“Surge in testosterone treatments raises alarm”

That headline on a Bloomberg News item grabbed my attention. The first paragraph of the piece got right to the point. Noted author Shannon Pettypiece (no, that really is her name) “In what may become one of the most sought-after sex enhancement treatments since Viagra 14 years ago, new testosterone drugs are in hot demand”.

The trouble is that in the entire article, no justification is provided for speaking of testosterone in the same sentence as Viagra. Bloomberg is a business publication not one devoted to medicine, but I’d have expected that after an opening implying that hormone supplementation is in hot demand for “sex enhancement,” at some point the reader would learn why that was stated in the first place. But no luck.

We do learn business-related facts; prescriptions for testosterone have doubled over the past 6 years to 5.6 million/year in the US. We learn that over the next five years sales are expected to triple to 5 billion dollars. We learn that Abbot and Lilly are increasing their advertising budgets.

Thankfully, we also learn that medical experts are very dubious about all of this. Checking the levels of testosterone involve a notoriously unreliable test, and a Cleveland Clinic doc takes pains to note he only prescribes it for patients with a medical need. What a concept!

The issue of testosterone supplementation comes up weekly in my clinic. A while ago I decided that we would not be supplementing people unless they could a) produce lab tests showing they really were low and b) their doctor would simply not write a prescription for hormone replacement. So far exactly one person met the criteria, and after starting them on a gel we turned the management of that over to his primary care physician. We are not much into the testosterone business.

The reason for this is that despite the popularity of using testosterone to help erectile dysfunction it rarely works. We see many, many patients who have tried it, for example. Had it actually worked, they would not be coming to us.

There is no good reason why it should help most patients. If a man’s levels are in the normal range, boosting the levels above normal (or to the high end of the normal range) does not help him. Ask your local urologists. We certainly did and they were explicit about this logic. Everything I’ve seen supports their reasoning. Testosterone has more to do with desire than the actual mechanisms that produce erections. Oddly, this is true for females too! When the occasional man comes in with genuinely below-normal testosterone levels they have usually noticed a drop in libido, prompting testing.

No libido will produce a certain failure to achieve an erection. That I don’t dispute. The occasional man with this problem can (and should!) be supplemented. When this happens, their condition usually improves. The thing is, we are talking perhaps 3-4% of the ED patient population. The vast majority of ED patients have testosterone levels that are within the normal range.

So where do people (and Bloomberg writers) get the idea that male hormone is an ED treatment? Well, sex sells. Some men find that they feel improved energy levels on testosterone. Body builders in particular (as noted in the article) are pretty big on the subject. The same guys who fill out the pages of muscle magazines, who abuse anabolic steroids, are all for it. Hmmmm.

The drug companies are not going to quibble over this. It is claimed that 13.8 million Americans have low levels. Seems high to me! Men’s levels do tend to drop after age 45, as the ads on late-night TV keep reminding us, but five billion dollars in sales by 2017 looks pretty good to them. Note: Viagra sales last year totaled 2 billion, with Cialis is right behind at 1.9 billion. But both these medicines are effective for most men with ED. The class of medication (phosphodiesterase inhibitors) to which they belong will help perhaps 60% of men with ED. Compare that to maybe 4% for testosterone.

Testosterone, like any potent hormone, can have drawbacks. While no studies have ever shown (at least none so far) that extra male hormone can produce an increased risk of prostate cancer that remains a theoretical risk. As for BPH (Benign Prostatic Hypertrophy) standard therapy for men with enlarged and troublesome prostates is to LOWER their most potent forms of testosterone.

A former competitor (thankfully now out of business) used to supplement everyone seeking treatment for ED with testosterone cream. Everyone! Shameless staffers would tell patients it would add 30 yards to his golf drive. Steroid misuse can enhance athletic performance as anyone who follows sports knows. Some improvement of energy levels and/or athletic performance probably does take place with many men on testosterone.
But how much comes from the placebo effect? I sure do not know.

