This past Friday, FDA officials stated that less than 1 part per million of the industrial chemical melamine found in infant baby formula is safe. This announcement came after trace amounts of the industrial chemical were found in U.S. formula, and it came two months after 50,000 infants were sickened in China from large amounts of it being put directly into milk. 

The FDA had previously not set a safety limit.                                

Doing so now, with no recent research to back this conclusion, makes no sense.

While I don’t think the amounts found in the U.S. should be sufficient to scare mothers away from formula (esp. those who aren’t able to breast feed), I am very concerned about the FDA’s continued inability to properly police our food. Also, the precedent of allowing ANY amount of this chemical to reside in our food is wrong.

- What is melamine? Melamine is a white powder used in plastic-making. It was first synthesized by a German scientist in the 1830s. Its most common form is melamine resine, a mix with formaldehyde, where it used in the manufacture of formica, floor tiles, whiteboards, and kitchenware. Adding melmine to watered-down milk makes its protein level appear higher because it is high in nitrogen. Criminal merchants use this process to fool inspectors.

- Why the concern? Melamine can be harmful. Since it was discovered in infant formula in September in Asia, more than 50,000 infants have been sickened and 4 have died. It has been tested in animals in small amounts and found not to be toxic. But in high amounts it can be toxic to the kidneys and urinary tract, causing  stones and blocking ducts, manifesting with bloody urine, especially when it mixes with another cheaper chemical, cyanuric acid. Cyanuric acid (a chemical stabilizer in swimming pools) is also used to falsely raise protein content in milk and infant formula, to make them look protein rich.

- Should parents be alarmed? Parents should always be cautious, but the chances of currently available formula causing a problem in your infants is very low.

- What should the FDA do? The melamine problem is a wake-up call to the FDA to set more precise standards and to back them up with increased regulation of products, esp. those coming into the U.S. from other countries. With our current economic troubles, it would be nice to see domestic production favored, especially when the chances of a toxic chemical originating here and going undetected is far less likely. The melamine-contaminated infant formula now found in the U.S. likely originates from a powdered milk ingredient from Asia.

- Is the FDA effective? Keep in mind that there is no real purpose whatsoever to have melamine in food except to fool inspectors. The FDA has been inconsistent and ineffective on melamine risk. The agency needs more teeth - more regulatory power and a larger staff to implement it.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

This past Thursday, Attorney General Mukasey was delivering an impassioned speech when (as news videos show) he began to hesitate, his words slowed, he shook slightly, his head went down and he crumpled to the ground.  He reportedly lost consciousness, but was awake a few moments later. This is known as a syncopal episode, which is a transient blackout usually accompanied by falling, and followed by a prompt recovery.

The most common cause of syncope by far is a faint caused by a slowing of the heart rate and insufficient blood flow to the back of the brain. This is also known as a vasovagal episode and is often brought on by stress or feeling hot, which appears to be what happened to Mukasey. 20-50% of adults experience at least one blackout in their lives, and the percentage increases to 75% over the age of 70. Mukasey is 67.     

He was brought to the hospital, and in fact 6 % of all hospital admissions are due to syncope. He was observed and monitored overnight, and tests (including stress test, CT and MRI of the brain) were all negative, confirming that this was likely a faint and not a stroke or heart arrhythmia. TIA or transient ischemic attack, (warning signs of a stroke that lead to an actual stroke 1/3 of the time), seemed more and more unlikely.

I think there are three important lessons in Mukasey’s sudden blackout. A man in good health, who exercises regularly, he returned to work the following day:

1) We in the media are sometimes too quick to jump to the worst possible conclusions. As soon as Mukasey blacked out, early news reports were speculating stroke, when in fact the most likely explanation was a faint.

2) Expert medical training is important to distinguish between benign and more concerning symptoms. A good neurologist takes a comprehensive history and conducts a comprehensive exam before ordering tests. A good neurologist could tell that Mukasey’s symptoms - despite appearing scary were likely benign.

