Category Archives: Medicine

Ending gay marriage could increase teen suicides


As triumphant Republican lawmakers, now controlling the national legislature and the legislatures of 32 states, we can expect action of promises to end same-sex marriage,

But, if successful, will those efforts lead to a spike in teen suicides?

That’s to conclusion of a new scientific study released today.

From the Johns Hopkins Bloomberg School of Public Health:

The implementation of state laws legalizing same-sex marriage was associated with a significant reduction in the rate of suicide attempts among high school students—and an even greater reduction among gay, lesbian and bisexual adolescents, new Johns Hopkins Bloomberg School of Public Health research suggests.

The researchers, whose work was published today in JAMA Pediatrics [open access], estimate that state-level same-sex marriage policies were associated with more than 134,000 fewer adolescent suicide attempts per year. The study compared states that passed laws allowing same-sex marriage through January 2015 to states that did not enact state-level legalization. A Supreme Court decision made same-sex marriage federal law in June 2015.

The findings show the effect that social policies can have on behavior, the researchers say.

“These are high school students, so they aren’t getting married any time soon, for the most part,” says study leader Julia Raifman, a post-doctoral fellow in the Department of Epidemiology at the Bloomberg School. “Still, permitting same-sex marriage reduces structural stigma associated with sexual orientation. There may be something about having equal rights—even if they have no immediate plans to take advantage of them—that makes students feel less stigmatized and more hopeful for the future.”

Suicide is the second-most common cause of death among people ages 15 to 24 in the United States, trailing only unintentional injury. U.S. suicide rates have been rising, and data indicate that rates of suicide attempts requiring medical attention among adolescents increased 47 percent between 2009 and 2015.

Gay, lesbian, and bisexual high school students are at particular risk. In the new study, 29 percent of gay, lesbian, and bisexual high school students reported attempting suicide in the previous year as compared to 6 percent of heterosexual teens.

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Trump’s travel ban’s impact at the doctor’s office


While folks rightly invoke human rights and basic human decency to oppose the Trumpster’s travel ban, there are also purely pragmatic reasons for opposition.

On of those reasons is simple: An extreme travel ban could result in longer lines at the doctor’s office.

John Burkhardt and Mahshid Abir, two physician/academics from the University of Michigan medical school, explain in this essay from  The Conversation, an open source academic journal written for lay readers:

The Ninth Circuit Court of Appeals in San Francisco on Feb. 9 upheld the restraining order on President Trump’s immigration ban. A key argument used by the States of Washington and Minnesota was the negative impact of the ban on higher education, but an important corollary is the impact on medical care in the U.S. While the world waits for a final decision on the matter, potentially from the Supreme Court, it’s critical to look at the potential ramifications of the ban.

Regardless of the ultimate ruling, the travel ban has already had significant consequences for people from the seven targeted majority Muslim countries and American citizens. Doctors are among those people directly affected – and that has big implications for health care delivery in U.S. hospitals, particularly those in rural America and inner-city safety net hospitals.

Physicians who are citizens of these nations who were traveling outside the country at the time of the ban have been detained or refused access to the U.S.

Larger-scale, lasting effects of a ban on the graduate medical education system are likely to be even more severe and may further strain an already overstretched health care system and affect the care of communities across the U.S. Indeed, the president of the American Medical Association already has written a letter to the Department of Homeland Security, explaining how the ban could affect those who are already underserved by limiting doctors from other countries.

As physicians involved with educating and training the next generation of doctors, we see dire consequences for health care delivery in our country if the travel ban is reinstated.

Even though the ban has been temporarily lifted, the timing could not be worse for international applicants hoping to train in the U.S. While new resident physicians typically begin on July 1, the match process that allots positions occurs much sooner. On Feb. 22, residency program directors must submit their rank list of which applicants they would like to have in their program.

Therefore, without clear signs that travel for foreign applicants will be possible by July, program directors who want to protect their training program from staffing shortages may decide against ranking these applicants. The loss of a single incoming class of international medical graduates will significantly decrease the number of residents in training and physician capacity in hospitals and health care systems across the U.S.

Graduates from outside the United States constitute 26 percent of the U.S. graduate medical training. These foreign medical graduates usually fill resident training positions that are left vacant after medical schools match U.S.-based students to residency programs.

