems, at least in part, to be cultural: As Julie Morse described in The Atlantic recently, douching has really, um, shot up in Mexico in recent years. Women told Morse they do it to prevent vaginal infections, for a “clean feeling,” or simply because their mothers told them to do it and they never stopped.

Ami Zota, an assistant professor of environmental and occupational health at George Washington University, says that though some women are still motivated to douche in an attempt to relieve odor or irritation, there are also “societal factors … pressure to conform to societal beauty norms. There can be an element of using certain products as a way to culturally assimilate.” And of course, “targeted ads of these products to African Americans” don’t help.

Zota and other researchers from George Washington University and the University of California San Francisco recently discovered yet another reason not to douche. In a study of 739 women published last week in the journal Environmental Health, they found that women who douched had urine with a much higher concentration of phthalates. Phthalates are industrial chemicals that can adversely impact human health by altering the action of hormones in the body. In the study, women who douched had a 52 percent higher urinary concentration of a metabolite of one particular kind of phthalate, diethyl phthalate. Zota suspects that’s because diethyl phthalate is found in fragrances, and many vaginal douches are perfumed.

It’s not just douches that might be dangerous, of course. Phthalates are also found in most scented personal grooming products, such as perfume, nail polish, or hair products. They’re in shower curtains, medical devices, and other plastic consumer goods. It’s not entirely clear why, but certain meats and dairy products contain high levels, too.

These chemicals work by disrupting reproductive and thyroid hormones. Phthalates seem to have the greatest effect in the womb, so they are most concerning for women of reproductive age. In animal studies, phthalates have been linked to birth defects, and they also may contribute to developmental problems among children who are exposed in utero.

What You Really Need to Know About Egg Freezing

Some call it an “insurance policy” for modern women. But does it really work? Watch TIME’s investigation of the latest fertility craze

Egg freezing has been hailed as a game-changer for women, an “insurance policy” to revitalize waning fertility, a breakthrough as revolutionary as the birth control pill. But how well does it really work?

In this week’s issue of the magazine, we took a deep dive into the promises and pitfalls of egg-freezing. If you’re reading this, you probably already know all the facts about how egg quality and quantity deteriorate with age, which is why some women consider freezing their eggs until they’re ready to use them.

Here are seven key takeaways from six months of reporting on whether procedure lives up to the hype:

1) Egg-freezing is taking off among professional women. Doctors say they’ve seen more interest in the procedure since Apple and Facebook announced last year they’d cover egg-freezing in their employee health plans, and younger women are beginning to ask about how they can preserve their fertility. In 2009, only about 500 women froze their eggs—in 2013, almost 5,000 did, according to data obtained from the Society for Assisted Reproductive Technology (SART.) Fertility marketer EggBanxx estimates that 76,000 women will be freezing their eggs by 2018.

2) While there is no widespread published data on the live birth rate from elective egg-freezing, initial data provided exclusively for TIME by Dr. Kevin Doody, former chairman of the SART Registry, gives us the clearest picture so far. Of the 353 egg-thaw cycles in 2012, only 83 resulted in a live birth. After 414 thaws in 2013, 99 babies were born. Those are the most comprehensive live-birth rates for egg freezing, and they’re just under 24%. (It should be noted that some of these eggs may have been frozen with an older slow-freeze method, which has a much lower success rate.)

3) Elective egg-freezing gained popularity after the American Society for Reproductive Medicine removed the “experimental” label from the procedure in 2012, in part because a new quick-freeze vitrification method radically improved success rates. But in the same document, the ASRM also warned against using egg-freezing to electively delay motherhood, citing lack of data. “Marketing this technology for the purpose of deferring childbearing may give women false hope,” they wrote.

4) That marketing is happening anyway. Fertility companies and specialists are hosting egg-freezing parties and other informational gatherings to encourage women to consider freezing their eggs as an “insurance policy,” and in some cases offer Groupon-style discounts if they commit immediately. One of these fertility companies, EggBanxx, recently merged into a new company, Progyny, that’s privately held and funded in part by Merck Serono Ventures. Merck Serono Ventures is the strategic corporate-venture arm of a biopharmaceutical division of Merck KGaA, which just happens to make three major fertility drugs.

5) Freezing your eggs is expensive. The egg retrieval process can cost $10,000-15,000, and that’s not including storage fees or the cost of fertilization and embryo transfer. And it can be physically grueling as well—patients give themselves daily hormone injections for two weeks before eggs are retrieved from the ovaries. The good news is that the procedure doesn’t take very long—most patients said it was over in about 15 minutes.

6) Nobody knows how many babies have been delivered from a mother’s own frozen eggs. When you ask doctors about success rates, they tend to compare the procedure to IVF (which is done with fresh eggs) or egg donation (which often uses frozen eggs from women in their early 20s). And while anecdotal evidence suggests egg freezing is comparable to IVF because frozen eggs behave like fresh ones, IVF itself is hardly foolproof—even in women under 35, the majority of cycles don’t result in a live birth. But because IVF is such a common procedure, women are often reassured when they hear the comparison.