3) At the same time, it is important that if you do black out, that you seek medical attention right away. A disturbing number of patients ignore a faint and refuse a workup. But a thorough syncopal work-up, such as the one Mukasey had, can sometimes show that a blackout is not due to a simple faint.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

A few years ago, with my LDL cholesterol pushing 125, I decided to start myself on Lipitor with the approval of my own internist. Despite the fact that my father has heart disease, I knew that I was in the category of patients where there were no clearcut guidelines. In fact I knew at the time that most cardiologists would probably say that I was jumping the gun and erring on the side of overtreating. But the latest research would suggest that I was probably right.

As most of my readers know by now, a new landmark study just published in the New England Journal of Medicine, Known as JUPITER, looked at more than 17,000 healthy men and women at multiple centers in the U.S. and Europe with normal cholesterols (LDL less than 130 mg/dl) but with elevated C-Reactive Protein levels. Many scientists believe that high levels of this protein correlates with a high risk of heart disease, though there is by no means a consensus on this.

Previous studies who shown that patients with multiple cardiac risk factors have less heart attacks and strokes when taking a statin drug, but this is the FIRST large study in people with relatively normal cholesterol where taking a statin dramatically affected outcome.

The JUPITER trial was stopped after 2 years because the results were so dramatic - there were half as many heart attacks and almost half as many strokes and unstable angina in the group which received Rosuvastatin (Crestor). I’m sure that these results will lead more doctors to prescribe more statin drugs, expecially Crestor. But the real question is, who should receive the drug and who shouldn’t? Detractors of the study will point out that Astra Zeneca, which makes Crestor, was a sponsor of the study and that it was only two years long. But this doesn’t take away from the dramatic results.

Patients and their doctors who have previously been very conscious of muscle aches that they ascribe to the drug, or are now aware of the possible slight increase risk of diabetes that the study detected, will still have to consider the fact that Crestor and likely other statin drugs appear to dramatically decrease cardiac risk. Here is my take:

*  I will have a much lower threshold for prescribing statin drugs, especially in patients older than 50. (the study looked at men in their 50s and women in their 60s).
*  I will be more inclined to prescribe statins for primary prevention (patients who have no known heart disease) on the basis of cardiac risk factors (family history, smoking, high blood pressure, etc) even when their cholesterol is only mildly elevated (LDL cholesterol between 110 and 130).
*  I will follow CRP levels in patients over 50 years old, especially in those with cardiac risk factors, but I continue to reserve judgment on the specific significance of these results.
*  I will continue to emphasize diet modification, stress reduction, and increased exercise as mainstays of primary prevention of heart disease.
*  I will be glad to see further longer studies on statins, though I recognize the importance of JUPITER.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

No matter how many studies suggest that testosterone, the hormone of sexual desire for both men and women, can help overcome a decreased libido, I will still be a fan of romantic dinners.  

Recent studies revealed that 25-50 percent of women have a low sex drive. I suspect that stress, dealing with diapers, lack of sleep and selfish mates have as much to do with this as an ebb in hormones. Nevertheless, in the wake of these findings, a new study, just published in the prestigious New England Journal of Medicine, has found an increased rate of “satisfying sexual episodes” in postmenopausal women who used a 300 mcg testosterone patch.

At a time when reproductive hormones are falling (post menopause), it is not surprising that a little testosterone goes a long way to rekindle the flame. But there is a clear cost. Testosterone can increase facial hair, muscular development, and even give you a lower voice. So, you may feel like having more sex, but you may look more like a man which could turn your partner off. Plus, there are the longer term risks to consider including potentially breast cancer, heart attack, or stroke.    

Testosterone patches are not approved for this use by the FDA, though they have been prescribed as sexual enhancers for women “off-label” for many years. An FDA advisory panel has considered them as recently as 2004, but rejected  them on the basis of safety issues. I’m sure that Proctor and Gamble, which manufactures the Intrinsa testosterone patch, and provided research grants for the current study, aptly named APHRODITE, will now expect the FDA to reconsider the issue, based on the study’s positive results. But safety is still an important issue. 4 of the study participants who received the patch as opposed to the placebo - were diagnosed with breast cancer. The long term risk of heart attack and stroke has still not been sufficiently studied, and remains a major concern.

