Category Archives: General Health

Vitamin Supplements and Outcomes

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EA O’Connor et al. JAMA. 2022;327(23):2334-2347. doi:10.1001/jama.2021.15650. Full text -open access: Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Key findings:

  • In pooled analyses, multivitamin use was significantly associated with a lower incidence of any cancer (odds ratio [OR], 0.93 [95% CI, 0.87-0.99]…However, the evidence for multivitamins had important limitations
  • Limited evidence suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium])
  • Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use.

Summary of this study –USA Today (6/30/22): Are common multivitamins worth the money? New study explores the benefits, harms. In this “massive meta-analysis from JAMA of 84 studies on vitamins and supplements, …

  • Beta-carotene: supplementation associated with increased risk of lung cancer and cardiovascular mortality.
  • Vitamins D and E: not associated with increased or decreased risk of all-cause mortality, cardiovascular disease or cancer. In summary, no benefit.
  • Based on these findings, the United States Preventive Services Taskforce 1) recommends against the use of beta-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer and 2) states that there’s insufficient evidence to assess the benefits or harms of multivitamins or other single or paired nutrient supplements for the prevention of cardiovascular disease or cancer.
  • Americans spent $50 billion on multivitamins and supplements in 2021.

My take: Most people will not benefit from vitamin supplements and should focus on developing a healthy diet. Certain populations, including pregnant women and those with intestinal disorders, do need additional vitamins.

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Los Poblanos Ranch, Alburquerque

The Relief Room

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This weekend, on “Wait, Wait, Don’t Tell Me” (Transcript July 2) on their ‘Bluff the Listener’ game, they highlighted three stories of a new Philadelphia tourist attraction. The true (very funny) story was regarding “The Relief Room.” A bathroom (suitably) dedicated to Philadelphia pitcher relievers and covered in memorabilia.

GONDELMAN: 45-year-old Matt Edwards, has gone above and beyond turning his home’s downstairs bathroom into a monument to his beloved Phillies.

GONDELMAN: The Relief Room, as Edwards calls the commode, is a celebration of retired Phillies relief pitchers.

GONDELMAN: Though the room is jampacked with Phillies ephemera, such as signed photographs and figurines, the area above the toilet remains largely empty. That’s because it’s reserved especially for pitchers who have played for Phillies championship teams.

GONDELMAN: Edwards did miss an opportunity for guests to declare their need for personal relief the same way that catchers deliver signals to a pitcher – throw down one finger if you need to do what the Phillies do with a late-inning lead…

GONDELMAN: …Two fingers if you need to do what the team is playing like overall.

Here’s a link to a very descriptive NY Times article/pictures: When Nature Calls, Phillies Relievers Have a Place to Go

Apple Adding Medication Tracker to iPhones

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The Verge: Apple adds medication tracking feature to the Health app (6/6/22)

An excerpt:

Apple is adding a new tool to remind people to take medications to the iPhone health app, the company announced today…will let users add any drugs they take by either scanning a label on a medication bottle or searching through a list of medicines. People can create custom schedules for each drug they are taking and receive alerts to remind them when it’s time to take one.

In the United States, the app will also alert users if there are any dangerous interactions between the drugs that they take.

Related blog post: Presorted Pills -A Good Idea

Ahmyo Wine Garden, Santa Fe NM

Genomic Sequencing At Birth

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The Economist (5/13/22): Full-genome screening for newborn babies is now on the cards (Behind a paywall).

This article delves into the topic of genome screening at birth and its potential role in supplanting current newborn screening.

Rationale: “Doctors have described more than 7,000 rare diseases, generally defined as those affecting fewer than one in 2,000 people. So, though individually unusual, such illnesses are collectively a serious problem—a long-tail of need which is hard to treat because patients are few in number and their symptoms often picked up too late.”

Background: “A government-owned company called Genomics England … will soon start a pilot project intended to sequence the genomes of 200,000 babies. That could presage a national programme.”

Key points:

  • “On May 4th, at a meeting held in London by Genomics England, Rick Scott, the organisation’s chief medical officer, said discussions with parents and doctors had led his team to conclude that people want any genomic-screening programme for newborns to look for a far narrower set of conditions than BabySeq sought. The most appealing tests were for variants associated with a high probability of childhood illness, and which would benefit from early treatment.”
  • “One particular finding, according to David Bick, a clinical geneticist who advises Genomics England, is that parents want certainty. They feel it is no use being told that a child is “fairly likely” to have a condition. Rather, they want a pretty clear “yes” or “no”.”
  • “Many also do not want to know of adult-onset illnesses that their children may one day suffer. This means rejecting tests which might indicate a newborn’s risk, later in life, of contracting cancer, diabetes or Alzheimer’s disease.”
  • Potential problems: learning about degenerative diseases & mental health problems without suitable treatments, data security, mutations with variable phenotypes (variable age of onset and severity)

My take: Genomic screening could broaden the benefits of newborn screening but identifying all of an individual’s genetic flaws is likely to be more detrimental than beneficial at this point.

