Soy products and nutrition and cancer: Conflicting messages

June 6, 2013

One of my granddaughters is allergic to cow’s milk. I saw effects of such allergies decades ago when a nephew was born with severe allergies to cow’s milk and used goat’s milk. My granddaughter used goat’s milk for awhile but seemed to develop an allergic reaction to it as well. Not as severe as cow’s milk but not waiting around to make that happen…

What about soy milk, my son asked. I have read some of the research and debate surrounding soy and phytoestrogens and cancer. But I never read anything specifically about infants. So I searched and read a number of pieces written. I want to recommend this one written by a pediatrician: http://www.babycenter.com/404_is-it-safe-to-give-my-toddler-soy-milk-if-she-wont-drink-cow_1200425.bc

In a nutshell, the author notes various deficiencies in soy milk that need to be address, such as its lack of B12, and the importance of buying whole soy milk to obtain the fats necessary for brain development, and the importance of having soy milk that is fortified with vitamins A & D, as well as calcium.

The pediatrician does not address the phytoestrogen controversy directly but observes that there is no research linking adverse outcomes to children.

Another alternative is coconut milk. While I could not find any research or pediatrician discussing this as an alternative, I did find a site with a pretty complete discussion by moms, including moms who used coconut milk for multiple kids who are into adolescence now and still drink it. Coconut milk has they say a lot of good fats in it but lacks calcium and protein.

My son asked specifically about Asian diets rich in soy and the health benefits. I have worked closely with Asian graduate students over the past two decades and have come to understand that how they consume soy is quite different from what we think of. Our grocery stores offer tofu and soy milk as mainstays in soy products. Soy in Asian diets takes on different forms and is often fermented in miso, tempeh and natto. Soy milk and tofu are highly-processed soy products. So it appears that one part of the conflicting messages relates to the form that soy takes. More processed forms, as with so many food products, do not offer the same health benefits as less processed.

The Affordable Care Act and part time employment

June 1, 2013

…thanks to Darci Slaten for this picture…

One of the most gifted undergraduate students I’ve had in a Penn State health communication classroom is crossing her fingers that she will get a job she has interviewed for. I am hopeful for her as well. An odd thing about the job is that it is for less than 30 hours a week. I also have a nephew who recently started a new job at a sandwich shop. He loves the work. And he too is being employed for less than 30 hours a week. Neither was looking for part time work. And it does make me wonder. Could it be the Affordable Care Act’s rule that companies with 50 or more employees be required to provide health insurance to employees–except if they work less than 30 hours a week.

I don’t know the answer to this question. I haven’t talked to my nephew’s employer and the question doesn’t fit into a conversation as a reference for a former student. I do wonder about risk data relating to part time employees and projecting the cost for health care.

State laws covering workmen compensation do cover part time employees. If my nephew is hurt on the job–let’s say, for example, cuts off the tip of his finger with a meat slicer or gets a hand caught under a heavy bread tray and breaks a finger–workmen’s compensation will require his employer to pay the medical costs related to the accident and cover wages for the time he cannot work. So, that is a relief. But what it won’t cover is time off or care for the flu or a bad cold.

Looking at the issue from a public health and public good perspective: Do we unintentionally incentivize ill workers to come to work when we adopt policies that won’t cover their care or give sick leave benefits? Do we pose other risks to the public besides exposure to ill workers when we move toward part time employment, risks associated with the experience one gains from being on a job full time, for example?

The federal sequester and health communication

February 28, 2013

Little else dominates the news right now besides the sequester. I have to wonder if anyone has calculated the costs associated with calcuating the costs of cuts linked to the sequester. Here is just one example: http://astho.org/Advocacy/Sequestration-Fact-Page/ The Association of State and Territorial Health Officials has taken the time from their already overloaded and underfunded docket to explain the effects of the impending cuts as envisioned. The picture is not pretty.

Besides the lost dollars and lost work hours, the lost productivity across all kinds of spheres associated with this ‘event’ relates to emotional tolls and the anxiety within families created by such uncertainty. These events turn into physical and mental health problems, including diseases associated with stress and depression. Interpersonal violence increases in personal and social relationships.

I hardly know what to say. From an ethical perspective, the dilemma linked to distorting and manipulating information for so long leaves so many with feelings of distrust. I like a good debate probably even more so than the average citizen, but the time is long past for beating the drums of authority and power, and instead to lead by example.

