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Editorial: Another threat to good health

Nobody seems to be calling it a public health crisis, but a new national report provides a startlingly unwelcome marker in America’s endless battle with sexually transmitted diseases, or STDs.

A study by the National Centers for Disease Control and Prevention shows a coast-to-coast increase in the occurrences of diseases such as chlamydia, gonorrhea and syphilis. Rhode Island doesn’t escape this disappointing trend: State health officials say their figures show such diseases to be at a 10-year high.

Neither the CDC nor the Rhode Island Department of Health are precisely sure why so many more people are getting the diseases. But they say more people should be screened for them.

And, of course, they say people should take precautions to limit the risk of infection — that is, practice safe sex.

“STDs are a persistent enemy, growing in number, and outpacing our ability to respond,” said Dr. Jonathan Mermin, director of the CDC center that monitors sexually transmitted diseases.

No population group escapes the trend. Health officials say more women than ever are infected with chlamydia, the most common sexually transmitted disease. And men who have sex with men are seeing the highest increase in rates of gonorrhea and syphilis, according to the CDC. Even newborns are victims, as they can contract syphilis if their mothers are infected and not treated.

The diseases are treatable with antibiotics, but untreated, can lead to serious illness, stillbirth, infertility, the spread of HIV or even death.

The report is an alarm bell for public health officials and others charged with preventing, diagnosing and treating disease. The CDC is urging state health departments to sharpen their focus on rapid detection and treatment, and urging health-care providers to include screenings for STDs in routine care, especially for pregnant women and men having sex with men.

And, it seems necessary to add, people should wake up to the risk of infecting — and being infected by — their sexual partners. As the CDC puts it, “Everyone should talk openly about STDs, get tested regularly, and reduce risk by using condoms or practicing mutual monogamy if sexually active.”

That’s a simple and reasonable prescription. Ignorance is the enemy of good health. People old enough to engage in sexual activity should understand the risks of doing so. They owe it to themselves to take precautions, such as using a condom and not straying from partner to partner. And, if they are sexually active, they should be tested regularly.

We can argue about which policies contribute to the problem and whether society is going to hell in a hand basket, but preventing the spread of STDs is ultimately a matter of personal responsibility.

The report makes clear that those engaging in sex outside a monogamous relationship are wise to take precautions.

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Fed’s Janet Yellen Says the Economy Remains in Good Health

Ms. Yellen said the prospect of tax cuts or other changes in domestic fiscal policy has not influenced the Fed’s monetary policy plans at this point. “We’re uncertain about the size, timing and composition of changes that will actually be put into effect,” she said.

She said anticipation of changes like tax cuts has buoyed measures of consumer and business confidence, but there is little evidence so far of increased investment. She said the Fed similarly is taking “a kind of wait-and-see attitude.”

Ms. Yellen’s term as Fed chairwoman ends in early February. President Trump has said he is considering whether to appoint her to a second four-year term.

The American economy added an average of 171,000 jobs per month during the first eight months of the year, a little lower than the monthly average of 187,000 in 2016, but well above the growth of the working-age population.

Reported employment shrank in September for the first time in seven years, but that is most likely the result of Hurricane Irma, which hit Florida while the government was conducting its monthly survey.

Ms. Yellen said the damage from recent storms, while “terrible,” was unlikely to leave a lasting imprint on the economy.

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“History suggests that the longer-term effects will be modest and that aggregate economic activity will recover quickly,” she said.

Other vital signs also are looking strong. The unemployment rate stands at 4.2 percent, and labor force participation has stabilized. While wage growth remains weak by historical standards, Ms. Yellen said, that was mostly the result of slow growth in productivity.


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“The pace seems broadly consistent with a tightening labor market once we account for the disappointing productivity growth in recent years,” she said.

Ms. Yellen also noted that domestic business investment has improved and stronger growth in other countries has increased demand for American exports.

“I perceive that risks to global growth have receded somewhat and expect growth to continue to improve over the near term,” she said.