I will grant that some men surely think they do better with their ED from testosterone, but considering only 3-4% of those being treated actually have a need for testosterone supplements, I would say that most of these men are experiencing a placebo effect. After all, rich Chinese consumers are paying top dollar for powdered rhino horn (and helping wipe out the last of these mighty beasts) even though rhino horn is chemically identical to powdered fingernail clippings. But they swear it works, because when they tried it they felt better. We must do better than that as we have millions of men starting supplementation.

As I finished typing this, a clipping fell out of one my files that was remarkably appropriate. It noted that 9 years ago a panel had been being convened to examine the ever-growing issue of hormone supplementation. At the time Science magazine noted that the Institute of Medicine in Washington concluded that the efficacy of the treatment needed to be established, the adverse effects needed to be examined more closely and that in the meantime “men and their doctors shouldn’t consider testosterone preventative medicine against age-related symptoms”.

Although this all remains true today testosterone has climbed in the back door to become a billion dollar industry in no small part due to the matter of erectile dysfunction being a major “age-related” symptom. There is much to discuss before millions line up for $250 a month injections or Barry Bonds-like gels. We will have more to say about this in the future.

The Mayo Clinic, famed for its cutting edge medical care, has conducted research that is being called revolutionary in the field of aging. Dr. Darren Baker’s work involved genetically engineered mice, but could be a breakthrough for homo sapiens. According to a recent article in Nature a strain of mice were developed that were afflicted a genetic disorder that produced the mouse equivalent of progeria, that strange disease that causes premature aging. As with humans afflicted with progeria young animals develop conditions associated with old age.

A certain molecule is produced when cells get old that prevents further cell divisions. This is one method cells use to prevent the runaway growth of cancer. The Mayo team cleverly figured out a way to induce cells that switched on the gene for the molecule to self-destruct. They did this by slipping a gene for another protein very close to the one producing the age-related molecule. The new gene was activated by the same switch that turned on the age molecule. When they exposed that protein to a drug it proved deadly to the cell. So it was the old cells could be made to selectively commit suicide.

No one was sure what selectively killing the old cells would do, but it so happened that the mice slowed their too-rapid aging in a spectacular way. Their muscles remained strong, their fatty tissues did not waste as fast and they did not develop cataracts. The effect was more pronounced the sooner in life the mice were given the cell killing drug, but older mice still benefited.

This approach is different to methods employed previously which have been based on either finding a way for cells to divide longer (with an accompanying risk of cancer) or suppressing chemicals the cell produces that cause damage via inflammation.

This new method is related to the latter approach however. The old cells killed by this technique were causing harm to nearby cells via an inflammatory effect. In the absence of the chemicals (the cellular equivalent of a fire alarm that turns on a sprinkler to douse the flames) the younger cells stayed healthier.

Tinkering with an organism’s life span is surely problematic. There are reasons why we are not immortal. This method raises the possibility that a healthier life can be extend in time. To my mind this is the cellular equivalent of the face lift that smooths wrinkles. After the procedure you are left with less material than what you began with, which itself is potentially a problem.

In this case the fewer cells remaining will also age and stop dividing, but while they live they suffer fewer untoward effects from molecules from those old cells and the inflammatory response they induce. So while one might not live longer one could experience a healthier, more vigorous old age. When people talk about living to 150 nobody has in mind living out 60 or so years as a 90 year-old

This experiment needs to be repeated. First on mice that are more normal than the progeria strain. Some mice strains live 3 plus years vs the normal two year life-span so they are the next logical candidates. This experiment has a long way to go before benefits to human health can made a reality, but it is exciting. A whole new approach to dealing with age has been opened up.

Photo Credit: TEASSARE TS Rogers Illustration and Design

In news sure to shake up the world of men’s health the US Preventative Services Task Force has firmly come down AGAINST the use of the PSA test to screen for prostate cancer.

The screening test has been argued about for years. A prostate specific antigen test has a profound weakness. It is not able to distinguish benign vs deadly forms of cancer. In other bad news for advocates of screening the USPSTF has noted that digital rectal exams and ultrasound examinations are also unreliable in diagnosing prostate cancer.

This argument hinges on the stats. While supporters of testing point out that lives CAN be saved when a dangerous cancer is located sooner rather than later – or so common sense would seem to dictate – the data does not seem to support the utility of the tests on two fronts.