I am not yet an advocate of these patches, though I know many other knowledgeable doctors who are, and have found them to be quite effective. For these doctors I would say that if romance isn’t the answer, that perhaps they are being reasonable to consider prescribing the patches on a case by case basis, even while I have my eye on the need for further research.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

Conventional wisdom has always been that Emergency Rooms are stuffed to overflowing by the uninsured. Without a regular doctor to go to, most health experts say, those without health insurance have little choice but to flock to the ER with the slightest sniffle or fever. An ER visit is quite expensive, but how many of the uninsured end up either receiving or paying these bills?     

When the Centers for Disease Control and Prevention reported that the number of visits to emergency rooms nationally rose 19% from 1995 to 2005, even as the number of hospital ERs fell by 9%, most experts continued to believe that it was the uninsured who were clogging the shrinking ERs. As hospitals relocate to the suburbs, a growing trend, they would likely be dealing with a growing number of insured patients, potentially leaving behind the uninsured blocking their ambulance bays with minor complaints.

Is conventional wisdom correct? Apparently not.

A new study published in JAMA this past week has suddenly called the conventional wisdom into question. The study reviewed 127 articles from 1950 to 2008 and determined that “available data do not support assumptions that uninsured patients are a primary cause of ED overcrowding, present with less acute conditions than insured patients,or seek ED care primarily for convenience.”   

According to this study, uninsured patients are far less likely to visit the ER for non-urgent care than insured patients. 17% of Americans are uninsured, but they account for only 10-15% of ER visits.

What are the likely reasons for this trend?

* Today’s managed care type of health insurance doesn’t give you instant access to your physician for minor problems. There are fewer primary care doctors these days. Unable to get an appointment or timely visit, you may turn to the ER.
* Whereas the uninsured could get hit with a large bill contrary to popular wisdom, on the other hand, an insured patient will only have to deal with the co-pay.
* Uninsured patients may not be in the habit of seeking medical care for minor complaints, whereas health insurance without deductibles may encourage or support hypochondria, or worry that leads to an ER visit.
* Laws keep the ER from turning you away, so if you have insurance, you will be seen and you won’t have to pay for it.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

The National Institutes of Health recently published an interesting study in the “BMJ,” where they approached 1,200 internists and rheumatologists about what they called “placebo treatments,” where patient expectations rather than an expected physiological response was the rationale for the treatment. Only 679 physicians responded, which limited the conclusions, along with the design of the study itself, as this type of survey is a weak form of science. Nevertheless, the results were disturbing - about half of the responding doctors indicated they prescribed these kind of treatments on a regular basis, and more than 60 perecent believed there was no ethical problem in doing so. It has long been known that cures and responses to treatment can be affected by a patient’s mental attitude and expectation, and that healing itself involves suggestion as well as chemical intervention.

But I find these results deeply disturbing for the following reasons:

1) Most of those surveyed were not using sugar pills or harmless salt water, they were using medicines with potential side effects. These included over-the-counter analgesics (41percent), vitamins (38 percent), sedatives (13 percent), and antibiotics (13 percent).

2) More than 90 percent of upper respiratory infections are viral, yet physicians are knowingly prescribing antibiotics to meet patient expectation.

3) Patients are fueled to ask for pills because of advertising, the Internet and a culture of instant gratification.

4) Physicians are motivated to provide a quick fix rather than a more elaborate explanation which could eliminate the need or urge for the treatment. A study published in the “Annals of Family Medicine” published in 2005 concluded that physicians only spend 55 percent of their time in face-to-face patient care. In this environment of 5 to 10 minute office visits, it is often easier for doctors to provide a quick placebo treatment rather than a more elaborate diagnosis and explanation.