The most obvious cause for concern is the weakness of inflation, which has remained below the Fed’s 2 percent annual target since the financial crisis. Other developed nations are grappling with the same phenomenon.

“The apparent disconnect between strong economic activity, on the one hand, and low inflation and wages on the other, is one of the standout characteristics of the ongoing recovery, almost everywhere,” said Vitor Constancio, vice president of the European Central Bank, who spoke on the same panel as Ms. Yellen.

Some Fed officials regard weak inflation as evidence the Fed should retreat more slowly from its stimulus campaign.

Ms. Yellen reiterated on Sunday that she did not agree, because she regarded inflation as likely to increase as growth continued.

“My best guess is that these soft readings will not persist,” she said.

She added that she saw little evidence soft inflation in the United States is the result of a change in the global economy.

Follow Binyamin Appelbaum on Twitter: @bcappelbaum.

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Second Opinion | Remembering forgetting could be a good sign

Hello and happy Saturday! Here’s this week’s round-up of eclectic and under-the-radar health and medical science news.

If you haven’t subscribed yet, you can do that by clicking here.

Forgetting where you put the keys? Can’t remember names? Is it the first sign of dementia?

That might depend on whether you remember that you’re forgetting things. And whether your caregivers are more worried about your memory loss than you are.

“It seems that when caregivers see it as more problematic than patients then it’s predictive of whether or not people go on to develop dementia,” said Dr. Philip Gerretsen, a clinician scientist at the Centre for Addiction and Mental Health in Toronto.

Using brain imaging data and other clinical information from more than 1,000 patients with early cognitive decline, his new study suggests there’s a relationship between a person’s level of awareness of memory issues, and their risk of future disease.

Some of the people studied thought they were having memory issues, but their caregivers weren’t convinced. And those people didn’t end up developing dementia.

“Most intriguingly it’s the patients that seem to be hyper-aware of having some cognitive problems relative to their caregivers that actually don’t go on to develop dementia,” Gerretsen said, adding that those people might be suffering memory loss for other reasons, including anxiety or depression.

Gerretsen believes there might be clues to dementia in the region of the brain that controls disease awareness, a condition called “anosognosia” — a neurological term for not knowing that you’re sick.

“The most interesting thing is anosognosia, or illness awareness, is really under-studied and what we’re seeing is that it’s an independent predictor of going on to develop dementia when people complain of memory issues.”

Gerretsen says there’s a suggestion that Alzheimer’s disease might be affecting the brain regions involved in illness awareness. His next study will investigate whether brain stimulation methods can improve those underlying brain structures, which in turn might help slow down the progression to dementia.

Death of a ‘good cholesterol’ idea

The theory was beautiful. If lowering bad cholesterol reduces heart attack risk, (and it does, as the statin drugs have shown) then raising good cholesterol should do the same thing.

Scientists even knew how to do it by interfering with a blood protein called CETP (cholesteryl ester transfer protein.) Because the CETP is involved in turning good cholesterol (HDL) into bad, (LDL) then a drug that blocked the protein should cause good cholesterol to rise.


The demise of a promising hypothesis about ‘good’ cholesterol. (Shutterstock)

It worked, setting off a pharmaceutical race that had industry analysts predicting the next blockbuster drugs.

But optimism faded when the first CETP inhibitor had unintended off-target effects that actually increased heart attacks. Pfizer immediately abandoned the drug. That was 2006.

By 2015, two more companies had dropped their CETP programs after the drug failed to improve cardiovascular outcomes.

Analysts finally called the hypothesis officially dead this week when Merck announced it would not be submitting its CETP drug for market approval.

So what went wrong? Human physiology once again proved to be devilishly complicated. It’s more proof that using drugs to change surrogate biomarkers (indicators that doctors measure with lab tests) doesn’t always translate into better health. In this case, it turns out that simply raising good cholesterol, by itself, does not prevent heart attacks, strokes or death.