First, the aggressive cancers, even when found earlier are so problematic that earlier discovery does not seem to make a big difference in their treatment. Second, treatment of slow growing types of prostate cancers may do as much (or more) harm as they help, especially since many older men with slower cancers never suffer harm from their disease.

Given the data from five well-controlled clinical trials the Task Force elected to come down firmly against testing. When the USPSTF came down against women in their 40s receiving mammograms two years ago a firestorm of controversy was unleashed. This move seems sure to do likewise.

The biology of prostate cancer is curious in that one third of men between 40 and 60 apparently have some form of the disease. By age 85 the vast majority of men have it, but in most instances its benign nature means that it has no impact on their mortality. As such screening men over 70 has been long recognized as least valuable. Older men have the least chance of meaningful improvement from treatment, while sustaining all the usual negative effects associated with such treatments.

A biopsy of the prostate, the logical next step after finding an elevated PSA is not without problems. The multiple core samples retrieved from the gland can involve damage to nerves which can contribute to erectile dysfunction. We have long been aware of this in my ED clinic. While the injury to the nerves may heal completely they may not. Even if they do, it may take months. And any surgery to the prostate, even the “nerve sparing” types are very likely to cause injury to local nerves.

No surgery is 100% safe, of course. It is estimated that up to 70,000 men suffered serious complications to surgical or radiation therapy between 1986 and 2005 (and at least 5,000 died). This is by-the-way out of 1 million men who received radiation, surgery or both. The numbers associated with erectile dysfunction and/or urinary incontinence are fairly startling. During that same time frame it is estimated that 200,000 to 300,000 suffered either or both, and I suspect those are very conservative numbers.

In addition to surgery and radiation there are several pharmaceutical agents used to battle prostate cancer by blocking male hormones. While they have notable side effects (erectile dysfunction again, also hot flashed and breast enlargement) they have not proven to be especially helpful treatments. This failure has also been noted in these recent studies. Given the fact that treating people with high PSAs is a lucrative business there is bound to be some push-back from many doctors and drug companies. And in many cases their objections may not be rooted in mere avarice.

In some cases it might be possible to find a cancer early (thanks to PSA tests and screening digital rectal exams) that is localized and thus surgically curable. It is hard to justify not doing the screening given the reality of such cases, but in the end one has to look at what actions will generate the greatest good for the greatest number.

The data supporting the benefits of routine prostate tests remains surprisingly weak. This is why the USPSTF has acted as it has. We will re-visit this topic after

One hates to sound like a bit of a broken record, but the matter of supergerms needs a re-visit and a fine place to go is the recent Discover special issue on evolution. The article titled “The Rise of the Killer Mutants” goes into greater detail than we have here on the topic of antibiotic misuse as it relates to livestock.

The article by Jessica Snyder Sachs outlines how unnaturally high levels of antibiotic resistance genes have been found in soil sediments where rivers come into contact with farm runoff and/or municipal waste-water effluent. This discovery is kind of a no-brainer if one keeps in mind how evolution works (which was the theme, after all, of the special issue of the magazine).

Given a situation where chemicals toxic to bacteria (antibiotics) are concentrated, as is the case at sewage treatment plants, the natural tendency is for evolution to select for resistant strains. In the case of treatment plants, the contamination problems of sludge – with its high levels of resistant bacteria – could be mitigated by drying the solid material. But this costs money. So instead, the wet material is trucked away and applied as a slurry to forests, roadsides and crop fields. What a great place to sew anti-biotic resistant bacteria, eh?

In the case of animal farms, the situation is even worse. The livestock pharmaceutical industry wants to say it still has not seen anything “definitive” to link their operations to human disease. By their own data, however, they sell over 20 million POUNDS of antibiotics to industrial farms. Most of these antibiotics are NOT used to fight disease, but to increase the animals growth rates! As a bit of back-of-the envelope math, keep in mind that one human dose of doxycycline is 100 milligrams. One ounce of such antibiotic represents almost 300 doses of drug. One pound would represent almost 5,000 doses. Multiply that by 20 million and…. well what it adds up to is a lot of antibiotic in the environment.

