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Teen girls see big drop in chemical exposure with switch in cosmetics

A new study led by researchers at UC Berkeley and Clinica de Salud del Valle de Salinas demonstrates how even a short break from certain kinds of makeup, shampoos and lotions can lead to a significant drop in levels of hormone-disrupting chemicals in the body.                                

The results, published today in the journal Environmental Health Perspectives, came from a study of 100 Latina teenagers participating in the Health and Environmental Research on Makeup of Salinas Adolescents (HERMOSA) study.

Analysis of urine samples before and after a three-day trial in which the participants used the lower- chemical products found significant drops in levels of these chemicals in the body. Metabolites of diethyl phthalate, commonly used in fragrances, decreased 27 percent by the end of the trial period. Methyl and propyl parabens, used as preservatives in cosmetics, dropped 44 and 45 percent respectively. Both triclosan, found in antibacterial soaps and some brands of toothpaste, and benzophenone-3 (BP-3), found in some sunscreens under the name oxybenzone, fell 36 percent.

Journal reference: Environmental Health Perspectives

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Physician Activist...The New Frontier of Public Health?

A recent article published in the February 16, 2016 JAMA, “Aspirations and Strategies for Public Health,” outlines two aspirations and 4 public health strategies for the 21st century. I’ve outlined them below.

Aspirations for Public Health

Take a leadership role in confronting and influencing the social, political, and economic factors that determine population health to sustainably protect the health of the public against old and new threats. 

Take a leadership role in reducing inequities by working to narrow health gaps across groups in ways that promote social justice and human rights.

Public Health Strategies for the 21st Century

Relentlessly prioritize actions to do what matters most to the health of populations.

Engage the mechanisms that explain how core foundational structures produce population health.

Move from government-dominated public health to multisectorial public health.

Formally adopt the Universal Declaration of Human Rights as the Code of Public Health Ethics

Physicians who take leadership roles must choose whether or not unfair housing and racial segregation are factors that determine population health. The increasingly visible cases of Black and/or Muslim young women and men being shot by police officers appear to me as clear examples of how social and political factors are affecting entire populations living in the United States. While I would argue that these are hardly new threats to the African American community (renamed threat, if anything), it is important also to realize how these factors wide. n the health gap across different groups. The question to ask is what the physical and psychosocial effects are as a result of these deaths that were caused by police officers. 

Taking a step deeper into the murky waters, the case of Officer Peter Liang and his sentencing further complicates the issue. The fact that an Asian American police officer was found guilty following the death of a black man while other police officers (non-POC) were not found guilty is telling of the justice of the justice system. While I think that any police officer who is trained in the use of a gun is at fault if his gun misfires and strikes someone, it is hardly full justice for an officer who had a misfire to be sent to jail compared to officers who shot a man’s back multiple times. 

Double standards. In both of these cases, people are dying. The health of the public are at risk. As long as it is held that white police officers will not be held responsible for killing unarmed black people, this will continue. 

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Mindfulness in Medical School

How to find happiness at work? Mindfulness and compassion.

In mindfulness, focus on connecting with each moment and identifying what is not our own assumptions. 

In compassion, identify your own preconceived notions of who deserves our compassion. 

Takeaways (There’s a lot of them)

Mindfully set expectations of what your job means to you.

There are different foci for your work. Why are you working?

For money? Work is a job

For your goal? Work for your career.

For your passion? Work because it’s your calling

Set a daily intention, reshape it everyday

Pay attention fully to what is in front of you.

take meaningful breaks

Emphasize the importance of compassion, connection, and communication

Look at your own body expression and facial experssion. It impacts your career as a doctor

You cannot be a good doctor unless you are intrinsically whole. 

Be true to yourself

Be realistic with your goals

Don’t say yes to everyone and everything

Take time to smell the roses

Eyes on the prize, but acknowledge those who are vital to your success.

Don’t sweat the small stuff

keep a sense of humor!

