Older Is Better, even with oral contraceptives

New stories, including this one,

Bayer Withheld Yasmin Data From U.S., Former Agency Chief Tells Court - Bloomberg

highlight the elevated risks with the new oral contraceptives. The one under major scrutiny is drospirenone, also known as Yaz or Yasmin.

First, the most important thing: The increased risk of blood clots is small. Your risk of blood clots is probably still higher if you are pregnant. Yes. Your risk of blood clots is higher being pregnant, than being on Yaz or Yasmin. So, patients: Please do not suddenly stop your OCP suddenly. Talk to your doctor first.

When you do talk to your doctor, consider switching to an older contraceptive. One of my mantras in prescribing is that older drugs are usually better, as we know more about their safety. One of my mentors told me, "Never be the first or last to prescribe a new drug." I tend to use norethindone, but any older oral contraceptive will do.

I never understood the hype of Yaz and Yazmin. The drug companies just did a good job marketing it as an acne drug. The truth is, most OCPs work for acne. It appears that Bayer also did a good job of hiding drospirenone's side effects. How many times will we hear this story?

McDonald's: Doing it Wrong

San Francisco's ordinance on free give away toys at fast food restaurants was intended to nudge restaurants to improve the health of their kids meals. The ordinance requires meals that have free toys to meet certain nutritional requirements. The ordinance is a great idea, as the toys are just marketing gimmicks, designed to create brand loyalty with McDonald's.

As this article states, McDonald's, instead of improving their meals, will charge 10 cents for each toy. This will get them around the ordinance and allow them to change meals on their own terms. Still, the pressure from this law got McDonald's to make some changes to the kids meals, such as reducing the portion of fries. But, they are still not healthy. The extra charge will also likely prevent some from buying the toy, as it's not included with that meal.

So it's time to put more pressure on McDonald's, and we have more legal tools that we can use. I want to know why McDonald's has to sell toys. Aren't they in the business of selling food? Why should food establishments sell toys? Why not create a law that states that restaurants cannot sell toys? I'm not yet sure if this is legal, but I would like to find out.

Do Kids Need 3-4 servings of Milk a Day?

Many of you know that I have long said that the benefits of milk were overstated. The article below does a good job of reviewing the evidence why:

Wisconsin milk board overstates dairy’s benefits to children, some experts say | WisconsinWatch.org

The key statements are this:

“The so-called calcium requirement in the United States is based on very short-term studies (that are) irrelevant to long-term calcium needs,”

-Dr. Walter Willett, who chairs the nutrition department at the Harvard School of Public Health

“We know that those individuals who avoid milk and animal products that contain calcium do just fine in terms of their growth, their development, and their bone health,” - Jennifer Nelson, director of clinical dietetics at the Mayo Clinic

“I wonder how the marketing board explains why the highest rates of osteoporosis are found in countries that drink the most milk, or how cows manage to make huge bones that support their weight while eating mostly grass?”- Marion Nestle, Chair of Nutrition at NYU

“It’s hard not to be sarcastic about this kind of marketing,” Nestle added. “Milk is a fine food if you like it, but it is not an essential nutrient.”

Healthy Checkout At Walmart

This video is a great example of a couple of things:

1. Creating healthy checkout aisle shows that behavioral economics works: kids want fruit when it's in their check out aisle.

2. Walmart is doing some more great things in encouraging healthy eating. This was however, a local store initiative. Big Walmart is not yet doing this. Let's how they do.

3. Federal money can work for good. The reason these changes happened was because West Virginia got a grant from the CDC, likely as part of the Affordable Care Act. Federal Money -> States -> Promoting Healthy Changes and Increased Sales.

WATCH IT HERE:

Life in the health lane - News - The Charleston Gazette - West Virginia News and Sports -

Is the Food Industry a Partner in Battling Obesity?

Check out this debate about whether the food industry can be a partner in fighting obesity.  Our study is featured about half way through.



Food Industry Friend or Foe Debate: Yoni's opening arguments from Yoni Freedhoff on Vimeo.

This is just the first in a series of videos by Yoni.  For more, see his blog.

Every day is Medicine Day. But, today is Food Day.

Every day is Medicine Day.  Every time a family doctor like me sees a patient who struggles with weight gain, diabetes, or high blood pressure, I give them medicine.  But today is different.  Today is Food Day.