Were the meat industry to only use antibiotics not used in human medicine, this situation would not be so bad, as the bacteria wouldn’t develop resistance to the specific drugs we use to save lives. Unfortunately there exists no such restrictions on their use. In 2008 the FDA proposed a new rule that would limit the use of the 4th generation of cephalosporins (a class of broad spectrum antibiotics) in food-producing animals. Since these drugs are vital in fighting human infections like meningitis, this simple rule seemed sensible. Reportedly, after receiving “critical comments,” the FDA they withdrew the suggested rule (that sounds pretty gutsy, doesn’t it?) and allowed the industry to continue its nutty practices.

How hard is the pharmaceutical industry looking to find cases of human disease linked directly to antibiotic misuse? A good question, but let’s just say, it is difficult to convince somebody of something when their income depends on their NOT understanding it.

On a side note, the article was pretty definitive on antibacterial products like triclosan and triclocarban. They have been shown to promote antibiotic resistance and provide the consumer with nothing. They do not keep anything “cleaner” than regular soap and water. They should be eliminated from the market. If you are using any such products save your money.

The topic of antibiotic resistance is not going away. The money flow supports the status quo, but the costs to human health have NOT been factored in. We here at Sacramento Men’s Health will be keeping the human cost in mind as we continue to follow this dilemma.

California is delinquent – yet again – on a promise to pay back “borrowed” money, and it may directly effect your health.

A recent report by the nonprofit organization Public Citizen shows that California’s Medical Board failed to enact disciplinary procedures on 710 medical doctors, even if the doctor’s own hospitals and/or medical organizations felt compelled to take actions against him or her. State budget woes (and sleight-of-hand by our governors) are making this situation worse.

Of the unpunished 710 physicians, 35% were repeatedly sued for malpractice. Now, it is important to recognize that being sued does NOT necessarily mean a doctor is bad. Many physicians who are willing to take on the toughest cases may find themselves sued in our litigious society. Tougher cases have bad outcomes more often, and with a bad outcome enters the lawyer from stage left. On the other hand, this stat does invite concern. Commenting on the California Medical Board’s inactivity as compared to other medical organizations Dr. Sidney Wolfe, Director of Public Citizen’s research group told the LA Times’: “Hospitals rarely discipline doctors. When they do, it is usually for very serious infractions”

How serious? The report by Public Citizen laid down many examples. In all cases these physician evaded discipline from the California Medical Board. To cite just three:

A surgeon (disciplined three times in 2007 and 2008) had eight malpractice payments from 1991 to 2008 totaling $2 million, including a misdiagnosis and failure to perform a procedure.

Another doctor (disciplined six times from 2005 to 2009) had privileges suspended for providing substandard care. He was judged “unable to practice safely” and had his privileges suspended in 2009 for posing an “immediate threat to health or safety”.

A third doctor (disciplined in 1991) subsequently had 15 medical malpractice payouts – totaling about $1.9 million – between 1993 and 2009. Two cases involved an object left behind after surgery.

Wolfe noted that in describing a doctor in California, you should not have to use the term “posing an immediate threat to health or safety” adding “The hospitals, HMOs, and peer reviews are all saying that these people are unfit to practice medicine, yet the State of California is doing nothing about it. Why are these physicians allowed to continue holding their licenses without an inquiry?” A partial, though definitely incomplete answer, is a lack of funds.

Jennifer Simones, a spokeswoman for the Medical Board, told the LA Times that state hiring freezes and budget cuts are taking their toll on the ability of the board to operate. Simones noted “we have a 20% vacancy rate and we’re trying to focus on our core functions.” Unaddressed by that response is what the Board imagines constitutes their core functions. Reigning in dubious docs seems high on the list to this correspondent.

Simones also pointed out that in 2008 Governor Schwarzenegger “borrowed” $6 million from the Medical Board’s $55 million dollar budget to spend elsewhere in the bureaucracy. That money was not repaid, as promised. Worse, Governor Brown is considering another episode of “borrowing”. Because the Board operates on fees paid by practitioners, its financial status is more secure than other state agencies.

