How a Seasonal Flu Shot May Help You Battle Swine Flu

Information from the US Armed Forces shows that having a seasonal flu vaccination cuts the cost of swine flu by 45%; the overall risk of developing swine flu is cut by 42% and the risk of hospitalization by 62%.  On further analysis, it seems not everyone is protected.  Seasonal flu vaccine wasn’t effective in personnel aged 25-39, but it was effective (50-55%) in those under 25 or over 39.

What’s the explanation?  It’s been shown that people given seasonal flu vaccine don’t develop antibodies to H1N1 swine flu virus.  But antibodies are only one arm of the immune system – the other is ‘cell-mediated immunity’, where T-cells learn to recognize pathogens like the virus.  The next exposure to T-cells causes them to kill the invading virus, limiting the extent of the infection.  So seasonal vaccine provides partial immunity to swine flu. 

But why doesn’t this happen in the personnel aged 25-39?  Because, apparently, H1N1 viruses didn’t circulate from 1958 through 1978, so this the T-cells in people born during these years weren’t ’primed’ by a flu infection.

In fact, the more vaccinations or natural infections you have with different kinds of flu viruses, the better.  So it’s advisable to have a seasonal flu vaccination every year; next year, or the year after, the seasonal vaccine will probably contain specific protection against swine flu, but that isn’t essential to get a degree of protection from other H1N1 vaccines.

Why Is Alternative Medicine So Popular?

Sale of herbs and dietary supplements are soaring, and visits to acupuncturists, chiropractors, osteopaths, and yoga or biofeedback experts are also rising rapidly.  All these non-conventional medical therapies are grouped under the title Complementary and Alternative Medicine (CAM).  The most likely conditions for the use of CAM by US consumers are musculoskeletal problems such as back, neck, or joint pain. Its use for head or chest colds has declined slightly in recent years. 

Obvious reasons for choosing CAM over conventional medicine therapy are based on cost, convenience, and failure of conventional treatment.  However, there are probably other reasons that may be more important.

The Journal of Consumer Research is posting an article online in the near future that analyses the reasons for consumers choosing between Western Medicine and its Eastern counterparts – Traditional Chinese Medicine (TCM) and Ayuverdic medicine.  Their conclusions are summarized in a press release from the journal.  The researchers state:  “Western Medicine is primarily concerned with the material aspect of the body and views all medical phenomena as cause-effect sequences, relying on rigorous scientific studies and research that seeks empirical proof to all phenomena.  On the other hand, TCM and Ayurvedic Medicine favor a holistic approach, view the mind and body as a whole system, and rely upon inductive tools and methods for treatment.”

Surveys in the USA, China, and India have shown that consumers prefer TCM when there’s diagnostic uncertainty; a holistic medicine tolerates uncertainty better than Western Medicine.  Moreover, they prefer TCM because of their (lay) belief that TCM offers a basic cure of the condition, while Western medicine only tackles the symptoms. 

With my training, I obviously prefer Western medicine, and I feel it is my calling to use this blog to promote evidence-based medicine, at the expense of treatments that cannot be proved to work in well-conducted clinical studies.  But I’m more than happy to report overlap between CAM and conventional medicine, when a particular CAM is shown to be safe and effective in such studies.

Spanish Men’s Hearts Tolerate Alcohol Better

Almost internationally, medical research has suggested that the bottom of the J-shaped curve for alcohol intake is 2 drinks a day for men and 1 drink a day for women.  Both more, and less, amounts lead to an increase in a number of conditions – chiefly in the cardiovascular field.  A study from Spain, reported in the British Medical Journal, suggests that Spanish men (but not women) may have an advantage in this regard. 

Over 40,000 Spanish men and women completed questionnaires about their lifestyles, including alcohol consumption; they were then followed for an average of 10 years. During that period, 1.5% of them had a cardiovascular event (sudden cardiac death, a heart attack, angina, or a stroke).

Moderate, high, and very high alcohol consumption in men was associated with a reduced risk of cardiovascular events:  The reductions were 14% in former drinkers, 36% with low, 53% with moderate, 55% with high, and 51% with very high intake.  The levels ‘moderate’ to ‘very high’ covered 1 drink (up to 5 mg) to 6 drinks (more than 90 mg) daily.  The type of alcohol beverage played no role.  In women, intake wasn’t significantly associated with cardiovascular events, probably because the number of such events was small.

Why are these findings so different from those in other ethnic groups?  The design of the study was adequate to remove the risk of ‘abstainer error’, in which people who had recently stopped drinking are classified as non-drinkers, thus enlarging and corrupting the reference group. 

We don’t suggest that male readers of this report throw caution to the winds and drink with abandon – not even if they are Spanish.  The dangers of too much alcohol are not limited to cardiovascular disease.  Don’t forget cirrhosis of the liver, with its complications – portal hypertension and esophageal varices.

“Get a Dog and Cut Your Pain Meds in Half”

Total joint-replacement surgery is usually accompanied by a pretty painful recovery period.  A paper given at the Conference of the International Society of Anthrozoology and the first Human-Animal Interaction Conference has proposed a way to reduce the usual consumption of pain pills during this time.  The study was done at Loyola University, Chicago.   

The press release from Loyola (see link) is tantalizing.  The claim is made that adults who use pet therapy after joint-replacement therapy require 50% less pain medication than those who don’t. But there’s no study data, just a cheerful sales talk for assistance dogs.  In Santa Fe, where I live, there’s a school for assistance dogs, and once a year we can see the graduation ceremony and practical demonstrations of the skills of the graduates.  And our local hospital patients benefit from visits from a number of assistance dogs.  So I don’t need any convincing of the benefits of these lovable nurses.  But I’d like to see more numbers showing just how much they help the joint-replacement patients.