Don’t compromise your integrity

Surround yourself with people who love you and provide “constructive criticism”

Love what you do, do what you love

Have a partner that compliments you and your interests, edifies you and your goals

Nurture your friendships and your hobbies

Work hard play hard

On a 2-physician family:

Accept help, save time and money

Create a schedule for the family

stay organized, there’s a place for everything and everything is in it’s place

Evaluate the leadership roles in your house: Someone will be partime

division of labor is key

Make time for each other

Make time for yourself

I had the opportunity to attend the APAMSA Region IV Conference at Tulane University SOM this past weekend (02/20/2016). This series of posts highlights some of the information I gained from that conference.

Dr. Betty Lo is the Director of the Med-Peds Residency at LSU. I had the opportunity to complete my preceptorship with her during winter break. 

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Showcase: NOELA Community Health Center

Julie Hoang works at the New Orleans East, Louisiana Community Health Center. During her talk, she covered some health problems prevalent among the Vietnamese American patient population in New Orleans East. At her clinic, they use a sliding pay scale to treat primarily Vietnamese-speaking and Spanish-speaking patients. (40% Vietnamese!).

Type 2 Diabetes: 

Of 1262 Asian patients, 258 of them had Type 2 Diabetes. 

Hepatitis B:

is passed on through body fluids/transfer. Few people know they have it because it rarely presents with symptoms, but Hepatitis B is common among Asians because the standards of sterilization are not as strict as in "the West.” Needle reuse in things like acupuncture have increased the number of people with Hepatitis B. In the USA, Asian Americans are only 5% of the general population but have 50% of the chronic Hepatitis B cases. woh.

Cervical Cancer:

There are higher cervical cancer rates in Vietnamese American populations, probably due to lower screening rates. 

Some History:

Vietnamese Americans living in New Orleans have lived through Hurricane Katrina and the BP Oil Spill. These events have increased the risk for PTSD and PHQ-2 Screenings are a potential diagnostic for mental health problems. 

_____________________________________________________________

I had the opportunity to attend the APAMSA Region IV Conference at Tulane University SOM this past weekend (02/20/2016). This series of posts highlights some of the information I gained from that conference.

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Personalized Medicine: Fruit Fly Edition

President Barack Obama’s vision of personalized medicine depends on bipartisan support and the creation of a database of an individual’s genetic profiles. Behind Obama’s vision is decades of research demonstrating the power of using DNA sequencing to identify genetic mutations for different diseases and customizing drugs for small patient populations.

But how does this work? Creating customized drugs relies on prior knowledge of the protein that the mutation has changed. Decades of research into these proteins must happen before cures can be developed. In Fragile X Syndrome, a disease resulting from single gene mutations, understanding the function of the affected protein and other proteins that work with it have allowed scientists to propose potential drugs to cure this disease, such as Dr. McBride’s recent proposal to inhibit PDE-4.

Drosophila melanogaster have long been used to study diseases and scientists are beginning to take advantage of them for personalized medical treatments. Ross Cagan, Director of the Center for Personalized Cancer Therapeutics (CPCT), is using personalized fly models to fight cancer. Cagan hopes to mimic a patient’s cancer in the fly and develop personalized treatments by testing drug treatments on them. Using the Minerva supercomputer, the CPCT will study a patient’s tumor. Using this data, members of the Cagan Lab can create “personalized fruit flies” that match the patient’s tumor. After screening drug combinations and testing them on these flies, Cagan hopes to develop customized treatments.

While the fruit fly seems far removed from humans, a short lifespan combined with a genome similar to humans make this model perfect for mimicking a patient’s tumor while still allowing enough time for developing customized treatments.

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Medicine and Me

I will never forget the smile that stretched across his face as DiDi, whose name I changed for confidentiality, stood on his own two feet for the first time. Born with cerebral palsy, DiDi required an orthotic to rehabilitate his ability to walk. The week I spent molding an orthotic helped him walk, but he would always live with cerebral palsy. Helping DiDi taught me how connected research and medicine is. While medical treatments could help DiDi, research would provide the key to his cure.  

By the time I met DiDi, I had seen the impact that research can have on medicine. In my lab, I focused on the biology of Autism Spectrum Disorder (ASD). Seeing how my research helps doctors treat ASD motivated me: knowing that I will help a person’s life provides a sense of purpose that I cannot grasp in the lab. Without scientists pushing our understanding of diseases, doctors cannot devise treatments. I want to apply my research as a physician scientist to push my understanding of how diseases alter the body to provide informed care while pushing treatment possibilities.