It’s no surprise to Dr. Dennis Ko at the Institute for Clinical Evaluative Sciences in Toronto. After studying data on more than 500,000 Ontario residents, Ko showed that high levels of good cholesterol alone didn’t predict good health.

The data revealed that people who have low levels of good cholesterol also have other problems, including low income and unhealthy lifestyles. Ko concluded that simply increasing the HDL without addressing those other factors will not by itself improve heart health.

“I think most people have changed their minds about HDL cholesterol in terms of whether we can change the levels to dramatically improve cardiovascular outcomes,” Ko said.

So what’s the message for people obsessed with their cholesterol levels?

“I would probably worry less about the HDL levels,” Ko said, adding if it’s very low, it might be a marker of poor health and efforts to improve lifestyle would be the most beneficial thing.”

‘Life finds a way’ as malaria mosquitoes win 1st round in gene drive battle

A “gene drive” is a tool scientists are developing to spread new genetic traits rapidly through a population.

Ever since the CRISPR gene editing system made it possible to easily and cheaply manipulate DNA, scientists have been tinkering with gene drives as a way of controlling disease-carrying mosquitoes.

The idea is to genetically alter the mosquito genome to weaken its reproductive system and then spread that change as fast as possible through new generations of insects.

Malaria mosquito

Nature fought back when scientists attempted to manipulate the DNA of malaria mosquitoes. (James Gathany/CDC)

But as usual, nature has a way of deflecting human interventions. And it seems mosquitoes won the first round in the gene drive battle, according to a new paper published in PLOS Genetics.

Scientists at Imperial College London used CRISPR to engineer a weakness in the female malaria mosquito’s reproductive system so there would be fewer offspring. They then introduced that genetic weakness to a caged population of mosquitoes.

The gene drive spread rapidly in just four generations of insects. But after 25 generations the scientists noticed that it slowed down as new mosquitoes developed a genetic mutation that fixed the flaw and restored their reproductive rate.

Despite the resistance, lead scientist Tony Nolan called the experiment a success, saying it’s the first ever proof in principle for a gene drive designed to reduce mosquito populations.

Now they’re going back to the lab to tweak the gene drive and come up with ways to overcome the resistance problem, presumably not at all deterred by the prophetic words of Dr. Ian Malcolm (actor Jeff Goldblum) from the movie Jurassic Park:

“Life..uh..finds a way.”

Currently there are no gene drive programs being used outside the lab.

Thanks for reading! You can email us any time with your thoughts or ideas. And if you like what you read, consider forwarding this to a friend.

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Health Alert: Connection between healthy personal relationships and good heart health

In today’s Health Alert: Healthy personal relationships and good heart health may go hand in hand, especially if you’re a man.

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Chuck Sweeny: Expanding association health plans is good idea

But Trump’s order to cut federal subsidies under Obamacare is not

Last Wednesday, President Donald Trump signed an executive order requiring federal bureaucrats to write regulations to expand the availability of association health plans to more employers, organizations and individuals, and to allow the plans to be nationwide.

This, Trump believes, would open health insurance to the kind of competition we see displayed nightly on clever ads put on TV by auto and homeowners’ insurance companies and Medicare supplement sellers.

It’s also part of Trump’s plan to “repeal and replace” the Affordable Health Care, aka “Obamacare” on his own by issuing sweeping executive orders, after the Republican-controlled Congress failed twice this year to repeal and replace it with substantially less coverage.

(Remember when Barack Obama was president and the same Republicans regularly denounced executive orders as flagrant violations of the democratic process by an authoritarian president? Me too.)

But let’s go on. Basically, Trump’s order allows groups like the Farm Bureau, National Federation of Independent Business (NFIB) to form large, member health care pools that can bargain with insurance companies for lower rates and better coverage.

“Trump discovered that he does not need Congressional approval to do this,” said Don Manzullo of Egan in Ogle County who represented Rockford and northwest Illinois in Congress as a Republican for 20 years ending in 2013. We talked Friday by phone.

