Iliff Family Practice
Politics and Health Rant
Politics and Health is the theme of this year's rant. I can't help it. There is just too much juicy stuff, and I can't avoid it. We'll start out with a Surgeon General's health advisory from last August:
Parenting Can Be Hazardous to Your Health, said Dr. Vivek Murthy. Prospective parents are stressed, because they are not sure it is possible to combine professional ambitions with children. College students are lonely and stressed. Single men are lonely and stressed. Single moms are lonely and stressed. Teenage girls are lonely and stressed. Old people are lonely and stressed. What's going on?
My Diagnosis is the Digital Revolution and Affluenza. A study published last year in JAMA Pediatrics associated digital tablet use at age 3 with outbursts of anger at age 4, which is then associated with increased tablet use at age 5. As the authors note, These results suggest that early-childhood tablet use may contribute to a cycle that is deleterious for emotional regulation. There is no longer any doubt that social media obsession causes emotional disregulation among teenage girls. And it's pretty well established that digital devices contribute the epidemic of loneliness which was already underway since the 1980s. Meanwhile, social scientist Jonathan Haidt has been warning about the dangers of social media for years, and his recent book The Anxious Generation seems to have finally breached the dam. School districts all over the country- and including the recommendations of the Kansas School Board- are banning smart phones in the classroom. So there is hope. If your school board is debating this issue, feel free to share my opinion.
The closing of many Topeka restaurants was the lead story of the Capital-Journal on the final day of 2024. The problem is that costs have gone up, and incomes have gone down since the inflation-producing fiscal uber-stimulus of the Covid pandemic. Now, if all restaurants would close, America could get a handle on our waistlines. We've known for decades that the health of citizens in First World countries generally gets better when rationing or financial stress restricts calorie intake. Meanwhile...
I don't know if RFK Jr. will be confirmed Secretary of Health and Human Services, but I think we'll continue to hear about his ideas in 2025, regardless. As background, I think the greatest medical mystery in America is the rise in autism, which is clearly more than just better diagnosis. Something is going on, and we don't know what it is. It is relatively easy to prove what it is not- like the MMR vaccine, a scandalous lie by a phony scientist which has been debunked, but still promoted by Kennedy. It's not high power lines. . But something is going bonkers in the environment, so I have no problem with Kennedy asserting that we ought to be using vegetable colors instead of chemical dyes in our cereals. There and hundreds or thousands of other candidates, too, like "forever chemicals" which never seem to leave the food chain.
Furthermore, we are facing a perplexing increase in cancers, especially colorectal cancers, in young people. We don't know why this is happening, either. Being explored: forever chemicals, obesity, alcohol, change in the microbiome (gut bacteria), light from devices disrupting circadian rhythms, loud of gut mucus, and antibiotics. Stay tuned. It's another mystery.
Fluoride in the water supply has been linked in recent headlines to a drop in IQ. These studies were mostly done in foreign countries with high levels of natural fluoride, like parts of China. The levels in Topeka water are below 0.7 ppm, which is considered safe. With fluoridated toothpaste, we could stop adding it to Topeka water. Until then, babies should have formula mixed with unfluoridated water, because they don't have teeth and fluoride is slightly more dangerous to the immature nervous system.
Ultraprocessed foods are promoted by Kennedy and virtually every news outlet in the country as the main cause of American obesity and expensive ill-health compared to the rest of the Western world. This I know is bogus, because I grew up in the most ultraprocessed environment in world history, the 1950s. When my generation dies, this will cease to become common knowledge. Back then we did not have fresh fruits and vegetables year-round, because the worldwide shipping infrastructure did not exist. When I ate pears and green beans, they usually came out of a can. Bologna or peanut butter and jelly sandwiches were the norm for lunch. Pork chops and hamburgers were fried in grease, not grilled. Popcorn was popped in Crisco. Kool-aid- a combination of artificial flavors and colors, sugar, and water- was a staple of summer drinks, and Coca-Cola came in 7 ounce bottles. AND HARDLY ANYBODY UNDER AGE 50 WAS FAT. So you can put the "ultraprocessed" diagnosis in the bottom drawer and move on to...
The volume of calories consumed by the average American has gone up by maybe 200 per day, and that is 20 pounds a year all by itself. One regular Coke a day is 13 pounds a year. Don't get me started on Big Gulps at the Kwik Shop. By those numbers, many of us ought to weigh half a ton, and the fact that we don't is due to some sort of metabolic miracle which takes place in our bodies. Secretary Kennedy would tax fast-food and snacks out the wazoo, but Mayor Bloomberg of New York City tried to add a penny-per-soda tax on soft drinks, and provoked a civil war. The real villain is Hamburger U and all its offspring, which relentlessly devise and taste-test new recipes, reject 99 out of 100, and export the rest to Wanamaker Road. They taste really, really good. I visited McDonalds for the first time in years a couple of Sundays ago, and thought to order a quarter-pounder with bacon and cheese, a vanilla shake, and a small fries. Then I added up the clearly-posted calories, and the total was 2100. That's more than I need for my 155 pounds every day, and I exercise regularly.