To be honest, I have long tried to emphasize the importance of food choices in preventing and treating disease.  I high-five my patients when they lose weight or cut out sugar-loaded beverages from their diet.  When people pick a food to eat, they are making one of the most important health decisions of their day.  The vast majority of problems I see in primary care are related to what people eat.  Our food system and our health system are closely linked.  It's no surprise that the faults or our food system contribute to the problems of our health system.  

Our general taxes fund massive giveaways to large agribusinesses, so that they can grow corn (for sugar) and soy.  This makes the major ingredients for most processed foods and beverages cheap, allowing the big food companies to spend billions of dollars a year getting Americans to eat a lot of junk.  And it works. Obesity and diabetes rates are skyrocketing, leading to increased patient suffering and corresponding health care costs.  Guess who pays for those costs?  The same taxes that fund agricultural subsidies help our seniors buy the medications to treat the conditions the subsidies helped cause.

There is a very simple way to break this cycle.  And we don't have to rely on politicians to do it.  All we have to do is know where our food comes from.  Then we just vote with our fork and start eating food that is not part of the industrial food system.

This is the idea behind the first annual Food Day, today, October 24^th (www.foodday.org).  Food Day was founded on six national priorities: reduce diet-related disease by promoting healthy foods, support sustainable farms & cut subsidies to big agribusiness, expand access to food and alleviate hunger, protect the environment & animals by reforming factory farms, promote health by curbing junk-food marketing to kids, and obtain fair wages for all workers in the food system.

One of the best ways to do this is to visit a farmer’s market.  At farmer’s markets we can directly ask the food producer: Where does this strawberry come from?  Did you spray it with pesticide?  Is there any chance it is infected with bacteria from a nearby animal slaughterhouse?  How much do you pay your farm workers?  So visit your farmer's market this week, ask these questions, buy some fruits and vegetables, and provide your family with a few healthy meals.

For those of you who want to celebrate food day in other ways, you can celebrate Meatless Monday by not eating any meat or poultry today (and every Monday).  You can turn your child's television (and internet) off so they do not see all the junk food ads.  Stand outside McDonald's or Taco Bell and warn people about the dangerous food they are planning to eat.  Celebrate water by joining the "Life is Sweeter" campaign and get sugar-loaded beverages out of the buildings where you work.  Or grow a tomato plant on your porch.  You can involve your family in any of these activities, while teaching your children where food comes from.  

While I'm hoping that the 2012 Farm Bill will fix some of the problems with our food system, I'm not optimistic.  However, I am optimistic that many of our food issues can be solved without relying on politicians. By choosing to eat non-industrial food, we can start our own food movement.  

So when I see patients tonight, instead of picking up my pen and writing a prescription for a new medicine, I'm going to write a food prescription for my patients.  I'll give my patients three choices of what I can write: "Eat seven vegetables a day," "Don't Drink Sugar-loaded beverages," or "Give up meat on Mondays."  I hope other doctors follow my lead, and that my patients do too.

Protecting your Prostate and your Package

According to reports out today, the United States Preventive Services Task Force will give a D rating to prostate cancer screening. This means they recommend men should not get the test.

Physicians who have watched the data on prostate cancer screening for awhile could have seen this coming. When I counsel men on PSA (the antigen that screens for prostate cancer) screening, I tell them that the test more likely to harm them then help them. Most prostate cancers are slow growing and never cause problems. How can this be? Cancer is a growth of abnormal cells in your body. The body is always fighting off abnormal growths. It often suppresses early cancers through the immune system and other mechanisms. Even if a cancer continues to grow, it may take years and years to cause something bad. Most people die of a heart attack before the prostate cancer does anything bad.

Now there are a very small amount of people where prostate cancer kills people. The problem is that medicine does not have a way to detect these people. So as in breast cancer, universal screening of women under 40 will result in a lot of people getting mastectomies to prevent one "bad" cancer in women. In prostate cancer, if we screen everyone, we will make millions of men unable to get an erection or be able to hold on to their urine while trying to prevent one prostate cancer.

Screening is not the best way to stop cancer deaths. The best way to prevent them is to stop them in the first place. According to the World Cancer Research Report, you can prevent prostate cancer by eating a lot of fruits, vegetables, and whole grains; and by avoiding a high calcium diet. And that doesn't involve becoming impotent or incontinent.