The Morning Drill: October 11, 2011

A collection of dentistry and health related links/comments for your day.

The trouble with prostate cancer tests

Doctors who treat prostate cancer disagree on the value of the prostate specific antigen, or PSA, test. But they agree on one thing.

Men are often hurt by overdiagnosis and treatment for prostate cancer.

"There are clearly people we harm with therapy," said Dr. Bruce Roth, professor of medicine at Washington University in St. Louis. "I don't think there's doubt about that. We wouldn't be having this conversation if the therapy was nontoxic."

Prostate cancer treatments are known for side effects such as sexual dysfunction, incontinence, difficulty urinating and controlling bowel functions.

At least 20% to 30% of patients who get radiation therapy or surgery will experience incontinence and erectile dysfunction, according to a report released last week by a federal advisory board. At the same time, prostate cancer survivors say their lives have been saved by PSA tests and subsequent treatments.

The PSA test has become increasingly controversial as more doctors and studies question its effectiveness.

To examine that topic, the U.S. Preventive Services Task Force, an independent panel of experts, reviewed the existing evidence and released a draft recommendation against PSA testing.

There is convincing evidence that "PSA-based screening leads to substantial overdiagnosis of prostate tumors," the draft stated. The task force found "small or no reduction" in prostate cancer deaths and that the test was also "associated with harms related to subsequent evaluation and treatments."

The task force will open the recommendation Tuesday for a comment period before issuing a final recommendation.

New Alzheimer's Drug Shows Early Promise

An experimental Alzheimer's disease drug, gantenerumab, may help lower levels of amyloid plaque in the brains of people with the disease, an early clinical trial indicates.

The new study, which appears online Oct. 10 in the Archives of Neurology, is among the first to show the effects of an anti-amyloid drug in humans with Alzheimer's disease, but experts caution that while promising, more research is needed before this drug can be deemed safe or effective.

And, in what may turn out to be an equally important caveat, experts also say that it's by no means certain that reducing levels of amyloid plaque would stave off memory loss and the other mental declines associated with the disease because the role of the plaque in Alzheimer's isn't fully understood.

Alzheimer's disease is the most common form of dementia. Symptoms including serious memory loss, confusion and mood changes develop gradually and worsen with time. Recently, many strides have been made in diagnosing Alzheimer's disease earlier, but doctors have been stymied by a lack of effective treatments to stop or slow the course of the disease.

It's long been known that a protein fragment called beta-amyloid builds up in the spaces between nerve cells in the brains of people with Alzheimer's disease. The new drug, gantenerumab, targets these amyloid proteins by priming the body's immune system to recognize them as invaders.

The need for a drug to delay the onset or slow progression of Alzheimer's disease can't be underestimated, Aggrawal said. In the United States alone, there are 5.4 million people with Alzheimer's disease, and the numbers are expected to increase to 13 million by 2050, when approximately three of every five people over the age of 85 will have Alzheimer's disease, she said.

Dentists offer cash, gifts for kids' Halloween candy

Scott J. Pettinato is not a fan of the harm candy can inflict on children's teeth.

With Halloween creeping ever closer, the Scranton dentist is among those who will look to spare young patients some sugary damage while still preserving their seasonal fun - and sending a little cheer to American troops deployed overseas in the process.

For the third consecutive year, Dr. Pettinato will participate in the Halloween Candy Buyback Program, which allows children across the country to trade 1 pound of their Halloween haul for $1. The candy will be turned over to Operation Gratitude for its holiday care packages that are shipped to troops.

"We love the fact that we're taking the candy out of the hands of the kids so that they're not putting quite so much of it in contact with their teeth," Dr. Pettinato said.

Dr. Pettinato's practice at 821 Oak St. will be accepting the candy on Tuesday, Nov. 1, and Wednesday, Nov. 2, between 8 a.m. and 5 p.m.

Previous years netted between 200 and 250 pounds of candy, he said.

Dr. Joyce Perih, 321 Spruce St., Scranton, offers a unique twist on the program. For every pound of candy donated to her orthodontic practice, she provides patients with four "ortho" dollars, equivalent to $2. The "ortho" dollars can be used to purchase gift cards, T-shirts, backpacks and other items.

"I think it's a win-win situation," Dr. Perih said of the candy buyback program. "It's a more healthy alternative. The less candy dissolving in your month, the better off you are."

Dr. Perih said in years past she also donated dental cleaning supplies such as toothpaste and toothbrushes to troops. This year, she said she will match whatever is received from the program and donate it to the local American Red Cross for local flood victims or to the Flight 93 National Memorial Campaign. Candy will be accepted through Nov. 18.

Enjoy your morning!

The Morning Drill: October 4, 2011

A collection of dentistry and health related links/comments for your day.

Survey finds support for dental therapist concept

More Americans are delaying dental care due to cost, and many are open to the concept of a new type of dental care provider if it would make more services available to those who currently cannot afford them, according to a survey released today by the W.K. Kellogg Foundation.

According to the survey of 1,023 adults nationwide, 41% of respondents reported that they or someone in their household has put off dental care because of cost, and 30% said they do not have a place to receive dental care. In addition, 79% said that receiving regular dental care is important, but 40% said they do not have dental insurance.