7) Even young women have a high percentage of eggs with chromosomal abnormalities. And while genetic testing of eggs is technically possible, it’s too expensive to become part of the regular procedure in the U.S.—so genetic testing only happens once a egg has been fertilized and grown into a blastocyst (a pre-embryonic state.) That means women don’t know if their eggs are genetically healthy until they’re thawed and fertilized, which means they could be freezing—and pinning their hopes on—bad eggs.


Tuna and Mercury- The Latest

(Based on consumer Reports, June 2015)

The 2015 Dietary Guidelines Advisory Committee, a Federal committee, submitted the Scientific Report of the 2015 Dietary Guidelines Advisory Committee to the Secretaries of the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) in February 2015. In that report, a recommendation was made to eliminate the warning for young children and women of childbearing age to limit intake of tuna.

Consumer Reports and other private consumer advocacy organizations oppose this latter recommendation. Mercury can cause brain and nervous system damage, especially when exposure occurs during pregnancy. Consumer Reports therefore recommends that pregnant women avoid eating tuna or any other fish that may have high mercury content (shark, tilefish, swordfish).

Consumer Reports also recommend to limit tuna consumption in young children, women of childbearing age, and anyone who eats more than 24 ounces of fish per week. Ahi tuna in sushi (Yellowfin and Bigeye) is particularly high in mercury and vulnerable groups should avoid it. If you are a woman of childbearing age, eat no more than one 5 ounce can of albacore (white) tuna per week.


As confusing as the conflicting recommendations are, better play it safe: avoid tuna in pregnancy and limit its intake for children and women of childbearing age.

Dr. Oz and the Pathology of ‘Open-Mindedness’ (Quackademic Medicine)

Alan Levinovitz Apr 23, 2015 (The Atlantic)

The Dr. Oz Show provides critics with ample material: séances, energy healing, miracle diet products. Once a media darling, Oz has been subjected to a steady stream of public humiliations, from his shaming in front of a Senate subcommittee to an April 15 letter that a group of doctors wrote to Columbia University, urging his dismissal from the faculty, accusing him of promoting “quack treatments and cures in the interest of personal financial gain”—to which Dr. Oz responded with an ad hominem attack on the letter-writers and a defense of free speech. But despite numerous subsequent think pieces about the man behind the curtain, a crucial question stands out: Why call for Dr. Oz’s dismissal, when many medical schools and hospitals endorse the most outlandish of his claims?


Or take energy healing. The prestigious Cleveland Clinic has a “fact sheet” on reiki—the Japanese energy healing tradition practiced by Oz’s wife, Lisa—which explains how reiki uses “universal life force energy” to “detoxify the body” and “increase the vibrational frequency on physical, mental, emotional and spiritual levels.” (Pets and other animals “respond positively to Reiki healing as well.”)

Like Oz, other established academics lend their credentials to miracle diet products. Antioxidant expert Carmia Borek is a professor at Tufts University School of Medicine, and she allows herself to be listed as part of the scientific advisory board for an unsubstantiated “revolutionary weight loss formula” called TAISlim. Borek is in good company: another member of the board is UC Davis School of Medicine professor Judith Stern. (Borek and Stern also appear on a website that sells acai berry “anti-aging serum.”)

One need not even look beyond the walls of Oz’s own university. Woodson C. Merrell, assistant professor at Columbia Medical School and executive director of Mount Sinai Beth Israel’s Center for Health and Healing, lists homeopathy as one of his clinical interests—despite a scientific consensus that homeopathy is inconsistent with some of the basic laws of chemistry and physics.

Indeed, a vocal minority of physicians and scientists have long claimed that Dr. Oz is a symptom, not the problem. Most prominent among them are Yale neurologist Steven Novella and Wayne State University surgical oncologist David Gorski, who refer to the problem as “quackademic medicine.” For Novella and Gorski, the concern is not merely that people will waste money on homeopathic sugar pills or fruitless miracle diets. They emphasize that Dr. Oz and universities alike endanger public health by legitimating alternative medical traditions such as naturopathy and chiropractic. This, in turn, can lead people to reject standard medical care. Vaccination is a classic case: Though most people are unaware of it, the official position of the American Chiropractic Association supports “providing an alternative elective course of action regarding vaccination.” Similarly, the New York University medical ethicist Arthur Caplan expresses concern that naturopaths—who practice an unstandardized mix of therapies including traditional Chinese medicine, homeopathy, craniosacral therapy, iridology, and reiki— routinely grant vaccine exemptions, and are licensed to do so in 17 states.


Critics often imply that any exploration of alternative methods means abandoning conventional approaches. It does not. In fact, many institutions like mine use the names ‘complementary’ or ‘integrative’ medicine, which is also appropriate.

But integration requires a delicate balancing act. It’s good to be open-minded, but not, as the old saying goes, “so open-minded that your brain falls out.” For those who believe that past lives exist and energy healing increases our vibrational frequency, who’s to say that there aren’t good alternatives to vaccines, or that miracle diet pills don’t actually work?

Today, millions watched as Dr. Oz defended himself against critics on his show. What his audience might not have realized is that some other respected physicians at prestigious medical schools were watching along and hoping, if quietly, that he would succeed.

