If stodgy medical journals ever hyped themselves, last week’s New England Journal of Medicine could have been hyped as the special weight-loss surgery issue.  It featured two studies that examined the effects of weight-loss surgery on mortality, and an editorial which discussed the findings of the two studies.  The studies received much press coverage, including this LA Times article.

Both studies compared obese patients who underwent surgery for weight loss to patients who had the same weight and age who did not have surgery.  The studies were not randomized.  Patients and their physicians decided if surgery was appropriate.  They weren’t randomly assigned to a surgical group or a non-surgical group.  Both studies followed the two groups of patients for a number of years and found fewer deaths in the patients who had surgery.  The death rate from heart disease and diabetes was lower in the surgery group, and surprisingly so was the death rate from cancer.  This is the first time that studies have suggested that surgery for weight loss may be life saving.

Last year, I wrote about a study which showed that gastric banding (the least invasive weight-loss surgery) led to more weight loss and a higher quality of life than diet and exercise.  As surgical techniques improve and the risk of surgery diminishes, this will be an increasingly realistic option to the very many people whose attempts at diet and exercise have been unsuccessful.

Tangential Miscellany:

Have a relaxing and happy Labor Day weekend!

Two weeks ago I warned you about excessive sun exposure.  Ironically, this week I’m warning you about a consequence of insufficient sun exposure.

A recent article in the New England Journal of Medicine exposes a very common and under-diagnosed problem, vitamin D deficiency.  This has become a bigger problem as our activities have moved increasingly indoors, and is even more common in Europe where food fortification with vitamins is rare.  The article cites studies that show that more half of post menopausal women taking medications for osteoporosis are deficient in vitamin D, and children and young adults are frequently deficient as well.

The effects of vitamin D deficiency on bone health are well understood.  Vitamin D deficiency leads to osteoporosis and in extreme cases to rickets.  Vitamin D is also essential to muscle function, and an intriguing study a couple of years ago also linked vitamin D deficiency to an increased frequency of falls in the elderly.  The article also cites many other studies that implicate vitamin D deficiency in a host of other diseases, from heart disease to colon cancer.  Most of these studies are observational, not experiments, so I’m not prepared to accept that vitamin D deficiency causes everything from bubonic plague to inflation, but the widely accepted effects on bone health and falls are reason enough to take it seriously.

There are two important points to take away from the article.  The first is that vitamin D deficiency is very common and easily diagnosed with a blood test called 25-hydroxyvitamin D.  The second is that the current dietary guidelines for vitamin D are likely insufficient and that everyone should be encouraged to get at least 800 IU of vitamin D daily.  For post-menopausal women who have been encouraged to take calcium and vitamin D supplementation, that will likely mean switching to a supplement with more vitamin D.  For example, Oscal + Extra D has 500 mg of calcium with 400 IU of vitamin D, so taking one tablet twice a day would give 1 gram of calcium with 800 IU of vitamin D.

(Thanks to my partner, Dr. Rubencio Quintana, for brining this article to my attention.)

In our germ-phobic culture antimicrobial soap, once only used in hospitals, has become very popular in households.  This issue of the journal Clinical Infectious Diseases contains a study which reviews the literature comparing antimicrobial soaps versus plain soap.  The results of the study was reported in many media articles, including this Washington Times article.

The study reviewed both the soaps’ ability to kill germs on hands and their ability to prevent actual infectious diseases.  The surprising results were that antimicrobial soap was no better than plain soap from removing bacteria from hands and did not lead to lower incidence of infectious diseases.  Even worse, antimicrobial soap seems to select for resistant bacteria that are also resistant to conventional antibiotics.

It’s comforting to know that in the twenty first century there’s still nothing better to wash hands with than plain soap and water.

Tangential Miscellany:

Further proof that you’ll read it here first and it’ll still be true months later.

In January I wrote about the CDC warning about the dangers of cough and cold medications in children.  This week, the FDA released a strongly worded Public Health Advisory that every parent of small children should read.

In May I asked you not to panic about the concern that Avandia increases heart attack risk.  A study in an upcoming issue of the Annals of Internal Medicine finds that the effect of Avandia on heart attacks is still uncertain.

With the long days of summer upon us, many of us are hitting the beaches and getting suntans.  Southern California is obsessed with both beauty and health, and tanning sits at the intersection of the two.  Suntans have become symbols of status, health and beauty.

But why?  There are certainly no health benefits to tanning, and many health risks.  Dermatologists have been warning us for over a generation that sun exposure increases our risk of melanoma, the most dangerous form of skin cancer.  It certainly increases the risks of less serious skin cancers too, not to mention wrinkling and other forms of skin damage.  The Darker Side of Tanning, a publication of the American Academy of Dermatology details the dangers of tanning.  They should hand it out at beaches and indoor tanning centers.

Sunshine certainly has a couple of health benefits.  Sunshine stimulates our skin to make vitamin D, but the amount of sunlight needed for adequate vitamin D is just a few minutes a day, much less than is needed for tanning.  (And you can get vitamin D in fortified foods or in supplement pills and skip the sun altogether.)  The other benefit to sunshine is its effect on our mood.  There is no question that sunshine (or bright fluorescent light which has the same color spectrum) elevates our mood.  Some people even get depressed when the daylight hours shrink in the winter, a condition called seasonal affective disorder.  But we don’t need to tan to get the mood-elevating benefits of longer days.  It’s enough to just see the sunlit outdoors though a window (which blocks harmful ultraviolet rays).

So why do we associate tans with health and beauty?  Like many other modern standards of beauty, the answer is purely passing fashion.  Before the beginning of the twentieth century tans were considered evidence of low status, since it implied having to do manual labor outdoors.  The wealthy worked very hard to avoid the sun and used makeup to lighten their skin.  Then, in the twentieth century, when most labor moved indoors, suntans became a symbol of affluence and leisure, suggesting a lifestyle that can afford a beach vacation.

So I encourage you to start a new trend.  Perhaps we can make it cool to have skin that’s as brown, black, yellow or pink as the day we were born.  That would be healthy, and in my opinion, beautiful.

Tangential Miscellany:

In case you were looking for more misleading meaningless studies that nevertheless get a lot of attention, here’s another study to ignore.

I know I just wrote about the common cold two weeks ago, but I don’t make the news, I just report it.

This week the news is about zinc.  A study in the journal Clinical Infectious Diseases reviewed all the studies in the medical literature on the efficacy of zinc for the common cold.  The study attracted some coverage in the general press including this article in Fox News.  The review simply found that the majority of studies were too small or too poor in quality to draw a definitive conclusion.  So even though most of the lay press headlines are suggesting that zinc isn’t effective in colds, a more honest conclusion is that we don’t know yet.  In the authors’ own words:

This structured review suggests that the therapeutic effectiveness of zinc lozenges has yet to be established.

Tangential Miscellany:

Our receptionist, Jennifer, will be leaving us to enroll in nursing school and pursue her dream of a career in nursing.  We wish her much success.  We are excited that our new receptionist, Jaymes, comes wonderfully recommended by physicians we know and respect.  He has many years of experience listening to, advocating for, and helping patients.  Please help us welcome him, and go easy on him the first couple of weeks!