Aspirin & Colorectal Cancer Prevention

Fish Oil & Respiratory Infections in Children

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ALCOHOL ABUSE BEFORE & AFTER MILITARY DEPLOYMENT

I retired from the Army, in 2006, after a nearly three decade career that began as a 17 year-old Private and ended as a Colonel in the Medical Corps.  Enlisting shortly after the end of the Vietnam War, I experienced, first hand, the demoralization of the US armed forces at the time, and the Army’s subsequent and agonizingly slow recovery from that particular debacle.  Then, as now, an exhausted and dispirited Army had reached a dramatic nadir, its warrior culture decimated by an unpopular war that came to be viewed by a large percentage of the population as ill-advised at best, and illegitimate at worst. 

There are sentinel differences between the war in Vietnam and the current (and seemingly dwindling) conflict in Iraq, to be sure.  The war in Vietnam was, arguably, one of the single most important catalysts behind the raging social conflict and upheaval that unfolded here at home in the late 1960s and early 1970s.  During these turbulent years, the very fabric of American culture was being ripped apart at its seams across socioeconomic, political, racial, gender and sexual fault lines as the conventional wisdom across all of these fundamental cultural and social dimensions came increasingly into question.  And amidst all of this social discontent spilling out into the open, the Vietnam War was the center of focus of not only the fight against the then dreaded prospect of another “domino” falling to the global Communist conspiracy, but also a stark mirror that reflected, and amplified, the longstanding racial, class, and gender inequalities that finally boiled to the surface of the seething social cauldron that marked the late 1960s.  At the heart of the Vietnam War’s dramatic impact on this transformational social revolution was the draft that fed the American war machine in Southeast Asia.  More pointedly, the draft’s many inherent loopholes, which allowed the wealthy scions of white America to avoid service in the jungles and rice paddies of Vietnam (and we all know some of the more renowned beneficiaries of these loopholes…), served as a bitter metaphor for the lack of equality back here at home.

Coming of age in the post-Vietnam War, post-draft Army, I was both a witness to and a participant in the then-reviled uniformed services’ gradual reform and rehabilitation.  But it was the ascent of the Powell Doctrine, as espoused by then General Colin Powell, that clarified the US Army’s proper mission and role in expeditionary combat operations.  The Powell Doctrine was first implemented as the US prepared to evict Saddam Hussein’s forces from Kuwait. 

The essence of the Powell Doctrine can be distilled into just a few geopolitical strategic imperatives:  military action should only be considered in situations of vital national interest and should have a clear and attainable objective, and then only after all non-military options have been exhausted.  Moreover, a plausible exit strategy should be clear, and the American people, if not the international community, should be supportive of any such military intervention.

Following the successful application of the Powell Doctrine to the brief and startlingly successful 1990-1991 “Gulf War I,” the rehabilitation of the post-Vietnam War armed forces had become essentially complete, nearly a generation after the United States abruptly abandoned its South Vietnamese ally under the faux pretense of a formal peace agreement.

In contrast to the Vietnam War, the current war in Iraq, or “Gulf War II,” which began in 2003, has been fought entirely by volunteer soldiers (as has the ongoing conflict in Afghanistan).  And although some have opined that economic pressures continue to disproportionately compel those at the bottom of the socioeconomic ladder to enlist, and aside from the stark reality that enlisting in the armed forces obligates one to potentially die for his or her employer, the US military has become a surprisingly egalitarian society-within-a-society.  Somewhat ironically, the stringent military hierarchy that rigidly incorporates its own caste system of enlisted and officer corps also provides an important level playing field, in terms of economic and educational opportunities, for people from all ethnic, socioeconomic and educational backgrounds.

Another important contrast between the two conflicts has been the public’s disposition towards soldiers returning home from war.  Although servicemen and servicewomen from both wars were only following the orders of their superior officers and elected politicians, military personnel returning from the current conflicts have not had to bear open displays of contempt from civilian society, unlike their Vietnam War counterparts.

