First, must be the delightful announcement that we have arranged a new office location. In early August we will move to 2448 Guerneville Road, Suite 900. It is an attractive building, conveniently located and easy to find. We are pleased and hope you will like it as much as we do.

The office will be closed after business hours this Thursday (June 16) until Thursday, July 7 for vacation. If you have medical problems during that time you will need to seek care elsewhere.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

The benefits of exercise as preventive medicine are incontrovertible. Now we are learning more about the power of exercise as a treatment modality. A powerful new study of data collected as a part of what many feel is the most important ongoing study of women’s health (the Nurse’s Health Study) shows a dramatic effect in women with breast cancer.

Investigators looked at these women’s exercise data compiled every other year in the study. They found a dramatic reduction in the risk of dying, directly correlated with the women’s exercise pattern. Women who walked briskly (or exercise of equivalent intensity) for 1-3 hours a week lowered their risk of dying by 20 percent. Women who walked 3-5 hours a week cut their death rate in half. The effect was most pronounced in women whose breast cancers where estrogen receptor positive (i.e., estrogen driven).

If the treatment under consideration was a new form of chemotherapy, this would be good news because of the magnitude of the effect. As exercise is essentially free of adverse effects, this is fantastic news.

Until very recently the most common surgery in the United States was the insertion of ear tubes into children’s ears. The rationale went something like this - kids get a lot of ear infections, ear infections are associated with persistent ear fluid, it is hard to hear when you are underwater in a swimming pool, children are prone to ear infections during the years they develop language skills, so, let’s punch holes in children’s ear drums to drain the fluid. Just punching holes doesn’t last so well, because the body heals the holes closed. Refining the strategy, surgeons then determined to use metal or plastic grommets to hold the holes open.

Many years ago a study found that sticking foreign objects through ear drums and leaving them there led (unsurprisingly to me) to scarred ear drums and (oops) hearing loss. Also, the studies over the years have failed to clearly prove that persistent ear fluid does impair language development. Now, adding another nail to that coffin, comes a meta-analysis of studies. The authors concluded: “The effects of conventional ventilation tubes in children studied so far are small and limited in duration. Observation (watchful waiting) therefore seems to be an adequate management strategy for most children with OME (otitis media with effusion - i.e. persistent ear fluid).

So we now know that a surgical intervention, for a problem that might not really be a problem, is a bad idea.

When I speak about athletic training, the topic which is most consistently controversial is stretching. Why is that? The problem is that everyone knows how wonderful stretching is. Information is always helpful, except when it is partial or wrong. That is the problem here.

Remember, anything which can heal must also possess the power to harm. Carefully designed studies show that static stretching before vigorous exercise INCREASES the risk of injury. That short little sentence describes a very specific scenario, with the key words “static”, “before” and “vigorous”.

There are many kinds of stretching. Most of us learned that ballistic (i.e., bouncing) stretching is a bad idea, but that extending as far as possible into a position and holding it is a good idea. Most likely the truth is that each variety of stretching has a time and a place.

Holding a static stretch makes the muscles weaker and interferes with the nerve feedback about body position (proprioception). These effects last about an hour. As a consequence, when an athlete engages in high-level activities involving explosive muscle work or difficult balance, the body can’t perform to the best of its capability.

If you watch the warm up of professional soccer teams you will see them use dynamic stretching. These stretches are like a slower version of the movements the athlete will perform in the competition.

This is not to say that dynamic stretching is the only correct form of stretch. If the activity is not so intense, the athlete does not need to be so particular about the preparation. If the stretching is after the activity, there is no reason to avoid static stretching. If the athlete wants to gain long-term flexibility, it may be that a routine program of stretching first thing in the morning (I prefer static or slow dynamic stretching like yoga or tai chi at that time) might be best.

A very disturbing study, conducted by researchers at the University of Minnesota, was published in NATURE the other day. They found that 1/3 of American scientific researchers anonymously admitted to violating ethical protocols. Most troubling was the finding that 15% admitted to altering study design, methods or results because of pressure from a financial sponsor. Less than 2% admitted to falsifying data, the ultimate research lie. Although other confessed unethical activities were less venal, many of these improprieties lead to the same falsehood, potentially endangering patients.

This study proves, quite compellingly, that the full financial disclosure requirement maintained by the best medical journals is absolutely essential. At least this disclosure warns the reader to view the study skeptically when the investigators could have a financial interest in the outcome of the study.