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Epigenetics: Phenomenon or Quackery?

Source: Jeffrey Craig via The Conversation

Are you really what your mother ate, drank or got stressed about? The simple answer is “no”, but not in the way you think.

We are products of nature via nurture. Our genes and environments interact. And “environment” can be what we are experiencing now or at any time during our life.

An overwhelming body of evidence, from both humans and other animals, has shown that the environment we experience in the first 1,000 days of life influences our risk of chronic diseases: conditions such as heart disease, diabetes, psychiatric disorders and some cancers.

Changes to epigenetics – molecules that lie literally “on top of genes” – have been implicated as a possible mechanism by which early environment (nurture) can leave a long-term change in the risk for chronic disease.

Nature, meet nurture

In a recent article in The Guardian, Adam Rutherford argued that the term “epigenetics” is now being abused by pseudoscientists in a similar way to “quantum” and “nano”. I’d like to argue that the term has not been misused any more than most scientific terms, bar the odd cosmetic product, or health store.

Although researchers sometimes disagree over the meaning of the word “epigenetics”, it can be best understood through its conceptual development over time.

Aristotle didn’t like the prevalent idea in his day that we all grow from a microscopic version of ourselves. He coined the term “epigenesis” to describe the developmental process whereby a complex organism develops, through successive stages, from a simple start. This is essentially what we know today as developmental biology… Read More>>

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What to learn more about epigenetics?
Next week Healthed will be running The First 1,000 Days, DOHaD evening seminar in Brisbane on Tuesday 8 September regarding the various issues during gestation and post-partum that can affect future health. To view the program, please click here.

 

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Testosterone Therapy is Not Linked with Blood Clot Disorders in Veins

Source: University of Texas Medical Branch at Galveston via Medical Xpress

A new study from The University of Texas Medical Branch at Galveston of more than 30,000 commercially insured men is the first large comparative analysis to show that there is no link between testosterone therapy and blood clots in veins. The study found that middle-aged and older men who receive testosterone therapy are not at increased risk of this illness. The findings are detailed in Mayo Clinic Proceedings.

Venous thromboembolism is a disease where blood clots form in the veins and cause blockages. The most common forms of VTE are deep vein thrombosis, which occurs often in the legs and pulmonary embolism, which is a clot in the lungs. VTE is the third most common cardiovascular illness, after heart attack and stoke.

“In 2014, the Federal Drug Administration required manufacturers to add a warning about potential risks of VTE to the label of all approved testosterone products,” said Jacques Baillargeon, professor of epidemiology in the department of preventive medicine and community health and lead author of the study. “The warning, however, is based primarily on post-marketing drug surveillance and case reports. To date, there have been no published comparative, large-scale studies examining the association of testosterone therapy and the risk of VTE.”

As a result of this conflicting evidence and the broad media attention it has received, there are many men with medically confirmed low testosterone who are afraid to receive testosterone therapy and there may be physicians who are reluctant to prescribe testosterone therapy based on this conflicting information.

The case-control study included 30,572 men 40 years and older who were enrolled in one of the nation’s largest commercial insurance programs between Jan. 1, 2007 and Dec. 31, 2012. Cases were defined as men who had a primary diagnosis of VTE and received an anticoagulant drug or an intravascular vena cava filter in the 60 days following their diagnoses. Cases were matched with three control subjects on age, geographic region, diagnosis of low testosterone and diagnosis of any underlying pro-clotting condition… Read More>>

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Self-Proclaimed Experts More Vulnerable to the Illusion of Knowledge

Source: Association for Psychological Science via Medical Xpress

New research reveals that the more people think they know about a topic in general, the more likely they are to allege knowledge of completely made-up information and false facts, a phenomenon known as “overclaiming.” The findings are published in Psychological Science, a journal of the Association for Psychological Science.

“Our work suggests that the seemingly straightforward task of judging one’s knowledge may not be so simple, particularly for individuals who believe they have a relatively high level of knowledge to begin with,” says psychological scientist Stav Atir of Cornell University, first author on the study.