The making of Dr. Oz (How an award-winning doctor turned away from science and embraced fame)

by Julia Belluz on April 16, 2015 (

It’s a dark and biting March morning on Manhattan’s Upper West Side. Lilly is standing outside ABC’s brick studio building, waiting to be let in to watch a live taping of Dr. Mehmet Oz’s television show.

“I’ve been here since 7 am,” she says.

Though the sun is barely out, her phone is buzzing with text messages from nearly every member of her family — all Oz-lovers excited about her peek behind the curtain.

They’re not alone. Dr. Oz is arguably the most influential health professional in America. The Dr. Oz Show, which started in 2009, has an average audience of more than 4 million people each day in 118 countries. He has his own magazine (The Good Life) and syndicated columns that have run in the most widely read periodicals in North America. He has radio segments, about a dozen books, and the show’s website — a go-to resource on medical questions for millions. He has millions of followers on his Facebook, Twitter, Pinterest, and YouTube accounts, and a starring role on the new medical reality show NY Med. Across all these channels, he preaches the same message: you can take control of your health with simple tricks and natural remedies.

Parts of Dr. Oz’s message have come under fire recently from the federal government and the scientific community for deviating too far from established medical fact. This scrutiny, however, hasn’t cooled the ardor of fans like Lilly.

“He has this practical, common-sense use of things on the planet to stay healthy,” she says. “It’s not about popping pills or using medication.”

After covering Oz for several years, I’m fascinated by him. How did a gifted, award-winning cardiothoracic surgeon with credentials from three Ivy League schools become a TV star who promotes belly-fat busters and anti-aging tricks? I’m also intrigued by the hold he has on his fans. Why do so many people place their trust — and their health — in the hands of a TV personality? What does his popularity say about Americans’ attitudes toward science?

I spoke to dozens of Oz’s colleagues, mentors, and other health professionals who have been touched by the surgeon or his work, some who’ve known the man since his early days fresh out of the University of Pennsylvania and Harvard. I read his early books. I talked to his fans — including my own mother. I found out that the roots of Oz’s experimentation with alternative techniques go all the way back to his childhood, and that his departures from evidence-based medicine have gotten more extreme as he’s become more famous. I also learned that the making of Dr. Oz says more about America’s approach to health than it does about its most famous doctor…

(

Is the Annual Physical Necessary?

Jenny Gold, NPR, April 6, 2015

It’s a warm afternoon in Miami, and 35-year-old Emanuel Vega has come to Baptist Health Primary Care for a physical exam. Dr. Mark Caruso shakes his hand with a welcoming smile.

Vega, a strapping man with a thick black beard, is feeling good, but he came to see the doctor today because his wife thought he should. She even made the appointment. It is free to him under his insurance policy with no copay, as most preventive care is under the Affordable Care Act.

Vega is one of more than 44 million Americans who is taking part in a medical ritual — visiting the doctor for an annual physical exam. But there’s little evidence that these visits actually do any good for healthy adults.

Caruso listens to Vega’s heart and lungs, checks his pulse in his ankles and feels around his lymph nodes. He also asks Vega about his exercise and sleeping schedule and orders blood and urine tests. If everything checks out all right, Caruso says, Vega should return for another exam in a year. Vega says he definitely will.

It was a positive experience for both doctor and patient. But many other doctors think the annual physical is unnecessary and can even be harmful.

“I would argue that we should move forward with the elimination of the annual physical,” says Dr. Ateev Mehrotra, a primary care physician and professor of health policy at Harvard Medical School.

Patients should really only go to the doctor if something is wrong, Mehrotra says, or if it’s time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view.

“When I, as a doctor, say I do not advocate for the annual physical, I feel like I’m attacking moms and apple pie,” Mehrotra says. “It seems so intuitive and straightforward, and [it's] something that’s been part of medicine for such a long time.”

But he says randomized trials going all the way back to the 1980s just don’t support it.

The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid completely for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but with so many people getting them, that adds up fast.

“We estimate that it’s about $10 billion a year, which is more than we spend as a society on breast cancer care,” Mehrotra says. “It’s a lot of money.”

Then there’s the risk that a doctor will run a test and find a problem that’s not actually there. It’s called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could cause real harm. Dr. Michael Rothberg is another primary care physician and a health researcher at the Cleveland Clinic. He tries to avoid giving physicals.

“I generally don’t like to frighten people, and I don’t like to give them diseases they don’t have,” Rothberg says. “I mostly tell my family, if you’re feeling well, stay away from doctors. If you get near them, they’ll start to look for things and order tests because that’s what doctors do.”

Back in Miami, Caruso is also well versed in the research on annual physicals, but he still believes in them. “I think having a look at somebody is worth its weight in gold,” he says.

It’s an important part of developing a relationship with a patient, he says, and there have been countless times over his career when he’s found real problems during an exam just like the one he gave to Emanuel Vega.

“What if Mr. Vega had had a lump or bump that wasn’t right?” Caruso says. “What if when he had his shirt off Mr. Vega said, ‘Oh yeah, I forgot to mention this spot on my chest,’ and it ended up being a melanoma we discovered early?”

And Vega did end up needing a little help; he has a bad back that’s landed him in the emergency room several times. Caruso was able to link him up with a back specialist to help him manage the problem.