Health Communication, Health Literacy, and the Affordable Care Act

November 8, 2012

If you are like me, you imagine a time when you will be less ‘scheduled’. This has been a time of being over-scheduled in the past half dozen weeks. I have a pile of topics I want to discuss relating to communicating about health. And too little time to do so.

One of the topics that keeps coming through my piles relates to an article written by Stephen A. Sommers and Roopa Mahadevan that was commissioned by The Institute of Medicine–IOM–and published in October 2010. I came across it when preparing to talk about health literacy and health communication with my undergraduates last year. It has been shuffling about on my desk since then. Today is finally the day I will share my thoughts about it.

First, the relationship between health literacy and health communication that I discuss with my undergraduates in a ‘designing health messages’ course is two-fold. On the one hand, low levels of health literacy, meaning the audience is unlikely to understand many health and science terms or be able to use math and statistics to make decisions–suggests that health communicators, whether they are public health program planners or medical doctors, should adapt their communication so that it will be understood, and informed decisions can be made based on an accurate understanding. A great deal of health communication message design research and practices focuses on this effort, working to assure that knowledge gaps do not become wider between more and less educated audiences, for example.

The second issue related to health communication and health literacy relates to efforts to improve health literacy. In other words, how could we communicate to motivate someone with low levels of health literacy to become excited about learning more vocabulary and applying more statistics in making choices about health?

Addressing both health literacy issues in health communication is the ethical thing to do. Knowing that someone does not understand health vocabularies or may be embarrased to ask questions when they do not understand places a responsibility on the health communicator to adapt. Knowing that high levels of health illiteracy uniformly exist in the U.S. suggests that health communicators ought to be involved with improving the situation across the many contexts for talking about health.

Stephen A. Sommers and Roopa Mahadevan open their paper with the statement that the Affordable Health Care Act does not address low health literacy directly. BUT–they assert–the law cannot be successful unless national efforts strive to address low health literacy. Health literacy is mentioned in the ACA in relation to research dissemination, shared decision-making, medication labelings, and workforce development. “All four suggest the need to communicate effectively with consumers, patients, and communities in order to improve the access to and quality of health care” (p. 6).

So there we have it. If we are to achieve the aims associated with the ACA, including improving the population’s health and bringing health care costs under control, we will only achieve these aims through communication that adapts to and accommodates low levels of health literacy while motivating citizens to improve their health literacy.

Health communication and IOM paper findings about how to discuss medical evidence

September 26, 2012

I have talked often about the importance of evidence to guide our informed decisions about health. A new paper from the Institute of Medicine discusses how to talk about medical evidence [see http://www.iom.edu/Global/Perspectives/2012/~/media/Files/Perspectives-Files/2012/Discussion-Papers/VSRT-Evidence.pdf].

One of the interesting issues considered addresses ways that language relates to patient confidence about evidence and health care. 1,068 US adults were surveyed to answer this question: 71% were White, 48% male, 46% 55 years of age and older, 55% rated themselves as in ‘very good’ or ‘excellent’ health, 62% were not living with any chronic condition, 88% had health insurance, and 36% usually or always bring a list of questions with them to ask their doctors.

The summary of findings is in Table 1. ‘What is proven to work best’ was found to be the phrase leading to the greatest level of confidence, 79%–in the evidence used for their health care.

I wonder, given that so many come prepared to ask questions, if the participants would ask any questions about the evidence. Things like ‘is the evidence based on someone my age, my biological sex, or my race/ethcnity?’

I wonder, too, about the levels of education for this group. IOM has convened panels to write reports about health illiteracy in this nation. What does ‘evidence’ mean to the large percentage of adults in the US who are health illiterate? What does ‘evidence’ mean to this group of mostly white, mostly insured, and very healthy personal advocates [they ask a lot of questions on their own behalf] participants?

Hopefully, the responses do not become scripts for medical interview education.

The paper also makes ‘evident’ that US health consumers want their personal goals to take a priority in conversations about their health with health professionals. So, we need to understand what goals the patient has about the ‘evidence’ being used to guide decisions. Is it their goal to understand more about what makes up medical evidence? If so, I am not ‘confident’ that this advances that aim.