To find out why people make these spurious claims, Atir and colleagues David Dunning of Cornell University and Emily Rosenzweig of Tulane University designed a series of experiments testing people’s self-perceived knowledge, comparing it to their actual expertise.

In one set of experiments, the researchers tested whether individuals who perceived themselves to be experts in personal finance would be more likely to claim knowledge of fake financial terms.

One hundred participants were asked to rate their general knowledge of personal finance, as well as their knowledge of 15 specific finance terms. Most of the terms on the list were real (for example, Roth IRA, inflation, home equity), but the researchers also included three made-up terms (pre-rated stocks, fixed-rate deduction, annualized credit)… Read More>>

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Cleaning the Stethoscope

By Dr Vivienne Miller

Doctors are well aware of the need for good hygiene and prevention of the spread of bacteria and viruses. However, we are probably more likely to clean the ear pieces of our stethoscopes than the bell and diaphragm.  The diaphragm, in particular, comes into contact with potentially contaminated skin on a regular basis. The research is clear that most stethoscopes harbour bacteria and the colonisation is greater in stethoscopes not regularly cleaned (defined as at least weekly).1 It is suggested that stethoscopes be cleaned with isopropyl alcohol, sodium hypochlorite, or benzalkonium chloride.1  Stethoscopes do have the capacity to transfer pathogenic bacteria, although adverse consequences of this have not been documented.1

1. Chigozie J. et al. Bacterial contamination of stethoscopes used by health workers: public health implications. J Infect Dev Ctries 2010; 4(7):436441 http://www.jidc.org/index.php/journal/article/viewFile/20818091/414

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A Previous History of Gestational Diabetes

By Dr Vivienne Miller

Diana was 36 years old, had a body mass index of 28kg/m2 and six years previously, as a P1G0, had developed gestational diabetes and requiring insulin. She presented to her GP with an unexpected second pregnancy. The fetus was calculated to be about ten weeks’ gestation at diagnosis. Diana and her partner were pleased about the pregnancy. However, Diana had not had any follow-up for diabetes after her first baby was born. The General Practitioner immediately organised a fasting blood glucose level along with the usual antenatal screen. He also organised the nuchal scan and genetic counselling for twelve weeks’ gestation.

Diana returned after the nuchal scan for her results. She was now almost thirteen weeks’ gestation and had felt very reassured by the ultrasound results and the genetic counselling consultation. Diana was consequently diagnosed with gestational diabetes again (on the basis of her initial blood glucose level being 12mmol/L fasting, so she did not require a two hour glucose tolerance test). Diana had not understood that the risk of her developing type 2 diabetes was 50% within five to ten years of her gestational diabetes.1 She also did not realise the importance of excellent blood glucose control (defined as a HbA1c of 6.5% ideally, or 7.0% if taking insulin)2 in the three months prior to a pregnancy. Excellent diabetes control is important prior to conception, as there is an increased risk of miscarriage and congenital malformations in the babies of women with diabetes; this risk is proportional to the increase in HbA1c at conception.2

It should be noted that the HbA1c is not recommended as a diagnostic test for diabetes or to monitor blood glucose control in pregnant women.2 Diana went on to have a large but normal baby delivered at 38 weeks’ gestation by elective caesarean section (for cephalopelvic disproportion). She was officially diagnosed with type 2 diabetes at six weeks’ post-partum.

1. International Diabetes Federation: http://www.idf.org/gestational-diabetes

2. International Diabetes Federation: http://www.idf.org/webdata/docs/Pregnancy_EN_RTP.pdf

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Next week Healthed will be running The First 1,000 Days, DOHaD evening seminar in Brisbane on Tuesday 8 September regarding the various issues during gestation and post-partum that can affect future health. To view the program, please click here.
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Prolonged QT on ECG

By Dr Vivienne Miller

The “QT interval” is the time measured from the beginning of the Q wave to the end of the T wave for each heart beat documented on an ECG. The QT interval normally decreases with increasing heart rate. There are a number of mathematical formulas that can calculate the QT interval at variable heart rates.  However, as an approximate guide, if there is a normal resting pulse (60-80 beats per minute), a prolonged QT interval is more likely to be present if it is measured as over 500msec; under 450msec is more likely to exclude the condition.