Dr. Wolfe sent Governor Jerry Brown a letter encouraging him to investigate Pubic Citizen’s report, and fill the California Medical Board’s staffing vacancies. The Governor’s office said he will review the report, but as the LA Times previously reported Governor Jerry Brown plans on “borrowing” $9 million more from the Board.

Far and away my favorite part of this article was the comment from Brown spokeswoman Elizabeth Ashford about this potential move. She said, “It won’t contribute to the backlog because, in the event we did see an effect, we’d repay it.” This is great, if unintended comedy; better than “I haven’t done anything wrong and promise never to do it again”.

Ashford’s claim that what Brown is going to do will produce no harm because if it does (and pause a moment to enjoy that phrasing) Brown will then pay back amount that caused the harm. Never mind the fact that before the money is even removed there are 710 unresolved cases about physicians potentially posing a threat to public safety.

For its part the Board says it will tackle these matters when it has more resources to devote to them. Speaking as someone who has tried repeatedly (and failed repeatedly) to move the Board to act against a physician who is apparently mentally ill (and believe me, a potential threat to the public) I am not holding my breath.

Despite the Medical Board’s evident lack of zeal in acting in a timely and forceful manner, robbing Peter to pay Paul in our budgetary crisis is wrong. California’s physicians pay hefty fees to insure that proper supervision is made of practitioners in the state. Our governors can’t resist stealing that money (that’s what it’s called when you “borrow” money you have no intention of repaying, right?), and it only means that the Board will do a worse job than it is doing already.

Let us hope that you, dear reader, do not have an unhappy outcome with your physician on account of this financial debauchery.

Placebos work. They have, in fact, guaranteed over the centuries that many treatments offered by physicians were regarded as effective, even if they were not. We now know that some of them could not possibly do most patients a bit of good. Bleeding the patient comes to mind, as does the use of tobacco. As recently as the 1940s cigarettes were recommended – yes, recommended by doctors! – to “calm peoples nerves”.

For years there have been doubts about the efficacy of antidepressant pills. Because they were much less toxic than prior medications – which were fine pills with which to commit suicide – the SSRI class of drugs (selective serotonin inhibitors) have been widely prescribed for decades. How widely? No fewer than 10% of Americans are on some form of SSRI. With 30 million people taking SSRIs on a daily basis, an annual sales of an incredible 10 billion dollars is generated from their use.

In its July 22, 2011 issue, The Week magazine’s Briefing section addressed the controversy and echoed remarks we have made previously. We know that SSRIs can alter brain chemistry, We know that some studies reported patient improvement with their depression. Unfortunately, the pharmaceutical industry has never presented convincing data that the drugs are actually working better than a placebo.

Worse, they have presented the world with the dubious theory that people’s depression results from a “deficiency” in serotonin which (lucky for the patient) is fixable with these wonder drugs that……. drum roll please…… raise people’s too-low serotonin levels. There is no definitive evidence to supports this widely believed notion. In fact the levels of neurotransmitters in the depressed are no different than levels found in the non-depressed.

Psychologist Irwin Kirsch studied the clinical trials done on behalf of the SSRIs between 1987 and 1999, and guess what – more than half showed results no better than placebo. In January 2010 JAMA published a study showing that for mild to moderate depression the difference between placebo and SSRIs was “nonexistent to negligible”. FDA rules allow companies to do as many studies as they like with negative results just so that they can arrive at two positive trials, which then leads to the drugs approval.

The SSRIs are doing something to the brains of 30 million Americans. Side effects range from reducing people’s sex drives, to agitation, to thoughts of suicide. It is just that the best evidence fails to show that they fix depression in most people. It seems to this correspondent that the best explanation for their popularity is the 10 billion dollars they generate for the companies that manufacture them. To fully document the weak case made for SSRIs, Irwin Kirsch had to resort to the Freedom of Information Act. Using this tool Kirsch was able to uncover numerous studies performed, but not published, which showed antidepressants failing to perform better than placebo.

Do SSRIs have a role to play in treating depression? Surely they do.