Health communication about eating sugar and wrinkles

August 29, 2012

Another one of those incomplete messages came my way. I was reading again while waiting for a meeting. And the headline was ‘Face facts about sugar.’ There it was. A statement, with no link to the published medical research and no mention of a journal it was published in. The magazine is a 2012 one. But when I went to search for research related to the idea that “Consuming sweets can damage skin’s collagen”–the article’s claim–I found research that was published in 1998 and conducted on male rats [see http://jn.nutrition.org/content/128/9/1442.short]. OK, interesting. But it seems worthy of at least a descriptive study in humans. And worthy of including female humans. While we might not want to volunteer for a randomized clinical trial in which we get assigned to a group that eats, let’s say, the amount of sugar that is ‘average’ or eats no sugar at all, it seems like there may be some ‘natural’ study groups out there to observe and survey. Folks who simply don’t eat sugar or eat very little sugar. Let them provide photos of their faces, or some lab work relating to collagen levels. Compare the results to a group that eats more ‘normal’ levels of sugar. Factor in whether they are male or female, how old they are, and a few of the other correlates related to collagen–such as lifetime sun exposure [see, for example, http://www.ncbi.nlm.nih.gov/pubmed/8642084]. It would be interesting to ‘see’ if there are differences in the appearance and would give us some actual ‘human’ face facts.

Health communication about BONIVA

August 25, 2012

“BONIVA has not been proven to stop and reverse bone loss in 9 out of 10 women and is not a cure for postmenopausal osteoporosis” [http://www.stategazetteftp.com/mags/parade/Pg_07.pdf]. This message has appeared in numerous magazines and newspapers. Have you seen or heard it?

I wonder how Sally Field feels about that. She appeared in ads to endorse the product and she read the script that said the research had shown that BONIVA reversed bone loss… I will track down the research and see if we can find what the published research really found. For now, I am reflecting on how many of us heard Sally’s ad versus how many of us have seen or read about the FDA’s retraction. And I am enjoying having the strength, including my bones, to pick up my 4 year old grandson and wrestle him into my lap for a family gathering at a restaurant after church on a warm Sunday afternoon.

When is reading a mammogram like looking for a polar bear in a snowstorm?

August 9, 2012

When you have dense breast tissue… at least, that is what some physicians say [go here, for more: http://www.womentowomen.com/breasthealth/densebreasttissue-mammograms.aspx ].

It has been 15 years since my annual mammogram led to a callback from the doctor for more x-rays and then a needle biopsy and finally ‘the all clear’ — no sign of cancer pronouncement. But it happened again last week. I got my annual mammogram on my way out of town to go to Atlanta for a visit with my daughter and granddaughter and son-in-law. And the day after I had the screening, I got a message on my home machine to call for a return visit…

Things have changed in the last 15 years, of course. Now, digital mammography makes some things more likely to be seen on the x-ray compared to film. Go here for a comparison: http://www.umm.edu/breastcenter/digital_mammography.htm?gclid=CNbCiKu_27ECFUlnOgodsH4A_A

At any rate, I returned to the imagery center for more x-rays. Here is how the communication went. First, it was nearly impossible to understand the message on my answering machine. My husband and I listened to it a half dozen times. We looked up the phone numbers of the imagery center, and none of them matched what we thought we were hearing. Nonetheless, I wrote what we thought they were saying and tried the number. It rang out to a message saying that it was long distance. Not likely then to be what I needed to call. Next, I tried calling the number using the first 3 numbers that all the numbers online for the imagery center used. And the last 4 numbers we thought the caller was saying that appeared nowhere in the online listing. Success. I got a nurse who checked and said, “When can you come in?” And I made an appointment for the day after I would return from my visit, which was a week after the first mammogram.

I went to the imagery center, this time with my husband coming in. The volunteer greeted me with, “Oh. I am so sorry.” Yikes. Not what you want to hear. She remembered me from the week before because we had a long chat about my height. At any rate, I would venture to say–“so sorry” is not quite the right expression in this situation. Perhaps “sorry you have to come in for more tests” if ‘sorry’ is to be used at all. The expression and her empathy were, however, unsettling.

Once I was in the room with the x-ray technician, I encountered the other end of the spectrum. The communication was reactive rather than proactive regarding what she wanted me to do. “Put your arm up and grab the handle? I did. “No. Turn this way. Face the machine.” Her tone was irritated. Wow. It is 9:30 in the morning. Why is she so grumpy? I am the one getting my boob smashed again.