A prolonged QT may be congenital, hereditary and genetic and is associated with ventricular ectopics, sudden ventricular tachycardia and sudden death (especially in females). There are approximately ten genetic forms of congenital long QT syndrome, most commonly LQT1 (35% of cases), LQT2 (30% of cases), and they occur in one in several thousand people.

There are also other hereditary associations with a congenital long QT. Jervell and Lange-Neilsen syndrome has an autosomal recessive inheritance and includes congenital deafness and sudden death from ventricular arrhythmias (especially with sudden stress or fright). There is a 50% mortality by young adulthood if it is untreated. Andersen-Tawil syndrome (LQT7) is autosomal dominant and highly clinically variable. It is associated with skeletal deformities, low-set ears, clinodactyly, micrognathia and periodic paralysis.

The genetic abnormality prolongs the action potential of the ventricle and thus the length of the QT interval. It is thought that the abnormal repolarisation of the ventricle causes a delay of the QT interval, and thus adrenaline (from stress, exercise) and adrenergic medications will lead to re-entry ventricular tachyarrhythmias. Notably, approximately 15% of patients with the condition have a normal QT interval on their ECGs. A personal and family history of palpitations, dizziness, fainting and sudden death are important to discuss with patients.

Congenital prolonged QT syndrome is much less common than other causes.  A prolonged QT may also occur from medications, bradycardias, hypothyroidism, hypocalcaemia, hypokalaemia, anorexia, myocarditis, dilated cardiomyopathy and some forms of heart failure and congenital cardiac disease.  The risk of sudden death is higher in the elderly and in patients with underlying cardiac disease.

Because there are so many commonly prescribed medications that cause a prolonged QT interval, it is important to be aware that potentially serious complications increase with the number of contributory agents. It is common for QT prolongation and medication interactions to be forgotten, especially in psychiatric patients and the elderly. An ECG is a simple screening test for this condition. Patients at risk of prolonged QT interval should be instructed to tell other potential prescribers (such as dentists) of their condition and a list of medications should be kept in their wallet.

List of common medications associated with a prolonged QT interval

Chloroquine Antidepressants Pseudoephridine Lithium
Tricyclics Adrenaline Co-trimoxazole Antipsychotics
Fluoroquinolones Methadone Sotalol Methylphenidate
Dopamine Sumatriptan Macrolides Amiodarone
Fluconazole and other azoles Quinine Indapamide Salbutamol
Tamoxifen Terbutaline

 

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Lucrative Pseudoscience at the International Positive Psychology Association Meeting

Source: James Coyne via Plos

A plenary session dripping with crank science may be an outlier, but it’s on a continuum with the claims of mainstream positive psychology.

Follow the conference attendees following the money, does it take you to science?

Imagine a PhD student going to her first positive psychology conference, drawn by the opportunity to hear research oriented psychologists such as Richard Davidson and Jonathan Haidt in one place. But at the first plenary session she attends, Rollin McCraty is talking to an enthralled audience about “the science of what connects us.” McCraty says the heart radiates a measurable magnetic field which carries emotional state information, and can be detected by the nervous systems of nearby.”

Puzzled, she googles McCraty and comes to websites and articles making even more bizarre claims, like:

There is compelling evidence to suggest that the heart’s energy field (energetic heart) is coupled to a field of information that is not bound by the classical limits of time and space.

But any research-oriented attendees were disappointed if they sought first-ever reports of breakthrough, but reproducible science. Personal coaching and organizational and executive consulting themes predominated in the preconference workshops and presentations.