Eli Reshef MD  February 23, 2015

Several times a month, I encounter infertile couples in whom the male is on testosterone treatment by injection, pellets, or gel. Most of these males are unfamiliar with the adverse effects and side-effects of testosterone treatment. Quite frequently, the couple is infertile because of significant reduction in sperm performance directly due to testosterone treatment.

Here is how testosterone treatment harms sperm: the testicles produce two major commodities- sperm and testosterone. When testosterone is given to a male, the brain, specifically the pituitary gland that regulates testicular production of sperm and testosterone, gets a signal that there is adequate amount of testosterone. Consequently, the pituitary gland shuts down its production of hormones that stimulate testosterone and sperm production. Sperm production then shuts down and infertility due to male factor ensues. This harmful effect of testosterone on sperm production is temporary but may last 3-12 months after stopping testosterone treatment.

In this age of improved communication and the search for immediate gratification, “Low-T” commercials are abound. Symptoms of low energy and low libido, common with the rapid pace of modern life, often drive males to their doctor’s office to seek diagnosis, then treatment, of presumed low testosterone. When low blood level of testosterone is confirmed, the simple solution is testosterone treatment.

Here are some of the pros and cons of testosterone treatment:


1. “Easy fix”- rather than changing lifestyles that are harmful to testosterone production, especially obesity, taking testosterone may result in improving immediate issues (low libido, fatigue) and a false sense of well-being but harm in other areas (prostate health; cardiovascular health; fertility).

2. Reduced male fertility- many physicians prescribing testosterone do not ask beforehand about conception attempts by their male patients. Many male patients do not realize that testosterone treatment may harm male fertility, at least temporarily, and unknowingly harm the couple’s attempts to have a child.

3. Prostate health- testosterone treatment may result in prostate enlargement and possibly with small increased risk of prostate cancer. Prostate enlargement may lead to bothersome urinary symptoms and increased frequency of visits and urological procedures.

4. Cardiovascular health- especially with high doses of testosterone, there is an increase in blood clots in the lower extremities and lungs; and worsening of cholesterol levels (which may result in increase in heart attacks and strokes).

5. Cost and inconvenience: testosterone treatment is costly, and requires daily application of gel or frequent injections.


1. Improved feeling of well-being and stamina

2. Improved libido, reduced erectile dysfunction

3. Improved bone density

4. Increased muscle mass.

So what’s wrong with feeling better? Not much, unless it comes at the expense of long-term health risks! One should strongly consider weight loss and increased exercise instead of testosterone treatment- this may accomplish improvement in stamina and well-being, possibly also with increased libido and sexual performance, along with greater success in conceiving.


Measles: Perilous but Preventable

By   (New York Times)

Measles has been spreading in the United States at a rate that worries health officials, with 102 cases so far this year in at least 14 states.

Most infections are linked to an outbreak that began in Disneyland in December, almost certainly started by someone who brought the disease in from another country. A “smattering” of other imported cases have also occurred, according to Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

Measles was eliminated from the United States in 2000, meaning that the infection no longer originates here. But worldwide, there are still about 20 million cases a year; in 2013, about 145,700 people died of measles. Travelers can bring the virus into the United States and transmit it to people who have not been vaccinated.

Measles spreads through the air and is among the most contagious of all viruses; in past epidemics, it was not uncommon for one patient to infect 20 others. Some 90 percent of people exposed will get sick (unless they are immune because they have had measles already or have been vaccinated). The virus can hang suspended in the air for several hours, so it is possible to catch measles just by walking into a room where an infected person has recently spent time. Inhaling a tiny amount of viral particles is enough to cause illness.

The disease is cause for particular concern because it can have severe complications, including pneumonia and encephalitis, which can be fatal. Those who survive encephalitis can wind up with brain damage. Measles can also cause deafness. And even without complications, the virus makes children very sick, with high fevers, a rash and sore eyes. Painful ear infections are also common.

Here are some commonly asked questions about measles and the vaccine that prevents it.

Q. Has the United States been particularly hard-hit?

A. Many relatively wealthy countries are having worse outbreaks. Virtually all of continental Europe has been undergoing a large outbreak since 2008, with more than 30,000 cases in several years.

France, which gets more tourists than any other country, had 15,000 measles cases in 2013, with at least six deaths. About 95 percent of the cases were in people who had never been vaccinated or had not had both recommended doses.

In the United States, vulnerable communities have had outbreaks in the last few years, including Orthodox Jews in Brooklyn and the Amish in Ohio. But vaccination rates are also relatively low in some wealthy, liberal neighborhoods. The Seattle suburb of Vashon Island is believed to have the lowest vaccination rates of any health district in the country.

Who is most at risk of becoming seriously ill from measles?

Babies and young children who have not been vaccinated are most vulnerable, and most at risk for dangerous complications.

“Even in developed countries like the U.S., for every thousand children who get measles, one to three of them die despite the best treatment,” Dr. Schuchat said during a news teleconference last week. In the United States from 2001 to 2013, 28 percent of young children with measles needed to be treated in the hospital.

In pregnant women who have never been immunized or never had measles, the disease increases the chance of premature labor, miscarriage and having a baby with a low birthweight. People with leukemia and other diseases that weaken the immune system are also at risk of severe illness from measles.