But war is, indeed, hell, and there is ample clinical data from every recorded conflict in human history confirming that increasing exposure to the horrors of war leads, inevitably, to increasing risks of subsequent mental illness and substance abuse.  Certainly, the current and ongoing conflicts in Iraq and Afghanistan are, once again, confirming this particular adverse effect of war.  Moreover, given the reduced manpower of the Active Duty armed services following the post-Cold War drawdown, the extensive and repeated deployment of Reserve military forces and the “citizen-soldiers” of the National Guard has been a rather unique feature of the still smoldering conflict in Iraq, and the worsening tactical situation in the Afghanistan combat theater. 

A new clinical research study, recently published in the Journal of the American Medical Association, reports on the incidence and severity of alcohol abuse among members of the armed forces both before and following deployment to combat zones since 2000.  A notable feature of this clinical research study is that its authors are, themselves, members of several military and veterans’ hospitals here in the United States.

The “Millennium Cohort Study,” which is funded by the Department of Defense, is the largest long-term prospective healthcare study in military history, and currently includes nearly 150,000 participants.  In this alcohol abuse sub-study, 48,481 participants completed confidential pre-deployment and post-deployment health questionnaires.  Active Duty military members accounted for 26,613 of the participants, while the remaining 21,868 participants were members of the Reserve and National Guard forces.  When broken down further, more than 5,000 of the study participants had been deployed to combat units, while a nearly equal number of participants had been deployed but were not exposed to combat operations.  Finally, more than 37,000 of this study’s participants were not deployed at all during the study.

Among the Reserve and National Guard troops who admitted to the consumption of alcohol prior to deploying into combat conditions, the prevalence of pre-deployment and post-deployment heavy weekly drinking was 9% and 13%, respectively, while the prevalence of binge-drinking was 53% and 53%, respectively, and the prevalence of social or legal problems related to alcohol use was 15% and 12%, respectively.  More concerning were the Reserve and National Guard soldiers who deployed to combat units, and who indicated minimal alcohol use, or no alcohol intake at all, prior to being deployed.  When these soldiers were again surveyed after their deployments, they reported a 9% prevalence of new-onset heavy weekly drinking, a 26% prevalence of new-onset binge-drinking, and a 7% prevalence of new-onset alcohol-related personal, social or legal problems.  (The prevalence of new-onset alcohol abuse among Active Duty soldiers, following deployment to combat zones, was similar to that of their Reserve and National Guard brethren.) 

When the study’s researchers further analyzed this self-reported data, they determined that the Reserve and National Guard soldiers who were deployed to combat zones had nearly twice the risk of becoming involved with new-onset heavy weekly drinking, binge-drinking, and alcohol-related troubles in their personal and professional lives when compared to their non-deployed fellow soldiers.  Not surprisingly, the youngest soldiers were at the highest risk of newly engaging in these risky alcohol-related behaviors following combat deployments. 

This study, which concentrated on the alcohol-related behaviors of Reserve and National Guard soldiers before and following combat zone deployments, found an alarming rise in new-onset alcohol abuse among this cohort of part-time military reservists and “citizen-soldiers,” particularly among younger soldiers.  Ultimately, with the exception of those who have paid the Ultimate Price, all of these deployed Active Duty, Reserve and National Guard soldiers will eventually return to civilian society and, based upon the results of this study, many of their lives will already have become ravaged by alcohol abuse, and other substance abuse, by the time they complete their military service.  Chronic alcohol and drug abuse have long been known to be associated with an increased risk of divorce, unemployment, physical and mental illness, and criminal behavior.  Unless more can be done to effectively (and preferably) preempt alcohol and substance abuse within the uniformed services, and to implement a more robust counseling and treatment program for military personnel and veterans who are already suffering from combat-related alcohol and substance abuse, our society is very likely now looking at the early phase of a large-scale epidemic of alcoholism and other substance abuse among the thousands of veterans who are returning from combat deployments, and who are returning to civilian life. 