Manzullo, now the president and CEO of the Korea Economic Institute of America, chaired the House Small Business Subcommittee in the early and mid-2000s and was a champion of association health plans.

I traveled to Washington, D.C. in 2002 to shadow Chairman Manzullo on Capitol Hill during Small Business Week. He spent many hours that week listening and talking to small business organizations who wanted Congress to expand association health plans.

“The bill passed the House but died in the Senate at the hands of Republicans,” Manzullo remembered.

One reason it failed to pass in 2002 was that big health insurance companies didn’t like the bill because it would have increased competition for them to provide lower rates and better policies.

“Trump’s order would allow self-employed farmers to buy health insurance as part of a large group. It would also be great for small businesses, who are really getting hammered with premium increases,” Manzullo said.

I decided association health plans were a good idea back in 2002. Small business owners I knew in Rockford supported them, too, and I figured if insurance companies didn’t like them they were probably beneficial to regular people.

I still support these plans’ expansion because the overwhelming majority of businesses in this country are small ones. Small businesses create most of the new jobs and they can expand easier if they are allowed to join together in big health care pools to tailor-make coverage that gives people choices. Obamacare is a one-size-fits-all approach, and one size definitely does not fit everyone.

Trump followed his first executive order on Wednesday with a second on Thursday that halted about $7 billion in federal payments to health insurance companies that subsidize health care premiums under Obamacare. This will no doubt raise the cost of coverage, helping Trump prove his claim that “Obamacare is imploding.” 

This order was not met with great enthusiasm from Democratic House spokeswoman U.S. Rep. Cheri Bustos, D-East Moline.

“President Trump directly promised there would be insurance for everybody and health care would be a ‘lot less expensive,’” Bustos said in a statement.

“His decision to take away funding that millions of Americans rely on to see a doctor is the very definition of a broken promise … When Americans see their health insurance bills increasing and lose access to quality care, it will be because of Donald Trump and Washington Republicans.” Bustos pleaded with Republicans to work with Democrats to lower the cost of coverage and “expand access to more Americans.”

It’s clear by now that with Trump’s silver hammer coming down on its head, Obamacare is not long for the world. But just as Democrats did when they forced their partisan Obamacare bill on the American people, the all-Republican repeal effort is a lousy way to end it.

Republicans and Democrats ought to develop a replacement for Obamacare that combines free market competition with a government-assisted safety net for the poor. There are attempts in Congress being made to do that, but they have been squelched by GOP leaders.

Hyperpartisan politics — aided by cable TV “news” networks that inflame controversies to boost ratings, and social media chaos aided by posts put up by Russian troll farms, have killed legislative compromise and bipartisanship that once was the feature of every major piece of legislation that became law.

Chuck Sweeny: 815-987-1366;; @chucksweeny

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Your Good Health: Man told stone must be removed

Dear Dr. Roach: I am 57 and generally in good health. My doctor diagnosed me having chronic pancreatitis after I had weight loss with diarrhea and was found to have fat in my stool. The CT scan showed that I have a 12-mm stone blocking my pancreatic duct. My doctor says I have chronic pancreatitis and need surgery to remove the stone.

Is this a life-or-death surgery? If no one will perform the surgery, is there another way to get rid of the stone?


Chronic pancreatitis is a relatively common condition, but sometimes can go for a long time without being diagnosed. The presence of fat in the stool is a big clue to the diagnosis. Patients may notice that their stools seem oily, and it might take several flushes of the toilet to completely remove it.

The diarrhea happens because the pancreatic enzymes are necessary for the body to absorb fat. Without the pancreas, the fat passes all the way through the body, causing fatty diarrhea, called steatorrhea. Many people have abdominal pain, sometimes episodic, but at least 20 per cent of people have none.

There are many causes of chronic pancreatitis. Chronic alcohol abuse is the most common cause that I saw in my training, but obstruction of the pancreatic duct by stone or tumour is another.

Unfortunately, removing the stone might not stop the pancreatitis. In many people, the changes in the pancreas from longstanding obstruction are irreversible. Nonetheless, I wholeheartedly agree with removing the cause of the obstruction.

