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The Dreaded Pink Eye

"Pink eye" typically refers to conjunctivitis (inflammation of the eye lid and related structures). Most cases are caused by viruses or allergies, and thus, have typically not needed antibiotic eye drops. Even bacterial conjunctivitis is often self-limiting, so, in an era of growing antibiotic resistance, many physicians do not recommend use of antibiotic drops even for bacterial conjunctivitis. A recent review identified 11 studies with 3673 participants and concluded that although acute bacterial conjunctivitis is frequently self limiting, the use of antibiotic eye drops is associated with modestly improved rates remission in comparison to the use of placebo. Use of antibiotic eye drops should therefore be considered in order to speed the resolution of symptoms and infection.

Vitamin C

There is a belief that if something is really good, more is better.. however, this is not always true for our health. Although the great chemist and Nobel Prize winner, Linnus Pauling was an advocate of mega doses of Vitamin C, (not what he won the prize for) as a remedy for all things including revving up the immune system, the body doesn't appear to need or want a lot of C. There are no studies that show an significant improvement in infection fighting capacity with excess C.

Vitamins and minerals are absolutely necessary for life but are not foods or substitutes for foods in of themselves, there are essential catalysts that allow the body to use nutrients. There also work best when provided by the foods in which they are found, for example, in citrus food, tomatoes; all high in Vitamin C.

Vitamin C is not stored in the body , it is water soluble and excess is excreted by the kidneys. If a person begins to take in more than the body's chemistry requires, the kidneys are signalled to become more active and excrete all the extra Vitamin.. so mega doses help to fertilize the sewer system. This is no problem if the kidneys are healthy, however, if the mega doses of C are abruptly stopped, it takes a while for the kidneys to stop over excreting and then there can be deficiency of C that produces a disease called scurvy.

The bottom line is, everything in moderation and 5-6 portions of fruits and vegetables daily. provides all the vitamins and minerals needed.

Computers Help Weight Loss?

A recent review of 14 weight loss studies with a total of 2,537 participants, and four weight maintenance studies with a total of 1,603 participants showed that compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.

Wieland LS, Falzon L, Sciamanna CN, et al. Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. Cochrane Database Syst Rev. 2012 Aug 15

Long term Benefit of Statins

Large randomized trials have shown that lowering LDL cholesterol with statins reduces vascular morbidity and mortality rapidly, but limited evidence exists about the long-term efficacy and safety of statin treatment. The aim of a recent extended follow-up of the Heart Protection Study (HPS) is to assess long-term efficacy and safety of lowering LDL cholesterol with statins. 20,536 patients at high risk of vascular and non-vascular outcomes were given either 40 mg simvastatin daily or placebo. The study concluded that prolonged LDL-lowering statin treatment produces larger absolute reductions in vascular events. Moreover, even after study treatment stopped in HPS, benefits persisted for at least 5 years without any evidence of emerging hazards. These findings provide further support for the prompt initiation and long-term continuation of statin treatment.

Bulbulia R, Bowman L, Wallendszus K, et al. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20,536 high-risk individuals: a randomised controlled trial. Lancet. 2011 Dec 10;378(9808):2013-20.

Good Bugs to Prevent Colds

Probiotics may improve a person's health by regulating their immune function. Some studies show that probiotic strains can prevent respiratory infections. However, no evidence of the benefits of probiotics for acute upper respiratory tract infections (URTIs) and related potential adverse effects has been published. A review of 10 trials which involved 3451 participants demonstrated that probiotics were better than placebo in reducing the number of participants experiencing episodes of acute URTIs, the rate ratio of episodes of acute URTI and reducing antibiotic use. This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs. However, the results have some limitations and there were no data for older people.

Hao Q, Lu Z, Dong BR, et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD006895

PSA: To screen or not?

Recent data have suggested that the benefit of routine screening for prostate cancer with PSA testing may be lower than previously believed. A recent recommendation from the US Preventive Services Task Force reviewed recent studies. Of 5 screening trials, the 2 largest and highest-quality studies reported conflicting results. One found that screening was associated with reduced prostate cancer-specific mortality compared with no screening in a subgroup of men aged 55 to 69 years after 9 years while the other found no statistically significant effect after 10 years. The Task Force concluded that prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary. It is suggested that the best approach is to discuss whether PSA screening is right for you with your healthcare provider.

Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Dec 6;155(11):762-71.

Hearing Loss

Although the issue of diminished hearing is often not thought about by persons in their early 50’s, it should be. Hearing loss occurs in up to 40% of the population, making it is a wide spread problem affecting many individuals. Since there are many interventions available that can ameliorate the condition, the US Preventive Task Force (USPSTF) suggests that routine screening to asses hearing begin at age 50 years.

Reference: Ann Intern Med. 2011;154:347-355

Antibiotics

Sinus infections have been very bad this past year and are one of the most frequent reasons for visit to the doctor accounting for 20 million visits annually in the United States and 15% to 21% of annual antibiotic prescriptions. We hear of more and more patients going to their doctor for sinus infections, insisting on receiving antibiotics. As it turns out, this might not be in their best interest.

A recent study in the Archives of Internal Medicine indicates that antibiotics for mild to moderate sinus infections may cause more harm than good. Treating sinus infections was among the Top 5 activities in primary care where changes in practice could lead simultaneously to higher quality care and better use of finite clinical resources.

The meta-analyses of randomized controlled trials published in the past 10 years comparing antibiotic treatment with placebo summarized the evidence regarding the benefits, harms, and costs of antibiotic treatment of acute mild to moderate sinusitis.

Improvement 7 to 15 days after beginning treatment was more common among patients assigned to antibiotics compared with placebo, but the differences were small (7% to 14% improvement with antibiotics). The rate of complications and recurrence did not differ between those treated with antibiotics and placebo. Adverse effects, primarily diarrhea, were 80% more common in the antibiotic compared with the placebo groups. In addition to adverse effects, overuse of antibiotics can also harm population health by increasing rates of antibiotic resistance.

Therefore, the authors of this study concluded that antibiotics should not be prescribed for mild to moderate sinusitis within the first week of the illness. Avoiding antibiotics for acute sinusitis could reduce antibiotic adverse effects, antibiotic resistance, and the cost of health care. So, keep this in mind the next time you have a sinus infection and discuss with your doctor whether antibiotics really are a good idea for you.

Reference: Smith SR, Montgomery LG, Williams JW Jr. Treatment of mild to moderate sinusitis. Arch Intern Med. 2012 Mar 26;172(6):510-3.

Fish Oil Supplements

Fish oil supplements (omega 3 fatty acids) have exploded in popularity due to their proposed benefit for cardiovascular disease. What about their benefit in people with already early issues with heart disease? Although previous randomized, double-blind, placebo-controlled trials reported efficacy of omega-3 fatty acid supplements in the secondary prevention of cardiovascular disease (CVD), the evidence remains inconclusive. A recent study published in the Archives of Internal Medicine investigated the efficacy of eicosapentaenoic acid and docosahexaenoic acid in the secondary prevention of CVD. The authors identified 14 randomized, double-blind, placebo-controlled trials (involving 20,000 patients). In reviewing these studies, they found that supplementation with omega-3 fatty acids did not reduce the risk of overall cardiovascular events, all-cause mortality, sudden cardiac death, myocardial infarction, congestive heart failure, or stroke. The study concluded that there was insufficient evidence of a secondary preventive effect of omega-3 fatty acid supplements against overall cardiovascular events among patients with a history of cardiovascular disease.

These findings describe a pooled analysis and might not be applicable to all individuals. However, we need to continue to use evidence-based data to guide recommendations of supplements, and not simply buy into the latest craze at the health-food store.

Reference: Kwak SM, Myung SK, Lee YJ, et al. Efficacy of Omega-3 Fatty Acid Supplements (Eicosapentaenoic Acid and Docosahexaenoic Acid) in the Secondary Prevention of Cardiovascular Disease: A Meta-analysis of Randomized, Double-blind, Placebo-Controlled Trials. Arch Intern Med. 2012 Apr 9

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