The Veterans Administration, which is already reeling from its current burgeoning caseload of physically and psychologically wounded veterans from the ongoing wars in Iraq and Afghanistan, is unlikely to be able to cope adequately with the alcohol-related health and social problems of the many thousands of soldiers who are continuing to transition to civilian life.  A national public health epidemic of combat-related alcohol and drug abuse is likely to follow in the aftermath of the two ongoing wars, much as was seen following the Vietnam War.  Only a much greater emphasis on alcohol and drug abuse education, prevention and treatment within the uniformed services, and among our growing population of veterans from these two ongoing conflicts, is likely to reduce the scale of this growing epidemic, and which is, of course, one of the many terrible consequences of war. 

 

RUNNING & AGE

May of us who are following the ongoing Olympic games in Beijing will be inspired to begin (or resume) an exercise program of our own. There is abundant clinical data supporting the beneficial effects of frequent aerobic exercise on the body and mind. As we grow older, however, both strength and endurance decline, making it ever more challenging to remain physically fit.

A new study of aging runners, from Stanford University, provides evidence that regular jogging or running can not only help young people to stay healthy, but can also pay huge health dividends for middle-aged and elderly people as well. In this study, just published in the Archives of Internal Medicine, researchers administered questionnaires to 538 members of a nationwide running club and 423 healthy adults who lived more sedentary lives. All of these volunteers were 50 years of age or older at the time they entered into this study. At the end of the 21-year study period, 284 runners and 156 sedentary “controls” remained in the study. The researchers then collected data on running and exercise frequency, body mass index, disability, and death among the study’s volunteers.

The baseline level of disability was already significantly higher in the otherwise healthy sedentary control group at the beginning of the study, when compared with the runners. The passage of time was associated with increasing levels of disability in both groups of middle-aged and elderly participants, but the runners experienced less than half as much increased disability, over time, when compared to the sedentary volunteers.

A huge difference in mortality between the two groups was also evident. After an average of 19 years of observation, only 15% of the regular runners had died, while 34% of the sedentary volunteers had died. As the participants in this study approached age 90, the differences in disability and death rates between the two groups of participants continued to enlarge.

In conclusion, this study found that engaging in regular, vigorous aerobic exercise, even very late in life, was associated with a significant reduction in the risks of disability and death when compared to living a sedentary lifestyle. Time to start practicing for the Senior Olympics!

RUNNING & YOUR TESTICLES

On a somewhat related theme, as men age, their testicular function gradually declines. Testosterone secretion diminishes with advancing age, leading to a flagging libido. The manufacture of sperm in the testes also suffers, along with the manifold other ravages of aging, resulting in both fewer and poorer quality sperm. As we age, virtually all of the cells in our bodies, including testicular cells, develop cumulative evidence of damage from metabolic byproducts, including free radicals.

A new study in the Journal of Epidemiology compared testicular function between laboratory mice that were allowed to run on a daily basis and mice that lived an enforced sedentary lifestyle. This study was conducted by researchers at the National Institute on Aging in Baltimore and the University of Central Florida in Orlando.

Young male mice were divided into “running” and “sedentary” groups, and were observed until they reached a ripe old age (at least for mice) of 20 months. Subsequently, the animals were euthanized, and their testicles were then studied under a microscope. The testicles of the sedentary mice revealed the expected changes of aging. Small numbers of sperm and poor sperm quality were observed in these sedentary animals, as well as increased rates of DNA damage and other signs of cellular aging. However, the testicles of the mice that had run, on a daily basis, throughout their lives, revealed normal-appearing sperm cells and sperm precursor cells, with large numbers of sperm cells present in the ducts of the testicles. Chemical evidence of DNA and cellular damage was, likewise, much less severe among the runners” in this study.

Although it is always potentially hazardous to assume that mouse physiology is identical to human physiology, this intriguing little study nonetheless suggests that daily, vigorous aerobic exercise is able to maintain essentially normal sperm-generating function in elderly mice. Moreover, evidence of chronic metabolic damage to DNA appears to be reduced by lifelong running, in mice. While not many men would enlist in a clinical research study that required at least one of their testicles to be removed, standard fertility tests for males include an assessment of the quality and number of sperm produced by the testicles. It would, therefore, be interesting to compare these factors between otherwise healthy men who exercise regularly and those who lead a largely sedentary life.

