Flame retardants, household dust, and thyroid cancer

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A new report from Duke University finds an explanation for increases in the frequencyth of thyroid cancer in household dust.

“Thyroid cancer is the fastest increasing cancer in the U.S., with most of the increase in new cases being papillary thyroid cancer” [PTC], said the study’s lead investigator, Julie Ann Sosa, M.D., MA, professor of surgery and medicine at Duke University School of Medicine in Durham, N.C. “Recent studies suggest that environmental factors may, in part, be responsible for this increase.” (1)

Prior studies have shown that some flame retardants used in the home and in vehicles have a similar chemical structure to thyroid hormones and can disrupt thyroid function.

The study measured the content of household dust as well as the incidence of chemicals in blood samples taken from occupants.  The study used a post facto experimental design with test and control groups.  All of the 140 participants lived in their homes for more than 11 years.

This study established that these flame retardants

  1. Appear in household dust in measurable quantities, where they can be inhaled by occupants and
  2. The level of two of them found in dust and blood samples are associated with the probability of having PTC.

The two problem chemicals identified in the study as elevating cancer risk belong to a class of chemicals, polybrominated diphenyl ethers (PBDEs).

  • Decabromodiphenyl ether (BDE-209). This is the most commonly used retardant, and appears to double the risk for thyroid cancer.
  • Tris(2-chloroethyl) phosphate (TCEP).

Participants with high levels of TCEP in their house dust were more than four times as likely to have larger, more aggressive tumors that extended beyond the thyroid, according to the study.

Participants with high levels of BDE-209 in their blood were 14 times more likely to have a version of the cancer that tends to be more aggressive.

Why should you care?  These chemicals are used as flame retardants in plastics (including TV cabinets), furniture, drapery backing, some carpets and in consumer electronics, both in home and in automobiles.  Both exposure to these chemicals and the prevalence of thyroid cancer are increasing.

Note:  This research was funded by Fred and Alice Stanback, the Duke Cancer Institute, and the Nicholas School of the Environment at Duke University, and not by industry sources.

What you need to consider:

  • Do you have a home air purification system? Not something that makes the air smell nice, but something that removes dust and other particles from what you breath. Maybe it’s time to invest or upgrade.
  • Read the labels on what you buy.

 


Sources:

  1. The Endocrine Society. “Exposure to common flame retardants may raise the risk of papillary thyroid cancer.” ScienceDaily. ScienceDaily, 2 April 2017. <www.sciencedaily.com/releases/2017/04/170402111311.htm>.
  2. US Environmental Protection Agency, “Technical Fact Sheet — Polybrominated Diphenyl Ethers (PBDEs) and Polybrominated Bophenyls (PBBs),” January 2014.
  3. Wikipedia, “Decabromodiphenyl ether.” https://en.wikipedia.org/wiki/Decabromodiphenyl_ether

Life Expectancy in the US: Falling Behind

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The current (2016) life expectancy from birth for the US as a whole is 79.8 years.(1) How does that compare with other countries? Countries where people live longer than in the US include

  • Andorra 82.8
  • Anquilla 81.4
  • Australia 82.2
  • Austria 81.5
  • Belgium 81.0
  • Bermuda 81.3
  • Canada 81.9
  • Cayman Islands 81.2
  • Faroe Islands 80.4
  • Finland 80.9
  • France 81.8
  • Greece 80.5
  • Guernsey 82.5
  • Hong Kong (China) 82.9
  • Iceland 83.0
  • Ireland 80.8
  • Isle of Man 81.2
  • Israel 82.4
  • Italy 82.2
  • Japan 85.0
  • Jersey 81.9
  • Korea, South 82.4
  • Liechtenstein 81.9
  • Luxembourg 82.3
  • Macau (China) 84.5
  • Malta 80.4
  • Monaco 89.5
  • Netherlands 81.3
  • New Zealand 81.2
  • Norway 81.8
  • Saint Pierre and Miquelon 80.5
  • San Marino 83.3
  • Singapore 85.0
  • Spain 81.7
  • Sweden 82.1
  • Taiwan 80.1
  • United Kingdom 80.7
  • Virgin Islands 80.0

Of course, the issue is that the US spends more per capita on healthcare than any of these other countries.  In many cases, far more.

What’s a year of life worth to you?

On top of that, the US is falling behind in growth in life expectancy.(2) Kontis et. al. forcast growth in life expectancy in industrialized countries, and the US ranks near the bottom of the list, with minimal improvement.  South Korea, which is already ahead of the US, ranks near the top in growth in longevity.

lifeexpectancychangeYou spend a lot on healthcare and health insurance.  What exactly are you getting for your money?