There are several approaches to removing a pancreatic stone, including endoscopic removal, laser treatment and shockwave lithotripsy (using soundwaves to break up the stone). Only your treating doctor can say what is the best treatment for you.

Although any of these may be considered surgery, there also are surgical treatments for chronic pancreatitis, and I’m not sure if your doctor is recommending one of those. Surgery for chronic pancreatitis (as opposed to removing the stone) is usually used for people whose pain can’t be controlled.

Another important treatment in chronic pancreatitis is the use of replacement enzymes. These help to digest the fat and protein in the food, relieving the diarrhea and, in some people, relieving pain. They also can help the body absorb fat-soluble vitamins.


Dear Dr. Roach: I recently had a PET scan. It showed that my stomach is almost completely up in my thorax with a large hiatal hernia. I have no discomfort or symptoms. Is this dangerous? Should I have surgery?


The diaphragm is a large sheet of muscle that separates the chest from the abdomen. It has a hole in it, called the diaphragmatic hiatus, that allows the esophagus to carry food into the stomach. In some people, the hole is large enough for part of the stomach to go up into the chest. This condition is called a hiatal hernia, and it may bring on variable symptoms, especially heartburn. Usually, it’s a “sliding” hiatal hernia — the stomach can go into the chest, but later come back in the abdomen where it belongs.

In people with no symptoms, surgery rarely is required. However, if the entire stomach is in the chest, it’s possible for it to get stuck, which predisposes a person to bleeding and, rarely, to a condition called volvulus, in which the stomach twists in the chest against the part left in the abdomen. These complications often need surgery. I have seen only two cases in my career.


Dr. Roach cannot answer individual letters, but will incorporate them in the column when possible. Email questions to ToYour

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One Good Choice: Make the Most of Your Health Plan’s Free Tools

The following is sponsored by SelectHealth

Figuring out your health insurance benefits and budgeting for medical care can be overwhelming—but most health insurers provide free resources that can help you make sense of it all. One of the most convenient sources of information? Online member tools.

Your health plan website will require you to create a username and password to access their tools because it’s important to keep this data secure. But once you’re in, you’ll have access to a ton of helpful information, such as your coverage documents, year-to-date totals (also known as accumulators), and medical claims. Here’s a run-down on the most commonly found tools and how to use them:

  • The Dashboard. Your health plan may call it something different, but this starting page gives you an overview of your plan. Think of it as a snapshot. You should be able to tell at a glance how much you’ve met toward your deductible and out-of-pocket maximum. This is important because it can affect how much you owe each time you get medical care (or fill a prescription). The amounts you are responsible to pay typically change once you’ve met your deductible—keep this in mind when planning for expenses.
  • Claims. If you have medical, pharmacy, or even dental coverage through your health plan, you should be able to view your claims online. See who billed for which services, or find out exactly how much your insurance plan paid towards claims versus how much you are responsible to pay. Not sure what the terms mean? Read more FAQs and find definitions.
  • Coverage. Let’s face it, most of us file away our plan coverage documents and don’t look at them again. Don’t dig through your files when you need a service, view your plan benefits online. How is an office visit covered? What about preventive care or a trip to the urgent care? It’s all documented, so no more guessing games.
  • Budget. Speaking of guessing, there’s no need to guess at healthcare costs anymore. Companies like SelectHealth have Medical Cost Estimators so you can get an estimate for how much you’ll pay for everything from a standard office visit to knee replacement surgery. Don’t wait for the bill—plan ahead before you get the service, and you’ll feel a lot less overwhelmed (and a lot more in control!).

If you don’t find yourself in front of a desktop computer very often, many plans provide these tools and more in a mobile version, so you can access them directly from your phone. Spending a few minutes to become familiar with what’s available from your health plan really pays off—you might be surprised how handy it is and you’ll certainly be prepared when you need it. Instead of giving up on understanding insurance, get in the know and take a spin in the driver’s seat.