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Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html

________________________________________

Send your feedback to Dr. Wascher at: rwascher@doctorwascher.net

________________________________________

http://www.doctorwascher.com

________________________________________

Copyright 2008. Robert A. Wascher, MD, FACS.
All rights reserved.

________________________________________

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SMOKING CESSATION & RISK OF DEATH

Smoking, as we all know, is associated with an increased risk of cancer, cardiovascular disease, non-cancer lung disease, and early death.  It is also widely known that smoking cessation will, over time, lead to a reduction in smoking-associated health risks.  However, the extent of this reduction, and the duration of smoking cessation required to realize significant health benefits, has not been entirely clear.  Now, a new clinical research study from the Washington University School of Medicine and Harvard University, and published in the Journal of the American Medical Association, provides important data that directly addresses these critical questions.  This study was part of a much larger overall study, the Nurses’ Health Study, and includes more than 100,000 female nurses who have participated in this prospective clinical research trial since 1980. 

In this particular clinical study, a total of 12,483 women died during the course of the parent study.  Among the women who died, 36% were “never-smokers,” 29% were active smokers, and 35% were prior smokers who had previously quit.  When all 104,519 women participating in this huge study were evaluated, active smokers were found to be almost 3 times more likely to die (of any cause) than “never-smokers.”  When the researchers looked at the incidence of cancers known to be associated with smoking, the active smokers had more than 7 times the risk of these cancers than were observed among the women who have never smoked.  Even those cancers not definitively associated with smoking were still more commonly observed among the active smokers, occurring approximately 1.6 times more frequently in this group when compared to the “never-smokers.”  When compared to “never-smokers,” the incidence of colon and rectal cancer was observed 1.6 times more frequently among the women who were active smokers, and 1.2 times more often among the women who had smoked in the past but previously quit.  Death due to lung disease (other than cancer) was (not surprisingly) also significantly more common among the women who were active smokers.

Based upon the results of this long-term prospective study, a full 20 years of smoking cessation was necessary before death rates in previous smokers fell to the level observed among “never-smokers.”  Strikingly, when the actual causes of death were assessed, this study concluded that 64% of the deaths observed among the actively smoking women were directly attributable to cigarette smoking, while 28% of the deaths observed among the former smokers were smoking-related.

This study is very valuable from a public health perspective, as it relies upon a very well designed and managed prospective clinical research trial, with long-term follow-up, to provide high quality clinical data.  In doing so, the statistics derived from this study are both sobering and likely to be valid.  What is abundantly clear is that smoking is a potent cause of otherwise preventable and early deaths.  What is also clear is that the earlier one starts smoking, and the longer one continues to smoke, the greater the risk of chronic illnesses and early death.  On the other hand, quitting smoking can, over time, reduce the excess risk of illness and death associated with smoking.  This risk reduction begins immediately after smoking cessation, but it appears to take approximately 20 years before all of these smoking-related health risks disappear entirely.  The lesson is simple, really.  You are much better off, health-wise, if you never start smoking.  However if you are already a smoker, quitting (and quitting right now) will allow you to begin that long but worthwhile journey back to the level of health risk that you would otherwise have enjoyed had you never started smoking in the first place.

CHILDHOOD TRAUMAS & ADULT SUICIDE RISK

The experiences that we have during the pivotal developmental years of our childhood can have an enormous impact on our adult lives.  Many among us struggle, consciously or subconsciously, late into life with the adverse experiences of our early years.  A new clinical study from the University of California at San Diego, and from several medical centers in Canada, and just published in the American Journal of Public Health, further illuminates this very private arena of our lives, and the results of this study are rather sobering.  Using data from a large mental health study, sponsored by the National Institutes of Health, in which nearly 10,000 adult men and women volunteered to take a detailed survey within their homes, this particular research study was designed to assess the impact of childhood traumas on mental health and suicide risk during adulthood.  The specific types of adverse childhood experiences assessed included physical abuse, sexual abuse, and the witnessing of domestic abuse. 