Elements of a trade show blended into a revivalist meeting. Hordes of “certified” life coaches and wannabes were seeking new contacts, positive psychology products, and dubious certificates to hang in their offices. These coaches had paid out-of-pocket, without scholarship for degrees from “approved” masters of arts in positive psychology programs (MAPPs) costing as much as $60,000 a year. Many were hungry. But there are inspiring -positive psychology is about inspiring- stories on the Internet… Read More>>

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Entitled kids? These Parenting Tips Can Change Behaviour

Source: Amy McCready via TODAY

We all have them: the “What were we thinking?” parenting moments. We let our kids sneak in after curfew because we don’t want another battle. Or we stock our purse with candy to make it through errands. Or maybe we’ve been cleaning the forgotten guinea pig’s cage — every Saturday for two years!

Guilty as charged? In fact, most of us have probably gone to similar extremes rather than trying to actually change our kids’ behavior.

There’s nothing wrong with helping our kids out every so often — but when our “helping” and “allowing” become a way of life, we’re walking the slippery slope of the entitlement epidemic.

In fact, more and more parents are recognizing the signs of entitlement in their kids. We see kids who won’t lift a finger to help out, who think the world revolves around them, who rarely show gratitude and empathy and who demand more…more…more!

But the seeds of entitlement are sown over the years in a million little parenting decisions — all made in the name of love. Sometimes a few tweaks in parenting style can make all the difference. Below are some of the most common entitlement-prone parenting styles, as well as a few proven fixes:

1. The “Keep Em Happy at All Costs” Parent

This might be you if: You’d rather let your kids dominate your phone during errands or pull strings with teachers and coaches than face a tantrum… Read More>>

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Immediate Diagnosis of Concussions Better Protects Youth Athletes

Source: Audrey Breen via Medical Xpress

Athletes under the age of 18 are the most vulnerable when it comes to sustaining concussions. Accurately diagnosing concussions on the field of play is an important way to protect them, according to research published this month in the Journal of Child Neurology.

“The continued play by a child who has sustained a concussion puts them at significant increased risk,” said Jacob Resch, associate professor at the University of Virginia’s Curry School of Education and co-author of the study. “To keep a concussed child from continuing to play requires immediate and accurate diagnosis.”

Every state but one requires youth athletes suspected of having a sport concussion be removed from play and not allowed to return without written clearance from a health care provider. But, according to Resch, many young athletes are playing without the elements in place needed to accurately diagnose a concussion during a game.

The article, “The Acute Management of Sport Concussion in Pediatric Athletes,” provides a clinical framework for the assessment, evaluation and management of pediatric sports concussions.

One key element: the presence of an athletic trainer or trained clinician at sports events.

“Diagnosing sport concussion requires specific training,” Resch said. “Think of it as a medical specialty that not necessarily all general practitioners or pediatricians are well versed in. There is a range of assessments used in diagnosing concussions and each of them requires specific training.” …Read More>>

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Is There Anything Actually ‘Medical’ About Medical Marijuana? 

Source: Aaron E. Carroll via The New York Times

It is becoming easier to get marijuana, legally. In the last 20 years or so, 23 states, as well as the District of Columbia, have passed laws that make it legal to use marijuana for medical treatments. So have some countries, like Austria, Canada, Finland, Germany, Israel and Spain.

Advocates believe that this has allowed many with intractable medical problems to receive a safe and effective therapy. Opponents argue that these benefits are overblown, and that advocates ignore the harms of marijuana. Mostly, opponents say that the real objective of medical marijuana is to make it easier for people to obtain it for recreational purposes.

Both sides have a point. Research exists, however, that can help clarify what we do and don’t know about medical marijuana.

A recent systematic review published in The Journal of the American Medical Association looked at all randomized controlled trials of cannabis or cannabinoids to treat medical conditions. They found 79 trials involving more than 6,400 participants. A lot of the trials did show some improvements in symptoms, but most of those did not achieve statistical significance. Some did, however… Read More>>

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