5) This is a survey of doctors, but it is highly doubtful to me that patients would be satisfied with this approach. I suspect that a similar survey of patients would reveal that less than 10 percent of patients believe that it is okay for placebo treatments to be given for deceptive reasons, with false expectations. I suspect that most patients would like an interaction with their doctor to be completely honest and based on full disclosure.

Do my readers agree?

VIDEO: Watch Dr. Siegel Talk About The Placebo Problem

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

Here in America, we’ve become a society so worried about skin cancer, that we’ve overlooked some of the good things that the sun provides for us. One of those things is an improvement in our mood. Another is Vitamin D. But Vitamin D is also obtainable through food including oily fish, eggs, fortified cereals, milk and orange juice. It can also be taken as a pill or liquid supplement.

Vitamin D works directly on the cells in the body, affecting metabolism the way a hormone dose. It is an extremely important vitamin, and we are finding out just how important with each new study. Deficiencies can lead to bone softening disease (rickets short term, or osteoporosis long term), dementia, heart disease, diabetes, Multiple Sclerosis, some cancers, autoimmune diseases, and infections.

As we lather ourselves and our children with sunscreen, we increase our deficiencies. A recent study from Children’s Hospital in Boston revealed that 40% of infants were lacking in Vitamin D. Those especially affected had darker skin which interferes with absorption, or are from the Northeast, where there is less direct sunlight.

But the solution to the growing Vitamin D deficiency problem in our children is NOT to expose them to more sun. Supplying a liquid supplement by mouth is just too easy. The American Academy of Pediatrics has just wisely doubled the recommendation for infants and children to 400 IU daily. This amount is completely safe, and is the amount of Vitamin D found in a liter of infant formula.   

The problem, believe it or not, is worse for mothers who are breast feeding. When was the last time you heard a doctor say that breast milk was deficient in anything? The problem may come from mothers not having enough Vitamin D, which is then lacking in their breast milk. It may be easily correctable by administering supplements to breast-feeding mothers rather than their infants, but this has yet to be studied. In the meantime, the Boston study showed 10 times the amount of Vitamin D deficiencies in infants of breast feeding mothers as compared to those who used formula feeds. This is a huge discrepancy, especially when you consider how easy it is to supplement this essential vitamin.

So use sunscreen on your children’s skin, but at the same time consider giving them a daily drink of Vitamin D.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

With Halloween approaching, kids will soon be considering bright orange cupcakes and otherworldly candy. Though I am all for limiting artificial ingredients in favor of more natural dyes from carrots and beets, at the same time, it is difficult to prove that artificial colors are unsafe.
   
Many studies have been done which have NOT shown an association between food dyes and hyperactivity in children. The FDA has previously stated that these dyes are safe based on a 1980s report. A 2004 study from Schwab at Columbia reviewed available data and concluded that neurobehavioral changes may be due to artificial food colors. BUT a clever 2004 study in the American Family Physician showed that parents perceived a difference in behavior after kids tasted artificially flavored beverages, whereas independent observers did not. So it appears that the parents were either not trained to judge hyperactive behavior, or possibly biased.

A year ago the flood gates opened when the reputable British Journal Lancet published a study which looked at 153 3-year olds and 144 9-year olds and game them drinks containing either artificial colors or placebo.  They were then assessed by parents in terms of concentration, fidgeting, and restlessness. After this study came out, the UK Food Standards Agency asked manufacturers to pull the synthetic colors involved in the study. Here in the U.S., the Center for Science in the Public Interest is now petitioning the FDA to demand that 8 synthetic blues, yellows, greens, reds, and oranges be removed from the market. Yet the current evidence would still appear to be flimsy at best.

BOTTOM LINE: To draw a conclusion on this seemingly conflicting information, I turned to director of the NYU Child Study Center and world expert in Attention Deficit Hyperactivity Disorder, Dr. Harold Koplewicz. “There have been multiple studies,” he said. “There is no evidence that the artificial colors effect children.”