She sighed. Letting out a clear expression of annoyance, she said. “Stick your bum out.” Who talks like that? “No. Look at me– Like this–” she said as though talking to someone she regarded to be extremely stupid. Finally, she was satisfied.

Time for another image. She turns me a bit and I try to enact what I have learned. I stick my bum out. “No.” she says harshly. “Stand up straight.” My arm began to quiver. Unavoidably uncertain about what I was doing wrong. Several more images and abrupt commands later, we were done.

“Will the radiologist come in here to discuss these with me?”

“No. Wait in the waiting room. I will get you when he is ready for you.”

I asked the volunteer if she would get my husband when I got called to the radiologist meeting. She told me to ask the technician to do it. So, when the technician came to get me, I asked her. And she did. No attitude. Wow!

And then there was the radiologist. I don’t think he could have been nicer or clearer. He put two pictures up on a screen and pointed to a small round dark spot about the size of a pellet for a BB gun. “This is what we’re looking at that’s different,” he said. “All this is your muscle and dense breast tissue.” It all looked like a lot of snow to me but I could see the BB…

“We’re going to do an ultrasound to see what we can learn about that spot.”

“What will the ultrasound tell you?”

He launched into a helpful answer that I will summarize as, ‘if the sound waves go through the mass, it’s a cyst. If they don’t it may be something we need to take a look at.’

The sound waves showed no mass. He spent plenty of time making sure that it did not appear in any direction. And then he announced, “I believe it’s a cyst. I will call this ‘normal’ and you won’t need to return for a year. Unless, of course, you see or notice changes that should be checked. Any questions.”

Hip Hip Hooray…. But I wish someone would give me a satisfaction survey to fill out about the volunteer and x-ray technician. I have a few thoughts about how their communication could be improved.

Health communication about medical test sensitivity: The TSH and CA 125 blood tests example

July 23, 2012

Doctors often recommend blood tests to help them diagnose our condition or to check our health status. For example, I have an underactive thyroid condition. As discussed in my book ‘Talking about health’ — my ‘normal’ numbers fall outside the range of a healthy ‘normal’ [see for a discussion http://www.denvernaturopathic.com/news/TSH.html]. I was diagnosed with this condition in my 20s and have taken daily medication to address it since that time. My mother was diagnosed with the condition in her 20s as well. I go to see my internist annually, and he puts in an order for a TSH [thyroid stimulating hormone] test [http://www.endocrinology-online.com/Content/For%20Patients/TSH.htm] that I go to the lab for several weeks before my scheduled appointment. This test is considered to be very sensitive–but what does that mean? It is the probability that a person having a disease will be correctly identified by a clinical test. However, a careful reading of the article at the link shows that the results may depend on the time off day you were tested–a reason why the test is given in the morning after fasting.

But aren’t all medical tests highly sensitive? Otherwise, why do them?

The answer to the latter is ‘because that is the best that can be done’. The answer to former is ‘no’.

Take the CA 125 test, for example. The test was hoped to be a valid indicator of ovarian cancer. However, the test indicates the presence of other disease as well. So a positive CA 125 test validly indicates the presence of ovarian cancer sometimes but often does not:

“The result of a Ca-125 test is interpretable only by considering the context in which it was ordered. When you order a Ca-125 test you will have to estimate your patient’s risk for having ovarian cancer. If your patient can be put in a group in which the likelihood of cancer is high then a positive test is probably correct and a negative test wrong. If your patient can be placed in a low risk group then the positive test is probably wrong and the negative test meaningless. Furthermore, there is no way to evaluate a positive test. You can repeat the test and pick the best 2 out of 3; 3 out of 5; 4 out of 7, etc. Otherwise, she will be heading for surgery” [http://www.gynoncology.com/ca-125/].

So if your doctor orders a CA 125 test, remember that the results should be discussed. This is true of all medical tests.But when a test that has been ordered is not highly sensitive, it is really important to discuss the meaing of the test result. If the test comes back positive and is not highly sensitive, have a conversation and ask: ‘What’s next to rule in or rule out the condition you were testing for?’ AND ‘What other conditions could the positive test result suggest I may have? How will we rule out whether I do or do not have them?’