Therefore, foreign graduates typically do not take spots away from graduates of American medical schools, but instead provide medical care in hospitals that will otherwise be understaffed. These include rural hospitals around the country, where it is especially hard to recruit physicians, and safety net hospitals serving the poor.

Even if all current residency positions could be filled with U.S. medical school graduates and eliminate the need for any additional resident physicians from outside the U.S., the projected demand for physicians in the near future will still not be met.

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A plastic that makes you fat, starting in the womb


And it does it by interfering with the body’s signalling system that tells you when you’ve eaten enough.

We posted reams about studies of bisphenols, the chemicals widely present in food packaging, including cans and bottles, and linked to a wide rabnge of disorders including breast cancer, endometriosis, ADHD, asthma, behaviorial problems in girls, birth defects, prostate cancer and lowered sperm counts, and more.

And now a new study reveals that the chemical might play a crucial role in America’s growing [literally] obesity epidemic.

From the Endocrine Society:

An expectant mother’s exposure to the endocrine-disrupting chemical bisphenol A (BPA) can raise her offspring’s risk of obesity by reducing sensitivity to a hormone responsible for controlling appetite, according to a mouse study published in the Endocrine Society’s journal Endocrinology.

BPA is a chemical found in a variety of food containers, including polycarbonate plastic water bottles and can linings. BPA can interfere with the endocrine system by mimicking estrogen, one of the main sex hormones found in women. Research indicates BPA exposure is nearly universal. More than 90 percent of people tested in population studies had detectable levels of BPA and compounds produced when it is metabolized by the body in their urine.

As of 2014, nearly 100 epidemiological studies had been published tying BPA to various health problems, according to the Society and IPEN’s Introduction to Endocrine-Disrupting Chemicals.

The new study found mice born to mothers exposed to BPA were less responsive to the hormone leptin, which is sometimes called the satiety hormone. Leptin helps inhibit the appetite by reducing hunger pangs when the body does not need energy. The hormone sends signals to the hypothalamus region of the brain to suppress the appetite.

“Our findings show that bisphenol A can promote obesity in mice by altering the hypothalamic circuits in the brain that regulate feeding behavior and energy balance,” said the study’s senior author, Alfonso Abizaid, Ph.D., of the Department of Neuroscience at Carleton University in Ottawa, Canada. “Low level prenatal exposure to BPA delays a surge of leptin after birth that allows mice to develop the proper response to the hormone. BPA exposure permanently alters the neurobiology in the affected mice, making them prone to obesity as adults.”

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Chart of the day: Alternative medical choices


From the Pew Research Center:

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Climate change boost ocean toxic mercury levels


From the paper [open access], anticipated changes in runoff by the end of the 21st Century.

From the paper [open access], anticipated changes in runoff by the end of the 21st Century.

Anyone who lives along San Francisco Bay has seen the signs, warnings that fish caught in the waters fed by the American and Sacramento Rivers contain levels of mercury so high that fishers are warning to sharp curb their consumption of whatever they catch.

As the City of Richmond  [just north of Berkeley] notes on its website:

Do not eat any fish from the Richmond Harbor Channel because high levels of mercury, PCBs, pesticides, DDT, dieldrin, and other chemicals have been found in the sediments on which the fish feed.

Mercury, PCBs, and other chemicals of concern have been found in fish from the San Francisco Bay. The amounts of chemicals found in fish in the San Francisco Bay are not known to cause immediate sickness. However, chemicals can collect in the body over time and may eventually affect your health or the health of your children. Adverse health effects that may occur from continued exposure to high levels of toxic chemicals in the fish include cancer, slower growth or brain damage in children, and kidney damage.

More from the the San Francisco Bay Regional Water Quality Control Board:

In humans, mercury is neurotoxic, affecting the brain and spinal cord, and interfering with nerve function. Pregnant women and nursing mothers can pass mercury to their fetuses and infants through the placenta and breast milk. In children, particularly those under age six, mercury can decrease brain size, delay physical development, impair mental abilities, cause abnormal muscle tone, and result in coordination problems. Substantial mercury exposure is also associated with birth defects and infant mortality. Adults exposed to mercury may experience abnormal sensations in their hands and feet, tiredness, or blurred vision. Higher levels of mercury exposure can impair hearing and speech. Long-term exposure can damage the kidneys.