 


SourcesI

  1. CIA World Factbook. https://www.cia.gov/library/publications/the-world-factbook/fields/2102.html
  2. Vasilis Kontis, PhD, James E Bennett, PhD, Colin D Mathers, PhD, Guangquan Li, PhD, Kyle Foreman, PhD, Prof Majid Ezzati, FMedSc, “Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble,” The Lancet, 21 February 2017. http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/fulltext

 

Gene Mutation and Juvenile Deaths

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StarryNight_by_Van_GoghEvery so often, we hear a story about a high school or college athlete dropping dead after a practice or game.  My son had a classmate in 5th grade who died while playing kickball on the school playground.  What causes death at that age in someone seemingly fit and healthy?

These deaths have prompted calls for heart screening for young athletes.  However, it’s difficult to search when you don’t know what you want to find.

How we have a better idea.

Research groups in Canada, South Africa and Italy have identified a gene mutation that can cause this sudden death in otherwise healthy young people. CDH2 is a recently identified gene that governs the production of a protein essential for normal adhesion between cardiac cells. When the gene is absent, the victim is at risk for sudden cardiac arrest. Fewer than 10% of victims with sudden heart stoppage outside of a hospital survive.

Since genetic screening isn’t common, finding a genetic cause is a mixed blessing. It means that families that have experienced a premature death need to be screened to see if others in the family have this genetic defect. However, at least in the near term, it won’t do much to prevent that first, shocking death.


Sources:

  1. Linda Carroll, “Teen athletes’ sudden deaths spur call for heart screening,” Today, 2 February 2011. http://www.today.com/health/teen-athletes-sudden-deaths-spur-call-heart-screening-2D80555866
  2. Fox News, “High school athlete’s sudden death stuns Baltimore community,” 1 February 2017. http://www.foxnews.com/health/2017/02/01/high-school-athletes-sudden-death-stuns-baltimore-community.html
  3. Bongani M. Mayosi et al. Identification of Cadherin 2 (CDH2) Mutations in Arrhythmogenic Right Ventricular Cardiomyopathy. Circulation: Cardiovascular Genetics, March 2017 DOI: 10.1161/CIRCGENETICS.116.001605
  4. McMaster University. “Gene found to cause sudden death in young people: CDH2 is responsible for the production of Cadherin 2 or N-Cadherin, a key protein for normal adhesion between the cardiac cells.” ScienceDaily. ScienceDaily, 9 March 2017. https://www.sciencedaily.com/releases/2017/03/170309150637.htm

Internet Insecurity Revisited

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Your applications encrypt your data.  You’re protected, right?ben_franklin

Wrong.

There are three things you need to know about the latest round of papers made public by Wikileaks:

  • The CIA (in some cases in partnership with UK’s MI5) developed ways to hack device operating systems. The devices include all types of computers and cell phones, networked TVs, car onboard systems — basically everything anyone uses that’s connected to the Internet. The operating systems affected are Windows, Android and Apple.
  • The hack allows the user to read data as it is entered (typed or oral), before it is encrypted.  Everything.
  • The hack allows users to control devices and use them for spying on device owners.
  • The CIA may have LOST CONTROL of these hacks, meaning that they are out in the public domain where others can use them.

The CIA might not care about you, but are there others who might want your bank account?

The revelations have shocked experts.

Still, the amount of smartphone vulnerabilities and exploits detailed in these documents was shocking even to experts. “It certainly seems that in the CIA toolkit there were more zero-day exploits” – an exploitable vulnerability in software not known to the manufacturer – “than we’d estimated,” Jason Healey, a director at the Atlantic Council think tank, told Wired Magazine. He added: “If the CIA has this many, we would expect the NSA to have several times more.”(3)

Early reports are that the documents published by Wikileaks appear authentic.  None of the companies involved have commented on the situation. Nor do there appear to be any patches immediately in the offing.  After all, none of the players is yet admitting that they have something to patch.

Some writers see a bright side in these revelations: the decision to hack operating systems means that data encryption tools work.  That may or may not be true.  We don’t know what is still to be revealed.

Security problems aren’t under control or going away.

“Anybody who thinks that the Manning and Snowden problems were one-offs is just dead wrong,’’ said Joel Brenner, former head of U.S. counterintelligence at the office of the Director of National Intelligence. “Ben Franklin said three people can keep a secret if two of them are dead. If secrets are shared on systems in which thousands of people have access to them, that may really not be a secret anymore. This problem is not going away, and it’s a condition of our existence.’’(4)

I’ve said that nothing on the Internet is private, but this takes that statement to an entirely new level.  Nothing you type or speak into an Internet connected device is private. 