Learn more about SelectHealth and the tools they provide to put members in charge of their own health.

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Circumcision Good forWomen’s Health

The one and only.

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Riding An Electric Bicycle Is Good For Your Health

There is a popular misconception that riding an electric bicycle has no health benefits. Real bicyclists do without help from electric motors and batteries. All that pedaling makes for a good aerobic exercise, they say, while people on e-bikes are “cheaters” — lazy slugs who get no health benefits.

Electric bicycle study
Researchers William Byrnes (left) and James Peterman demonstrate a pedal electric bicycle in Boulder, Colorado. (Photo by Sydney Chinowsky / University of Colorado Boulder)

They might as well stay home and watch videos of the Tour De France while sitting in their La-Z-Boy eating popcorn drizzled with butter. Actually, the debate gets pretty ugly at times, with traditional bikers wanting electric bicycle riders banned from bike paths and mountain bike trails.

Not so, say researchers at the University of Colorado Boulder. They recruited 20 sedentary volunteers who agreed to ride an electric bicycle to work at least three times a week for a month. The riders were free to choose the level of assist they preferred. The only requirement was that the trip to and from work take at least 40 minutes.

First, the volunteers were given a full fitness workup to determine their overall health, blood glucose regulation and fitness. After a month, the volunteers had the very same tests conducted again. All 20 had noticeable improvements in their cardiovascular health, with improved aerobic capacity and blood sugar control noted in all cases.

“Commuting with a pedelec can help individuals incorporate physical activity into their day without requiring them to set aside time specifically for exercise,” said James Peterman, a graduate researcher in the Department of Integrative Physiology at CU Boulder and lead author of the new study.

“Participants rode a pedelec in the real world at a self-selected moderate intensity, which helped them meet physical activity recommendations. Pedelec commuting also resulted in significant improvements in 2-h post-OGTT glucose, and power output. Pedelecs are an effective form of active transportation that can improve some cardiometabolic risk factors within only 4 weeks. The results of the study were published in the European Journal of Applied Physiology.

The research was funded in part by the City of Boulder, which is trying to decide whether to allow electric bicycle riders to use city bike paths, which some traditional bicycle riders are opposed to. At one time, people who started their own cars with a hand crank may have looked down their noses at people driving cars with self starters.

Now that there is research showing riding an e-bike actually has positive health benefits, those bike snobs will have to think of some other way to feel superior to pedelec riders.

Source: Cycling Industry News


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Could working out be sabotaging your gut health?

You probably hear about the benefits of regular exercise on the reg, but one serious topic that doesn’t get brought up a whole lot? Overdoing your fitness regimen. One doc says overexerting yourself could even be sabotaging your gut health.

According to an article B.J. Hardick, DC, wrote for mindbodygreen, all those hours you log at the gym do pay off—until they start costing you, that is.

Overexercising can stress out your body, leading to leaky gut, a condition that increases inflammation and increases susceptibility to autoimmune disorders and metabolic diseases, like type 2 diabetes. —Dr. Hardick

Overexercising can stress out your body, which is bad news for your digestion: Stress can cause leaky gut, a condition that not only increases inflammation but also makes you more susceptible to autoimmune disorders and metabolic diseases, like type 2 diabetes, Dr. Hardick said.

“Your intestinal barrier keeps out food particles and other things that shouldn’t go through, but when it becomes loose, things not intended to get through the wall suddenly do,” Dr. Hardick said. “What results is intestinal permeability, more commonly called leaky gut.”

There are many ways to keep leaky gut at bay: Eat a healthy diet, get the recommended amount of sleep, keep your stress levels in check, and—most importantly—just listen to your body. There’s nothing wrong with taking a rest day or keeping your workouts light.

When you don’t give your body time to recover, it simply won’t. So don’t go overboard when it comes to your workout routine in order keep your body (and gut) happy and healthy.

Here’s why Selena Gomez swears by rest days—and why you should too. Still not convinced? This expert reveals why rest days aren’t optional.

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