And more than 80% said they believe it is difficult for people to get free or low-cost dental care in their communities and that the number of Americans who cannot access dental care is "a problem."

Those most likely to be putting off care due to cost are those with annual incomes of less than $30,000 (55%), those without dental insurance (54%), and those with a high school diploma or less (47%). In addition, Latinos (47%) are more likely than African Americans (36%) and whites (42%) to have put off dental care in the last 12 months due to costs. Women are also more likely than men (47% versus 35%) to have put off dental care because of cost.

"This survey clearly shows that people throughout the country are struggling to get dental care," said Sterling Speirn, president and CEO of the W.K. Kellogg Foundation.

One of the most surprising findings, according to Mike Perry, an analyst and partner at Lake Research Partners, the company that conducted the survey, came in response to this question:

    Many efforts are going on to improve affordable access to dental care in our country. One effort is training license dental practitioners to provide preventive, routine dental care to people who are going without care. Would you support or oppose this effort to train licensed dental practitioners?"

More than three-quarters (78%) of survey respondents said they would support the training of licensed dental practitioners to make preventive, routine dental care more accessible, according to the survey.

"We did not provide them with a definition of dental therapists," Perry said. "You introduce the idea of a midlevel dental professional who is out in the community providing routine and preventive dental care and they say, 'Oh, OK, like a physician's assistant.' This research suggests that the general public is open to someone other than a dentist providing routine and preventive care."

Behavioral Therapies Effective in Weight Loss

Behavior-based weight loss interventions are safe and effective, according to a systematic review published in the October 4 issue of the Annals of Internal Medicine.

A 2007-2008 study showed that 32% of US men and 36% of US women were obese. The US Preventive Services Task Force recommends that physicians screen all adults for obesity and institute intensive counseling and behavioral interventions for obese adults.

The researchers, led by Erin S. LeBlanc, MD, MPH, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, reviewed studies of primary care-relevant weight loss interventions for overweight and obese adults. The studies were pulled from MEDLINE, the Cochrane Central Register of Controlled Trials, and PsycINFO (January 2005 - September 2010) and from systematic reviews for studies conducted before 2005.

Mom's Healthy Diet Reduces Birth Defects

An overall healthy diet -- not just folic acid supplementation -- may be key to reducing risk of neural tube and orofacial cleft birth defects, a population-based study indicated.

Prepregnancy dietary quality in terms of fruits and vegetables, grain, calcium, iron, and folate, as well as fat and sugar intake, significantly predicted risk of these defects even after controlling for supplement use, Suzan L. Carmichael, PhD, of Stanford University in Stanford, Calif., and colleagues found.

The highest quality diets were associated with up to 51% lower risk of anencephaly, 34% reduced risk of cleft lip, and 26% lower odds of cleft palate compared with the poorest diets.

These links were stronger than seen with folic acid or other nutrients individually in a prior analysis of the same cohort, the group reported online in the Archives of Pediatrics & Adolescent Medicine.

"It's important to think of nutrition in all of its complexity," Carmichael told MedPage Today.

That doesn't mean the emphasis on boosting folic acid intake through supplements and fortification of the food supply has been misplaced, Carmichael cautioned in an interview.

Folic acid clearly can prevent neural tube defects, which have dropped in prevalence since food fortification, she pointed out, calling it "a huge public success story."

But further progress in tackling the still extensive burden of these birth defects that develop often before women are even sure they are pregnant may require a more whole-diet approach, her group argued.

Drunk on Facebook? That could be a problem

College students' Facebook pages might hold clues to which of them are at risk for alcohol dependence and abuse, according to a new study.

Researchers found that students who had pictures or posts about getting drunk or blacking out were more likely to be at risk of drinking problems, based on a screening test. That was not necessarily the case for students who mentioned alcohol or drinking on their pages, but not in a way that showed that they drank too much or in unhealthy situations.

It's possible that Facebook pages could help schools find out who needs to be assessed for alcohol-related problems -- although privacy and ethical concerns might make that complicated, researchers said.

The question is whether "what's being found on these sites... is actually predictive of clinical conditions," said Dr. James Niels Rosenquist, a social media researcher and psychiatrist from Massachusetts General Hospital who wasn't involved in the new study.

The findings suggest that messages on Facebook sites do seem to be linked to what happens in the "real world," he told Reuters Health.

Enjoy your morning!

Marathon Training Does Not Always Mean Losing Weight

Me finishing the 2011 Disneyland Half Marathon

Ask me how I know?

If you've ever trained for a marathon, you probably expected to lose weight. And why not? Long runs that last two, three, and four hours burn a serious number of calories. But many runners step on the scale just before race day and discover that instead of dropping pounds, they've added some. Runners sometimes gain weight because they change their diets along with their mileage, or because other factors, such as hormonal fluctuations, come into play. And occasionally extra pounds are actually a sign things are going right. Here's why the numbers on the scale go up during training, and how to fuel yourself so you get to the start at an ideal weight.