The best protection for high-risk people, Dr. Schuchat said, is a high rate of vaccination in everyone else, so the disease cannot gain a foothold and start spreading.

Is the measles vaccine safe?

There is no evidence that the vaccine causes harm. Research in 1998 linking it to autism was proved fraudulent and was retracted. Children may briefly run a low fever — an increase of about 1 degree Fahrenheit — after the shot and may develop a mild rash.

When should children get the measles vaccine?

They need two shots, one when they are 12 to 15 months old, and another when they are 4 to 6 years old, according to the C.D.C. The injections contain a mix of vaccines to prevent measles, mumps and rubella.

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About the Advice on Dr. Oz and The Doctors- Here is What Experts say

Experts evaluated the advice given on medical talk shows, and the results were surprising. Many Americans get their health advice not from their doctor, but from daytime television. But how good are those recommendations? 

Reporting in the BMJ, Canadian researchers analyzed two medical TV talk shows—The Dr. Oz Show and The Doctors—and found that only 46% of the recommendations on The Dr. Oz Show and 63% on The Doctors were supported by evidence. 15% of advice given on Oz and 14% of advice on The Doctors contradicted the available published evidence in journals.

“The bottom line message is for people to be really skeptical about the recommendations made on these medical television shows,” says study co-author Christina Korowynk, associate professor of family medicine at the University of Alberta. “They should look for more balanced information to be presented, and understand that they need all of that information in order to make an informed decision.”

They measured 80 major recommendations made on the two shows from January to May 2013 against evidence gleaned from published studies in medical databases. They looked at both consistency—how much the conclusion was supported by the studies—and believability, which included the quality, number and type of study.

On average, Korownyk’s group found that both shows mentioned how the advice might specifically help a person in only about 40% of the recommendations, and they mentioned the amount of benefit, another aspect of useful health advice, in less than 20% of recommendations. (Harms were mentioned in less than 10% of the recommendations, and costs in less than 15%). She says that without such information on how much benefit and harm a particular recommendation might have, it’s hard for people to make informed choices about whether the advice is right for them.

Korownyk and her colleagues aren’t the first to cast doubt on the quality of advice given on the shows. In June a Senate subcommittee heard testimony from Oz on false advertising of weight loss claims and Sen. Claire McCaskill queried the doctor about the statements he made on the show. “I do personally believe in the items that I talk about on the show,” he said at the hearing. “We have to simplify complicated information. We have to make the material seem interesting and focus on the ‘wow’ factor.”

Representatives for The Doctors said in a written statement to TIME: “The Doctors was never contacted about the study or the article. Our producers and doctors all do their due diligence to make sure information provided on the show is sound, relevant and timely—often debunking the myriad of medical myths that abound in the media and across the internet.”

Members of The Dr. Oz Show wrote: “The Dr. Oz Show has always endeavored to challenge the so-called conventional wisdom, reveal multiple points of view and question the status quo. The observation that some of the topics discussed on the show may differ from popular opinion or various academic analyses affirms that we are furthering a constructive dialogue about health and wellness.”

Korownyk acknowledges that the exact impact of television health advice isn’t clear, since the study didn’t investigate how many of the recommendations people adopted and whether they had an effect on their health. But the advice is clearly reaching people. “What we’d love to see is a process on these shows where the evidence is reviewed in a critical manner, and presented in a balanced, objective way so the audience can understand,” she says. “As physicians, we are moving toward that, and we’d love to see the broader television personalities doing the same sort of thing.”

Gluten intolerance- Fact vs. Fiction

(Based on “The Truth about Gluten”, Consumer Reports, January 2015)

Fad? New health prophesy? Gluten, a protein found in wheat, barley, and rye, has recently been targeted as the source of all dietary evil. Even though less than 7% of Americans are truly gluten-sensitive (with some variation of Celiac Disease), many others claim significant relief from various troublesome physical and mental symptoms by adopting gluten-free diet.

Gluten-free diet may be poorly balanced and devoid of important nutrients. When considering such diet, one must be aware of the following:

1. Gluten-free diet may be less nutritious: A true gluten-free diet may be low in certain nutrients (e.g. folic acid and iron) and may lead to increased consumption of sugar and fat.

2. Potential increased exposure to Arsenic: Rice-containing gluten-free diet may have increased amounts of inorganic Arsenic, a carcinogen.

3. Weight gain: Despite common misconceptions about the weight-reducing properties of gluten-free diet, the reverse may be true- weight gain due to increased sugar and fat content in such diet.

4. More expensive: Approximately double the cost of regular diet.

5. Serious health conditions may be missed: Certain anemias and gastrointestinal conditions may be missed. Many people who are not truly gluten-sensitive may feel better on gluten-free diet in the first few weeks or months, either due to placebo effect or due to reduction in certain carbohydrates (e.g. fructose) that may be the original source of troublesome symptoms.

6. You might still be eating gluten anyway: Approximately 5% of “gluten-free” foods actually still contain gluten.

Bottom line:

Gluten-free diet may still provide relief from troublesome mental and physical symptoms in people who are not truly gluten-sensitive but care must be exercised to avoid compensatory increase in calories (especially from sugar and fat) in gluten-free diet. One must ascertain that nutritional deficiencies, especially iron and folic acid, are avoided. Other diets that are less expensive and laborious may achieve the same effect.