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

Watching the worried pundits on the FOX Business Channel for the past few weeks, I’ve been wondering, medically speaking, what the solution is going to be for all the stress that is sure to result from our flailing economy. It has been well documented that stress, including the financial kind, can lead to heart attacks, strokes, depression, suicide, and certain kinds of cancer.     

But as often is the case with health, a complex problem may lead to a simple solution. Coincidentally, in the middle of all our worry, a new study was published that shows the positive effects of touch.

*  A new study from Utah researchers published in Psychosomatic Medicine shows that warm touch decreases stress hormones and lowers blood pressure. The study looked at married couples ages 20 to 39 in their own environment and found that massage, touch, hugging, kissing, had these effects and also increased the calming hormone oxytocin. A key positive feature of this study was the non-laboratory setting. Criticism of previous studies on stress and touch have included concerns about the artificial environment of the laboratory.

*  According to the American Hospital Association 37 percent of hospitals in the U.S. use complementary and alternative treatments including touch therapy. This policy is growing, and may help improve disease outcomes.

*  Previous studies from Miami (Touch Research Institute) show that massage and relaxation therapies enhance mood and immune function for women with breast cancer. The institute has also published data revealing faster growth in premature babies, a better tolerance of pain, lower glucose level in diabetic children who were frequently touched.

*  Another interesting study from Virginia showed a decrease in fear, danger, and threat responses in the centers of the brain when women touched the hands of their husbands while experiencing pain.

* Petting dogs has been shown to be calming, to lower stress, and to have a positive impact on immune function and the fight against disease.

I am advocating touch as a treatment for stress, but there is a downside. Of course touch increases the risk of spreading many bacteria and viruses. And with cold and flu season right around the corner, I am compelled to add that while you are hugging and stroking to compensate for your worry, make sure to wash your hands afterward.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

Sometimes looks are deceiving. Not so in the case of Senator McCain’s healthy appearance during the first presidential debate this week.

Back in May, Carl Cameron and I joined a group of journalists in Phoenix, Ariz., and I looked closely through the 1,000 plus pages of McCain’s health records. One thousand pages may seem like a lot, but they include hundreds of pages of administrative documentation not directly related to healthcare. In addition, there were hundreds of pages that documented careful screening rather than actual disease.

The records revealed a vigorous man in good health. He has borderline blood pressure and a history of kidney stones, for which he takes a diuretic. His cholesterol is elevated, and he is taking an effective statin drug (simvastatin) for it. Several of his physicians attested in the records, and again during a phone conference call, to his very high pain tolerance. He has had two procedures done on his right arm, and his shoulders, both of which were fractured when he was a POW. Healed without treatment, his right shoulder was in a deformed position.

Here are some key points that attest to Senator McCain’s current state of good health:

- A 2 cm melanoma in 2000 was removed with surgical pathology showing NO spread. Thirty-three lymph nodes were removed and were ALL negative including the highly predictive seminal node. Staging was II B because of the size and depth, and the chance of recurrence now is likely less than 10 percent.

- Other SUPERFICIAL skin cancers include a superficial melanoma in 1993, a preliminary (in situ) melanoma on the left arm in 2000, a basal cell in 2005, and a preliminary (in situ) squamous cell in early 2008. ALL were removed without incident.

- An Echo stress test in March was excellent. McCain showed great exercise tolerance and his heart was normal.

- A colonoscopy, also in March, showed benign polyps.

- 2008 office visits showed normal blood pressure, and labs were unremarkable.

Senator McCain is close to his ideal weight, at 163 pounds. I think that fact, as well as the aspirin and cholesterol drugs he takes, and the fact that his skin is so carefully screened by Mayo Clinic in Phoenix, Ariz., are predictive that he will remain in very good health. Like Obama, he is a former smoker, but he hasn’t smoked since 1980. 

These days, thanks to modern medicine, linear age isn’t the only factor that predicts health. My advice to a vigorous Senator McCain is to continue the long walks but to stop the candy bars.