Like all of you, I am concerned about the war, the factors that led to this and the consequences. Now that it has begun, we hope it ends quickly with as little death and destruction as possible. As much of the suffering for the civilian population comes from starvation and disease after the combat ends and no one thinks this war is the fault of the Iraqi people, please consider making donations to humanitarian organizations like OxFam (http://www.oxfamamerica.org) or the Red Cross (http://www.redcross.org/) to provide food, water and shelter to refugees. Maybe some day human beings will learn to settle our differences without resorting to violence. Now the best we can do is to help the healing.

OFFICE SPACE! Although my current office is less than ideal in some ways (location and unusual building) the office space itself is nice. As a result it was disappointing when my landlord withdraw their offer to renew my lease 4 days ago so that they can expand into my space. Even worse is the fact that my lease ends June 30 and I had already looked hard at other options.

So, if any of you know of any suitable space in Santa Rosa (roughly 1,000 sq feet, disabled access, a sink and windows that open) for lease or sale please call the office (545-1554).

Remember to check out the website � www.carlstonmd.com

Best,

Michael Carlston, M.D.

• Breakfast Is Good For You!
• Kava Advisory
• Multiple Vitamin
• Inappropriate Antibiotics
• Suicide and Cosmetic Breast Implants
• Asthma - Long Term Prognosis

Researchers at Harvard University have added to the already considerable evidence we have had for decades that breakfast appears to be the most important meal. People who regularly ate breakfast were much less likely (35-50%) to develop obesity or diabetes. As diabetes and increased weight are important risk factors for heart disease, eating breakfast is likely to lower the risk of heart disease as well.

Ongoing analysis of the rare but very serious reactions some people have had to kava extracts is concerning. Quite low doses (80 mg/day) have not been safe. Extracts using alcohol as well as acetone have caused liver failure. Growing evidence suggests that some few people have unpredictable devastating reactions to the herb. At the same time we have records of literally centuries of seemingly safe use. At this time I think the wisest advice for the time being is use kava only if as is the South Pacific tradition - in other words, chewing up the plant or soaking the plant in water. Chemical extracts of kava should be avoided until we know more.

Another study adds further evidence of the benefit of taking routine multiple vitamin/mineral supplementation. Diabetic (Type II) patients were randomly assigned to placebo or a multiple vitamin/mineral combination. Those who received the vitamin pills were much less likely to develop infections. This is potentially quite important as infections are one of most serious complications experienced by diabetic patients.

One of the biggest and oldest ongoing studies of American medicine is the National Ambulatory Medical Care Survey. I participated in it for many years myself until I tired of filling out forms (and torturing the researchers who had to read my handwriting). A recent article using data from that survey adds to our knowledge of inappropriate antibiotic use. Data from nearly 2,000 adult patients with URIs (Upper respiratory illnesses - colds, ear infections, sore throats etc) showed that US physicians prescribed antibiotics for 63% of these patients despite the consensus that antibiotics should only be used rarely for some types of URIs and not at all for others. Worse still, American physicians tended to use the "big guns" (broad spectrum antibiotics) which should be saved for serious problems.

Internists were more likely to use antibiotics inappropriately than family physicians with those in the Northeast and Southern areas of the US the worst. NonHispanic white patients were most likely to receive a prescription for antibiotics inappropriately.

This sort of overuse inevitably leads to bacterial resistance so that they won't work when we really need them. In addition, patient often experience both short and long term ill effects form antibiotics. The evidence is that this problem is lessening but we still have a very, very long way to go.

The rising rate of cosmetic surgical procedures may be fueled in part by low self-esteem. In some ways this seems obvious but, eliminating any doubt Dutch and Swedish researchers found that from 1966 - 1993 women with cosmetic breast implants were three times as likely to attempt suicide than other women. One of the researchers, Veronica Koot said "Our findings suggest there might be a psychological problem in some women".

One of the longest studies of asthma patients began in the 1960's in Australia. After 30 years, 21% of adults who had asthma in childhood no longer had asthma symptoms, 17% had asthma infrequently, 28% frequently and 34% persistently.

Children who had wheezing only with upper respiratory illnesses rather than asthma fared much better. After 30 years, 60% had no asthma, 17% had asthma infrequently, 17% frequently and 6% persistently.

Children who did not have either asthma or wheezing with respiratory illnesses seldom grew into an adulthood with asthma (9% had frequent or persistent asthma).

Although reassuring in most ways I am still concerned by the large number of adults in this study with frequent or persistent asthma.