Quack Alert: Political Hack, Medical Quack- Glenn Beck says he has adrenal fatigue. Endocrinologists beg to differ.

By  (Slate magazine, November 19, 2014)

Glenn Beck used to be a very sick man. Last week he revealed that he has suffered through years of debilitating physical symptoms—intense pain in his extremities, an inability to speak, vision loss, and severe chronic insomnia. He feared for his career, and even his life, until he was diagnosed and treated for adrenal fatigue and other unspecified disorders. Beck says he’s now on the road to recovery.

I’ve never met Glenn Beck, nor listened to him for more than a few minutes at a time. In fact, I didn’t realize Beck was still working until a Slate colleague sent me an article about his health revelation. As a fellow human, I’m genuinely pleased that his health has improved, but I’m very concerned about the story he’s telling.

Let’s start with one of Beck’s diagnoses—adrenal fatigue. You have two thumb-sized adrenal glands sitting atop your kidneys. They produce many of the hormones you know by name, including testosterone and adrenaline. Like any other part of your body, the adrenal glands can malfunction. The accepted scientific term for most of these problems is “adrenal insufficiency.” The autoimmune system, for example, sometimes attacks the glands, suppressing production of cortisol. The result is Addison’s disease, which can cause muscle fatigue, weight loss, nausea, and a host of other symptoms. Acute cases can be fatal, especially in young people.

Adrenal insufficiency, however, must be kept separate from adrenal fatigue. Immunologist James Wilson coined the latter term in 1998 to describe a syndrome caused by prolonged stress overburdening the adrenal glands. The symptoms supposedly include extreme fatigue, a general sense of unwellness, and what Wilson calls “gray” feelings.

Wilson is prone to overstatement. He boasts of three doctoral degrees, but two of them are in the scientifically dubious fields of chiropractic and naturopathic medicine. He claims that adrenal fatigue affects millions of people around the world, but provides no credible data to support that statement.

Wilson also says his book on adrenal fatigue has been “received enthusiastically by physicians.” Not exactly. The Endocrine Society—the world’s largest association of people with formal, legitimate training in the treatment of adrenal disorders—says that adrenal fatigue is “not a real medical condition.” The group goes on to say that the diagnostic tests are “not based on scientific facts or supported by good scientific studies,” and that some of the supplements prescribed for the disorder, which include extracts of human glands, have not been adequately tested for safety. The statement concludes by urging patients “not to waste precious time accepting an unproven diagnosis.” Endocrinologists apparently do not beat around the bush.

Robert Vigersky, a past president of the Endocrine Society, says that the adrenal glands perform in precisely the opposite manner that Wilson suggests: “When you’re under stress, the adrenal glands increase output of cortisol and related hormones, and they don’t fatigue. They continue to produce those stress hormones.”

The clinic that diagnosed and treated Glenn Beck also deserves a mention. The Carrick Brain Centers were founded by “chiropractic neurologist” Ted Carrick, who, like James Wilson, has questionable credentials. His Ph.D., for example, comes from a for-profit university that now operates exclusively online. Carrick has made wild claims about restoring patients’ eyesight and hearing. He also claims to bring people back from comas. If extraordinary claims require extraordinary evidence, you’d think Carrick would have a series of massive, randomized, placebo-controlled, double-blind studies to prove his results. In fact, he has nothing but anecdotes. Yale neurologist and noted quackery hawk Steven Novella sums the situation up nicely: “Chiropractic neurology appears to me to be the very definition of pseudoscience—it has all the trappings of a legitimate profession, with a complex set of beliefs and practices, but there is no underlying scientific basis for any of it.”

Glenn Beck says relatively little about how he was diagnosed with and treated for adrenal fatigue. The treatment included electrical stimulation, hormonal supplements, and being whirled around in some sort of gyroscope.

If this is all nonsense—as I believe it is—then why is Glenn Beck feeling so much better? Here’s one possibility: He made a bunch of life changes that are known to treat a wide range of disorders. He slept. He ate healthier foods. He exercised and went through physical therapy. Those are reliable first-line treatments for everything from high blood pressure to diabetes to some mild psychological disorders. If Beck benefitted from a miracle cure, these lifestyle changes were it.

There’s a particularly irksome layer to Beck’s story that shows how quacks sell themselves to patients. If his account is to be believed, it appears that some of Beck’s treatment providers spent as much time stroking his ego as treating his ailments…

The Risk of Catching Ebola (and Other more Likely Risks)


Data sources: David Ropeik/Harvard University, National Weather Service, World Health Organization, Northeastern University Laboratory for the Modeling of Biological and Socio-Technical Systems, National Geographic, United States Censusi

Data sources: David Ropeik/Harvard University, National Weather Service, World Health Organization, Northeastern University Laboratory for the Modeling of Biological and Socio-Technical Systems, National Geographic, United States Census Adam Cole and Ryan Kellman/NPR hide caption

Health officials are saying it. Scientists are saying it. Heck, even many journalists are saying it: “The risk of Ebola infection remains vanishingly small in this country,” The New York Times wrote Wednesday.