Ben Franklin was indeed a very wise man.


Sources:

  1. Sharon Profis and Sean Hollister, “WikiLeaks and how the CIA sees your WhatsApp messages, explained,” CNet, 7 March 2017. https://www.cnet.com/how-to/wikileaks-cia-hack-phone-tv-router-vault-7-year-zero-weeping-angel/?ftag=CAD3c77551&bhid=25995825932822145966367556179766
  2. Jose Pagliery, “Wikileaks claims to reveal how CIA hacks TVs and phones all over the world,” CNN Tech, 7 March 2017. http://money.cnn.com/2017/03/07/technology/wikileaks-cia-hacking/
  3. Trevor Timm, “WikiLeaks says the CIA can use your TV to spy on you. But there’s good news,” The Guardian, 7 March 2017. https://www.theguardian.com/commentisfree/2017/mar/07/wikileaks-says-the-cia-can-use-your-tv-to-spy-on-you-but-theres-good-news
  4. Devlin Barrett, “FBI prepares for new hunt for WikiLeaks’ source,” The Washington Post, 7 March 2017.

Your Health: Warning for Colds and Flu

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I was helping a friend yesterday whose child was ill.  At one point the child came to the mother because she was feeling poorly, and admitted taking some medication on her own while the mother was busy.  That’s the prompt for this post.influenza-virus-fulltext-sm

Acetaminophen is perhaps the most common active ingredient in cold and flu medications.  It is found in a wide range or products, including Tylenol, Excedrin and Sinutab.  Used according to instructions, it can be effective in treating symptoms.

However, acetaminophen has now surpassed hepatitis as the second leading cause of liver  failure in the US.  Overdose tends to produce few symptoms other than lethargy, but this can be followed by nausea and tenderness in the upper right section of the abdomen in 24 hours.  If untreated, organ failure can start after 72 hours, and can be fatal.

Minimum toxic doses of acetaminophen for a single ingestion, posing significant risk of severe hepatotoxicity, are as follows:

    • Adults: 7.5-10 g
    • Children: 150 mg/kg; 200 mg/kg in healthy children aged 1-6 years  [Medscape]

For treatment, the doctor needs to know what was taken (what medication containing acetaminophen was used), when it was taken, and how much was taken.

What you need to do:

  • Read the label.  Know what’s in what you take.
  • FOLLOW THE DIRECTIONS FOR THE PRODUCT.
  • Be careful about using multiple products in combination.  If each contains acetaminophen, you can follow the directions for each and still end up with an overdoes.
  • If concerned about an overdose, call a medical professional. 

Sources:

  • Susan E Farrell, MD, Germaine L Defendi, MD, MS, FAAP, Asim Tarabar, MD, “Acetaminophen Toxicity,” Medscape, 18 May 2016.  http://emedicine.medscape.com/article/820200-overview#showall
  • NIH US National Library of Medicine, “Acetaminophen,” MedlinePlus, 15 August 2014.  https://medlineplus.gov/druginfo/meds/a681004.html
  • Centers for Disease Control and Prevention

The Radiation Legacy of WWII

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Radiation is a part of American life.  Everyone gets some.  A few “lucky” ones get a lot  more.

North St. Louis County, Missouri, is peppered with sites identified by the US Army Corp of Engineers as radioactive.  It’s the legacy of uranium processing for nuclear arms programs in World War II.  Uranium waste was dumped into a landfill near the St. Louis airport (Lambert Field).  However, the area is subject to flooding by Coldwater Creek, and that has spread radioactive material to parks and yards across North County.

The result: North County has been turned into a cancer hotspot, and shown in the map below.  Some of the cancers seen in this area are extraordinarily cancer_cases_1242rare.

Coldwater Creek drains into the Missouri River above the juncture with the Mississippi River, and just above the intake for drinking water for the City of St. Louis.

There have been a number of law suits file over the last 6 years, with some thrown out by various judges and some still active.

OK, that’s known, at least to local residents.  Whether it has had an impact on tourism or on convention traffic isn’t known.

However, St. Louis was only one processing center,  There were five others:

  • Tanawanda, New York (on the Niagara River upstream from Niagara Falls)
  • Deepwater, New Jersey (on the Delaware River across from Wilmington, Delaware)
  • Canonsburg, Pennsylvania (south of Pittsburgh)
  • Oak Ridge, Tennessee (near Knoxville)
  • Cleveland, Ohio (on Lake Erie)

There are radiation issues in all of these communities.  In many cases, the coverage is old enough that current residents may not even be aware of the problem.  A 2006 article labeled Canonsburg as “the most radioactive town in America.”