Are 10% of American’s “depressed” and/or benefiting from their use. I doubt it, as the evidence for this is dubious. This topic needs a re-think. If you are on SSRIs you need to talk to your doctor about stopping them. Exercise has been proven to help with depression. Substituting an exercise program for a daily pill is definitely something to think about. This is a topic we will visit again.

Last Thursday, McNeil Consumer Healthcare, the makers of Tylenol, announced plans to lower the maximum daily dosage of the popular drug from 6 pills (4000 mg) to 4 pills (3000 mg) per day. These changes were facilitated with the FDA in an effort to reduce liver damage from accidental overdoses.

Dr. Edwin Kuffner, Vice-president of OTC medical affairs and clinical research at McNeil, assured consumers that when taken as directed, acetaminophen (aka Tylenol), is perfectly safe. Dr. Kuffner told CNN correspondent Saundra Young:

“Some people accidentally exceed the recommended dose when taking multiple products at the same time, often without realizing they contain acetaminophen or by not reading and following the dosing instructions…McNeil is revising its labels for products containing acetaminophen in an attempt to decrease the likelihood of accidental overdosing in those instances.”

In fact, acetaminophen is an ingredient in over 600 different medications, some of which you wouldn’t necessary expect, such as NyQuil or Alka Seltzer.

If all of this is beginning to sound familiar, it is because I blogged on this exact subject two an a half months ago, long before McNeil announced their changes. You can find that blog here:

http://www.sacramentomenshealth.com/hidden-dangers-in-your-medicine-cabinet/

For the record, despite Dr. Kuffner’s position with the McNeil company, the FDA and most sane physicians will agree with him that – when taken as directed – Tylenol is one of the safest drugs on the market today. It’s place in our society as an analgesic (pain reliever) and anti-pyretic (fever reducer) is unquestioned. I think the move to re-label Tylenol’s dosage should be a wake up call to consumers that they need to be aware of what they put in their body. Even over-the-counter medications can be deadly when used improperly.

Chris is a physiology enthusiast, not a licensed physician. Despite his incredibly astute pre-empting of the Tylenol labeling issue, his advice should be used for educational purposes only, and never supplant a visit to and diagnosis from a medical professional.

We’ve all been there. You are having dinner with a friend, engaged in what you feel is a compelling conversation. You feel the vibration on the table as your friend’s phone receives a text. Without a second thought she picks up the phone mid sentence, and furtively glances at it while pretending to stow it away. As the conversation goes on, you can’t help but be annoyed by her incessant glances down at her lap, constat distraction, and “what were you saying?” statements. Whether it is text messages, emails, Twitter or Facebook, we all have friends whose obsession with checking their smartphone is getting on our last nerve. If you don’t have any friends like this, then perhaps you need to take a look at your own smartphone checking habits.

We are becoming a nation obsessed, or rather possessed, by our smartphones. This overwhelmingly obvious conclusion has recently been quantified by a study in the Journal of Personal and Ubiquitous Computing.

The study authors found that habitual smartphone users develop what they have termed as “checking habits.” These habits generally consist of checking one’s phone for less that 30 seconds at a time, in approximately 10 minute intervals. The study noted that the subjects checked their phones, on average, 34 times per day. Researchers determined that these “checking habits” were compulsory, with participants checking their phones unconsciously, rather than out of necessity.

Loren Frank, a neuroscientist at the University of California, San Francisco, breaks down this unconscious compulsion.

Consider the act of receiving an email, text message, or Facebook notification. In general, it conveys a sense of self importance, and feels good. Our brains then begin to associate the act of checking our email, with the rewarding pleasurable sensation of receiving an e-mail. The distinction between checking our phones for messages, and actually receiving the messages is lost, super ceded by the occasional reward of an actual text or email.

I am reminded of a study done in rats where they were rewarded with an injection of cocaine whenever they pushed a lever in their cage. As the researchers scaled back the frequency with which the cocaine was delivered, the rats didn’t scale back their pushing of the lever. In fact, the rats became so addicted to the pleasurable reward of cocaine that they would continually press the lever despite the fact that no cocaine would be injected to their systems. The act of pressing the lever had been associated with the pleasurable response, and the rats became compulsive about pushing the lever.