But what does that mean? Are you more likely to be struck by lightning or catch Ebola?

It all depends on what you do for a living and where you travel. For instance, three of us from NPR are spending 10 days in Monrovia, Liberia, to report on the outbreak. What’s our chance of catching the virus?

So far in the U.S., we’ve had too little data to calculate a real risk. But we can do some back-of-the-napkin math to give some perspective.

Up until now, two people have caught Ebola in the U.S. Both were nurses in Dallas, who cared for Thomas Eric Duncan, the Liberian man who was diagnosed with the virus.

Oh, The Mercury We Eat!

Mercury poisoning facts*

*Mercury poisoning facts by John P. Cunha, DO, FACOEP

“Mercury is a naturally occurring element that is found in air, water and soil. A highly toxic form (methylmercury) builds up in fish, shellfish and animals that eat fish. Fish and shellfish are the main sources of methylmercury exposure to humans.
Mercury exposure at high levels can harm the brain, heart, kidneys, lungs, and immune system. High levels of methylmercury in the bloodstream of unborn babies and young children may harm the developing nervous system, making the child less able to think and learn.
Symptoms of methylmercury poisoning may include impairment of peripheral vision; disturbances in sensations (“pins and needles” feelings); lack of coordination; impairment of speech, hearing, walking; and muscle weakness.
Elemental (metallic) mercury primarily causes health effects when it is breathed as a vapor where it can be absorbed through the lungs. Symptoms include tremors, emotional changes, insomnia, weakness, muscle atrophy, twitching, headaches, disturbances in sensations, changes in nerve responses, and performance deficits on tests of cognitive function. Higher exposures may result in kidney effects, respiratory failure and death.”

Consumer Reports, in its October 2014 issue, presents information about mercury in the fish we eat. It also advances the argument that the recent guidelines of the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) regarding how much fish is healthy to eat, especially by women and children, may lead to the consumption of too much mercury. The latest federal proposal is to increase the amount of fish eaten by women who are pregnant or trying to get pregnant to 8-12 ounces per week. Nevertheless, certain fish contain higher amounts of mercury than others, and meeting these fish consumption guidelines may lead to excessive amount of mercury intake.

The following is a list of fish based on mercury content:

Highest mercury fish (to be avoided by pregnant women, breast-feeding women, and children: Swordfish, shark, King Mackerel, gulf tilefish, marlin, orange roughy

Moderate mercury fish (whose consumption must be limited): Grouper, Chilean seabass, bluefish, halibut, sablefish (Black Cod), Spanish mackerel, fresh tuna.

Low mercury fish: Haddock, pollock, flounder and sole, catfish, trout, Atlantic mackerel, Atlantic croaker, mullet, crawfish, crab.

Lowest mercury fish: Wild and Alaska salmon (fresh or canned), shrimp, sardines, tilapia, scallops, oysters, squid.



Skip The Stirrups: Doctors Rethink Yearly Pelvic Exams (SERIOUSLY?)


The American College of Physicians said Monday that it strongly recommends against annual pelvic exams for healthy, low-risk women.

In fact, the intrusive exams may do more harm than good for women who aren’t pregnant or don’t have signs of problems, a group of doctors wrote in the Annals of Internal Medicine.

When we heard that news here at Shots, we were happily surprised. No more stirrups? No more stripping down below the waist or hearing those dreaded words: “Now, you’re going to feel a little pressure”?

Sounds great! I’m canceling my annual visit now.

Not so fast. Not all doctors agree about these new guidelines…

(For entire story:


Don’t cancel your regular visit with your gynecologist. If you are healthy and without symptoms, you can see your doctor every 2-3 years rather than annually, though. Many women use their gynecologist as their only primary care physician. The conscientious and thorough gynecologist can be just as effective and knowledgeable as an internist or family physician. Better yet, many non-gynecologist physicians have no clue how to perform an adequate gynecological examination or a Pap smear or even a rectal examination!

As a physician who performs many annual physical examinations, let me let you in on some professional “secrets”:

1. The likelihood of finding a serious medical condition during a physical examination on a patient without symptoms (asymptomatic) is incredibly low.

2. The most important aspect of a periodic examination of an asymptomatic patient is in educating her about preventive care and inquiring about family history of serious illnesses rather than finding a serious medical condition.

3. The physical examination’s most important aspects are blood pressure, weight (and BMI), examination of the skin, thyroid, breasts, pelvic (and Pap smear where necessary), and rectal examination (when necessary). The rest (including head, neck, lung, heart, abdomen, and extremities) is simply less important in asymptomatic patients.

4. So, if you are an asymptomatic, healthy female, skip your internist or family medicine physician (unless you find one that can perform an adequate examination below the belly button…) and see your gynecologist (unless he/she do not adequately address preventive medicine issues and do not examine you above the belly button).

5. During an examination, I always examine the neck and abdomen, and listen to the heart and lungs in addition to the more crucial elements (thyroid, skin, breasts, pelvis) despite extremely low likelihood of finding anything of importance in a healthy, asymptomatic patient. When you professionally and tactfully apply the hand touch, patients often feel reassured that their physician is both thorough and caring.