That said, some level of radioactivity exists in all areas of the US.  The map below is from a civilian volunteer monitoring program (the Radiation Network).  Unfortunately, none of the civilian volunteers appear to be focusing on historical problem sites.

getmap163195638-7813-97-03912-7yynnynnnnn

Take-aways

Knowledge is safety.  The more you know about where you live and where your kids play, the better you can try to protect yourself and them.


Sources:

 

 

 

What’s Best for the Patient?

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[Note: in all of my writing, I try to place personal opinion in blue italic font to separate it from what I am reporting from other sources.]

doctor-clip-art-doctor-clip-art-4There are a number of factors that can affect decisions that doctors make about patient care. What’s “objectively best” for the patient may be only one consideration.  Patients need to know this.  While you may not be a doctor, you bear the ultimate responsibility for your own care.  You’re the one who has to live with the results.

 

Recent articles point to some of the issues that can impact treatment:

  • Doctor revenue.  Doctors can (and a few have been accused of this) maximize revenue by ordering unnecessary tests and performing unnecessary procedures.
    • A common example in the literature is the use of CT, MRI or X-ray in the first 30 days after reporting lower back pain.  Other systems besides back pain may require these test, but for lower back pain alone, no.
      • “One study found that people who got an MRI during the first month of their back pain were eight times more likely to have surgery than those who didn’t have an MRI — but they didn’t get relief any faster.” [Agnvall]
    • 61 doctors were among 301 people criminally charged earlier in 2016 with billing Medicare for care and prescriptions that weren’t medically necessary.
    • One of the current curiosities concerns rotator cuff surgery
      • Outpatient rotator cuff surgeries have increased by 272% in the last 5 years.  (Are we really that much more active??)
      • Rates of post surgery problems vary between surgery facilities from a low of 1/2% to 20%.  (If you need the work, are you having it done by the right doc?)
  • Measurements used in the current Federal “pay for performance” initiative.  “Pay for performance” is an effort to reward doctors and hospitals that delivery high quality care and penalize those that don’t.  The metrics include patient satisfaction questions, and some doctors argue that inclusion of those questions might cause doctors to cater more to what patients want than what is medically necessary.
    • That in turn raises two questions
      1. If docs pay more attention to what patients are saying, is that a bad thing?
      2. This criticism by surgeons seems similar to the complaints some teachers have about standardized testing.  In both situations, would the absence of any metrics make the situation better?
  • What insurance will cover, of course.
    • However, a dedicated physician can encourage the insurer to do the right thing.
    • My wife was injured, and the doctor felt she required a treatment the insurer was unwilling to approve.  His reaction was to hospitalize her (for which the insurer was committed to pay) until the insurer agreed to the treatment.  It worked.

What you need to do:

  • Learn how to search for information on your medical symptoms before you consult with a medical professional.  Be an informed patient.  If you don’t know, ask someone for help.
  • Prepare intelligent questions for your conversation with the doctor.
  • If tests are recommended, ask what they will accomplish.
  • If surgery is discussed, consult another doctor from a different medical practice who is unknown to the first doctor.  Conflicts of interest can be a problem, and you don’t want to go there.

Sources:

  1. Agnvall, Elizabeth, “10 Test to Avoid,” AARP Bulletin, 3 December 2015.  http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.html
  2. Cohen, Jessica Kim, “Outpatient rotator cuff repairs increase 272% in a decade — 5 facts on orthopedics in ASCs,” Becker’s ACS Review, 4 January 2017.  http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/outpatient-rotator-cuff-repairs-increase-272-in-a-decade-5-facts-on-orthopedics-in-ascs.html
  3. Frelick, Marcia, “Current Measures Flawed, Could Cause Problems, Surgeons Say,” Medscape.com, 6 January 2016.
  4. Gawande, Atul, “Overkill”, The New Yorker, 11 May 2015.  http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
  5. Haelle, Tara “Putting Tests to the Test: Many Medical Procedures Prove Unnecessary—and Risky,” Scientific American, 5 March 2013.  https://www.scientificamerican.com/article/medical-procedures-prove-unnecessary/
  6. Sandhu, Sarina, “40 common treatments and tests that doctors say aren’t necessary,” iNews, 24 October 2016.  https://inews.co.uk/essentials/news/health/40-treatments-doctors-saying-bring-little-benefit/
  7. Sun-Times Wire, “Skokie, Buffalo Grove doctors charged in Medicare fraud sweep,” Chicago Sun-Times, 23 June 2016.  http://chicago.suntimes.com/news/2-suburban-doctors-charged-with-medicare-fraud/