Its funny how, despite our incredible advances in technology, we can’t seem to escape our basic biology.

Of course, habitual phone checking isn’t as inherently dangerous as habitual cocaine usage, but is does have some negative effects.

In addition to annoying our friends, Dr. Adam Gazzley of UCSF reminds us that whenever we (consciously or unconsciously) divert our attention away from our task at hand to check our smartphone, our concentration suffers. While some people might consider themselves multitasking professionals, studies have shown that multitasking WILL affect a person’s efficiency and performance, no matter how well practiced they might be.

Elizabeth Cohen, Senior Medical Correspondent for CNN, lays out some self checks that you can make on yourself, to see if you might fall into the category of a “habitual checker.”

How to know if you are a habitual checker:

1. You check your e-mail more than you need to.

Sometimes you’re in the middle of an intense project at work and you really do need to check your e-mail constantly. But be honest with yourself — if that’s not the case, your constant checking might be a habit, not a conscious choice.

2. You’re annoying other people.

If you’re ticking off the people closest to you, it’s time to take a look at your smartphone habits.
“If you hear ‘put the phone away’ more than once a day, you probably have a problem,” says Lisa Merlo, a psychologist at the University of Florida.

3. The thought of not checking makes you break out in a cold sweat.

Try this experiment: Put your phone away for an hour. If you get itchy during that time, you might be a habitual checker.

In addition, Cohen lays out the foundation of some steps with which a person might take, in order to find a bit of balance in their lives when it comes to their Smartphone usage. The first step, according to Cohen, is to admit you have a problem. I think that this is important for people to realize. Some people might actually think that habitually checking their smartphone is helping them excel at their job, or be the most popular person on Facebook. Realistically, you are only hurting yourself. Online friends can never be a replacement for face time with real people. Constantly checking your social network while simultaneously annoying your actual friends might end up significantly damaging the relationships that matter. In addition, overworking yourself by constantly checking you email could lead to a whole host of stress-related ailments. In fact, exposure to bright lights (such as those from your smartphone) in the late evening can lead to restlessness and insomnia, and sleep-deprivation can significantly harm your work performance. So while you may think that continually being on your phone might lead to personal and professional success, you are really just sabotaging yourself for short term gratification.

Lets talk about how were all mentally ill, as some would have it.

I was intrigued by a review in New Scientist Magazine of the book Over Diagnosed: Making People Sick in the Pursuit of Health. The authors of this book make note of a new epidemic sweeping our nation, an epidemic of diagnosis. People don’t just have diseases these days, they have “pre-diseases;” pre-hypertension, pre-diabetes, pre-obesity, etc. In the face of one of these “pre-diseases,” otherwise healthy people seek treatment for ailments that they don’t have, and probably never will. While it should be made clear that if someone has symptoms they should check with their doctor, this book argues against the constantly changing thresholds of disease – our habit of defining more and more people as patients and in need of medication or treatment. God knows if you watch late night television you will find some condition which you surely have, and must ask your doctor about medicine x.

The authors of Over Diagnosed note that, when in 1977 the definition of diabetes changed from a fasting blood sugar level of 140 mg/dl to 126mg/dl, 1.6 million Americans became diabetic at the stroke of a pen. Despite cases like the this, some folks think we are actually not diagnosing enough.

Recently, people have been suggesting that we might be missing most cases of autism. Now, autism is a very real thing, a condition which has garnered much attention over the last decade. I have to ask, however, if autism diagnoses are maybe something else – there are such things as “fad” diagnoses.