Dangerous levels of mercury [represented by the red squares and triangles] are widely present in fish caught in America’s streams, as shown in this map from the U.S. Geological Survey:

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Another map from the California Office of Environmental Health Hazard Assessment via the USGS, lakes and rivers in the Golden State with warnings of dangerous levels of mercury in fish catches:

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Climate change promises to make things worse

All those streams and rivers empty into the world’s oceans, the ultimate dumping ground for all the chemicals we’ve been throwing into the environment with such reckless abandon.

Already, many species of ocean fish carry dangerous levels of mercury, with the dangers increasing all the way up to the top predators in the food chain, where mercury and other toxins are concentrated at the most dangerous levels by means of a process called biomagnification., illustrated in another graphic from the USGS:

blog-biomagnificaitonA new study from Rutgers University reveals that climate change promises to make things worse. . .much worse, threatening a major source of vital protein for many of the world’s poorest people:

A highly toxic form of mercury could jump by 300 to 600 percent in zooplankton – tiny animals at the base of the marine food chain – if land runoff increases by 15 to 30 percent, according to a new study.

And such an increase is possible due to climate change, according to the pioneering study by Rutgers and other scientists published Friday [open access] in Science Advances.

“With climate change, we expect increased precipitation in many areas in the Northern Hemisphere, leading to more runoff,” said Jeffra K. Schaefer, study coauthor and assistant research professor in Rutgers’ Department of Environmental Sciences. “That means a greater discharge of mercury and organic carbon to coastal ecosystems, which leads to higher levels of mercury in the small animals living there. These coastal regions are major feeding grounds for fish, and thus the organisms living there serve as an important source of mercury that accumulates to high levels in the fish people like to eat.”

The study showed that an increase in natural organic matter entering coastal waters can boost the bioaccumulation of methylmercury – a highly toxic chemical found at elevated levels in many species of fish – in zooplankton by 200 to 700 percent. The huge increase in methylmercury shifts the food web from being autotrophic (largely microscopic plants and cyanobacteria that make food from inorganic matter) to heterotrophic (bacteria that eat organic matter produced by plants and cyanobacteria).

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Lack of health insurance can shatter communities


Lack of health insurance isn’t just bad for the health of individuals and familieies  without it. It can also increase tensions within communities and shatter social cohesion.

From sociologist Tara McKay, Assistant Professor of of Medicine, Health, and Society at Vanderbilt University, writing in The Conversation, an open source academic written for lay readers.

All links in the article are, unfortunately, to paywalled academic journals:

Dismantling the Affordable Care Act (ACA) without a replacement plan is projected to increase the nation’s uninsured population by 18 million in the first year after repeal and by 32 million in 2026, according to recent estimates by the Congressional Budget Office (CBO). As lawmakers and the American public consider repealing portions of the ACA, it is an important time to reflect on what limiting access to health insurance might mean for Americans and their communities. If a repeal occurs, not only individuals, but also their communities, could be affected.

Whether we like it or not, health insurance affects our lives in significant ways. Sometimes these effects are very direct, determining whether we can afford to see a doctor when we need to. At other times, health insurance affects us in less direct ways by shaping whether providers hire that extra nurse or relocate to a wealthier area of town.

One of the things we’ve paid a lot less attention to is whether the effects of health insurance go beyond things like health and costs to shape other aspects of our social lives. My new study with Stefan Timmermans of UCLA addresses this gap by examining the consequences of uninsurance for cohesion and trust in Los Angeles communities during the 2000s.

Using longitudinal data from the Los Angeles Family and Neighborhood Survey (L.A. FANS), we find that people living in communities with lower levels of insurance are less likely to feel connected to and trust their neighbors, even after controlling for several other neighborhood and individual factors that might affect people’s perceptions of and engagement with their communities.

We also test whether broader access to health insurance through a policy like the ACA could strengthen communities over time. This analysis demonstrates that people’s perceptions of their neighbors and communities improve as more people gain access to insurance in their community.

Consequences beyond health care

How does this work?