From my experience since beginning marathon both in walking and running, if you do not watch your diet closely, it is easy to gain body weight.

Most training programs say do not diet during your training and keep everything the same. Well, I say BS to that.

YOU WILL GAIN WEIGHT.

I am using My Fitness Pal on my PC and Android phone (myfitnesspal.com) and am monitoring all of my training (for calories expended) and dietary intake (calories in). I am so making sure I have sufficient carbohydrates in my diet to replace the muscle glycogen used on my long runs and protein to help repair muscle fibers.

I have lost 11 pounds in about 11 weeks (which is my goal). I have a long way to go but my body appreciates not lugging around the extra pounds on Saturday morning when I go out for at least 6 miles and now ramping up to 26.2.

Why do you gain weight?

YOU'RE HUNGRIER!

Marathon training almost always requires more mileage, which boosts the number of calories you burn as well as your appetite. "Your body is trying to help fuel your increased activity," says Jenna Bell, Ph.D., R.D., a nutrition consultant and coauthor of Energy to Burn. "One of the ways it does this is by making you hungry." It's worse for women: Researchers at the University of Massachusetts discovered this heightened sense of hunger is stronger in women than men because exercise accelerates the production of appetite-regulating hormones, prompting them to eat more; men, it turns out, aren't as susceptible to these changes.

YOU'RE OVEREATING!

You go for a 10-mile run, come home starving, and inhale a stack of whole-grain pancakes, a smoothie, eggs, bacon, toast, and a few well-earned cookies. Oops, you've eaten 1,200 calories—a few hundred more than you burned on the run.

To limit overcompensation—that is, eating above and beyond what you need for recovery and erasing the calorie deficit achieved during a workout—you need to make smarter food choices all day. Bell recommends eating mostly whole, minimally processed foods rich in carbs, fiber, and protein. The latter two take longer to digest, keeping hunger at bay and helping you avoid eating more than you should. Sabato also warns runners against falling into the "I deserve it" mind-set. "Going for a long run does not give you license to eat an entire batch of cookies," she says.

By using a system to monitor your daily NET calories, you can set a body weight goal and lose weight while training for a marathon. Do not use the marathon as a crutch for weight loss.

It is all about the calorie math.

Besides, aren't you training for the marathon for other reasons?

The Daily Drill: September 9, 2011

A collection of dentistry and health related links/comments for your day.

As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments

Until she tore her hamstring a year and a half ago, Tina Basle ran marathons. Since then, she has been on a desperate search for a cure.

It took her from doctor to doctor, cost her thousands of dollars and led her to try nearly everything sports medicine has to offer — an M.R.I. to show the extent of the injury, physical therapy that included ultrasound and laser therapy, strength training, an injection of platelet-rich plasma (or P.R.P.), a cortisone shot, another cortisone shot.

Finally, in February, she gave up.

“I decided this is never going to heal, so let’s get on with it,” she said.

And so Ms. Basle, a 44-year-old digital media consultant who lives in Manhattan, started running anyway. She has lost a lot of speed and endurance. And, she added, “the stupid hamstring is really no better.”

Medical experts say her tale of multiple futile treatments is all too familiar and points to growing problems in sports medicine, a medical subspecialty that has been experiencing explosive growth. Part of the field’s popularity, among patients and doctors alike, stems from the fact that celebrity athletes, desperate to get back to playing after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal.

But now researchers are questioning many of the procedures, including new ones that often have no rigorous studies to back them up. “Everyone wants to get into sports medicine,” said Dr. James Andrews, a sports medicine orthopedist in Gulf Breeze, Fla., and president-elect of the American Orthopaedic Society for Sports Medicine.

Weight Watchers Produces Bigger 'Losers' Than Standard Weight-Loss Care

Dieters may be more likely to slim down if they are referred to a commercial program such as Weight Watchers than if they battle the bulge with primary health care providers alone, a new study finds.

Overweight adults in Germany, Australia and the United Kingdom who were referred to Weight Watchers by a primary health care provider lost about twice as much weight over a year as dieters assigned to standard weight-loss care, according to the study, which was funded by Weight Watchers and published Sept. 8 in The Lancet.

"The greater weight loss in participants assigned to the commercial program was accompanied by greater reductions in waist circumference and fat mass than in participants assigned to standard care, which would be expected to lead to a reduction in the risk for type 2 diabetes and cardiovascular disease," the researchers said in a journal news release.

The study involved 772 overweight and obese adults who were randomly assigned to a year of diet care overseen by a primary care professional or to 12 months' free membership at a local Weight Watchers group.

Fifty-four percent of the standard-care dieters completed the 12-month study, compared to 61 percent of the Weight Watchers group.

Those who stuck with their standard diet lost an average of about 7 pounds, while those who attended Weight Watchers shed nearly 15 pounds on average. Also, the Weight Watchers participants were more than three times as likely to have dropped 5 percent or more of their body weight compared to the standard dieters, said the researchers.

A quarter of those randomly assigned to work with a primary care professional did lose 5 percent of their body weight, however -- a feat the researchers said confirmed the capability of primary care professionals to deliver the support and care needed for people to lose weight and keep it off during a year's time.