Maybe the patients benefit from the additional exercise involved in getting up frequently to let the dog go outside?

Saturday Quack – Careful with Selenium Supplements

The use of selenium dietary supplements has risen recently, largely due to the (erroneous) belief that the mineral can reduce the risk of cancer and other diseases.  However, a small 2007 US study has shown that selenium supplements are linked with an increased risk of developing type 2 diabetes.  Now a study from UK, where selenium blood levels are usually lower, has been reported in the Journal of Nutrition; it shows that too much selenium can possibly be harmful. 

Plasma selenium levels were measured along with blood lipid profiles in over 1,000 British adults aged 16 to 64.  In those subjects with higher plasma selenium there was an average 10% increase in total cholesterol levels.  And there was a 10% increase in non-HDL-cholesterol - that really means the bad, LDL-cholesterol.

As the researchers say, “These findings raise additional concern about potential adverse cardio-metabolic effects of high selenium status”.  Until there is evidence demonstrating conclusive benefits from selenium supplements, it’s probably better (and cheaper) not to take them.

Seniors Who Play High-Impact Sports Have Better Bones

Lots of seniors continue to participate in high-impact sports into their later years.  (By high-impact sports, we mean baseball, basketball, football, handball, hockey, karate, racquetball, running, soccer, or waterskiing.)  You might think that this is risky, due to the expected thinning bone density in old age, allowing a greater likelihood of impact-induced fractures.  However, you might be wrong, according to a study reported in the journal Sports Health: A Multidisciplinary Approach.  

Data was obtained during the 2005 Senior Olympics.  560 athletes completed a detailed questionnaire on health, and had ultrasound measurement of their heel bone density.  They were classified into high-impact or non-high-impact sport participants.  High-impact sports covered basketball, road-race (running), track & field, triathlon, and volleyball. 

Overall, the average age was 66; half the participants were women.  And roughly half of them participated in high-impact sports.  The average body mass index (BMI) was 26.  T-scores, the measure of bone mineral density in the heel bone (calcaneum) averaged 0.4 and -0.1 for the high-impact and non-high-impact groups, respectively.  Obviously, the high-impact group had better bone health.  The relationship was demonstrated to be statistically significant, after adjustment for age, gender, obesity, and use of medications to prevent osteoporosis.

This means older people shouldn’t give up their favorite sports, just because they are getting older and worry about injury.  They’ll do better, from a health viewpoint, than their non-exercising friends.  And just about anyone over 65 can take up weight training, which will have similar benefits.

Sling Surgery for Stress Incontinence Can Be Almost Non-Invasive

As many as a third of all US women suffer from some degree of stress urinary incontinence – the involuntary leakage of urine on effort, exertion, sneezing, coughing, or laughing.  The condition can cause considerable social distress and embarrassment.  Treatment includes exercises for the pelvic floor muscles (Kegel exercises), weight control, and medications.  When these fail (and they often do), surgery is the remaining option.

There are several types of surgery for stress incontinence.  Sling operations, which are the favorite method, involve strips of material placed below the urethra and anchored each side.  When the woman strains the sling tightens, supporting the bladder.  UK experts have reviewed reports of minimally invasive sling operations and just published their findings in the Cochrane Review.

Sixty-two controlled clinical trials of minimally invasive sling surgery were reviewed.  A total of   (This procedure is done under local anesthesia by inserting a synthetic material, using a needle, underneath the urethra; it is not fixed to the muscles or ligaments.)    The trials compared this method with the open surgical approach or with a laparoscopic approach (i.e. access through a small incision in the abdominal wall).

Short-term cure rates of 80% were obtained with both open surgery and the minimally-invasive method.  The latter, however, had fewer operative complications, less difficulty with postoperative voiding, shorter operative times and hospital stays, but more frequent perforations of the bladder – a non-serious ‘complication’.

Similar benefits of the minimally-invasive procedure were found in the comparison with the laparoscopic approach.  Mesh monofilament tapes had better results than other types of sling material.

The reviewers found a major weakness of all the trials was lack of good long-term follow-up data.  However, one can conclude that there’s good evidence that minimal procedures are safe and effective; no woman with stress incontinence should be afraid of visiting a urological surgeon to get a relatively ‘easy fix’.

Common Infections Can Increase the Risk of Having a Stroke

Stroke is the third leading cause of death and the leading cause of serious disability in the USA.  Risk factors include high blood pressure, heart disease, high cholesterol, and smoking.  But some victims have none of these risk factors.  One possibility is infection, or a series of infections.  A group of physicians have investigated this, and reported in the Archives of Neurology.

The study included 1,625 healthy stroke-free men and women of average age 68 living in Manhattan, New York.  They were followed for an average of 7.6 years.  Baseline samples of their blood were examined for antibodies to 5 common infection-causing biological agents: Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus 1 and 2.

During the follow-up period, 67 of the volunteers had a stroke.  Analysis showed that each of these 5 infections was positively linked with an increased risk of a stroke (although the increased risk was not statistically significant).  When the total infective burden was calculated for each volunteer (e.g. whether they had one, two, three or more infections), there was a significantly increased risk of stroke in those with the greatest burden.  After making allowances for known risk factors, and excluding those subjects with coronary heart disease, the increased risk amounted to 50%.      

As the authors of the report state: “Further studies are needed to confirm these findings and to further define optimal measures of infectious burden as a stroke risk factor”.  And then one should see if clearing up such infections can have a protective influence . . .