The vaccine debates continue, and you deserve to know my thoughts- with the warning that scientific judgments by me or anyone else are tentative and prone to revision with further knowledge. Proven effective and rarely harmful: polio, measles, mumps, rubella, diphtheria, tetanus, pertussis, Hemophilus influenza B, hepatitis A and B, human papillomavirus, influenza, meningococcal, pneumococcal, and RSV for kids. These are the ones which prevent death, hospitalization, and major disabilities, have eliminated the need for spinal tap trays in my office, and will eventually exterminate cervical cancer. Pretty effective, rarely harmful, maybe not worth the cost: chickenpox, shingles, RSV for adults, Covid, and rotavirus.
Young parents often worry about giving so many vaccines at one time. In my opinion they shouldn't. What they don't realize is that the number of antigens presented to the immune system from these combination injections is dwarfed by what those systems confront every day in the normal environment. If parents are still concerned, we just encourage them to spread out the vaccines at the Shawnee County Health Department, which store them separately. I don't believe in shaming vaccine deniers, and consider them to be "free riders" as long as enough kids get vaccinated to generate "herd immunity." Too many free riders, though, and communities get in unnecessary trouble.
"In Some Doctors' Offices, the Weigh-in Is No Longer Required," a recent article in The New York Times, is my candidate for the silliest journalism of the year. Yes, most people hate being weighed, but besides blood pressure, your weight is the most important physical measurement I follow. The even more important vital sign is your one mile walk time, which I once managed to get declared the "fitness vital sign" by the Kansas Medical Society and the Kansas Academy of Family Physicians- but I can't get my patients to do it.
I know a woman who once answered phones for a local hospital. She quit when she thought the administration no longer cared about service. That was some years ago. When I call the hospital today, after the obligatory recommendation to call 911 if I have an emergency, I am led through an excruciating phone tree. All of you know the kind of thing I'm talking about, because it happens whenever you call for help anywhere. This is not good service. When a patient calls our office during business hours, they get a live person immediately who may recognize their voice from long experience. After hours, a live operator who can help them, or connect with me. Why is this important? Because sometimes, time is of the essence in medicine. It's a quality measure, and it is something you should expect wherever you get medical care. I won't be around forever, but I'll do my best to make sure you don't get turned over to the "efficiencies" of corporate medicine.
Until recently, I haven't considered the medical profession to be insane. As is the right and responsibility of every physician, we should primum, non nocere (first, do no harm) the old edict of English physician Thomas Sydenham. What it means is that every medical decision has risks, as well as benefits, and it is our responsibility to balance those as best we can under the circumstances. Now comes the judgment of the American medical establishment that sex is not recognized and declared at birth, but rather assigned. This is just nuts. I could add vulgar adjectives in front of "nuts," but refrain. I remember what it was like to be a child. I remember my confusions of adolescence. This is not a time to make life-changing decisions for ephemeral reasons under sway of volatile emotions. What a person at age 18 or 21 decides to do with their body is a different story, as we all recognize in other decisions of life. This issue cost Kamala Harris the election, as it should have, because Americans have better sense than their medical "leaders." Just my opinion.
Have you noticed how many absurd click-bait medical cures show up online? Have you noticed how many of your friends are selling pills out of their purses? Have you wondered if there is any truth to the convincing online presentations by doctors from Harvard? Out of the thousands of products promoted, one or two may actually work if rigorously tested. But I don't know which ones. So if you think you are a good candidate for a placebo effect, shell out the cash. If you ask me, I'm agnostic.
Meanwhile, the country faces another administration, which all of us encounter with varying degrees of hope and fear. Here's my response. It's something I pray every morning from a hundred-year-old prayer book, and it may have been borrowed from a book older still. And it will be good as long as we have a Republic:
ALMIGHTY God, who hast given us this good land for our heritage; We humbly beseech thee that we may always prove ourselves a people mindful of thy favor and glad to do thy will. Bless our land with honourable industry, sound learning and pure manners. Save us from violence, discord, and confusion; from pride and arrogancy, and from every evil way. Defend our liberties, and fashion into one united people the multitudes brought hither out of many kindreds and tongues. Endue with the spirit of wisdom those to whom in thy Name we entrust the authority of government, that there may be justice and peace at home, and that, through obedience to thy law, we may show forth thy praise among the nations of the earth. In time of prosperity, fill our hearts with thankfulness, and in the day of trouble, suffer not our trust in thee to fail; all which we ask through Jesus Christ our Lord. Amen.
Cheap Trick for Colds, Sinusitis, Allergic Rhinitis, and Snoring: Twice each day, squirt each nostril with a nasal steroid (fluticasone, sold as Flonase over the counter, or others by prescription) and a nasal decongestant (oxymetazolone, sold as Afrin and many other trade names). Oxymetazolone will say not to use it more than 3 days because of addiction, but that doesn't apply with a steroid spray at the same time. You can also use the same combination at bedtime if you snore because of nasal stuffiness. I've done it for years.
Pain Relief Without Narcotics: Start with extended-release acetaminophen 650 mg (Tylenol Arthritis), 2 pills every 8 hours. Then, as long as you aren't diabetic or suffering kidney disease, add ibuprofen 200 mg (Advil), 3 pills every 8 hours, or naproxen 220 mg 2 pills every 8 hours. You can take both drugs at the same time. That will handle almost all acute and chronic pain. Next stop: tramadol 50 mg (prescription) every 8 hours. Yes, including one tramadol that is 5 or 6 pills 3 times a day. But it's better than narcotics! If you have muscle spasms, I might throw in carisoprodol 350 mg every 8 hours. Don't worry-- all these medicines play well together, and are cheap and effective.