The researchers suggested that the structure of the commercial program -- including group support, weekly weighing, instruction about diet and physical activity, and motivation -- can be a clinically useful tool for battling overweight and obesity on a large scale. However, they acknowledged that a cost-benefit analysis and further research is needed to see if the gains (or, in this case, losses) could be maintained over time.

The researchers also said the findings suggested that overweight people were more likely to lose weight if they were referred to a commercial weight-loss program by a physician or another primary care provider than if they enrolled on their own.

Kids who live with smokers have more ear infections

Kids whose parents smoke are more likely to get ear infections and have hearing problems, according to a new review paper.

When moms lit up, kids were also almost twice as likely to need surgery for recurrent ear infections or similar problems, researchers reported.

The findings come from a combination of 61 past studies. While they can't prove that smoke exposure causes ear infections, researchers suggested that if that's the case, hundreds of thousands of ear infections may be due to parents' smoking each year.

"It's pretty impressive, especially since ear infections cause enormous pain," said Dr. Michael Weitzman, who studies the effects of parental smoking at New York University Medical Center and was not involved in the study.

The new paper "once again highlights a common child health problem that is profoundly influenced by mothers' smoking," he told Reuters Health, "and it focuses our attention more than previous studies have on it resulting in surgical procedures for children."

Taken together, the studies showed that kids living with a smoker had a 37 percent higher risk of any "middle ear disease," including ear infections and hearing problems -- and a 62 percent higher risk if the household smoker was their mom.

When mothers smoked, kids were also 86 percent more likely to get surgery for a middle ear condition, including recurrent ear infections, than if no smokers were in the house.

About three out of four kids have had an ear infection by the time they are three years old.

Enjoy your morning!

The Morning Drill: September 1, 2011

A collection of dentistry and health related links/comments for your day.

Cavities ache many in the Latino community

Do you know what is the most chronic infectious disease among children in the U.S.?

According to the Centers for Disease Control and Prevention (CDC), it is tooth decay — what most of us call cavities. More than one out of every four children aged 2-5 years and half of those aged 12-15 years have tooth decay.

The problem is even more prevalent in the Latino community.

According to government statistics, 40 percent of Mexican-American children aged 6-8 years have untreated tooth decay. Amongst Mexican-American adolescents – those aged 12-19 years – one in five suffers from the same condition.

If left untreated, tooth decay can snowball into much larger problems that permeate various aspects of a child's growth and development, says the CDC.

Teen Boys Drink a Whole Lot of Sugar

Average daily sugar consumption among male teenagers in the form of sodas, energy drinks, and sweetened fruit juices was more than double the government's recommended limit for all added sugar in the diet, a large national survey found.

Among boys and young men 12 to 19 years old participating in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008, so-called sugar drinks accounted for a mean of 273 calories in their daily diet, according to data compiled Cynthia L. Ogden, PhD, and colleagues at the CDC's National Center for Health Statistics.

The U.S. Department of Agriculture's recommended daily limit for added sugars in all forms -- including candies, baked goods, ice cream, and other foods in addition to drinks -- is 128 calories. The "DASH" diet for reducing blood pressure has an even lower limit of about 50 calories in sugar daily.

Findings from the NHANES analysis appeared in NCHS Data Brief No. 71, released this week.

Men in their 20s and 30s were not far behind their teen counterparts, with an average daily intake of 252 calories from sugar drinks in the NHANES data.

More Runners Are Going Bare

Barefoot or minimalist running is on the rise. To assist runners with their transition, the Minnesota Chiropractic Association (MCA) is hosting a public education program designed to help "safely" transition runners who want to move toward minimalist or barefoot running.

Seminar participants will learn the benefits of barefoot running, gain valuable injury prevention information and techniques to assist with their transition while gaining insight from experienced barefoot and minimalist runners.

According to the Journal of Medicine & Science in Sports & Exercise, 70 percent of traditional runners experience some level of injury. Presenter, Dr. Candace Salmi, says, "Barefoot running, when done correctly, can be energizing while having a positive impact on the body."

Silicone Breast Implants Will Stay on Market

An FDA official said silicone breast implants made by Johnson & Johnson’s Mentor and Allergan will stay on the market, and that the agency will work with the companies to increase participation in post-approval studies, Dow Jones Newswires reports. Companies have struggled to maintain follow-up on the 80,000-plus women originally included in those studies, originally planned to last a decade, with Allergan tracking about 60.5% of them for two years and Mentor following 21% for three years. If more women aren’t tracked, the studies won’t be able to detect possible long-term health issues.

Enjoy your morning!

The Morning Drill: August 30, 2011

A collection of dentistry and health related links/comments for your day.

Flavored mouthguards attract athletes young and old

As a former professional soccer player and multisport athlete most of his life, Bruce Angus knows firsthand one of the biggest problems with mouthguards: They don't taste good.

"Anyone who has worn a mouthguard before, for sports or at night [to protect against bruxism], they know that it's not a great experience," Angus said. "People who use them complain they don't fit well, cause dry mouth, and have a plastic taste."

Even for sports in which mouthguards are required, many athletes balk at the thought of wearing them.

"The problem with mouthguards today is that because it is not a great experience, athletes often won't wear them," Angus said. "They shove them in their helmets, into their gloves -- and this is at all levels. The second the whistle blows, they want it out of their mouth."

Chocolate Good for the Heart and Brain

In a city renowned for its love of food, it is only fitting that researchers presented the results of a new study in Paris, France, showing that chocolate is good for the heart and brain. In a presentation at the European Society of Cardiology (ESC) 2011 Congress, British investigators are reporting that individuals who ate the most chocolate had a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

In the study, published online August 29, 2011 in BMJ to coincide with the ESC presentation, Dr Adriana Buitrago-Lopez (University of Cambridge, UK) and colleagues state: "Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease."

Dentist disciplined over Botox allegations

Helaine Smith thought patients at her dentistry practices in Needham and West Roxbury would benefit if she began offering Botox treatments to smooth wrinkles and adjust smiles.

Smith, a 45-year-old Needham resident, was disciplined by the state Board of Registration in Dentistry last month on accusations of using botulinum toxin on patients, as well as for numerous more serious violations. She was the first dentist punished under a board policy enacted in January 2008 prohibiting the use of Botox by general dentists. She closed on the sale of both offices last week.

The board allows certified oral and maxillofacial surgeons, who receive training in the use of Botox and dermal fillers, to use the injections in the course of treatment for “disease, disfigurement, or disfunction.’’ But some take issue with the distinction, saying that general dentists are most qualified to administer the injections and may take continuing education courses to learn how.

“As a licensed dentist, I can do dangerous, life-threatening surgery in the oral cavity,’’ Smith said in a recent interview. “Botox is not life-threatening in any way.’’

The state began investigating Smith soon after she told The Boston Globe in March that she had been offering the service for about a year and had seen high demand.

Smith agreed in July to surrender her license for at least six months, dating from the March investigation. The agreement said she had advertised Botox services and provided them in her office. Despite signing that document, Smith contends she had never administered Botox to patients, though she planned to.

The state agreement outlines a long list of other alleged violations, including the failure by Smith to conduct weekly tests of sterilization equipment, correctly store dental instruments, provide necessary emergency medical equipment, or maintain proper records. In addition, Smith improperly prescribed controlled substances, kept inadequate records of patients receiving them, and administered sedation without a permit, the document said.

Smith said she felt bulldozed by the board, which is overseen by the Department of Public Health. She said she tried to fix the violations within days of the investigation.

But Jean Pontikas, director of the Division of Health Professions Licensure, said Smith’s violations were serious. Smith’s use of Botox was “a minor issue’’ that may have prompted only a cease and desist notice if it weren’t for the other infractions, she said.

For Women, Active Sex Life May Mean Better Aging

Sexual satisfaction in older women is associated with successful aging and a better quality of life, a new study finds.

Researchers looked at information gathered from over 1,200 San Diego women, aged 60 to 89, and found that satisfaction with overall sex life was reported by 67 percent of those aged 60 to 69; 60 percent of those aged 70 to 79; and 61 percent of those aged 80 to 89.

"Contrary to our earlier hypothesis, sexual satisfaction was not significantly associated with age," study co-author Wesley K. Thompson, an assistant professor of psychiatry with the Stein Institute for Research on Aging at the University of California San Diego School of Medicine, said in a UCSD news release.

"Although the levels of sexual activity and functioning did vary significantly, depending on the woman's age, their perceived quality of life, successful aging and sexual satisfaction remained positive," he said.

The study is published in the August issue of the Journal of the American Geriatrics Society.

"What this study tells us is that many older adults retain their ability to enjoy sex well into old age," Thompson said. "This is especially true of older adults who maintain a higher level of physical and mental health as they grow older. Furthermore, feeling satisfied with your sex life -- whatever your levels of sexual activity -- is closely related to your perceived quality of life."

Enjoy your morning!

The Morning Drill: August 26, 2011

A collection of dentistry and health related links/comments for your day.

Bright Now! Dental Opens Another California Dental Office in Fresno

Smile Brands Inc., the nation's leading provider of business support services to dental groups in the United States, is pleased to announce the grand opening of its next Bright Now! Dental office in Fresno, CA – the 67th office in the state of California. Bright Now! Dental will continue to grow in the state with offices slated to open in Murrieta, Upland, San Jose, Simi Valley, and Stockton later this year.  

Smile Brands Inc. is the largest provider of support services to dental groups in the United States. Smile Brands Inc. provides comprehensive business support services so dentists can spend more time caring for their patients and less time on the administrative, marketing and financial aspects of the dental practice. Smile Brands Inc. services support more than 1,100 dentists and hygienists practicing in over 320 Bright Now! Dental, Monarch Dental, and Castle Dental offices in 18 states.

Based in Irvine, Calif., Smile Brands Inc. and its affiliated dental offices combined employ approximately 4,200 people nationwide.

Steve Jobs Faces Uphill Battle Against Cancer: Experts

One of the hallmarks of Steve Jobs' tenure as CEO of Apple Inc. was the secrecy that shrouded products he was about to unveil -- from the iPod to the iPhone to the iPad -- creating tremendous consumer interest.

Jobs' announcement Wednesday night that he was stepping down as the head of the hugely successful technology company he co-founded in a northern California garage 35 years ago was similarly thin on details, although speculation immediately turned to his ongoing health problems.

In a letter to Apple's board, the 56-year-old Jobs said he "always said if there ever came a day when I could no longer meet my duties and expectations as Apple's CEO, I would be the first to let you know. Unfortunately, that day has come."

This much is known about the health of Jobs, a legendarily private man: Since 2004, he has been fighting a rare form of pancreatic cancer called neuroendocrine cancer. In January, he took his second medical leave from Apple after undergoing a liver transplant for tumors that had spread to that organ.

Pancreatic cancer expert Dr. Craig Devoe, from the department of medicine at North Shore-LIJ Health System in New Hyde Park, N.Y., said that "neuroendocrine tumors are uncommon, with only a few thousand cases a year."

For those that affect the pancreas, the numbers are even lower with fewer than 1,000 cases a year in the United States. In contrast, there are around 40,000 cases of other pancreatic cancers a year, Devoe said.

Dr. David M. Levi, a professor of clinical surgery, liver and GI transplantation at the University of Miami Miller School of Medicine, said neuroendocrine cancer "is an unusual tumor. It can arise in a number of places, including the pancreas." Such tumors can also start in the lungs.

It's one of the few tumors that can benefit -- to some extent -- from a transplant, Levi said. Jobs' cancer started in the pancreas and then spread to the liver, making the liver transplant an option, Levi said, adding he has treated patients with this type of cancer and done liver transplants.

While the prognosis for neuroendocrine cancer is often better than for the more common type of pancreatic cancer, in which patients generally live less than a year after diagnosis, neuroendocrine cancer "can also be bad," Levi said.

Neuroendocrine cancer can return after treatment, Levi explained. And while a liver transplant can be effective, "it is not as great a picture as we first thought," he said. "A lot of these patients who have transplants eventually do recur."

"The vast majority of patients that have recurrent disease will die of their disease. One of the problems with the [liver] transplant is that now you are on immunosuppressant drugs, and while they keep you from rejection or destroying the liver, the immune system also would have helped deal with tumors," he said.

Weight Loss from Cutting Calories Less than Expected

Common rules of thumb exaggerate how much weight people will lose from a given dietary calorie reduction, leading to unrealistic expectations and disappointment, researchers said.

Whereas patients are often told that cutting 500 calories a day will let them lose a pound a week, a more realistic formula is that such a caloric reduction would lead to a 50-pound loss over three or more years, according to Kevin D. Hall, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Md., and colleagues.

Even then, they explained in the Aug. 27 issue of The Lancet -- a special edition devoted to obesity -- such weight loss is possible only if the calorie reduction is actually maintained over that time.

The standard rules -- endorsed by the National Institutes of Health and the American Dietetic Association, among others -- fail to consider that human metabolism responds dynamically to changes in diet and body composition, Hall and colleagues asserted.

If a 300-pound dieter could really lose a pound a week by cutting his regular diet by 500 calories, he would vanish entirely in six years.

"This ubiquitous weight-loss rule (also known as the 3,500 [calorie]-per-pound rule) was derived by estimation of the energy content of weight lost, but it ignores dynamic physiological adaptations to altered body weight that lead to changes of both the resting metabolic rate as well as the energy cost of physical activity," the researchers wrote.

When people gain weight, their baseline energy needs increase, to keep the extra tissue alive and to move it around. Likewise, when weight is lost, their baseline needs decrease.

So when people cut calories below the baseline requirement -- thereby triggering weight loss -- the gap between their intake and their baseline energy needs begins to shrink. At some point, it may disappear altogether, at which point weight loss stops.

Hall and colleagues put together what they said was a better model of caloric intake and resultant weight loss, incorporating feedback mechanisms to reflect metabolic changes over time in response to diet and body weight.

It indicated that weight change in response to caloric restriction occurs over a relatively long period of time.

Each reduction of 100 kilojoules daily -- 24 calories -- in intake eventually leads to a loss of 1 kg (2.2 lbs) in body weight, the researchers determined. But only half that loss occurs in the first year. In three years, 95% of the ultimate loss will be realized.

Enjoy your morning!

The Morning Drill: August 23, 2011

A collection of dentistry and health related links/comments for your day.

Dentist fined for failing to register X-ray machine

An Exeter Township dentist has been fined for not renewing registrations for his X-ray equipment or paying the associated fees since 2003, the Department of Environmental Protection said Monday.

Dr. Jon M. Kanegawa, who operates a clinic at 4400 Boyertown Pike, is required to pay $13,250 in penalties, according to the DEP.

Kanegawa could not be reached for comment.

DEP inspectors recently reviewed Kanegawa's equipment and determined it was working properly, the release said.

According to the DEP:

Newly acquired X-ray equipment must be registered with the DEP within 30 days. After that, the registration must be renewed each year.

The registration fee covers the cost of inspections.

This is not the first time Kanegawa was faced by the DEP over registration fees.

In 1995, he was fined $1,560 for not paying fees in a timely manner between 1989 and 1994.

He was then accused of not paying fees from that point through 2002. He paid a portion of those fees in 2006.

Falls From Windows Claiming Too Many Children's Lives

For more than 5,000 American children each year, an open window brings serious injury or even death, a new report finds.

And the younger the child, the bigger the odds that a tumble from a window will prove lethal. The study, done at the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, found that children under the age of five were more than three times as likely to die from head injuries sustained in window falls than children aged five to 17 years old.

And even though it's assumed that urban kids are at greatest risk, injuries from window falls occur "throughout the nation in urban and suburban areas," the study authors say.

"We have known for decades about the problem of children falling from windows," said Dr. Gary Smith, director of the center and an author of the study. "Despite the fact that we have known about it, we still have a problem."

Although falls from a window represent a small percentage of childhood mishaps, "they are preventable, and that's why we focus on them," said Smith.

The findings were published online Aug. 22 in the journal Pediatrics.

The 'heart attack proof' diet?

Dr. Caldwell Esselstyn Jr. didn't become a doctor to change the way America eats. He was a general surgeon.

But researching cancer, he stumbled on a fact that changed his career: Certain cultures around the world do not suffer from heart disease, the No. 1 killer in the Western world.

Esselstyn's practice took a dramatic turn -- from performing surgery to promoting nutrition. For more than 20 years, the Cleveland Clinic doctor has tried to get Americans to eat like the Papua New Guinea highlanders, rural Chinese, central Africans and the Tarahumara Indians of Mexico.

Follow his dietary prescription, the 77-year-old Esselstyn says, and you will be "heart attack proof" -- regardless of your family history.

"It's a foodborne illness, and we're never going to end the epidemic with stents, with bypasses, with the drugs, because none of it is treating causation of the illness," Esselstyn says.

The Esselstyn diet is tough for most Americans to swallow: no meat, no eggs, no dairy, no added oils.

Hip Implant Complaints Surge, Even as the Dangers Are Studied

The federal government has received a surge in complaints in recent months about failed hip replacements, suggesting that serious problems persist with some types of artificial hips even as researchers scramble to evaluate the health dangers.

An analysis of federal data by The New York Times indicates that the Food and Drug Administration has received more than 5,000 reports since January about several widely used devices known as metal-on-metal hips, more than the agency had received about those devices in the previous four years combined.

The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.

The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.

Though immediate problems with the hip implants are not life-threatening, some patients have suffered crippling injuries caused by tiny particles of cobalt and chromium that the metal devices shed as they wear.

Hip replacement is one of the most common procedures in the United States and, until a recent sharp decline, all-metal implants — one in which both the artificial ball and cup are made of metal — accounted for nearly one-third of the estimated 250,000 replacements performed each year. According to one estimate, some 500,000 patients have received an all-metal replacement hip.

Enjoy your morning!

Cows, Running and Enjoying the Sport of Running

Lucky for me, I was extremely obese and could not obsess about a really fast race.

What’s running rock bottom? For me, it was being passed by a cow in a half marathon. The cow was ambling beside a fence, and she outpaced me on only about 100 meters. Still, she did it.

Until then, I’d been running for about five years. I was an O.K. runner, better than most. I didn’t expect to be offered a Nike sponsorship anytime soon, but I usually placed in the top three of women in my age group for local races. Prizes included a gift certificate to a taco joint called Macho Taco, a pair of Vibram FiveFingers Shoes and a gaudy trophy with what looks like a man on the top. Nothing fancy, but validation that I was doing something right.

But I let those items get to my head. If I could win those prizes in my first few years of running, what was to stop me from coming in No. 1 for my age group? My times were dropping with every race. I’d never run a marathon before, but I set out to qualify for the Boston Marathon first time out.

Then I got injured. Running — the thing that had been my daily salvation and the only pocket of time in my overscheduled day when no one else could bother me — became a chore. A painful, stabby chore that ended with me eyeing the tail end of a cow.

I thought about quitting. Maybe I’d take up biking. Maybe I’d become one of those power walkers with the bright white shoes who did laps around my town’s park.

I was very lucky that my wife Alice found The Extra Mile Podcast, Kevin who is the host, and the Run/Walk/Run Running guru Jeff Galloway.

Now, I have reduced my obesity some (I continue to diet and wish to reduce another 50 pounds) and enjoy running - but in moderation and according to a Galloway Run Until You Are a Hundred Schedule.

The Morning Drill: August 18, 2011

A collection of dentistry and health related links/comments for your day.

Being Overweight May Take Years Off Seniors' Lives

Elderly people with extra body fat may not live as long as those who maintain a normal weight, according to a new study that contradicts previous research.

In following seniors over an extended period of time and accounting for changes in their weight, researchers found a higher body mass index (BMI), or height-to-weight ratio, is associated with a shorter life expectancy.

"We had a unique opportunity to do 29 years of follow-up with a cohort that was also followed for mortality outcomes," said study lead author Pramil N. Singh, associate professor in the School of Public Health at Loma Linda University, in a university news release. "Across this long period of time, we had multiple measures of body weight, which provided a more accurate assessment."

For the study, recently published in the Journal of the American Geriatrics Society, researchers examined 6,030 healthy adults who never smoked. They found that men older than 75 years with a BMI greater than 22.3 would live nearly four years less than those with a lower BMI.

Similarly, women older than 75 years with a BMI greater than 27.4 would live roughly two years less than other women their age who were of normal weight.

A BMI between 18.5 and 24.9 is considered normal weight. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.

The study pointed out, however, that the negative effects of excess weight kick in for men and women at different BMIs. Men experienced a greater risk of dying beginning with a BMI of 22.3, while this risk did not appear for women until they had a BMI of 27.4.

The study authors suggested this difference may be because in postmenopausal women body fat is the main source of estrogen, which may help protect them from heart disease and hip fractures.

These findings contradict previous studies, which concluded that overweight elderly people live longer than their thinner peers. The authors of the current study said previous findings are limited because they do not account for participants' weight changes over an adequate length of time and consider how these fluctuations in weight might affect their life expectancy.

70% Indonesians have tooth decay: Association

Nearly 70 per cent of Indonesians have tooth decay and yet only 1.6 per cent of them have sought treatment, an association has said.

School of Dentistry Association chairman Eky S. Soeria Soemantry said Tuesday in Jakarta that the figures covered children and adults.

He added that up to 89 per cent of children under the age of 12 had tooth cavities.

"People are reluctant to have regular dental checks because they're afraid it'll hurt and they think it's costly," Eky said.

He said that the modern equipment in dental clinics and hospitals enabled treatment for tooth decay to be relatively painless.

He added that the cost should not be too high if patients visited dentists before the tooth decay became severe, tempointeraktif.com reported.

From omnivore to vegan: The dietary education of Bill Clinton

By the time he reached the White House, Bill Clinton's appetite was legend. He loved hamburgers, steaks, chicken enchiladas, barbecue and french fries but wasn't too picky. At one campaign stop in New Hampshire, he reportedly bought a dozen doughnuts and was working his way through the box until an aide stopped him.

Former President Clinton now considers himself a vegan. He's dropped more than 20 pounds, and he says he's healthier than ever. His dramatic dietary transformation took almost two decades and came about only after a pair of heart procedures and some advice from a trusted doctor.

His dietary saga began in 1993, when first lady Hillary Clinton decided to inaugurate a new, healthier diet for her husband. In a meeting, she asked Dr. Dean Ornish to work with the White House chefs, who were accustomed to high fat, French cuisine.

"The president did like unhealthy foods, and we were able to put soy burgers in White House, for example, and get foods that were delicious and nutritious," said Ornish, director and president of the Preventive Medicine Research Institute in Sausalito, California. Other new menu items included such healthy fare as stir fry vegetables with tofu, and salmon with vegetables.

Even with the revamped White House menu, Clinton battled his weight throughout his two terms as president. At his annual physical in 1999, the White House physician noted the president had put on 18 pounds since a checkup two years earlier. The prescription: refocus on exercise and a low-calorie diet.

Clinton didn't know it, but weight was not his biggest health concern. The 42nd president has a family history of heart disease, and plaque was building up in the coronary arteries leading to his heart, undetected by White House doctors.

Most Physicians Will Be Sued for Malpractice by Age 65

The risk of getting sued for malpractice in any given year ranges from 2.6% for psychiatrists to 19.1% for neurosurgeons, but over a medical lifetime, most physicians across all specialties can expect to face at least 1 lawsuit, according to an article published today in the New England Journal of Medicine (NEJM).

The findings, drawn from the files of a major malpractice insurance carrier with clients across the country, represent more fodder for the ongoing debate on tort reform, a subject dear to organized medicine.

Physicians in the 5 least-sued specialties — psychiatry, pediatrics, a category called "other specialties" in the study, family medicine, and dermatology — have a 75% chance of getting sued by age 65. The odds increase to 99% for physicians in the 5 most-sued specialties: neurosurgery, thoracic cardiovascular surgery, general surgery, orthopaedic surgery, and plastic surgery.

Despite physicians having a high lifetime risk for malpractice litigation, most plaintiffs do not receive a payment in the form of a settlement or jury award, write lead author Anupam Jena, MD, PhD, from Harvard Medical School, Boston, Massachusetts, and coauthors, echoing what other students of medical liability have found. On a yearly basis, 7.4% of all physicians are hit with a malpractice claim, but only 22% of these claims lead to a payment. Through age 65, physicians in the low-risk specialties run a 19% risk of facing a suit that pays off for the plaintiff, compared with a 71% risk for the high-risk specialties.

The size of average payments across specialties also was all over the map, ranging from $117,832 for dermatologists to $520,923 for pediatricians. However, this variability does not appear related to how often a particular specialty is sued. Neurosurgeons, for example, are roughly 6 times more likely to face a malpractice suit than pediatricians, but their average payment of $344,811 is substantially lower.

Enjoy your morning!