While shadowing a doctor at physical rehabilitation institute, I saw amputee patients who struggled with their mental health. I noticed how grateful patients were when the doctor focused on their mental and physical health. This humbled me; although he used his training to treat patients, it was his ability to understand each patient that made him a great doctor. This allowed him to provide care focused on the patient.  Shadowing doctors showed me that, although research and medical knowledge are important, it is the challenge of understanding the patient that rewards and challenges a doctor.

One day, I hope to return to DiDi’s clinic, equipped to treat his disorder. I will never forget the regret that surged through me when I realized that I could not help DiDi anymore than the orthotic. That regret motivates me to translate research into medical treatment as a physician scientist. As a scientist inspired by patients to create new treatments and a doctor pushed by research to provide personal care for my patients, my research and clinical experience contributes to my medical narrative; I seek a life spent as a medical innovator, a curious investigator, and a compassionate doctor.  

This essay was part of my application to medical school and gives a glimpse into my motivation for pursuing a medical degree and the vision I have for my career as a physician. I have changed or omitted names of people and institutions. 

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Glowing Proteins and Understanding Autism

Autism Spectrum Disorder (ASD) has come up often over the past few months whenever vaccines were being discussed. Scientists do not know the cause of ASD, but scientists are pursuing genetic like mutations in a person’s DNA and environmental causes like exposures to toxins and parental age. Concerning vaccines, no studies have been able to link autism and vaccines.

A “protein map” was created last year that showed the relationships between different proteins that have been linked to autism. Funded by the Simons Foundation Autism Research Initiative, a scientific initiative whose mission is to “improve the understanding, diagnosis, and treatment of autism spectrum disorders,” this map included many variations of a protein, known as different isoforms, and provides a reference for ASD research.

New research published in January 2015 seeks to build on this map and show the different proteins interacting through a technique called “fluorescent protein exchange.” By having two proteins fight to bind to a third protein, red and green will flash as one of the two proteins wins. This movie shows flashes of green and red, which reveal interactions between proteins and will hopefully help scientists study how proteins linked to ASD interact.

Dr. Campbell, senior author and University of Alberta chemist, says that "with this development we can immediately image activity happening at the cellular level, offering an alternative to existing methods for detecting and imaging of protein-protein interactions in live cells." A major push in science research is to use fluorescent proteins to help scientists see the scientific processes in action. Previous developments along this line are colorcoding neurons in the brain via Brainbow, visualizing the activity of a zebrafish brain as it swam, and seeing a T-cell engulf damaged cells

With Professor Campbell's new technology, scientists will be able to understand how changes in protein interaction lead to ASD and will allow scientists and doctors to identify ways to treat ASD. Outside of ASD research, this new method will help answers fundamental questions in biology and will help in the discovery of new treatments for other diseases like diabetes.

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House Votes for Transparency on the EPA by Excluding Experts and Including Industry Interests

The House of Representatives passed a bill today that seeks to change the rules for appointing members to the Science Advisory Board to improve transparency. This board's main function is to advise the Environmental Protection Agency, or EPA, on environmental science topics. 

This bill, known as the EPA Science Advisory Board Reform Act of 2014, is sponsored by Texas Republican Ralph Hall, who says that "This bill contains basic, common-sense reforms to deal with legitimate concerns about balance, impartiality, independence, and public participation."

Republican Representative Michael Burgess  says that this bill will increase transparency on the EPA and include more industry experts, but critics of the bill argue that this bill is simply an attempt to make the EPA's job more difficult and isin line with previous attempts by Republican lawmakers to delay EPA rules.

Democrat Representative Eddie Bernice Johnson argues that "the supposed intent [of the bill] is to improve the process of selecting advisors, but in reality, the bill would allow the board to be stacked with industry representatives, while making it more difficult for academics to serve. It benefits no one but the industry, and it harms public health.”

Democrat Representative Jim McGovern from Massachusetts spoke to the members of the House more bluntly. "I get it, you don't like science. And you don't like science that interferes with the interests of your corporate clients. But we need science to protect public health and the environment.”

For scientists, the criticism is aimed at the portion of the bill that creates a committee of non-experts. The bills revision to the board stipulates that "Board members may not participate in advisory activities that directly or indirectly involve review or evaluation of their own work." 

