Sometimes there are news items that just need to be discussed, but they don’t really generate enough material for a podcast of their own. Today we are talking about those headlines – contraception, immunizations, cpr, gun safety, and more.
[00:00:00] Kendall, this is one of my favorite podcasts to do the headline roundup.
[00:00:04] That’s not something we really do Amy.
[00:00:06] Well we did the quirky stories of 2016 at the end of the year and I loved it. So I made it a thing that we also do in May.
[00:00:13] Did the board of directors approve it?
[00:00:15] I don’t know did you?
[00:00:16] Hello and welcome to 2 Docs Talk. The podcast about health care the science of medicine and everything in between.
[00:00:22] All right. First headline. Diet soda linked to stroke and dementia. Dun dun dunnn.
[00:00:28] Yes. I love it. OK. This headline came from a study published in the American Heart Association journal, Stroke. This is a follow up study of the long running Framingham Heart study, it looked at the offspring of the original study cohort.
[00:00:44] Sidenote: this is a cool thing about these long term cohort studies. You can follow them for years and years, follow their children for years and years and ask all sorts of research questions and dig for answers in the data. It’s a great resource for researchers.
[00:00:56] Yeah but these sorts of studies don’t show cause and effect. They suggest associations.
[00:01:02] But anyways in this study the association was in people who drank one or more diet sodas a day compared to those who drank less than one each week. The diet soda drinkers had strokes and dementia more often three times more often in fact.
[00:01:15] Three times more often. That seems huge. And you’re saying that there is not cause and effect here?
[00:01:20] I’m not saying that, I’m saying this study doesn’t prove a cause and effect relationship. Since this is a cohort sitting not a placebo controlled trial, it didn’t control for other factors that could influence these outcomes.
[00:01:32] So what it does is point to an area that we should pursue more robust research to establish or refute a cause and effect relationship.
[00:01:39] Right. Not everything is a smoking gun even if headlines want you to believe that.
[00:01:42] Yeah most headlines I saw got that part right. They say things like “associated with” and “may increase the risk” so that’s OK. But let’s go back to that three times more often because.
[00:01:53] That’s the relative risk. So. A person with a diet soda habit is three times more likely relative to someone without the habit to develop stroke or dementia. But what does that translate to in actual numbers.
[00:02:06] Yeah the actual numbers would be the absolute risk so in this study of 2888 people over 45 years of age 3 percent total develop new stroke and 5 percent develop new dementia. These are not large numbers. So the absolute risk isn’t huge either way. So should people stop drinking diet soda. Well not based on this study. However we are big fans of processed foods so it doesn’t seem like a smart addition to your diet. But that’s different than saying it will cause you to become demented.
[00:02:34] OK. So next headline.
[00:02:38] Hormonal birth control associated with higher risk of depression.
[00:02:42] Okay this is a study of about a million women out in Denmark. Right there was a say…Denmark… way north. Seasonal Affective Disorder.
[00:02:56] So those folks don’t apply to people.
[00:02:59] It is not totally generalizable, you wouldn’t say?
[00:03:01] Not to women living in Texas.
[00:03:05] OK. OK. It’s a prospective cohort study so let the diet soda study. We don’t have cause and effect established, however. The results were strong enough to take notice.
[00:03:14] Yeah. They compared women who use birth control with those who didn’t and looked at first diagnosis of depression and first antidepressant use.
[00:03:22] The relative risk – here we are again – relative risk for women on birth control to develop depression ranged from one point two three to two point zero. The difference was most pronounced among adolescent girls in the study.
[00:03:34] Now there are lots of possible confounding factors here, as you mentioned. Would women on birth control be more likely to seek medical care for depression for example? But the results and the large number of women in the study do make it worth taking note of the results.
[00:03:47] So should women stop using hormonal birth control?
[00:03:50] In medicine we rarely get research that gives us absolutes like that. And this case is no exception.
[00:03:56] So the answer is no. Hormonal birth control can work very well for many women. And if you want to prevent pregnancy it comprises a big chunk of the available options. The good news is that there are so many options for reliable birth control out there.
[00:04:10] True. So discuss your concerns and any difficulty you have or have had with depression with your doctor. He or she can help you find a birth control method that will work for you without exacerbating your depressive symptoms or creating new ones.
[00:04:23] In other contraceptive headlines there are all the shenanigans happening in Washington with regard to health care coverage.
[00:04:29] Shenanigans is too nice a word for what’s happening there, Kendall.
[00:04:32] True but I don’t want to put the E rating on our podcast.Anyway there is a lot to talk about with this deal but one thing that stands out is the contraceptive mandate. Tom Price, the secretary of Health and Human Services, is ready to axe that portion of the Obamacare the minute he can.
[00:04:50] Yes so what does that mean.
[00:04:51] That means that potentially the cost of contraception will go way up. If that happens.
[00:04:55] Yeah so it may be worthwhile to check in with your doctor if you use contraception. Particularly if you want a long acting reversible contraceptive. The price of these – these aren’t cheap because you buy it once and it lasts for five to 10 years. So these prices could potentially go quite high without the Obamacare coverage.
[00:05:14] Nobody has a crystal ball so we can only speculate on what will happen here but it will hurt to consider your options before any changes are made.
[00:05:21] All right. So moving on we just did a podcast on the mumps outbreak and vaccines. Now we have a measles outbreak among Somali immigrants in Minnesota. Now to be clear they did not bring the measles with them from Somalia. The group was specifically targeted with misinformation by anti-vaccine proponents. As of this podcast, fifty people have come down with measles. Forty five of whom were unvaccinated.
[00:05:45] Yeah the Somali community in Minneapolis dropped from a 90 percent vaccination rate for measles in 2006 to about 40 percent today.