Health communication and Dr. Oz’s message about paraben

May 1, 2012

I am in the midst of final exam week and grading. In the background, Dr. Oz started talking about ‘paraben’ and how it acts as an estrogen. I am always on the alert for these kind of messages. Hormones, research, cancer, blood clotting… these all came to mind. I got up from the computer and went to listen carefully. And then I went to my bathroom. My shampoo have five kinds of paraben in it. My two different types of body lotions had multiple forms of paraben as well. I got rid of them. Trash. Not a moment’s hesitation.

Why? Well, one of the facts Dr. Oz shared is that in one research study, 19 of 20 women diagnosed with breast cancer had significant levels of paraben in their breast tissue. I will hunt down the research and share it soon. For now, here is a summary of content from Dr. Oz with the link to the story at the end:

”

Flushed Away

We all know about industrial pollution and climate change, but there’s a new threat to the environment much closer to home – pharmaceutical and personal care product pollution (PPCP). Experts are increasingly worried that marine life across America is showing us the harm it’s doing to our planet and ourselves.

What’s Happening to the Environment?

In river basins around the country, the United States Geological Survey has found fish with both female and male sex organs. Intersex frogs are also popping up all over. And experts have found evidence of chemicals called endocrine disruptors, such as atrazine (an herbicide) and Bisphenol-A (BPA) in the country’s water supplies.

What are Endocrine Disruptors?

These chemicals alter the actions of hormones in our body, which can hurt us in 2 ways. First, they can block our hormones from acting as they normally would, and, secondly, they can act like hormones triggering effects that may include early onset puberty in adolescents.

What’s Happening to Us?

Breast cancer rates are increasing, girls are entering puberty earlier, sperm counts and testosterone levels are falling drastically, and certain genital abnormalities are on the rise.

What Should We Watch Out For?

Though the evidence is not definitive, experts fear that products we are introducing into our environment could be to blame, and they are urging us to decrease the use of certain chemicals. Here’s what to look for:

Bisphenol-A (BPA)You may have heard about BPA, the chemical used to make hard plastics, line cans, and create carbonless receipts. It’s proven to raise the risk of breast cancer in rats and the FDA has raised an alarm about the potential harm BPA can cause; Connecticut even banned its use in children’s products.

Ninety-three percent of us have BPA in our bodies. We live with it, and we excrete it when we go to the bathroom, sending the chemical into the environment.

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Phthalates

These difficult-to-pronounce ingredients help fragrance linger on the body after you have applied a lotion or body cream to your skin. They’re also found in toys, floor coverings, detergent, soaps, nail polish, and shampoos. Unfortunately, they mimic the hormone estrogen and have been linked to reproductive problems in rodents, such as lower testosterone and fetal malformation. Often they are not listed on beauty products, so the best rule of thumb is to avoid any products with fragrance.

Parabens

Found in moisturizing shampoos and body lotions, parabens are the most widely used preservatives in the beauty product industry, and they also act similar to estrogen in our bodies. One study found parabens in the breast cancer tissue of 19 out of 20 women studied; experts worry there could be a connection.

Use these chemicals as a litmus test for a healthy product. If you see them listed on the label (often as methylparaben, butylparaben, or propylparaben), it shows that the manufacturer is not concerned about limiting exposure to potentially harmful chemicals.

Leftover Prescription Medicine

The medication we take ends up in our water supply in 1 of 2 ways. We secrete it in our urine (which we can’t control), but many of us also flush unused medication down the toilet, contributing to the rising amount of pharmaceutical pollution found in our water supply. In 2008, the Associated Press found that dozens of pharmaceuticals end up in our water supplies, and eventually, in our tap water. That’s because water treatment plants are designed to neutralize biological hazards, such as bacteria, but not pollutants such as antibiotics. Scientists are now discovering bacteria in the wild that are not only resistant to antibiotics, they can actually live off them.

What Can You Do?

Drink water from stainless steel bottles
Avoid plastics with the numbers 3, 6, and 7 on the bottom
Never heat plastic in the microwave (even if it says it is microwave safe)
Choose frozen and fresh produce over canned
Use BPA-free baby bottles
Avoid any products that contain fragrances; opt for those that get their scent from essential oils
Stay away from parabens
Choose products that are paraben- and phthalate-free
Dispose of leftover medication by throwing it in the trash with coffee grinds or cat litter (to keep harmful medications from being picked from the trash), return the unused portion to your pharmacy, or go online to find your local hazardous waste disposal facility.”

http://www.doctoroz.com/videos/flushed-away?page=2