The Union of Concerned Scientist's Director, Andrew Rosenberg offers this explanation in his letter to Congress. “This [bill] effectively turns the idea of conflict of interest on its head, with the bizarre presumption that corporate experts with direct financial interests are not conflicted while academics who work on these issues are. Of course, a scientist with expertise on topics the Science Advisory Board addresses likely will have done peer-reviewed studies on that topic. That makes the scientist’s evaluation more valuable, not less.”

Although the bill has been passed in the House, it is at most a symbolic gesture. Even if the Senate decides to take up a similar bill, President Obama has already pledged to veto the bill if it comes to the White House.

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Predicting Disease Outbreaks Before they Happen

Predicting outbreaks in city before they occur is the goalof “Pathomap,” a new map that seeks to investigate the bacteria living in the New York City subway system.

Before Pathomap, scientists had focused on studying the air and rodent population of major metropolitan cities. By focusing on bacterial outbreaks, scientists at Weill Cornell Medical College hope to track bacterial populations and study the world around us. Previous research on bacterial pathogens has revealed that they can live on common items like an airplane seat pocket for weeks.

Dr. Christopher Mason and his team collected DNA from the 466 subway stations of New York. More than 30% of the DNA they identified originated from bacteria that can be a threat to humans.

They also identified a handful of DNA identified as Yersinia pestis and Bacallis Anthracis, which are associated with anthrax and the cause of the Bubonic Plague, respectively. Any fear-based responses from these disease-causing bacteria, however, are unfounded. As Dr. Mason mentions here, the researchers “noted that there was no evidence that they were alive” and that only trace amounts of DNA were found for both of these pathogens.

Source: The Wall Street Journal

“Expanding on PathoMap and developing real-time sequencing technology that can allow us to monitor cities in real-time will be the greatest application to public health and urban healthcare,” he said. And when he says monitor cities, Dr. Mason hopes that Pathomap will  be able to“monitor the levels of bugs that can pose a potential threat to human health”.

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Memory loss from Alzheimer’s disease might be restored by taking advantage of the body’s immune system.

Alzheimer’s disease (AD) is an irreversible brain disease that causes loss of memory. Buildup of beta-amyloid (AB) plaque in the brain induces this memory loss. New research from University of Southern California shows that rebalancing the immune system clears beta-amyloid plaques from the brain and might reverse memory loss and brain damage.

Current treatments for AD have previously aimed to reduce the production of these AB plaques, but this approach has often had adverse effects on patients. The investigators have noted that the “more promising alternative approach would be to target the other side of the equation: AB clearance.”

Using mice models, Town and colleagues blocked interleukin-10 and showed a reduction in AB plaque in the brain as well as showing some improvement in memory. More research still needs to be done to determine if balancing the immune system can actually restore memory loss in AD patients, but this initial research argues that targeting the immune system might be therapeutic.

“The immune response can be ‘rebalanced’ to wipe away toxic AB plaques from the brain,” senior author Terrence Town, PhD, professor of physiology and biophysics at the Keck School of Medicine at USC. “Our hope is to identify specific immune cell targets for a safe and effective next-generation treatment for this devastating illness of the mind.”

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Bigger Spending, Better Results? Well at least for Emergency Medicine

One of the biggest debates in health care policy is whetheror not the United States’ investment in health care is saving more lives. With costs taking up 18% of the U.S. gross domestic product, recent papers have often concluded that increased spending does not always produce better results.

Joseph Doyle and colleagues show that, at least for emergency care, higher spending does save more lives. Focusing on Medicare expenditures in New York City, Doyle’s research shows that hospital expenses matter for patient survival and “one standard deviation increase in hospital spending is associated with a 10% reduction in mortality.” This result argues for caution in previous claims that there is unnecessarily large waste in the medical system.

Although this paper has introduced a caveat to the idea that wasteful spending in the health care system is widespread, the research needs to be expanded to medical specialties other than emergency medicine and to areas outside of New York City. To address this, Doyle is examining hospital outcomes based on other specialties and is extending this paper to “hunt for waste.” Outside of specialties, he hopes to understand how other factors like number of patients admitted or readmission rates relate to mortality rate.