When large groups of people don’t have health insurance, this places unique financial and organizational strains on individuals, providers and health care markets. Research demonstrates that a lack of access to health insurance negatively affects health, health care access and quality, utilization of preventative services and out-of-pocket costs for the uninsured.

These effects also frequently spill over to the insured, negatively affecting the health and out-of-pocket costs for people living or receiving care alongside large groups of uninsured. Such spillovers come about as providers try to lower their exposure to a large uninsured population by reducing, dropping or redistributing staff and services that are disproportionately used by the uninsured, such as emergency care.

These provider strategies also go on to affect access to health care, quality of care and trust in health care providers for everyone living in a community, not just the uninsured.

Given the particular pressures that uninsurance places on individuals, providers and health care markets, it’s not surprising that we find the consequences of uninsurance go beyond health and health care.

We specifically measured the consequences of living in a community with high levels of uninsurance on residents’ reports of social cohesion, or their feelings of trust, mutual obligation and reciprocity toward their neighbors. Moving from a community where almost everyone has health insurance to one where more than half are uninsured results in a 34 percent decrease in residents’ perceptions of social cohesion in their community, we found.

We tested many possible explanations for this decrease, including differences in the composition of these communities over time, but this result is persistent. There is a social cost for communities that carry a larger burden of uninsured. This 34 percent difference in social cohesion is a substantial difference that has important consequences for other individual and community outcomes pertaining to health, political engagement and more.

New tensions created in communities

There are two primary ways that a lack of health insurance might affect communities.

First, in battles over state and local budgets, attempts to cover the uninsured through the redistribution of new or existing funds may run into political barriers or be forced to compete with other public services such as education and law enforcement. These battles can create competing interests and goals within a community that contribute to the breakdown of social cohesiveness, trust and reciprocity among community members over time.

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Immigration raids impact pregnant women, babies


As Donald Trump begins his word on the undocumented, one new study reveals that the promised raids to come will have direct and adverse impacts on babies born to mothers pregnant at the times of the raids.

Many of the children born to those women will be underweight and premature, and with the costly medical problems those conditions so often entail.

From the University of Michigan:

With deportation and discrimination fears currently on the minds of many in the United States, a University of Michigan study shows that the stress from an historic immigration raid is associated with Latina mothers delivering babies with lower birth weights, and sometimes early.

The U-M School of Public Health and Institute of Social Research team found that after the federal immigration raid in Postville, Iowa, in 2008, Latino babies born in the 37 weeks after the event had a 24 percent greater risk of lower birth weight than babies born the prior year. There also was an increased risk in preterm birth among Latina mothers compared with non-Latina white women.

“While health disparities often are believed to be caused by differences in individual health behaviors, access to health care, or even genetics, our findings implicate the impact of racial/ethnic stereotyping and related psychosocial stressors on health,” said Arline Geronimus, research professor at the U-M Institute for Social Research and a professor at the School of Public Health.

Other U-M authors were Nicole Novak of the U-M Institute for Social Research and Aresha Martinez-Cardoso of the School of Public Health. Their research is featured in the International Journal of Epidemiology.

In one of the largest single-site raids in U.S. history, federal immigration officials used military tactics to arrest 389 employees of a meat-processing plant in the small Iowa community. Ninety-eight percent of those arrested, handcuffed and held in various detention centers were Latino, as all were initially suspected to be undocumented immigrants.

“In the wake of the Postville immigration raid, U.S.-born and immigrant Latino families feared deportations and follow-up raids, and faced increased economic and social marginalization,” Novak said. “These stressors permeated the lives of both U.S.-born and foreign-born Latina mothers, potentially activating harmful physiological responses that could result in the poor birth outcomes we documented among their babies.”

“Our findings, then, shed light on what is to come for our nation’s health if we continue down this road of anti-immigrant rhetoric and continue fueling a deportation regime, including implementing it by criminalizing immigrants and using militaristic tactics,” Martinez-Cardoso said.

Psychosocial stressors can affect pregnant mothers by shifting stress hormone balances in ways that affect a developing fetus by triggering premature birth, leading to growth restriction and low birth weight even for babies born at full term, and by reducing social and material support networks that promote a mother’s health during pregnancy, the researchers said. Low birth weight is associated with increasing a baby’s chance of dying or having long-term health and academic problems.

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