Diagnosed cases of Autism have been steadily rising in the US, and now supposedly 1 out of every 110 children are autistic. Research done at UC Davis by Irva Hertz-Picciotto shows some evidence that the DNA damage and mutation related to autism might be from the exposure to environmental chemicals and toxins. Now, there may be some truth in that, but maybe there is also some truth in the fact that we as a society just want to diagnose everyone as being autistic – or suffering from ADD, ADHD, OCD, depression, or whatever illness might be topping the headlines of the day. A study cited by the Centers For Disease Control took a look at a group of 55,000 kids between the ages of 7 and 12 in a community just outside Seoul, South Korea. The study was done by Young-Shin Kim, a Yale university psychiatrist, says that 2/3 of the children with autism were under diagnosed and untreated. He claims hat about 1 in 38 school aged students, rather than the currently accepted 1 in 110 students should be diagnosed with autism. The study reportedly used a widely accepted questionnaire to reach these conclusions. I have my doubts about the effectiveness of this “questionnaire.” You think maybe its possible that some kids are just socially awkward, rather than suffering from Asperger’s syndrome? I do love the quote from Kim’s co-author on the study: “if we look hard enough, cases of autism will be found.” I’ve got no argument there.

On a similar note, I have a horrifying headline from medical journal, Family Practice: “ADHD drug studied for the first time in 5 year olds.” Apparently children on Atomoxetine showed that after 8 weeks, their mean total scores on the ADHD-4 rating scale were reduced significantly more in the treatment group than the placebo group. I don’t know about you folks, but I wouldn’t put my full confidence in the “ADHD-4 rating scale.” A friend of mine recently told me a story where her son was recommended for ADHD medication because the teacher just seemed to find that all of the boys in her class needed it. In fact, of the 17 boys in the class, 11 were on ADHD medication, thanks to her astute bird-dogging them to the appropriate psychiatrists and psychologists. My friend denied the medication for her son, suspecting the deficiencies might lie more with the teacher than with the students.

The punch line here, as quoted from Over Diagnosed is, “psychiatric diagnoses and the medications that follow, are prone to faddishness. Perhaps a bit of skepticism here would do us all a lot of good.” I could not agree more. If a psychologist diagnoses your kid over the phone and starts prescribing medicine, I might suggest you look for help elsewhere.

This epidemic of over-diagnosis, especially as it exists among psychological disorders, is a topic we will be keeping an eye on. Expect more on this later.

Recent research is revealing what complex creatures you and I are. If you count the number of cells which we consist of, then “we” are 90% foreign bacteria. If you tally it by weight these tiny living things are, in the aggregate, are still a presence. Perhaps 3 pounds of our total weight are bacteria, mostly living in our guts.

Despite nearly different 1000 species of bacteria living in our gut, three distinct types bacterial communities have been identified by scientists. This discovery might partially explain why some of us are skinny and some are fat. After all, some people really do seem to gain weight no matter what they eat, and their gut bacteria might be playing a role in that.

We depend upon the bacteria in our guts to do useful things for our bodies. Our friendly tenants plug gaps in our own cellular machinery to produce things like vitamin K and B vitamins, which left to our own devices would be in scarce supply. Additionally, we humans cannot digest the cellulose which is found in all plant cell walls. Our gut microbes can.

(By the way, termites use their gut microbes to digest wood cellulose, why this useful trick has been managed by so few organisms is a fine mystery in biology)

Cellulose, once broken down into its component sugar (glucose) is digestible.
Since some people’s guts surely harbor bacteria that are better at this than others, this seems a perfectly sensible explanation for how some people gain weight regardless of what they eat.

Assume that Fats McGee, desperate to lose weight lays off the donuts (which contains starch – highly digestible by all humans) in favor of fruits in vegetables, which consist of large amounts of cellulose, pectin, and other minimally digestible complex carbs. Fats is doing what he can to cut calories, but hard at work in his gut are overzealous bugs, which have the ability to chomp up these normally undigested bits of fiber better than the run-of-the-mill bacteria.

You can see where this leads – frustration for McGee. His weight stays up despite eating apples, carrots and celery. He has been thwarted by his own gut. Studies in mice show this to be a very real phenomenon. Transplant bacteria from fat mice into ones that were raised germ free and they will get fatter than ones who got their bugs from donors who were skinny!

Does this research open the door to better control of weight related diseases through manipulation of the bugs that live inside us? It almost certainly does, but as always the devil will be in the details. We have yet to figure out how these different ecosystems behave, let alone how to get them to do what we want.

I am confident this area of research is going to mean breakthroughs for weight control, obesity related illnesses and diseases of the gut. They won’t come tomorrow, but they should come in the next decade. This is good news from the world of basic science.