[00:05:52] Forty percent.
[00:05:53] Yes. Thank you Andrew Wakefield. CNN has a good summary of what’s happened in that group during that time. Link in this universe.
[00:06:00] Ok so 40 percent think about that. That’s well below any threshold that we can rely on for herd immunity.
[00:06:05] And let’s review. We’re talking about measles not German measles. Measles is the first M in the MMR vaccine. It can cause severe disease including pneumonia and death. It also causes the rare but terrible condition called subacute sclerosing pan encephalitis years after the measles infection. And measles is not a mild disease and the consequences can be dire.
[00:06:27] Now the R in the MMR vaccine stands for rubella which causes German measles. Now German measles is a very mild viral illness that rarely causes complications. However when pregnant women contract rubella it can cause severe fetal anomalies – deafness blindness heart disease problems with just about any organ in the body and developmental delays. So we vaccinate to protect the unborn from rubella.
[00:06:50] In short everyone should get the measles mumps and rubella vaccine unless there is a specific medical contraindication. And these are rare. Your physician can help you determine if this applies to you or your child. Yes. OK.
[00:07:02] So on the topic of vaccines there was an anti-vaccination movie released last year – Vaxxed – produced by a controversial anti-vaccine proponent Andrew Wakefield. It was his research which was later retracted that really kicked off the whole anti-vaccine movement.
[00:07:16] Medical news Web site Stat has reviewed the movie which we’ve linked in the show notes it sounds like equal parts conspiracy theory glossed over data and anecdotal tugging at heart strings – the emotional appeal. I’m probably not buying a ticket.
[00:07:31] And still more in the news on vaccines after the Disneyland measles outbreak in 2015. California passed a law – SB 277 – which eliminated the personal belief exemptions for people who want to send their kids to public school.
[00:07:44] Yeah and we talked about that in our mumps podcast. And apparently it’s working vaccine uptake has increased from around 90 percent to over 95 percent in California in the two years since SB 277 was passed. So congratulations on the job well done out on the left coast.
[00:08:01] OK so let’s move off vaccines here. I’m sure more opportunities will come up to talk about it later.
[00:08:06] So let’s talk about the report in the Annals of Internal Medicine that looked at handgun purchases after mass shootings.
[00:08:12] OK this is interesting. They looked at gun sales in California after the San Bernardino California and Newtown Connecticut shootings. They found that gun sales in California increased 53 percent in the 6 weeks after Newtown and 41 percent after San Bernardino. In the area around San Bernardino, sales increased 85 percent.
[00:08:32] OK so this demonstrates the skewed reality we live in. Of the more than 32000 gunshot deaths in the U.S. each year, less than one in 100 are mass shootings.
[00:08:42] And mass shootings I believe are defined as a shooting of four or more people. So it isn’t necessarily the random horrific stories like San Bernardino or Newtown, but also gang and other crime related violence.
[00:08:52] Which doesn’t make those deaths less regrettable, it just means that we have a skewed perception of our personal risk of random gun violence.
[00:08:58] But the real threat as you know is that a gun will be used in a suicide and simply having one in the house increases the likelihood that that will happen.
[00:09:06] Yes. And it also increases handgun related domestic violence.
[00:09:09] So it seems we need better messaging on this or we need more emotional appeal. I actually think that.
[00:09:18] See vaccines.
[00:09:20] Journalists have a code of how they report on suicides – not reporting names and only giving necessary details. Obviously they have to report on mass shootings. But a similar code that emphasizes the real risks posed by firearms from reporting on these cases could be a good start in addressing the problem.
[00:09:35] OK journalists out there. Did you hear that?
[00:09:37] Yeah but you know I also think we really have to have the emotional appeal. I mean you need anecdotes you need stories about.
[00:09:44] Stories of people who have killed themselves or children who have found their parents gun and hurt themselves or someone else.
[00:09:50] Because let’s face it in spite of everything we do, Amy.In spite of the fact that we do these podcasts and that we try to base them on data we try to be some evidence in the end, emotional appeals are more effective.
[00:10:03] That’s true. And I mean I don’t think that’s I don’t think that’s necessarily even saying anything bad. I think that’s just kind of how the human brain is wired. Don’t you think? I mean there’s something about hearing a story that draws us in.
[00:10:16] Yes. Well let’s end this on a positive note.
[00:10:19] OK. How about the study on bystander CPR?
[00:10:22] Very positive. A study published in The New England Journal of Medicine looked at individuals who experienced cardiac arrest. Those who receive CPR from bystanders while waiting on EMS were more likely to survive and less likely to have brain damage or go into a nursing home in the year following the event. There was even more benefit if an AED was used.
[00:10:45] AED – let’s be clear here – an automated external defibrillator was used. It’s a little machine that will shock shock the patient and get their heart beating again. So what does that actually mean for us.
[00:10:54] It means everybody should learn how to do CPR.
[00:10:57] Right. And here’s more good news. CPR now no longer includes mouth to mouth like you might remember from a long time ago. All you have to do is chest compressions. So any risk from rescue breathing is no longer a concern. Go to the Red Cross Web site to find out exactly how to perform CPR.
[00:11:13] Yes. And when an aid is available, don’t be afraid to use it. This machine will detect the victim’s heart rhythm and determine if it’s the right call to shock them or not. As the operator you can’t really mess it up.
[00:11:23] So that’s our show for today. We hope you’ve enjoyed it. There are lots of interesting headlines. Lots to think about.
[00:11:29] But if you walk away with one take home today it’s this. Learn how to do CPR. It’s easy to feel helpless about healthcare these days. This is one thing you can control and literally save lives
Be sure and subscribe in iTunes or Stitcher if you haven’t already. And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk!