Quotes of the Week

Caffeine Consumption
The risk of caffeine consumption causing a spontaneous abortion abortion during pregnancy has been controversial. In an article by Mark A. Klebanoff M.D,et al. in the Nov.25th, 1999 issue of The New England Journal of Medicine, they used a metabolite of caffeine, paraxanthine, to measure significant consumption of caffeine during pregnancy and found only very high levels of paraxanthine were associated with spontaneous abortion. It was their opinion that a moderate intake of caffeine was not likely to stimulate an abortion.
     Ed. This is a significant study since it measures objective evidence of caffeine intake rather than relying on subjective questionnaires. This supports the maxim that moderation is a key to success.

In an abstract in the Nov.24th ,1999 issue of The JAMA it was reported that there was an increased rate of lung cancer in non-smoking females when they were exposed to indoor air pollution from Chinese style cooking. This was based on a study of a population based Cancer Registry in Shanghai. Furthermore this risk was increased by cooking with un-refined rapeseed oil (canola oil) at high temperatures.
     Ed. This is further evidence of the cancer causing effects of inhaled hydrocarbons.

In the Nov.24th, 1999 issue of The JAMA a report from the Public Health Advisory was published showing the causes of childhood death (Age 1-11) in the United States in 1995. Homicide accounted for 14% of the deaths, suicide 7%,cancers 7%,congenital defects 5%,and unintentional injury 41%. Uncategorized deaths were listed as 25%. The deaths in the unintentional injury group were significantly related to alcohol. (drunk driving while the child was a passenger)
     Ed. This is a very important report and should be extensively studied by Public Health Organizations that have some influence on this segment of our population. A significant percentage of the three groups: homicide, suicide, and unintentional injury; could be prevented.

John S. Hong and colleagues presented an interesting paper in the Nov. 1999 issue of The American Journal of Medicine. They wanted to know if patients really wanted an antibiotic when they went to the doctor with an upper respiratory infection. The premise of this study was that most upper respiratory infections are caused by a virus yet about 60% of patients visiting a physician are given antibiotics. This uncalled for use of antibiotics predisposes to antibiotic resistance. Their study suggests that physicians can satisfy their patients if they provide them with medications and then explain that this medication will make them feel better and relieve the patient of the symptoms associated with the infection.
     Ed. If patients understood that antibiotics are not indicated in viral infections unless there exists a severe underlying medical; condition such as emphysema this would aid this approach. Physicians need to educate their patients in this regard. The study shows that the patients are amenable.

At the annual meeting of the American Academy of Otolaryngology. (ear, nose and throat) Head and Neck Surgery Foundation the latest information on laser treatment of otitis media (middle ear infection) was presented. Its proponents were quite high on this procedure which makes a small hole in the ear drum to promote drainage as opposed to tube placement conventionally used to drain fluid from the middle ear. The laser procedure can be done in the doctor’s office with topical anesthesia whereas a general anesthetic with hospitalization is required for tube placement. The cost is less for the laser procedure and its proponents also cite the decrease in antibiotic requirements as a plus.
     Ed. There were some critics. Most of them wanted more data before embracing the technique which could significantly reduce the estimated 24 million annual visits to pediatricians with a 5 billion price tag on diagnosis and treatment not to mention lost wages costs for the parents of these children.

"I have changed my ministers, but I have not changed my measures; I am still for moderation and will govern by it."
     - Anne, Queen of Great Britain (1665-1714), to members of the new Tory ministry, Jan. 1711

"Where more is meant than meets the ear"
     - John Milton (1608-74), English poet

Take care until next time,
RJT, Editor.

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