6. There is a famous story about a physician who owned a horse. Being a true scientist, and tight in the pocket, he decided to gradually reduce the horse’s feed (wishing to save on expenses and relying on the lack of scientific evidence that a certain amount of feed is vital for his horse’s survival.) The program worked elegantly, but then the horse died… I personally would feed this horse a regular diet and skip the psuedo-scientific, misguided advice of the American College of Physicians…

Doctors Don’t Know What Women Want To Know About Birth Control

by Maanvi Singh    (NPR) 

Women have choices in contraception, from pills and injections to intrauterine devices and the NuvaRing. But when women discuss birth control with their doctors, they may not be getting all the information they want, a survey finds.

Doctors tend to think it’s most important to discuss how to use contraceptives and which methods are most effective at preventing pregnancy, according to the poll, which was published in the journal Contraception. Women, on the other hand, are often more concerned about safety, side effects and how the contraceptives work.

Researchers surveyed 417 women, aged 15 to 45, and 188 health care providers. The women were either using contraceptives or interested in using them. While 41 percent of them ranked questions about safety as one of their top three concerns, only 20 percent of the doctors thought discussing safety was a top priority. That may be because providers know that for a healthy woman, contraceptives are usually safer than pregnancy, the study says. But women may still worry about complications caused by hormonal birth control, like blood clots, though they are relatively rare.

Those considering permanent contraceptive option may be worried about safety as well. Recently, the safety of Essure, a device that’s permanently inserted into the fallopian tubes to block them, came under question when a number of women who used it complained about pain, hemorrhaging and headaches.

“The main takeaway is really that it’s very important for providers to speak about what’s most important to women,” says Kyla Donnelly, a reproductive health researcher at the Dartmouth’s Institute for Health Policy and Clinical Practice, who led the study.

Yet providers don’t always know what what’s most important to their patients, she tells Shots. “And doctors are increasingly having to manage very short consultation periods.”

These results aren’t the final word — the participants were mostly white, and they had to have Internet access in order to complete the survey. But it does show that doctors and patients aren’t always on the same page.

Donnelly says she’s working with other researchers to developing guides — called option grids — to help health care and patients discuss contraceptives. “That way providers can feel supported with the right information.”

Toothpaste, sunscreen chemicals ‘interfere with sperm function’

Monday 12 May 2014 – 8am PST (Medical News Today)

Written by

Endocrine disruptors are chemicals that interrupt the processes of natural hormones and have been previously implicated in affecting human reproduction. Now, these chemicals – which can be found in household and personal care products – have been shown to affect sperm function, potentially impacting fertilization.The research team, from the Center of Advanced European Studies and Research in Germany and the University Department of Growth and Reproduction in Denmark, published the results in the journal EMBO reports.

Medical News Today recently reported on several findings regarding endocrine-disrupting chemicals (EDCs). One study questioned the safety threshold for such chemicals, while another detected EDCs in commercialized bottled water.

The researchers from this latest study note that EDCs are present in everything from food and textiles to drugs and household products, including plastic bottles, toys and cosmetics.

Currently, the European Commission is reviewing its policy on EDCs, and their plans from last year sparked a debate between endocrinologists and toxicologists on how to regulate such chemicals.

Though proving adverse effects of EDCs on humans has been difficult with a lack of acceptable experimental systems, lead study author Timo Strünker, from the Center of Advanced European Studies and Research in Germany, says their study “provides scientific evidence to assist forming international rules and practices.”

With a new bioassay developed by the researchers, they were able to rapidly test hundreds to thousands of chemicals for potential interference with function of human sperm.

EDCs prompt changes in sperm swimming behavior

They explain that for their study, they tested about 100 chemicals and found significant results that suggest endocrine disruptors may lead to widespread fertility issues in the Western world in a way that has not been identified until now.

The team’s findings reveal that about one third of these chemicals showed adverse reactions.
Researchers found that certain ECDs in household products, such as toothpaste and sunscreen, affected human sperm function, potentially impacting fertility.

Some of these chemicals include ultraviolet filters such as 4-methylbenzylidene camphor (4-MBC), which is used in some sunscreens, and Triclosan, an anti-bacterial agent used in toothpaste.

“For the first time,” says Prof. Niels E. Skakkebaek, leader of the Danish team, “we have shown a direct link between exposure to endocrine disrupting chemicals from industrial products and adverse effects on human sperm function.”

They looked specifically at how these chemicals affected the CatSper ion channel, which they explain is a calcium channel that controls sperm motility.

Applied at concentrations they measured in bodily fluids, the team says EDCs directly open the CatSper channel, increasing calcium levels in sperm and changing their swimming behavior. The investigators say this also triggers the release of digestive enzymes that help the sperm to break through the egg.

Additionally, EDCs make sperm less sensitive to progesterone and prostaglandins, which are two hormones released by cells around the egg.

The team says their findings illustrate how EDCs disturb the mechanisms underlying fertilization by prompting changes in swimming behavior, hampering sperm navigation and interfering with penetration into the egg’s protective coat.

The authors conclude their study by writing:

”Here, we provide a direct link between exposure to EDCs and potential adverse effects on fertilization in humans. About 800 omnipresent man-made chemicals are suspected to interfere with the endocrine system. To this day, the majority of these potential EDCs have not been evaluated for their action in humans.”