An Apple A Day

Many medications are available only by prescription (unless you own a computer or travel to another country). That is because of the risks that accompany their use. When drugs become available we tend to believe that availability is some sort of certification that they are safe, and weak compared to prescription meds. Not true.

Recent news that daily use of aspirin lowers the risk of a number of cancers (especially esophagus, colon, rectum and lung) is another example of apparently wonderful information that is not, if you know enough. Seems great, doesn’t it? Take a safe drug and prevent some very nasty diseases. Shouldn’t I be taking it anyway, because it prevents heart attacks and strokes?

Here comes the buzz kill. Other studies, larger and more carefully designed, have not found this effect. Also, studies have found that taking aspirin does not prevent a first heart attack or stroke, as we had thought it would. It might be a good idea for that purpose in some middle-aged individuals, and probably is for those who have already had a heart attack or stroke. Finally, recent data shows that daily aspirin doubles the risk of macular degeneration, already one of the most common causes of age-related blindness.

Aspirin used to be routinely given to infants with fever. Then we learned that this could lead to (potentially fatal) Reyes Syndrome. I have never liked using it in this circumstance, because fever is generated by the body in its effort to make itself an unpleasant place for bacteria and viruses to live. Squashing the fever squashes the immune response and, as research shows, prolongs illness.

Ibuprofen, (aka ADVIL, MOTRIN, MUPRIN, RUFEN) seems like a good choice to so many. Inflammation is “bad”, so anti-inflammatory is then good.

Ibuprofen is the leading cause of impaired kidney function in the US. Years ago a kidney specialist told me she would not see a new patient for kidney trouble until the patient had been off ibuprofen entirely for at least a month, because dropping the kidney-imparing ibuprofen fixed 75% of the patients sent to her.

Ibuprofen markedly increases the risk of the most serious problem commonly seen in marathon runners. Their kidneys slow down from the exertion. Taking ibuprofen makes it worse. Their sodium drops and they can die. Not good.

Many athletes take ibuprofen before engaging in their sport. Ironically, ibuprofen increases damage to muscles and soft tissue because “inflammation” is one aspect of the healing process. At the medical meeting of physicians working with endurance athletes before the Marine Corps Marathon last fall, I was delighted to find myself in the company of others who shared my dislike for ibuprofen. We discussed its harms at length, as well as the muscle damaging effects of statin drugs. I loved it.

Is Tylenol, the “safer choice”. Not really. Starting from the very beginning of my medical training I spent a great deal of time working as an Emergency Room Physician. One of my first ER shifts I took care of a teenaged girl who was upset and, crying out for help, took an overdose of Tylenol, believing it was safer than aspirin. By the time she arrived in the ER, she had changed her mind and was feeling fine. She did not realize that, although , in the coming days her life was at risk due to the delayed, liver toxicity of acetaminophen/tylenol.

Following the recognition of the link between aspirin and Reye’s Syndrome, everyone switched to Tylenol. Now many think that the rise in childhood asthma, which began at the same time, is not a coincidence.

Remember, there is no “free lunch” biologically or otherwise. The best medication is no medication. Taking care of yourself, minding the essential health habits, will do far more to help you live well and happily than any medication. There is a place for drugs but they are only pharmacological band aids.

Over time we have gotten used to the idea that some things we cannot see, can still cause us harm. In fact, much longer ago, say 1,500 years, people were concerned about vaporous humors floating out of swamps and causing illnesses. Those ethereal malefic influences often proved to be tiny creatures like mosquitoes carrying invisible ones like bacteria. Since Rachel Carson proved that DDT was ruining our world despite its invisibility, we have learned to be skeptical about all kinds of things.

Most of us, including me, would rather not have to worry about something else, especially another invisible but ever present hazard. A new study dealing with electromagnetic radiation provides an unpleasant jolt to our complacency. Given the strength of the study and the potential impact of the finding, I am more than a little surprised by the lack of media attention. Maybe that is because no one really wants to believe it, especially electronic media workers and their bosses?

Whatever else anyone has to say, good or bad, about Kaiser, clinical records of Kaiser patients are a goldimine for researchers. Dr. De-Kun Li is a researcher working for Kaiser, specializing in reproductive and hormonal health studies. Years ago, this group found that exposure to electromagnetic fields (EMF) doubled the risk of miscarriage for pregnant women. This time they studied pregnant Northern California patients, looking for an association between EMF exposure and asthma. The study design was particularly strong for this kind of research. They gave over 800 pregnant women monitors to wear, measuring EMF exposure during pregnancy. The children were tracked until age 13 to learn which of them developed asthma.

Children of women with the highest levels of EMF exposure during pregnancy were three times more likely to develop asthma than children of the least EMF exposed mothers. The greatest EMF exposure came from home appliances (hair dryers, microwave ovens and vacuum cleaners). The meters used did not measure radio frequency energy, so this study teaches us nothing about smart meters, cellphones and the wireless networks all around us. Dr. Li, however, has also expressed his concern about radio-frequency exposure.

Although we have lots of evidence showing that vitamin D lowers the risk of many diseases, the lingering concern is that vitamin D levels might simply tell us who was healthier to begin with. In other words, healthy people go outside more often because they are healthy not the other way around.

With the passage of time and completion of the more demanding studies required to determine causation rather than association, vitamin D continues to look every bit as promising. Identifying physiologic pathways important in specific disease and influenced by vitamin D raise our confidence that the effects of D are real.

The latest such discoveries come from National Jewish Health in Denver, a famous center for asthma and allergy research. Studies they conducted of adults and children with asthma have shown that lower D levels are associated with worse asthma symptoms. Reaching further into the “how could that be” side, these studies have shown that vitamin D enhanced anti-inflammatory effects of certain immune cells and accentuated the effectiveness of steroids prescribed to treat asthma. One study found that a certain steroid was 10 times more effective when administered in conjunction with vitamin D.

Even if vitamin D only helped asthmatic patients by reducing their steroid dose, that would be great because, as the “heavy guns” of medical pharmacology, steroids have many nasty adverse effects and those effects are dose-related. However there is excellent cause to believe that D does much more and can help many asthmatics come off of medication entirely.