Based upon the data collected during this study, the researchers estimated that 22% to 32% of the psychiatric disorders observed in the women volunteers were associated with adverse childhood events, while 20% to 24% of the mental illness observed in the male volunteers appeared to be associated with traumatic childhood experiences.  Suicidal thoughts and actual suicidal attempts in women appeared to be linked to adverse childhood events in 16% and 50% of such cases, respectively, and in 21% and 33% of men, respectively.  Increasing numbers of traumatic events experienced during childhood also appeared to be associated with an increasing risk of psychiatric illnesses and thoughts of suicide (or actual suicidal attempts). 

While mental health studies, such as this one, rely on far more subjective findings than most non-psychiatric clinical research studies, the results of this study nonetheless provide at least a semi-quantitative estimate of the contribution of traumatic childhood illnesses to those people already suffering from mental illness, including those who have either contemplated or actually attempted suicide.  While there are many among us who have suffered tremendously adverse experiences during childhood, and who nonetheless have progressed into adulthood without any obvious evidence of any mental health difficulties, clearly, there many people who continue to struggle with the impact of such early-life experiences throughout their adult lives.  If you are one of those people who struggle with depression, poor self-esteem, chronic anxiety, or other troubling symptoms of poor mental or emotional health, then I urge you to seek help from your personal physician, or from a mental health professional.  The same goes for the thousands of young men and women who are returning from the battlefields of Iraq and Afghanistan with post-traumatic stress disorder symptoms.  If you are feeling badly, please get help, now.

“WHITE COAT” HYPERTENSION & CARDIOVASCULAR DISEASE RISK

Most physicians are very familiar with the “White Coat Syndrome.”  Patients who are anxious about their visits with their doctor often have evidence of increased adrenaline secretion, which typically manifests as anxiety, sweating, a rapid pulse, and elevated blood pressure.  In most cases, after the patient has become more comfortable with their physician, these signs of an overactive sympathetic nervous system begin to subside.  I often see this “syndrome,” particularly in patients seeing me for the first time, or in those who have returned to see me for results of biopsies and other surgeries.  Since I am exclusively a cancer physician and surgeon, the stakes for most of the patients who I see are very high, and many of them are, understandably, very anxious about both the reasons for their visit with me and the potential outcomes of their visit.  I, and many other physicians, have also noted that patients with minimal or very mild baseline hypertension often experience significant “White Coat Syndrome,” particularly with respect to their blood pressure readings at the beginning of their visits with us. 

A newly published clinical study, in the European Journal of Internal Medicine, looks more closely at the relationship between “White Coat Syndrome” and the presence or absence of cardiovascular disease.  In this study, 100 patients already suspected of having coronary artery disease (but never diagnosed) underwent blood pressure measurements, for 24 hours, in an ambulatory clinic, and then underwent ultrasound evaluation of their hearts and carotid arteries (the large arteries in the neck the supply the majority of the blood flow to the brain).  Additionally, these patients also underwent coronary artery angiograms to further assess their coronary arteries. 

This study determined that the patients who presented with “White Coat Syndrome” in the ambulatory clinic were significantly more likely to have coronary artery disease than those patients who, despite already being suspected of having coronary artery disease, presented with normal blood pressure measurements.  Likewise, in the group of patients who initially presented with elevated blood pressure readings, the incidence of abnormal heart function and narrowed carotid arteries (from atherosclerosis) was significantly greater than was observed in the patients who did not initially present with high blood pressure readings. 

In summary, among 100 patients suspected of having coronary artery disease, those who presented initially with elevated blood pressure readings were much more likely to have significant coronary artery disease, abnormal heart function, and narrowed carotid arteries than those patients who presented, initially, with normal blood pressure readings.  Based upon the results of this study, the presence of “White Coat Syndrome” may, at least in some patients, be a harbinger of underlying cardiovascular disease, in addition to being a manifestation of patient anxiety during their visit with their doctor.

 

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html

Send your feedback to Dr. Wascher at:  rwascher@doctorwascher.net

http://www.doctorwascher.com

Copyright 2008.  Robert A. Wascher, MD, FACS.  

All rights reserved.

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