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Bandelier National Monument, New Mexico. Caves in the “tuff” volcanic rock.

Tired of Seeing This Headline

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The Onion has used the same headline 21 times since 2014. The article was first published on May 27, 2014, following the Isla Vista killings.

Milwaukee, El Paso, Dayton,

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Partisan Divide, Misinformation and Risk of COVID-19 Death

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NPR: Pro-Trump counties continue to suffer far higher COVID death tolls

Since May 2021, “those living in counties that voted 60% or higher for Trump in November 2020 had 2.26 times the death rate of those that went by the same margin for Biden. Counties with a higher share of Trump votes had even higher mortality rates…. previous polling has shown that belief in misinformation is highly correlated with being unvaccinated. Kaiser examined several common pieces of misinformation such as the idea that the government is exaggerating the severity of the pandemic, or that the vaccines contain a microchip. Kaiser’s poll found that 94% of Republicans believed one or more false statements about the vaccines.”

Related blog post: Perception of COVID-19 Risk, Vaccine Uptake and Media Source

Delusional Thinking That COVID-19 Is Over

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A couple recent articles indicate a lot of reasons for concern.

First of all, it is important to recognize that even among persons less than 55 years of age, COVID-19 was the leading cause of death in 2021. Inside Medicine: Open Access: The million US Covid dead are younger than you think.

Sadly, more than 300,000 deaths in the U.S. could have been averted (NPR: This is how many lives could have been saved with COVID vaccinations in each state)

There has been a culture shift to learn to live with the virus. This is evident almost everywhere from packed restaurants, crowded venues, etc. However, there is currently high transmission and variants that are evading vaccine protection as detailed by Eric Topol, Open Access: The Covid Capitulation

Key points:

  • The United States is now in the midst of a new wave related to Omicron variants BA.2 and BA.2.12.1 with over 90,000 confirmed new cases a day and a 20% increase in hospitalizations in the past 2 weeks…The real number of cases is likely at least 500,000 per day, far greater than any of the US prior waves except Omicron.
  • “Infections…beget more cases, …Long Covid, … sickness, hospitalizations and deaths. They are also the underpinning of new variants.”
  • CDC currently is vastly underestimating the number of cases leading many towards false confidence, “feeding the myth that the pandemic is over.”
  • “As of last week, 43% of new cases were attributable to BA.2.12.1 …. BA.2.12.1 is out-competing BA.2 with its 25% higher transmission rate, which foretells its further rise to dominance across the US in the days and weeks ahead.”
  • “This family of Omicron variants with functional impact indicates more rapid evolution of the virus than what we have seen previously.”
  • There has been a “reduction in vaccine effectiveness that we are now encountering…[Protection from severe disease] has declined to approximately 80%, particularly taking account the more rapid waning than previously seen.”
  • “It’s overly optimistic to think we’ll be done when Omicron variants run their course. Not only are they providing further seeding grounds for more variants of concern, but that path is further facilitated by tens of millions of immunocompromised people around the world, multiple and massive animal reservoirs, and increased frequency of recombinants.”
  • “Vaccinated individuals accounted for … 42 per cent [of the deaths] during the Omicron wave. This is attributable to waning of protection, lack of boosters, and the diminished protection against Omicron (BA.1).”
  • What needs to be done: More boosters/vaccines (“we rank 60th in the world’s countries for boosters”) along with more medicines, and nasal vaccines which could induce mucosal immunity

My take: Unfortunately, these articles indicate that we have a long way to go. High quality masks are going to be needed at health care settings for a while. For those trying to avoid COVID-19, it will remain important to avoid large indoor gatherings. For public policy/economic policy, we need to continue to fund COVID-19 resources.

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Shifting of Infectious Diseases Due to Climate Change

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CDC (January 2022): Open Access PDF: Our Risk of Infectious Diseases Is Increasing Because of Climate Change

“Between 2004 and 2018, the number of reported illnesses from mosquito, tick, and flea bites more than doubled, with more than 760,000 cases reported in the United States. Nine new germs spread by mosquitoes and ticks were discovered or introduced into the United States during this period. The geographic ranges where ticks spread Lyme disease, anaplasmosis, ehrlichiosis, and spotted fever rickettsiosis have expanded, and experts predict that tickborne diseases will continue to increase.”

EPA: Climate Change Indicators: Lyme Disease This EPA website has links to many other climate change indicators.

The lack of dots in Massachusetts in 2018 is due to a difference in
reporting standards, not an absence of Lyme disease

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